Case Notes - Client Leadership by Architecture + Design Scotland - Health Programme

CASE NOTES: Client Leadership C a s e s t u d i e s o n t h e ro l e o f t h e c l i e n t i n t h e d el i v e r y o f e x em p l a r y h e al t hc ar e b u i l d i ng s .

Foreword

There is a growing recognition that good design in healthcare buildings makes a measurable difference to the experience of patients, staff and visitors. A well designed environment can make attending a healthcare facility less stressful, improve health outcomes, increase efficiency and lower staff turnover. Such benefits are not only felt by the people using the building but can also contribute towards efficiencies in the operational costs of the services being delivered - a well designed building uses resources more efficiently, costs less to run and maintain and is more readily adapted as service needs evolve and change. Dr Kevin Woods Director General Health Chief Executive NHSScotland

â&#x20AC;&#x2DC;Better Health Better Careâ&#x20AC;&#x2122; sets out a flagship vision for healthcare in Scotland, requiring new models of care and new buildings in which to deliver this agenda. It presents an Action Plan for NHSScotland for the next 5 years which sets the agenda around improving health and wellbeing, reducing health inequalities and achieving the highest quality in healthcare services through a range of actions, including a renewed focus on integrated and responsive health services which put the patient at the centre of the planning, provision and delivery of services. Patient experience is therefore now central to the design of healthcare environments. This ambition has been recognised through the Policy on Design Quality for NHSScotland, setting out the requirement for Health Boards to appoint their own Design Champions to ensure that good design is enshrined as an essential aspect of any new capital project. Through this recognition, we have an unprecedented opportunity to shape a healthier, more compassionate and sustainable Scotland through the quality of the buildings and environments created for the NHS. What we build now can and should provide patientfocused healing environments of a quality that we can be proud of and that can support healthcare delivery for the decades to come.

Foreword

Key to the realisation of this potential are the estates and facilities professionals within Health Boards who work to get the best from our existing assets and lead the procurement of new works. These important people need to be supported in this endeavour both by their boards and by the best skills and efforts available from our construction industry. As part of our Framework Agreement with Architecture and Design Scotland, we have agreed to prepare this document to assist those professionals involved in the procurement, planning and development of our new healthcare facilities. The document provides examples of how some of the most successful clients of recent healthcare buildings in the United Kingdom have, through strong leadership and determination, delivered facilities that provide an uplifting environment for patients, visitors and staff and I urge those leading the procurement of our new healthcare buildings to embrace these principles and take inspiration from the case studies contained within this document.

Contents

Introduction

What is good design?

Why is good design important?

How do clients deliver good design?

Case note 01 John Cole – Health Estates NI

Case note 02 Sylvie Pierce – Building Better Health

Case note 03 Malcolm Aiston – Northumberland, Tyne and Wear NHS Trust

Case note 04 Laura Lee – Maggie’s Cancer Caring Centres

Case note 05 Patricia Pope – Lewisham Primary Care Trust

Case note 06 Richard Glenn – Alder Hey Children's NHS Foundation Trust

Case note 07 Tony Curran – NHS Greater Glasgow and Clyde

Conclusions

Introduction

Good places aren’t created by accident. Those which support staff in their working practices, which make us feel comfortable and reassured and provide us with privacy and dignity in the hustle and anonymity of a healthcare environment are not the happy side effect of a singular concentration on programme and budget. They are the result of an evolutionary process whereby design is used to interrogate and develop our understanding of our needs and to imagine a form to house and support them.

Gareth Hoskins Scotland’s Healthcare Design Champion

Maggie’s Highlands Photo: MCCC

Our very human needs are best cared for in places with access to daylight, fresh air and landscape. To capitalise on these wins, healthcare clients must pursue them as goals from the outset. This publication is intended to both inspire and inform client teams within NHSScotland. Often overlooked, these professionals have an essential role in delivering the Government’s ‘Better Health Better Care’ agenda, which envisages a sea change in healthcare provision in Scotland and will require a re-examination of the estate within which the NHS operates. These healthcare projects can only be successful with the support of good, well-resourced client and design teams. Here we celebrate the clients behind some of the most successful healthcare buildings recently established in the United Kingdom and learn lessons from their hard work and leadership. Each client has delivered award-winning buildings; places that lift the human spirit and support our wellbeing; healthcare facilities that embody the ethos of the NHS and offer its users an ‘architecture of hope’.

What is good design?

The effects of new buildings reach far beyond their immediate physical environment. Well-designed buildings and public spaces enhance and enrich people’s lives. There is growing recognition, backed up by research, that good design in healthcare buildings makes a measurable difference to the experience of staff, patients and their families. A well-designed environment can make attending a healthcare facility less stressful, improve health outcomes, increase efficiency and lower staff turnover. Such benefits are not only felt by the people using the building; they can amount to significant savings for its operator.

The term ‘good design’ is not a question of style or taste but a coherent, intelligent and creative response to a range of factors including: strategic planning of healthcare provision; social and physical regeneration; the local urban (or rural) context; links to infrastructure and transport; sustainability agendas; the building’s sense of welcome; intelligibility of layout; security; unobtrusive supervision; ease of use and maintenance; efficiency; and promotion of human dignity. It covers the myriad ways in which buildings sit within – and contribute to – their communities, as well as how they work and look. Heart of Hounslow Photo: JAM

Successful healthcare design resolves a wide range of functional requirements efficiently while providing an uplifting environment for patients, visitors and staff. Such places can only be realised if there is a commitment at the highest level in each Health Board to support a context-sensitive, high quality design approach for every development. Delivering design quality requires strong local leadership.

Why is good design important?

W h a t i t m e a ns f o r p at i en t s an d t h e w i de r p u bl i c The experience of patients and their involvement in the service is central to the way in which the new mutual NHS operates. A recent Mori poll found that 76% of Scots believe that well designed hospitals could aid patient recovery and there is increasing evidence to support this belief.

Research published by NHS Estates in 2003 (The Architectural Healthcare Environment and its Effects on Patient Outcomesi) linked well-designed hospitals to reduced treatment times. In this study, treatment times for mental health patients were shown to have been cut by 14% and those for medical non-operative patients by 21%. The aspects of design these effects were attributed to were not esoteric, but generic place-making factors such as views, privacy and control over one’s own environment. Clear entrances and routes were identified as reducing stress among visitors, lessening the anxiety associated with hospital visits.

Maggie’s London Photo: MCCC

A further study published in 2004 (The Role of the Physical Environment in the Hospital of the 21st Century : A Once-in-a-Lifetime Opportunityii) showed additional benefits from good design in lowering patient stress by noise reduction, improving opportunities for sleep and lowering perceived pain levels, reducing the need for analgesia and speeding up post-surgery recovery through positive distractions. Importantly, access to gardens was seen as immensely beneficial to patients and their families – providing social support, positive escape and a sense of control over one’s own environment.

Why is good design important?

W h a t i t m e a n s f o r N H S s t a ff In the 2004 study, the experience and behaviour of healthcare professionals was shown to be significantly affected by building layout, proving that staff stress, effectiveness and satisfaction can all be influenced by design factors. The layout of in-patient bedrooms and the location of en-suite facilities, for example, can increase opportunities for staff to wash their hands between seeing patients (thereby assisting in reducing the incidence of hospital acquired infections) and – by determining the distance walked by staff – impact on their ability to observe patients. In the study, gardens were also shown to benefit healthcare workers, who used them for escape and recuperation from stress. Figures provided by CABE's ‘Healthy Hospitals’ campaigniii, in association with the Royal College of Nursing, state that: > 90% of Directors of Nursing say that patients behave better towards staff in well designed wards and rooms.

> 87% of nurses believe that working in a well designed hospital would help them do their job better. Royal Alexandra Children’s Hospital Photo: David Barbour

> 74% of nurses maintain that the quality of a hospital building, its setting and interiors makes a significant difference when looking for a new job, rising to 84% for 18-29 year old nurses.

Why is good design important?

T h e w i d e r i n f l u e n c e o f h e a l t h c a re b u i l d i n g s In research carried out by the Urban Task Force Towards an Urban Renaissance 1999v, 85% of people surveyed felt that the quality of public space and the built environment has a direct impact on their lives and on the way they feel. In designing a building and external environment that is welcoming to patients and staff, the opportunity exists to contribute to the wider public realm, given that the first impression of a building (and therefore the services it provides) is from out with the site and very much tied up with how the design responds to local scale and character.

In an increasingly carbon-conscious climate, what and how we build has even wider implications and there is a greater urgency to minimise the environmental impact of running and maintaining the built estate. Indeed the Chief Executive of NHSScotland is required to report to the Government on progress in reducing emissions. New buildings need to be sited to maximise the use of natural resources such as daylight and ventilation in an intelligent manner â&#x20AC;&#x201C; using the form, orientation and fabric of the building to minimise the need for mechanical systems which are expensive to operate and maintain.

Royal Alexandra Childrenâ&#x20AC;&#x2122;s Hospital Photo: David Barbour

Why is good design important?

W h a t i t m e a ns f o r t h e he a l t h s e r v i c e Each of the aspects described has a clear financial consequence, whether that be the cost of maintaining the facility, or increasing the number of patients that can utilise each bedspace, or increasing staff health and satisfaction (thus affecting the costs associated with sick-leave and recruitment). There are also any number of 'hidden' benefits to be gained from good design â&#x20AC;&#x201C; the 2004 studyiv referred to earlier cited a 600 bed hospital where clinical staff spent 4,500 hours per year assisting hospital visitors with wayfinding rather than carrying out their duties; the annual cost of wayfinding was calculated to be more than $220,000 per year ($448 per bed space) in 1990.

It is becoming clear that good design does not cost the health service more. In fact, if anything, it is more likely to save money over the whole lifecycle of an efficient, inspiring and patient-focused estate.

Kaleidoscope Photo: Nick Kane

â&#x20AC;&#x153;Good design may initially cost a little more in time and thought, although not necessarily in money. But the end result is more pleasing to the eye and more efficient, costs less to maintain and is kinder to the environmentâ&#x20AC;?. (Lord Reavi)

How do clients deliver good design?

The following case studies consider how seven client bodies have approached the procurement of recent healthcare buildings that are widely considered to be exemplary. The studies are based on interviews with some of the key people responsible for delivering these buildings and an evaluation of the results by A+DS, with particular emphasis on the client management of the processes involved.

As with most projects, the clients have learned lessons from the commissioning of their buildings and would â&#x20AC;&#x201C; in some cases â&#x20AC;&#x201C; do things differently in future. For the most part though, they excel as strategists, with their buildings being shining examples of how good design can enhance the modern health service and their approach recognised in various national award schemes.

Maggieâ&#x20AC;&#x2122;s Highlands Photo: MCCC

01.

J o hn C o l e, C hi e f E x e c ut i v e , H ea l t h E s t a t e s N I

Project Name: Project Type: Client: Architects: Completed: Location: Funding: Value: Procurement Type:

Carlisle Centre Community Care and Treatment Centre North & West Belfast NHS & Social Services Trust Penoyre & Prasad/Todd Architects 2007 Belfast city centre North & West Belfast NHS & Social Services Trust £9.2m Performance Related Partnership

Project Name: Project Type: Client: Architects: Completed: Location: Funding: Value: Procurement Type: Awards:

The Arches Centre Community Care and Treatment Centre South & East Belfast NHS & Social Services Trust Penoyre & Prasad/Todd Architects 2005 Belfast city centre South & East Belfast NHS & Social Services Trust £11m Performance Related Partnership 2004 Building Better Healthcare Awards, Winner ‘Best use of art’ 2006 RIBA award 2006 Health Estates Recognising Design Merit, ‘Certificate of Merit’ 2006 Building Better Healthcare Awards, Winner ‘Best primary or Community Care Design 2008 Civic Trust Awards Commendation

Case note 01

I n t ro d u c t i o n John Cole The Arches Centre and Carlisle Centre

John Cole is Chief Executive of Health Estates, an Executive Agency of The Department of Health, Social Services and Public Safety (DHSSPS) in Northern Ireland. A respected architect, he is the Department's designated champion for both design and sustainability and sits on its management board. In this crucial capacity, he is responsible for capital project procurement policy and his team of 120 staff are directly involved in all projects over £1m. Through this system, and his personal knowledge, passion and flair, he has embedded the importance of good design in both policy and practice, most notably in combined Community Care and Treatment facilities such as The Arches Centre and Carlisle Centre, Belfast. The projects are part of a wider investment in the healthcare estate in Northern Ireland which plans to create over 40 similar centres throughout the country. They were commissioned by the Health and Social Services Trusts of South and East Belfast and North and West Belfast respectively, though the Trusts are now amalgamated. The brief was to create centralised facilities for the promotion of wellbeing at the heart of the community. This has succeeded in generating two truly holistic centres, where “care” does not simply mean the provision of health and social services but extends to civic initiatives such as Citizens Advice. Costing just over £20m in total, both facilities were procured by Health Estates on behalf of, and in cooperation with, the client body Trusts. Maximising the benefits of Performance Related Partnering, they were delivered by the same design team of Penoyre and Prasad in collaboration with Todd Architects over an 18 month period, from November 2005 to May 2007. They are widely recognised as exemplars of their type, with The Arches Centre (the earlier of the two buildings) winning national accolades from both the Royal Institute of British Architects and Building Better Healthcare.

Case note 01

D es cr i p t i o n The Arches Centre Photo: Dennis Gilbert/View

The Arches Centre and Carlisle Centre are located in Belfast, a city recovering from sustained social unrest and associated damage to its built environment. They are driven by a set of common aspirations resulting from the key role of Health Estates in the briefing process. At their heart is John Cole’s recognition of the impact of good design on healthcare outcomes, staff retention and civic pride. The Arches Centre in particular demonstrates a positive effect on its urban context. Through major extension and refurbishment, it gives a 1960s building a rejuvenated civic presence, with white render and coloured panelling creating a cheerful, modern identity. It is noticeable that – in an otherwise neglected urban fabric – the building remains unspoiled, four years after completion. It is located next to a public transport hub. The key design concept behind both buildings is the logical arrangement of services around an internal central courtyard. This aids clear wayfinding between the range of facilities on offer, which in the case of the £11m Arches Centre includes purpose-built accommodation for 22 GPs, occupational therapy and dentistry. It also provides generous public space in a calm and respectful internal environment. Art has been treated as integral to the design of both buildings from the outset. Externally, specially commissioned elements include entrance screen glazing, grills and sculpture. Internally, individual pieces and works in series are rendered in a variety of styles, drawing on the input of the community. They have both practical and aesthetic functions. The success of the buildings is apparent from both critical acclaim and first-hand observation. The Arches Centre has won three national design awards, including one for 'best use of art', and its easy to see how its strengths have informed the Carlisle Centre. This is a clear advantage of the Performance Related Partnering route, which – dependent on good performance – allows for the appointment of the design and/or construction teams on further projects without competition.

Case note 01

P r o c u r e m e n t p ro c e s s The integrated Community Care and Treatment Centres were procured via Performance Related Partnering, a model devised by Health Estates to focus on the achievement of design and construction quality, ongoing performance and assured value for money. The process is based on the Agency's willingness to pay what it considers to be the right price for the right building. Health Estates performed an enabling role, acting as 'informed client' for the two Health and Social Services Trusts. They adopted a value (rather than cost) based approach, setting fees in advance of the design team selection at a level which they thought would best allow bidders to adequately resource projects.

The Arches Centre was the first building to be procured and was subject to a rigorous selection process. The Official Journal of the European Union (OJEU) notice highlighted the partnering nature of the commission and the potential for further work (e.g. the Carlisle Centre). Six design practices were short-listed using clearly specified criteria. Chief among these were creativity, relevant experience and ability to deliver. The majority of bidding teams consisted of more than one architectural practice. Carlisle Centre

Over a relatively short timeframe, the six design teams were asked to produce a high-level response to the brief, prepared by Health Estates in close collaboration with the userclient Trust. This was an opportunity to demonstrate flair and a broad-brush approach to aspirations. The successful team was then selected on the basis of a competitive design interview (the fee having already been set). The project was developed up to approximately RIBA Stage D, a process which involved iterative refinement of the brief and the production of a full performance specification. The latter confirmed all aspects of required quality, at which point a Works Cost Limit (WCL) was set. This was then audited by an independent quantity surveyor to ensure that it represented value for money.

Case note 01

OJEU advertisement of the construction phase produced a short-list of contractors with the capacity to deliver the building to the agreed quality and programme within the Works Cost Limit. Each was invited to propose how they could bring added value to the project, with the highest scoring appointed as 'preferred contractor'. This was further to the submission of a guaranteed maximum price (again within the WCL) and collaboration with the clientâ&#x20AC;&#x2122;s design team during detailed design development. At this stage, the contractor identified any opportunities for cost savings below the Works Cost Limit which were split 50/50 with the client on a quality proviso.

Post engagement of the 'preferred contractor', independent design reviews were carried out at predetermined intervals, with the project proceeding only after the results from one panel were tested at the next. Approximately three months before completion, a final review took place to assess the building's readiness for service. This was perceived as critical in regard to the familiarisation and training of staff.

The Arches Centre Photo: Dennis Gilbert/View

Under the terms of Performance Related Partnering, post-occupancy evaluation is mandatory for all healthcare projects. Following completion of The Arches Centre, assessments were made of both the design and construction teams to determine suitability for re-appointment. Satisfaction with the standards achieved enabled Health Estates to proceed with delivering the Carlisle Centre without recourse to further competition. The ÂŁ9.2m project was completed 18 months later in May 2007.

Case note 01

Su m m a r y For a country of only 1.7m people, Northern Ireland is currently producing healthcare buildings of unprecedented quality. Beyond the design and contractor teams involved in exemplar buildings such as The Arches Centre and Carlisle Centre, credit is due in no small part to the leadership of John Cole and the skills and tenacity of his 120-strong team.

Under Northern Ireland Government policy, all capital projects must be procured through an accredited Centre of Procurement Excellence (COPE). As a COPE, Health Estates has earned the responsibility to ensure the most effective procurement route for healthcare projects and to develop appropriate methodologies such as Performance Related Partnering (PRP). This is a significant task and one made all the more considerable by both the scale of the healthcare building programme in Northern Ireland (£3.3bn of development over the next 10 years) and the level of specialist support that Health Estates provides (direct involvement in every project over £1m).

Carlisle Centre

The success of Health Estates is surely attributable to the way that the Agency is resourced and led. Recruiting 'hands on' professionals such as architects, engineers, surveyors and health facility planners has built a team that can engage effectively with designers and contractors, assigning tasks to those most skilled to undertake them. In keeping with the collaborative spirit of PRP, it has fostered an atmosphere of trust, where the architects have the freedom to concentrate on the overall design concept and placemaking and the Agency can utilise its technical know-how in developing appropriate functionality. It is currently, for example, exploring the off-site manufacture of standardised room types with integrated services - “islands of functionality floating in a sea of creativity”, as John Cole refers to them.

Case note 01

Health Estates is attuned to private sector skills and innovation but is rooted in the heart of the public sector. Just as the team can work collaboratively with designers, so too can they liaise effectively with the user-client Trusts, particularly in the preparation of briefs. Their experience allows them to share leading-edge thinking between different client bodies and to help each client challenge pre-conceived solutions. Continuous experience of 'live' projects has enabled them to refine and standardise several key briefing tools, such as functional room layouts.

Health Estates requires that individual design champions from within both the client body and design team are assigned to all projects. For these flagbearers, John Cole provides obvious vision and leadership. His fundamental commitment to the value of good design underpins a review programme in which projects are appraised up to five times. He personally contributes to the process and also ensures the involvement of nationally recognised experts in independent reviews at key project stages.

The Arches Centre Photo: Dennis Gilbert / View

While Performance Related Partnering in itself cannot guarantee a good building, it must surely improve the likelihood of success. Perhaps the main reason for this is that the people who use the process day-to-day have been instrumental in devising it. As a unit, they share the desire to procure good buildings and – through demonstrable skill – have achieved the autonomy to shape the tools for their job. PRP seems intrinsically linked, then, to the expertise and confidence of the procuring professionals, especially in exercising a value rather than cost-based approach. An inexperienced or non design-led project manager might find it easier – and more 'accountable' – to back off from the design process and select their methodology on the basis of the (apparently) cheapest route. The trade-off is often a weakened relationship between architect and client, a reliance on the contractor for what are often poor design skills and an underestimation of the 'cost in use' of healthcare buildings which – over a lifetime – can be between 50 and 200 times the cost of initial construction.

Case note 01

John Cole The Arches Centre and Carlisle Centre

As for the buildings themselves, success is undoubtedly measurable by their sense of permanence within the community. They are light, spacious and people-friendly. Their roof-top staff rooms provide respite from the work environment; their gardens are relaxing for patients to visit. They are made of robust materials and their layouts are flexible and well-considered. Thought has been given as to how individuals of all age groups and backgrounds will perceive and use them, public and staff alike. They are welcoming, safe and pleasant, with comfortable, well subscribed cafĂŠs. In both social and economic terms, their service to the local community extends (as do their opening hours) far beyond the normal 9 to 5.

Carlisle Centre

02.

Sy l vi e P i er ce , C h i ef Ex ec u t i ve , Bu i l d i n g B e t t e r H e al t h

Project Name: Project Type: Client: Architects: Completed: Location: Funding: Value: Procurement Type: Awards:

Heart of Hounslow Polyclinic Primary Care Trust of Hounslow Penoyre & Prasad 2007 Hounslow town centre Primary Care Trust of Hounslow £18m LIFT 2007 Building Better Healthcare Awards, Commendation ’Best Primary or Community Care Design’ 2007 Winner Best Public Building Award, Hounslow rewarding design 2007 BD Health Architect of the Year (awarded to Penoyre and Prasad for projects including Heart of Hounslow)

Project Name: Project Type: Client: Architects: Completed: Location: Funding: Value: Procurement Type: Awards:

St John’s Therapy Centre Therapy Centre Primary Care Trust of Wandsworth Buschow Henley 2008 Wandsworth town centre West London Ltd £8m LIFT 2007 AIA/UK Excellence in Design Award Commendation 2008 BD Health Architect of the Year (awarded to Buschow Henley for projects including St John’s Therapy Centre) 2008 Civic Trust Award Commendation 2008 Wandsworth Design Award

Case note 02

I n t ro d u c t i o n Sylvie Pierce Heart of Hounslow and St John's Therapy Centre

'Design Champion of the Year' in 2008, Sylvie Pierce is Chief Executive of Building Better Health (BBH), an award-winning development company that specialises in healthcare projects commissioned through the NHS LIFT initiative in Greater London. BBH is the designated Private Sector Partner (PSP) and majority stakeholder in three LIFT ventures: West London Ltd; South West London Health Partnerships Ltd; and Lambeth Southwark Lewisham Ltd. Building Better Health's aspiration is to combine the values of the public sector with the expertise and innovation of the private. Its objective – founded on Sylvie's personal vision – is to deliver “outstanding public service buildings that surprise and delight”. Backed by a growing evidence base, Sylvie is passionate about the benefits of good design in the healthcare estate and believes that 'new generation' NHS facilities should have the status of respected civic edifices such as libraries and town halls. St John's Therapy Centre is one of BBH's first realised projects and Heart of Hounslow (HOH) its largest to date. Both are integrated care centres bringing together a wide range of community-focused health and social services. Each new building replaces a redundant facility on an urban site and plays an important role in enhancing the public realm through striking landmark design. This has been recognised in several award schemes, from national campaigns such as Building Better Healthcare and The Civic Trust to Local Authority initiatives. HOH and St John's were procured for the Primary Care Trusts of Hounslow and Wandsworth respectively at a cost of £18m and £8m. In each case, the level of user and critical acclaim has contributed to the designers securing 'Healthcare Architect of the Year' status: Penoyre and Prasad in 2007; and Buschow Henley in 2008.

Case note 02

D es cr i p t i o n Heart of Hounslow Photo: Dennis Gilbert / View

LIFT development is largely focused on urban areas where the existing healthcare estate is deemed to be in urgent need of repair. Situated in the London Boroughs of Hounslow and Wandsworth respectively, both Heart of Hounslow and St John’s Therapy Centre provide visual legibility to busy urban environments and aspirational focus to communities. Heart of Hounslow replaces an existing health centre on the site of a former hospital. Fronting onto a main road, it is accessed from a new public square. Its impact on the streetscape is maximised by grey terracotta cladding and a three storey glazed atrium. At 9,000m2, the building is one of Europe’s largest integrated care centres. Known as a ‘polyclinic’, it expands on the uses of the former health centre to bring in services operated by the Local Authority, as well as the PCT. It is laid out over six floors with a total of twelve departments. The building plan is flexed to accommodate the full-length atrium, which is the key circulation space and home to a ground floor café. Strips of coloured glazing give it a cathedral-like quality. St John’s Therapy Centre has a similarly diverse brief. As well as two GP practices, it houses a number of community-based therapy services and a mental health unit. It is laid out over four storeys and – while having a real presence on the street – is predominantly focused on two internal courtyards. Together with a roof terrace, these bring daylight into cloistered spaces which are designed for intuitive wayfinding. Buschow Henley have thought carefully about the flexibility of St John's, introducing standardised rooms that can be reconfigured with partitions. Clinical accommodation has been 'clustered' and each floor organised into 'front-' and 'back-of-house' areas. The proportions of the building are designed to give it the status of a grand civic edifice but the space lends itself to the intimacy of a therapeutic environment.

Case note 02

P r o c u r e m e n t p ro c e s s The procurement of LIFT buildings starts with a wider competitive process: that of a private enterprise bidding to become the Private Sector Partner (PSP) of a LIFT company. Thus the story behind the procurement of Heart of Hounslow, for example, starts with Building Better Health being chosen by various public stakeholders to join the partnership now known as West London Ltd.

The Department of Health announced the third 'wave' of LIFT projects in August 2002. In December that year, the Primary Care Trusts and London Boroughs of Ealing, Hammersmith & Fulham and Hounslow came together with West London Mental Health NHS Trust and the London Ambulance Services NHS Trust to advertise for the procurement of a Private Sector Partner in the Official Journal of the European Community (now the Official Journal of the European Union). They were joined by Partnerships for Health, which since late 2007 has been known as Community Health Partnerships.

Heart of Hounslow Photo: Dennis Gilbert / View

The advertisement drew responses from eight private sector organisations who believed they had the expertise necessary to work with public stakeholders in rejuvenating the primary care estate in West London. This was based on a remit to co-ordinate the design and delivery programme, a task which would include both sourcing and managing the design and construction teams. A pre-qualification questionnaire was issued to assess the organisations' technical capability and a long-list of six bidders drawn up. Each was asked to provide a written response to a series of questions focused on more local issues and then to attend an interview. Three bidders were adjudged to have offered strong proposals and invited to engage in the Intention to Negotiate (ITN) stage. This was effectively a competition which required the bidders to submit design proposals for three sample schemes (including Heart of Hounslow) and to respond to specific financial, legal, commercial and partnering questions.

Case note 02

Evaluation of the bids involved a stakeholder group beyond what was already a multifaceted partnership of LIFTCo members and advisers, bringing in the views of local NHS staff and members of the public. Scoring was based on a nationally agreed evaluation matrix, with bid quality deemed to be sufficiently high for all bidders to achieve a “passmark”. This negated the need for a Best and Final Offer (BAFO) stage. Building Better Health scored highest in four of the six categories and was appointed 'preferred partner' in August 2003, thus completing the partnership known as West London Ltd.

Heart of Hounslow's design and construction team consisted of Penoyre and Prasad and Willmott Dixon. Both had been working with BBH since its establishment in 2003 and – together with Buschow Henley (designers of St John's Therapy Centre) – remain on its list of supply chain partners.

St John’s Therapy Centre Photo: Nick Kane

The design process continued in the spirit of partnership established during bidding. Through consultation with Hounslow Primary Care Trust, its 'grassroots' staff, service users and the community, the preferred design was refined and tested. Given the sheer size of the scheme, Penoyre and Prasad faced an aesthetic and functional challenge to achieve what is an efficient, coherent and landmark design. In April 2004, planning permission was granted and – together with a smaller scheme for Ealing PCT – Heart of Hounslow achieved Financial Close in March 2005. Work started on site three months later (with Penoyre and Prasad novated to Willmott Dixon) and in December 2007, over four years after BBH were appointed as PSP, the building was officially opened.

Case note 02

Su m m a r y Building Better Health's aim is to create “outstanding public service buildings” that reflect the value of good design. Through the integration of function and architectural expression, the company has elevated projects like Heart of Hounslow and St John's Therapy Centre to the status of respected civic buildings. This represents the best of the LIFT initiative, which aims to make the healthcare estate not only more efficient but accessible and inspiring to local communities.

From the outset, the Building Better Health (BBH) team have had very clear objectives. They limit their scope to a concentrated geographical area (Greater London) and have put in place a network of preferred supply chain partners with local knowledge and a track record on delivery. This has enabled them to offer a vast array of services, including subcontracted skills like design, construction and health planning.

Heart of Hounslow Photo: Dennis Gilbert / View

In contrast to the drawn-out process involved in attaining PSP status, the company selects its own partners in a much more streamlined way.... “nothing very scientific”, as Sylvie Pierce puts it. This is an unexpected freedom in the LIFT process and one taken advantage of by BBH to build an interesting team that has always been consciously restricted to a few firms from each discipline. In 2003, Penoyre and Prasad and Buschow Henley were the only two architects in the pool, chosen for their design “brilliance”, ability to work with public sector clients and cost management. Six years on, they have been joined by only three more practices, each of them very well respected. Willmott Dixon was – and still is – the only construction firm, highly regarded by BBH for its communication skills and ability to deliver quality on time and to budget.

Case note 02

The BBH pool is select and experienced, but co-ordinating them on any given project still takes excellent strategic skills. Again, success seems to derive from intuition and tenacity rather than box-ticking and protocol. All of the company's senior staff have excelled in their individual fields, which cross the public / private divide. Sylvie has been Managing Director of a private regeneration company since 2000, developing mixed use community schemes in inner city areas. Alasdair Liddell (BBH's Health Advisor) is a former Department of Health Management Board member and Director of Planning for the NHS (with over 20 years experience managing hospitals and health authorities).

Building Better Health have misgivings about the length of the LIFT process, its cost and its emphasis on process rather than quality outcomes. Indeed, Sylvie talks of the “miracle” of getting buildings like Heart of Hounslow out of the ground. She feels that the public sector's focus on accountability and cost effectiveness can stifle enthusiasm, confident decision making and a willingness to take risks on things that are prized in the private sector such as innovation and flair. Perhaps best placed to do so, because of her background, she has identified an ongoing lack of trust between the two worlds. Heart of Hounslow Photo: Dennis Gilbert / View

On the other hand, both Sylvie and her supply chain partners clearly respect the emphasis LIFT places on partnership and are adamant that the “small army of people” involved in exemplar buildings like HOH and St John's are key to their success. In both cases, consultation was not limited to the many-headed client body but involved detailed liaison with the community through exhibitions and public meetings. Staff and patient user groups met regularly from appointment to completion, with a workshop format used to test all aspects of the design from the conceptual to the detailed. This has generated a high degree of 'ownership' of both the buildings themselves and, ultimately, the wider strategy of service co-location.

Case note 02

Sylvie Pierce Heart of Hounslow and St John's Therapy Centre

St John’s Therapy Centre Photo: Nick Kane

For the architects involved – whom Sylvie regards as outstanding – partnership has extended beyond the usual client/designer relationship to include collaboration across the supply chain. Penoyre and Prasad and Buschow Henley have been jointly investigating ways of making healthcare buildings even more flexible, through standardisation of room sizes and grid layouts. However, if there is a criticism of HOH and St John's, it is that some areas have been over-specified, leading to problems of change-of-use. This is attributable, in part, to unforeseen changes in regulations concerning issues such as local decontamination. Certainly a lot of work was done with service providers to clarify requirements and adjacencies, as well as each building's overall form. The team is divided on whether the machinations of LIFT promote or devalue the 'whole lifecycle' of buildings. Whatever the process, both Heart of Hounslow and St John's Therapy Centre achieved NEAT accreditation, with St John's being one of the first NHS buildings to secure an 'excellent' rating. This building in particular derives its richly textured external form from an innovative response to buffering noise and fumes from the urban environment. Although no renewable energy strategies have been used, it is laid out to maximise natural light and ventilation, especially in shared spaces. The same is true of Heart of Hounslow and it is perhaps unsurprising that the overwhelmingly positive response to both buildings by staff, patients and the community focuses on their success in claiming a little pocket of nature for built-up city sites.

03.

M a l c o l m A i s t o n , A s s o c i a t e D i re c t o r o f E s t a t e s & Fa cilit ies , No rth um be rla n d, Tyn e an d We a r NHS Tru st Project Name: Project Type: Client: Architects: Completed: Location: Funding: Value: Procurement Type: Awards:

The Bamburgh Clinic, St Nicholas Hospital Mental Health Centre (Medium Secure Unit) Newcastle, North Tyneside and Northumberland Mental Health NHS Trust MAAP 2004 Gosforth NTW NHS Trust £22m ProCure21 2006 Green Apple Awards – Award for Best Built Environment 2006 Building Better Healthcare Awards – Award for Best Patient Environment – Finalist 2006 Building Better Healthcare Awards – Award for Best Mental Health Design - Finalist 2006 Building Better Healthcare Awards – Award for Best Hospital Design - Finalist 2006 Building Better Healthcare Awards – Award for Best External Space - Finalist

Case note 03

I n t ro d u c t i o n Malcolm Aiston Bamburgh Clinic, St Nicholas Hospital

Established in 2006, Northumberland, Tyne and Wear (NTW) is one of the UK's largest NHS Trusts. It provides a wide range of mental health, disability and other specialist services to over 1.4m people in the North East of England. Malcolm Aiston has worked for the Trust since its formation, adopting a senior role in its award-winning Estates & Facilities team. He is currently the Project Director for all its buildings delivered under ProCure21, with one of his most high-profile successes being the Bamburgh Clinic. The Bamburgh Clinic is part of the St Nicholas Hospital complex in Gosforth. It was commissioned in two phases by Newcastle, North Tyneside and Northumberland Mental Health NHS Trust, which later became part of the wider NTW Trust. Designed as a flagship facility for new national standards of care, it comprises two in-patient mental health facilities. The first is a small Low Secure Unit in a refurbished Victorian building, while the second is an entirely new-build 41-bed Medium Secure Unit. The ÂŁ22m project was initiated by the Department of Health as part of a national pilot programme for the treatment of personality disorders. The brief for the Medium Secure Unit was to provide an appropriate physical environment for the delivery of innovative treatment models. The Trust wanted to move away from a traditional 'custodial' care approach and focus on recovery and social inclusion. This shaped the requirement for a sensitively designed building that could offer both a secure and therapeutic environment. In keeping with the spirit of the MSU project, the Trust wished to adopt a collaborative approach to design and construction. The building was delivered via ProCure21 to an exceptionally tight 18 month programme. The standard of both 'process' and 'product' has been recognised in numerous award schemes, including the Building Better Healthcare and Constructing Excellence initiatives.

Case note 03

D es cr i p t i o n Bamburgh Clinic Photo: MAAP

The Bamburgh Clinic is laid out over two separate buildings. The Low Secure Unit is part of the Victorian estate of St Nicholas Hospital while the new-build Medium Secure Unit (MSU) occupies a brownfield site on the campus periphery. It is bordered by residential properties, a wildlife centre and a postal depot. The MSU provides 25 'medium secure' beds and 16 beds for patients with personality disorders. Some service users have committed criminal offences and are prone to aggressive behaviour. Through detailed consultation and sensitive design, MAAP Architects have provided a facility that the community feels comfortable having in its midst while de-institutionalising the patient environment. The plan comprises three wards in an L-shaped configuration with centrally located support functions. It draws a clear distinction between 'living' and 'working' areas, thus simulating real environments and promoting occupational healthcare. Each ward is made up of single-occupancy bedrooms, shared therapy and assessment areas and day spaces arranged around generous enclosed courtyards. Observation is inherent in the design, with good sightlines across the plan. Together with the courtyards, multiple windows introduce daylight and views. The centrepiece of the development is an open-sided multigames 'sports barn' which provides a high site boundary. There is minimal security fencing. The project uses energy efficient technologies and low maintenance materials. The prefabricated timber frame is exceptionally robust, has good acoustic insulation and readily incorporates recessed fittings for ease of servicing. It was ideal for the fast-track programme, having a 'dry construction' time of ten weeks. Locally sourced timber is also used for hardwood frame windows, cladding and courtyard furniture. Rainwater is harvested from one third of the roof area. Using the NHS Environmental Assessment Tool, the building has achieved an 'excellent' rating of 77.92%. It is used as a case study by the SHINE network for sustainable healthcare buildings. Now in its third year of operation, it is in excellent condition. It has been cited as a factor in attracting new staff and reducing absence among the existing team. Crucially, it has significantly reduced incidences of patient aggression, with a 90% reduction in the Psychiatric Intensive Care Units (PICU).

Case note 03

P r o c u r e m e n t p ro c e s s The Bamburgh Clinic's status as a pilot project meant that the NHS Trust was able to mobilise resources quickly. The Estates & Facilities (E&F) team wished to capitalise upon this potential for fast-track delivery without risk to design, build or clinical quality. With the support of the Department of Health, they chose to use ProCure21 for its notional ability to secure these outcomes and its focus on partnering. In October 2004, the Trust approached the ProCure21 framework of 12 Principal Supply Chain Partners (PSCPs) to ascertain the general level of interest in the scheme. They received nine expressions of interest, from which they short-listed four bidders.

The next stage was to evaluate the detailed offer of the four short-listed PSCPs, appraising each bid from three perspectives: clinical; estates; and project management. Instead of submitting 'cold' documentation, the bidders were invited along to an 'open day'. They were given a 45 minute question and answer session with each of the Trust's three groups and a further 45 minutes to describe their offer and what they perceived to be the project's key drivers. Bamburgh Clinic Photo: MAAP

Using a broad scoring matrix, Laing Oâ&#x20AC;&#x2122;Rourke was chosen as the preferred PSCP and invited for formal interview. Their appointment was confirmed just six weeks after they were first approached to express interest. At the Trust's request, architects Reid Jubb Brown were retained for the refurbishment project, based on their long-term involvement with the St Nicholas Hospital site. The Low Secure Unit was completed in December 2004 at ÂŁ70,000 less than the Guaranteed Maximum Price, with savings being invested in Phase II of the project: the Medium Secure Unit.

Case note 03

The design of the Medium Secure Unit was awarded to specialist firm, Medical Architecture & Art Projects (MAAP). Although London-based at the time, MAAP soon established a presence in Newcastle, which they still retain. Following appointment, the design and delivery process for the Medium Secure Unit was launched by a partnering workshop. This involved four main stakeholder groups: clinicians; supporting members of the Trust body (including the E&F team); design consultants; and the contractor. The aim was to establish what expectations the teams had about working together and to explore what partnership might actually entail 'on the ground'. People were asked to express their fears, as well as hopes, for the project. The workshop culminated in the agreement of a charter of shared objectives.

For strategic direction, the Trust established a high-level Project Board Team of four members. These represented the interests of the business case, the clinicians, the E&F team and the PSCP. They met for one hour every week from appointment to completion, with occasional input from a Department of Health architect. Bamburgh Clinic Photo: MAAP

The workshop format was rolled-out across the lifetime of the commission in a series of two hour sessions entitled “A day in the life of...”. This gave clinicians and service users direct access to the design and construction teams, including consultants and suppliers. The brief evolved as, collectively, the team redefined how people might use the space day-to-day. The workshops were also a testing ground for new materials and products. The final workshop took place between completion and occupation. Styled as the 'Bamburgh Clinic Experience', it involved a group of 40 volunteers from across the delivery team living in the unit for all – or part of – a five day working week.

Case note 03

Su m m a r y The design and delivery of patient-focused mental health facilities is a challenging commission for all concerned. Getting it right involves openness, flexibility and a destigmatised attitude to service users. The Bamburgh Clinic is an exemplar project because it has fostered this attitude from the outset, not just among clinicians and staff, but nonclinical areas of the Trust and the design and construction teams. The quality of the care environment is undoubtedly enhanced by the willingness of all stakeholders to explore what life might be like for users and to seek to improve it.

The client NHS Trust is well informed and knowledgeable and was probably more prepared than most for the project, especially given its Department of Health pilot status. The Estates & Facilities team have experience of a number of different procurement routes. When strategising for the Bamburgh Clinic they applied critical and contextual thinking. They needed to deliver the project quickly but to a high quality standard. They understood that ProCure21 would allow them immediate access to the delivery team and improved cost certainty.

Bamburgh Clinic Photo: MAAP

When contacting the 12 Principal Supply Chain Partners initially, the Trust only supplied a one-page outline brief and asked for replies by the following week. In retrospect, this might have been too hurried a process without adequate input from clinicians. However, the evaluation of short-listed bidders on a tripartite basis was an early recognition of the different skills sets involved in designing and delivering an exemplar building. Respecting the professionalism of others remained inherent to the process throughout the commission. It was fundamental, for example, to the progress made by the four Project Board members. These key players are all “can do” personalities. They made focused decisions and ensured they were actioned. They shared commitment, receptiveness to new ideas and – perhaps most importantly – a sense of humour.

Case note 03

The partnering workshop acknowledged that ProCure21 was a relatively new phenomenon for everyone concerned and was going to be a steep learning curve. It shone a spotlight on preconceptions and openly addressed hesitation about the fast pace of the project. People became excited, not daunted, about the challenges ahead.

During the course of the workshops, the clinicians brought in ten years of experience of running a Medium Secure Unit and a clear idea of how they wanted to operate differently. The estates, design and construction professionals could apply this thinking to layouts (particularly the integration of courtyards), functionality and detailed design elements. Maintenance issues were addressed as challenges, rather than restraints, and led to the use of off-site components like the prefabricated timber frame. This was an excellent use of the benefits of ProCure21. Through early collaboration between designers and clinicians, the Trust 'bought' themselves time to test innovation without risk to budget or programme.

Bamburgh Clinic Photo: MAAP

Using an established architectural practice with progressive ideas about designing for mental health and a track record on delivery was welcomed by all stakeholders. The opening of MAAP's Newcastle office was seen as further positive commitment to both the project and the wider community. It facilitated close collaboration with the client, users and locally-based consultants such as the mechanical and electrical engineer, CAD 21. This provided the Trust with continuity of service. For their part, Laing O'Rourke invested savings from the Guaranteed Maximum Price (GMP) in the project's peace garden. A further 1% of the GMP went towards public art, but this was perhaps not as integrated into the overall design process as it might have been. The brief made no provision for the use of colour in the building, though this is now being considered.

Case note 03

Malcolm Aiston Bamburgh Clinic, St Nicholas Hospital

The building undoubtedly meets its brief to facilitate a step-change in the Trust's provision of mental healthcare. Its non-hierarchical plan – based on single rooms, shared treatment areas and a discreet relationship between staff and patient functions – de-stigmatises the environment, playing down any sense of “them and us”. It is sized and scaled to have a domestic feel, with a light and airy ambience. This reinforces the idea of it being a real space, which enables clinicians to deliver individual treatment pathways based on engagement and stimulation. External spaces which are meant for lingering not simply people-moving are crucial in this regard.

Bamburgh Clinic Photo: MAAP

04.

La u ra L e e, Ch ie f E xe cu tiv e Office r, M ag g ie’s Can c er C a r i n g C e n t re s

Project Name: Project Type: Client: Architects: Completed: Location: Funding: Value: Procurement Type: Awards:

Maggie’s Cancer Caring Centre, Highlands Care Centre MCCC Page\Park 2004 Inverness, The Highlands Donations/National Lottery’s New Opportunities Fund £850,000 Traditional 2006 RIAS Andrew Doolan Award for Architecture

Project Name: Project Type: Client: Architects: Completed: Location: Funding: Value: Procurement Type: Awards:

Maggie’s Cancer Caring Centre, London Care Centre MCCC Rogers Stirk Harbour + Partners 2008 Hammersmith, London Donations £2.3m Traditional Judges Special Award for Primary Care Design in the Building Better Healthcare Awards Civic Trust Award 2009 Judges’ Special Award for Primary Care Design, National Building Better Health Care Awards 2008 FX Award Public Space category 2008 Hammersmith Society Environment Award

Case note 04

I n t ro d u c t i o n Laura Lee Maggie’s Cancer Caring Centres Highlands and London

Eighteen months before her death from cancer, Maggie Keswick Jencks set out a vision for a care centre – a supportive environment outside the mainstream hospital experience. Based on the comfort she felt from taking 'ownership' of her disease, exploring the potential of diet and complementary therapies in its management, she wanted to create a holistic facility in which fellow sufferers could regain control through knowledge – making patients into people again. Laura Lee met Maggie in 1993 while working as an oncology nurse in Edinburgh. Their relationship developed to the point where, on Maggie's death two years later, Laura became responsible for delivering the Cancer Caring Centre vision, supported by many friends and patrons including Marcia Blakenham. The first Maggie's Cancer Caring Centre (MCCC) opened in 1996 on the site of the Western General Hospital in Edinburgh where Maggie had been treated. There are now six operational centres and five being planned. All the buildings are located beside NHS cancer hospitals but are procured and operated independently and are consciously noninstitutional in scale. In line with Maggie's firm belief in the therapeutic value of good buildings, Laura, Marcia and their advisers recruit well-respected design teams who give appropriate architectural expression to the charity's integrated, patient-focused approach. Maggie's Highlands is the second MCCC designed by Page \ Park. Delivered in 2004 to a budget of £850,000, it was part-financed by the National Lottery's New Opportunities Fund and won the 2006 RIAS Andrew Doolan Award for Architecture. Maggie's London is the first of the facilities outside Scotland. Designed by Rogers Stirk Harbour + Partners, it was built at the request of Imperial College Healthcare NHS Trust. Entirely funded by donations, it cost £2.3m and opened in 2008. Later the same year, it won the Judges Special Award for Primary Care Design in the Building Better Healthcare Awards.

Case note 04

D es cr i p t i o n Maggie’s London Photo: MCCC

Maggie's disorientation after her cancer diagnosis was felt all the more keenly for being in a large clinical building with no appropriate space to think or talk about the disease. In developing her vision for Cancer Caring Centres, which are primarily information resource facilities, she placed distinctive but small-scale design at the heart of the process, envisaging “a domestic haven where patients could... rediscover the joy of living in the fear of dying”. Although markedly different in style, the Highlands and London centres share a set of basic design principles. They are flexible, open-plan buildings with a kitchen at their 'heart'. They emphasise physical and visual connection with the landscape and optimum access to light, air and colour within an urban environment. They encourage shared access to resources yet are conducive to intimacy, using simple devices like partitions to create different spaces. Crucially, the quality and attention to detail apparent in their design makes the people who use them feel that they matter. The Highlands MCCC was designed by Page \ Park in collaboration with Maggie’s husband, landscape architect Charles Jencks. It comprises a striking trilogy of a copper and timber clad building and two landscaped forms. All three are vesica-shaped (like almonds) and interconnect in a pattern based on mitosis – the subdivision of healthy cells. This creates a spiralling sequence of free-flowing spaces with blurred boundaries between inside and out. The sculptural forms naturally shape areas for quiet contemplation on an otherwise exposed edge-of-campus site, part of the Raigmore Hospital in Inverness. Maggie’s London is part of the Charing Cross Hospital campus in Hammersmith and thus set in a busy city streetscape. This has influenced the design of a 'wrapped' building that is bound with its internal courtyard gardens in a continuous one and a half storey wall. In contrast to the spiralling form of the Highlands MCCC, the building is set out on a rational orthogonal grid. The roof 'floats' over the envelope, separated from the bright orange walls by upper level glazing. This floods the interior with natural light, picking out exquisite detailing such as birch panelling to create the overall impression of a “homely jewel”.

Case note 04

P r o c u r e m e n t p ro c e s s Maggie's Cancer Caring Centres are procured traditionally, with the client commissioning design consultants and contractors directly. This is in line with guidance from the National Lottery, which has part-funded Maggie's Highlands. From the outset, Laura Lee has been central to Maggie Keswick Jencks' vision. Since her stewardship of the MCCC programme became official, she has worked in tandem with Marcia Blakenham as the design team interface on all Maggie's buildings. This reflects the personal input both women have had into the honing of Maggie's original blueprint.

Laura and Marcia are supported by a 'building governance' team (Sarah Beard, AnnLouise Graham and Kirstine Roberts) of property developers who deal with contractual matters. In addition, Maggie's husband – Charles Jencks – advises on architectural issues, drawing on his career expertise in architectural theory and landscape design as well as his personal knowledge of Maggie's pioneering vision.

Maggie’s Highlands

Laura and Marcia approach each project on a bespoke basis, reviewing design publications for ideas on best practice and seeking advice from architectural critics. Per scheme, they invite up to eight design practices to express interest, issuing the brief to those who wish to come forward for interview. No design proposals are required at this stage. At interview, the brief is discussed in full and thus forms the criteria against which each candidate is assessed. The clarity of Maggie's original concept is such that this crucial document – just two-and-a-half pages long - has changed little in over ten years. It is mainly qualitative rather than quantitative, seeking to describe a sense of place rather than prescribe how it might be delivered.

Case note 04

Laura takes the view that the people who deliver care are not best placed to design buildings and that functional solutions should be proposed by architects following their own exploration of user and staff needs, ensuring that any perceived failings in previous buildings are actively addressed. This iterative process is in keeping with the importance the Maggie's care experience places on individuals and feedback. It is time consuming, but this – in some respects – is beneficial to the client, who can undertake fundraising concurrently. In the main, Maggie’s projects are competitively tendered using traditional contracts. Crucially, in addition to a competitive fee, the client assesses bidding contractors in relation to high quality skills and craftsmanship, a clear understanding of the brief, ability to deliver and good working relationships with design teams.

The build costs of Maggie's projects are high but the focus on quality seeks to ensure each building's longevity. Low energy and maintenance 'costs in use' are noted as requirements in the brief and it is requested that materials are obtained from sustainable sources. Maggie’s London Photo: MCCC

Architects fees across all the projects to date have ranged from 0% to 13%. In terms of the forward programme, which involves the £15m development of five new centres, Laura and her team envisage commissioning design development prior and independently to any cost restraints. This is to promote creative concepts that are robust enough to absorb cost appraisal later in the process.

Case note 04

Su m m a r y Maggie Keswick Jencks’ experiences and inspiration have brought about a series of remarkable buildings across Scotland and the UK, designed passionately (and often for a reduced fee) by well-respected architects. The success of the programme is built on Laura Lee’s 'ownership' of Maggie’s vision and her expertise in engaging directly with designers to maximise the potential of a highly qualitative brief.

The relationship that Maggie and Laura developed during a protracted and unpleasant clinical process was an, albeit unwitting, prototype for stakeholder engagement. It constituted a critical appraisal of the existing healthcare estate (particularly oncology facilities) that led to a proactive and aspirational blueprint for the way ahead. It drew on the experience of Maggie as a patient and a designer and Laura as a healthcare professional. It was founded on the compatibility of Maggie and Laura as people.

Maggie’s London Photo: MCCC

The thinking that led to the development of Maggie's vision was based on her fundamental belief in the value of good design and its impact on health outcomes. Laura, Marcia Blakenham and their team now have a growing evidence base of the benefits patients and their families derive from the facilities. A visitor to Maggie's London recently described how, afterwards, she likes to “go home, close my eyes and hold the image of the place in my head”. Similarly, a patient using Maggie's Highlands describes the experience of being in the building to that of “being hugged”. The brief for Maggie's buildings does not emphasise flagship design, at least in terms of what is commonly understood as the 'wow factor'. It is based on sound design principles, not aesthetics, and is very clear that buildings should be “modest and humane” not “intimidating”. The concept of identity, however, is central to the success of the programme.

Case note 04

The individuality of the buildings has enhanced fundraising opportunities, particularly where communities have taken 'ownership' of designs at an early stage, often via extensive press coverage. For potential service users, especially men, the level of intrigue alone can make all the difference between seeking help and suffering in silence. In this respect, the buildings play a key role in helping Maggie's distance itself from cultural embarrassment around cancer.

It is undoubtedly due to the Jencks’ professional interests and connections that the Cancer Caring Centres programme has become synonymous with a mix of high-profile and emerging design practices. Richard Rogers (Rogers, Stirk Harbour + Partners), for example, is a family friend. The level of expertise now available to Laura and Marcia is unprecedented, especially given the projects' small and consciously domestic scale. This is potentially challenging, but handled with self-assurance by the team.

Maggie’s Highlands

Laura and Marcia gravitate towards architects who exhibit a mature confidence and will not aggrandise their involvement. They use a traditional form of procurement because it allows them close and continuous contact with the design team, a critical factor when the brief is evocative, not prescriptive. From the earliest procurement stage – the interview – they focus on face-to-face communication and a shared appreciation of the intangible nature of Maggie's concept. This helps to mitigate risk. As the team have always worked collaboratively, originally with Maggie and now with patrons and advisers, they have always been comfortable with devolving decisions to those professionally best placed to make them. The 'building governance' panel plays a key role in managing the contracts, working in tandem with architects, builders and the NHS Hospitals where centres are built. Laura firmly believes in the appropriateness of architects choosing other design team members. While continued appointments are now being considered, the diversity of the teams assembled to date is perhaps a factor in the successful avoidance of designing-by-numbers. Indeed, it is remarkable how different the six centres actually are, considering the constancy and simplicity of the brief.

Case note 04

Laura Lee Maggie’s Cancer Caring Centres Highlands and London

The most challenging aspect of the brief is maintaining patient privacy on exposed, edgeof-campus sites, while also capitalising upon the opportunity to incorporate managed external space within the schemes. In actuality, this has generated the most interesting design responses and – in the case of Maggie’s Highlands, with its maze-like arrangement of vesicas (almond shapes) – the building’s defining ‘look’. Internally, the use of partitions, furnishings, fittings, colour, light and shade both suggest and enable intimacy in areas that can easily accommodate large groups. It is interesting that Maggie’s has never received a single complaint about lack of privacy, despite it being commonplace for discussions on health, treatment options and benefits issues to take place around an open kitchen table in the centre of each building. The scale and attention to details and materials communicate the feeling of being ‘at home’, something entirely missing from the anonymity of a hospital environment.

Maggie’s Highlands

The architecture has influenced Maggie’s staff to behave differently. Laura reports that, for the first year, many feel uncomfortable losing the emotional defences they would have in mainstream hospital environments when dealing with patients. A recent study by David Spiegel MD has confirmed that Maggie’s teams use different body language to hospital-based staff: that they are physically alongside patients rather than positioned behind clipboards, imparting information. If buildings can be judged by ‘uptake’ alone, especially in conjunction with their capacity, then daily visitor numbers of 30 (Highlands) and 40 (London) a day are tantamount to the enduring success of Maggie’s Cancer Caring Centres. In recognition of the consistently high standard that she achieves (together with her advisers, staff, designers and contractors), Laura has been given honorary fellowship of the Royal Institute of British Architects.

05.

P a t r i c i a P o p e , B u s i n e s s M a n a g e r f o r C h i l d re n s Se rv ice s, L e wish am Pr imar y Ca re Tru s t Project Name: Project Type: Client: Architects: Completed: Location: Funding: Value: Procurement Type: Awards:

Kaleidoscope - The Lewisham Children and Young People’s Centre Children and Young People’s Centre Lewisham Primary Care Trust van Heyningen and Haward 2006 Lewisham, London Lewisham Primary Care Trust £13.5m Traditional (Design Competition) 2007 Short listing for the Prime Minister’s Better Public Building Award 2007 Building Better Healthcare Awards Highly Commended for Kaleidoscope, Children and Young People's Centre 2007 RIBA London Award for Kaleidoscope, Children and Young People's Centre 2007 RICS Community Benefit Award Runner-up for Kaleidoscope, Children and Young People's Centre 2008 Civic Trust Award - Commendation

Case note 05

I n t ro d u c t i o n Patricia Pope Kaleidoscope Centre

Lewisham Primary Care Trust (LPCT) provides healthcare services to over 265,000 people in one of London's most deprived boroughs. Since its establishment in April 2002, it has forged excellent relations with the local authority in Lewisham, capitalising on shared opportunities for landmark urban regeneration and the integrated provision of services. Patricia Pope has worked for the NHS in Lewisham since 1995, initially as part of the Neighbourhood team. She is currently the manager of Kaleidoscope, a facility she has been instrumental in developing since joining Children and Young Peoples Services in 2000. Kaleidoscope's mission is to offer an integrated, child-focused care experience to young people and their families. Primarily the vision of Lewisham PCT, the project was developed in close collaboration with South London and Maudsley NHS Trust and two Directorates within the London Borough of Lewisham (Education & Culture and Social Care & Health). When the brief was devised in 2002, it cut across all aspects of community-based health, mental health, special education and social care, requiring a relatively new building type for the time. With the support of CABE, LPCT opted to run an architectural design competition for their pioneering 'one stop shop' that has since delivered a multifunctional urban building of high artistic merit. Delivered for a capital cost of ÂŁ13.5m, Kaleidoscope was designed by van Heyningen and Haward and procured traditionally following the open competition. Championed by a client that values the effect of good design on staff retention, it has fostered a truly collective ethos among 23 operational teams (comprising 260 people in total) and is a centre of excellence for training. It opened to the public in November 2006 and has since secured several national design accolades. These include a short-listing for the Prime Ministerâ&#x20AC;&#x2122;s Better Public Building Award in 2007.

Case note 05

D es cr i p t i o n Kaleidoscope Photo: Nick Kane

Kaleidoscope â&#x20AC;&#x201C; The Lewisham Children and Young Peopleâ&#x20AC;&#x2122;s Centre â&#x20AC;&#x201C; occupies a gateway urban site in the heart of its London borough. It brings together under one roof a range of services and clinical professionals, with two storeys of consultation and treatment facilities and three floors of offices. The key to maintaining efficiencies, good daylighting, inspiring views and easy wayfinding is a simple C-shaped plan with a central garden courtyard and extensive glazing. The design is notable for the absence of enclosed corridors and for the use of bold colour-coding to create an ordered yet vibrant interior. The brief identified resource efficiency and optimum flexibility as priorities, leading to the choice of a concrete frame for its potential to support different configurations and for its thermal mass and fire resistant qualities. The shallow floor plan facilitates a natural ventilation strategy for all floors above ground level and the heating and cooling strategies are based on the principle of a thermally active slab. The project was one of the first in the UK to use this technology, which removes exposed pipe work and other hazards from an internal environment largely used by children. The issue of child supervision is treated sensitively in the building, with the layout supporting a swipe card security system that restricts access to certain areas and details such as discreet peep holes in doors. The spatial opportunities that the structural system allows respond well to the need for adaptable and highly efficient interiors, with much use being made of moveable internal walls to alter the size and layout of rooms. Overall, the client benefits from a beautiful, welcoming building with a clear, child-friendly identity that meets its functional needs while providing a high quality care and working environment. Critical praise has come from many quarters, including the RIBA, RICS and Building Better Healthcare.

Case note 05

P r o c u r e m e n t p ro c e s s Kaleidoscope as a concept pre-dated the formation of Lewisham Primary Care Trust (LPCT) in 2002. By the time the Trust assumed responsibility for the project, the gateway site (a former school) had already been selected and a feasibility study completed. The decision to hold an open design competition was based on the new organisation's aspirations for the building, the Borough and its own future working styles. The enthusiasm of the managerial team and their openness to the value of good design were picked-up on by CABE, who were advertising to assist a small number of healthcare trusts via a pilot Enabling programme (funded by NHS Estates).

In June 2002, Enabler Mick Timpson (an architect and urban designer) began to work with LPCT and within one month the team had finalised both a Mission Statement ... a truly integrated, child focused, specialist service ... and Outline Business Case. It took a further three months to consolidate the brief, allocate PCT management resources and establish assessment criteria.

Kaleidoscope Photo: Nick Kane

The competition was announced in the Official Journal of the European Union (OJEU) in October 2002, with first stage submissions requiring only a short expression of interest. This was organised under four headings: full design team structure; communication; design flair & capability; and healthcare experience. Forty submissions were received and ten bidders invited for interview. The interview was a chance for bidders to describe their understanding of the project and propose a notional approach to meeting the outline brief. Communication was verbal and no actual design work was required. Using the same four criteria as at OJEU stage, a short-list of four teams was identified and â&#x20AC;&#x201C; after the PCT had finalised the brief and funding sources â&#x20AC;&#x201C; the design phase of the competition commenced.

Case note 05

The four competing teams were each issued with the brief in January 2003. It began with the Mission Statement and then outlined a range of requirements, from 'non-variables' such as the site, funding and accommodation needs to more qualitative factors such as “an upbeat and welcoming” environment for children of all ages. The short-listed practices were asked to focus specifically on the way the building would relate to the site and the wider urban context. The judges wanted to ascertain how the facility might look on approach and how privacy, noise and other environmental factors would be mitigated and energy conserved.

At an 'open day', all four teams visited the site and met with representative staff user groups. Notes and any technical questions were circulated among all participants before entries were submitted in March 2003. Further to the issue of drawings, the teams presented to three stakeholder panels; parents of service users; staff; and the PCT judges (comprising both technical and non-technical members). All assessment was based on the NHS Achieving Excellence Design Evaluation Toolkit (AEDET) and build costs were not disclosed in advance of the winner being chosen. Kaleidoscope Photo: Alex Griffiths

The successful team was led by van Heyningen and Haward architects who were subsequently commissioned directly by LPCT to develop the full design. Client-side, overall direction became the responsibility of the Associate Director of Commissioning for Children & Young People’s Services, with design and technical issues delegated to the Head of Estates. Over the next year, the design progressed in further consultation with staff, parents and voluntary sector stakeholders and the brief refined in response to the needs of new client agencies. Planning permission was granted in April 2004 and the Full Business Case approved six weeks later. The contractor was appointed in December and the building handed over to the PCT in August 2006.

Case note 05

Su m m a r y The issue of choice is central to the way in which the new NHS operates. In creating a patient-focused environment for one of the most vulnerable of user types, Patricia Pope and colleagues exercised choice at the highest level, embedding the concept within their exemplary project by opting to run an architectural competition for its design.

When Kaleidoscope opened in November 2006, it had been in development for over ten years, seven of which pre-dated the existence of the lead client, Lewisham Primary Care Trust. On taking ownership of the vision in 2002, LPCT regarded it as both an important opportunity to establish themselves in the heart of Lewisham and a daunting logistical challenge. For both reasons simultaneously, they were keen to devote maximum time and effort to making the project count.

Kaleidoscope Photo: Nick Kane

The managerial team within the PCT were very attuned to the value of good design, both in enhancing the care experience and inspiring and motivating staff. They also appreciated the importance of the chosen site as a gateway between Lewisham and Catford, spotting the potential for regeneration. They had a clear idea of the quality they wanted to achieve in the project, but no pre-conceptions as to what form the building should take. They decided to run an architectural competition to work through the important early stages of the project with a range of options and designers. From the outset, Patricia Pope and colleagues adopted a partnership approach which fed into their choice of â&#x20AC;&#x201C; and relations with â&#x20AC;&#x201C; the design team. At all stages, they were willing to work collaboratively, in the first instance with CABE for support in articulating their aims. This was crucial to the success of the project and reflected the wider aims of the PCT and partners such as the London Borough of Lewisham and South London and Maudsley NHS Trust.

Case note 05

One of the benefits of introducing an Enabler into the process was the objective focus this brought to defining the brief. Requirements were broken down into an early Mission Statement, outline brief and detailed summary, with the relevant information being released to bidders at key stages. As well as allowing the various client stakeholders to work iteratively, it encouraged the designers to focus on the bigger urban picture. This gave the competition a wider and more enduring relevance for the client, who has gone on to commission a number of other buildings.

Another way of maintaining focus, as well as accountability, throughout the project was the use of the same basic criteria at all judging stages. As the competition progressed, this allowed a broader range of interests to engage with the decision making process without duplication of effort or risk to continuity. No speculative design work was required until short-listing stage, with all four firms receiving an honorarium.

Kaleidoscope Photo: Nick Kane

The clarity of the evolving brief reflected the commitment of the PCT managers but also the quality of wider consultation, specifically the sited-based 'open day'. This was crucial, given the key issue of multi-agency occupation and the special requirements it placed on the building in terms of mechanical and electrical services and inherent flexibility. Bringing in parent representatives, clinicians and other care professionals, the consultation process was demanding but paid dividends. The use of the NHS Achieving Excellence Design Evaluation Toolkit helped both technical and non-technical judges make confident, informed decisions. The judges did not take build cost into account until after they had selected van Heyningen and Haward as the winning team, praising the simplicity, economy and elegance of the design. Kaleidoscope was subsequently procured using a traditional contract because it facilitated close, ongoing contact between the architects and the designated client Project Board. This reflects the PCT's willingness to take responsibility â&#x20AC;&#x201C; not only for meeting aspirations â&#x20AC;&#x201C; but also for bringing the building in on time and to budget.

Case note 05

Patricia Pope Kaleidoscope Centre

During the design and delivery process, when specialist service and building design issues arose, LPCT employed the external skills needed to tackle them. Following initial reservation on the part of office-based teams towards open-plan working, a designated office planner was brought in to consult with users and guide the ‘change management’ process. Anecdotally, the transition has been considered a great success, with staff reporting that the working environment is good and that it has increased both social interaction and productivity. The only aspect that they feel may have benefited from more consultation was the provision of ICT. Kaleidoscope undoubtedly meets Lewisham's vision for its new facility, honouring the history of the long-term project and, in some respects, exceeding requirements. The central garden is considered one of its most successful elements, although the brief did not prescribe the need for open space. The project as a whole has been described by one senior staff member as “a sanctuary... a place which exudes respect for children, young people and families and those who work here”. Such accolades are testament to the investment made by all involved, not only in terms of capital outlay, but in time and boundless energy.

Kaleidoscope Photo: Nick Kane

06.

Ri ch ard Gle n n, Pro je ct Direc to r, Ald er Hey Chil dre n 's NHS F ou n da tio n Tru st Project Name: Project Type: Client: Architects: Completed: Location: Funding: Value: Procurement Type: Awards:

Royal Alexandra Children’s Hospital Children’s Hospital Brighton and Sussex University Hospitals NHS Trust Building Design Partnership (BDP) 2007 Brighton Kajima £37m PFI 2009 Civic Trust Award 2008 The Prime Minister's Better Public Building Award 2008 Design and Health Academy Award (Healthcare Design Project Award) 2007 Building Better Healthcare Award (Highly Commended — Best Designed Hospital and Winner, Best Client Team) 2007 Health Business Award (Hospital Building Award)

Case note 06

I n t ro d u c t i o n Richard Glenn Royal Alexandra Children’s Hospital, Brighton

Richard Glenn has over 35 years experience of delivering visionary healthcare projects worldwide, specialising in the large-scale redevelopment of acute hospital facilities. Currently acting as Project Director for the new £330m Alder Hey Children’s Hospital in Liverpool, which will be the UK's first children's health park, he has also been instrumental in developing the Royal Alexandra Children’s Hospital in Brighton, which opened in 2007. Both projects book-end a two year period at the Department of Health's Private Finance Unit, where Richard was tasked with reviewing all major PFI acute hospital schemes in development in order to assess best value and streamline the delivery process. Richard has been based in the UK since 2002 and – as well as spearheading the delivery of specialist children's facilities – has served as Capital Developments Director for the South Devon Healthcare NHS Trust. The Trust's phased redevelopment of Torbay Hospital in Devon is considered at the highest level to be an exemplar of a general hospital reinventing itself as a pioneering, high-tech acute facility that works collaboratively with local NHS providers. One of its partner developments is the new community hospital in Newton Abbot, which opened in 2009. The common factor across the projects Richard has worked on, both in the UK and overseas, is the transformational nature of development. This reflects his firm belief in the role of new and refurbished buildings in supporting a changed healthcare ethos and associated ways of working. Following on from his ground-breaking scheme to co-locate four hospitals in what is now one of New Zealand's largest public buildings, Auckland City Hospital, he has looked in-depth at improving access to services through concepts such as inter-disciplinary 'clustering'. His overriding principle on all developments is to embed facilities within the communities they serve.

Case note 06

D es cr i p t i o n Royal Alexandra Children’s Hospital Photo: David Barbour

The redevelopment of Alder Hey Children's Hospital as a parkland health campus is characteristic of the type of project that Richard Glenn has championed over the past thirty years. In this time, he has worked with many leading designers to apply sustainable design principles to large, complex, highly-serviced buildings. Immediately prior to his relocation to the UK, Richard worked on the development of Auckland City Hospital. This involved bringing together architectural practices from both New Zealand and Australia to design an integrated building of 80,000m2. Opened in 2003, the hospital co-locates state-of-the-art facilities for acute adult, cardio-thoracic, maternity and gynaecological services and is linked to a specialist children's facility on the same campus. The H-shaped plan incorporates a large internal courtyard which floods both the public areas and wards with natural light, enhancing an interior design scheme that uses warm colours and fabrics to promote a welcoming, homely ambience. The Royal Alexandra Children’s Hospital takes forward the principles of the Auckland project – the centralisation of services in a large yet non-clinical building – and applies them to the specialist area of paediatric medicine. Winner of many design accolades, including the Prime Minister's Better Public Building Award 2008, the ark-like edifice maximises the potential of a tight urban site in Brighton to support nine floors of integrated inpatient and outpatient accommodation. It is envisaged less as a building than a sustainable community, designed around the needs of both patients and their families and aesthetically influenced by its waterfront setting. The emphasis is on the therapeutic quality of the environment as much as on its clinical efficiency, with open play decks on the upper levels, a vibrant colour-coded interior and myriad child-scaled windows giving each individual room an inspiring sea view.

Case note 06

P r o c u r e m e n t p ro c e s s The process behind the realisation of the Royal Alexandra Children’s Hospital gives an insight into the timelines and issues that are often involved in bringing a large public healthcare building to fruition under the Private Finance Initiative. The pivotal point in the project was undoubtedly when the client's management structure changed and Richard Glenn was brought in in 2002 to develop the Outline Business Case (OBC) into a Final Business Case (FBC). Before this watershed, though, the project had already been a 'live' concern for five years. The Strategic Outline Case (SOC) addressing the overall scope of the project was approved towards the end of 1998 on the condition that the hospital was increased in size. While the OBC proceeded to be developed on this basis, administrative complications delayed its approval until 2001.

The notice advertising the project in the Official Journal of the European Union (OJEU) appeared in March 2002. Of the teams who subsequently expressed interest in the development, four were selected to proceed to the next stage. Three responded to the invitation. Royal Alexandra Children’s Hospital Photo: David Barbour

Following a government initiative to streamline the procurement of PFI schemes – as set out in Improving PFI Procurement (March 2002) – a Preliminary Invitation to Negotiate (PITN) was issued to the three interested parties in October 2002. On receipt of the responses five months later (in March 2003), two teams were selected to receive a Final Invitation to Negotiate (FITN). These teams were led by Kajima Europe (a subsidiary of the Kajima Corporation) and The Costain Group.

Case note 06

The selection criteria were closely linked to the output specifications that had been issued to both bidders. The Kajima team – which included Building Design Partnership as the principal designer – was adjudged to have followed these specifications most accurately and comprehensively. The team responded to the need for a hospital with more accommodation on the upper floors than the lower by producing the genesis of the arklike building that was ultimately delivered in 2007. The early concept also had many of the iconic and child-friendly qualities that distinguish the hospital today, such as the colour coded interior.

The Kajima team was selected and Financial Close achieved later in 2004. In January 2004, planning permission was granted and the hospital proceeded on site six months later. Richard left the project during 2004.

Royal Alexandra Children’s Hospital Photo: David Barbour

In line with the requirements established in the Strategic Outline Case of 1998, the “Alex” was built with three times the floor space of the old hospital and double the number of beds. It was completed on time and to budget and opened in June 2007. This milestone was officially recognised by a visit from Princess Alexandra in October the same year. Twelve months on, the project was named as the recipient of the Prime Minister's Better Public Building Award. The Rt Hon Gordon Brown MP described it as an example of “what can be achieved when high-quality design is coupled with highly effective delivery”.

Case note 06

Su m m a r y Over the course of his professional career, Richard Glenn has worked with a specific building type – the hospital. The lessons to be learned from his stewardship of over thirty acute facilities relate to the way in which hospitals have diversified worldwide from the 'district general' model of thirty years ago to the medical campuses and specialist centres prevalent today. These changes are intrinsically linked to governmental moves towards localised delivery and new funding mechanisms.

Having worked with the New South Wales Department of Health in developing and implementing Partnership Contracts, Richard's UK experience is largely focused on achieving excellence via the Private Finance Initiative (PFI). The Royal Alexandra Children’s Hospital is held up by the Department of Health as an exemplar of how PFI projects should be managed and is the first healthcare building to win the Prime Minister's Better Public Building Award. Richard is currently overseeing plans for the £330m redevelopment of another specialist paediatric hospital, Alder Hey in Liverpool.

Royal Alexandra Children’s Hospital Photo: David Barbour

Richard's philosophy is based on the desire to embrace change, both within procurement and healthcare pathways. In paediatric projects (of which Alder Hey is his fifth), he has found the ideal outlet for doing things differently. This is based on growing recognition at all levels that – for the most vulnerable of patient types – a “hospital which doesn't feel like hospital” is the ideal environment for healing. Richard is adamant that projects which are a focus for operational change require aspirational visions and robust briefs. In the 'long game' of PFI procurement, the early engagement of stakeholders is vital. Facilitated consultation with clinicians, nurses and management teams needs to be oriented towards future needs, not mired in the shortfalls of the existing environment. To contribute effectively to the briefing process, people need to be encouraged to think about how they want to work, with the design evolving to support this cultural shift.

Case note 06

At briefing stage, Richard has found it helpful to identify the more junior 'drivers' within the client body and work with them to foster ownership of the vision. This is based on the fact that they will grow with the project – the building and what it represents – as their professional careers develop. At Alder Hey, for example, plans for the new children's health park are linked into a Rapid Improvement Programme and Excellence through Learning, a development initiative which supports staff in adopting new working methods. The hospital is leading the way in investigating the impact of ICT on patient care, which demands agility of both the staff team and the built environment.

Royal Alexandra Children’s Hospital

In general, Richard's experience of involving medical planners at briefing stage is positive and he values their work in accommodating future needs through the production of essential data on adjacencies. His one reservation is that output specifications can often lack aspiration, adding little to the vision of a inspiring, non-clinical environment. The Royal Alexandra Children’s Hospital is an example of a more proactive approach, with good integration between planners and designers. Its vision for a sustainable, familyfocused community was facilitated by clinical studies, leading to a decked arrangement of services (with living, lounge and play areas uppermost) and an efficient yet vibrant interior organised into different departmental habitats.

Photo: David Barbour

In terms of wider consultation, the “Alex” (as it is known locally) derives much of its success from the early input of patients and their families. Through a Children's and Young People's Board, users had input into all aspects of the building's development, including furniture, wayfinding and graphics. Their desire for a reassuring and uplifting building with access to outdoor space fed into the idea of the hospital as a children's ark, with its boat-like shape resolving the constraints of a tight urban site and creating a strong civic presence. Critical praise has highlighted the building's contribution to Brighton's waterfront townscape, reflecting the role of new healthcare buildings in enhancing the public realm and rejuvenating communities.

Case note 06

Richard Glenn Royal Alexandra Childrenâ&#x20AC;&#x2122;s Hospital, Brighton

For a project like Alder Hey in Liverpool, which has one of the highest levels of deprivation in the UK, the imperative to act as a catalyst for regeneration is all the greater. As part of a targeted healthy living strategy for the area, the vision for the children's health park is grounded in the therapeutic benefits of good design, specifically with regards to access to fresh air and green space. Working closely with The Environment Agency, the client is addressing issues such as energy efficiency, material selection and the minimisation of waste at all stages of development. Crucially, this forms part of an holistic approach to sustainability, in which socio-economic factors like civic pride and increased employment opportunities are identified and valued as outcomes.

Royal Alexandra Childrenâ&#x20AC;&#x2122;s Hospital Photo: David Barbour

07.

To n y Cu rra n , Hea d of Cap ita l P lan n in g & P r o c u r e m e n t , N H S G re a t e r G l a s g o w a n d C l y d e

Project Name: Project Type: Client: Architects: Completed: Location: Funding: Value: Procurement Type: Awards:

Easterhouse Community Centre Health Centre NHS Greater Glasgow and Clyde Davis Duncan Architects (Archial group) 2004 Easterhouse, Glasgow NHS Greater Glasgow and Clyde £2.5m Traditional 2004 Scottish Design Awards – Best Publicly Funded Building 2004 Glasgow Institute of Architects Award

Project Name: Project Type: Client: Architects: Completed: Location: Funding: Value: Procurement Type: Awards:

Partick Community Centre for Health Health Centre NHS Greater Glasgow and Clyde Gareth Hoskins Architects 2004 Partick, Glasgow NHS Greater Glasgow and Clyde £2.5m Traditional 2005 RIAS Andrew Doolan Award, Best Building in Scotland, Finalist 2005 The Roses Design Awards, Best Public Building, Silver Award 2005 Glasgow Institute of Architects Awards, Winner 2005 Scottish Design Awards, Best Public Building, Commendation 2005 NHSScotland Property and Environment Forum awards, Building Section, Commendation

Case note 07

I n t ro d u c t i o n Tony Curran Easterhouse and Partick Community Centres

A surveyor by training, Tony Curran is Head of Capital Planning & Procurement at NHS Greater Glasgow and Clyde. Over the last eight years, he has set about addressing the needs of the city's primary healthcare estate by focusing on the value of good architecture and urban design. Like many British cities, Glasgow has a legacy of 1960s healthcare buildings which, in many cases, no longer provide a quality environment for patients and staff and have become part of a disjointed urban fabric. Tony believes that a more aspirational approach to new buildings can enhance their status among communities, simultaneously increasing uptake of key services and effecting a wider improvement of the cityscape. Formed in 2006, NHS Greater Glasgow and Clyde is the largest NHS body in Scotland. It provides services to a core population of 1.2m people and its estate includes 25 major hospitals, as well as 10 specialist units and 60 health centres and clinics. Of the latter, the Community Health Centres in Partick and Easterhouse are widely considered to be exemplar facilities, especially in terms of design. Located in the inner city and an outlying post-war suburb respectively, they were commissioned by Greater Glasgow NHS Primary Care Trust when Tony Curran was its Head of Estates. The buildings rejuvenate existing NHS sites through a completely new-build project (Partick) and extension and refurbishment (Easterhouse). Although their briefs differed in many ways, they each facilitate an integrated response to service delivery and establish a strong identity within their respective communities through quality design and an appropriately civic scale. Procured by traditional means, they were delivered in 2004 for under ÂŁ2.5m each using architects not previously known for healthcare design. For their faith, astute planning and management skills, the Primary Care Trust and its client sponsors have been rewarded with high-impact, fit-for-purpose buildings that have drawn accolades from many quarters, including the Scottish Design Awards, RIAS and Glasgow Institute of Architects.

Case note 07

D es cr i p t i o n Partick Community Centre Photo: John Cooper

The Community Health Centres in Partick and Easterhouse are located in very different parts of Glasgow but share a common set of design aspirations and principles. Although respectful of local character, each has a distinct presence in the streetscape, drawing much critical acclaim. While one uses large areas of glazing to invite views in, the other wraps its interior in a sinuous ‘closed’ outer wall. The use of contemporary materials and interesting forms to break up the street frontages sends out a positive signal to communities, while the scale is befitting of civic facilities. The aim of both buildings is to create non-institutionalised facilities that feel comfortable to approach and easy to navigate. Good wayfinding is based on rational space planning and maximum transparency in shared areas, with the use of a triple-height void in the Partick building and enclosed courtyards in Easterhouse to draw daylight into the heart of the plan. Adjacencies between clinical areas – which in Partick are contained within a beautifully detailed timber ‘box’ – promote efficiencies between service providers, reducing ‘travelling time’ for both staff and patients. In each case, the design team has dealt innovatively with the co-location of spaces for distinct user groups. In the Partick building, the sloping site is exploited to incorporate a garden level nursery below three floors of integrated community healthcare facilities. The entrance to the nursery is tucked away behind the building, away from the bustle of the street, under a projecting canopy that also provides sheltered outdoor space for the children. In the reconfigured Easterhouse building, users of its mental health resource now access the facility through the same entrance as those attending the health centre. This is located in a curving entrance wall that wraps around the two previously segregated facilities, unifying their appearance from the road. By de-stigmatising the approach to the building, the first barrier to patients seeking help, the client hopes to increase the uptake of mental health services. The infill structure between the two existing buildings provides much needed additional space for community users.

Case note 07

P r o c u r e m e n t p ro c e s s The Community Health Centres in Partick and Easterhouse were procured by Greater Glasgow NHS Primary Care Trust (GGNPCT) before the body became part of NHS Greater Glasgow and Clyde in April 2006. In each case, the architects' fees fell below the Official Journal of the European Union (OJEU) threshold and – with a modest budget of under £2.5m each – the projects were subsequently procured using traditional contracts, maintaining a direct link between design team and client.

GGNPCT provided the projects' backbone in terms of client-side technical expertise. Tony Curran acted as Head of Estates while a trained architect, John Donnelly, took on Project Manager duties. The client sponsors of each project were independently managed Local Health Care Co-operatives (LHCCs).

Partick Community Centre

In 2002, four potential design teams were asked to submit proposals for each project, these being judged in relation to design quality (60%) and fee (40%). Gareth Hoskins Architects were awarded the commission for the Community Centre for Health in Partick, having been involved in assessing the feasibility of the project from 2000 onwards. Davis Duncan Architects (now part of The Archial Group) were successful in securing the commission for the redevelopment of the Easterhouse site.

Photo: John Cooper

The projects were led locally by LHCC senior managers, encouraging stakeholder 'ownership' of designs. In each case, the brief centred on a schedule of required accommodation. Initial meetings between the PCT, design team and LHCC client were fundamental in communicating wider social aspirations for each project and reinforcing the need for quality design in both building and urban terms. For each project, the design process was governed by a Steering Group which – crucially – included clinicians. Regular Design Reviews involved representatives from all key stakeholder groups, allowing refinement of the brief in response to precise client requirements (although some alterations have subsequently been made). This open,

Case note 07

collaborative approach (both among the various elements of the LHCC and – subsequently – between them, the PCT and design team) was essential in terms of conceiving truly integrated buildings. With regards to the Partick scheme in particular, where the initial brief was simply to replace an existing health centre, collaboration led – at an early stage in the design process – to the idea of incorporating a council-run nursery school into the project. The team were thus able to captialise on a larger, more prominent site on the corner of Sandy Road and Dumbarton Road, where the childcare facility had been operating from temporary accommodation.

At tender stage, both design teams provided full production information, having also either designed or specified many of the furnishings and fittings. Bills of Quantities were issued to bidding contractors and – in each case – the lowest priced tender was accepted.

Easterhouse Photo: Archial Group

The Community Centre for Health in Partick was completed and opened in 2004. A second phase of development, again designed by Gareth Hoskins Architects, received planning approval in February 2007 and went on site in September 2007. The £2.6m project extends the building along Sandy Road, providing new accommodation for GPs, mental health services and children’s health services. For Easterhouse Community Health Centre, where the brief was to extend, reconfigure and enhance existing facilities, it was imperative that the project did not disrupt the day-to-day operation of the various client users. The work was delivered in four key phases, completing in April 2004, and the newly integrated centre was officially opened in October the same year by Andy Kerr MSP, (then) Minister for Health and Community Care.

Case note 07

Su m m a r y The challenge for large NHS client bodies, especially those recently amalgamated from across a wide geographical area, is how to create a coherent, easily managed estate that remains finely tuned to the character and needs of individual communities. Through aspirational briefing, empowerment at local level and the development of an action plan, NHS Greater Glasgow and Clyde is building on the strength of two facilities that vary widely in scope and context but achieve mutually excellent standards of design and care.

Tony Curran's success as a client – particularly in terms of his strategic remit – is his ability to see the 'bigger picture'. From his days at Greater Glasgow NHS Primary Care Trust, he has been emphatic that all community healthcare projects in Glasgow should contribute to an enhanced public realm and the city's wider urban context. In the case of the Health Centres in Partick and Easterhouse, this have been achieved on modest budgets through appropriate scale, interesting architectural forms and high quality materials. It is a mark of their success in this regard that both buildings remain vandalism free, five years after completion. Not only does this send positive messages to communities about how they are valued but improves the longevity of each building's fabric, thus lessening the client's maintenance burden. Easterhouse Photo: Archial Group

Tony believes that much of the design innovation shown by both Gareth Hoskins Architects and Davis Duncan Architects is due to the fact that – on appointment – both practices were relatively new to the healthcare market. Teamed with healthcareexperienced surveyors and engineers, they brought in expertise from other sectors (including commercial mixed use developments) and encouraged the client team to think beyond pure functionality, tapping into their aspirations for community outreach. Interestingly, had the outline project budgets and/or architects fees been higher, both practices could potentially have been unsuccessful in bidding for the work in the first instance. This is based on the PCT's established scoring procedure for OJEU-advertised appointments, which required sound evidence of previous experience in the sector.

Case note 07

On the client side, there are several reasons why the PCT and Steering Groups were responsive to the ideas proposed by the architectural 'fresh blood'. Firstly, John Donnelly's training as an architect is certainly a factor, although projects managed by other disciplines within Tony's team have also demonstrated a successful move away from wholly clinicalbased design solutions towards a more holistic approach.

The co-operative nature and purpose of the LHCC client sponsors is undoubtedly relevant. In 1999, these bodies were specifically established to encourage integration between healthcare providers, so collaboration and innovation were built into their working processes from the start. Although accountable to Primary Care Trusts, they acted as separate management entities and the level of local 'ownership' they had in projects such as the Partick and Easterhouse Community Health Centres was a strong incentive to achieve the best possible results. They relied on the knowledge of John Donnelly and the wider Estates team, but they were pro-active project leaders in their own right.

Partick Community Centre Photo: John Cooper

LHCCs have now evolved into Community Health Partnerships, of which there are currently ten across Greater Glasgow and Clyde, including six designated Community Health and Care Partnerships. To pave the way forward for these clients, Tony and his team have worked hard to ensure that lessons learned from the Partick and Easterhouse projects have been recycled back into the procurement of other facilities, both informally and through NHS Greater Glasgow and Clyde's Design Action Plan. Launched in September 2008, this strategy relates to how the organisation plans and builds its healthcare facilities, whether new-build or refurbishment. It aims to produce best value buildings that achieve both quality of space and optimum functionality. Developed in collaboration with local authorities, architects, staff and patients, the Design Action Plan recognises the impact of good design on health outcomes and on broader social objectives such as civic pride. It underlines the need for the involvement of all stakeholders in the design process, including both clinicians and service users. In focusing as much on the process of good clientship as on the product, it refers outside of itself to self-assessment techniques such as the Achieving Excellence Design Evaluation Toolkit 83

Case note 07

Tony Curran Easterhouse and Partick Community Centres

(AEDET Evolution) and the sustainability-focused BREEAM Healthcare, which have now been used on the Stobhill and New Victoria hospital redevelopments. Perhaps most importantly of all, it recognises the contribution of a strong figurehead â&#x20AC;&#x201C; the Design Champion â&#x20AC;&#x201C; to all major schemes and the need for continual review of both individual buildings and the Plan itself, based on evidence from 'live' projects and constantly evolving best practice.

Partick Community Centre Photo: John Cooper

A call from NHSScotland As a senior professional working within NHSScotland, Tony Curran is very familiar with plans for Framework Scotland and HubScotland. These new strategies, which are founded on the pressing need for more economical and less adversarial procurement routes, have raised some concerns around the perceived transfer of control to third parties, either local Hub Companies or ‘design and construct’ partners. In his interview, Tony urged that great care should be taken to ensure that processes considered to be ‘improvements' do not actually result in more and more procedural implementation. He fears that this may inhibit potential for architectural ingenuity and skill, particularly in small, intimate community projects where engagement and local ‘ownership’ is vital. The case studies in this publication show that excellence can be achieved irrespective of the procurement route chosen, using – in some cases – methodologies similar to those being introduced in Scotland. So what are the key lessons to be drawn from these successful clients? How can NHSScotland get the best outcomes from the new, quicker, more efficient procurement routes? These are precisely the questions that this publication sets out to help answer...

Conclusions

These case studies demonstrate that good buildings can be delivered via any available procurement route. They show that a number of different approaches to healthcare projects have resulted in the same quality threshold, suggesting that procurement itself is neither an instrument for nor, ultimately, a barrier to good design. The key message here is that it is people â&#x20AC;&#x201C; both within client bodies and delivery teams â&#x20AC;&#x201C; that develop and maintain the vision, working within and sometimes despite the rigours of the chosen procurement vehicle. The studies offer strong messages as to the essential project elements that should be given prominence irrespective of procurement choices. This makes them entirely relevant to the Scottish context, even though some of the methodologies used are either not currently available here (LIFT's resemblance to Hub notwithstanding) or are becoming less prevalent. Indeed, in the changing procurement landscape of NHSScotland, the focus on issues such as client leadership, clinical and public engagement, visions, outcomes and skills can give early momentum to the development and implementation of new procurement strategies.

Conclusions

C l i en t l ea de r s hi p The Arches Centre Photo: Dennis Gilbert / View

The people considered in our case studies come from different backgrounds and disciplines. Technical and non-technical, they reflect the range of influences now active in delivering healthcare buildings, including the private sector. Some like Patricia Pope and Laura Lee have had direct responsibility for projects, while others like John Cole and Tony Curran have been facilitators, establishing the context for good practice and working with colleagues to provide an informed interface between commissioning clients and design teams. In each case, those we applaud for their clientship have been instrumental in driving projects forward on behalf of owners, operators and users. The common factor among our flagbearers is a demonstrable belief in the new NHS and the value of good design. Amid the complexity of procurement and delivery processes, they have acted as a visible and constant focus for aspirational change. They are enthusiastic, open and dedicated, showing personal commitment to what are often longterm projects. Their assurance and willingness to take responsibility have inspired the confidence of others responsible for delivering the vision, including younger, less experienced team members (in the case of Richard Glenn) and multi-disciplinary partners (Malcolm Aiston). As national accolades testify, most recently in the case of Sylvie Pierce, our clients have been true Design Champions. Across all remits, sites and contexts, they have shown that there is a place for intuition and innovation in healthcare procurement, supporting an environment within which good design can flourish. They have recognised that buildings are more than the sum of their parts and that â&#x20AC;&#x201C; by looking outside traditionally narrow views of functionality â&#x20AC;&#x201C; the places we build can enhance a more rounded sense of wellbeing among users, turning aspiration into expectation.

Conclusions

U s e r e ng a ge m e n t From cancer caring centres to children's hospitals, secure mental health units to community facilities, the buildings we have studied all share a pioneering, patient-focused vision. Through high quality design of an appropriately civic scale, they send out clear messages as to the dignity of the patient experience and the role of the service user in the new NHS. They are reaching their full potential as a means to better care delivery because they support staff in their evolving working practices and have the flexibility to continue to do so in the future. In each case, the precise requirements of those who use the facilities day-to-day have been articulated as much through quality consultation, particularly at briefing stage, as overarching management strategies.

In terms of 'engagement', the lessons to be learned from our studies relate to the way in which fostering genuine collaboration between users, clinicians and designers can help NHSScotland move towards implementing Better Health Better Care. To confidently address this culture-shift, it is important to establish and agree fundamental principles for the ethos of the development early on and test the design against them at key stages. This means early and ongoing access to architects and significant support in getting the most out of this engagement. Easterhouse Photo: Archial Group

Through involvement in extensive consultation, Richard Glenn has identified that it is often very difficult for people without a building design background to imagine or describe how new care pathways might be supported in built form. Out of context, i.e. outside the 'live' design process, asking users what they want or need often results in reactive feedback... “what we have at the moment, minus the problems!”. With proper integration, enabled by people who cross the technical/non-technical divide, design can be used – not simply as an end product – but as a 'change management' tool in itself. For estates professionals, establishing good relationships between client-users is critical as 'polyclinics' and 'one stop shops' become increasingly prevalent. Through the design process, both management and staff can test the physical implications of new working methods and the consequences of their decisions and priorities in relation to how buildings look, function and feel. Working iteratively with designers, they can imagine their new

Conclusions

future in three dimensions and come to see the space available to them as a resource rather than a territory, thus paving the way for effective working and asset management. Otherwise there is a danger that the mistakes of the past will simply be carried over into the next generation of healthcare facilities, as CABEâ&#x20AC;&#x2122;s 2008 study showed...

â&#x20AC;&#x153;Some buildings had benefited from the opportunity to incorporate new services or new ways of providing services. (However) most buildings reflected older patterns of working rather than facilitating the new (and showed) a frequent unwillingness on the part of individual practitioners to talk to other tenants at design consultation phase about the development of more efficient care models. There was a noticeable amount of underused and unused space in some buildingsâ&#x20AC;?. Assessing Design Quality in LIFT Primary Care Buildings

The Carlisle Centre

The Community Care and Treatment facilities in Belfast are wonderful examples of projects that have grown from a clear care strategy and which now embody and support new joint working practices, bringing most stakeholders with them on this journey. They have met the challenge of unlocking the potential of new buildings by supporting userclients at briefing stage, with Health Estates performing an enabling role. Similarly, the contribution of Mick Timpson to the Kaleidoscope project can be felt most keenly in the way the building promotes interaction between its 23 operational teams, a key tenet of the early Mission Statement. Though the methodology for wider consultation varies, our studies show that workshops are providing designers with some of the most useful insights into space utilisation and appreciation. While simulation exercises such as the Bamburgh Clinic Experience may not be possible for most developments, the 'Day in the Life Of...' sessions run by Malcolm Aiston and partners could easily be rolled-out across projects of any scope and scale. A key factor in their success is consistency of approach from stage to stage, which is borne out by the techniques used by other exemplar clients such as NHS Greater Glasgow and Clyde and Lewisham PCT. For these bodies, tools like AEDET are making the design process more inclusive, allowing greater and more meaningful patient contribution to decision-making.

Conclusions

M e a s u r i n g o u t c o m e s , n o t p ro c e s s a l o n e It is absolutely crucial that clients be well prepared for development, have a robust business case in place and can demonstrate that public money has been spent in a correct and accountable manner. However, as Sylvie Pierce testifies, solely attending to the efficacies of process (i.e. the demands of auditors and paper trails) can leave project leaders with little time or energy to devote to the actual purpose of procurement... the delivery of exemplary healthcare buildings. This drives the tendency towards prescriptive briefing and design, in a bid to 'nail down' quality. What this cannot accommodate is flexibility, a key principle behind both the rapidly modernising NHS and architecture of lasting value.

The clients we have profiled have had the tenacity to resist the pitfall that catches out so many of their number, that of concentrating solely on what is readily quantifiable about development. By formalising a top-line mission statement (as with Kaleidoscope) or agreeing a charter of shared objectives (the Bamburgh Clinic), they have each established a vision which focuses on what they want to achieve, rather than predetermining how.

Heart of Hounslow Photo: Dennis Gilbert / View

The vision – or 'big picture' – takes into account the wider influence of healthcare buildings, such as the regeneration of cities like Belfast, Glasgow and Liverpool. As Richard Glenn has noted, it attributes value to factors like civic pride, family wellbeing and the sustainable development of communities. In the 'long game' of procurement, especially in a new hospital development, the vision is the one constant amid a sea of evolving requirements. It thus serves as a quality benchmark against which all key decisions can be tested and – critically, in terms of future-proofing projects – opens the door to innovation and flair.

Conclusions

The success of the Maggie's brief demonstrates that a shift in emphasis from quantitative to qualitative when establishing objectives does not equate to a move away from 'measurable' outcomes such as optimum spatial efficiency and ‘cost in use’. To use AEDET terminology, this signifies the ideal balance between ‘impact’, ‘functionality’ and ‘build quality’. In the same vein, one of Lewisham PCT’s main objectives in developing Kaleidoscope has been to influence the public perception of the Trust and set down a visual mandate for future development. This has impacted on the client’s choice of procurement route, specifically the use of a design competition to shape a building of discernible character and urban integration.

The Arches Centre Photo: Dennis Gilbert / View

The emerging discipline of ‘whole lifecycle’ assessment cannot yet give a measure for factors such as delight but is a move towards recognition of a building's value over time. In tandem, the Scottish Government Health Directorate is leading the way in developing systems that encourage Boards to more demonstrably link changing clinical practice with capital spend in their business cases and to highlight the role of a well- designed building in delivering this change. Combined with an increased concentration on measuring the outcomes of this investment, the move is to be welcomed as a way of helping us all to learn from each other’s good practice and provide a more rigorous basis on which to brief future projects and to judge both proposed design solutions and the skills behind them.

Conclusions

Va lu in g d e sig n sk ills Designers – be they architects, engineers or health planners – do not produce the building itself: they neither lay bricks nor weld steel. What they bring to the process is the ability to synthesise the needs and aspirations of the client, the opportunities of the site and a host of governmental policies and legislation into a vision for a better future. They bring time and quality of thought, so it is perhaps unsurprising that the clients we interviewed each wished to make special note of the role of their design teams in achieving exemplar facilities.

Designers are more than just draughtsmen. The best ones, those most likely to produce buildings of lasting value to communities, are themselves people-focused. Before any design work begins, they need to understand the client’s requirements, be attuned to the particular needs of user groups and have the skills to engage with clinicians and stakeholders.

The Arches Centre

The design teams behind the buildings we have profiled in our case studies were chosen in a number of ways: most through competitive processes and/or prior working relationships with the bidding developer. In each case, their ability to design was a prominent factor in the selection process. This may seem obvious, but is not universally applied.

Photo: Dennis Gilbert / View

Clients can shy away from assessing design skills for a number of reasons. Some can see the process as subjective and difficult to account for, particularly when they feel they don't have the background or confidence to make such judgements. There is also a misapprehension that good designers cost more and that they certainly design buildings that cost more. Our case studies challenge this assumption by providing examples of excellence procured within the normal cost constraints of the NHS. Kaleidoscope, for example, was costed in accordance with NHS Estates guidance at £13.5m (including VAT, contingency and professional fees). Announcing the winning design, the judging panel (comprising both technical and non-technical members) congratulated the team “on having the guts to present such a deceptively easy proposal”. Since the quality of the competition and briefing process was so strong, only minor tweaks to the budget were necessary during construction. 94

Conclusions

T h e ro l e a n d v a l u e o f e s t a t e s p ro f e s s i o n a l s Audit Scotlandâ&#x20AC;&#x2122;s 2009 report Strategic Asset Management in the NHS in Scotland described the challenges faced by NHS bodies in relation to their estates workforce. These key people are often undervalued and overlooked within the wider clinical context, which focuses attention on the pressures of delivering care day-to-day. However, without appropriate buildings to support this care, the prime function of its providers is severely compromised, potentially to the point of failure.

In the procurement of new healthcare facilities, estates professionals play a pivotal and multi-faceted role. They develop the business case, co-ordinate stakeholders (often to the extent of playing 'marriage guidance counsellor' between different interests), appoint advisers and delivery teams, support design dialogue and meet a raft of auditing requirements in the process. All this within an environment that generally focuses on programme and capital costs but too often allows little scope for valuing outcomes.

The Carlisle Centre

Our case studies show that the best new buildings have been designed in an atmosphere of trust. Their success is due to an openness among those who procure, design and build them, with each profession recognised and respected for what it brings to the table. Where new delivery models have been seen as challenging, tenacious clients have mobilised quickly to bring both hopes and fears for projects out in the open. Through de-mystifying the design and construction process, the blueprint has been established for all future relationships that affect the projects day-to-day. Given the importance and difficult nature of their remit, estates professionals need to be encouraged and supported in their role and deserve greater recognition of a job well done. It is hoped that â&#x20AC;&#x201C; through highlighting the achievements of those at the coalface of producing good buildings â&#x20AC;&#x201C; this publication goes some way to redressing the balance, both for the teams profiled and also for estates professionals within NHSScotland who are charged with delivering the exemplar developments of the future.

Appendices

R e f e re n c e s i Prof. Bryan Lawson and Dr Michael Phiri, University of Sheffield. The Architectural Environment and its Effects on Patient Health Outcomes. A Report on an NHS Estates Funded Research Project. Crown Copyright 2003 ISBN 0-11-322408-X ii Roger Ulrich and Craig Zimring The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity. September 2004 iii CABE, Health Hospitals, 2003 iv Roger Ulrich and Craig Zimring, The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity. September 2004 v Towards an Urban Renaisance. Final Report of the Urban Task Force. Chaired by Lord Rogers of Riverside. Crown Copyright 1999 ISBN 1 85112165 X vi Hansard, Lord Rea, House of Lords, 29 January 2003.

Appendices

F u r t h e r R ea d i ng Creating Excellent Buildings: A Guide for Clients Commission for Architecture and the Built Environment (CABE) 2003 Summary – http://www.cabe.org.uk/AssetLibrary/2280.pdf Full report – http://www.cabe.org.uk/AssetLibrary/4037.pdf Assessing Design Quality in LIFT Primary Care Buildings Commission for Architecture and the Built Environment (CABE) 2008 Summary – http://www.cabe.org.uk/AssetLibrary/11283.pdf Full report – http://www.cabe.org.uk/AssetLibrary/11284.pdf Asset Management in the NHS in Scotland Audit Scotland 2009 http://www.audit-scotland.gov.uk/docs/health/2009/nr_090129_asset_management_nhs.pdf LWPCT Children and Young People’s Centre Design and innovation for primary health and social care Commission for Architecture and the Built Environment (CABE) http://www.cabe.org.uk/publications/lewisham-primary-care-trust General Information on LIFT www.dh.gov.uk/procurementAndProposals/PublicPrivatePartnership/NHSLIFT/fs/en SHINE Shine Healthcare Learning Network www.shine-network.org.uk Building Better Health www.buildingbetterhealth.co.uk

Appendices

S o u rc e s o f I n f o r m a t i o n a n d S u p p o r t Scottish Government Health Directorates - http://www.pcpd.scot.nhs.uk/design.htm Health Facilities Scotland - www.hfs.scot.nhs.uk Architecture and Design Scotland (A+DS) - www.ads.org.uk

A rc h i t e c t s â&#x20AC;&#x2122; W e b s i t e s Archial Group - www.archialgroup.com BDP - www.bdp.com Buschow Henley - www.buschowhenley.co.uk Gareth Hoskins Architects - www.garethhoskinsarchitects.co.uk MAAP - www.medical-architecture.com Page/Park - www.pagepark.co.uk Penoyre and Prasad - www.penoyre-prasad.net Rogers Stirk Harbour + Partners - www.richardrogers.co.uk Todd Architects - www.toddarch.com van Heyningen and Howard Architects - www.vhh.co.uk

Published in 2009 by Architecture and Design Scotland (A+DS) Architecture and Design Scotland (A+DS) is Scotland’s champion for excellence in place-making, architecture and planning. It is an NDPB of the Scottish Government. This Publication has been produced as part of the work undertaken with and for NHSScotland, and in association with the Scottish Government Health Directorate. With thanks to those interviewed in the development of the featured case studies. Interviews by Jill Malvenan, Jim Chapman and Jane Mulcahey. Additional research and text by Máire Cox. Some rights reserved. No image or graphic from this publication may be reproduced, stored in a retrieval system, copied or transmitted without the prior written consent of the publisher except that the material may be photocopied for non-commercial purposes without permission from the publisher. The text of ‘Case Notes: Client Leadership’ is licensed under a Creative Commons Attribution 2.5 Scotland License. Designed and produced by REPUBLIC www.republicproductions.com Image Credits: Front cover: Kaleidoscope. Photo: Alex Griffiths Inside front cover: Kaleidoscope. Photo: Nick Kane Contents page: Partick Community Centre. Photo: John Cooper Architecture and Design Scotland Bakehouse Close, 146 Canongate, Edinburgh EH8 8DD T: 0131 556 6699 F: 0131 556 6633 E: info@ads.org.uk

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“ ‘Better Health Better Care’ sets out a flagship vision for healthcare in Scotland, requiring new models of care and new buildings in which to deliver this agenda...What we build now can and should provide patient-focused healing environments of a quality that we can be proud of and that can support healthcare delivery for the decades to come. ” Dr Kevin Woods Director General Health | Chief Executive NHSScotland Architecture and Design Scotland Bakehouse Close, 146 Canongate, Edinburgh EH8 8DD T : 0131 556 6699 F : 0131 556 6633 E : info@ads.org.uk

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This publication shows how successful client leadership Is key to ensuring a high quality outcome for the healthcare estate.