It’s shaping up to be an interesting year for the NHS, with the recent change of Government, promise of more funding for hospitals and the probability that new build projects will go ahead. While there is a plethora of advice on every aspect of building a new facility there remains a shortage of advice on how to manage vacant buildings once a move has been completed, and what to do with redundant assets (particularly those that continue to carry value).
New build projects are often planned years in advance. They involve countless meetings and generate a forest-worth of paperwork, from documents, and reports, to proposals and plans.
While so much planning goes into preparing for new builds, often little planning is put into the logistics of moving from A to B and what happens to A when it is vacated. Perhaps it’s because new builds are exciting with their gleaming corridors and towering atriums. Unlike having to figure out what to do with old desks and out of date equipment.
Site clearances can be expensive, and if you are clearing an entire hospital the costs could easily creep into the millions. With appropriate planning, these costs can be mitigated – and even offset – by the sale of redundant assets.
This blog provides a guide to managing an efficient site clearance and includes advice to make the transition as smooth as possible. Because early planning pays huge dividends.
Step 1 – Asset Management
Before engaging a consultant to compile a potentially costly inventory, engage an Asset Management company to carry out an initial site assessment. This highlights areas of value and identifies potential liabilities. The team makes broad recommendations and creates a site clearance framework within which to work.
The initial site assessment provides proposed methods of clearance and sale of assets. This makes the process of preparing for site clearance tenders much easier, and ensures the tenders received are relevant to the site.
Step 2 – Contracts
Always include site clearance in the initial scope of work for a new facility. Acknowledging site clearance as part of the project from day one ensures that it will not be overlooked when writing the contract.
By the time the contract is being prepared, the Project Team should have clarity as to how the old site will be cleared and closed and how all services will be moved to the new site. Moving is complicated, and much consideration and planning is given to how patients and staff will be transferred, although there are still frequent delays. Often, site clearing cannot commence until the wards are empty, decontamination has been carried out, and any potential asbestos has been removed.
Once the clearance agents gain access to the site, they will need sufficient time to sell residual assets, which might include boilers and plant or radiography equipment. This should also be factored into the contract when considering timeframes.
After the site has been cleared of assets, the hospital’s Estates Department have to decommission services. Often these teams are also heavily involved in commissioning the new site so may be short staffed. In some cases, these team members may have been transferred to an outsourced Management team at the new hospital, meaning they no longer work for the Trust. Careful planning at the contract stage can mitigate this risk.
We often find contracts contain unrealistic site clearing timelines and include provision of processes that are redundant or unnecessary (for example, requiring sterilisation of areas that would not normally be considered hazardous) while not making allowances for processes that are likely to incur last minute changes or challenges.
We also find that contracts do not accurately define the fixtures included in the sale. This means that expensive plant forms part of the sale of the site and is given to the buyer instead of being retained by the Trust or sold on its behalf. We have seen vague contracts with undefined responsibilities, leading to costly, and lengthy, disputes.
Failure to vacate a site in time may incur a penalty, however, not allowing enough time to vacate a site is a common occurrence. These examples demonstrate why it is important to consider timelines, processes, definitions, fixtures and responsibilities at the contract stage.
Step 3 – Clearance Manager
Appoint a Clearance Manager early in the process and ensure their duties and responsibilities are defined up front. It seems an obvious point, but we often find that Project Managers (who manage multiple responsibilities with regards to the move), are not aware that they are also responsible for the site clearance.
The Clearance Manager should be someone who is familiar with the old site. Preferably someone from the Estates Department as they will have easy access to information on the site services. A good coordinator, who can work with clearance contractors and liaise with the appropriate hospital managers to resolve problems, is essential. The Clearance Manager must have authority to make decisions and be able to ensure that decisions are made quickly. Time is of the essence when it comes to site clearances.
Step 4 – Clearance Agent
Similar to a Clearance Manager, a Clearance Agent should be appointed early in the process. Clearances, and the sale of redundant assets, require a great deal of planning. If you want to maximise the value of your second-hand medical equipment, allow the agent enough time to find the right buyer.
To engage a Clearance Agent you will likely be required to issue a formal tender (unless the value of the clearance is very low). You should allow yourself plenty of time to evaluate the applicants. Always ask applicants for a minimum of 3 references and ensure that these references are followed up. All Clearance Agents can tell you they are the best, but it is their past results that should be used to make your decision. Once you have engaged a Clearance Agent you are bound to them by contract, so make sure you are comfortable and confident with your decision.
Step 5 – Include the staff
Before moving to the new site, the staff can save the Trust a great deal of money by following this checklist:
• Have staff sort through any paperwork cluttering up storerooms or gathering dust in offices. There will likely be paper waste (some confidential) and old manuals for equipment long gone. Having this sorted prior to contractors’ involvement saves time and money. Staff are also better placed to identify important material that needs to be securely disposed of or retained.
• Ensure keys are securely taped to the item to which they belong, for example, drug cabinets or mobile x-ray devices (without keys these items are devalued).
• Similarly, ensure manuals and service records are attached to the items to which they belong.
• Leave internal doors unlocked.
• Ensure all fridges and drugs cabinets have been cleared.
• The Estates Department to review areas where old furniture is deposited to ensure that they have been cleared out.
• The IT Department to remove hard drives from computers on site, but to be strictly monitored so that they do not remove any hard drives from medical equipment, as this significantly reduces the value of the equipment. Medical equipment hard drives to be checked for patient data and the data removed.
• Appoint one member of staff in each department as the person responsible for overseeing the clear out of that area prior to the move. Have them sign off that their area has been properly cleared. Personal accountability makes for an efficient site clearance.
Step 6 – Prepare to be flexible
Hospital moves rely on a number of variables to fall into place to be completed smoothly. In reality, there are many factors at play and most moves come with unplanned changes and challenges. The more preparation you can do, the better.
Working as a team is essential. When a ward move doesn’t take place as scheduled, it has repercussions for everyone in the chain – from nursing staff and patient transport managers, to patients and their families. Also affected is the Clearance Contractor and Facilities Department.
To manage changes to schedule, regular key personnel meetings are essential and should take place daily during the move. These meetings should include the people directly responsible for relevant departments and focus purely on the task at hand – the move.
The move is not an appropriate time to air grievances – meeting members should be solely focused on solutions. Flexibility is key – it is important to include team members you know you can rely on and have demonstrated resilience and adaptability in the past. You need practical people who take initiative and are comfortable with change.
When it comes to changing plans, trying to muddle through often leaves Trusts vulnerable to unpredictable cost escalations. Changing plans to suit the changing circumstances is the best way to manage.
Step 7 – You are nearly there!
The last patient has moved onto the new site. The Photography Department has been relocated to a cupboard somewhere on the seventh floor. Clearance of the old site is in full swing. The culmination of 5 years’ planning is nearly complete. But don’t take your eye off the ball just yet. As soon as the last patient leaves the old site the building will attract unwanted attention. This is where you need to consider security.
One of the worst cases I have seen was in the north of England and involved travellers usurping hospital security to establish living quarters in the vacant hospital site. It took five days to receive an eviction order from the court and during this time the travellers had stripped lead off the roof, cut through live cables to remove a generator and endangered the sale of a £200,000 MRI by cutting the power to the coils’ refrigerator. While an extreme case, it highlights the importance of managing vacant sites appropriately and planning ahead.
Managing the removal of a large quantity of equipment, personnel and patients creates issues that managers may not be anticipating so having extra support in the form of external security is beneficial. Overseeing many people coming in and out of the site, makes it difficult to prevent theft. Experienced supervision is essential.
This is far from an exhaustive check list and does not take account of the myriad of issues that can present during a site move. For example, how do you dispose of those jars of unknown green liquid in the basement? How do you manage the press? What are the environmental impacts to consider? Environmental factors relating to a move warrants an article of its own!
Usually, members of the community are very attached to their old, crumbling Victorian hospital with draughts and dodgy plumbing, and some can have difficulty understanding why the Trust is planning to move. Strategically planned communications assist in managing people’s expectations, addressing their concerns and getting them onboard with the move.
Every site clearance is different and there is no one tried and tested method to ensure that everything runs smoothly. A site clearance should be considered a project in its own right and therefore planned accordingly. It will pay off in many ways at the end.
