ppp header

Queen Mary's Hospital, Roehampton

Category: Hospitals

“I think this has definitely been a successful project. I think if we looked at what we set out to achieve 5 years ago, we’ve achieved it. It’s been delivered within the timeframes; it’s been delivered within budget. The performance of the hospital has exceeded our expectations and I think we’ve ended up with a very pleasant, attractive and modern facility that patients like coming to and staff like working in."

Stuart Reeves, Associate Director, Queen Mary's Hospital Roehampton

August, 2007

The new Queen Mary’s Hospital Roehampton opened in 2006 after a two year redevelopment. Queen Mary’s is a large community hospital housed in a state of the art four-storey building containing all the modern equipment needed to offer the local population and its patients from around the world the latest treatment techniques. The new Queen Mary’s provides outpatient rapid diagnostic and treatment facilities, mental health community services, a minor injuries unit, burns dressing clinic, limb fitting services and a sexual health clinic. The hospital also houses the world famous Douglas Bader Rehabilitation Unit.

The PPP Forum interviewed Stuart Reeves, Associate Director, Queen Mary’s Hospital Roehampton.

So, it was a newbuild on a brownfield site from within the existing hospital grounds.

We had to demolish to create space. We had to move services which were sparsely populated over the whole site, compact them down to one end of the site and then demolish the other end to create the plot of land for the development. This allowed us to keep the show on the road so the services carried on throughout the whole process. And the advantage was that we knew at the end we were going to end up with something that would be significantly cheaper to run from a revenue perspective and would also release a very large amount of capital because the plan always was to dispose of the land. It’s good residential land and it had always had planning permission so it was always going to be worth a lot of money.

If that hadn’t happened, in effect, QM’s probably would have just closed and services would have been redistributed amongst other hospitals which would have been a shame because much of what was going on here was special because of the integrated nature of the services. And I think that if you split the services into their individual bits, some of the value would be significantly less than when you have them all together. And to be honest, when we kicked off that strategy, PFI was the only show in town. Originally we were planning to have QM’s as a community hospital without mental health services and during our design phase, the local mental health trust decided that they really had no other option than to use QM’s site for mental health so in effect we had to put another floor on the building which had a significant design impact - the design of the building was such that we had to completely redo the foundations. So there were actually quite a few big changes during the process.”

There were two other projects, both for Queen Mary’s, which had failed before you went down the PFI route.

They failed because they couldn’t get the financial model to stack up and I think there wasn’t the political support and they were too ambitious.

This was about 5 years before we started off with PFI and when they were trying to create QM’s as yet another District General Hospital (DGH). That’s probably where they failed because the main issue here is that we’ve actually got quite a lot of hospitals around us so that was not a sustainable prospect. It wasn’t until we came up with a model of this high tech community hospital that you could really get something that would stack up financially. It fitted in with where you could see the health agenda was going, basically moving treatments closer to where people live.”

Did you start with a blank sheet of paper with the design?

Yes that’s exactly what we did here and I think there’s been a lot of interest because we were actually quite ahead of the game. For example we took the opportunity to redesign our disability services which were previously on more than one site and were fragmented. We designed a service that is able to give you a one-stop shop service. For example, many people who have got artificial limbs also use wheelchairs so we wanted to make sure that you didn’t have to go over there for your wheelchair, over to that hospital for your artificial limb and so on.

Another example is that a lot of people who have got a brace are also in a wheelchair, so why not design the wheelchair with the brace in it as part of the design in the first place?

So that’s a good example of where we could look at things that were occurring on the different sites, and then use that blank sheet of paper and design around that.”

Did you get some good suggestions from the people who were bidding for the projects?

Yes, I think the design that we’ve got here is probably 90% as good as we could have got. I think we’ve done a very good job. And I think it is ‘we’, we as in the architects and us.”

So you worked together in partnership?

Yes. I thought the Architects were very good. I think they managed to interpret what we needed very well. It was quite clear in the beginning that they had the best understanding and interpretation of what our requirements were.”

How did you find the construction phase?

Once we started work it went quite smoothly for us. I think we had the advantage that we were already working with the standard PFI Contract so we had a good framework. On our side, we had a very strong system of controlling variations from day one, which meant that through the design and build phase, there were very few variations, so obviously that didn’t affect the timescales or the finance. That’s very important. We personally invested very heavily always going for the most modern, leading-edge pieces of equipment and made that decision right at the beginning so everything that has gone into the building from a diagnostic perspective was at the apex of design at that time. We took in almost nothing of our own, we replaced everything and I think that was the right decision as well.”

Is there a lot of flexibility built in to the design of the building?

We’ve built it on a grid. We’ve got very high numbers of generic rooms. This office we’re sitting in is replicated many times throughout this building throughout. We spent a lot of time designing all our examination rooms the same so that we knew they could be used for whatever clinical specialty we wanted to use them for at any particular time. We’ve got at least 80 of these examination and consultation rooms and they all look exactly the same, they’re all kitted out with the same couch, the same procedure lights and the same diagnostic equipment on the walls. This means that we can use a room on a Monday for ENT, on a Tuesday for Orthopaedics and on a Wednesday for Neurology. With some departments (like cardiology) where they’ve got quite a lot of diagnostic equipment that you can’t move there is a suite that is used just for them. However the vast majority of the outpatients area is generic space and that gives us a lot of flexibility. Even these rooms are all built onto a grid so if there is a need to remove a wall it is designed so you can do that.”

The project was a steep learning curve for you then?

For me it was a learning curve right through the process, from outline business case onwards. It gets more and more intense as you build up to the move in and you spend a lot of time planning for the physical side of moving 600 staff and goodness knows how many patients and equipment. Because we had completely new equipment we had to make sure the staff were all trained to use the new equipment before we moved in.

It’s an enormous amount of work leading up to the move and that journey does carry on after moving in…you’ve at least another 6-12 months to get fully up to speed operationally. Reinventing all the little processes that used to happen in the old hospital that of course weren’t documented and relied on people. I’d say to anyone don’t see the date of moving into a new hospital as the peak of your mountain…that’s more like the Hillary Step…it carries on afterwards for a while! It’s then that you realise how important the relationship is with the service provider.”

So how is the relationship with your private sector service provider?

It’s worked very well since the team providing the service came in to set up. It certainly does feel to me that we can resolve most problems between myself and the site director.

It’s a healthy relationship. I am completely sure and confident that we are actually providing a better soft FM type service here in this new hospital. Part of the reason though is that the hospital is new and much easier to keep clean. The hospital is undoubtedly much cleaner and we’ve got a much better mechanism for measuring the quality of that service. The downside is that the restaurant is no longer subsidised so therefore the prices have had to go up.”

Have the staff been fully engaged throughout the entire process?

The advantage we have over most hospital PFI’s is that this is a relatively small project. There is a very big difference between a £200 million PFI and a £50 million PFI just in terms of the number of people that you are interacting with. I think the scale of QM’s made it easier to make sure that everyone was engaged. We are also lucky that unlike most London hospitals, we don’t have a very large turnover of staff.”

Do you think the new facilities help with the recruitment and retention of staff?

We didn’t have a problem in the first place - we have always had a small turnover of staff. Since we’ve moved in here, undoubtedly this hospital is a very attractive place to work in. We have absolutely no problem recruiting to any posts here at all and certainly for the type of hospital that we’ve designed, it’s an extremely attractive place to work if you’re interested in rehab or diagnostics.

It’s very much at the forefront of skills here, right at the apex of anywhere in the country. If you want to specialise in disability or rehab this is where you want to come to work if you can. So if you come for a visit, if you compare the facilities that we’ve got with other facilities across the country, they are clearly modern, innovative and leading edge.”

Do you have any views on the length of the contract term – 30 years?

It doesn’t bother me particularly, no. And it’s completely transparent in relation to costs. I’ve got to say that in relation to the quality of the building, that doesn’t worry me. This building will last 30 years. There is enough flexibility in the design, I’m sure, to allow it to carry on through that period.

Probably one of the significant advantages to me is the managed equipment service – we invested in that new equipment and because of the way the financial models are set up to ensure the ongoing maintenance and replacement of that equipment, we’ll be able to keep that equipment leading edge as well. So from my perspective it means not having to worry about a CT scanner that is going to have to be replaced in 3 years time, and how we might find a million pounds for that! I don’t have to go and make a case to my PCT to find the capital - it’s already built into the project, along with all the maintenance and the equipment.”

What are the benefits of PFI?

The benefit to me of PFI is that we have got a managed equipment service. I think that works very well.

We could have designed this hospital, sitting down with the architects, without a PFI structure. I think it was more down to the right architects and us having the clear vision, and you could have done that through a conventional route.

I think the construction speed may have been quicker through PFI. I was surprised at how quickly you could build the hospital but I’ve got no idea if that had anything to do with PFI.

I suppose PFI has delivered something that we were not able to get done through any other route. The reality was, at the time that we set off, we’d never have been able to raise the capital through any other route so it gave us the opportunity to put forward our vision and convince the powers that be that this was worth investing in. Almost more like a conventional private sector business deal, where you’d come up with a vision and go to the bank. I don’t know if we would have been able to do that without PFI.”

Do you have any final thoughts?

I think this has definitely been a successful project. I think if we looked at what we set out to achieve 5 years ago, we’ve achieved it. It’s been delivered within the timeframes; it’s been delivered within budget. The performance of the hospital has exceeded our expectations and I think we’ve ended up with a very pleasant, attractive and modern facility that patients like coming to and staff like working in. That’s why I’m confident the issue of a 30 year contract is not an issue. If anything it gives us a guarantee for the next 30 years.