Focus on facilities management

As we move into another new year many of us working in healthcare facilities management are looking forward to new developments or refurbishments and trying to make sure that we include the lessons learnt from the past as well as keeping an eye to the issues of sustainability.

Meaning of sustainability
There are a number of areas in which sustainability is used and all can be important to us at different times.
    
In a pure business sense we have to ensure that business models are sustainable: the decisions we make and paths we choose have to provide for the ongoing provision of the business we are involved in – in our case the health of the nation. This means that we must ensure that the work we carry out is appropriate not just for today but also for tomorrow, and it is interesting to note that the Welsh Assembly Government has commissioned the first all single occupancy new hospital development.
    
At almost the same time as this announcement Nicholas Timmins wrote in the Financial Times that health spending as a share of national income is expected to rise, but he argues that, despite the current climate, healthcare may remain affordable if economic growth continues (currently looking an unlikely premise). He suggests that this means health policymakers must live with a paradox: struggling daily to contain and improve costs, while acknowledging that if economic growth continues healthcare will probably remain as affordable as it has ever been. But within healthcare facilities we are still under pressure to continue the now long established trend of year on year costs savings while improving and maintaining more technically complex facilities to appropriate standards. There almost seems to be a contradiction here; a paradox indeed.

The future
As we look to continue implementing the NHS Plan, healthcare construction in various forms is ongoing and we need to be sure that the design and materials used are not just fit for today’s purpose but to try and work with a firm eye on the future. New build on existing hospital sites is always difficult as space is at a premium and the need to maintain existing services is paramount with minimum disruption to the functioning of the hospital and access for both patients and visitors. Such new build, and indeed refurbishment of existing premises, needs to be planned with the sustainability of current service delivery.
    
Looking into Primary Care the re-provisioning of GP surgeries and health centres needs the same level of careful planning to ensure continuity of the care delivery to the local communities. Such a scheme has recently been completed in Wolverhampton where an old church/community hall site was purchased and developed in the new surgery for one of the local GP practices. Opening 1 December 2008 the old surgery was unaffected by the new development throughout the construction.

Natural resources
Sustainability is also used in the context of the environment and our use of the natural resources that provide heat and light is another pressure point for healthcare facilities managers to deal with and try to make sense of. Rising prices and the pressure to use less again come into conflict with the drive for cost savings. Higher energy pricing is used as an incentive to be more fuel efficient but reducing our consumption can move us down the volume discount tables and increase our unit costs – so we can be hit with the double whammy of using less (perhaps heating one degree lower?) but suffering increased costs as a result.
    
At the Flourishing FM Conference in September 2008, Wayne Churches of Gwent Healthcare NHS Trust spoke of the new methodology developed with Honeywell for their utilities provisioning. From the level of questioning afterwards and the number of people seen around Wayne over coffee this was clearly a topic of real interest. The issue of wind turbines on hospital premises to generate our own electricity has often been raised but the majority of healthcare premises are not in suitable positions for this technology and feedback from commercial premises (like the large distribution depots) that have tried this does not seem to give the payback periods that healthcare finance directors would like to see. While CHP schemes have been implemented in the past these too seem to have fallen from favour with the increased costs of particulate and other by-product (pollutant) control.
    
While NHS PASA continues to develop and maintain appropriate supply contracts the volatility of the energy markets will always be a financial uncertainty that we have to deal with. More importantly perhaps is the risk to supply; as we loose our current nuclear generation capacity and environmental pressure is applied to coal generation we more regularly face the possibility of loosing electricity supplies to hospital premises and so the provisioning of standby capacity and the split of essential and non essential supplies throughout the facility becomes all the more important. The Department of Health has already produced a DVD looking at the “near misses” suffered with the flooding of summer 2007 which just goes to reinforce the importance of us realising that healthcare facilities do not stand alone and can easily be affected by external events.

Water control
With ‘Clean by Design’ being driven into new technologies for flooring and décor as well as actual building and services design it is interesting to note some of the new developments in water control that can help with both consumption levels and also health and safety issues like scalding and legionellosis.
    
Rada, the commercial division of Kohler Mira, has developed the Rada Sense digital mixing valve, which is a clever hand washing/showering product that incorporates no touch activation and temperature control, minimising the risks associated with cross contamination and HAIs. Activated by a wave of the hand, the control panel illuminates to provide the user with a pre-programmed range of safe temperatures from which to select, including cold if needed.
    
The really innovative aspect is that the digital control unit can record water activations and use and so can be invaluable in monitoring and controlling water usage in conditions that may possibly lead to legionellosis contamination. The ability to automatically induce a regular dead leg flush at a safe temperature is an interesting application of this technology and I would like to see how this develops further. Perhaps a digital link with the belt worn alcohol gel sachets with a sensor to record when staff are using it would make it possible to see how often staff are using the gel and washing their hands – or is that perhaps a little too much 1984 even for the cleanliness conscious NHS of the 21st century?
    
So the question to healthcare facilities managers and designers has to be ‘Is your facility sustainable?’ Can it be built in a sustainable way, does its layout and function facilitate the ongoing provision of the healthcare it is called on to support, can it be maintained and improved in a sustainable way and does it have the necessary green credentials not just to be environmentally friendly but to ensure that with a changing climate and energy provision environment it can actually sustain the healthcare provision it is there to enable?
    
Food for thought? Oh yes – I had not forgotten about the sourcing of our food supplies but the Health Caterers Association has already produced some excellent information and articles on this.

Photography © Healthcare Facilities
Consortium 2008