gbpartnerships Strategic Estates Lead, Jonathan Wilson (RIBA) reflects on what we have learnt from our work supporting clients respond to business-critical issues brought about by COVID-19, and how we will use this learning to help support the NHS in developing robust, future-proof, estate strategies with a structured strategy and methodology for COVID-19 response going forward.
The COVID-19 virus took the country by storm in mid-March, having hovered on the side-line as a moderately worrying news item for weeks beforehand. It is fair to say that no one was ready for what was to unfold.
Within days, gbpartnerships’ consultancy and project teams found themselves working closely with NHS partners to develop response plans. These ranged from assessing sites to quickly create additional step-down bed capacity, to converting community health centres and GP premises to create ‘hot hubs’, to installing screens at reception desks.
In the first days of the crisis, it appeared that ICU facilities around the country would be quickly overwhelmed. In addition to new field hospitals quickly fitted out in exhibition centres to boost ICU capacity, plans were laid to add capacity in step-down beds which would allow patients to be shifted out of ICU as soon as possible.
The step-down facilities would accommodate patients no longer infected but needing further observation and care before discharge. Sadly, the facilities would also accommodate palliative care wards.
Ian Sabini, gbpartnerships Managing Consultant lead for London and South East, was asked to consider 15 sites, both healthcare and non-healthcare, as potential step-down facilities. These included decommissioned hospital wards, vacant care homes, sport/event facilities and disused commercial units. Ian and I put together a team that quickly formulated an assessment matrix. The initial list was narrowed down to two sites with the potential to provide beds at scale. One was a major sport facility, the other a building with three recently decommissioned hospital wards.
The team, comprising a national contractor with significant healthcare experience and a building engineering services consultant, then worked up proposals and costs. Assessing the sites was challenging given lockdown restrictions. The team consulted with resident facilities managers and carried out inspections where possible. Record drawings were used to assess existing building engineering infrastructure and the required modifications. Achieving the necessary air changes in bed areas would require temporary air handling units in some areas.
For the sport and events site, the team explored a range of temporary structure solutions: modular buildings of various kinds and event marquees. Each of these solutions had different pros and cons such as off- and on-site lead in, availability, infrastructure included and not included. Within a week we worked up proposals to create 350 beds on this site to be delivered within 6 weeks. The beds were in a combination of temporary structures and retrofitted existing accommodation. We were surprised to discover how amenable a hospitality and event building is to adaptation for in-patient use. It has commercial catering facilities and ample toilet facilities.
We were equally surprised to discover how much work is required to bring a recently decommissioned ward back into use. Many aspects of the existing accommodation had to be carefully assessed in order to accurately determine the number of beds that could be accommodated and associated scope of works. Particular challenges were placing accessible toilet and bathing facilities within acceptable distances from beds, and recommissioning ventilation systems. The final report and recommendation included layouts, scoping documents, programme and costs (capital and operational).
In the primary care sector, other members of the gbpartnerships consultancy team worked with partners to set-up COVID-19 GP ‘hot hubs’ and to retrofit screens in existing GP reception areas – such as at South Liverpool Treatment Centre.
In North London, a COVID-19 GP ‘hot hub’ was set up over the Easter bank holiday weekend in an MSK outpatients’ area that had been stood down early in the outbreak. The team assessed the area against the latest COVID-19 infection control and estates guidance. Once the area had been assessed and we were satisfied that it could be made compliant, we moved into the mobilisation phase. To ensure that we hit the deadline for occupation, we managed multiple activities, ranging from setting up short-term soft and hard FM service arrangements, sourcing the availability and delivery of medical gases, procuring certified temporary signage, to ensuring the licence for occupation was in place.
Rachael Samain, gbpartnerships Estates and Business Performance Manager based in Hampshire, led a challenging assignment to rapidly convert an existing primary care LIFT facility, in which the NHS Trust was a CHP sub-tenant, to a 24/7 in-patient centre. The revised use of the facility was specified by the Trust and communicated through a series of marked-up floor plans. These plans were regularly updated by hand to suit the evolving brief and shared with the project team for review and action.
Rachael quickly established the governance structure to kick start the project: she identified who had the knowledge, authority and time to form a working group. From here, the roles and responsibilities of core for the project team were assigned. Rachael tasked the core team to take responsibility for access to other key roles within their respective organisations, such as the Fire Officer and operational teams. Virtual meetings were held daily in first instance, then becoming bi-weekly. The Project Team consulted senior clinical and infection prevention and control personnel at the earliest planning stages to mitigate late changes in build process. The project was successfully completed and opened in one month from commencement of works.
So, what next?
Drawing on all of this experience from the pandemic, we think it is crucial that NHS organisations assess their facilities systematically and develop SMART plans for adaptation and emergency response.
gbpartnerships is developing a structured strategy and methodology for COVID-19 response going forward. Called ‘Building in Resilience’, it identifies the key issues that need to be addressed both in existing buildings and in future ones. In conjunction with this work, we have consulted with partners through facilitated round table discussions to ensure that we fully understand the emerging challenges and needs across a variety of public sector organisations.
‘Building in Resilience’ will guide estate managers and commissioners through the process, helping to produce robust future-proof estate strategies.
Looking ahead, it seems clear to us at gbpartnerships, that many aspects of current guidance and practice will have to be re-thought: circulation space, lift provision, public gathering spaces, space planning standards, building entrances and patient flows, ventilation standards, digital tracking and management of space use, zoning for infection risk, collocation with non-healthcare services.
We may even see an update to the NHS Long Term Plan. In the meantime, watch this space for the first release of ‘Building Resilience’!
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