New hospitals must enable transformation of services 

The mismatch between population needs and healthcare services is among the biggest challenges facing societies in the next 40 years. Without change, new hospitals won’t accommodate demand. As populations age and illness rates increase, The Health Foundation estimates 23,000-39,000 beds are required by 2030 to deliver pre-pandemic rates of care.¹ 

Capital investment in estates is a critical enabler for transformation: new models of care and ways of working that allow health and care services to better meet the needs of local populations and reduce the size required of new hospitals. The challenge is to embed meaningful transformation within capital programmes to deliver new hospitals. A self-learning health system must translate approaches known to work. 

What can be learned from national clinical transformation programmes? 

The PSC are transformation experts, with a collaborative, tried-and-tested approach to transforming services at local, regional, and national level.  Here are 3 key insights from The PSC’s experience and their implications for the construction of new hospitals: 

1. Balancing top-down & bottom-up change 

Good Quality Improvement (QI) programmes originate on the shopfloor, where staff are best placed to identify opportunities for improvement and to deliver these improvements. But if these projects are misaligned to organisational objectives, QI projects can end up peripheral to the fundamental change required.  

The relevance to the complex programmes delivering new hospitals is clear. A new hospital provides endless opportunities to do things differently, but transformation must be geared towards a future model of care and operating model that responds to funding constraints, national funding streams, and & population needs. 

The PSC balances these factors, achieving a “locally-owned, centrally-supported approach”. We’ve worked closely with multiple systems and Trusts to support admissions avoidance and reduce length of stay – with more information included in the case study later in the article – and are currently supporting NHS England to deliver the National Mental Health Act Quality Improvement Programme.  

2. System-wide transformation 

Effective care happens inside and outside hospital, and relies on a network of organisations: acute trusts, care homes, local councils, and voluntary and community sector organisations. In The PSC’s experience, complex challenges (e.g. delayed discharge) require system responses. Effective change requires a joint vision and governance, aligning resources and funding to a common set of priorities. 

Capital programmes must be similarly collaborative. Designing new clinical models around current acute services risks embedding current models of care and ways of working into the construction of future hospitals. Without whole-pathway transformation, no local or national economy will be able to afford the new hospitals required. Every lever for transformation must be considered, allowing improvement in population health and prevention, more care closer to home, escalation to the most appropriate acuity, productivity, and patient-led, digitally-enabled pathways. 

3. Plan, do, study, act 

The NHS England (NHSE) Change Model emphasises “plan, do, study, act” (PDSA) cycles – iterative experiments to build knowledge and allow  gradual progress towards intended outcomes.² The PSC has used PDSA cycles in a range of contexts including supporting NHSE South East to work with regional partners to implement and expedite acute and community-based same day emergency care. 

Iterative working poses a challenge for capital programmes, which too often plan for transformation to begin on opening day. National clinical change programmes suggest this iterative process must begin before capital programmes mature and run in parallel, developing understanding of the transformative change possible, and enabling the calibration of planning assumptions. 

How have The PSC supported clinical transformation programmes? 

Case study: Admissions avoidance and Length of Stay (LoS) reduction 

The PSC worked with Sussex Partnership Foundation Trust to set up and deliver the Reducing Length of Stay programme, aiming to tackle avoidable admissions and inappropriately long LoS in mental health inpatient services. 

Many of the improvement initiatives required better collaboration between urgent, acute and community services towards a service-user-centred, pathway-based approach. Following pressures and changes to ways of working from COVID, the Trust had recognised that this system-wide collaboration was one of the key enablers to drive improvements.  

Over the 6-month period of this programme 2023, the Reducing Length of Stay programme, we contributed to the Trust’s work in eliminating their inappropriate Out of Area Placements and reducing the usage of independent acute bed contracts by 12.5%. 

To find out more about our support, please read the full case study. 

Case study: Transforming accident & emergency services 

The PSC worked with NHS South East to support a regional roll-out of ‘Think NHS 111 First’, notably taking charge of Programme Management to ensure tight deadlines were met across 19 NHS Trusts. 

The PSC’s rigorous programme management approach supported the regional NHS team in two ways: 

1) Provided a centralised team to coordinate the overall programme 

2) Deployed multiple local teams to support Trusts to deliver their pathway changes. 

Due to the size and complexity of the programme, governance and assurance processes were established early to allow the region to track implementation at a Trust-level and identify critical path actions.  

As a result, the regional team was able to roll-out the ‘Think 111 First’ programme at pace, and with success across the region. At the time of writing, all Trusts that were planned to ‘go-live’ had been successful and all milestones achieved. 

To read more about the roll-out, please see our full case study. 

Click here to see our full poster presented at the conference. 

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). 

[1] https://www.health.org.uk/publications/reports/how-many-beds-will-the-nhs-need-over-the-coming-decade

[2] https://www.england.nhs.uk/wp-content/uploads/2018/04/change-model-guide-v5.pdf