better buildings - health service journal · pdf fileadding detail for a more robust business...

BETTERBUILDINGS

IN ASSOCIATION WITH PROCURE21AN HSJ SUPPLEMENT/20 MARCH 2008

IT NEEDN’T COST THE EARTHSUSTAINABILITY: 4-5

Health Service Journal supplement 20 March 2008 hsj.co.uk

COMMENT

Building it right first time

1 Overview: Background on ProCure21 2 Case study: West London Mental Health trust’s The Orchard4 Sustainability: A new environmental assessment tool will help trusts go green 6 Case study: United Bristol Healthcare trust’s dental school and heart institute8 Training: Helping clients to be better buyers9 Minor works: Big savings for small scale9 Tax: Taking the hassle out of claiming back VAT

Editor Alexis NolanSub editor Christy Lawrance Design Jonathan Dawson Picture editor Frances Topp Illustrations Frances Castle

Patients expect a lot from their new NHS facilities. They certainly expect them to be finished on time, to budget and represent value for money, as should you. But you should also expect to take pride in them because more than likely you will have worked very hard to get them. Yet, traditionally, many of these expectations have not been met. Often NHS capital projects have been delivered late, over budget – and have not always been of the quality the patient needs or deserves.

In 2001 the National Audit Office reported that only 26 per cent of public construction projects were delivered on budget and only 28 per cent delivered on time. In 2006, using ProCure21, NHS trusts delivered 94 per cent on budget and 83 per cent on time – and not at the expense of quality. They earned an average rating of 7.9 out of 10 for product satisfaction.

As the NHS is being challenged by a more consumer-led marketplace, estates play a significant role in attracting business. ProCure21 is being used by over 150 trusts to provide attractive, patient-focused facilities at least six months quicker than traditionally possible.

We’ve seen a significant step change in the delivery of NHS capital projects, and we are keen to use the lessons learned in the development of the next framework. We are keen to see ProCure21 respond to the needs of foundation trusts and provide the flexibility of a truly integrated procurement tool.

This supplement looks at how some leading trusts are tackling the challenge.

It will give those who are new to ProCure21 the basics, and offer some

fresh angles on the programme from those within it.

If you have questions on anything you see here or any other aspects of the programme please don’t hesitate

to get in touch. ●Peter Sellars is head of ProCure21 and

gateway reviews for the Department of Health.

‘Using ProCure21, NHS trusts delivered 94 per cent on budget and 83 per cent on time – and not at the expense of quality.’

hsj.co.uk 20 March 2008 Health Service Journal supplement 1

ProCure21 is a procurement method for publicly funded NHS capital schemes that was set up in 2003 and will run until Setpember 2010. It is being used widely to deliver community hospitals, primary care centres, mental health units and acute services such as cardiac care and outpatient units.

It is recommended by HM Treasury guidance and complies with the Office of Government Commerce’s common minimum standards policy. It represents the latest construction industry best practice and helps trusts guard against the poor practice and results that have been associated with traditional tender procurement.

ProCure21 allows trusts to use approved construction companies – known as principal supply chain partners (PSCPs) – under a framework deal to deliver their capital schemes using common principles, practices and tools.

PSCPs offer a full range of services to assist with all aspects of business case formulation, design and construction.

PSCPs can be selected by trusts without their having to go to OJEU tender, saving at least six months’ tendering time. The use of the ProCure21 framework also produces further time savings on site – seven weeks for schemes of £1m-£5m and 17 weeks for schemes of £5m-£15m.

ProCure21 offers trusts cost certainty by using a guaranteed maximum price. The trust and the PSCP agree a final cost of the scheme and, as long as the trust does not make changes that affect cost, the final cost will be no more than the guaranteed maximum price. Any overspend is borne by the PSCP and any underspend is shared 50:50. Often savings are identified early and are reinvested into the scheme.

The cost of ProCure21 schemes are in line with industry indicators and are constantly monitored by the Department of Health. Contrary to some opinion, ProCure21 has shown its schemes have no cost premium over those using traditional tendering.

ProCure21 encourages user involvement in the design process to ensure that the building performs well for all users.

It also encourages involvement of the supply chain in the business case and design process. This helps the scheme by:● Getting expertise onto the scheme early to advise on feasibility and affordability issues;● Adding detail for a more robust business case;● Increasing the supply chains’ knowledge of the trust, their key drivers and the scheme;● Improving construction planning, leading to reduced construction periods and better safety on site;● Encouraging an open working relationship and a positive problem-solving attitude;● Engaging other users and stakeholders; and● Providing certainty to trusts on cost, time and quality.

ProCure21 uses the ECC contract option C, which requires the client and supply chain to work together in an open honest relationship. Activities such as open book accounting and early warning notices ensure the project team work in an transparent manner. Problems can be solved at an early stage, encouraging an a positive working relationship. To date, there has been no litigation on any ProCure21 schemes.

Each scheme has a dedicated implementation adviser from the DH. They can provide as much support as the trust needs and as well as access to standard guidance, risk and benchmarking tools. Implementation advisers are a reference point for best practice across ProCure21.

To get started, you need to go the ProCure21 website at www.nhs-procure21.gov.uk. Register your scheme and ProCure21 will contact you. ●

WHAT ISPROCURE21?

OVERVIEWThis procurement method for NHS capital schemes offers clients access to expertise, true partnership with contractors – and cost certainty

‘It helps trusts guard against the poor practice and results that have been associated with traditional tender procurement’

Mental health patients needing a secure setting for their treatment require particularly high levels of attention paid to the fixtures and fittings of the places where they receive care.

But when West London Mental Health trust began planning a women’s enhanced medium secure service, the fact that a similar service does not exist anywhere in the UK meant planning for the service had to go back to basics.

Trust director of capital development John Corlett explains that concerns about the number of women in England’s three high-secure hospitals culminated in the trusts running those services being asked to come up with alternatives.

“Most of the women, of whom there were up to 300, did not need a high-secure setting,” he explains. “Most were felt to not be a threat to the community but rather more to themselves. But neither was it appropriate for all of them to be housed in medium secure settings if they are difficult to manage.”

Around 50 women were deemed to still need a high-secure setting and have been moved to a high-secure unit at Nottinghamshire Healthcare trust’s Rampton hospital. For a remaining cohort deemed to have too many needs for a general medium secure setting, a women’s enhanced medium secure services has been developed. The facility, at West London Mental Health trust’s site at St Bernard’s Hospital in Ealing, is not intended to be long stay. The intention is for patients to stay for up to two years while being stabilised to the point where they can “step down” to a less secure setting.

“There are no development guides for this so we had to start from the first principles of ward layout and size that we believed would meet the needs of the women,” says Mr Corlett. “Everything hinged around their treatment needs. We spent a lot of time thinking about the facilities; we have tried to create a living environment that will reflect what you find in the community.”

Constructed near to the original St Bernard’s Hospital, The Orchard was built on the site of a former laundry and boiler house that provided services for both St Bernard’s and the acute Ealing Hospital it is situated alongside. Boiler facilities for the rest of the large site had to be relocated, meaning £4m of the £28m spend went on the complex engineering of that move.

Central to The Orchard is its core atrium. A popular coffee shop, patient shop, bank, hairdresser’s, kitchen, horticulture room, library, art room, gym and physical health room are all situated around the edge of it; the aim is to make a visit to it like going to a local shopping centre. All wards can be accessed from the atrium and the area can get busy. Its high ceiling and hard surfaces have meant acoustics have been an issue; sound absorption panels are now to be fitted high up the walls.

The Orchard has been built for 60 patients in six wards, providing both medium-secure and enhanced secure settings. Two are five-bedded wards – one for women with personality disorders and another for women who struggle to settle in larger wards.

Safety has been built into every aspect of the design, often drawing on design from the trust’s dangerous and severe personality disorder pilot unit The Paddock at high security Broadmoor.

In addition to furniture and bathrooms that were deemed ligature free and safe after rigorous testing by the trust’s security team, the walls have been constructed of extra robust material (see box). Furniture is extra heavy to make it difficult to lift. Each ward in The Orchard has a safe suite, which contains an isolation room and de-escalation room with extra high ceilings so none of the pipe work in the ceiling can be reached.

Each ward’s electric and water supplied are centred in a supplies cupboard so access to rooms is not needed to carry out repairs or maintenance or to cut off supplies – water to showers is limited so showers cannot fill up. ●

A SAFEPLACE CASE STUDYA London trust had to go back to basics to deliver a women’s enhanced medium-secure unit, says Emma Dent

2 Health Service Journal supplement 20 March 2008 hsj.co.uk

The atrium at West London Mental Health trust’s Orchard enhanced medium secure site is designed to reflect a shopping centre environment.

Key points● xxxxxxxxxxxxxxx.● xxxxxxxxxxxxxxx.● xxxxxxxxxxxxxxx.● xxxxxxxxxxxxxxx.● xxxxxxxxxxxxxxx.● xxxxxxxxxxxxxxx.


Key points● The Orchard is a new enhanced medium

secure women’s unit in west London.● There were no development guidelines so

designers started from first principles.● The unit includes a coffees shop,

hairdresser’s and other services.

THE VALUE OF VALUE ENGINEERING AN OPEN BOOK APPROACH

The Orchard was originally envisaged to be a three-storey building, with the top floor used by administrative staff, but early on in the scheme it became clear that this would push the cost to well above the £28m budget.

Value engineering workshops ensured that these staff found a new home in a previously dilapidated and unused wing of the original St Bernard’s Hospital building across the road, which was refurbished by principal supply chain partner Kier as part of the development cost.

The other principle change devised by the PSCP was switching the construction of the frame of the building from a concrete frame with concrete block walls to a steel frame with a dry lining system for the walls. This made the building much lighter, eliminating the need for expensive piling in favour of pad foundations.

“It was a huge change,” says Kier project manager Ben Stevenson. “The original plans would have been hugely expensive but the open book approach of ProCure21 meant we sat down together with the client to decide how we were going to make it work.

Off the shelf“If we had not made those changes, the project would have almost certainly be deemed as unviable and be left on the shelf. It also made the build much quicker than it would have been if we had used a traditional wet build approach.”

Close working with the client also meant all fixtures and fittings were rigorously tested by the trust before being signed off.

With a client group at high risk of self-harm all windows, doors, bathroom fittings and bedroom furniture had to be ligature free. The windows (made of toughened glass, only open to a certain point and can be locked by staff) were specially designed, as were ligature-free handles.

Fixing fittingsAll furniture had to be indestructible and inert, so it cannot be set on fire and does not react to spillages. A material, Trespa, made of epoxy resin and compressed paper, fitted the bill but not before full-size mock-ups of rooms allowed the trust’s security team to test out a prototype of the building for its robustness and safety.

“The window configuration completely changed as a result. We originally envisaged having higher specification steel windows in the bedrooms and aluminium windows in the patient communal areas. But the security teams were concerned about the ability to get out of the latter so all the windows were upgraded to steel,” says Mr Stevenson.

Viewing holes into the en-suite bathrooms were also altered to improve their visibility.

To resolve concerns that dry lining the walls meant they were less robust, the studs were put closer together than usual, at 300mm instead of 600mm, with plywood, plasterboard and a plaster skim.

“None of these things would have happened on a non-ProCure21 project,” Mr Stevenson adds.

“Traditionally you only find out about the limits of a building when it is finished and things go wrong.”

After five years, the NHS environmental assessment tool used in all capital procurement activity is about to have its day. The health service is adopting an adapted version of the standard Building Research Establishment environmental assessment method.

Although the Department of Health will replace NEAT with BREEAM Healthcare, the assessment element of NEAT, which was designed to match the BREEAM “excellent” criteria for new builds and “very good” for refurbishment, will remain.

Lorraine Brayford, DH estates and facilities sustainable development manager, says the most significant element in the change is from self-assessment to accreditation.

“Slight changes in BREEAM as it now is mean that you can get a certificate at the outline and planning stages of the development. What we have said is that we are not happy with that. A contractor or a new development can get an initial report to identify that the scheme, such as they anticipate providing it, would be scored as ‘excellent’, but we all know that through the gestation and delivery period the capital scheme does change,” she says.

“Crucially, what we want to know is that the building that is actually delivered is what is assessed as excellent, so the certificate will not be issued until completion of the build.”

Such an initiative presents clear opportunities for all NHS capital projects, including those through ProCure21, to bring a BREEAM qualified assessor – or somebody with a good grasp of the process – on to the project team to offer advice and keep the scheme on target.

“That would be a very positive move for us,” says Ms Brayford, “because what we have found all too often is that project teams do not have a sustainability or environmental adviser and sometimes they don’t even have an energy adviser. The danger with that is when a design that might have all number of wonderful features is handed over to the engineers, they have to find efficiency solutions.”

Which is why, she argues, people often have a view of sustainability as being costly when, in truth, it might be that steps in the procurement process are being taken out of sequence.

NEAT and BREEAM Healthcare are not the only drivers of sustainability in healthcare construction projects. There are mandatory, regulatory or advisory documents that the DH, other government departments, the NHS and ProCure21 must satisfy or will want to respond to, and more are emerging.

Responses were sought at the end of 2007 to a draft strategy for sustainable construction from the Department for Business, Enterprise and Regulatory Reform, due to be finalised this year.

The opportunity to share some ProCure21 views on this draft strategy, based on actual schemes and giving tangible evidence of applied technology, proved the catalyst for the formation of a sustainability working group.

“This was a chance to show how elements of the sustainability agenda are being brought into the supply chain for the development of specific projects,” says Ray Stephenson, ProCure21 programme manager. “The group, made up of representatives from the principal supply chain partners (PSCPs), is going to continue and, once all the targets for construction especially have been agreed across government, we will work to develop guidance to address sustainability very early in the whole process.

“At the moment, we are seeing some outline business cases which are only just starting to pick up sustainability issues, whereas they should be thinking about and getting these on the agenda at the outset of planning and design.”

Examples of best practice case studies from a number of ProCure21 projects have been posted on the programme’s website. The group hopes to build this into a library of pooled resources for NHS organisations to use.

One of the reasons for this is the recognition that, because NHS trusts do not enter into capital projects with great regularity, they do not make for the most knowledgeable clients.

“What I am expecting, as with a lot of other areas in the ProCure21 programme, is that the PSCPs and their specialists in the supply chain assist the trusts with this, getting them engaged early on with all the sustainability options that a new scheme presents,” says Mr Stephenson.

The ethos and practice of ProCure21 – that this forms part of a learning process in which all information, once paid for, is open and belongs to the wider NHS – supports such an approach.

“We are now collecting and collating knowledge on new sustainability innovations,” says Terry Finch, ProCure21 implementation adviser and sustainability lead. “These include things such as ground-source heat and cooling systems and rainwater harvesting. Any PSCP going to a trust now has that to hand. It raises the bar and means all of us can operate at the very highest level.”

Members of the programme and its sustainability group are examining the BREEAM Healthcare standard ahead of its release to gauge its implications for the ProCure21 process. Some of the emerging technologies – such as the next generation of solar water heating panels – may go on to form the subject of a series of specially commissioned studies.

“With hundreds of schemes on our database and the expertise of our supply chain, any trust that wants to consider sustainability in a project will not be working in isolation. Somebody somewhere will have done or is doing what might be of interest to a trust,” says Mr Finch. ●

BUILT TO LAST A

LIFESUSTAINABILITYNew buildings are expected to be sustainable and environmentally friendly. Stuart Shepherd reports


NATURAL LIGHT AND VENTILATION

Elyn Lodge, completed in December 2003, is a 60-bed rehabilitation ward at St Helen’s hospital, part of the St Helen’s and Knowsley Teaching Hospital trust, and was the first full project designed and

constructed through the ProCure21 framework.

One challenge arising from the project, as part of an overall desire to champion engineering innovation and as a result of the lodge’s cellular internal layout ,

was the integration of natural daylight and ventilation.

A rooftop system driven by wind pressure cut down on energy and maintenance needs and improved air quality in non-clinical areas.

Natural ventilation terminals that deliver five air changes every hour, and the use of external solar shading make the need for any mechanical air conditioning systems redundant.

GROUND SOURCE HEAT AND COOLING

Barnsley primary care trust’s Kendray hospital mental health unit is looking to become a showcase for green NHS design. A ground source heat pump at the unit will transfer heat from the earth to an

underfloor system in two of the wards.

This will help maintain the building’s temperature during colder weather and will provide some 70 per cent of the underfloor system’s energy


Key points● xxxxxxxxxxxxxxx.● xxxxxxxxxxxxxxx.● xxxxxxxxxxxxxxx.● xxxxxxxxxxxxxxx.● xxxxxxxxxxxxxxx.

GROUND SOURCE HEAT AND COOLING HARVESTING RAINWATER PROVES COST EFFECTIVE

“Wherever you put any kind of large development these days, the local authority is reluctant to let you discharge storm water into what is probably a well-loaded or even already overloaded

drainage system,” says Terry Finch, ProCure21 implementation manager.

“The answer is to put in an interceptor tank which will act as a buffer in the event of a downpour. At Bamburgh

mental health clinic, now part of Northumberland, Tyne and Wear trust, they decided instead to put in a rainwater harvesting system – the tank collects and filters the drainage water and

then uses it to flush toilets and fill the washing machine.

“The tank costs £15,000 and, with savings of £2,000 a year on water bill, can pay for itself in seven and a half years.”

requirements. It can be backed up by a high-efficiency gas boiler.

The trust predicts the heat pump will pay for itself within nine years, while cuting carbon dioxide emissions by 13.25 tonnes a year.

Ground source cooling on the same site will help to dissipate heat from parts of the hospital, an important feature as the costs of air conditioning go up and average summer temperatures climb.

It should be all too easy to describe the complexity of Bristol’s dental school refurbishment as, well, like pulling teeth. After all, a programme of works that involved no fewer than 28 sectional completions and a bewildering cycle of department relocations was further aggravated by the demands of the academic timetable and the necessity of maintaining a service to patients.

But no, this £13.5m, ProCure21 scheme was completed in September 2007, on time and within budget, and, along the way, overcame a major obstacle that might have thrown a more conventionally contracted project into disarray.

It all started as a government initiative to train more dentists and the chief dental officer asking dental schools to consider plans for expansion. The school of dentistry at Bristol is a joint

initiative between United Bristol Healthcare trust and Bristol University and is where students, having completed three years of mainly theoretical work, move on to clinical practice.

The site itself comprises a cluster of four buildings of varying ages, the oldest dating back to the 1930s, the newest being five years old. Surrounded by roads and close to the city centre, the site has is no potential for any outward expansion. Pressures on space over the years have led to the sporadic and seemingly random reassignment of rooms and an accompanying lack of logic to much of the internal layout.

“Both the trust and university were keen to make a bid to take more students,” says Bob Pepper, UBHT director of estates and facilities. “Given that we couldn’t increase the floor area, that left us having to look at a complete

rationalisation of use throughout almost all the buildings and an upgrade of the patient area, all to be done while the service continued as normal.”

The choice was a “decant, refurbish, move in” cycle, over 28 distinct phases. Having to work around the academic year and an increasing number of students was another feature and meant that, if the building was to be up and running in time for the final extra intake, the work would need to be done by September 2007.

After a little fine-tuning to an original bid, funding was agreed. All that remained was to actually make the plans work.

“Two things came to mind,” says Mr Pepper. “First, we needed a project manager and cost adviser to help us through the maze. So I went to the Office of Government Commerce framework contract and within seven days had both those appointments in place. I also recommended to the board – on the basis of experience – that we followed the ProCure21 process. It accepted.”

The benefits of ProCure21, as Mr Pepper saw them, were twofold. Sharing objectives with a principal supply chain partner – in this case Laing O’Rourke – meant both client and contractor would want to get the job done well. The other benefit was the better understanding of and ability to manage risk, avoiding time overrun and keeping to budget.

From day one, construction managers were looking at the practicality of building the designs that had been created in response to UBHT’s ideas. This included examining how the layouts would work, asking how works would be programmed and when tradespeople and operatives could be brought in, as well as checking that the costs would not exceed budget.

“It was an approach that saw the contractors bring everybody to the table,” says Mr Pepper, “including the planners and removals people, vitally important because logistics were going to be as important as the actual building work.”

Setting out with a clear cost plan and costed risks for the entire project proved its worth early on. The old 1930s building turned out to have a very large asbestos content, much bigger than

ARRANGEMENT WITH

TEETH CASE STUDYCollaboration between client and contractor made a lot of dental work far from painful. Stuart Shepherd explains


had been anticipated. Under normal circumstances this could and had been managed safely. However, it became clear that it had not only been used for insulating purposes. In some places, it had been used as a building material.

“This first phase of the project was a nightmare,” says Mr Pepper. “Every time we went into a new area, we would have to seal it off first and do an asbestos clearance. This was potentially a massive financial risk but, because we were sharing it, both UBHT and Laing O’Rourke could put those risks on the register and cost them out.

“The steep learning curve and the collaborative effort involved also helped us hit a high level of success in phase two.”

One feature of this was the manner in which the contractors and their in-house mechanical and electrical (M&E) team Crown House Technologies handled the challenges thrown at them while replacing the mains services. Much of this took place in a building that had already undergone several previous but poorly recorded refurbishments and which needed to continue supplying electrical power for patient services.

“With a programme spread out over 28 sections,’ says Richard Skone, project manager for Laing O’Rourke, “the M&E people were generally working a floor at a time. This is how electrical circuits are configured usually, so making an area safe to work in by isolating and switching off the power isn’t normally a problem.

“Every now and then, however, a wire had been tapped down to a lower floor and turning off the circuit threatened leaving a clinic or treatment room without power. So the electricians, working alongside the UBHT estates team, were going in to do assessments in the evening or over a weekend to ascertain what the next step was.”

Exposing surprises like this on a traditional construction contract could have been difficult, causing repeated stops in work and a wait for further instructions. Under ProCure21, however, where client and contractor work much more closely and with higher degrees of trust, early

warnings can be raised and people meet round the table to discuss the best way forward.

Mr Skone says: “Everybody on ProCure21 works towards the same goal: an efficient and value-for-money build. There are no games, confrontations or financial wrangling. The budget is upfront, the contractor works towards the target costs and, unlike the traditional tender process where the cheapest design wins, as long as the client has the money there is no incentive to cut corners or lower the quality. Ultimately, you concentrate on delivering the project.”

When the project got to the stage where it was

time to fit out the “dummy head” training equipment – with cameras (linked to a data network) in the mouths to monitor student dentists’ progress – UBHT directly contracted a team of installation specialists and brought them on site to work alongside the M&E team.

What stood out above many of the other features of the refurbishment for both parties was close co-ordination and communication. This made it possible to keep what is not only a training centre for dentists but also a drop-in primary care dental facility up and running.

“We were communicating with everybody in the four buildings every week,” says Mr Pepper. “We worked with Laing O’Rourke on a weekly newsletter showing who was going to be working on what floor, for how long and doing what.

“It was surprising once everybody had this kind of information how they could put up with the noise and inconvenience. Knowing that in turn their department would benefit from a refurbishment work made it easier to cope with. There was also day-by-day planning and logistics of who was shifting where, all put together by the contractor’s planners, who made sure that whenever a room was moved it all got put back together properly.’ ●

‘This was potentially amassive financial risk but,because we were sharing it, both UBHT and Laing O’Rourke could put thoserisks on the register and cost them out’


Key points● Buildings at Bristol’s school of dentistry needed modernising.● A “decant, refurbish, move in” cycle was chosen.● It was completed on time and within budget.

THE HEART OF THE SERVICE BRISTOL’S CARDIAC FACILITIES

ProCure21 at United Bristol Healthcare trust is not limited to the dental school project. As well as the smaller centralisation of acute paediatrics, work to the Bristol Heart Institute is also well under way.

The £41m contract with Laing O’Rourke will bring together the trust’s dispersed cardiac facilities into

11,000 sq m of clinical space to provide an expanded cardiac intensive care unit, additional catheter labs and a centralised outpatient clinic.

“Since 2006, there has been a huge amount of ground works to get the site ready,” says Andy Headdon, UBHT strategic programme development director.

This includes the removal of 44,000 tonnes of material and the construcion of 135 piles to a depth of 28m.

“The original project was signed off three years ago. We have now brought commissioning managers to the project. ProCure21 has allowed us to have frank and open dialogue with Laing O’Rourke

and the design team to do some development work that brings the project up to current standards – in an environment where we know what the cost impact of that has been.

“With ProCure21, we are able to turn around the financial and programme impact of significant changes in two to three weeks.”

Smile please: students at work at Bristol’s refurbished school of dentistry.

Enabling the NHS to be a better construction client is essential if it is to implement the recommendations of the Darzi interim report on the Our NHS, Our Future review. The shifting focus of healthcare delivery outlined in the report requires new, patient-focused buildings.

The NHS needs to make sure it has the skills to take advantage of the opportunities for new premises. And training is a hugely important tool in equipping the NHS with the skills it needs to deliver procure capital building works.

ProCure21 uses a common set of principles, practices and tools that are different from those used in traditional contracting. These involve working in partnership, which can be very rewarding but does require a significant shift in thinking and a more open approach.

ProCure21 requires the NHS to take a very active role in the development and ongoing management of its schemes. It can be a demanding process and the speed of ProCure21 is such that it requires the trust to be clear in respect of its clinical and service strategy, as well as affordability and resourcing. This is particularly important as any OJEU requirements have already been met.

Not having to advertise in the OJEU typically saves six months’ procurement time, allowing a faster start on site. The first six weeks of a scheme can be the most demanding, especially for trusts limited in resources and expertise.

Historically, performance in respect of capital procurement and building within the NHS has been patchy, with the construction industry suggesting we have been a poor client – yet we are expecting the NHS to embrace new practices within ProCure21, learn on the job and, ultimately, deliver a successful scheme first time.

The roles and responsibilities of the trust’s project director, project manager and cost adviser are essential for success.

The project director is the employer’s representative and is responsible for scheme delivery. It is expected they will possess the experience and competencies to ensure successful delivery. They must have strong leadership skills and be able to influence at a senior level.

The project manager must have knowledge of principles, practices and tools to deal with the

day-to-day issues of the scheme. They will work very closely with the principal supply chain partner (PSCP), the supply chain and the cost adviser to develop the scheme and manage the contract. The project manager is the key appointment made by the project director.

The cost adviser is also a vital role, supporting the project director and project manager.

Many early problems seen on ProCure21 schemes stem from a lack of familiarity and expertise within project teams. Healthcare construction may not be the “day job” of the NHS, but it is crucial in respect of provision of appropriate facilities to support clinical and service strategies.

Construction and project management expertise is essential to ensure schemes are delivered successfully. The NHS needs to make sure its internal project structure is appropriate to deliver the scheme and fulfil its governance requirements. Some organisations have brought in external project management, while others have resourced and developed this internally.

The process of developing the scheme to detailed design and agreeing a guaranteed maximum price (GMP) is challenging. Commercial expertise is often invaluable in ensuring a robust full business case and GMP. Some trusts then use in-house expertise to oversee the construction itself, with the pre-construction project manager staying involved for continuity.

In the 2007 ProCure21 MOT process, 71 per cent of the project directors visited were on their first scheme. Although most had received training from their PSCP, a significant number said they would benefit from further training.

ProCure21 has provided training since its inception. Now, with 350 schemes registered and ProCure21 being used as a delivery vehicle by more and more organisations, the demand for training has increased.

Over the past six months, ProCure21 has offered many free training courses all over the country to meet this increased demand. To date, every course has been full and more than 400 delegates have been trained.

These courses have been largely introductory, covering key areas relevant to those first six weeks, such as how to select a PSCP, partnership working, developing the brief and key roles and responsibilities. A full day is dedicated to an introduction to the NEC contract, how it is structured and some of the key elements, such as the formulation of works information and dealing with changes and defects.

Although some of the subject material is challenging, it is presented in a way that is practical and demonstrable on live schemes. A ProCure21 implementation adviser provides “real life” expertise and experience on each course.

Course participants have identified a need for more in-depth courses on specific topic areas of ProCure21, such as management of the contract, resource scheduling and risk management. An additional training programme is being developed to cover these areas.

ProCure21 also intends to enhance the training courses that can be delivered locally, customised to the needs of the individual project. They deal with technically complex subject areas and will be delivered by its in-house specialists, supported by experienced facilitators. ●For more information on training, contact Julian Colaco, ProCure21 communications and training manager at [email protected]

CLASSROOM

CLIENTSTRAININGThe NHS’s performance around capital works has been mixed, writes Julian Colaco. Trusts need to build expertise


‘Healthcare constructionmay not be the “day job” ofthe NHS, but it is crucial in the provision of appropriate facilities to support clinical and service strategies’


Arguably Stephen Walker should have a price on his head. The VAT manager for Leeds Teaching Hospitals trust and VAT consultant for ProCure21 was the architect of a VAT recovery service for NHS capital projects that has cut the need for external advice, to the tune of £4.3m in saved fees.

In 2002, when the Department of Health and the Treasury were concerned about VAT recovery and how much it was costing NHS trusts in consultancy fees, Mr Walker worked with Revenue and Customs to come up with an alternative.

“We came up with a simplistic methodology of recovering VAT,” says Mr Walker. “The incentive was to say to the trust, here’s a free VAT service and we will bill ProCure21 a fee for me and colleagues to undertake that work.”

The model was approved and five years later Mr Walker and Richard Southall, VAT auditor at Birmingham Heartlands and Solihull trust and another ProCure21 VAT consultant, have handled VAT recovery for 206 projects with a total charge of £216,000 in fees.

“If you compare that with the external advisers they would have charged something in the region of £4m,” says Mr Walker.

“Companies ring up complaining it’s unfair. My view is that we in the NHS should be looking after our own interests. It’s money going back to patients and we are able to do it.”

The model has proved so successful that Scotland and Wales have now adopted it. Mr Walker has completed his first review in Kirkcaldy, Fife, under the Procure Scotland agreement and the Welsh Assembly government has given its approval for Building for Wales projects to use the system. ●

VAT’S ALL FOLKS

TAX RECOVERY

SMALL SCALE

BIG SAVINGSTraditionally, minor works can be costly and time-consuming to administer. Each task has to be managed on an individual basis. This presents a serious drain on NHS resources.

The ProCure21 minor works contract allows NHS clients to engage ProCure21 principal supply chain partners (PSCPs) on minor and maintenance works. It provides a consistent approach to managing a series of small tasks under a single management, design and build contract. It allows administration and programme management to be passed to the supply chain, offering the NHS client speed and flexibility.

The ProCure21 minor works contract uses the same experienced supply chains already approved for the major works programme. Trusts

are able to select their supply chain avoiding OJEU tender requirements.

Similarities to the major works programme do not end there. The minor works contract continues to promote the principles of ProCure21 throughout of:● Confidence concerning cost, time and quality;● Development of a common understanding of the scheme and aims, as well as of roles and responsibilities;● Collaborative working between the NHS and the construction industry; ● Guaranteed maximum price;● Development of long-term relationships.For more information on the minor works contract, go to www.nhs-procure21.gov.uk.

MINOR WORKSThe ProCure21 minor works scheme brings small tasks together under a single contract, administered by the client trust’s principal supply chain partner

CHECK LIST WHY SHOULD AN NHS CLIENT USE THE MINOR WORKS CONTRACT? ● Dissatisfaction with traditional minor works procurement;● It provides a singular solution for annual maintenance spend;● It avoids lengthy tender requirements;

● NHS clients can take advantage of their existing relationship with their ProCure21 principal supply chain partner; ● The long-term relationship acts as an

incentive to the PSCP to deliver consistently good performance;● It facilitates a flexible programming of work;● It’s a solution for small project

management capacity gaps in house;● It gives the client the ability to use local supply chains under the management of their principal supply chain partner.

Get Involved

Use ProCure21 to deliver your publicly funded capital scheme and become another statistic.

For more information on how your trust can deliver your scheme on time, within budget, and six months earlier than possible with traditional tender, go to our website and get a copy of our latest case study pack.

www.nhs-procure21.gov.ukProCure21 is an initiative of the Department of Health

84%93%84%

84%80%

of schemes completed on time or early

of schemes were completed within budgetaverage rating for product

of schemes reported zero accidentsrating on defectslitigation on schemes to date0%

79% average rating for service

better buildings - health service journal · pdf fileadding detail for a more robust business...

Documents