What opportunities do new hospitals present?

The construction of new hospitals offers a chance to reconsider the configuration of health and care services – aligning services with population health needs and ensuring sustainable clinical services. Planning new facilities or redeveloping existing ones reduces the costs of transitioning to a new configuration and can ensure services are accommodated in fit-for-future estates. 

Nevertheless, reconfiguration decisions remain difficult, requiring careful analysis, ambitious clinical leadership, system-wide collaboration, and public consultation. Within capital programmes, these decisions must be taken swiftly or risk the momentum of the entire programme. 

How can commissioners and providers navigate reconfiguration?  

The PSC has extensive experience helping NHS Trusts navigate reconfiguration decisions under estates programmes.  Here are 3 key insights from The PSC’s experience and their implications for the construction of new hospitals: 

1. Evidence-based decision-making 

Business cases for capital programmes require a robust foundation of evidence from engagement and data. This work can also be used to review the provision of services at a hospital and consider how reconfiguration can address identified challenges. 

For example, reconfiguration efforts can leverage the long-term thinking (typically 10-20 years in the future) required for business case-development (e.g. demand and capacity models) to ensure new care models think about long-term needs rather than immediate challenges. In practice this means that population health need informs future service demand, from which potential future models of care can be developed and assessed for impact on quality, system provision and clinical inter-dependencies.  

The PSC have successfully used this evidence-based approach to population need and models of care to inform estates planning via the ‘blueprint’ approach to healthcare estates in Plymouth.  

2. Bringing the right people together 

Large capital programmes necessitate involvement and endorsement from diverse stakeholders, and require alignment among the public, providers, commissioners and the broader health system. This provides an opportunity to integrate clinical and operational staff alongside key system partners in service reconfiguration, as reconfiguration work can leverage existing forums within the Trust's capital programme.  

This holistic engagement provides decision-makers with a broader perspective of needs, departmental pressures and potential system-wide impacts, facilitating accelerated decision-making.  

Moreover, the approach provides the right balance of bottom-up insight and top-down ambition. Top down engagement ensures that programmes align with system-wide drivers for change, financial envelopes, operational priorities and long-term ambitions, while bottom-up working empowers clinicians to decide service configuration, based on engagement (and potential co-creation) with service users.  

3. Providing Capital Support 

Reconfiguration efforts within programmes delivering new hospitals offer unique opportunities to align clinical services with population needs while leveraging capital support. Unlike standalone reconfigurations, which often rely solely on existing estates, this parallel approach ensures that reconfiguration decisions not only consider the use of future estates but also align with the pace and progression of capital development.  

Indeed, efforts aligned to capital programmes are not limited by constraints on space or equipment like traditional reconfiguration efforts are. Furthermore, the synergy between reconfiguration and the capital programme enables the identification of other benefits, such as service improvements for struggling services, that do not require capital. 

What are the impacts and benefits? 

The PSC recently applied these principles in assisting a multi-site NHS Trust with reconfiguration decisions within an estates programme. Over 18 months, The PSC mobilised clinical service reviews that targeted struggling services, notably maternity and paediatrics, facing capacity challenges and quality issues. This raised the Integrated Care Board’s awareness of service challenges, leading to immediate quality improvement measures, and promoting productive work across the system’s priorities. Linking into the capital programme, our clinical service reviews were able to progress decision-making at pace and harness the mobilisation around the redevelopment programme to enable reconfiguration. 

You can see our original poster presented at the EHDC here. 

The PSC exists to make public services brilliant. We’re known for tackling the most complex challenges in the public sector, including an extensive track record in capital investment programmes. Speak to our team to find out more.  

Authors: The PSC Built Environment Advisory Team (Nicole Samuel, Ellie Lane and Joe Cruden).