Repeatable Mental Health Bedrooms The Radisson Blu Portman ... · Repeatable Mental Health...
Transcript of Repeatable Mental Health Bedrooms The Radisson Blu Portman ... · Repeatable Mental Health...
www.procure21plus.nhs.uk
Repeatable Mental Health BedroomsThe Radisson Blu Portman Hotel25th March 2015
www.procure21plus.nhs.uk
Delivering Cost Reduction through StandardisationRoll-Out of Repeatable Rooms and Standard Components
25th March 2015
Agenda
• Introduction and Welcome• DH Opening Address• NHS Trust Address• Cost Reduction Journey• Repeatable Room: Functional MH Bedroom• 11:10 Break, Exhibition and Video
Agenda
• Repeatable Room: Organic MH Bedroom• Standard Components• Target Cost Savings• 12:30 Lunch, Exhibition and Video• Implementation• Panel Q & A• Work Group Session• 14:30 Break, Exhibition and Video
Delivering value with P21+
DH – Leading the nation’s health and care
Ray StephensonProCure21+ National Framework Programme LeadFinance and NHS Directorate25.03.15
99 DH – Leading the nation’s health and care
Government Construction StrategyDH and the Principal Supply Chain Partners
• Introduced May 2011
• To deliver up to 20% cost efficiency savings for NHS CapitalProjects
• Challenged the PSCPs
• PSCPs responded with repeatable rooms, standard materials andcomponents and discount/bulk buying
• Benchmarking Targets
1010 DH – Leading the nation’s health and care
• All delivered within 2 years
• Consulting with the NHS
• 95% Buy-in
• Repeatable Rooms acute sector - Delivered
• Standardisation/Priced Components - Delivered
1111 DH – Leading the nation’s health and care
Your Challenge
• Opportunity to change the way capital projects are delivered
• Get involved, engage early
• Invite your PSCP to talk to you about this initiative for your scheme
• Support information sharing
1212 DH – Leading the nation’s health and care
The Future
• This is the start of a wider push for efficiency in NHS Estates andFacilities Management
• We will be collaborating with the Industry to identify and deliverfurther savings both Cap Ex and Op Ex
• This framework is providing a model of engagement for the future,including sharing designs more widely in the healthcare sector
• Supported by Central Government as part of wider efficiency agenda
1313 DH – Leading the nation’s health and care
Beyond 2016
• Health Minister has agreed to a new Framework when P21+ ends –P22
• Development work already started
• Engagement with the NHS about your requirements – consultationevents June/July
• Embedding standardisation and developing the Repeatable Roomsand Standard Components within P22 framework
1414 DH – Leading the nation’s health and care
Today
A lot of work has gone into this day
• Engage with us
• Tell us what you think
• Talk to your PSCP
• Go and see for yourself
www.procure21plus.nhs.uk/club
ProCure 21+ Cost Reduction Programme
USING REPEATABLE ROOMS AND STANDARDISEDCOMPONENTS FOR MENTAL HEALTH
Duane PassmanDirector of 3Ts
Brighton & Sussex University Hospitals NHS TrustVisiting Professor, MARU, London South Bank
University
25 March 2015
Reflecting on the past:
Harness/Nucleus/”Best Buy” – StandardisationSeen as a straightjacket and not an opportunity;
A LOT of energy expended in how to avoid standardisation/repeatability;
Egan et al looked at the benefits of increased repeatability;
P21–few organisations used the process to undertake multiple projects;
Opportunities to reduce capital cost – and revenue?
Acute single rooms evidence not decisive on medication errors;
>21,000+ mental health beds – wider opportunities;
Limited capital – more for less;
The pressure on mental health services can only intensify.
The Challenge
• GovernmentConstructionStrategy
• Efficiency Agenda
Our Response• Cost reduction
programme
• Repeatablesolutions
• Standard materials& Components
• National Events
Cost Manager
LEADERSHIP
Programme Manager
OurCommittedResponse
All 6 PSCPsWorking
together withDH, Supply Chain
and Industry
Core Teams
Today’s car is 50% cheaperand… Better quality, more reliable and safer
Standardisation - The Principles...
How this has been achieved…
Standardisation with continuous improvementReuse of designs and components with mechanisation
Standardisation - The Principles...
Choice to suit our requirements and budgetChoice to suit our requirements and budgetKit Car
£25,000+Seat Leon£18,490
Skoda Fabia£13,670
VW Golf£20,500
Standardisation - The Principles...
We are putting this Principle intoPractice for NHS facilities
Unique but expensive –reliability?
These all use the same main componentsOnly what we interface with differs – we choose
RepeatableRoomDesign
RoomSpecification
OperatingPolicy
Literature/ResearchReview
EvidenceMatrix
PatientFocusGroup
PreviousSchemeDesigns
PeerReview
In-UseReview
PostProject
Evaluation
SupplierDevelopment
Development Process
Specification
Operational Policy
Literature Review
Evidence Matrix
Patient Group
Design Assessments
Peer Review
Applies to all Rooms& Designs
Design
Published WorkP21+ Club website
Guidance
Development WorkReports
Literature reviewsAssessment Schedules
Updated & NewFrameworkDocuments
CharterWorks Information
Procurement StrategyGuidance Note 19 & 20
NHS England & TDABusiness Case
checklists
Published Work
P21+ Club websiteStandard Share
Standard Materials &Components:
Soft & Hard FlooringSuspended Ceilings
Doors & IronmongeryLighting
Sanitary WareFire & Smoke Dampers
Bedhead ServicesRadiant PanelsCeiling Hoists
Paint
What have weachieved
14 Standard RoomsDeveloped &
Validated:
Acute• 3 Single Bedrooms• 3 4Bed MBB
Primary/Acute• 5 Consult/Exam Rooms
Mental Health• Functional Bedroom• 2 Organic Bedrooms
INNOVATION
INTEGRATION ANDCOLLABORATIVEWORKING
What we aredoing now and
in the future
EmergencyDepartment Rooms:
• Fixed acuity• Acuity-adaptable• Chair-centric
Review Feasibility &Benefits for :
• 8 Bed Cluster
Standard Components
Repeatable Rooms in Use
• Projects at Stage 3:– Doncaster– Chase Farm– Addenbrookes– Basildon– Oxleas
Repeatable Rooms in Use
• Projects at Stage 4:– Wrightington, Wigan and Leigh
• IHP and IBI Nightingale
– Lymes Wards 112 & 113, Royal Stoke UniversityHospital
• Kier and Gilling Dod
Repeatable Rooms in Use
• Completed Projects– Lilac Ward, Scarborough Hospital
• Kier and RLA
– Lymes Wards 110 & 111, Royal Stoke UniversityHospital
• Kier and Gilling Dod
34
How you willbenefit
COMMERCIALTECHNICAL
Off the shelfsolutions-ready for
use
Off the shelfsolutions-ready for
use
Compliant designs andproducts
Compliant designs andproducts
Endorsed byDepartment of Health
Endorsed byDepartment of Health
Quicker design periodQuicker design period
Significant savingson HBN Bespoke
Designs
Significant savingson HBN Bespoke
Designs
Benchmarked CostsBenchmarked Costs
Supporting theGovernment
Construction Strategy
Supporting theGovernment
Construction Strategy
Helps you deliver realsavings
Helps you deliver realsavings
Use on New build andrefurbished projects
Use on New build andrefurbished projects
Value for MoneyValue for Money
Helping youachieve your
savingstargets
&improve your
businessCan youafford
not to?
What are the repeatablemental health bedrooms?What they are:
For two care groups:
•adults with functional mental illness
•adults with organic mental illness
What they are not:
• children or adolescents
• disabled patients
• patients with intensephysical nursing needs
• patients with specificbariatric requirements
Literature Review
• Evidence baseddesign
• MARU (MedicalArchitectureResearch Unit)
• Over 50 studies
• Evidence Tables
Evidence Based Matrix
Pers
onal
isat
ion
Uni
tSiz
e
Day
Ligh
ting
Pers
onal
Sto
rage
Artif
ical
Ligh
ting
Artw
ork
Reduce Violence & AggressionReduce Stress & AgitationIncrease Patient SafetyIncrease Patient SatisfactionIncrease Patient ControlIncrease Social Support
Increase Staff Observation
Increase Staff Satisfaction
Ther
apeu
ticE
nviro
nmen
t
Ope
nnes
s&
Sigh
tLin
es
Pers
onal
Spa
ce&
Priv
acy
Anti-
ligat
ure
Mea
sure
s
Patie
ntEx
perie
nce
Staf
fEx
perie
nce
Fixtures & Fittings
Loca
tion
ofth
ebe
droo
m
Res
iden
tialC
hara
cter
Win
dow
Spec
ificat
ion
Doo
r&H
andl
eS
peci
ficat
ion
Tem
pera
ture
Vent
ilatio
n
Acou
stic
s
EnvironmentalComfort
Out
look
Design Principles
Patient Workshop: Mental Fight Club
• February 2014
• Personalisation and identity
• Bright with a connection to outdoors
• Open and spacious
• Storage
compliant design features:-•15.0 sqm combined bedroom and en-suite•Sight-line from door•daylight and views out•en-suite HBN00-02 and 03 compliant•Rooms paired to share services•Anti-ligature•1800mm corridor widthrecommendations:-•Bed relative to window•Personalisation•Acoustic consideration•Furniture detail•Ceiling height min 2700mm (‘break the box’)•Recognise function of corridor + threshold•Carpet in part of the room
MH functional single bedroom en-suite – key drivers
En-suitesh/wc
En-suitesh/wc
Sleep/rest
Sleep/rest
Work/play
storagestorage
support recovery
entryentry
Bedroom design incl staff / therapeutic features En-suite design featuresN
etro
omar
ea(s
qm)
Cle
arw
idth
Cle
arde
pth
Bed
posit
ion
Sight
-line
from
door
Wor
ksp
ace
Stor
age
prov
ision
Perso
nalis
atio
n/
artw
ork
Tech
nolo
gy
Cei
ling
heig
ht
Win
dow
size
+op
erat
ion
Doo
rtyp
e
Doo
rsiz
e+
oper
atio
n
Net
room
area
(sqm
)
Duc
tare
a(s
qm)
Loca
tion
rela
tive
tobe
droo
m
Con
stru
ctio
nin
-situ
/pod
Doo
rtyp
e
door
size,
oper
atio
n+
lock
-ba
ck
MH Functional bedroom assessments
• En-suite comfortable, not over or under sized• Sight-line, move into room, impact of f,f+e• Bed position impact on the ‘sense of space’
MH functional bedroom in-board en-suite – room testing
features:-100% sight-line, more bed positions, efficient footprint, tested observation recess depth
MH functional bedroom en-suite – model test
Technical Workshop
• Detailed design:– Support for work on
storage– En-suite arrangement:
• Solid stub wall• Pocket door
• Broader principles:
– Standard brief
• What is an acceptablelevel of risk?
• Definition of anti-ligatureand testing
• Expectations – infectioncontrol
– Flexibility: baseline forforensic bedroom?
MH functional bedroom en-suite – 2 arrangementsIn-board with sight-line splay Parallel/nested
enhanced design features:-Weight sensitive door, sliding or pocket doors to en-suite, higher ceiling, window seat,fitted furniture, artwork, opportunity for personalisation
features:-100% sight-line, 2 bed positions, efficient footprint, reduced corridor length
MH functional bedroom en-suite – in-board
En-suitesh/wc
En-suitesh/wc
Sleep/rest
Sleep/rest
Work/play
storagestorage
support recovery
entryentry
bedroom, 11.8sqmen-suite, 3.1 sqmduct, 0.4sqm
• Padded waistcoat• Waterproof top• shoes• trainers• boots• 4 pairs of trousers• 2 tracksuit bottoms• shorts• 7 t-shirts• 3 rugby tops• 3 jumpers• 7 boxers• 7 socks• Baseball cap• (2 bath towels)• (2 hooded tops)
MH bedroom storage test - triangular
MH bedroom storage test – rectangular high level
• Padded waistcoat• 2 Waterproof tops• shoes• trainers• boots• 8 pairs of trousers• 2 tracksuit bottoms• shorts• 10 t-shirts• 6 rugby tops• 6 jumpers• 7 boxers• 7 socks• Baseball cap• 2 bath towels• 4 hooded tops
MH bedroom storage test – rectangular low level
• Padded waistcoat• Waterproof top• shoes• trainers• boots• 4 pairs of trousers• 2 tracksuit bottoms• shorts• 7 t-shirts• 3 rugby tops• 3 jumpers• 7 boxers• 7 socks• Baseball cap• 2 bath towels• 2 hooded tops
Patient Workshop: Mental Fight Club
• September 2014
• What does this space say to me?
• What does this space expect of me?
– Bed position
– Furniture
– Storage
– Colour
features:-Modular options, single fixed room design, 4 bed positions
MH functional bedroom – modularised fitted furniture
HBN compliance- HBN 35Size: Bedrooms with en-suites- but no showers 17m2
5.46 Single rooms, with en-suite WC and washing facilities arerequired. The wash basin will need to be at a height suitable for aperson sitting on a chair. The en-suite facilities will need to havewheelchair access.
5.47 The bedroom may be furnished with a variable height bed andgeneral type bed head services but piped oxygen and suction arenot required. An emergency call system is required. The room willalso require a bedside locker, a chair of appropriate height andstorage for clothes.
What are the needs?
• Nursing care – continuation of care that has been provided at
home
• Interventions to encourage activities of daily living
• Safety – falls prevention and harm relating to falls
• Rest and relaxation
• Security and observation
Literature Review and Workshops
• Literature Review
• Mental Health Survey
• The Kings Fund
• South Essex CarersGroup
• Innovate Dementia
compliant design features:-•17.0 sqm -19.0sqm combined bedroom and en-suite•Sight-line from door•daylight and views out•en-suite HBN00-02 and 03 compliant•Rooms paired to share services•Anti-ligaturerecommendations:-•Familiarity ‘v’ ligature•Accommodate more interventions•Memory box•Sight-line to wc•Fitted furniture detail•Ceiling height min 2700mm•Recognise function of corridor + threshold•Seamless floor finish
MH organic single bedroom en-suite – key drivers
En-suitesh/wc
En-suitesh/wc
Sleep/rest
Sleep/rest
Work/play
storagestorage
support recovery
entryentry
Bedroom design incl therapeutic/nursing features En-suite design featuresN
etro
omar
ea(s
qm)
Cle
arw
idth
Cle
arde
pth
Bed
posit
ion
Sight
-line
from
door
Wor
ksp
ace
Stor
age
prov
ision
Perso
nalis
atio
n/
mem
ory
box
artw
ork
Cei
ling
heig
ht
Win
dow
size
+op
erat
ion
Doo
rtyp
e
Doo
rsiz
e+
oper
atio
n
Net
room
area
(sqm
)
Duc
tare
a(s
qm)
Loca
tion
rela
tive
tobe
droo
m
Sight
-line
bed
tow
c
Con
stru
ctio
nin
-situ
/pod
,gr
abra
ils
Doo
rtyp
e
door
size,
oper
atio
n+
lock
-ba
ck
MH Older Adult/Organic bedroom assessments
• En-suite comfortable, not over or under sized• Bed type and size• Option peninsula or against the wall
MH organic bedroom in-board en-suite – room testing
Technical Workshop• Detailed design:
– Size of the en-suite inrelation to assistance
– Single leaf entrance door
• Broader principles:– Standard brief
• What is an acceptable levelof risk?
• What level of assistance arewe designing for?
– Flexibility: baseline forforensic bedroom?
Organic in-board en-suite
Increased lengthby 275mm
Increased depthby 200mm
whb
showerchair
1010mm s.o.doorset
assistance on and off wc, with two staff1. 2. 3.
adjustments made to organic en-suite post technical workshop
layout pre and post workshop
features:-100% sight-line, efficient footprint, four bed positions, sight-line to wc
MH organic bedroom in-board en-suite
En-suitesh/wc
En-suitesh/wc
Sleep/rest
Sleep/rest
Work/play
storagestorage
support recovery
entryentry
bedroom, 14.3sqmen-suite, 3.8 sqmduct, 0.4sqm
bay, 0.6 sqm
Organic nested en-suite
whbshower
chair
1010mm s.o.doorset
assistance on and off wc, with two staff1. 2.
New layout nested en-suite post technical workshop
features:-Shallower plan depth, two bed positions, seating area within corridor
MH organic bedroom nested en-suite
En-suitesh/wc
En-suitesh/wc
Sleep/rest
Sleep/rest
Work/play
storagestorage
support recovery
entryentry
bedroom, 13.8sqmen-suite, 3.8 sqmduct, 1.3 sqm
bay, 0.6 sqm
features:-100% sight-line, efficient footprint, four bed positions, sight-line to wc
MH organic bedroom – modularised furniture
features:-100% sight-line, shallower plan depth, longer corridor, two bed positions, sight-line to wc
MH organic bedroom – modularised furniture
“StandardShare”
• P21+ Club website– Hard Flooring– Suspended Ceilings– Doors– Lighting– Sanitary Ware– Fire Dampers– Partitions– AHUs– Pipework– Chillers– Bedhead Services– Radiant Panels– Ceiling Hoists– Paint
Benefits – Potential Savings• Total potential saving:
£30.24m, or c5.04%(against typical market rates, and based on £600m total spend pa)
• Flooring: £4.20m• Doors: £3.84m• Lighting: £2.52m• Ceilings: £2.46m• Bedhead Services: £1.98m• Ceiling Hoists: £1.20m• Sanitary Ware: £0.54m• Radiant Panels: £0.48m• Paint: £0.18m
• Partitions: £4.5m• Pipework: £3.54m• Chillers: £2.64m• AHUs: £2.16m
This image cannot currently be displayed.
9 Month Savings
• Total: £1,114k
• Lighting: £511K (20%)
• Sanitary Ware: £319k (59%)
• Ceilings: £180k (7%)
• Flooring: £92k (2%)
• Doors: £9k• Fire Dampers: £2k
AiredaleBuckland and Dover
CroydonDarlington Memorial
HillingdonLeighton
New CrossNottingham University
RotherhamRoyal Stoke University
ScarboroughSouthampton General
St BernardsStepping Hill
The Walton CentreWorcester Royal
Queen Elizabeth, Gateshead
MH Components Journey
• PSCP Component Survey• Trust wide specifications• Feedback Analysis
– Multiple Suppliers– Varying specifications
• Specification or Supplier led proposals
Mental Health Components
• Extension of Primary/Community/AcuteComponents
• Available now:– Fire/Smoke Dampers; Hard and Soft Flooring;
Sanitary Ware; Radiant Panels; LightingDoors and Ironmongery; Windows; and Paint
• Being concluded:– Furniture
Hard Flooring
• Tarkett Flooring• Vinyl and Linoleum products• Capex and Opex focused options• Fixed price to end 2015• Up to 37% savings
Soft Flooring
• Tarkett Flooring• Tandus Carpet• 25 year warranty• Fixed price to end 2015• Up to 22% savings
Doors – Mental Health
• Specification led component• 6 standard door sets• 6 Suppliers
– Arnold Laver; David Smith; Datim; Leaderflush;Lloyd Worrall; and Safe Hinge
• Fixed prices to end 2015• Up to 32% savings
Lighting – Mental Health
• Whitecroft Lighting• Product Selector• CF or LED options• Tuneable LEDs• 5 year warranty• Fixed price to end 2016• Up to 27% savings
Sanitary Ware –Mental Health• Armitage Shanks and Pipe Centre• Product Selector; Room Packs• Contour and Sentry 21• L/M/H secure unit options• Fixed price to end 2016• Up to 20% savings
Radiant Panels
• Pipe Centre and Sabiana• Pulsar Ceiling Panels• Fixed price to end 2016• Up to 28% savings
Paint
• Akzo Nobel Paints and PPG Industries• National technical specification teams• Free next day delivery• Free can recycling• Fixed price to end 2016• Up to 30% savings
Windows
• Britplas• Safevent system for natural ventilation• Option for Window Seat/Bay Window• 2 year warranty and 12 month
inspection/service• Fixed price to October 2016• Up to 19% savings
Skirting Heating
• Discrete Heat• Alternative to Radiant Panels• Perimeter skirting heating option• 10 year warranty• Fixed price to October 2016• Up to 20% savings
Fire/Smoke Dampers
• Advanced Air• Fire/Smoke Damper with Adjustable Frame• Fixed price to end 2016• Up to 40% savings
Pipework
• A Technical Guide• Prepared with PSCMs and Suppliers• Benefits of alternative jointing systems;
purchase cost and installation cost• Robust installation and test procedures• Up to 20% savings
Chillers
• A Technical Guide• HTM: recommendations only• Prepared with PSCMs and Suppliers• Review specification for project requirements• Up to 40% capital cost;
27% CO2 emissions; and36% annual energy costsavings
Air Handling Units
• A Technical Guide• HTM: recommendations only• Prepared with PSCMs and Suppliers• Review specification for project requirements• Up to 30% capital cost;
27% CO2 emissions;36% energy costs; and40% size savings
The ChallengeGovernment Construction Strategy – Efficiency Agenda
Sharing goodpractice/
standardisation
Innovation,changing
culture, BIM,Govt softlandings
Incentivisingsupply chain
collaboration toprovide value/
bulk buying
Controlling scope& understanding
what costsmoney
Challengingtime-scales
Managingexpectations
Reviewingperformance
Publishingcost
analyses
20% savingsrequired
14.1% savingsproposed
Target Cost SavingsRoom sizes?• Inboard en-suite – both
organic and functionalsimilar to HBN
• Nested en-suite minimalsaving against HBN
Efficiencies?• Right solution first time• Quality time• Component savings
Focus onpatient care
RepeatableRoomDesign
RoomSpecification
OperatingPolicy
Literature/ResearchReview
EvidenceMatrix
PatientFocusGroup
PreviousSchemeDesigns
PeerReview
In-UseReview
PostProject
Evaluation
SupplierDevelopment
Development Process
Specification
Operational Policy
Literature Review
Evidence Matrix
Patient Group
Design Assessments
Peer Review
Applies to all Rooms& Designs
Right solution first time
All rooms
All designs
Consistent
Thorough
Evidencebased
Quality Time!
Design / Consultation• Detailed analysis – once• Consistent details• Improved Patient Experience
Construction• Early Involvement of the right supply
chain• Quality install
• More off site• Better co-ordination• Familiarity
• Certainty and knowledge• Speed to market
£1,425 cost saving for PSCP / PSCM teamper room
If take into account Trust (clinical andmanagement) time this saving will more
than double.
Components – benefits andsavings
112
Up to 37%savings
ManufacturersFixed price duration,extended warranties, UKmanufactured
Wholesalers Up to40%savings
National, efficient call-off,any size scheme, Fixedprice 2016
Guidance Up to30%savings
Specification clarity,understanding cost,technical design review
Specification Up to32%savings
Rationalise door sets (15)
Lessons learnt
Investment
Aggregatespendprofile
Collaborationwith keysuppliers
Focussedresources
Speed tomarket
Understandthe market
Design led– ensurecompliant
specification
Benchmarkand review
Best pricenot bestdiscount
Trustedrelationships
Communicateand market
Innovatetogether
Client BenefitsPSCP
Investment
Baselinefor localbranding
andadaption
HBMcompliantdesigns
Evidencebased
Quickerdelivery,right first
time
New NHSspecific
products
Free researchand
development
Efficientcapitalspend
Reduceddevelopment
time
Removal ofwaste
Realistic androbust
Integratedworkinginnovatetogether
The end result
115
Standardisedcomponents &
design
Increasedcertainty oftime, cost,
quality
Whole life costchoices
Target Costsaving > 5%
Ben
efit
Standardisation
Up to 5% targetcost saving:Area/DesignBetter buying
Road to Savings
GCS 14.1%target
20%+Potential with:StakeholderengagementStafffamiliaritySupplierresponseLifecycle
Think BIM• Block model existing
• “Cut & Paste” additionalrequirements (fromStandardShare)
• Accommodation &Adjacencies to meetClinical Strategy
www.procure21plus.nhs.uk
Work Group Sessions – Implementation Barriers
David KershawPSCP Programme Director
Delivering value with P21+
DH – Leading the nation’s health and care
Ray StephensonProCure21+ National Framework Programme LeadGovernance and Assurance Directorate25.03.15
Further Rooms & Components
• ED Rooms• 8 Bed Ward cluster
• Components• to suit rooms
• Low/Medium Secure
Anyone interestedin participatingplease contactDavid Kershaw
Continuous Improvement
• Government Soft Landings• Post Occupancy Evaluation
= Enhanced standards on StandardShare
Ready to Go!
• April 2013: 95% support standardised design• Second designs now delivered by PSCPs• Available in StandardShare for all to use