An Urgent Revolution

In May, Renova Developments won the Best Operational Project at the Partnerships Awards. Paul Jarvis went to find out why, and what the industry can learn from it

“Ask me anything about car parks,” says Dave Sweeney on arrival at the Widnes Urgent Care Centre. “I’m an expert in them now.”

It’s not the sort of thing one might expect the director of transformation at NHS Halton’s clinical commissioning group (CCG) to be focused on. But then, Sweeney and his team are far from orthodox when it comes to developing their region’s health estate.

The car park in question is on an adjacent piece of land to the urgent care centre, and is being leased from the local council by the CCG to hold the anticipated increase in patients coming to the newly opened centre. Sweeney sees it as the final piece in a jigsaw that has seen an existing Lift building transformed from a walk-in centre to an urgent care facility, in response to the needs of the local population.

“The public had been very clear in our consultation that they needed car parking,” he explains. “As we now lease a 140 space car park the journey has been interesting.”

Opened in February 2006 at a cost of £7m, the facility has undergone a major refurbishment exercise that has tested the partnership’s ability to react and respond to the changing health environment, and is believed to be the first of its kind to take an existing Lift building and redesign it.

The result is a partnership that runs beyond simply the CCG and its private partner, the Fulcrum-led Renova Developments, to encompass the two acute trusts in the region and Halton Borough Council.

That engagement has proved crucial – and made the resulting development a prime example of NHS chief executive Simon Stevens’ vision of a more integrated health service, where the boundaries between primary and acute care are far more blurred.

“We know that the creaking acute estate was continuing to be overrun with people who should not be in A&E, this was as much as 23%,” explains Sweeney. “So we had a discussion with Renova.”

It soon became clear that something innovative could be done with the existing walk-in clinic in Widnes, where a whole floor had been taken over by the previous management from the primary care trust. It meant that the centre was working at around 46% of its capacity, with the rest of the space either taken up with meeting rooms or left empty, costing the CCG money while providing no function.

Nonetheless, paying to renovate the centre to provide the services that would finally take the pressure off A&E would prove tricky. Community Health Partnerships (CHP) would have to be involved, as the owners of the land in place of the now defunct primary care trust, but it wasn’t a simple question of asking the agency for the cash.

“There was quite a large and untidy list of organisations having an interest in the building,” says Mike Chambers, investment director at CHP. “It was the first time that anyone had decided to change a Lift building’s purpose, so there were questions over who should pay for it and how it should be done.”

For many, this could have been where the deal fell down, as each side looked to the other to find the cash. But with almost 10 years of partnership already behind them at the point of these discussions, the strong relationships that had built up ensured that a route was found to get the project done.

True partnership
“We looked where there was extra capacity for services,” says Mark Fredrickson, operations manager at Renova. “There was a laborious approvals procedure, but that was because it had never been done before.”

Chambers agrees that the key was the willingness of all parties to take some risks to try something different. “Renova took a lot of risk up-front and went out on a limb to get it done,” he says. “It has been a true partnership approach.”

The result is a building that is now far more fit to service the needs of its patients than it had previously been. From the clinicians’ point of view, the introduction of the urgent care centre, with a whole suite of new facilities such as X-ray machines and other diagnostic facilities, means patients who once had little choice but to sit in A&E can now be seen on-site – and have an initial assessment within just 15 minutes.

But it also offers a much more holistic approach to patient care. “Primary care ends the other side of A&E,” argues Dr Cliff  Richard, chair of NHS Halton CCG. “Until that happens, you can’t build a system of patient care that makes any sense. The urgent care centre should be that part of the primary care offer.”

In his view, the key to this project’s success – as well as the integrated approach of services that now exists across the Knowsley, Halton, Widnes and Warrington region – was Renova’s willingness to develop a strategic view across the whole estate.

Ian Stewardson, director of service modernisation at St Helens & Knowsley Teaching Hospitals NHS Trust, agrees that personal connections are important. “Everyone put aside their traditional boundaries to look at what we have got and what we can improve. People recognised that by adding the component parts, we could get something that was more than the sum of those parts.

“There have been some barriers along the way, but we have got to a place now where we work together and because we are all signed up to the partnership, we work together in a spirit of partnership.”

Renova Developments was established in 2004 as the Lift provider for the St Helens, Knowsley, Halton and Warrington region. Created with a 25-year lifespan, the agreement brought together all the relevant primary care trusts alongside Partnerships for Health (now Community Health Partnerships).

The majority partner in Renova is Fulcrum, alongside Community Health Partnerships (CHP) and Halton CCG. So far, the joint venture has delivered 17 new primary care and health facilities – making it one of the most prolific Lift companies in the country. But the changes in Widnes have taken it to a new level.

One of the most obvious things to have changed for patients arriving at the new-look urgent care centre is the fact that a bank of separate receptionists has been replaced by one reception desk providing a single point of entry for all patients.

And with the first floor cleared of management staff – some of whom are now housed in the council’s off ices – other services such as sexual health and, potentially, GPs, will soon be located in the same place.

Vital to all this reorganisation has been the way in which the clinicians themselves have been involved in developments. “We have all been part of the discussions,” says Fiona Melling, urgent care lead for Bridgewater Community Healthcare Foundation Trust. This meant that both patient experience and functionality of the technical equipment were worked out before being installed, avoiding problems – even down to simple things such as whether shelves could be put up above some pieces of equipment.

“It sounds simple but these things really do matter,” says Susan Doyle, nurse manager for Bridgewater at the urgent care centre.

And so far, the patients have responded positively to the changes. Given that they can now get results of tests within an hour or two of walking through the door – as opposed to being sent for the tests in two weeks’ time, only to have to wait another week or more for the results – it is no surprise that the centre is getting rave reviews.

In the context of the NHS Five Year Forward plan, Halton CCG’s experience offers much that could be replicated elsewhere to create the kind of integrated healthcare service that spans everything from GP surgeries to major operations and back again.

Perhaps unsurprisingly for such a proactive set of health professionals, they are already thinking about what comes next. “The next phase is to drop the ‘urgent’ from the centre and create a different type of hub,” says Stewardson.

“That is about another view on what ‘urgent care’ is,” says Richard. “If you can get the systems right it’s no longer urgent care, it’s a combined eff ort to keep people’s wellbeing on track so that less people need urgent care.”

Renova is far from finished with this vision for the region’s health services. Next on the list of jobs at the Widnes site is for the creation of facilities to enable ambulances to service the facility. It is currently going through planning, which will take a few months.

And then there’s that car park. “We’re going to have some street art on the wall at the back, hopefully,” says Sweeney, excitedly. “It’ll be health related and it will act as a way of promoting both public health and this centre.”