Maidstone & Tunbridge Wells NHS Trust
Pembury Hospital Redevelopment Scheme Design Review 1
April 2004
Design Review
Contents page 3 Foreword by Trust Design Champion page 4 Introduction page 6 Geographical and Site Context page 9 Scheme Overview page 10 Brief Outline History of Trust Site page 11 Existing Site Occupation & Usage page 14 Public Sector Comparator page 19 The Public Sector Comparator Preferred Option: Acute Hospital page 21 Clinical Model of Care page 24 Site Overview: Landscaping & Phasing page 25 Mental Health Unit page 30 A Vision for the Arts page 31 Access to Site page 33 Decant Strategy page 35 Green Travel Plan page 36 Environmental Philosophy page 37 Key Stages and Master Programme page 38 Conclusion
A New District General Hospital for Tunbridge Wells
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Design Review
Foreword At the beginning of the 21st century, we confront possibly the greatest opportunity and
I am totally convinced that the team we have assembled can rise to the challenge.
responsibility that has occurred in this locality in the last hundred years; namely designing and bringing about a new hospital for the residents of Tunbridge Wells and the surrounding area. At
Finally, to show that our vision is sound and will last the test of time, I would conclude by referring
a time when our skills for the treatment of the sick are increasing at the fastest rate ever, we have
to the essentials of architecture which were laid down over 2000 years ago by Vitruvius who
to rise to the challenge to create a built environment to match them.
described them as:
Hospitals, with their ward areas, clinics and treatment places are unique as a building type. Whilst they are the daily workplace for thousands of people, it is easy to overlook something
Commodity, Firmness and Delight
more profound. They are also places where people are at their most vulnerable and where they
“A useful thing, whose value lasts and whose use gives constant delight “
experience seminal moments in their lives and the lives of those closest and most important to them. At times of birth, illness, death and of life-changing news, everyone deserves the environment to be as supportive and as reassuringly comfortable as possible. At times like these, the spirit of mankind is affected in a most fundamental way and we have a responsibility to
Graham Goddard Trust Design Champion
respond to that critical requirement. So we therefore seek a design to make this a very special place. The new hospital needs to be clean and bright and fit for the purpose for which it is to be used. That must be taken as read - but more than that it needs to support and stimulate the spirit of those who are treated and those who give that care. Good design is neither an add-on nor a luxury. Nor is it an expression of the style of the decade in which it is built. Good design happens when the building meets all the functional needs yet, in use, turns out to be robust, eminently flexible and adaptable to changing times and at the same time, have the power to provide inspiration to those who pass through it and work in it. It is the responsibility of the design team to achieve these demands in what is likely to be one of the biggest investments in the health service in this area. Having set ourselves such a significant objective, we need to make sure that it can be delivered. We need to ensure that, at all stages of the process, design is taken seriously. How will we achieve this? How will it occur? How will we know when it happens? How will we know we are successful at the end? We need to listen as well as to talk. The key to a successful design process is the involvement of not only the clinicians, the technicians and the support specialists, but must also include the views of patients, their families and friends and all those who use the buildings. For if we do not listen we will never move beyond replicating the same mistakes our previous generations have made. We believe that a well designed hospital will help patients recover their health and spirit. A well designed hospital will provide a pleasant working environment for our staff. A well designed hospital will also bring communities together and engender civic pride. It is this vision that the Trust now aspires to achieve.
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Design Review
Introduction
Design Evaluation Stages Estate Strategy Trust and Commissioner develop case for change
The Pembury site provides a rare opportunity to construct a large modern hospital on a site that has significant topographical advantages and sits adjacent to an area of outstanding
Develop Strategic Outline Case Define the Brief
natural beauty. Develop Outline Business Case
The new hospital will be one of the largest civic buildings to be constructed in Tunbridge Wells Outline Designs Reference Project
over the past 50 years and already has and will continue to generate a large amount of public
Trust select Technical Advisors, including Architects, Services Engineers, Cost Advisors and Healthcare Planners
interest and civic pride. DRP Stage 1 The Trust wishes the design to reflect these opportunities and to ensure that the hospital achieves excellence wherever possible. The Trust will be using AEDET (Achieving Excellence
OJEC Notice
Design Evaluation Toolkit) and NEAT (NHS Environmental Assessment Tool) to help evaluate the PFI Team’s proposals during the bidding process in design and environmental performance. This Design and Development manual has been produced to help inform the Design Review
Pre-qualify candidates and issue Invitation to Negotiate to 4
Project Co. Selects its Design Team
Outline design and clinical criteria in Memorandum of information
panel how the Trust’ s concept has evolved to its current stage. Specify Design Criteria
The development evaluation stages are highlighted opposite. Preliminary ITN Submission of 4 proposals
Concept Designs
Design Vision Statement and design & clinical criteria in Invitation to Negotiate
Evaluate Concept and selection of 2 bidders
Issue final Invitation to Negotiate
Design Submission
Evaluate Designs
Evaluation and selection of Preferred Bidder
Develop Full Business Case
Award Contract
Design Development Monitor Construction
Manage Contract
Post Project Evaluation
Evaluate design in use
A New District General Hospital for Tunbridge Wells
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Design Review
Current facilities within the neighbouring health economy The Maidstone and Tunbridge Wells NHS Trust was formed in April 2000 by the merger of the N
Mid-Kent Healthcare NHS Trust and the Kent and Sussex Weald NHS Trust. This merger was the outcome of a detailed service review of the provision of healthcare across South West Kent and Snodland
North East Sussex and serves a population of approximately 500,000
Preston Hall Foster St.
Larkfield
There are a number of other acute and community hospital located within the neighbouring Sevenoaks
health economies as indicated below and these have been taken into consideration when
Borough Green
Maidstone
Maidstone Molehill Copse
reviewing patient flows and activity. Coxheath
See Map 1 below Tonbridge
Edenbridge
GREATER LONDON
Pembury K&S
N
Ashford
Dartford
Tunbridge Wells
Gravesend Rochester Chatham
Epsom
Homeopathic
Margate Gillingham
Crowborough
Cranbrook
Hawkhurst
Sittingbourne
Banstead
Maidstone
Caterham Redhill
Canterbury
Oxted
Hospital with 24 hour A&E Department Other Major Acute Hospital
Tonbridge Ashford
Pembury Crawley
East Grinstead
Horsham
Km
0
5
10
15
Clinic
Dover
Tunbridge Wells Folkestone
Community Hospital
Map 2 indicating the location of Healthcare Premises within the Trust Boundary.
Maidstone and Tunbridge Wells NHS Trust provides acute care at Maidstone, Kent & Sussex
Haywards Heath
and Pembury hospitals with some ambulatory care from The Homoeopathic Hospital Tunbridge Wells and Preston Hall site at Maidstone.
Brighton
Worthing
Lewes Hellingly
Shoreham -by-sea
South West Kent and Maidstone Weald, and at a number of community hospitals managed by Eastbourne
Km
5
0
5
Community services are predominately provided by two of the Primary Care Trusts (PCTs),
Hastings
10
15
20
25
ACUTE HOSPITALS
PCTs; Sevenoaks, Tonbridge, Edenbridge, Hawkhurst, Crowborough and Uckfield providing a
Hospital with 24 hour A&E Department Other Major Acute Hospital
range of ambulatory Care, GP admissions and rehabilitation. Acute Mental Health services are provided on the Pembury site and at number of community
Map 1 indicating major Acute Hospitals in Kent & East Sussex.
locations. See Map 2 above
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Design Review
Geographical Context Pembury Hospital is located in the heart of the Kentish countryside. The area within which the site falls is characterised by undulating topography and a number of ridge lines. The site lies immediately to the south-east of three ridgelines. The site is situated between two conurbations
Out of town retail and light industry
, the major town of Tunbridge Wells and the village of Pembury itself. The village has a population of 6000 and is mainly made up of domestic housing with a few village shops. There is very little space for expansion within the village development boundaries. The town of Tunbridge Wells is a major Kentish town with a population of 104,000 and is a mixture of domestic housing, retail offices with some out of town retail and industrial areas, one of which lies to the northeast of the hospital site.
Tunbridge Wells
Pembury Hospital Site
Map 3 - Pembury Geographical Area
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Design Review
Site Set in Context of Area The Pembury Hospital site comprises approximately 14.1 hectares and is situated within the Metropolitan Green Belt area. It is surrounded by, but excluded from, the High Weald Area of Outstanding Natural Beauty (AONB) and the Pembury Walks Site of Nature Conservation Interest (SNCI) to the north. (The AONB is a nationally important landscape designation and the SNCI is noted for a large number of protected species, (hazel coppice and heathland.) The site is also surrounded by the Kent Special Landscape Area. There are three Sites of Special Scientific Interest (SSSI) located between 55 and 100 metres to the west and northwest of the site Therefore any development has to be sympathetic to the landscape and ecological constraints of the locality.
Pembury Hospital Site
The Pembury site, while being in the Green Belt, provides a number of unique development opportunities created by the sloping nature of the site, the location and surrounding environment. Open views to the site are generally restricted by the topography and the heavily wooded character of the area. The site slopes from west to east and north to south and is terraced at the mid point where the site is effectively spilt by the main hospital road running through its length. Although this produces some restrictions it also provides a number of opportunities to produce design innovation. Most of the site is developed at the present time and planning permission has been approved to develop to a similar footprint. However there is one area marked in yellow, at the south eastern edge of the site, that has been designated outside the development boundary to ensure that the site retains its synergy with the surrounding area. The site will continue to function during the development and while this does influence the solution, the fact that the site is effectively split in to upper and lower halves it does provide scope for the construction to take place with the minimum of disruption to services.
Pembury Village
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Design Review
Transport & Travel To Tonbridge
The Pembury site is located to the north west of Pembury village with good A and B road links to Maidstone, Tonbridge and Tunbridge Wells and the surrounding villages. Rail links to Castle Hill Section of A21
London and the South Coast are accessible from High Brooms and Tunbridge Wells. Trains from Tunbridge Wells to London and the South Coast run approximately every hour with a greater number of services available at Tonbridge. Longfield Road Roundabout
There are three main access routes to the hospital , the A21 London to Hastings, the A264 Tunbridge Wells to Pembury and the A228 Pembury to Maidstone. There are a number of
To Maidstone
local bus services from Tunbridge Wells and the surrounding villages. The Trust currently runs a staff bus between the Kent & Sussex Hospital and Pembury between 06.30 and 22.00 hrs at Pembury Hospital
approximately 15 minute intervals. High Brooms Station
There is a cycle route from Pembury to Tunbridge Wells and a short section on the industrial estate. A condition of the outline planning approval is to extend the cycle routes from the
New cycle route as part of the development
hospital to the traffic lights at the junction of the A264 and the A228. The main access route to the hospital is provided by the Tonbridge Road which is presently linked to the A21 at the Longfield Roundabout. Approval has now been given for the Castle Hill section of the A21 to be dualled. This work is scheduled to be completed before the hospital opens and will facilitate faster journey times to and from the M25.
To Hastings
Cycle route
Kent & Sussex Hospital
Tunbridge Wells Central Station
A New District General Hospital for Tunbridge Wells
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Design Review
Scheme Overview The nature of NHS healthcare provision in the Maidstone and Tunbridge Wells area underwent comprehensive restructuring in April 2000, when the Kent & Sussex Weald Trust merged with Mid Kent Healthcare Trust to form the Maidstone & Tunbridge Wells NHS Trust (MTWT). The newly formed Trust consists of three hospitals: ■
Maidstone Hospital
■
Kent and Sussex Hospital (Tunbridge Wells)
■
Pembury Hospital (Tunbridge Wells)
The Trust’s audit of healthcare services identified a need for wholesale restructuring of services, and the introduction of additional services; and the current inefficiency of the three hospitals in being able to provide an integrated service. It was concluded that site rationalisation should take place and that there should be one general hospital in Tunbridge Wells (rather than two, Kent & Sussex and Pembury) and one general hospital at Maidstone. The Trust’s proposals for a rationalisation of the Pembury site are based on a ‘Hub and Spoke model’. The ‘Hub and Spoke’ Model of Care seeks to balance the advantages of centralised specialist provision for the minority of patients who have acute needs, with the needs of the majority of patients who can be treated locally on a routine basis. The hub would be located where the specialty would be based, whilst the spoke would contain outreach services to the other site. The proposed development for a 595 bed District General Hospital Service for the wider health community, is for the provision of the complete range of Secondary care services (i.e. District General Hospital) including Accident & Emergency, Air Ambulance provision, Diagnostic & Treatment Centre, as well as a Community and Mental Health Service. The development is planned in collaboration with the Primary Care Trust, and will provide new and modern facilities to: ■
Improve the clinical quality of services by reducing split site working in Tunbridge Wells, ensuring sufficient capacity at Maidstone and Tunbridge Wells, minimising
clinical risk, allowing sufficient critical mass of clinicians and patients, improving functional relationship, eliminating obsolete buildings and equipment. ■
To improve the environmental quality of the services eliminating facilities that do not meet requirements of security, good patient managment, privacy and dignity
(including single sex accommodation) or disabled access and facilities, minimising travel between services- i.e: to provide a modern, appropriate, patient focused, healing and caring environments.
Option 4 - Preferred Option, View from Tonbridge Road
The new hospital at Pembury will provide acute in-patient services and out-patient services for the area. The
Emergency medical services
SERVICES
SERVICES
Emergency surgical services Obstetrics and gynaecology
LS E
R
S
LO
S
LOC A
CE
Accident & Emergency
AL
ICES E RV
VI
Local Services Spoke
C
Maidstone Site
HUB
HUB
Tunbridge Wells Site, Pembury
accommodation will comprise 545 Acute beds; 50 Day-Care beds as part of a 48 hour planned surgical process; 12
Local Services Spoke
incorporating A&E. The development will also include an Education and Training Centre for Pembury and host
Accident & Emergency
training for the University of Brighton.
Theatres; a Medical Day Unit, which will provide one-stop treatment and diagnostics; an Emergency Care Centre
Emergency medical services Emergency surgical services
There will be a 55 bed acute with 4 ICU beds and elderly mental health unit (see page 23) which will access acute
Obstetrics and gynaecology
services provided in the DGH.
Paediatrics
Paediatrics
Outpatient services for all specialties
Outpatient services for all specialties
A new 930 space multi decked car park and 270 spaces elsewhere on the site, will fulfill staff, visitors and patients
Day surgery/care for all specialties
car park requirements on site.
Services Hub
Services Hub
It is proposed ultimately, to demolish all the existing buildings with exception of the Sandhill House (1987), the
Ophthalmology - emergency and elective inpatients
ENT - emergency and elective inpatients
most recent accommodation building, which may be converted for clinical purposes. The current phase envisages
Urology – emergency and elective inpatients
Elective orthopaedics - elective inpatients only
the demolition of all accommodation south of a line from the Site spine road, as described on page 18.
Gynae oncology - elective inpatients and specialist clinics
Rheumatology - elective inpatients
Specialist Cancer surgery, to include Upper Gastro-
Dermatology - elective inpatients
intestinal (GI) and Urology.
Cardiology - angiography and some pacing
Day surgery/care for all specialties
Maidstone
Pembury
A New District General Hospital for Tunbridge Wells
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Design Review
Brief Outline History of Trust Site In 1834, two acres of land was purchased in order to build a Workhouse and Infirmary. These were built in 1836 and are now used as the Trust HQ. In 1838 the site became known as the County Hospital and in 1870 the chapel was built. In 1885 a 6-year building programme commenced, followed by further building works in the 1920’s and 30’s. In 1940 a number of temporary buildings, were constructed to accommodate the increase in casualties from the Second World War. These are still used as patient accommodation today. The last new building to be constructed was the Women’s Ante-Natal Clinic in 1987. Although the Pembury site is used for acute patient services, these are restricted to Care of the Elderly, Acute and Rehabilitation, Obstetrics and Gynaecology. There is also a large Radiology unit comprising Nuclear Medicine, MRI and Computerised Tomography Scanning. Acute Mental Health Care is provided on site. None of the buildings on the site are listed or under any type of protected status. Due to it’s current physical and operational condition, a new model is required to meet the needs of patients, visitors and staff as outlined in the NHS plan.
Nuclear Medicine and Doctor’s Accommodation (1890)
Hospital Chapel (1870)
Trust Headquarters (1838)
Hutted Wards at lower end of site (1940)
Summary of backlog maintenance (as of 2002-03 data) The Pembury hospital has a gross internal area of 31662m².
Pembury
£000’s
Fire
1,777
Disability Discrimination Act
1,498
Health & Safety
5,621
Physical Condition
30,791
Total
39,688
These figures illustrate the cost of upgrading the current estate stock to meet current legislative requirements and general physical repair to achieve Condition B.
Pembury 8.3% 10%
pre-1948 1965-74 1975-84 81.7%
Chart depicting the proportion of buildings within different age brackets.
A New District General Hospital for Tunbridge Wells
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Design Review
Existing Site Occupation & Usage The site is currently occupied by a 243-bedded acute hospital and 42 acute mental health beds managed by West Kent NHS and Social Trust, with associated staff accommodation and car-parking. Many of the buildings on the site are over 59 years old and some more than 100 years old. Direct access and egress to and from the site is achieved via Tonbridge Road on the Southern boundary of the site. The topography of the site is characterised by a south-east facing slope. The highest point at the crest of the slope is at approximately 120 metres (AOD), and at the lowest point of the site is at approximately 85 metres (AOD). The highest point of the tallest building on the site (the maternity building) is approximately 137.6 metres (AOD).
A New District General Hospital for Tunbridge Wells
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Design Review
Site Photographs
A New District General Hospital for Tunbridge Wells
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Design Review
Site Photographs Views that will be transformed by the new:
Acute Hospital
Mental Health Unit
1
2
13
14
25
26
3
4
15
16
27
28
5
6
17
18
29
30
7
8
19
20
31
32
9
10
21
22
33
34
11
12
23
24
35
36
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Design Review
The Public Sector Comparator The Trust’s architects were asked to produce some early design options for the site within
Planning Policy
Planning Constraints
As Pembury is within the Green Belt a number of national and local planning policies
The above planning policies and the Planning Authority placed the following restrictions on the
were taken into account during the PSC development.:
development:
certain constraints; the new hospital had to be built on the lower portion of the site and to be kept within a notional boundary not extending beyond the existing buildings footprint in area.
Design Brief
■
The development of the PSC is based on the following fundamental design criteria:
■
National Policy
■
The new building should not exceed the overall foot print area of the existing buildings - a
policy formulated in the Local Structure Plan. PPG1: General Policy and Principles, February 1997 ■ ■
The design must reflect the Trust’s clinical model, consumerism, sustainability.
■
■
The design must meet the planning restrictions of developing within the Green Belt.
■
PPG2: Green Belts, January 1995
The overall height should not exceed the present height of the buildings. The height restriction
states that the new building will not be any higher than the tallest existing building on the site (the Maternity Unit) i.e. above 137 metres AOD.
PPG13: Transport, March 2001 ■
■
The design should reflect a sustainable approach and more importantly, consideration must be
Protection of landscape character of locality, including Woodland Management and Ecological
■
Regional Planning Policy Guidance for the South East, March 2001
Management Plans.
■
Kent Structure Plan (Approved 1996)
The Outline Planning Application was submitted on 18 February 2002, including an
given to the life cycle costs. ■
The design should be a civic landmark and one in which the local population can take pride.
Environmental Impact Assessment and a Transport study. After a number of months of ■
■
The PSC design should be detailed enough to obtain Outline Planning Approval, to be costed
Tunbridge Wells Borough Council Local Plan and the supplementary Planning Guidance
Kent Design Guide to Sustainable Development
and demonstrate that the model of care can be achieved. However it should be developed only to a stage that does not place constraints on the PFI bidding team’s design strategies.
discussion this was granted by the Local Authority on 14 August 2002 and the forwarded onto the Government Office of the Southeast. It gained their approval and was passed to the office of the Deputy Prime Minister for approval. Approval was finally achieved on 28 April 2003 after
The Pembury Hospital site has undergone various extensions and internal reorganisations over
resolving outstanding issues with the Highways Agency.
the last century. Planning permission has been sought for a number of extensions, conversions There were a number of other design criteria that the final design took into account.
and changes of use on the site since 1974.
Noise and vibration
These may not be reflected in the PSC due to the minimal amount of detailed design undertaken. This should be kept in mind during the PSC development.
The hospital site experienced the most growth during the late 1970’s and through the 1980’s when there was a flurry of development and conversions. Most of the extension to the Pembury
Noise sources that could potentially have an impact on the site include construction work,
Hospital site took place between 1979 and 1984. This included some new staff accommodation
helicopter flights, noise generated by plant associated with the building, road traffic and other
and technical medical facilities as well as some administration facilities. During the 1980’s,
general operational activities.
additional buildings were developed for ancillary social and staff facilities, (i.e a sports hall, social club and creche) and some new after-care facilities. In 1987, when considering an application
There are no unusual constraints placed on the construction works other than adherance to
for a new self-care facility, the Local Authority raised a concern about ‘the redevelopment of the
normal working hours and to reduce noise etc. when ever possible.
hospital on a piece-meal basis’. The proposals therefore seek to rationalise uses and integrate new facilities through
The helicopter flying times are to be restricted to between 07.00hrs and 23.00hrs. It is expected
comprehensive redevelopment. They will allow the Trust to provide a modern and quality
that there will be approximately only one flight per week - therefore, this is unlikely to be an
healthcare service that could not be achieved through a continuation of ‘piece-meal’
issue.
redevelopment of the Pembury site. A planning restriction has been placed on the background plant noise to a maximum 5dB. While this is a low threshold, it is acheivable through good design. The are no restrictions placed on the general operational noise of the hospital once open.
A New District General Hospital for Tunbridge Wells
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Design Review
Public Sector Comparator Design Options: Acute Hospital The Trust asked its Technical Advisors to produce a number of options from which it could
Acute Hospital
choose a preferred design for the Public Sector Comparator. The advisors produced seven draft designs and these were presented for consideration at a workshop. The various options were
Mental Health Unit
discussed and from these discussions a PSC design was chosen. All seven options are described below.
Option 1 This is a conventional nucleus type plan configuration with two parallel wings linked by cross wings enclosing a central atrium. The wings are set at different levels following the slope of the site and are generally six storeys high. This option was selected for the shortlist of three but although this plan arrangement is a well tested layout it was felt that it created a rather monolithic shape on this site, and it was less sympathetic to the crossfall from the road down to the tree line and was therefore not elected as the preferred option.
Acute Hospital
Mental Health Unit
Option 2 This is a series of five L-shaped blocks set at irregular angles to each other to help reduce the impact of the size of the buildings on the site. The horizontal leg of the L is two 15m wide wings separated by a 10m hospital street / atrium, with the vertical leg being 15m wide following the slope of the site. It was felt that the overall plan was too fragmented and that the vertical leg of the L-shape was too isolated to permit the creation of good departmental relationships. This option was rejected at the outset.
A New District General Hospital for Tunbridge Wells
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Design Review
Public Sector Comparator Design Options: Acute Hospital Acute Hospital
Mental Health Unit
Option 3 This is a series of six C-shaped courtyard blocks linked in a step arrangement on plan and separated into two groups of three by a central entrance wing. As with Option 2, the configuration is designed to minimise the impact of the size of the hospital. The higher and lower wings each contained a hospital street linked by a cross wing. This was rejected because the larger number of blocks (6 No.) would make it difficult to provide sensible and adequate departmental spaces without excess fragmentation and that the two hospital streets required by the design will cause lack of clarity to the building complex.
Acute Hospital
Mental Health Unit
Option 4 This is developed to try to optimise the south east facing slope in that it explores the opportunity to step the building with slope, and consider the benefit of the south easterly aspect being used for useful solar gain. It comprises four blocks linked by staircase towers, with a hospital street separating two wings, one of 15 m width and the other of 20m. From the 20 m wing two 15 m wings run at right angles, stepping down the site and enclosing an atrium with a 45° glazed roof rising the full six storeys of the building. The glazed roof was subsequently removed as part of a cost engineering exercise. Because of its advantages over the other concepts, Option 4 was shortlisted and selected finally as the basis for the PSC.
A New District General Hospital for Tunbridge Wells
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Design Review
Public Sector Comparator Design Options: Acute Hospital
Acute Hospital
Mental Health Unit
Option 5 This is podium and tower concept considered to minimise the footprint of the building on the site. The three-storey podium is necessary to provide adequate space for Accident and Emergency and Diagnostic and Treatment Centre (DTC), with the tower containing the wards. It was considered that the impact of a 15 storey high building would not be acceptable to the Local Authority or the community.
Options 6 & 7 Acute Hospital
These are similar and are designed to try to keep the height of the building down to a minimum. Mental Health Unit
They are effectively large and wide plan forms, pierced by light-wells where possible to try to introduce daylight to the deep central spaces. These were rejected because although the wide and deep plan forms produce flexibility in planning the various departments the same plan form severely limits the amount of natural daylight which would reach many of the spaces, and would place a high emphasis on artificial ventilation. Acute Hospital
Mental Health Unit
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Design Review
The Site as Existing
A SPINE ROAD
See Decanting Options
Site Section A-A Zone 4 internal woodland
A
A Available Site Area
Central Spine Road demarcating zones of development
The environment offered by Pembury Hospital is unacceptably poor. It has been assessed by the Trust that around 70% of the Tunbridge Wells
A
estate, which consists of Pembury Hospital and one other hospital in Tunbridge Wells, is functionally unsuitable. The layout of the site makes it difficult to provide a secure environment for patients, visitors and staff. Buildings sprawl over a sloping site with long distances between departments. There are a large number of entry points, complex road infrastructures and long internal travel distances. Access to the site is poor because the facilities are overcrowded. The current accommodation is dispersed with staff, facilities, wards and accommodation located in no logical order. Split site working causes delays, disruption and communication problems. The proposals outlined
Site Boundary
in this document seek to re-order the buildings to enhance speed and efficiency in service provision, whilst providing a quality patient-friendly environment.
A New District General Hospital for Tunbridge Wells
Zone 4 internal woodland
Site Boundaries
18
Design Review
The Public Sector Comparator Preferred Option: Acute Hospital 1
North-West facing facades protected from winds by lee of hill and woodland cover.
2
Orientation of building mass primarily to south-east and in lee of valley, sheltered by extensive woodland - deflecting wind, limiting noise pollution and providing solar gain.
3
3
WOMEN & CHILDREN’S ENTRANCE
A&E ENTRANCE
5
1
MAIN ENTRANCE
Primary penetrating solar gain and low winter sun originates from the south-west
4
(p.m time). Primary building mass facing south-east.
4
Landscaping proposals increasing resistance to northerly winds and providing a sense of arrival and promenade.
6
5
Existing hospital entrance retains it’s function providing continuity, while new
12.00 Midday
Acute Hospital at Main Entrance - View towards South-East
access road clarifies site occupation to
2
visitors (post phase 2)
6
Preferred Design: Option 4
Service access clearly visible and distinct from staff and visitor access.
Option 4, the chosen design is located in the south-east zone of the site. There is a cross-fall within this area averaging 1:10 towards the woodland. The design is based on four, six storey
The Diagnostic and Treatment Centre would also be at this level adjacent to the main
modules adjacent to each other, and running parallel to the contours; which are linked by the
entrance which lies in the centre of the development.
hospital street and lift areas. The blocks are cut into the hillside with the lowest floors stepping up two storeys from front to back and along the length of the hospital to make maximum use of
The wards will be located within the southerly facing 15 metre wide wings or the north west
the change in site levels.
facing section to the front of the hospital. The 20 metre wide area behind the hospital street allows for the deep plan areas of theatres to be accommodated. The block will be serviced
Each block comprises two sections, one 15 metres wide and the other 20 metres. These sections
from the basement via a service duct and service corridor linking to the lift towers. This will
are separated by the hospital street and the blocks are linked by staircase towers. Two 15 metre
allow for the transfer of material vertically within each block without using clinical spaces,
wings run at right angles to the 20 metre section, stepping down the site and enclosing a
thus reducing the risk of infection.
landscaped external space. The shape of the building allows for the introduction of natural light to almost all spaces, with This design provides an excellent series of variable spaces, permitting the planning of clinical
the Hospital street providing a semi-enclosed and interesting space for horizontal circulation.
departmental relationships as well as creating flexible space for the future.
The ‘street’ atria will create open spaces and are an integral part of the design concept. The
Acute Hospital Lower Level - View towards North-East and Services Road
buildings are orientated so as to face south east making the maximum use of the views Due to the sloping site the building is entered at level three with the A&E building being the
and allowing the buildings to be suffused with light, with abundant fresh air, a known and
first block from the Tonbridge Road, easily seen and accessible.
sensible remedy for providing a feeling of well being in patients and staff.
A New District General Hospital for Tunbridge Wells
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Design Review
The Public Sector Comparator Preferred Option: Acute Hospital
LEVEL 5 LEVEL 4 LEVEL 3 LEVEL 2 LEVEL 1 LEVEL 0
Acute Hospital Section with Terraced Wings
Sketch of Landscape Court, indicating scope of visual continuity between Street / Atrium and woodland. LEVEL 5
Morning
LEVEL 4 LEVEL 3 LEVEL 2 LEVEL 1 LEVEL 0
Acute Hospital Section with Landscape Court The landscape court cross section shows how the space between the two wings functions as a seasonal space. The principle behind the street atrium and landscape court is twofold; to ensure that as much of the hospital areas have access to natural light and ventilation and to create additional space at ground level for patients, visitors and staff to access either while waiting Views
for or between treatments and during rest periods. Ideally all, or at least two atria should be enclosed to allow for year round use.
4 1
2
North
The atria and courts will contain a mixture of hard and soft landscaping. This cross section indicates the wider central block. This has been designed to be 20 metres wide as to allow for areas which require deep plan space such as theatres and diagnostics. The plant rooms are mainly at roof level which enables the roof profile to be curved further reducing the massing while enabling the supply of clean air
Cross Section through Site (refer to previous page for detail references)
and dirty exhaust air to be away from the public areas.
A New District General Hospital for Tunbridge Wells
Evening
20
Design Review
Clinical Model of Care Emergency Care Pathway
DTC / Theatres
Women & Children
The model of care developed for the original Outline Business Case proposed a “hub and spoke” service configuration between two District General Hospitals at Maidstone and Tunbridge Wells. The specific configuration of the “hub and spoke” was agreed through public consultation. The model identified three broad categories of care process : ■
Elective care
■
Unscheduled care
■
Rehabilitation, discharge and continuing care
Care principles and outline process flows were established in each of these categories, while service configuration was based on the existing specialty / care group arrangements within the Trust. The PSC design has been developed to reflect the best understanding of how these processes and principles would be reflected into practice.
A New District General Hospital for Tunbridge Wells
21
Design Review
Design Development of Clinical Model of Care
Since the Public Sector Comparator of early 2002 (submitted to the Local Planning Authority for Hospital Redevelopment), a more detailed clinical planning brief for the facility has been developed within the Trust. Further to the original Outline Business Case, the Trust established a process for ensuring focussed clinical involvement in the development of the detailed design briefing / specification material for the project. This process has included the review of the outline model of care in light of the national modernisation agenda and the development of clinical “best practice” both nationally and internationally. This has resulted in a more detailed model of care having been agreed, supported by a full range of operational design policies for clinical services. The outline care principles have been refined and are now supported by detailed care principles for each service area. The model of care is based on the principle of Graduated Care – the grouping of patients based on their level of clinical dependency / need rather than on the basis of specialty or service arrangement. The model identifies 3 care processes and the principle of graduation will be applied within each of these : ■
Emergency Care
■
Planned Care
■
Women & Children’s Care
Each of the care processes is supported by clinical diagnostics and other clinical support services.
A New District General Hospital for Tunbridge Wells
22
Design Review
Design Development of Clinical Model of Care
Detailed patient process flows have been identified throughout. Based on these, a comprehensive set of adjacency requirements have been developed with the intention of maximising the effectiveness of patient journeys and minimising the mixing of flows within the design solution. The intention is to separate the flow of patients, staff, visitors and supplies within the facilities. The Public Sector Comparator has been tested against the more detailed design brief and is being updated accordingly in design development. In order to accommodate revised spatial configurations, each ward block has expanded in width to allow as much bed space as possible to face south east, with administration and shared spaces located adjacent to the internal atria. The continuous 10m wide street / atrium becomes a series of wider atria within each block linked by a hospital street. The stepped profiles of the south-east face of the hospital are reduced. The patient / staff diagram illustrates movement within the buildings between departments and particularly focuses on the location of theatres. Thus the design process continues to Design Review 2, to the bidding teams and eventually to construction.
A New District General Hospital for Tunbridge Wells
23
Design Review
Site Overview: Landscaping & Phasing The topography of the site is characterised by a south - east facing slope. The highest point at the crest of the slope is 120 metres (AOD), and the lowest is 85 metres (AOD) The highest point of the tallest building on site (the maternity building) is 137.6 metres (AOD). The site is effectively terraced along the line of the internal service road where the ground drops by approximately 4 metres, dividing the site into upper and lower levels.
5
3
The site sits within the Green Belt and while this does bring some restrictions it does provide
3 3
some wonderful opportunities for development. There are a number of existing green areas within the site and it is proposed that, to a large extent, these will be retained and enhanced.
2
Zone 1, Valley Woodland
4
The strategy for this area will include the retention and enhancement of the existing woodland to improve visual as well as ecological character. Woodland glades will promote natural ground flora and a woodland walk an amenity for staff, patients and visitors.
2
2
Zone 2, Lower section of site Any loss of vegetation may be mitigated by tree and shrub planting to integrate the new hospital into the overall landscape. The existing hedge along the Tonbridge Road boundary will be retained and enhanced by additional trees to help screen the hospital from close and middle distance views. The Mental Health Unit will have specialist gardens and courtyards.
2
5
2
Zone 3, Upper section of site
1
Where possible mature best quality trees will be retained and any loss will be replaced by the planting of semi-mature trees. Planting on the roof of the multi level car park will help to screen vehicles and soften the facades. The area to the west of the car park can be grassed and used as an amenity area for staff, visitors and patients.
1
Zone 4, Internal Woodland Some new planting will enhance the visual and ecological nature of an area which is already ‘wild’ in character. The proposals will include the provisions of bird and bat boxes to encourage wildlife.
Zone 5, Tonbridge Road See page 29, Transport Proposal.
A New District General Hospital for Tunbridge Wells
24
Design Review
Mental Health Unit The Site The Mental Health Unit is an integral part of the PFI and it is proposed that patients will use the DGH facilities for acute medical treatment. Support services will be provided from the DGH, i.e: catering so its location within a reasonable distance is important. In the original option (see pages 15-17), the Mental Health Unit was designed as a traditional modern facility with separate wings for elderly and acute patients. The unit was located to the front of the hospital in all 7 options. However after some discussion it was agreed that this location would not provide the correct setting for the patients as it was too near to the internal and external roads and could possibly be detrimental to patients who need space 3
and tranquillity. It was therefore agreed to relocate the unit to the rear of the site (see drawing opposite). The unit will provide 26 adult inpatient beds, 4 intensive care beds, 29 older people’s inpatient beds, a 13 place older people’s day centre and house the older people’s CMHT staff for the locality. 2
There were a number of design parameters placed on the design of the building: ■
Patient accommodation should be at ground level
■
The building should be of domestic scale
■
There should be abundant natural light in the inner spaces
■
Provision of secure gardens within the design.
1
Site Plan
Two options were drawn up for the unit; Option 1 located the unit at the front of the site, and Option 2 at the rear of the site.
1
2
3
Photograph 1 indicates the steep slope approaching to the site. Photographs 2 & 3 indicate buildings occupying the site
Typical Site Section
A New District General Hospital for Tunbridge Wells
25
Design Review
Mental Health Unit Site Constraints & Planning Requirements 1. Concentration of Hub, Administration, Reception and Assessment for easy access to adjacent wards. 2. Adjacency of Assessment Units to PICU, access for police vehicles. 3. All wards and other elderly facilities at a single level - significant considering topography of site. 4. Privacy between Bed-areas vis-a-vis Male / Female and Adult / Elderly. 5. Staff observation of wards - Bedrooms and Day Suites clearly visible from pivot point. 6. Division of wards by sex or medical condition. 7. Access for emergency vehicles and requirements of HTM 81 and Fire Service. 8. Floor to floor heights in relation to site topography, mechanical services, and limited scope of site engineering.
Option 1 This design was single storey and based on a number of wings which contained the wards with a central service core which contained the common and service areas. The secure open spaces would be between the wings. See drawing below.
Option 2 This design is two storey with an additional upper level over half the site area. The main ward areas are split by a central core where the administration and service areas are contained. There are four gardens which provide secure open spaces. See drawing opposite.
Option 2
Option 1
A New District General Hospital for Tunbridge Wells
26
Design Review
Mental Health Unit The Chosen Design The chosen design was Option 2 as it provided a more compact design solution and by clever use of the sloping site the ward could be terraced which effectively makes the one building look and function as two thus minimising the massing thereby enhancing the domestic feel. The design also allows for separation of the facilities for adult patients from facilities for older patients while retaining easy access to both buildings for the staff using common areas. As the design has developed the effect of terracing has been used to produce a building which is split in to two levels while functioning as one. The content of each level is as follows:
Level 1 This is the lowest level facing south-east and is for the acute adult patients. Within this level there are both male and female wards divided by shared space and the Intensive Care Unit. There are secure gardens for the inpatient wards and the ICU. The main reception and the assessment units are used to link this level with the upper terrace, Level 2.
A New District General Hospital for Tunbridge Wells
27
Design Review
Mental Health Unit Level 2 This terrace level will contain the inpatient ward for older people. This ward is arranged in two distinct areas and shares some facilities including a secure garden. This ward leads to the CMHT administration offices and the Elderly Day Centre which are provided at the same level. The upper storey above the Male and Female Adult Wards is approximately half the size of the level below. Due to the terracing it has been possible to provide direct street access to both the CMHT administration and the Older People’s Day Hospital (which is constructed as a second floor of the adult building at level 1). The Older People’s Day Hospital has access to a roof garden. The plant space for the building is within the roof space of the central core above Level 2.
Plant Space
Elderly Ward, Day Hospital CMHT Level
A New District General Hospital for Tunbridge Wells
28
Design Review
Mental Health Unit: Site Massing F D C D
Entrance
C
F
Typical Site Cross Sections showing Upper and Lower Levels
Perspective of the Mental Health Unit
Long Section showing gradient for access vehicles
A New District General Hospital for Tunbridge Wells
29
Design Review
Vision for the Arts that attractive surroundings in which patients feel comfortable and at home can help reduce Art Operation, the Art in Health visual and performing arts programme for Maidstone and
stress and shorten their stay in hospital.
Tunbridge Wells NHS Trust has been evolving for the last three years.The Arts Co-ordinator, Suzy Minns, is part of the Estates and Facilities Care Group and is accountable to the Director of
A high value will be placed on colour, lighting materials and artwork. By integrating interior
Estates and Facilities / Design Champion.
design as early as possible into the development process, we will arrive at exciting, creative solutions, acheiving high quality, individually tailored results within an economic framework.
Art Operation aims to;
This is particularly evident in wayfinding. Colour will be used as a guidance tool, symbols and features can take their identity from a strong element of the building fabric. Clear, effective and
■
Promote access to and understanding of the arts within the healthcare environment.
innovatory graphics and colour coding will be used to aid orientation. In addition, the needs of disabled patients and visitors, including the visually impaired, will be
■
Explore the relationship between health, architecture, art and design for the purpose of
improving the healthcare environment, delivery of care and health promotion ■
given special consideration, so that interiors comply with the provisions of the new Disability Discrimination Act
Foster creativity, supporting engagement, participation and interaction with the arts for
patients and staff. With a grant of £35,000 the nurse-led multidisciplinary Arts team which includes estates and facilities staff, service users, Arts co ordinator and SHA representative, aims to work in partnership with colleagues and service users to influence and improve the environment in which they deliver care.The team will plan and manage the project having attended residential team development events ; these provided: ■
Skills for major project management.
■
Theory of hospital design.
■
Ideas of the physical nature of a healing environment.
■
Use of colour and light.
■
Working with artists and designers.
■
Consultation processes including patient and community involvement.
The vision for the new hospital is to consolidate all existing good practice in health allied with architecture, art, and design and embed those resulting ideas in the development and culture of the new hospital from the planning stage. We have, within the Hospital Development team, influential elements prepared to endorse this approach. The Design Champion, an architect, has been involved in the art in health movement for five years and is responsible for the trust being nominated for the Kings Fund Grant.The PFI Director is a strong supporter for integrating the arts into the new hospital. In keeping with the Trust’s holistic approach to healthcare architecture and planning, we believe
A New District General Hospital for Tunbridge Wells
30
Design Review
Access to Site The principle highway access for the new hospital will be from Tonbridge Road. A new signal controlled junction will be created, centred
N
on a point a little to the north-west of the existing access road. The new KEY
junction will necessitate some limited road widening, which will take place on the northern side of Tonbridge Road, utilising the space currently
Existing tree, shrub and hedge planting
occupied by the existing ‘slip’ roads. The new junction will provide safe
Potential taller planting
turning movements for traffic to and from the hospital, and will also be
Potential area of lower planting to 600mm to accommodate sight lines
able to incorporate pedestrian crossing facilities.
Footpath
This junction will provide a single point of access for public, staff and visitors to the hospital. Accident & Emergency vehicles will also use this junction in order to reach the A&E Department immediately inside the entrance to the site.
Proposed newaccess access road (see Proposed new road (see NightingaleAssociates Associates drawings) Nightingale drawings) Possible relocation Possible relocation of 40mphspeed speed of 40mph limit area limit area
A secondary access point will be constructed south of the main entrance. This will be a priority junction, with a dedicated right turn lane from Tonbridge Road, and will provide access for service vehicles, separating servicing activity from patient, staff and visitor movements.
Planting enhance ‘rural lanes’ Planting totoenhance ‘rural lanes’ character, screen and character and screen and proposals enhanceenhance proposals
signal New New signal controlled junction controlled junction
Existing removed Existing layby layby removed
Secondary access Secondary access andright right turn and turnlane lane facilities facilities
Client:
Drawing Title
MAIDSTONE & PROPOSED SITE ACCESS TUNBRIDGE WELLS NHS TRUST JUNCTION LAYOUT & OPPORTUNITIES FOR PLANTING Ove Arup & Partners Int. Ltd.
Job Title
PEMBURY HOSPITAL ENVIRONMENTAL STATEMENT
A New District General Hospital for Tunbridge Wells
13 Fitzroy Street London W1T 4BQ Tel: 020 7636 1531 Fax: 020 7580 3924 www.arup.com
Scales Drn.
Not to Scale Date
Ch'd.
Passed
Job No.
Drawing No.
68444/16
FIGURE 11.20
Rev.
31
Design Review
Access Routes within the Site Within the site, the main access road will provide a route to the main car parks. Car park traffic will turn off the access road shortly after entering the site. Other traffic will continue into the site. Provision is made at the main entrance for a turning area in order to allow public transport services to stop close to the entrance. The primary and secondary access roads will be connected via a roundabout at the Northeast end of the site which will allow the traffic to flow around both sides of the main hospital and not on the primary fire and vehicle routes.
Car Parks Car Park B 238 spaces
1200 car parking spaces will be required within the site. These are split over three areas; a 3 storey decked car park, a ground level car park to the rear of the site and dedicated parking adjacent to the Mental Health Unit. It is proposed that the majority of the decked car parking will be for patients and visitors as will
Car Park A
the Mental Health Unit car park. The car park to the rear of the site will be for staff only.
900 spaces
The hospital will be accessed from the decked car park via stairs and lifts with a zebra crossing across the main entrance road leading into the main hospital entrance. Car Park numbers shown WOMEN & CHILDREN’S ENTRANCE
Main Entrance
on the plan equal 1168. The remainder to be distributed on the site.
Bus Stop
Public transport There are already regular bus services to the hospital. These will be enhanced through the
Car Park C 30 spaces
planning obligations attached to the outline planning consent. In addition, provision will be made within the site to allow buses to enter and leave, and to stop outside the main entrance to set down and pick up passengers.
Services Entrance Bus Stop
A New District General Hospital for Tunbridge Wells
32
Design Review
Decant Strategy The Trust has undertaken a detailed space utilisation survey of the Pembury and Kent & Sussex Hospitals, and this has identified all the requirements of the parties occupying these sites if or when these parties have to be decanted. The solutions have been discussed in detail with stakeholders, detailed plans drawn up and costed by the PFI Team and approved by the Trust Board. The Trust has produced a detailed decant strategy site to allow construction to take place on the lower half of the site. The general principle is for non-medical support services to be moved off-site into alternative accommodation. Essential administration that cannot be split from the acute services will remain on the site. Early reconfiguration work is to be undertaken which will relocate medical wards (dark blue) to Kent & Sussex Hospital and Maidstone Hospital, 12 months before financial close. The drawing on the right indicates the decant moves from the lower half of the site to the top (ie: red to red, green to green, pale blue to pale blue etc.) Dark blue and grey accommodation decants off the site.
A New District General Hospital for Tunbridge Wells
33
Design Review
Decant Strategy The drawings opposite illustrate the phasing of works and subsequent decanting. The ‘Construction Phase’ drawing shows the continuing use of the accommodation remaining in the upper position of the site - post demolition of accommodation on the lower part which will be occupied by the new Acute Hospital. The Mental Health Unit to the eastern edge of the site will be the first of the new buildings to be constructed and occupied. The Acute Hospital will also be under construction at this time. The existing spine road will still be in use to service the upper site clinical area. Temporary car parking for 120 vehicles is shown at the north-east portion of the site. The ‘Site at Completion’ drawing illustrates the site subsequent to the decanting of clinical services to the new Acute Hospital. The spine road is relocated parallel to the north of it’s present route. The 3 storey car park is constructed, and the helipad completed in close proximity to the Emergency Services Block on the southern edge of the Acute Hospital. The Car Park is directly linked north-south to the Acute Hospital’s entrance. The environs of the new spine road and car park are extensively landscaped - see page 23 for landscaping proposals.
Construction phase (refer to page 19)
3 CAR PARK A
ACUTE
2
MENTAL HEALTH UNIT
1
Site at completion
A New District General Hospital for Tunbridge Wells
34
Design Review
Green Travel Plan ■
Maidstone & Tunbridge Wells NHS Trust serves a wide geographic area across Kent and
Contribute to public transport provision (the Trust to fund 3 x buses for a period of five
years to Crowborough, Tonbridge and Tunbridge Wells).
Sussex borders, with a population base of approximately 500,000. Local government plans Invest in cycling facilities including showers, lockers and racks, cycle loans for
have acknowledged that there is a range of problems generated by this, for which solutions
■
must be found in the near future. These are:
purchase and travel allowance for cyclists as well as cycle ways.
■
High level of car demand and usage.
■
Congestion on main routes, particularly at peak times.
■
Teleworking and flexible working hours for staff.
The new development and the transport plan ■
Comparatively low provision and usage of public transport. In 2001, the Trust collated base data, of staff, patient and visitors survey. This survey will be
Both national and local government have set the agenda to reduce the reliance on the
repeated every two years and the information gathered has formed the basis of the Trust’s draft
motorcar. The Trust, as one of the biggest employers and generators of car activity in the
Travel Plan that was approved by the Trust Board in July 2003.
South West Kent area, has a responsibility to promote the use of alternative means of travel. The Travel Plan included an Action Plan, of which a number of initiatives have already been As a component of its overall policy to meet environmental and social requirements, the Trust
put into motion, such as the establishment of a Trust Steering Group, chaired by the Head of
has drafted a Travel Plan, and established steering groups comprising volunteers from across
Logistics. From this Steering Group a number of sub groups have been established included a
a wide range of internal and external stakeholders, under the overall direction of Estates &
sub group of the Community Involvement Group (Public and Patient Involvement Forum).
Facilities. The Trust has also had discussions with external agencies such as Tunbridge Wells Borough Council, Kent County Council and local bus companies.
Areas that the Travel Plan will contribute to: Clinical planning - getting adjacencies of key department to avoid cross Trust
Tunbridge Wells Borough Council, as part of Section 106 outline planning conditions has set
■
stringent targets for the new hospital development to meet. Within 12 months of the new
movement.
hospital opening the Trust has an obligation to: ■
Introducing high level of I.T solutions – i.e. intranet, video conferencing and
■
Submit a green travel plan to Tunbridge Wells Council.
broadband.
■
Arrange for a traffic survey to monitor means of access to the Hospital site to be
■
Exploring park and ride schemes in conjunction with local council.
■
Established Kent wide contacts with special interest groups on travel and
submitted to Tunbridge Wells Borough Council. ■
Appoint a full time travel co-ordinator for the Trust.
transport.
■
Formulate a car parking policy and a car parking management plan which shall
■
Expanding inter-site staff transport between Pembury and Maidstone.
■
Consolidation of inter-site postal services with PCT and SHA.
■
Managed Car Parking multi-storey and landscaped.
include: ■
The criteria for the allocation of parking to allow for 1200 spaces on site, of which
950 are for staff. ■
Submit proposals for car sharing and pool cars.
■
Car parking charges ringed fenced to fund ‘green’ initiatives.
■
Provision of non-emergency patient transport.
■
Car Parking policy for staff.
A New District General Hospital for Tunbridge Wells
35
Design Review
Environmental Philosophy
Sustainability
Low Energy Design
The definition of good design, can be summarised as a mix of the following attributes:
The new hospital should be designed to take advantage of the latest construction techniques to
In line with the Government’s Sustainable Development Strategy, the Trust will incorporate into its brief and specification the four principles of sustainability: -
reduce heat loss or gain and be naturally ventilated wherever possible. Functionality in use: is the building fit for purpose, or even better, does it use know-how and innovation to provide business and social value? Does it optimise the operational cost of core
The use of sustainable materials should be used in the construction. Life cycle costs should be
services and, in particular, the productivity of staff?
given careful consideration when choosing materials.
Prudent use of natural resources, and
Build quality: is the building built on whole life cost principles – built to last and easy to
Wherever possible and practical use of renewable energy sources should be adopted to ensure
Maintenance of high and stable levels of economic growth and employment.
maintain?
the hospital is still operating within reasonable energy limits in 2040.
■
Social progress, which recognises the needs of everyone
■
Effective protection of the environment
■ ■
During the Outline Planning phase, the Trust has produced a comprehensive Environmental
Efficiency and sustainability: is the building designed in a way that it will be completed on (or
Impact Assessment, transport and travel studies.
before) time, to budget and to specification? Is the building environmentally efficient, in terms of where it is located, how it has been constructed and how it will be used?
The Trust when compiling its Environmental Impact Assessment liaised with: Designing in context: is the building respectful of its context, strengthening the identity of the ■
GOSE (Government Office South East),
■
Kent County Council
■
The Highways Agency
Design and Construction
■
SEEDA
Item 3 above is inscribed within the NHS Estates document ‘Sustainable Development in the
■
The Environment Agency
NHS’ and is a principle supported by the Trust. During the development stages, thus far the
■
English Nature
Trust’s team have studied various strategies to reduce energy consumption, which are set out
■
English Heritage
below. The report that provides guidance and looks at alternative, renewable energy sources
■
Forestry Commission
from biomass, photovoltaic electricity generation and windpower.
■
RSPB
■
Kent High Weald Project
Biomass
■
The Countryside Agency
The study has shown that while this is possible the amount of physical space required to store
neighbourhood in its landscape?
the material together with the frequency of fuel deliveries and the relative cost of the materials Previous PFI projects, such as the Great Western in Swindon, have demonstrated that investing
makes this unviable at the present time due to lack of space and no commercial benefits.
to deliver environmental improvements can also deliver best value for money through lower running costs, and importantly through health and social benefits such as better working
Photovoltaics
conditions, conserving resources, preventing/reducing waste and reducing pollution, both
The PSC design does allow for the use of these cells as part of the terraces. The study has
during construction and during the life time of the project.The Trust’s team developed design
indicated that while these cells are still relatively expensive in the UK it is possible to install
concepts on running a low energy consuming hospital. The Trust will encourage bidders
them with a medium to long term payback of 50 years. There are a number of funding schemes
innovation in sustainability.
available, such as the Department of Trade & Industry’s £20m first phase of the photovoltaic (PV) demonstration programme. Up to 60% of the total installation costs can be recovered and this
The Trust will use the NHS Environmental Assessment Tool (NEAT) to understand, identify and
may be a deciding factor. On a strict commercial basis, this may not be sufficient to encourage a
take action, to reduce and limit negative impacts on the environment.
PV installation, at this point in time. However, it is important to encourage a building that can be easily retrofitted with such devices at some time in the future.
The Trust/project team will complete the parts of the NEAT assessment that are within their control such as site transport and social issues. The NEAT requirement will be one of the tender
Windpower
selection criteria under ITN (Invitation to Negotiate) and will include the mandatory energy
While this is a well proven method of generating power, there are a number of planning
Performance Indicators (PI’s) for new buildings within NEAT.
constraints on this site that would prohibit its use.
Enhancing the environment will increase outputs and add to the quality of service. In doing so, the Trust will be able to attract both users and staff to the new facilities.
A New District General Hospital for Tunbridge Wells
36
Design Review
Key Stages
Master Programme
Summary of key project dates:
Act ID
Description
Rem Duration
Early Start
Early Finish
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
General Summary Key Stage
Time Scale
Service Review
1999 - 2000
SOC
2000
SOC Approval Clinical Planning
Feb 2001 Jan 2003
OBC Submission
Mar 2004
OBC Approval
May 2004
OJEU
May 2004
Shortlist to 4 Bidders
August 2004
Shortlist to 2 Bidders Appointment of Preferred Bidder
Design & Procurement
Feb 2005 Aug 2005
Current Stage of Project
1000
Complete Non - Clinical Service requirements
13w
01APR04
30JUN04
Complete Non - Clinical Service requirements
1010
Complete Clinical policies - scheduling & review
11w
01APR04
16JUN04
Complete Clinical policies - scheduling & review
1030
PSC finalisation
13w
01APR04
30JUN04
PSC finalisation
1040
Initial Site Surveys & reports
29w
01APR04
20OCT04
1055
NHS Design Review
0
19APR04 *
1060
Prepare MOI/ Collate PITN
1070
OBC Sign Off
1080
PFI OJEU notice published
1090
OJEU to Financial Close (inc FBC Approval)
1100
Design & Procure Enabling Works packages
52w
1110
Trust Dispatch PQQ
0
24JUN04
1120
Trust dispatch PITN to 4 shortlisted bidders
0
05AUG04
1130
Trust shortlist bidders to 2
0
03FEB05
1140
Trust dispatch FITN to 2 shortlisted bidders
1w
03FEB05
1150
Selection of Preferred Bidder
0
17AUG05
1160
Financial Close
0
Initial Site Surveys & reports NHS Design Review
13w
28APR04 *
0
19MAY04 *
27JUL04
0
20MAY04 *
104w *
20MAY04
16MAY06
23SEP04
22SEP05
Prepare MOI/ Collate PITN OBC Sign Off PFI OJEU notice published OJEU to Financial Close (inc FBC Approval) Design & Procure Enabling Works packages Trust Dispatch PQQ Trust dispatch PITN to 4 shortlisted bidders Trust shortlist bidders to 2
09FEB05
Trust dispatch FITN to 2 shortlisted bidders Selection of Preferred Bidder Financial Close
16MAY06
Construction Headlines Enabling Works
1170
Enabling Works
68w
25JAN05 *
16MAY06
1180
Construction Phase 1 (Main Hospt)
194w
17MAY06
17FEB10
Construction Phase 1 (Main Hospt)
1190
Trust Fit Out & Commissioning
26w
24NOV09
26MAY10
Trust Fit Out & Commissioning
1200
Construction Phase 2 (Car Parks)
85w
30DEC09
18AUG11
68w
25JAN05
16MAY06
FBC Submission
Feb 2006
FBC Approval
May 2006
Enabling Works
Financial Close
May 2006
Phase 1
Start Construction
May 2006
Construction Phase 2 (Car Parks)
Construction Details 1210
Hospital Operational ‘Top Site’ (car parking, etc) Completion Post Project Evaluation
Mid 2010 Mid 2011 2012
Enabling Wks (diversions,decant,asbestos,demol.)
Enabling Wks (diversions,decant,asbestos,demol.)
Start on Site - Main PFI Works
1220
Start on Site - Main PFI Works
0
17MAY06
1230
Structural Groundworks
64w
17MAY06
13AUG07
1240
Mental Health: Construct, Commission & Occupy
104w
12OCT06
16OCT08
Mental Health: Construct, Commission & Occupy
1250
Main Hosptital Superstructure Works
111w
23NOV06
19JAN09
Main Hosptital Superstructure Works
1260
Finishes and Fit Out
130w
17JUL07
20JAN10
Finishes and Fit Out
1270
Commissioning
45w
10MAR09
20JAN10
Commissioning
1280
Practical Completion of Phase 1 Works
0
21JAN10
1290
Trust Fit Out & Commissioning
26w
24NOV09
26MAY10
1300
Occupation of new hospital
19w
30DEC09
12MAY10
Structural Groundworks
Practical Completion of Phase 1 Works Trust Fit Out & Commissioning Occupation of new hospital
Phase 2 1310
Decant Clinical Areas (mostly into new hospital)
10w
30DEC09
10MAR10
1315
Strip out & Demolish all buildings on upper site
26w
30DEC09
30JUN10
1320
Car Parks, Upper Road, Final Landscaping
85w
30DEC09
18AUG11
1330
Substantial Closure of Kent & Sussex Hospital
0
11MAR10
1350
Practical Completion of Phase 2 Works
0
Number/Version Run date
68444/58 29MAR04
© Primavera Systems, Inc.
Decant Clinical Areas (mostly into new hospital) Strip out & Demolish all buildings on upper site Car Parks, Upper Road, Final Landscaping Substantial Closure of Kent & Sussex Hospital Practical Completion of Phase 2 Works
18AUG11
Maidstone and Tunbridge Wells NHS Trust Redevelopment of Pembury Hospital Master Programme Summary
A New District General Hospital for Tunbridge Wells
37
Design Review
Conclusion
The Trust recognises that good design is fundamental to achieving high quality public buildings. We therefore seek a design that will be functional, of high quality, efficient and sustainable, has good relationship with its surroundings and is aesthetically pleasing. We believe that a well designed hospital will help patients recover their health and spirit. A well designed hospital will provide a pleasant working environment for our staff. A well designed hospital will also bring the communities together and engender civic pride. It is this vision that the Trust now aspires to achieve.
Rose Gibb Chief Executive
A New District General Hospital for Tunbridge Wells
38
Design Review
Authors The Trust The Maidstone & Tunbridge Wells NHS Trust
Rose Gibb - Project Sponsor
Pembury Hospital
Chris Turner - PFI Project Director
Tonbridge Road
Laurence Bunnett - PFI Project Manager
Pembury
Carolyn Lewis - PFI FM Project Manager
Kent TN2 4QJ
Sue Martin - PFI Project Assistant Dawn Hollis - PFI Clinical Planner
Technical Advisor ARUP Project Management
John Seaman - Project Director
13 Fitzroy Street
Don Barron - Project Manager
London W1T 4BQ
Chris Cocks -Electrical Engineer / Co-ordinator Peter Bull - Mechanical Engineer Peter Schneider - Structural Engineer Laurie Richards - Environmental Consultant Mark Smith - Town Planning Team Leader Clive Wilson - Cost Planning Tom Honnywill - Project Planning Stuart Jenkins - Transport Engineer Alistair Morrison - Fire Engineer
Architect Nightingale Associates
Claire Stenton - Executive Director
The Cherry Barn
David Clarke - Healthcare Planner
High Street
David Cannon - Director
Harwell
Mick Gittins - Architect
Oxon OX11 0EY
Bryan Graham - Architect James Newcombe - Graphic Designer
Health Planner Adams Consulting Group
Kathryn Stephen - Healthcare Planner
Kingfisher House 1 Riverway Great Shefford Hungerford Berks RG17 7HX
A New District General Hospital for Tunbridge Wells
39