Guy's and St Thomas' NHS Foundation Trust

An estate strategy aligning service and estate needs to improve patient outcomes

Guy’s and St Thomas’ - one of the largest NHS Foundation Trusts in the UK - is a partner in the King’s Health Partnership Academic Health Sciences Centre and has been at the forefront of medical innovation for over 900 years. The Trust treats approximately 850,000 patients every year from two large sites in Lambeth and Southwark, providing a full range of hospital services for the local communities as well as specialist services for patients from across the UK and further afield.

Crucial to the continued delivery of the best possible healthcare outcomes is a built asset portfolio which allows the Trust to respond quickly to major healthcare changes (especially in the context of the Healthcare for London agenda) and which serves its patients in the manner most befitting their needs.

To achieve this, an ambitious capital investment programme was planned to divest of poor quality outdated accommodation and consolidate core clinical services in better quality existing buildings. This will subsequently release sites for new development in a major regeneration quarter in South London - unlocking significant value in the process.

EC Harris was appointed to advise the Trust on its estate strategy underpinning this transformation process, specifically providing healthcare planning consultancy services for this major capital programme.

Creating solutions

A robust estate strategy is crucial to the successful delivery of any capital programme, ensuring business, service and estate needs are aligned. At a time of unprecedented change and uncertainty in the sector, it is also essential that any strategy is sufficiently flexible to accommodate change - in timescale, priorities and funding availability - and that the complex interdependencies within it are fully understood.

The Trust had a number of specific aims from its capital investment programme to generate the maximum value from its estate:

• Investment should unlock financial benefits for the Trust
• Occupancy costs should be reduced
• Surplus assets should be identified and addressed
• Space allocation should be proportionate to productivity.

EC Harris worked seamlessly with the Trust’s capital estates and facilities team and clinical representatives to ensure a robust and responsive strategy was produced in response to these objectives. Specifically it focused on:

• Developing a model of care for cancer services to improve access across South East London, reduce fragmentation, expand capacity and establish the Trust as a world-class provider
• Streamlining care for emergency patients by co-locating all 24 hour services in a single location
• Enhancing the patient experience, modernising care and harnessing IT and workforce solutions for operational efficiency
• Tackling the patient privacy and dignity deficit associated with open plan wards
• Eliminating the risks associated with significant backlog maintenance on both sites.

Practically this involved assessing the estate capability on each of the Trust’s sites to accommodate strategic change and understanding the drivers for change/investment priorities from both a clinical and estate’s perspective.

From this information a range of strategic options for the re-development of both sites was produced, specifically considering the wider regeneration opportunities that could be unlocked in the process. A rigorous option-appraisal process followed and detailed feasibility studies were carried out for the preferred approach on each site.

This led to the production of a detailed decant plan and year-by-year programme and capital invest plan for each site; an analysis of the capital and revenue implications in delivering the overall strategy over the next ten years; and the development of a programme structure and resource plan to ensure its successful delivery.

The Trust therefore had a strategy which was affordable; flexible enough to respond to changes in the healthcare economy; met high level clinical strategy requirements; and facilitated new Models of Care.

Adding value

To successfully implement the programme on two intensely developed sites, ensuring no loss of capacity and protecting Trust income, required innovative and flexible solutions.

Using its wide community of experts to explore alternative procurement and funding options, EC Harris helped ensure the programme would be affordable via surpluses from operational savings, partnership working with a charity and joint ventures.

Crucially, the team also developed a phased incremental approach to the implementation of the capital programme to minimise the risks associated with time and cost and ensure the pressing need for additional radiotherapy capacity in South East London by 2014 was achievable.

Finally, by maximising opportunities for commercial development and ensuring that the wider regeneration of the community was considered at all stages, a built asset solution has been developed that should deliver significant financial and social benefits to the Trust, its patients and the local communities.

EC Harris continues to support Guy’s and St Thomas’ NHS Foundation Trust on the delivery of this major transformation programme.

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