Karl Redmond, BIM4HEALTH & BIM4SME representative and Director at Bowman Riley Innovate & Healthcare details how the future NHS Estates frameworks will fully support the BIM and GSL agenda…
The future of the NHS and all its many agendas, groups and countless chiefs have been given what some see as clear direction from Simon Stevens (CEO, NHS England) and the Five Year Forward View (October 2014).
The vision set out by the NHS Five Year Forward View captures the drivers for the estate and patient care which are to be undertaken to help meet the UK Government’s need to increase efficiency of the public sector estate and new/refurbishment build programs. It highlights the need to capitalise on the opportunities the ‘information revolution’ presents, including Building Information Modelling (BIM) and Government Soft Landings (GSL) processes.
This holistic approach aims to capture vital and valuable information, enhance and support the NHS objective of delivering tangible benefits which can significantly influence all future decision making relating to any and all asset/estates strategies. The BIM process, through understanding, collaboration and culture change, can aid the broader NHS agenda by introducing a diverse solution combined with local and national leadership, facilitated and coordinated via public, private and professional groups.
The Department of Health (DH) future estates strategists have indicated they will fully support the BIM and GSL agenda for all healthcare projects. Under the proposed new arrangements there will be a need for all lead Principle Supply Chain Partners (PSCPs) to handover ‘all required documentation, data under GSL requirements, BIM data and CDM documentation, before certification of the scheme completion’.
The DH have also hinted that successful delivery of a project will include ‘innovative processes, technology and designs’ which will be evaluated and assessed via formally submitted proposals with ‘improvement of clinical/business outcomes’ – a key requirement within this process. The lead PSCPs, along with their supply chain, will be tasked with proposing ways in which project information, processes and lessons learnt, can be used repeatedly – therefore saving the client resources and money. An example of this development is clearly illustrated through the growing influence and benefit of repeatable rooms and standard components or other cost saving initiatives. The DH will ‘collect and store project information’ for use by ‘other healthcare clients’, developing a repository of projects and associated information, which can be utilised for on-going and continuous improvement, best practice before, during, and post project hand-over.
Maximising the benefits
In order to maximise the benefits of the ‘information revolution’ including the BIM and GSL process, the DH are encouraging the development and creation of long term joint ventures and strategic estates partnerships between NHS clients, PSCPs and their supply chains. These engagement programs are to include facilities management services and the enabling of land and asset deals to help deliver capital and long term income streams. To carry out an effective long term engagement program, the clients, along with the PSCPs and their supply chains, will need to provide evidence based proposals detailing how they can support and address the changing healthcare provision, challenging budgets, ageing estate, changing demographics and increased expectations of patients.
An integrated BIM and GSL process that can be recorded, analysed, benchmarked and accessed intelligently over time by relevant stakeholders will enable more of those stakeholders to make more and better decisions about how best to utilize all asset and facilities.
Now more than ever we need to leverage the information available to us all intelligently, effectively and efficiently. Integrated teams that learn to do so, throughout the life cycle of an asset, will increase the efficiency with which they deliver planning, design, construction, operations and maintenance services.
A positive BIM & GSL process for any client with a substantial existing estate is achieved by beginning with the end in mind and identifying the downstream uses of information, to ensure information can be used and re-used throughout the project and life of the assets. With the ‘end in mind’ there needs to be an alignment of interests between those who deliver an asset and those who use it. GSL was developed to focus on two of the key objectives:
• Clients issue a brief that concentrates on required performance and outcome; designers and constructors work together to develop an integrated solution that best meets the required outcome;
• Create an alignment of interest between those who design and construct a facility and those who subsequently occupy and manage it.
Post occupancy evaluation (POE) can be used to assess performance post completion and handover to establish actual outcomes and lessons learnt. However, this will only be effective if the correct measurable data brief is transferred throughout the process and available in a usable format. It will also require clients to have full ownership, understanding, and the ability to manipulate and extract all relevant information – meaning we need educated clients.
The DH are strongly encouraging PSCPs and supply chains to help clients with the entire information revolution. It may be necessary for clients to nominate internal teams from various groupings e.g. finance, facilities, capital estates and clinicians to engage in the process.
The need for the NHS to bring together all groups that work, operate, build, fund and maintain clinical environments has never been more urgent. However, to enter into such a significant long term program of work without understanding the drivers i.e. patient care and their associated pathways, would be a massive mistake. Consideration will also need to be given to commissioners and auditors of care within the NHS e.g. CCGs and CQCs, to fully understand the size, state and complexity of the existing estate as well as any new build needs.
There is an immediate need for healthcare planning, strategic estates planning, patient informatics understanding, demographic awareness, NHS asset standards and regulation knowledge, funding expertise, design, construction and maintenance professionals to come together and deal with complex issues holistically. With rapidly advancing technological improvements and the information revolution in full swing there is no reason why we can’t deliver healthcare being demanded by clients and patients. It will not be simple or easy and the biggest shift will be in people – a culture change is needed along with a willingness and bravery to ask the ‘silly question’, until we are all up to speed with the inevitable changes we have to deal with.
I for one welcome the proposed strategy from the DH and the systems thinking this approach will need. I would go further and make some of the requirements mandatory and then extend this to the commissioners as well as the auditors. If this systems thinking, collaborative, information revolution program can be extended from the Acute hospital Trusts to all other healthcare providers e.g. GPs, Community Health, Mental Health, Extra Care etc – we will then see real change for the better, especially for the patient.
BIM4HEALTH & BIM4SME representative and Director at Bowman Riley Innovate & Healthcare