Hospital 2.0 with Emily King and Doug Baldock

Welcome to the Infrastructure Podcast. My name is Anthony Oliver and today we're taking a close look at the new hospital programme, a programme which has been described as perhaps the most ambitious National Health Service Infrastructure Investment in decades. The NHP programme is tasked with delivering a new generation of state-of-the-art hospitals across England and its core is hospital 2.0, a standardised repeatable and industrialised approach to hospital design and delivery that promises greater certainty, faster construction, improved quality, predictable costs and cutting-edge clinical environments. So to explain the programme and how it will be delivered, I'm joined today by Doug Bordock, technical services director and Emily King, director of industrialisation at the NHP, two leaders central to shaping the technical, commercial and industrial strategy underpinning hospital 2.0. And with a long-term pipeline backed by a rolling five-year funding envelope, averaging around £3 billion a year from 2030, the programme names not only to modernise the NHS estate but to boost innovation and strengthen supply chains and support economic growth across the UK. The scale of this challenge is immense, dozens of complex hospital schemes, varied site conditions, urgent rack rebuilds and of course the need to rebuild public and industry confidence after years of delay and uncertainty, yet with clearer planning assumptions, a 12-year 37 billion hospital 2.0 alliance procurement and deep engagement with suppliers, the programme now seeks to unlock the capability and investment needed for a sustainable long-term programme. Well, that's a theory that's fine out when it means in reality, Doug and Emily, welcome to the Infrastructure Broadcast. Thank you, great to be here. Nice to be here. Great, well, let's start with you. Build on my introduction, how would you describe the new hospital programme from a technical perspective? From a technical perspective, I think we have to look at hospital 2.0 as a system and it very much is designed to translate the strategic objectives that are outlined in the programme business case into a set of briefs that have been through thousands of engagements with clinical staff across the NHS into design solutions which demonstrate a golden thread from those strategic objectives through to the design solutions that will eventually be deployed into schemes to realise the benefits on our behalf. So it's very much a systematic approach so the hospital 2.0 is effectively a system. We'll give us a number then. How many hospitals, how much are you spending? What's the complexity and scale of the schemes in scope? So as you said, the programme is £37 billion investment from the government across 46 schemes, across three different ways or four ways. There's Wave Zero which are in flight projects now and then three ways following that Wave One which is in flight now and Wave Two and Wave Three which are effectively on the bench until we're ready to roll into them and that is aligned to the spending profile that the government wants to use over the next 15-20 years which are outlined up being £15 billion every five years. So we were talking about 40 hospitals. The reason why it's grown is effective the rack schemes a couple of years ago when there was a report that said they were in critical danger of falling down. They were added to the programme and prioritised and we very much put them at the front of the queue now. So hospital 2.0, it's a snappy term but fundamentally what does it change in the way that hospitals are designed and delivered for the NHS? I mean what are the technical innovations for example? How do they underpin faster end-to-end delivery? principally in the current NHS health care environment they have a set of clinical technical standards. We've created a set of design solutions which create departmental designs for 80% of a hospital across a acute build so clinical departments such as diagnostics in imaging, adult in-patients, emergency care etc and so we've created a full suite of design solutions that do translate the current standards but then modernised. Embedded in that is the industrialisation approach which consists of products, a bar from pods being a perfect example of one of those products but we have many that are embedded in that solution and will then transform. Well let's talk a bit more about industrialisation, Emily, you are director of industrialisation for the programme so in your words what does industrialisation mean in practical terms for a hospital 2.0, what's your role? Yeah no great question. So if I just first go back to a definition of industrialisation it's a relatively new term what we're really good at in this industry is creating new terms frequently to try and evolve it's to try and pull ourselves forward. Yeah yeah we're really good at it. So construction leadership council, define industrialisation around the standardising of systems, standardising of processes to make them repeatable, increase the productivity and efficiency and really fundamentally create stable relationships. What we've done when we've taken that into the new hospital programme is simplified it down to a removal of waste so wherever we see waste in the entire life cycle of a project delivery from concept through to completion and handover, we're trying to find the pieces where we can remove the waste, where it's being done. That's physical waste but it's also waste in time, waste in energy, effort and you know we've all seen the studies hopefully that an item when it gets to sight moves around seven times before it leaves sight and it leaves sight as waste. We're looking at literally taking away the waste but also the time waste, the product waste but design waste is really critical so up front the way we currently work in the construction industry, we do a concept design then we go through to design by a consultant, then it gets redesigned as a contractor and then it gets given to the supply chain. We're working directly with the supply chain with the hospital 2.0 to standardise designs to create buildable, repeatable products. So it's a visual, it's one step beyond, well at least one step beyond modern methods of construction. Yes, one step beyond or one step to the side, we're not defining how you do this, what we're trying to do is enable more efficient MMC, DFMA, whatever that might be. So what is digital technology, BIM, digital twins, data analytics, AI embedded from day one then? I mean it's at the heart of it as you can imagine. We base our approach on platform rulebook which is demand to develop deploy. So when you're looking at your demand the first thing you have to do is aggregate your demand. So as dogs talk about hospital 2.0 create standard spaces, we then have a demand tool which aggregates all those spaces and then turns them into products systems and we can then see where we have high weights of repeatability, high weights of standardisation and really start to dig into that and look at those products. So yeah, the data had to come first in this time. So repeatable design, offsite manufacturing, I imagine you've got to have a huge change in delivery culture across CNHS estate. That's been an incredible thing for us to watch because actually if you ask anyone they want to collaborate, they want to communicate and it's how you facilitate that. So yeah, the change in delivery both within the estate in the program, in the trust design teams is around sharing problems and sharing solutions and instead of solving a problem 20 times, solving at once and as soon as you evidence the benefit of that, everybody comes to the tape. And is that what makes NHP uniquely suited then to an industrialised model? This scale of different challenges, scale of activities going on. Yeah, absolutely. It's the scale of repeated activities in bespoke situations. So we identify the standard things within a really bespoke environment and repeat those and you facilitate improvements in maintenance, care because everyone knows where everything is, everyone will do their jobs quickly. Doug, I mean, I'll be giving you a agree with that, but these hospitals are all different. How do you standardisation still allow for clinical adaptability across such varied sites? How does that reduce design risk for individual schemes? So the design is based on a huge amount of clinical engagement. So that is the first thing that happened. Thousands and thousands of workshops, interviews and collaborative days with clinicians across the UK. This is the doctors who are actually going to use this. They have driven the development of that, the clinical briefs. And more recently over the last 12 months, we've taken the design solutions back to them, they've come through that system and played that back for their review. And this includes people like the World Colleges and the chief medical offices for England. And that process is ongoing now as we transition from what we call a reference design set, which is our first iteration of hospital 2.0 to a full set of mandated designs, which will be ready in Q1 next year. So that feedback is what we're getting now to have the confidence that clinically this works. I suppose, Emily, you've got to balance that standardisation and that discussion with the clinicians with the need for economic priorities, social value priorities as well. Yeah, absolutely. I think one thing that I'm really passionate about when you standardise things is not to hinder innovation, hinder local ability to interpret things the best for that environment. So one thing that's really important is we've standardised interfaces. We've standardised what we care about and not what we don't. And that's a really important philosophy. The interface is critical to allow supply chain to work together, contractors to go to different sources. But another really important thing from socio-economic perspective is our demand tool maps out demand across the country. So you can see heat spots and it's allowing local areas to invest in certain items where they can visibly see that pipeline for the next 12 years. When you say investing in what's available to you, you mean to the NHS estate in general, do you mean to you as a construction team? Yeah, so what we've mapped out over the next 15 years is exactly how many metres of pipe we need of a certain type, mapped out exactly the number of bathroom pods we need, exactly the number of the doors that we need and mapped it across the UK. We do not currently have the demand to meet that supply. So it's a challenge. We're saying you invest, the pipeline is here, you can see it, it's black and white. So it's allowing areas to respond to that. Yeah, well most of us ask you, how many doors do you need? Thousands. I mean it was upwards of 30,000, isn't it? Easily. Yeah, and it's one of the things that the NHS has been quite famous for is the number of different types of doors before we arrived was in the thousands and at now and tens. So we are, this centralised programme has a huge opportunity and that's just one example of bringing some really quite disparate sections of the NHS to very, very clear to find products that we can then build around and scale up and then the supply chain can respond to. Yeah, well I said that it was the most ambitious investment in NHS infrastructure in decades. Why do you say that? I don't think the NHS has ever had this much focus and created a programme of a scale before and I think actually it's the largest major programme full stop at the moment in the UK. So it's huge and I think it's needed. So we're with 46 of what is over a thousand buildings across England. So we're actually quite a small portion of the rebuild and I think there's very much a view that the three waves that are in the programme now will just continue and will leave a legacy and a capability within the NHS to continue to build hospitals Yeah, it's interesting when you talk about reducing the number of doors for instance, different doors from thousands to tens. I mean that is a sort of a fundamental bringing together of the way that you run a massive organisation like the NHS has got so many different services going on, so many different needs, so many different facilities but you're actually sort of fundamentally getting down to the nitty-gritty about what it is that matters. Yeah, absolutely and I think it's really important to recognise that this is a change in approach. It is not we're just delivering loads really quickly which we absolutely are but it is also that change in approach and that will facilitate maintenance to look different further down the line and how the estate grows will look different in because it's allowed to evolve and be better every time you do something because where you've standardised something you can improve it, you get that continual improvement cycle. I think the other point just to add on why this is needed is that the construction industry needs a rethink, you know, we've all seen that and to have this amount of pipeline at one time to be able to tackle that and challenge that at this scale, you get the buy-ins from the tier 2s, you get the buy-ins from the tier 1s because they can see that it might really happen. Yeah, and that's really exciting. Well, let's talk about some of the core principles. You said that some pretty bold outcomes from possible or 2.0, less unnecessary variation and complexity in design, predictable costs, scheduled and less, contract a risk, more consistency in project brief development, specification and design. What gives you the confidence that this time the programme is on the right footing to be delivered? First and foremost, is the work we've done in the background to define the system in the way we have and creating a system that is based on clear clinical briefs that have been huge amounts of engagement have now been translated to design solutions that we've got feedback from trust using the system and we're getting very light amount of feedback from them. So that gives us confidence to what we've done in the past is fit for purpose. And we expect that, with that feedback back in the design, we'll have a solution that is ready for the NHS to adapt and adopt. Well, we'll talk about the conversations you've been having with the supply chain in the moment, but Emily, why should the market believe that the long-term pipeline is now credible enough for them to invest in because it requires the supply chain to invest in new techniques, I imagine. How do you convince them? Yeah, again, brilliant question because we've been told as an industry many times that our pipeline exists and that it's real. I think what we've done this time is turned it into something granular and tangible. So rather than saying there's going to be six schools built next year, we're saying we're going to need 12,000 bathroom pods next year. Here is where they are. This is what they have to do. We're also tracking those hospitals as they go through their business cases and increasing the validity of the pipeline as they go through those business cases just to add strength to that. I mean, we talked about the way that you're innovating and driving forward modern methods of construction, but what would you say are the biggest misconceptions about industrialised hospital construction that you're getting back from this supply chain right now? So not right now, right now they're all on board, completely with the programme. Initially, it's obviously a nervousness that we're going to ask for 10,000 exactly this thing with no variation, no allowance to innovate, no allowance for them to consider what is already going through their pipeline. So the change has been we have co-created with the supply chain. These are not designs that we have done an issue out to them. These have been we've got working groups across mechanical and electrical, across façades, partitions, doors. These are co-created with the supply chain and fit into the trusted tested designs. So what I would say is this is not us imposing something on them. This is us collaboratively agreeing on what it should be. And presumably, you're also working with them to make sure that this industrialisation process, this pipeline helps them to tackle the long-standing workforce shortages and diversity challenges that face across the industry. Yeah, and I think again, what we can see because we've got all three waves bedded into our demand tool. We can see where there might be gaps and we might have to provide logistics cover as a programme to store certain things. So what we're doing this time instead of saying the risk is entirely yours is less solve these problems together. As I then said, we've got a heat map of this demand. So we can see the areas we're going to struggle in in East England in the southwest. And again, really early on we can work with the supply chain to understand how we tackle those. Yes. Exciting times for the programme but also for the industry. And I imagine for you too, as well in terms of your career, let's talk a bit about you. Doug, your background is in the design and construction of buildings, high and rise and low rise with Hawley, Lang O'Rourke, Rambole and most recently WSP. What aspect of the technical challenge most drew you then to this work at the New York Hospital programme? It's really clear to me the complexity. So throughout my career, I've always, since I've probably studied systems engineering about 15 years ago and given me a toolkit to address complex technical issues, I've been driven towards finding the most complicated things to go and solve. And when this opportunity came up to support the NHS in delivering multiple hospitals all at once with a standardised design, it was. So it is the complexity that really excites you about those challenges? Absolutely. Because I've, throughout my career and high-rise buildings that I gravitated towards those because they were really difficult and spent some time aboard working on some complicated schemes. Once you learn how to work in complexity and uncertainty, I think it's a bit of a bug that you can't get away from. When these opportunities come up, it's really not difficult. Because I suppose standardisation when it comes to this kind of a state, it means making everything designed with a purpose in the most efficient way possible. To enable what Emily is talking about, which is fundamental to the delivery of the hospital programme, we do have to be quite strict in holding the line. That standardised design we've created is really important. The trust when they use that design, which is why we're engaged with them so much, when it lands on their schemes, it has to stay, as we've designed it otherwise, Emily's bath and pool won't fit. And it has to fit because the programme's based on it. So we are quite tough actually around holding the line around our standardised. Well, Emily, you started your career in infrastructure with Arup and then you become immersed. I think immersed is the right word, in industrialisation and modern methods. What inspired you personally to get involved? Was it again? Was it this year's scale of the opportunity, the change of the world mentality? I mean, unfortunately, probably yes. So the past 15 years I've been on the delivery side, delivering for public sector programmes that were attempting to standardise. You know, they were the first evolution each one, department for education, Ministry of Defence, Ministry of Justice. And I, as a delivery person, have picked all the little problems and go, well, I wouldn't do like that. Well, I wouldn't do like that. Why haven't they thought about this? Because I've had that different perspective, I can see the line going through the factory. So when you change something by five centimetres, I understand the impact of it and the impact on equally. I understand that if someone gives me a standardised design and I go in and talk to the school and they go, yeah, but that's got no educational backing, me as a contractor, all of that disappears, the benefit of that standardised design. So being given the opportunity to actually go on the other side of the table and see if we can do this. It's really exciting. So in terms of professional challenges, then, is this the kind of the pinnacle the make or break a moment to prove all this proof that this industrialised way of working can actually be embraced by the construction sector in the way that it has by other manufacturing industries? Yeah. And I think even more importantly, it's what it means for us. You know, what we can't do is say, we're going to do this exactly how manufacturing works because of the complexity, actually, the dogs referring to you. There are too many interfaces, too many stakeholders. You can't just say I want that car and it only impact the family of four who's buying that car. You know, it's that broadest sense. So absolutely, it's the complexity and the challenge and understanding. If we can do it, and for me, it's a step, by the way, it's not the pinnacle. This programme is showing what the industry could do if we work differently from a procurement perspective, if we collaborate. The physical manifestation of what Latham and Egan were thinking about a few years ago. Well, personally, though, this is an NHS project. And it's a tough brief at the NHS right now for sure. What gets both of you up in the morning to actually come and take on the significant challenges that I imagine you face every day on this project? When I was asked to join, I joined because I was joined in the NHS and I felt a personal pride to come and support the National Health Service. Everyone's got their own story, but I think that, first and foremost, that is why I'm here, is to do my bit for the NHS. And I have a skill set that, luckily for me, is something they need right now to get the programme up and running and delivering the standardized hospitals. So it's a very much a personal purpose that drives me to get out of bed. And it's very, I've never had a job where I jump out of bed on a Monday morning, like I do here. Emily? Yeah, for me, actually, I am surrounded by the cleverest people I've ever worked with. My team are phenomenal. You know, they're theorising and then implementing. So for me, day to day, it's just enabling them to do their best and actually have the impact that I know they could. Yeah. I always ask people on the podcast what they get up to and they're not at work because I imagine you're pretty full-time doing this. What do you buy to get up to when you're not working? Emily? This morning a log fell down in one of our fields. So we've got chickens, dogs, kids running around all over the place. So you're not based in London? Not at all. I'm up in York. All right. And so there's a big rural lifestyle going on there. Many kids are many, many farm animals. Yeah. Okay, so there's two kids, but it feels like many at times. And that was a change three years ago, because I've always been a city person. So yeah, having that space is incredible. So I've got to back yourself. Where are you based? So I am based a bit closer to London than Emily. I'm based in Sussex. Also have children. I have three. And I've got passion for cycling. So I do, I try and do a lot of cycling around that, but three kids takes up most of my very good, very good. Well, you know, I imagine that, well, that, that, that link that you, that everyone has back with the, the NHS is a rural driver. I imagine for a project like that. And I suppose if anyone that's got some kids is always very, very familiar with the using using NHS, particularly if it's I imagine. So particularly if you're mucking around in fields and falling out of trees, I imagine. But let's get back on with 2.0 alliance. I know you've been carrying out some intense market engagement. How has the supply of feedback reshaped the technical rules and the standard components on the programme? So I'll focus on the feedback we've had from the sort of design community. Because when I joined, we hadn't engaged. And it was one of our biggest challenges, actually, is that we were talking about co-creation and designing these things together. But there wasn't any evidence on the market side of that. So we quite quickly set up a design hub where we invited all the design teams from the scheme, the schemes and started to share information with them and co-create effectively in some cases some of the designs. So the first thing was to build a relationship with this group. And as I said, we've now issued all of the designs to that to that group. And they started to feedback into us. And they were all influenced and changed some of the technical standards we've got and some of the designs to make sure that they are and they can be used on a scheme specifically. So the combination in that discussion, it's industry issues, but it's also clinical issues that you're looking at those are all. Absolutely. So the clinical niches have been engaged and there are certain departments of eternity as you can imagine is under a huge amount of pressure. And we're working with the clinical directors within NHS to support our designs. And they are taking a bit longer because they're so important and they're ones that are going through changes in the NHS now anyway because of feedback they're getting on the ground. Emily, what have you learned from market engagement about industry readiness? It's a supply chain ready and willing to bite your hand off to get stuck into industrialisation or use it for some more of a slow burn. No, to be honest our working groups are the best days that we have on this programme working with them because they are just brilliant and they are at the table immediately. And the co-creation that has taken place there has been amazing. So we've taken the designs from from the hospital 2.0 and then looked at the different products we've done a first iteration and then co-created that with a supply chain. And so they have changed layout of services as an example to speed up installation and they've told us the cost saving that'll give us because of the man hours it'll save. So they're really bought into this process. The first day for each of the working groups none of them wanted to share their feedback with each other and they wrote it down and we anonymised it and put it on a screen and showed them that they were all saying exactly the same thing. From that day forth the collaboration and communications been brilliant. And you mentioned that the fact that having a pipeline gives them the confidence to get on, are there some shifts in capability or culture that they really need to make? I think the biggest shift in culture is understanding that demand outstrips supply significantly. So sharing continual improvement, if we see someone doing something brilliant over there, we're going to share it with everybody else. So I think that mindset of getting away from strict competitiveness to better equals more. And we're going to need people to look at things differently. So for example with the the MEP supply, I think there's a huge opportunity for the MEP tier 2s and 3s to work with frame suppliers, manufacturers to create the horizontal distribution structures that go in. So we need them to look at a different way of delivering as well. Meanwhile, the next step of this is to create this hospital 2.0 alliance. How do you define or explain that alliance? The alliance is effectively an alliance framework that brings together multiple contractors to work in a collaborative environment to deliver these hospitals on time and on budget. And as Emily mentioned, the whole principle of the alliance is to make sure that we share best practice across the contractors so that good practice gets shared and demonstrated across all the schemes. In my view, Wave 1 is the opportunity for those contractors to prove they can work together and deliver value because there is a pipeline of Wave 2, Wave 3 and Wave 4.5. And I think there's an opportunity, I think, for the contractors to work with us in a collaborative way across not just the client team but the trust and the supply chain. So the process is now getting everything still up to really start working with that alliance from 2030. So the alliance effectively in terms of when the first contract would be signed, the procurement process for the framework is concluding beginning of next year, so 2026. At that point, we'll allocate a contractor to each of the Wave 1 schemes and then they'll go through the normal rebar for process and then the normal business case will then define the starting gun for any single trust. Yeah. I mean, have there been key learnings from other major infrastructure projects or programs that have tried the similar approach? Yeah, so I think Emily's case in point of having worked on DFE, MOJ, MOD, a lot of the commercial team have come from other major programs who have tried to do this in the past and this is very much and this is why it's so exciting. It's very much a collection of experience from trying to do this in the past and bringing all those ideas into a procurement exercise with the right pipeline and value and we do truly believe this will be the one that cracks the cracks. Well, what are the learnings? I mean, what are the things you can identify that said, well, you know, they tried this at MOJ and it just didn't quite jail or it didn't work or they tried this at DFE. What are the learnings? Emily, yeah. Yeah. So the evolution of what we mean by standardised design is a really good example. So with the DFE, that was the first time we'd really attempted this standardised design. What we didn't do was standardise interfaces, standardise components. It was like, oh, and here's an area where you're going to put a toilet. So then when you are a contractor and you go and you talk to the school and you go, well, what does this need to look like? It very quickly breaks the rest of the design because suddenly actually they want a little bit more here or they want a bit here and you haven't actually got to the nitty gritty of designing and defining those detail pieces. So I think the approach to standardised design is incredibly robust and has learned off the back of these things. Another thing taking from kind of MOD and MOJ world, doing performance specifications. So this idea of standardising or mandating what you care about and not what you don't. So you can allow innovation for DFMA for MMC to really come through. I think another key thing, really, really significant, is not the ability to direct award. So the procurement right now is an incredibly intense process but it will allow a much more expedited contract award later on. The fact that you are not competing with each other every time is really significant. It is in everybody's hands to do the best they can to keep moving forward. We need the contractors to prove this works just as much as we do rather than having the competition going, well, I'm going to want up them and I'm going to want up them. We also need them to share their supply chain. So an MEP analysis has shown that there isn't an MEP supplier that can deliver the biggest hospitals by themselves. So the tier ones are going to have to collaborate across their supply chains as well. So there is a very, very different approach in that area. So what happens next then? How should suppliers be preparing themselves for this whole phase of different waves of procurement that you've got coming down the track? I mean, the tier ones, I think, set through their through the framework procurement exercise. That's the first thing to get cracked. Once we've got that, we then move into the tier 2s and we've been working with those over the last few years. I guess the message to the supply chain is to get on board with the standardized design, work with us to understand it and then support us in delivering it through the tier one contractors. It's quite a small industry. All the tier 2s do work pretty much for all the tier ones. So it's about, I do think it's about getting comfortable with sharing information, getting comfortable with working with us to create solutions that will be used across multiple schemes and then investing in themselves and in the programme. I mean, one of the government's overarching, obviously it's mission for growth really tries to make sure that a big and national project like this does include regional suppliers from across the entire nation. How do you make sure that smaller and regional suppliers are included or supported? So we're creating a platform which is web based off the back of our designs and our mandated solutions. So any supplier, any person, when it's released can log on to that website, see live, where our different projects are, what mandated solutions there are, what the specifications for those are. So that any manufacturer supplier of any size or scale can go in and say, well, I could provide 200 of those in that specific area. You can then see what the scheme is. You can see who the contractor is. So we're trying to lower the barter entry there by really making the specifications incredibly clear. And to making that programme really accessible for the entire supply, Jay, not just the big tier one and tier two, are you getting signs that that's happening? Yes, absolutely. I think the brilliant thing is working with the tier two's and three's and saying to them, you need to hold the line with the tier ones now. You have co-created this with us. We've approved it. You've approved it. If someone tries to push back, we are fully behind you. So absolutely, I think that's like change in approach to design as it is really going to pay dividends. So as I dive into the world, decades into the programme, industrialized design expert Emily, what a success look like for you. Estabilized industry. Simple as that. Right. So what do you mean by that? So if we stabilize pipeline, if we stabilize what we're asking for and we allow people to invest, we will see a more stable industry that doesn't have these dips that we will see less companies going into administration because something falls through in the future. If one of our projects gets put on hold for planning for whatever else, whatever they've manufactured so that I can go straight to another scheme. So it's just about protecting the industry really. Doug, what about you? So what does success look like for you in terms of hospital 2.0? So we focus a lot on the technical and the industrial construction elements of this programme. I think first and foremost, we're here to deliver great healthcare facilities that are consistent across the trusts. And so my view of success is very much around delivering great patient outcomes. Wonderful places for people to work which is one of our most important objectives here to create spaces for staff to thrive in their jobs and do that across trusts so that they can work together more collaboratively and share data and improve the way that hospitals are delivering services and effectively support the 10-year plan for the NHS. Because fundamentally the construction process is an inconvenient moment in the life of a hospital. If we get to fix two things, why would we get to fix the construction, should we get to support any NHS and fixing their health care problem? So what message would you like the most like the market to take away from this conversation then? To get on board, I do feel we've got all the evidence, we've got all the the knowledge and the experience to have this a real good go at this and I think that we will change the way that we do deliver large buildings and infrastructure projects and we will change the way we deliver healthcare. So a dilemma of trust needed to let us get on with this now and deliver. Emily? Yeah I think for me it's about turning up with a positive outlook, come with the best of intentions and if something's not working, if you see a gap, tell us let us know we want to fix it. Wave 1 is just the first situation, we're in a continually learning process. Yeah well certainly it is a mammoth task and a mammoth opportunity to create those kind of changes, changes in industry, changes in the NHS. So thanks Doug and thanks Emily, you certainly have got a really interesting set of challenges ahead of you but some really fantastic opportunities there to make some changes. So thanks very much for joining me today on the podcast I've talked as well through them. So thanks a lot. Thank you. Thank you very much. Well sadly that's all we've got time for in the podcast now but there is more in the pipeline and more to talk about as we continue to probe the big issues faced across the sector. If you haven't done so already do check out the infrastructure podcast website www.inforcharity-podcast.com where you'll find background information and all the latest podcasts to listen to and to share. So thanks for joining us. Thanks again to Doug and to Emily. I look forward to seeing you again very soon.