23rd September 2024

Tackling healthcare challenges in Wales: Preparing NHS Estates for the future

Matt Ace, Regional Director, Wales, Hydrock, now Stantec, looks at the importance of modernising healthcare estates to ensure optimal patient care and staff wellbeing.

The NHS in Wales, like the rest of the UK, is grappling with a range of complex challenges against a backdrop of global and UK inflation, cost increases, a changing labour market and recovery from recent events. The need to modernise healthcare estates to ensure optimal patient care and staff wellbeing is more pressing than ever. But how do NHS Trusts in Wales balance these competing demands while delivering high-quality care?

Let’s explore five key areas where action is needed:

1. Decarbonisation: reducing carbon footprint while maintaining quality

The NHS is one of the largest contributors to public sector emissions in the UK, with NHS Wales recording a carbon footprint of approximately 1 million tonnes of CO2 The Welsh Government has been proactive in pushing forward its Net Zero Wales Plan, aligning with broader Labour government initiatives aimed at combating climate change, but more needs to be done to accelerate emissions reductions.

For NHS Trusts in Wales, this means not only reducing emissions but also ensuring that these efforts contribute positively to patient care and staff experience. Embracing renewable energy, such as wind and solar power, and transitioning to sustainable practices, including transport and reducing waste, could also potentially help with lowering operational costs for Trusts. By providing support, guidance and funding, Wales’ Green Plan will be a crucial part of this strategy – it’s aiming to cut more than 1 million tonnes of carbon over the next three years: the equivalent of taking 520,000 cars off the road.

2. Optimising estates: transforming NHS spaces for the future

With limited budgets and ageing infrastructure, optimising their estates to meet future demands will at times feel like an impossible task for NHS Trusts. The backlog of maintenance as a result of ever decreasing real term investment is significant, but this does present an opportunity to rethink how space is used. By modernising facilities and ensuring they are the right size for current and future needs, Trusts can improve efficiency, enhance employee experience, and deliver better patient care.

Digital efficiency also plays a critical role in this transformation. Integrating new technologies that can streamline operations, reduce waste, and create a more responsive healthcare environment should be at the forefront of estate renewal. Velindre University NHS Trust, for example, has taken bold steps by designing a new cancer centre from scratch, focusing on sustainability and patient-centric care, with renewable energy, biodiversity and wellbeing at its core. We can learn valuable lessons regarding best practice from the massive investment (made with the help of PFI) in Velindre, and translate them into improvements in community hospitals outside the capital.

3. Lift and Shift: Bringing healthcare closer to communities

The concept of “lift and shift” is gaining traction as NHS Trusts in Wales explore the potential of moving less acute facilities into available local spaces. By relocating services closer to communities and town centres, Trusts can make healthcare more accessible and tailored to the needs of the local population. The potentially symbiotic relationship between these spaces and the communities around them could also strengthen the economic fabric of a place, allowing for a simplified, multi-purpose trip.

An NHS Trust in South Wales is exploring the possibility of shifting some of its non-acute services into nearby vacant commercial buildings. Such moves could bring healthcare services closer to patients, reduce travel times (thus helping decarbonisation targets), and alleviate pressure on larger hospitals. This approach also aligns with broader efforts to decentralise healthcare and make it more community-focused.

4. Adapting to climate change: preparing NHS estates for new realities

Climate change poses a significant threat to healthcare infrastructure, with Wales experiencing warmer, wetter conditions that affect both staff and patients. Overheating in hospitals can have serious implications, from the physical wellbeing of patients and staff to the cooling of vital medical supplies. Additionally, the risk of flooding and system failures due to extreme weather events can lead to cancelled appointments and disruptions in care.

NHS Trusts in Wales must be given the funding to adapt their estates to withstand these climate challenges. This includes upgrading infrastructure to better handle temperature fluctuations and investing in flood defences. Moreover, there’s an emerging health threat from new airborne diseases, exacerbated by changing climates, which requires robust and adaptable healthcare facilities.

The narrative also needs to shift on climate change adaptation – it’s not a threat for later. NHS Wales has to be prepared for these changes now, as they happen, to ensure that its estates remain resilient and capable of delivering care in any circumstance.

5. Navigating PFI: Leave plenty of time for hand-back

The Private Finance Initiative (PFI), introduced in 1992, uses private funding for public sector projects. A private company finances the design, construction and maintenance, and owns the facility, which is leased back to the state for regular repayments. When the contract expires, the asset is handed back.

Although there are 84 hospitals in Wales, just over 10% of them have been financed by PFI, only marginally lower than the equivalent 14% of all hospitals in England.

While PFI has enabled the construction of much-needed healthcare facilities, it also presents financial challenges that NHS Trusts must manage carefully – repayments can often exceed initial costs.

Our advice is to start understanding the condition of the buildings at least seven years ahead of the expiry of the contract – agreeing defects to be rectified, securing planning, appointing advisors and contractors all eats up time. And every one of these buildings is a live, operational asset, so disruption also has to be accounted for.

Preparing for the future

For NHS estates teams in Wales, the challenges are vast and complex, but they are not insurmountable. In fact, like an overlapping Venn diagram, tackling one can have a positive impact on the targets posed by other challenges. For example, localising health services will reduce travel emissions. Tackling decarbonisation and adapting facilities for climate change secures PFI hand-back in a suitable, future-proofed state.

Encouraging trusts to improve facilities, access, sustainability, staff experience and patient care is easy – they all want better outcomes. It’s the right investment, a clear strategy and a long-term plan that transcends political cycles that Trusts need to create a healthcare environment that is not only fit for today but also resilient for the future.