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Discussion

Chris Higdon, Programme Manager, DTC Programme, Modernisation Agency

Chris covers the 46 announced DTC sites nationally.

Role of the Modernisation Agency programme is to link with all the DTC sites, work with the Department of Health and strategic health authorities and to make sure that the capacity gap that has been identified and can be filled by the DTCs actually transpires (and there can be difficulties measuring this).

The programme’s role is to help the DTC sites maximise what they can produce with the new facilities. Some of this will be looking at workforce issues – for example difficulties with diagnostics could become a ‘hidden waiting list’.

The team is working on workforce redesign, patient flows, integrated care pathways and a range of other issues.

See a lot of workforce redesign going on, and there are huge skills that need to be tapped into and nurtured.

Dr Michael Sinclair

Private investment driven by consumerisation of healthcare and by the fact that 40 per cent of premature deaths can be avoided by changes in behaviour (only a 10 per cent reduction can be achieved by more medical care). This points in the direction of business that should be the focus of attention in DTCs.

How can the businesses that he is involved with be involved in DTC programme? For example:

• Facilitating communications between patients and physicians – mostly on the web
• Nurse staffing – dealing with pressures on recruitment and retention
• Universal translation system that allows organisations to communicate without having to change hardware or software
• Interactive technology – put the patient first: eg NHS pilot involved a group consultation (20 hip replacement patients) having consultation from their homes, using keyboards to put their questions to a medical team. Result was that patients had more than an hour with the medical team. Patients learned from each other’s questions.

Sue Wainwright, Partner, Tangram Architects and Designers

Involved with two DTCs: one (Epsom) is orthopaedic surgery based, the other (Harlow) for general surgery. Both have pre-admission education units and same-day admission areas.

The Epsom DTC had a mentor – the hospital for special surgery in New York. New York hospital specialises in knee and hip surgery.

Both of the projects started with politically driven programmes ('from now until the next election'). Caused difficulties because the programmes were no longer than the normal construction programme for those buildings. Clients with little operational policy, no brief and no design, yet needing to open in 30 months. There is a need to find a way to maximise the most of that total time to enable them to develop their operational policy. The design process had to be moved on with a group of people who were still thinking about how the project would work.

This leads to a danger of building the wrong thing in haste. And construction has to start before design is finished, something we always used to try and avoid.

Architects and designers find themselves cross-fertilising clinical ideas between projects.

Shortage of time leads people to suggest prefabrication, but there are long lead-in times and conventional design can give you more time.

Dennis O’Keefe, Project director of PFI scheme in Bristol

Working closely with an independent provider hip and knee factory.

Procurement programme for new centre is very quick – from May to September.

Issues of concern include pre-operative assessments, what happens if things go wrong, clinical negligence.

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