In this article, Robert Snook, Director and General Manager of Portakabin Hire, offers some practical advice to help healthcare providers rapidly expand hospital facilities to reduce patient waiting times with no compromise on the quality of the accommodation.
Reducing waiting times is one of the most urgent priorities for NHS trusts. Department of Health figures show that almost 250,000 (9.4%) of the 2.6 million people on hospital waiting lists do not get treated within the 18 weeks guaranteed by the NHS constitution.
To help address this, the government has set a new target which states that no more than 8% of patients on waiting lists should have to wait more than 18 weeks. The Department of Health is actively monitoring progress towards this and is publishing a league table setting out hospital performance.
Two barriers to reducing waiting times are a lack of bed spaces and pandemics such as winter flu viruses, which can cause sudden increases in unplanned admissions. However, modular construction can give healthcare providers the opportunity to rapidly increase capacity without compromising standards, particularly on constrained hospital sites.
Complete, fully-fitted buildings for wards, consulting or treatment facilities can be delivered in a fraction of the time of a site-based construction solution. Critically, buildings can also be installed with much less disruption to patient care. Other applications include recovery suites, dialysis units, bariatric care, diagnostic facilities, out-patient departments and treatment centres.
The advantage of a hire solution means that a building can be reconfigured or relocated as local needs and priorities change and as demand for hospital services evolves. But how can you ensure the best possible outcome for the project? Here is what you need to know to avoid the most common pitfalls.
Carry out a cost-benefit analysis
Before you commit to hiring an interim healthcare building, a simple cost-benefit analysis should be carried out. Assess how many patients could be treated for a range of conditions in a given space over a specific period of time. You can then calculate the financial implications of the new facility.
For example, if you hire an 18-bed ward for specialist surgery, assuming an average hospital stay of ten days, it could cater for 657 patients per year. Over a three-year hire period, almost 2,000 patients could be treated in this interim facility.
Not only would this go a significant way towards reducing waiting times, the tariffs received for treating these additional patients could pay for the hire of the building. Once a quote for hiring this size of ward facility for three years has been obtained, you can calculate how long it would take for the building to pay for itself.
The types of treatment carried out in the new building and the associated tariffs would determine how quickly the cost of hiring the building can be recovered.
Identify requirements for the new facility
Decide what sort of facility would most effectively help to reduce patient waiting times. Are more in-patient beds needed or additional consulting rooms – or a combination of both? Would a specialist facility, such as a maternity unit, allow space elsewhere in the hospital to be freed up for other uses, or will a more general facility better meet the requirements?
Identify a site
In the majority of hospitals, the most likely space for an additional facility will be the car park. To make the best use of limited space on a constrained hospital site, a multi-storey building may be the most efficient option. Typically, modular buildings can be constructed up to four storeys high, maximising the floor space on any site. Check the multi-storey capabilities with the building supplier. The new building can be a stand-alone facility or it can be linked to the main hospital building to maintain patient flows.
If it is not possible to release car parking space for a new building, it may be possible to use other land adjacent to the hospital. The versatility of modular buildings also means that they can be craned into completely enclosed courtyards, sited on steel platforms, on the roofs of existing buildings or installed on other restricted sites where site-based construction solutions and access would be extremely difficult and disruptive to patient care.
Talk to the modular specialist about the options available and find out if a free site survey is available to identify the best possible location for the new building.
Research the market
Approach a number of modular building suppliers to find out what each offers, as not all suppliers are like for like and technical expertise can vary. Choose a supplier that can demonstrate an extensive track record in the health sector. Ask for proof of, and ideally visit, previous projects and look for their ability to design buildings that meet specific healthcare requirements particularly in relation to infection control and other patient-critical criteria.
The supplier should ideally have extensive experience of designing buildings that comply fully with the relevant HTM, HBN, SHTM (Scottish Health Technical Memoranda) and HAI-SCRIBE (Healthcare Associated Infection System for Controlling Risk in the Built Environment) guidelines.
Discuss the building layout
Talk to the building supplier about the optimum configuration of the ward or treatment facilities. Whatever the type of building required, it is likely to feature a central core of essential services and amenities. These are needed for the efficient functioning of any healthcare facility and should include a waiting room, a reception, a nurses’ station, kitchen facilities, toilets for patients and staff, clean and dirty utility rooms, and storage areas.
To achieve the most efficient configuration for the building, these central ‘servicing’ facilities can be located in a core module at the centre of the new facility. Onto this ‘core’ as much modular ward space or consulting room accommodation can easily be added.
Finalise the specification
Develop the detailed specification for the building in close collaboration with the modular supplier. Some specialists may have standard healthcare building layouts already available that provide all the required floor space, services and facilities for each type of healthcare building. These standardised designs can be replicated very quickly and adapted to specific site requirements, further reducing procurement and lead times.
Portakabin, for example, has a new range of healthcare buildings that provide complete ready-to-use facilities, equipped with everything needed to meet all relevant NHS guidelines. WardSpace buildings comprise a ‘central core’ with utility rooms, a nurses’ station, waiting room and all other essential facilities, onto which a choice of open-plan single-sex wards, single en-suite bedrooms or consulting room facilities – or any combination of these – can be added to suit local needs.
Specifications for WardSpace can include hand sanitisers and bed heads, patient call systems and wall-protection panels. At the design stage, it is important to assess how much of this equipment is already available in stock and how much needs to be supplied by the building provider. It may be, for example, that there is an existing contract in place for the bulk purchase of ward curtain tracks or hand sanitisers, which would make it more cost effective for these to be sourced internally. Any of these standard systems can easily be fitted into most modular buildings.
Standard or bespoke buildings?
If standardised healthcare buildings are available from the modular supplier, it will be more cost effective to choose this option, with minimal alterations. Patients can then benefit from faster delivery and it will be a more sustainable solution, as the building can be re-used on other hospital sites.
For project-specific requirements, any bespoke layout or fit-out should be possible. The interiors of the most technically advanced modular buildings are free of internal columns which gives the flexibility for rooms, corridors and open-plan spaces of any size to be created.
Choose the hire period
The length of time to have the building on hire can be varied. If a ‘surge’ ward is required simply to cover an expected increase in demand over the peak winter months, this can be catered for, although it is unlikely to be economical to hire a good quality ward building for such a short period.
It may be worth considering keeping the building for at least a year so the additional bed space can be used to reduce waiting times. After a year, the benefits of the extra space can be assessed and the healthcare provider can decide whether or not to keep the building or to replace it with a permanent facility.
Managing the building installation
Installing an additional facility on a busy hospital site requires careful planning and logistics, so it is important to work with a building supplier that understands all the issues.The delivery of the modules should be timed to coincide with quieter periods, such as weekends or holiday periods. Preparation of the site in advance of the building delivery needs to be carried out sensitively and with the minimum disruption to patient care. Foundations should be managed with particular care, as the ground could contain a complex network of gas, water and other services, electrical and fibre optic cabling and other essential supplies that are vital to the day-to-day running of the hospital.
The ground should be carefully surveyed before any foundation work is carried out. However, modular buildings can be installed with much less intrusive ground works. The extent and type of foundations required will depend on the size of the building and the number of storeys.
An experienced modular supplier will be able to advise on these issues and ensure that all site preparations are carried out safely, unobtrusively and efficiently. Once the modules are on site and craned into position, any remaining fitting out can be completed without further disruption to the hospital.
Ensure support is in place throughout the contract period
As soon as the building is handed over, it should be ready for occupation. The modular specialist should provide all necessary maintenance support throughout the hire period, ensuring the building continues to deliver optimum performance, and provides a comfortable, welcoming and well-equipped patient environment.
The flexibility of modular buildings means that if additional ward space is required, further modules can be added very easily and with minimal disruption. Conversely, if capacity requirements change, the size of facility can be reduced if required.
Case study – surge ward for Watford General Hospital
As a result of unprecedented increases in demand for emergency care, the existing wards at Watford General Hospital were put under severe pressure and so a requirement for a ‘surge’ ward was identified to provide additional ward capacity at peak times. A Portakabin hire solution was developed and an HTM-compliant modular ward building was delivered in just four months.
The new 18-bed ward will remain in use for the next three years while other changes are undertaken to allow West Hertfordshire Hospitals NHS Trust to cater for greater patient numbers. A further two-storey ‘surge’ ward building is also being provided by Portakabin at the hospital by the end of this year, for a five-year period.
These projects illustrate how temporary building solutions can be delivered to help healthcare providers meet waiting list targets and response times during peak periods and while longer term plans for expansion are progressed.
The specification for the ‘surge’ building comprises two separate wards to achieve same-sex compliance and to meet all relevant HTM guidelines. It features a central core area to accommodate facilities such as clean and dirty utilities, kitchen, reception, toilets and showers, with two spacious nine-bed wards to either side.
How the challenging timescale was met
Commenting on the project, Kyle McClelland, Associate Director for Strategic Developments at West Hertfordshire Hospitals NHS Trust, said, “The timescale for getting this building on site was extremely challenging. We evaluated a number of modular building suppliers and Portakabin was the only specialist able to commit to delivery within the four months we had to complete the building, and to offer the high quality buildings we required.”
“The whole process was greatly simplified because Portakabin could handle every aspect of equipping and fitting out the building, which made it possible to complete the project so quickly. There were just four months to design, build and hand over the building – and I am pleased to report, this was achieved on time.”
“The new ward has been well received by both staff and patients. The spacing of the beds is generous and the quality of the finishes meets all our requirements. The new facility has helped us manage the increased demand for our services.”
The building is located on a car park, with a link corridor to the main hospital, and its modular construction meant it required no intrusive ground works, allowing the car park to be left intact. Portakabin managed the entire building installation and fit out, including foul drain connections, all reception furniture, special NHS-standard bed-heads, alarm systems, heavy-duty flooring, cabling for data communications and climate control systems.
The building installation was timed to coincide with quieter periods at the hospital, and the modular site team worked closely with the Trust to ensure that any disruption was minimised.
For further advice about hiring interim healthcare buildings to reduce patient waiting times, call 0845 355 0350 or visit www.portanews.co.uk
