ProCure21: friend or foe to Trust and patient?

As a means of procuring health service buildings, ProCure21 has been enthusiastically promoted by the Government as the route that delivers the best value for money in the fastest possible time. Could you want for anything else in today’s health service where performance – with a heavy emphasis on financial performance – is everything? Yes, you could apparently, say ProCure21’s critics. Their principal objection is based on the belief that ProCure21 does not provide the best solution from the point of view of a facility’s users; that it is instead driven by the need to deliver quick and cheap facilities. They are suspicious that the apparent lack of a competitive element in the procurement process will result in increased cost, and are unsure what the result will be when the design process is not obviously architect-led. A key question then is whether ProCure21 can deliver high quality buildings to a restricted price and timetable. Having worked as a nurse, and now with a contractor that delivers hospital buildings across the south-east of England, I have had the benefit of experiencing ProCure21 at first hand from both sides of the fence. I have also seen and experienced the alternatives.

Performance not matching looks

As a nurse, I saw newly constructed, traditionally procured, architecturally appealing buildings which looked as if they should work, but which, in fact, did not. I know of one modern glass-bound, grand-looking entrance area, which is easy on the eye and befits the building’s status as the town’s main outpost of the health service. It is also bright, airy and welcoming in the summer. However, in the winter it is virtually impossible to heat, making it uncomfortable for patients and staff and expensive to maintain. There is another example that comes to mind where the doors of a newly developed maternity unit were not sufficiently wide to accommodate the unit’s standard bed. Above all, hospitals should be fit for purpose and that means, first and foremost, optimising space and designing for function, efficiency and practicality. Aesthetic design quality is, of course, important in the creation of an ambience that promotes health and wellbeing, and which is user-friendly. There is a huge focus on how facilities are used so that they can easily be adapted to fit with the changing needs of the community. Likewise build quality, both in terms of craftsmanship and materials, is vital for durability and ease of the cleaning and maintenance of what will, in all probability, be a heavily used facility. So, it is necessary to strike a balance between design and expediency whatever mode of procurement is chosen. At this point it is worth recapping the main features of ProCure21. First piloted in a few areas in 2002 and rolled out across England in 2003, ProCure21 is relatively new, but has been around long enough to have built up a considerable track record. Overseen by the Department of Health, it is a means of procuring publicly-funded NHS capital schemes such as community hospitals, primary care centres, mental health units, cardiac care and outpatient units, and is increasingly being used to support Trusts in clearing backlog maintenance. It is part of the armoury of NHS procurement methods, and sits alongside the Private Finance Initiative (PFI) and the Local Investment Finance Trust (LIFT) initiative.