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Hands across the water - Conference Review

[h5] The 17th HefmA National Conference & Exhibition welcomed a record number of delegates who enjoyed a programme of high profile and inspirational speakers dedicated to ensuring best practice among Estates and Facilities Directorates [/h5]

Ian Daccus, Chair of the London and South East branch, opened the 17th HefmA National Conference & Exhibition at the Hilton Brighton Metropole Hotel on Thursday 15th May by welcoming delegates to the international-themed event and reminding the audience of Estates and Facilities professionals of their vital role in supporting and enhancing the services the NHS provides.

In chairing the first session Mervyn Phipps, also from the London & South East HefmA branch, introduced Will Whitehorn as “the man famous for plucking Richard Branson from certain death”, who then went on to make the Virgin Galactic dream a reality.

Innovation culture

Whitehorn based his keynote address on how to get an innovation culture to work in an area such as healthcare. He pointed out that the NHS is “a full industrial structure, not just a service”, and the great difficulty is that it’s dealing with people’s lives on a daily basis. “When even top doctors can’t agree if statins are good or bad,” he said, referring to one of the top news stories of the morning, “how on earth are they going to agree on what makes a healthcare building fit for the next generation?”

He held Branson up as an example of an individual who can shape an organisation by creating the desired culture. “At Virgin it has always been very much a ‘can do’ culture,” he said. Branson, who had to find ways of overcoming his dyslexia and ADHD to succeed, had always thought about things in a very lateral way, he said, and when Mike Oldfield’s Tubular Bells – the first record released by the Virgin label – became the biggest seller of the 70s Branson was already thinking ahead as to how he could build the Virgin brand.

[quote bottom=said Whitehorn] He wasn’t embarrassed about doing things that didn’t work. There wasn’t a fear of change at Virgin, whereas in the NHS it’s a constant fear. [/quote]

Whitehorn went on to explain how Virgin began to introduce an innovation culture into its transport product 14 years ago when they as a company predicted that the price of oil would become prohibitively expensive. They designed a range of innovations into Virgin Trains which made them cheaper to run, faster, more frequent and more comfortable – and as a result twice as many people now use them and £200m a year is handed back to the public in subsidies.

“We were innovating to make a profit, by giving customers what they wanted,” said Whitehorn. It’s not the same in the NHS, he admitted, because people aren’t paying, but “innovation is also a way to save money, reduce cost and reduce risk”.

Innovation at the cutting edge is obviously at the forefront of the Virgin Galactic project, which Whitehorn describes as “an investment opportunity based around innovation and a sound business plan”. There are already 1,000 customers signed up – each having paid $200,000 dollars – for a flight in the carbon composite spacecraft which it is hoped will launch commercially by the end of the year.  

Extra capacity

The morning concluded with a presentation by Jon Huddy, a Consultant Architect with DLA Freemanwhite, who gave delegates an overview of some of the projects he had been involved with in the USA where ED departments needed to get more capacity out of the existing space.

Solutions he shared included putting four gases into a single resuscitation room to allow for increased capacity at the busiest times, keeping “vertical patients vertical” by using chairs or recliners, introducing ‘flex rooms’ (only 30% larger, but allows a second stretcher to be brought in at the busiest times), the ‘super track’ concept whereby patients only use the space when actually being seen by a clinician, and ‘care arrival’ areas where treatment can be started immediately, with inner waiting areas so the patient is never ‘bounced back’ into the public waiting areas – “they are always moving forwards in the process,” he said.

Ultimately, he said, architects could come up with solutions but it required the right culture for people to follow through on the changes and implement strong communications to ensure a more positive experience for the patient.

Section 17

Kay Mulcahy, Head of Estates and Facilities (Forensic) at Nottinghamshire Healthcare NHS Foundation Trust and her colleague Catherine Brooks from the Hotel Services team spoke about the ways in which they had changed working practices to produce “a recipe for success” with the Section 17 Restaurant. 

This latest project at the 76-bed medium secure psychiatric hospital aimed at facilitating patients’ recovery pathways and giving them a sense of purpose follows on from Woody’s Shop, a joint venture with Occupational Therapy, Hotel Services and patients, and the Farm Shop, a social enterprise scheme run by Hotel Services, the horticultural team and patients. The restaurant uses produce from the horticultural sector and the farm shop and offers a three-course menu for £9.95 a head.

What has been achieved with the restaurant has been “cost neutral”, explained Mulcahy and Brooks: “We were in effect asking the catering team to change their working practices.”

The main kitchen of the hospital gets taken over by the Section 17 people, so the existing catering team had to adapt to feed the rest of the patients and staff, using ward kitchens instead. It was “pivotal”, said Mulcahy and Brooks, to get the catering staff on board with the changes, so that the quality on offer to the other patients didn’t suffer. There was also lots of training involved, including boundary training to equip and empower catering staff who are normally isolated from the patients to deal with anything they may see or hear when working in ward kitchens to produce meals in close proximity to patients.

The initiative – which was based on the success of HMP”s The Clink restaurants – has received some “fabulous” comments from diners and the families of the patients involved and has created greater staff engagement.

Delivering best practice

Jonathan Gilmore of the Birch Foundation shared with delegates the wisdom of their approach to delivering best practice into the health service – “a standard approach, irrespective of what sector we are working in”, they said, and one that’s proven to deliver “huge savings” and “radically improve” performance. 

The service delivery begins with a high level overview; “then we look at opportunities for improvement, develop an improvement strategy, get people on board (caterers, porters, cleaners, etc), work out cost savings and improvements in patient safety”. The key then, they explained, was to deliver “little bits of the service”, test it and then roll it out.

They used two case studies to support their approach – Northern Lincolnshire and Goole NHS Foundation Trust, where the development of an integrated service model improved efficiency and delivery, and Kent and Medway NHS Facilities - still in the 16-week service review period which is looking at a “basket of goods” to reduce waste, improve workflow and deliver cost improvements.

All in a day’s work

Kate Adie’s anecdotal afternoon keynote address included a self-deprecating account of how she ended up doing a degree in Swedish & Ancient Icelandic after “pretty grotty” A Level results which led her headmistress to “phone a friend” to get her into university. She managed to land a job with the fledgling BBC local radio stations, where she  learned the job from the ground up.

Mindful of her audience she included a few hospital references…  In the design and supply of a hospital in a country that’s having a revolution, she advised, you need to look at the 5th floor “as your best line of defence”. This should involve putting the medical staff up there on the balcony with a plentiful supply of that which is available in a hospital. “They then take their syringe and they aim it…,” she said, only slightly tongue-in-cheek.

She also made a plea for hospital beds not to be made too low to the ground: it’s not great to have to do an interview from under the bed when you’ve just crashed into the hospital ward through the window in the midst of raging warfare, she pointed out.

And in regaling her audience with the story of how she and her cameraman delivered three women of premature babies by candlelight at a hospital in Sarajevo, Adie drew attention to the fact that most modern hospital buildings are not designed for modern warfare when the power station is often the first target of revolutionaries attempting to take over a country. “There are no windows; you end up with complete darkness. The hospital goes from 21st century back to the middle ages,” she said.

She also made the more serious point that “people” are the most important thing in both her job and within the NHS. She believes, she said, that listening to others and applying their wisdom “is the secret of being able to better deliver”.

One year on

The second day of the conference began with a presentation by Simon Holden, Chief Executive of NHS Property Services, on what the company had achieved in its first year.

Although there had been an element of “keeping the show on the road”, he admitted, following a challenging legacy of inherited deals, a dispersed workforce, and a complex estate of 3,700 properties, they had still managed to deliver over £16m savings, started 50 new developments, and disposed of 86 surplus properties resulting in £33.8m capital receipts, £3.6m revenue savings and 1,100 housing units.

He said the company was on track to produce some £64m savings (FYE) in 2014/15, making the best use of NHS estates by maximising the use of space, and creating environmentally sustainable properties as well as more broad-based multi-function facilities.

Innovation, integration and integrity

Next up, Peter Sellars announced the formal launch of the NHS PAM (Premises Assurance Model), and took part in a panel discussion with questions from members of the audience.

This was followed by a presentation by Mike Hall of the North West branch. He introduced the theme of next year’s HefmA National Conference – ‘Innovation, Integration and Integrity’ - and urged delegates to “step back from the day job and take time to think about the services you provide, pick up ideas and decide ‘what am I going to do different for these people?’

[quote bottom=he said] We’ve a big part to play in the patient’s journey, including how we get patients from the front door to the back door – patient flow. [/quote]

Hall said delegates should consider “what should our services be delivering to meet the needs of the service user? What should we do to meet the objectives of the Trust?” Answers, he suggested, might include being responsive, courteous, more visible, integrated (one team, one service), transparent, flexible (able to deliver what’s needed, when it’s needed), safe, commercial (driving performance through the supply chain), and measured (through evidence-based cost and performance improvements).

He went on to talk about the importance of using data in E&F, pointing to ERIC, PAM and last year’s launch of the HefmA Dashboards – “a real tool to improve productivity and reduce cost”.

Conference close

HefmA National Chair Nigel Myhill closed the conference by thanking the sponsors and exhibitors, and congratulating this year’s award winners. He also thanked outgoing President Rob Smith and outgoing Vice Chair Chris Needham, and welcomed the two new Vice Chairs – Mervyn Phipps and Paul Fenton. He said that Will Whitehorn’s tip not to think of the world as static was “good advice” and praised the wisdom of all the speakers. He said he’d had really good feedback from all the breakout sessions and thanked everyone involved in making the conference “a great success”.

Looking ahead, he said, everyone needed to look forward to the challenge of the new series of CQC inspections, implementing PAM, joint working initiatives between HefmA, HCA, AHCP and IHEEM, and the incorporation of HefmA Ltd with a commercial arm of the association.


This year’s exhibition saw yet more exhibitors taking part, and with larger stands than ever before. During the specific exhibition viewing times throughout each day the aisles were packed with delegates wanting to find out about the latest products and services to find their way to market; at other times delegates without a particular interest in the conference programme were able to enjoy a quieter, more relaxed stroll around the stands which, as one exhibitor pointed out, “allowed us more time to spend with individuals”.