A healthy approach to FM at Hefma

With the BIFM’s annual conference ThinkFM focused firmly on the UK, it was down to the Health Estates and Facilities Management Association’s yearly gathering to take a more international perspective. Cathy Hayward reports from Brighton

Hands Across the Water was an appropriate theme for this year’s Health Estates and Facilities Management Association (Hefma) conference, and not just because it was held in Brighton’s Metropole Hotel overlooking a sparkling English Channel. The two-day event had a distinctly international feel, with keynote talks from veteran international journalist Kate Adie, former Virgin Galactic president Will Whitehorn together with a stateside perspective on designing A&E facilities from Jon Huddy, consultant architect at DLA Freemanwhite.

After an introduction from Ian Dacuus, chair of Hefma’s London and south-east branch, and conference chair Mervyn Phipps, also from the branch, Whitehorn opened the conference with an inspiring presentation looking at how a can-do and innovative culture can be brought into organisations such as the NHS. Using his many years’ experience within the Virgin Group, he described how entrepreneur Richard Branson, who suffered from dyslexia and attention deficit hyperactivity disorder, created a culture of constant change and development. “Branson wasn’t embarrassed about doing things that didn’t work. In big organisations like the NHS, there is a fear about doing things that might not work. In Virgin there wasn’t that fear of change and that’s why it is so successful.”

Whitehorn described the expotential growth of Virgin from its routes selling the Sex Pistols to the introduction of the first premium economy seats and seat-back TVs on aeroplanes and WiFi on trains. “All of these innovations drove customers to the business. Even within the NHS, where people don’t typically pay for the service, you must remember innovation is a way to save costs and reduce risk and is therefore crucially important. Civil servants see innovation as risk, but it’s actually a way to reduce risk and cost and provide a better service.”

Whitehorn urged doctors to start treating medicine as a science and not an art. “There’s not enough use of data in medicine. I have more data and technology as a consumer than the doctor,” he said describing how patients are usually astonished to see the doctor shuffling paper patients’ notes rather than bringing them up on a tablet device. But he also acknowledged that there were many uncertainties in medicine. “If doctors can’t agree whether statins are good for you or not, then how can they agree on the design of a new hospital?”


Squeezing more out of the emergency room through better design of A&E facilities was the subject of Jon Huddy’s talk. More than 21 million patients every year visit A&E in the UK, a 50 per cent increase in a decade. Huddy suggested that thinking cleverly about design is a way to keep up with the increases, although he acknowledged that it had to be a partnership between design, FM and operations.

Huddy argued that FMs and health practitioners need to move away from thinking that every A&E patient needs to be horizontal. “As soon as a patient lays down, everything slows down. Stretchers and beds can be replaced by recliners in many incidences, which keep the patient vertical and more responsive and takes up less space.”  He also recommended more flexible use of A&E facilities would result in higher footfall through hospitals. Resuscitation rooms, for example, are used only a couple of times a day. If certain gases are kept in there, they can be used for other patients. And the design of individual rooms was also important, Huddy said, showcasing a design which included a dedicated family zone, so the family support does not get in the way of the clinical teams.

Security remains an issue in all A&E departments and Huddy discussed the importance of maintaining visibility across the department as a key way of maintaining a safe environment. Although he mentioned one Utah A&E which had a live German Shepherd dog as a back-up security guard. “If a drunk patient wants to fight of clinicians, he will, but he will be wary of a dog.”

The Clink

The afternoon saw a series of parallel sessions. The best was the team at Nottinghamshire Healthcare NHS Trust talking about the success of the catering at Wathwood Hospital, a medium-secure psychiatric hospital in south Yorkshire. Catering has been used to challenge both existing work practices and the stigma attached to mental health.

Echoing Whitehorn’s comments about taking risks to innovate successful, the trust’s head of estates and facilities Kay Mulcahy explained how the team had introduced vocational training in catering for patients to give them a career when they leave which reduces reoffending. This was achieved through a number of ways. Firstly the on-site shop Woody’s which is run by patients for patients and allows them to increase their work skills and give them a sense of purpose. In addition a farm shop, which is outside the secure perimeter, allows patients to grow and sell produce and deal with the public, under supervision. It sells everything from homemade chutneys and hanging baskets to fruit and vegetables, and gives patients who are suitable, time away from the wards, and improves their employability skills helping to integrate them socially back into the community.

Finally, the team was inspired by the Clink fine dining restaurants in several prisons, to launch a part-time fine dining facility called Section 17, where patients could learn catering skills. It has helped catering staff to adapt to new ways of cooking, improving their own skills, as well as allowing them to mix with patients and improve attitudes towards mental health. The cost-neutral venture has received praise from all parties.

The final keynote of the day came from broadcaster Kate Adie who, in talking through her career reporting from across the world, described her various experiences in hospitals, which generally involved counting casualties. “Don’t install hospital beds too close to the ground,” she warned, having conducted several TV interviews underneath them while sheltering from shells. “The problem with hospital design is that no-one thinks about what the hospital will be like when all the power has been taken away in the middle of war. The result is a lot of dark corridors.”

Cathy Hayward