Titled ‘Confronting the Estates Challenges of the Future’, the IHEEM Wales Regional Conference took place from 11-12 May 2023 at Cardiff City Stadium, alongside an exhibition. The evening of the first day also saw a gala awards dinner held at the historic Coal Exchange Hotel in Cardiff Bay
Prior to the presentation of five awards, (see HEJ – June 2023), guests enjoying pre-dinner drinks were entertained by the Cardiff Arms Park Male Choir, and an interesting presentation on the history of Cardiff Bay and the city’s docks, and the hotel itself, from Graham Stanton, who chairs the IHEEM AE(D) Registration Board, and is a member of the Decontamination Technology Platform and the Technical Platform Committee. After dinner, opera singer, broadcaster, and star of the Go.Compare insurance comparison website, Wynne Evans, entertained guests with some memorable moments from his varied career, before closing with a passionate rendition of ‘The Impossible Dream’.
Topical conference themes
Welcoming delegates at the start of the conference’s first morning, IHEEM CEO, Pete Sellars, said that over the following two days they would hear from leading healthcare figures on subjects including the Net Zero agenda; infrastructure; compliance, governance and assurance; healthcare planning; workforce requirements, planning, and training, and the pressing need for more healthcare engineers. He then introduced the first keynote speaker, Judith Paget, who recalled that the last time she spoke at an IHEEM Welsh conference, she had discussed the then recently completed 100% single-roomed Ysbyty Aneurin Bevan in Ebbw Vale, and staff there’s early experiences at the new hospital. Having been Aneurin Bevan University Health Board CEO immediately before taking up her current role, she said she was especially looking forward to hearing what her successor as CEO at the Health Board, Nicola Prygodzicz, had to say, in the conference presentation following hers.
Standpoint ‘on some of the challenges’
Judith Paget began: “I thought I would set out how I see some of the challenges we face together, as clinical staff, engineers, and estates professionals – because we absolutely all need to work together to ensure we have a modern, more resilient state. The first thing to say is that we must acknowledge we have an ageing estate; 61% of it built pre-1995, and NHS Wales is now reporting a very significant backlog maintenance figure, for the first time exceeding £1 bn.”
Against this backdrop, the speaker stressed the need to ensure that the service was collecting and delivering accurate estates and facilities performance management information. She said: “It’s vital to us all to be able to assess the state of our estate, its use, and functionality, and I know Shared Services Partnership is doing some fantastic work across Wales focusing on estate and engineering risks.
Identifying the major risks to service continuity
“Of course,” Judith Paget continued, “a key focus is identifying the major risks to service continuity, patient and staff safety, and our statutory compliance.” Capital funding needed to continue to be targeted at those areas seen as posing the greatest such risks, but ultimately, she emphasised, it was each Health Board / Trust’s duty to ensure it had a safe estate from which to deliver its services. She said: “Due to the age of the estate, it’s important that we continue to assess which of our buildings are key to service delivery, and which might be surplus to requirements. We need a really clear strategic plan.”
Acute sites ‘incredibly crowded’
The NHS Wales CEO told delegates identifying ‘that surplus estate’ was key, ‘because some of our acute sites are incredibly crowded’. She said: “We need to free up space for them, but also to make surplus land available to wider public sector organisations, or make space for renewables and biodiversity schemes.” Judith Paget believed the Welsh Government’s declaration of a climate emergency would continue to influence how the country’s NHS used and developed its estate. She said: “Our NHS Wales Decarbonisation Strategic Delivery Plan (2021-2030) sets out clear intent about what can and should be achieved, and how the NHS will contribute to Welsh Ministers’ ambition of the public sector being Net Zero by 2030 – a hugely ambitious target.” Meanwhile, the NHS Net Zero Building Standard would come into force for healthcare buildings in England and Wales from October, and the NHS in Wales was ‘still working through the implications’
Transition to low-carbon heating
Returning to the estate’s age and condition, Judith Paget said: “The target to transition to low-carbon heating in existing buildings will be challenging; fabric and condition need to be of a sufficient standard to allow heat pumps and other low-carbon heating solutions to operate efficiently.” In older buildings, the technicalities would be ‘far more complex’. She said: “I would encourage all to take a broad look at the decarbonisation opportunities for NHS Wales; our target is really challenging, but Welsh Ministers are committed to all public services meeting it. There are, of course, things we can do about renewable energy – working with others on district heating networks, for example, and considering the potential for using hydrogen in the future.”
Need for ambitious thinking
The healthcare EFM sector needed to be ‘amibitious in its thinking’, Judith Paget believed. She said: “I would like to see more schemes like the solar farm linked to Swansea’s Morriston Hospital – which is already realising significant decarbonisation benefits, and reducing electricity spend.”
Moving to how Wales’s future healthcare estate ‘should look’, she emphasised that the Welsh Government’s strategy was ‘all about treating more patients at home or closer to home’, and – ‘where appropriate’ – fewer in acute hospital settings. She said: “We need to develop new primary care and community facilities, and think how we can best support people in their own home.” Regional Partnership Boards had a key role in bringing together partners to facilitate cross-sector planning across health and social care, and making sure service planning and those models of care were clearly designed. She said: “We can then design our buildings appropriately.”
Integrated care pathways
The Health and Social Care Integration and Rebalancing Capital Fund, Judith Paget explained, specifically supports ‘a seamless delivery through a single point of access for delivering integrated care pathways’, and some of the examples emerging from Regional Partnership Boards with such facilities were ‘really great’. She said: “Linked to care closer to home, one of the positives to emerge from the pandemic is the opportunity to do more remotely – using technology not only to link GPs to hospital consultants, but also hospital consultants and GPs to patients in their own homes. Each NHS organisation will need to have a clear digital strategy. Ensuring we think about this when designing our service models and buildings is key.
Collaboration’s importance
“Before I get on to the funding challenges,” she continued, “I’d like to emphasise the importance of organisations working together. We have a clear ambition in Wales to make sure our NHS organisations collaborate across boundaries on regional solutions. They need to be explored, and delivered at pace. We can’t afford to replicate the same services at every site, and must use all our existing estate and capacity to best effect, which requires collaboration.”
The speaker acknowledged ‘much had been said’ about the waiting list backlog post-pandemic, and many Health Boards were now proposing standalone planned care facilities. She said: “These need to be planned and coordinated for the greatest benefits for the people of Wales. We all want to see waiting times and lists fall, but must ensure that any planned new facilities properly consider workforce availability.”
Maximum ‘bang for buck’
Judith Paget said that while developing such facilities was a clear priority for the NHS in Wales, resources must be targeted to areas that would afford the maximum impact for patients, represent really good value for money, and have ‘a high confidence of delivery’. NHS capital and revenue funding pressures were the same in Wales as across the rest of the service, resulting in ‘difficult decisions’. She said: “Capital schemes need to demonstrate revenue savings. Everyone here will have experienced very real cost of living pressures, and the NHS faces these too. Prioritisation will thus be key, and NHS healthcare organisations have recently sent in their plans to the Welsh Government, either for the next year, or the next three, and were also all required to submit a five-year capital plan.”
Need for a more ‘coherent and strategic’ approach
While Welsh Government needed to play its part in the prioritisation process, NHS organisations needed, she argued, ‘to move away from a wish-list of capital schemes, to ones we can ensure develop a more coherent and strategic approach to what we invest in, need, and develop, for the future.”
Challenging financial climate
Despite the ‘challenging financial climate’, Judith Paget said capital funding had been provided through the Estate Funding Advisory Board, and deliberately targeted at areas including fire, infrastructure, and decarbonisation. She said: “I’m told this approach has received considerable positive feedback, because funds have been used to focus on clear assessed priority areas.” NHS Wales organisations had also continued to benefit from decarbonisation scheme support through Re:fit Cymru.
The NHS Wales CEO acknowledged that the amount of capital targeted was ‘not as much as all of us would want or like’. “However,” she stressed, “we are trying to ensure the capital we have is invested wisely, and makes a difference. In conclusion,” she said, “I’d agree that while there are challenging times ahead, there are also opportunities for us all – including NHS healthcare estates and engineering colleagues. I hope you agree that NHS Wales and its wide range of partners need to continue working together to go as far as we can to make the changes we need to to the NHS estate – because it’s absolutely our job to ensure we do things that benefit the citizens of Wales.”