case notes: client leadership

CASE NOTES:Client LeadershipCCaassee ssttuuddiieess oonn tthhee rroollee ooff tthhee cclliieenntt iinn tthheeddeelliivveerryy ooff eexxeemmppllaarryy hheeaalltthhccaarree bbuuiillddiinnggss..

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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.

‘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. 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 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

5

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.

Foreword

Contents

Introduction 09

What is good design? 10

Why is good design important? 11

How do clients deliver good design? 15

Case note 01 16

John Cole – Health Estates NI

Case note 02 26

Sylvie Pierce – Building Better Health

Case note 03 36

Malcolm Aiston – Northumberland, Tyne and Wear NHS Trust

Case note 04 46

Laura Lee – Maggie’s Cancer Caring Centres

Case note 05 56

Patricia Pope – Lewisham Primary Care Trust

Case note 06 66

Richard Glenn – Alder Hey Children's NHS Foundation Trust

Case note 07 76

Tony Curran – NHS Greater Glasgow and Clyde

Conclusions 86

7

9

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.

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’.

Gareth Hoskins

Scotland’s Healthcare

Design Champion

Maggie’s HighlandsPhoto: MCCC

>

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.

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.

10

Heart of HounslowPhoto: JAM

>

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.

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?

11

WWhhaatt iitt mmeeaannss ffoorr ppaattiieennttss aanndd tthhee wwiiddeerr ppuubblliicc

Maggie’s LondonPhoto: MCCC

>

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.

> 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.

12

Royal Alexandra Children’s HospitalPhoto: David Barbour

>


WWhhaatt iitt mmeeaannss ffoorr NNHHSS ssttaaffff

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 – using the form, orientation and fabric of the building to

minimise the need for mechanical systems which are expensive to operate and maintain.

13


TThhee wwiiddeerr iinnfflluueennccee ooff hheeaalltthhccaarree bbuuiillddiinnggss


>

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 bed-

space, 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 – 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.

“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 environment”.

(Lord Reavi)

14


WWhhaatt iitt mmeeaannss ffoorr tthhee hheeaalltthh sseerrvviiccee

Kaleidoscope Photo: Nick Kane

>

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 – in some cases – 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.

15

How do clients deliver good design?

Maggie’s HighlandsPhoto: MCCC

>

16

JJoohhnn CCoollee,, CChhiieeff EExxeeccuuttiivvee,, HHeeaalltthh EEssttaatteess NNII

01.

Project Name: Carlisle Centre

Project Type: Community Care and Treatment Centre

Client: North & West Belfast NHS & Social Services Trust

Architects: Penoyre & Prasad/Todd Architects

Completed: 2007

Location: Belfast city centre

Funding: North & West Belfast NHS & Social Services Trust

Value: £9.2m

Procurement Type: Performance Related Partnership

Project Name: The Arches Centre

Project Type: Community Care and Treatment Centre

Client: South & East Belfast NHS & Social Services Trust

Architects: Penoyre & Prasad/Todd Architects

Completed: 2005

Location: Belfast city centre

Funding: South & East Belfast NHS & Social Services Trust

Value: £11m

Procurement Type: Performance Related Partnership

Awards: 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

17

Case note 01

IInnttrroodduuccttiioonn

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.

John Cole

The Arches Centre and

Carlisle Centre

19

Case note 01

DDeessccrriippttiioonn

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.

The Arches CentrePhoto: Dennis Gilbert/View

>

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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.

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 user-

client 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

PPrrooccuurreemmeenntt pprroocceessss

Carlisle Centre>

21

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 client’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.

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 £9.2m project was completed 18 months later in May 2007.

Case note 01

The Arches CentrePhoto: Dennis Gilbert/View

>

22

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).

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 place-

making 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

SSuummmmaarryy

Carlisle Centre>

23

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.

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

The Arches CentrePhoto: Dennis Gilbert / View

>

25

Case note 01

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 cafés. 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

>

John Cole

The Arches Centre and

Carlisle Centre

26

02.

SSyyllvviiee PPiieerrccee,, CChhiieeff EExxeeccuuttiivvee,, BBuuiillddiinngg BBeetttteerr HHeeaalltthhProject Name: Heart of Hounslow

Project Type: Polyclinic

Client: Primary Care Trust of Hounslow

Architects: Penoyre & Prasad

Completed: 2007

Location: Hounslow town centre

Funding: Primary Care Trust of Hounslow

Value: £18m

Procurement Type: LIFT

Awards: 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: St John’s Therapy Centre

Project Type: Therapy Centre

Client: Primary Care Trust of Wandsworth

Architects: Buschow Henley

Completed: 2008

Location: Wandsworth town centre

Funding: West London Ltd

Value: £8m

Procurement Type: LIFT

Awards: 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

27

Case note 02


'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.

Sylvie Pierce

Heart of Hounslow and

St John's Therapy Centre

29

Case note 02


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.

Heart of HounslowPhoto: Dennis Gilbert / View

>

30

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.

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


Heart of Hounslow Photo: Dennis Gilbert / View

>

31

Evaluation of the bids involved a stakeholder group beyond what was already a multi-

faceted 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.

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

St John’s Therapy CentrePhoto: Nick Kane

>

32

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 sub-

contracted skills like design, construction and health planning.

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

SSuummmmaarryy

Heart of HounslowPhoto: Dennis Gilbert / View

>

33

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.

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


>

35

Case note 02

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.

St John’s Therapy CentrePhoto: Nick Kane

>

Sylvie Pierce

Heart of Hounslow and

St John's Therapy Centre

36

03.

MMaallccoollmm AAiissttoonn,, AAssssoocciiaattee DDiirreeccttoorr ooff EEssttaatteess &&FFaacciilliittiieess,, NNoorrtthhuummbbeerrllaanndd,, TTyynnee aanndd WWeeaarr NNHHSS TTrruusstt Project Name: The Bamburgh Clinic, St Nicholas Hospital

Project Type: Mental Health Centre (Medium Secure Unit)

Client: Newcastle, North Tyneside and Northumberland Mental Health NHS Trust

Architects: MAAP

Completed: 2004

Location: Gosforth

Funding: NTW NHS Trust

Value: £22m

Procurement Type: ProCure21

Awards: 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

37

Case note 03


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 £22m 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.

Malcolm Aiston, Associate Director of Estates &Facilities, Northumberland, Tyne and Wear NHS Trust

Malcolm Aiston

Bamburgh Clinic,

St Nicholas Hospital

39

Case note 03


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 multi-

games '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).

Bamburgh ClinicPhoto: MAAP

>

40

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.

Using a broad scoring matrix, Laing O’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 £70,000 less than the Guaranteed

Maximum Price, with savings being invested in Phase II of the project: the Medium

Secure Unit.

Case note 03



>

41

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.

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


>

42

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 de-

stigmatised 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 non-

clinical 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.

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

SSuummmmaarryy


>

43

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.

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


>

45

Case note 03

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.


>

Malcolm Aiston

Bamburgh Clinic,

St Nicholas Hospital

46

04.

LLaauurraa LLeeee,, CChhiieeff EExxeeccuuttiivvee OOffffiicceerr,, MMaaggggiiee’’ss CCaanncceerrCCaarriinngg CCeennttrreessProject Name: Maggie’s Cancer Caring Centre, Highlands

Project Type: Care Centre

Client: MCCC

Architects: Page\Park

Completed: 2004

Location: Inverness, The Highlands

Funding: Donations/National Lottery’s New Opportunities Fund

Value: £850,000

Procurement Type: Traditional

Awards: 2006 RIAS Andrew Doolan Award for Architecture

Project Name: Maggie’s Cancer Caring Centre, London

Project Type: Care Centre

Client: MCCC

Architects: Rogers Stirk Harbour + Partners

Completed: 2008

Location: Hammersmith, London

Funding: Donations

Value: £2.3m


Awards: 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

47

Case note 04


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 non-

institutional 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.

Laura Lee

Maggie’s Cancer Caring Centres

Highlands and London

49

Case note 04


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”.


>

50

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, Ann-

Louise 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.

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


Maggie’s Highlands>

51

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.

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


>

52

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.

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

SSuummmmaarryy


>

53

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.

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

Maggie’s Highlands>

55

Case note 04

The most challenging aspect of the brief is maintaining patient privacy on exposed, edge-

of-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.

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.

Maggie’s Highlands

>

Laura Lee

Maggie’s Cancer Caring Centres

Highlands and London

56

05.

PPaattrriicciiaa PPooppee,, BBuussiinneessss MMaannaaggeerr ffoorr CChhiillddrreennssSSeerrvviicceess,, LLeewwiisshhaamm PPrriimmaarryy CCaarree TTrruussttProject Name: Kaleidoscope - The Lewisham Children and Young People’s Centre

Project Type: Children and Young People’s Centre

Client: Lewisham Primary Care Trust

Architects: van Heyningen and Haward

Completed: 2006

Location: Lewisham, London

Funding: Lewisham Primary Care Trust

Value: £13.5m

Procurement Type: Traditional (Design Competition)

Awards: 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

57

Case note 05


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 multi-

functional urban building of high artistic merit.

Delivered for a capital cost of £13.5m, 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

Minister’s Better Public Building Award in 2007.

Patricia Pope

Kaleidoscope Centre

59

Case note 05


Kaleidoscope – The Lewisham Children and Young People’s Centre – 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.


>

60

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.

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 – after the PCT had finalised the brief and

funding sources – the design phase of the competition commenced.

Case note 05


KaleidoscopePhoto: Nick Kane

>

61

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.

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

Kaleidoscope Photo: Alex Griffiths

>

62

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.

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 – and relations with – 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

SSuummmmaarryy


>

63

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.

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 –

not only for meeting aspirations – but also for bringing the building in on time and to

budget.

Case note 05


>

65

Case note 05

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

>

Patricia Pope

Kaleidoscope Centre

66

06.

RRiicchhaarrdd GGlleennnn,, PPrroojjeecctt DDiirreeccttoorr,, AAllddeerr HHeeyyCChhiillddrreenn''ss NNHHSS FFoouunnddaattiioonn TTrruussttProject Name: Royal Alexandra Children’s Hospital

Project Type: Children’s Hospital

Client: Brighton and Sussex University Hospitals NHS Trust

Architects: Building Design Partnership (BDP)

Completed: 2007

Location: Brighton

Funding: Kajima

Value: £37m

Procurement Type: PFI

Awards: 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)

67

Case note 06


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.

Richard Glenn

Royal Alexandra Children’s Hospital,

Brighton

69

Case note 06


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.


>

70

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.

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



>

71

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 ark-

like 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.

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


>

72

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.

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

SSuummmmaarryy


>

73

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.

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, family-

focused 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.

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


>

75

Case note 06

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.


>

Richard Glenn

Royal Alexandra Children’s Hospital,

Brighton

76

07.

TToonnyy CCuurrrraann,, HHeeaadd ooff CCaappiittaall PPllaannnniinngg &&PPrrooccuurreemmeenntt,, NNHHSS GGrreeaatteerr GGllaassggooww aanndd CCllyyddeeProject Name: Easterhouse Community Centre

Project Type: Health Centre

Client: NHS Greater Glasgow and Clyde

Architects: Davis Duncan Architects (Archial group)

Completed: 2004

Location: Easterhouse, Glasgow

Funding: NHS Greater Glasgow and Clyde

Value: £2.5m


Awards: 2004 Scottish Design Awards – Best Publicly Funded Building

2004 Glasgow Institute of Architects Award

Project Name: Partick Community Centre for Health

Project Type: Health Centre

Client: NHS Greater Glasgow and Clyde

Architects: Gareth Hoskins Architects

Completed: 2004

Location: Partick, Glasgow

Funding: NHS Greater Glasgow and Clyde

Value: £2.5m


Awards: 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

77

Case note 07


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 £2.5m 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.

Tony Curran

Easterhouse and Partick

Community Centres

79

Case note 07


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.

Partick Community CentrePhoto: John Cooper

>

80

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).

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.

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



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81

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.

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

Easterhouse Photo: Archial Group

>

82

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.

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 healthcare-

experienced 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

SSuummmmaarryy


>

83

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 clinical-

based 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.

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

Case note 07


>

85

Case note 07

(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 – the Design

Champion – 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.


>

Tony Curran

Easterhouse and Partick

Community Centres

86

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 arefounded on the pressing need for more economical and less adversarial procurementroutes, have raised some concerns around the perceived transfer of control to thirdparties, 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. Hefears that this may inhibit potential for architectural ingenuity and skill, particularly insmall, intimate community projects where engagement and local ‘ownership’ is vital.

The case studies in this publication show that excellence can be achieved irrespectiveof the procurement route chosen, using – in some cases – methodologies similar tothose being introduced in Scotland. So what are the key lessons to be drawn fromthese successful clients? How can NHSScotland get the best outcomes from the new,quicker, more efficient procurement routes? These are precisely the questions that thispublication sets out to help answer...

87

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 – both within client bodies and delivery teams – 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.

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 long-

term 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 – by looking outside traditionally narrow

views of functionality – the places we build can enhance a more rounded sense of

wellbeing among users, turning aspiration into expectation.

Conclusions

CClliieenntt lleeaaddeerrsshhiipp

89


>

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.

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

UUsseerr eennggaaggeemmeenntt


>

90

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 CABE’s 2008 study showed...

“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 under-

used and unused space in some buildings”. Assessing Design Quality in LIFT Primary Care

Buildings

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 user-

clients 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

The Carlisle Centre>

91

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.

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

MMeeaassuurriinngg oouuttccoommeess,, nnoott pprroocceessss aalloonnee


>

92

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 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


>

93

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 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.

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.

Conclusions

VVaalluuiinngg ddeessiiggnn sskkiillllss


>

94

Audit Scotland’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.

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 – through highlighting the achievements of those at the coalface

of producing good buildings – 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.

Conclusions

TThhee rroollee aanndd vvaalluuee ooff eessttaatteess pprrooffeessssiioonnaallss

The Carlisle Centre>

95

Appendices

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.

96

RReeffeerreenncceess

Appendices

FFuurrtthheerr RReeaaddiinngg

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

97

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

AArrcchhiitteeccttss’’ WWeebbssiitteess

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

Appendices

SSoouurrcceess ooff IInnffoorrmmaattiioonn aanndd SSuuppppoorrtt

98

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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

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www.ads.org.uk

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Architecture and Design ScotlandBakehouse Close, 146 Canongate,Edinburgh EH8 8DD

T : 0131 556 6699 F : 0131 556 6633E : [email protected]

www.ads.org.uk

“ ‘Better Health Better Care’ sets out a flagship vision for healthcarein Scotland, requiring new models of care and new buildings inwhich to deliver this agenda...What we build now can and shouldprovide patient-focused healing environments of a quality that wecan be proud of and that can support healthcare delivery for thedecades to come.” Dr Kevin WoodsDirector General Health | Chief Executive NHSScotland

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

case notes: client leadership

Documents