Integrated approach

Eleven years in healthcare construction: ProCure21+ is now a highly integrated framework that consistently delivers innovation and value excellence


In 2001, before ProCure21+ was introduced, just 28% of public sector construction projects were delivered on time, and only 29% were on budget. 3% of the NHS capital budget was spent on litigation. Immediately, ProCure21+ brought assurance: by 2004 it was delivering high cost-certainty, with consistently high client satisfaction on product and service, and a total elimination of litigation. It is now accepted that adopting the ProCure21+ framework and following its principles and processes will enable an NHS client to deliver a high quality capital project on time and within budget.

But eleven years on, ProCure21+ is not standing still. Now that the fundamental objectives are being widely achieved, the framework is moving beyond those basics to integrate cost-cutting strategies and initiatives aimed at delivering efficiency, assurance and improved value, while still achieving high-quality schemes that enhance patients’ experience and healthcare outcomes.

The ProCure21+ Cost Reduction Programme is focused on standardisation – repeatable room designs and standardised components – that incorporate the very best of proven design innovation, endorsed by NHS stakeholders including the Royal Colleges and patient representative groups.

While the Standardisation initiative is primarily cost-driven, it has associated benefits that continue into the operational life of a building: for instance, savings on maintenance programme time generated by standardised M&E components, and the reduction of patient and staff risk. The Standardisation programme has successfully delivered repeatable room designs and standardised components for acute care environments, which are being widely adopted by NHS clients in current schemes; its most recent work, launched in the autumn of 2014, is the equivalent repeatable room designs and standardised components for mental health environments.

ProCure21+ has made the repeatable room designs available to the entire NHS, whether using the ProCure21+ framework or not, enabling the NHS to utilise its buying power as one of Europe’s largest organisations to deliver more for less.

The Standardisation initiative is widely seen within the NHS as a means of delivering improved cost reduction while maintaining and improving on quality of patient care – because the programme embeds a high level of quality as standard within designs and components. Richard Venables, associate commercial director of ProCure21+ PSCP Interserve, believes that standardisation of quality dovetails with efficiency: “Clients and supply chains often spend a lot of time and valuable resources engaging with their clinicians in agreeing the specification and requirements for generic rooms and services. But when that’s all standardised, there’s a time-saving for all parties, which also translates into speed in the construction phase and increased assurance of programme time.”

Building Information Modelling has been mandated by Government for use on all public sector construction projects by 2016, and the ProCure21+ framework is actively embracing the challenge. BIM is effectively the process of generating and managing digital information about a built asset over its whole life, bringing together design, component and lifecycle information as a number of 3D digital models amalgamated into a single multi-disciplinary information-rich model.

All parts of the supply chain collaborate with the client to develop a BIM model, and the integrated model and supporting data improve client visualisation and understanding of the design, its sizes, shapes, fixtures and fittings, spatial relationships, clinical pathways, energy performance and lifecycle costs. At handover stage the BIM model can be passed to the client for ongoing facilities management purposes, where it continues to improve efficiency during the life and even the eventual demolition of the building.

“BIM works with the spirit of partnership that ProCure21+ fosters between client and supply chain,” says ProCure21+ programme director Ray Stephenson. “It encourages a collaborative design process that provides better assurance of design, engages staff and patients efficiently at design stage, and reduces programme risk and even delivery times.”

ProCure21+ guidance has been amended to incorporate the requirements of BIM. NHS clients can now easily initiate the entire process, using the BIM Benefits Matrix to specify the level of BIM they wish to use for the type of benefit they wish to achieve. There should be no extra cost overall: “Over the course of the ProCure21+ scheme, any additional costs should be recouped as a result of improved efficiencies and effectiveness of the design through better collaboration, co-ordination and visuals matching their requirements,” says Adrian Shilliday, BIM lead at PSCP Miller HPS.

ProCure21+ Principal Supply Chain Partner Balfour Beatty has carried out savings calculations on its current range of BIM-enabled schemes, and reports some significant savings relevant to size of schemes: around 2% overall. “This demonstrates that the so-called ‘cost’ of BIM can be readily offset by very tangible savings,” says Balfour Beatty BIM lead Peter Trebilcock.

The ProCure21+ framework provides an effective vehicle for innovation in healthcare construction, says Principal Supply Chain Partner IHP’s ProCure21+ programme lead Alan Kondys. “The framework requires us to use our expertise to propose innovative solutions with operational and cost savings, and then capture that innovation so we can use it again across the framework,” he says. “In a way, we are all linking innovation and standardisation.”

ProCure21+ Princpal Supply Chain Partners work from the principle of understanding NHS clients’ business in order to propose innovative solutions that are a good fit with technical requirements and current work processes. The sliding doors solution devised to meet the infection control and privacy requirements of the Burnley Integrated Urgent Care Centre is an excellent example; the design of a new method of air-handling for Gateshead’s Queen Elizabeth Hospital pathology laboratory is another.

There are numerous examples of innovation on current schemes: these are all available for ProCure21+ projects through the ProjectShare portal, with designs and solutions captured via the post-project evaluation exercise, and in this way are made available to all ProCure21+ clients and supply chain members.

If there is a common theme to the latest developments in ProCure21+, it centres on the integration of quality, innovation and value: it is often the case that developments focused in one area have associated benefits linked with another.

The story of IHP’s bathroom pods is one excellent example. Developed originally as a piece of innovation for a specific NHS client, the pods are a volumetric, pre-fabricated solution delivered as single units craned into place on-site, incorporating the service wall with all its services built-in. This not only reduces time on-site but also allows the incorporation of a solid floor in the pre-assembled pod, avoiding the poor-quality feel of the hollow floor more usually associated with volumetric solutions. There are obvious time, materials and cost savings in using the pod, and IHP is now actively working with the ProCure21+ Standardisation team to incorporate this principle within the Standardisation programme – embedding the benefits of innovation within the standardised designs. “More and more, as a framework, we aim at not having a whole series of different bits of innovation, but instead at having a piece of innovation that you can replicate across a whole range of projects,” says Alan Kondys: “that’s when the savings of time, risk and cost really start to accumulate significantly.”

This integration is the hallmark of a mature, well-developed framework, according to ProCure21+ programme director Ray Stephenson: “There is a line of development in the framework. We began in the early days with the need to provide assurance on time, cost and quality. But having put those foundations in place, we are building on that to incorporate more strategic-level initiatives, enabling the NHS to be a better, more co-ordinated multi-organisational client that challenges the construction industry to deliver better value for money across the board.”

In this way, the ProCure21+ framework continues to serve the NHS to develop, design, build and operate healthcare facilities that deliver on and exceed requirements. “The future of the framework will build from the considerable achievements of the last 11 years, but as we develop the next framework, ProCure22, we will be asking the NHS to give us the benefit of their experience and their thoughts on the future, so we can ensure that ProCure22 is the best tool to tackle what promise to be very steep challenges ahead,” says Stephenson.