The Conclude Consultancy

The Conclude Consultancy Limited has been in a dialogue with Health Facilities Scotland over the course of 2012, culiminating in an invitation for Professor Bacon to address their annual conference in November.  A copy of the presentation can be found here:

http://www.hfs.scot.nhs.uk/conference-/conference-2012/programme/parallel-sessions-c/

HFS are very interested in the new building science developed by Conclude called OCCUPANCY ANALYTICS ™. Scotland has an aggressive low carbon agenda and the Sottish government is determined to reduce the carbon impact of the health estate. A report by Davies Langdon last year concluded that the pay-back period for improving the energy and carbon performance of existing buildings was going to run into decades.  Clearly we need to make fundamental changes in the way that we design and operate our hospitals.

Here at Conclude, we believe that the solution to this challenge is by society learning to use it’s built assets quite differently, because it is only through a change in how we use our built assets, and specifically how we change the way that we use our hospitals, can we hope to achieve a the major  reduction in carbon emissions required by the Carbon Reduction Commitment.  It is the results of our work over the last two years that provides us with the confidence to substantiate this belief.  Nevertheless  it remains a significant challenge for Trusts and Hospital Boards in Scotland, England and Wales.  The scale of the problem can be appreciated by reading the Sustainability Development Unit’s 2012 Carbon Footprint report:

http://www.sdu.nhs.uk/documents/resources/Carbon_Footprint_Published_2012.pdf

Note from this report how building efficiency is forecast to get worse.  Indeed in most Strategic Health Authorities in Engand, carbon emission’s have risen over the reporting period.  This should not be a surprise, because the Royal Academy of Engineering commented in 2011 that buildings today perform little better than they did in the 1980’s.  They too lamented the demise of building science. Yet there is an alternative that some have commented is all too obvious: change the way that we operate our hospitals!  Conclude’s work in this area has clearly demonstrated the dramatic effects of changes in both how hospitals are operated as well as how they need to be designed.

Our work has been warmly received by clincians, and when asked why they feel so positive about it, the common answer has been: “for the first time we have real, tangible evidence of the impacts of our working practices”. Our work truly bridges the ‘Great Divide’ between designer and users, and provides the basis for a new dialogue between them. Our work speaks to the clinicians because it is evidence-based, and directly corelates their working practices to energy and carbon outcomes, as well as health outcomes.

Please do contact us to find out more.

The Conclude Consultancy is sponsoring a group of intrepid young people to cycle to Brugge from Brighton and back again. They are raising money for Macmillan Cancer Care a national charity, and  St Peter and St James Hospice in Wivelsfield, Sussex, in the UK.

These two charities have helped Ollie (team member) and his family since Ollie’s mum, Val, was diagnosed with a terminal brain tumour in June 2008.
Val took the news amazingly well, always determined to remain as happy and healthy as she could. Her regular visits to Brighton hospital for chemo and radiotherapy must have been distressing and painful, but she never once lost her smile or positive outlook.

Conclude’s work at Brighton & Sussex University Hospitals NHS Trust and specifically with the Oncology team there is just one of life’s little coincidences – helped by the fact that our esteemed leader’s son Laurie, is one of the team members too!  If any reader feels inspired to sponsor the team, their web page can be found at: http://uk.virginmoneygiving.com/fundraiser-web/fundraiser/showFundraiserPage.action?userUrl=Brighton2Brugge&faId=225061&isTeam=true

Laurie Bacon displaying the ‘official’ team shirt!

The Conclude Consultancy was long-listed for the Guardian Sustainability Awards 2012, which have only just been published.  Please see: http://www.guardian.co.uk/sustainable-business/best-practice-exchange/the-conclude-consultancy-science-energy.

Our work in OCCUPANCY ANALYTICS ™ has delivered compelling new data to inform hospital design.  Our work has identified that traditional approaches to hospital planning lead to significant over-estimation of occupancy.  The impacts of over-estimating occupancy lead to unnecessary capital and operating expenditure in the following areas:

• Significant over-sizing of the systems that service hospitals.
• Over provision of space.
• Over provision of Imaging equipment.

We have recently completed a validation process with clinical specialists and service managers on one project concerning OCCUPANCY ANALYTICS ™ studies for Oncology, Radiotherapy and Imaging.  The work is of significant importance because it has also clearly demonstrates its potential to inform the Department of Health, transformation programme called QIPP. Please see: http://www.dh.gov.uk/en/Healthcare/Qualityandproductivity/QIPP/index.htm.

Conclude are now working on projects that both drive efficiency into integrated care pathways AND which drive for low carbon performance.  This is achieved through a strategy developed by Conclude called ‘Peak Load Smoothing’.

Operational Policies tend to result in peak occupancy in a hospital during the middle part of the working day.  Peak occupancy drives peak energy loads.  Peak energy loads incur peak load energy tariffs. At Conclude we argue that if Operational Policies can be planned across the hospital such that peak occupancy of each clinical specialism can be managed relative to other specialisms then peak energy loads can be reduced by at least 23%.  The benefit of reducing peak loads is that engineering plant can be smaller, and work more efficiently, resulting in reduced carbon emissions.

Operational Policy tends to focus on discreet clinical specialisms, whereas ‘joined up’ policies ensure better co-ordination of working practices, better flow of patients, resulting in better patient experience, and as we have already mentioned, much improved carbon performance.  In bringing together the issues of space efficiency, process efficiency and carbon efficiency all resulting in low capital and operational costs, we consider this to be real innovation.

Dr David Pencheon OBE at the NHS Sustainability Development Unit describes our work in these terms:

” It’s an impressive way of thinking through an important dimension of sustainable, flexible, cost effective management of estate and probably an important step on the way to a more coherent approach to assessing health care premises.”

If you would like to learn more about our work please fill out the contact form on this site.

It is now becoming increasingly evident that NHS Trusts need to achieve better utilisation from their facilities. The Kings Foundation recently produced a report that identified that there is circa 2.0m square metres of unused or under-utilised floor space in the NHS, equivalent to the combined floor space of Sainsbury’s and Waitrose.  In a separate report, Cost Consultants E C Harris noted that under-utilised floor space in the NHS accounts for a life-cycle cost approaching £500m per annum.  This is the equivalent build cost of a major acute hospital, or 2% of the governments QIPP target (see http://www.improvement.nhs.uk/Default.aspx?alias=www.improvement.nhs.uk/qipp).

In numerous discussions with NHS Estate leaders we have been struck by a common issue that repeatedly arises in those conversations which can be rhetorically expressed as: “we usually know where we are inefficient, in terms of space utilisation – but what we do not understand enough of are the drivers that lead that space utilisation“. Our own reflection of these concerns is that to understand these drivers, we need to understand the processes that drive the utilisation of each facility.  The process will have considerable influence in terms of who, when and why different users makes use of a particular facility.  We need to understand the resource constraints, the process constraints and the key variables that influence utilisation.  Our research has also identified a number of issues concerning different working practices that can be directly correlated to patient flow and staff efficiency.  These become evident in patient dwell time, particularly for Outpatient visits.  Dwell time is the time that a patient spends in the process – a substantial proportion of which can be spent waiting.  It is often the working practices used by a specific clinical specialism that are the key drivers behind these issues.

Inevitably, these issues can be complex to resolve.  Often the factors are interdependent.  This is where OCCUPANCY ANALYTICS ™, a science developed by The Conclude Consultancy brings clarity, because it enables the clear correlation between driver and outcome – between working practice and space utilisation.  We presented some of our work at the NHS Sustainability 2012 conference and here were a few comments published on the post-conference debate web site:

“Absolutely inspiring and eye opening presentation”

“Excellent presentation. Great delivery, had data, strong conclusions. Should have been a plenary presentation”

“Absolutely fascinating. If we are to meet our 2050 outcomes, this IS the way forward. Best session of the day!”

“It’s rare to recognised a ‘Damascian Conversion’ moment at a conference. This was a worrying one, and I fear for how little this is known, understood and applied. Excellent! “Reset the course of the oil tanker”?”

If you would wish to understand how The Conclude Consutancy can help you achieve better space utilsation in your hospital facilities, then please do use the contact form on our web site.

Here at Conclude our research led, evidence based approach to low carbon design for hospitals enables us to explore innovative solutions to the low carbon challenge.  Those of our readers who have been following our work on OCCUPANCY ANALYTICS ™ will already understand the significant impact that this work is having on engineering design of ventilation systems.  We have been reflecting on how traditional approaches to ventilation design can be counter-productive to achieving low carbon outcomes. Our article in Building Better Healthcare (http://www.bbhealthcare.co.uk/show.php?page=feature&id=2010&story=2010) sets out an alternative proposition. You can also find a copy of the article here: http://www.conclude.org.uk/?attachment_id=319

We have also produced a PowerPoint presentation to accompany the article.  The presentation was delivered by Professor Bacon to the Leeds University, School of Healthcare three day course held on the 6-8th November 2011: Specialised Ventilation in Healthcare Premises.

If any reader would like a copy please do contact us.

Professor Bacon has been invited to address the European Health Property Network workshop to be held in Bologna in October.  The 2011 workshop will present exemplar projects and case studies in these areas, but also examine the evidence for and against the effectiveness of current policy initiatives.

The context for the workshop is the EU Commission’s 2020 strategy, which speaks of:

… an urgent need for Europe’s economies to achieve ‘smart, sustainable, inclusive growth’, and in particular emphasises a need to shift towards a more resource efficient and low-carbon economy.  As a major consumer of resources and hydrocarbons, the healthcare built environment has a particular responsibility in this area…

Professor Bacon will be explaining his pioneering work in Occupancy Analytics, which promises to fundamentally change the way in which hospitals are designed in the future. Key impacts on hospital design are:

• Space planning and space utilisation forecasting
• Spatial capacity forecasting including crowding potential
• Vertical circulation planning
• HVAC and Controls design optimisation

For more information please use the Contact form on our web site.

OCCUPANCY ANALYTICS ™, the new method developed at The Conclude Consultancy, has been bearing rich fruit.  We have been just completed a fascinating study into outpatient facilities for the Brighton & Sussex University Hospitals NHS Trust.  The Trust’s concern is that all too often there is too much space assigned to outpatients departments, which could be better utilised.  The over-provision of space is a reflection of  the inadequate analysis tools available to hospital planners. OCCUPANCY ANALYTICS ™ is the solution to these challenges.

The study has enabled the Trust to compare forecast demand of patients with the planned provision outpatient accommodation.  The study has also included a probability analysis of capacity forecasts, based in different variables.  Through OCCUPANCY ANALYTICS ™ the Trust now has the data that it needs to consider alternative operational scenarios that balance forecasts of patient demand, staffing and accommodation provision. With outpatient space costing in the region of £4,500/m2, and a typical consulting room requiring about 15m2 of floor area,  the commercial benefits of this study are obvious.

The analysis has also been applied to imaging equipment forecasting, so that we can now analyse the amount of imaging equipment required to meet forecast demand.  The analysis enables the Trust to alter key variables and so understand the impact of these variables on equipment utilisation. Understanding equipment utilisation also enables us to analyse the energy consumption profile of each item of equipment.  The significance of this will be explained in later posts.

Following The Conclude Consultancy’s research into Grey Water re-use (please see: http://www.conclude.org.uk/research-development/) Professor Bacon has now been appointed to develop a business case for the re-use of Grey Water at Brighton and Sussex University Hospital.

Most Infection Prevention Control specialists would strongly argue against the re-use of Grey Water.  However, Bacon and his team contend that as there is no specification in existence that controls the use of Grey Water, such arguments must be challenged. The team are developing a specification for Grey Water re-use and this specification will also consider the microbiology and well as the virological issues.

Bacon holds the view that the potential for reducing water consumption in UK hospitals, through Grey Water re-use, is often readily dismissed because of opinion which is he believes is all too often founded in myth.  He cites for example, Reverse Osmosis waste water, which is effectively potable water.  Yet it is regarded as ‘Grey Water’.  The purpose of the business case is to investigate the science as well as the potential for re-use, whilst ensuring human health. Water treatment manufacturers will be consulted in the process and a Life Cycle Costing Analysis will also be carried out as part of this study.

August 2011 update: A meeting has now been held with the Department of Health to review our strategy. The department is now supporting the project in order to understand what lessons can be learned from it.  A peer review team is also being established.

For more information please contact Professor Bacon through the contact form on this web site.