A+ds: Health Publication

A Vision of Health NHS Sc ot lan d ’s a ge n da fo r rea lisin g va lu e i n t h e d e v e l o p i n g h e a l t h c a re e s t a t e

A Vision of Health NHS Sc ot lan d ’s a ge n da fo r rea lisin g va lu e i n t h e d e v e l o p i n g h e a l t h c a re e s t a t e

Nicola Sturgeon MSP

Foreword

Foreword

The Better Health, Better Care Action Plan, published in 20071, affirmed the Scottish Government’s commitment to improving the physical and mental wellbeing of the people of Scotland through supporting the provision of well designed, sustainable places. The Action Plan also articulated the Scottish Government’s vision of a mutual National Health Service, a shift to a new ethos for health in Scotland that sees the Scottish people and the staff of the NHS as partners, or co-owners, in the NHS.

In this publication we celebrate the vision of some of Scotland’s healthcare leaders including the Chief Medical Officer and healthcare Design Champions and set out the practical measures being put in place to assist Scotland’s NHS Boards in guiding their projects to successful outcomes.

These policy changes place health and wellbeing and the over-arching issue of sustainability at the centre of the lives of the people of Scotland as the NHS strives to become more accountable and patient-focused. If we are to deliver on our commitment to create a healthier, wealthier, fairer, safer and stronger Scotland we must ensure that in the context of designing new facilities, NHS Boards deliver not only high quality solutions but also realise benefits for community development and the wider environment.

Throughout, we feature some current and future-planned projects within NHSScotland which look to provide the quality of environments to which we aspire. As the Scottish Government’s Purpose and National Performance Framework take ever greater effect in the day-to-day focus for our public services and on improving the outcomes and quality of life for all of Scotland’s people, it is important that the principles of visionary leadership of those who contributed to this publication are embraced by NHS Boards in Scotland and all others involved in the delivery of our healthcare infrastructure.

However, the necessary changes to our existing healthcare estate to articulate our commitments cannot be achieved by policy revision alone. They need people with vision to make them happen. Such people should not necessarily be limited to the various professionals tasked with the procurement, design and delivery of our new healthcare projects: all of us have part to play in influencing our healthcare environment as part of a mutual NHS.

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Contents

Introduction

09 how NHSScotland sees the developing estate

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conversation between the three bodies with an overarching influence on the healthcare estate

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practical steps to assist NHSScotland to deliver their vision

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The Context to Support Better Outcomes Support and Leadership from the Central Procurement Agencies The Board’s Role – the best start to projects The Board’s Role – checking all is well and lessons are learned 63 64

Dumfries Dental Centre, photos: Archial Group

Appendices

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Introduction

Stobhill Hospital, photos: Reiach and Hall Architects

NHSScotland is changing; changing the way in which services are provided, changing the relationship with patients and the public, changing the focus from treating illness to improving wellbeing. Alongside and in response to this programme of change, the NHS in Scotland is charged with delivering approximately £500 million of built infrastructure each year; making the NHS one of the largest public sector developers in Scotland with, consequently, significant potential to influence community regeneration.

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This publication seeks to establish, through discussion with NHSScotland, a collective vision of what can and should be achieved through this investment, of the issues to be faced in realising this vision and the practical steps being put in place to support Health Boards, and their partners, in delivering. This publication is also a commitment, made by Scottish Government Health Directorates (SGHD), Health Facilities Scotland (HFS) and Architecture and Design Scotland (A+DS) working together as a tripartite group to promote and support high quality design and the direct benefits it brings to the Health Service and to communities. As such it will be of interest to Board Members of NHSScotland Boards, to NHSScotland staff involved in reprovisioning and reconfiguration projects, and to partner bodies in the public and private sector involved in such developments. The contributions of both Dr Harry Burns and Nicola Sturgeon MSP underline the importance of, and high level support for, the design agenda within NHSScotland. Whilst the featured projects illustrate what is being achieved, setting a benchmark for future investment.

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1. The Vision

“ ...an estate designed with ‘a level of care and thought that conveys respect’; buildings that grow from the local history and landscape, that are developed in partnership with the local community. A work of joint learning and joint responsibility that is particular to that community and that place; ‘Not off the shelf shoe boxes’.”

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The Government has set out, in Better Health Better Care, its vision for what the Health Service should be. In response, NHSScotland is developing a vision of the facilities needed to support the evolving service; a consensus being articulated by professionals from a range of disciplines that sets a clear and challenging agenda for those charged with delivery.

Key

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Dr Harry Burns, Chief Medical Officer for Scotland

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Helen Byrne, Director of Acute Services Strategy Implementation and Planning, NHS Greater Glasgow and Clyde

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Jackie Sansbury, Director of Strategic Planning & Modernisation NHS Lothian

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Maureen Coyle, Project Director NHS Forth Valley

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Roelf Dijkhuizen, Medical Director NHS Grampian

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Murray Petrie, Vice Chair NHS Tayside

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1. The Vision R o y a l H o s p i t a l f o r S i c k C h i l d re n Project Type: Client Body: Location:

Children’s Hospital NHS Lothian Royal Infirmary of Edinburgh Little France

Delivery Team: Advisors: Davis Langdon PSCP: BAM Construction Ltd Architect: Nightingale Associates Completion: TBC Value: £130.9m (Construction cost) Procurement Type: Frameworks Scotland

Leaders within NHSScotland are thinking strategically about the physical environment for staff and patients and setting high aspirations not only for clinical efficiencies, but for buildings that are uplifting, improving the health and wellbeing of staff and patients alike. Facilities that are the physical manifestation of the ethos of the Service. Dr Harry Burns, Chief Medical Officer, took time out from planning responses to swine flu to articulate his vision and support an issue he feels to be of great importance. He described an estate designed with ‘a level of care and thought that conveys respect’; buildings that grow from the local history and landscape, that are developed in partnership with the local community. A work of joint learning and joint responsibility that is particular to that community and that place; ‘Not off the shelf shoe boxes’.

Images: Nightingale Associates

Design Champions within NHSScotland Boards, who face the day to day reality of balancing competing pressures for time and cash, understand that design is the intelligent application of a scarce resource. They look to use the opportunities of physical change creatively to make the service better; and must show the value in every penny spent when advocating the practical aspects of design to an audience more used to a basic utilitarian approach.

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New and reconfigured buildings crucially must support new working methodologies, and design is seen as key in this. A building which effortlessly and efficiently supports service delivery, both now and in the future, is the raison d’être for any new build or reconfiguration project. Integral in this purpose is supporting the very human needs of the people within the building; those on whom the service depends - the staff - and all those it is intended to serve. There is a recognition that it is time for clients to cast off any lingering ‘hair shirts’; that purely utilitarian environments undermine these human needs and therefore

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1. The Vision N ew S t o b hi l l H os pi t al Project Type: Ambulatory Care Hospital Client body: NHS Greater Glasgow and Clyde Location: North Glasgow Delivery team: Developer: Canmore Partnership Contractor: Balfour Beatty Construction Limited Architect: Reiach and Hall Civil / Structural Engineer: SKM Anthony hunts Mechanical & Electrical Engineer: DSSR Completion: March 2009 Funding: PFI Value : £65m (Construction cost) Procurement type: PFI Awards: Roses Design Awards 2009 – Nomination for Best Public Building (Final judging October 2009)

do not pay. A growing understanding, supported by research, that creativity is not expensive, in fact it more than pays for itself by improving productivity, wellbeing and recovery. Three very human, and healing, aspects sing out in NHSScotland’s vision for the healthcare estate: buildings that people of the local area are proud of; that are a symbol of the Service ethos and the staff; that convey respect to the patients and which encourage respectful behaviour in return; which offer an ‘architecture of hope’. that one size does not fit all: that both the service configuration and the architectural expression of this should grow from, and support, the community needs and the unique characteristics of the place.

Photos: Reiach and Hall Architects

the importance of daylight and contact with the natural environment; of knowing the time of day and weather; of being able to escape into a garden; of being sustainable and using resources efficiently.

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With Better Health Better Care signalling a shift in the balance of care and more services provided in partnership with others, the NHS cannot deliver this vision alone. Dr Burns sees imagination as the key to this: he underlined the need for more visionary teams comprising an ambitious Local Authority and Health Board with design and development partners who want to do something different - who will take and truly deliver on this agenda.

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2. The Challenges

Mike Baxter, Deputy Director (Capital Planning and Asset Management), Scottish Government Health Directorates; Paul Kingsmore, Chief Executive, Health Facilities Scotland and Gareth Hoskins, Scotland’s Healthcare Design Champion and Board Member Architecture and Design Scotland talk about the challenges faced in delivering the vision.

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Key 1. Mike Baxter 2. Garetth Hoskins 3. Paul Kingsmore

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2. The Challenges

2. The Challenges

Mike - I think as a policy document the design quality policy is clear in articulating our

Gareth - The policy document is very important within the health sector, particularly in terms of acknowledging and setting out to Boards the benefits and value that design quality can bring to healthcare environments. I think also, the leadership the Health Directorates are showing in putting this forward is very important as an example of the ‘client patron’, in this case through an over-arching role, identifying the benefits of design quality and requiring Boards to address the issue of design through their projects. The development and implementation of a Design Action Plan identifying how Boards will enshrine design quality within their estates is a mandatory requirement of the policy. However, when working with client and estates teams on the ground, it is evident that many of the people responsible for the everyday management of the Boards’ built environment and the commissioning of new projects see this as a difficult issue. They’re either unsure how they go about making it inherent within the work they are doing, or sometimes they feel that their Board will not support them in doing what is needed.

aims and vision for the design of NHS facilities. I think the effects have been very positive both in terms of raising awareness of the importance of design, not just from an aesthetic point of view but in supporting the effective delivery of healthcare. The reaction from Boards has been largely positive to its introduction and application. I think that since the policy’s been in place for three years it is time to have a review, take stock and refresh. We have already undertaken a review of the policy’s implementation in the last six months focussing on the implementation of Design Action Plans. I think therefore it’s important that we take the opportunity to use that information to refresh and give more impetus and direction to design quality. The other reason for review I think is clearly in terms of the relationships that we have with key stakeholders in influencing the design agenda, both Architecture and Design Scotland and Health Facilities Scotland. Taking forward the design agenda in a tripartite way I think is extremely important, together with the NHS Boards.

Paul - Implementation has been the most difficult part; I don’t think the Service is necessarily bought into the policy yet. The work we’ve done, A+DS and ourselves, will help support that. We will get better understanding from the Health Boards by working together in this tripartite way, I think this has been missing over the last couple of years and we’re now on the right path. So I would expect probably if you asked me that question in a couple of years time, would be much more positive than it is at the moment.

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2. The Challenges D u m f r i e s D e n t a l C e n t re Project Type: Client body: Location: Delivery team:

Primary Care / NES Dental Facility Dumfries and Galloway Health Board Bankend Road, Dumfries Davis Duncan (now Archial) Ashleigh Construction Completion: January 2008 Funding: Exchequer / NES Value: £4.48m (construction and fit out cost) Procurement type: Traditional Awards: NHSScotland Environment, Estates and Facilities design award (received) Paul Taylor Award (received)

Mike - I think the picture is mixed in that regard but I don’t think it’s because of any sort of resistance to design or to the importance of design as a concept. I think it’s more to do with our communication of the value of design and I think it’s important that we do look at design from a number of angles including how effective design can support high quality, effective and efficient healthcare in the future.

Photos: Archial Group

Paul - It’s probably understood among healthcare professionals in general. Where we don’t have a strong input is at Board level and I don’t mean just the Design Champions because I think their role still marginal in many cases. I think Boards themselves don’t see design as a priority. If you work on a Health Board your focus is about delivery and targets. I think something needs to be done to convince them it’s a priority; they need to understand the concept well enough to understand how it might help them deliver some of those targets better. We have to make the link between the design and their targets. The Design Champion understands it, but the wider Board doesn’t; I think, at the moment, they feel it’s an issue the Design Champion will pick up.

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Gareth - The point about communication is important, it’s about implanting that understanding that design quality is an essential part of the means of delivering effective services; we certainly see in working with the different Boards across Scotland a very different level of understanding and attitude towards the issue and benefits of design quality. Whilst the high level policy sets out good ambitions, I agree with Paul that until there is the means of establishing criteria that can be clearly implemented and enforcing mandatory requirements it will always be a little hit or miss in terms of how people are taking this up.

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2. The Challenges C ha l m e r s R e de v el o p m en t Project Type: Client Body: Location: Architect: Completion: Value: Procurement Type:

Sexual Health Clinic NHS Lothian – Edinburgh CHP Lauriston Place, Edinburgh Campbell & Arnott December 2010 £6.5m (Construction cost) Traditional

Paul - I think the question should be is there sufficient evidence in relation to outcomes. I don’t think we have enough evidence in the British healthcare system that says here’s what design has contributed to outcomes, if that then has a financial benefit, that’s great. If it makes the experience better that’s great as well, but bottom line is, does the patient and have a better outcome as a result of design? Mike - I think the evidence base is certainly developing around the importance and

Image: Campbell and Arnott

effectiveness of good design. You know, a lot of good work is ongoing at the moment around issues such as single rooms, the impact that has in terms of effective healthcare, looking at various models of ward configuration in terms of effective management and operation. We’re building up a design evidence base within Scotland and I think that’s really important to champion best practice as it develops here, and we have good examples in Scotland of facilities that are in development or have been developed. And I think it’s also important that we’re aware and promoting the really good practice and evidence base that exists elsewhere in the UK and across the world. So, for example the evidence based design movement in America. Projects such as the Pebble Project3. It’s important that we can actually take those lessons and apply them effectively in Scotland.

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Gareth - Although there’s a developing body of research globally4, it’s not used or tested with any real rigour in many projects; therefore much of the evidence within the UK is very much anecdotal. There is an interesting question here about the connection between the Health Board staff that are involved in the commissioning and procurement processes for projects and the assessment of the actual outcomes they achieved. The lack of formal evaluation being carried out across Boards leaves a major gap in our learning from the way projects are designed and implemented and the resulting evidence base from which we can improve and develop future projects. 23

2. The Challenges

Mike - That’s a key piece of work for us and a number of stakeholders are involved with this and, and taking forward that work. What we’re keen to see is a holistic view in terms of the planning, operation and management of the asset base of NHSScotland, and that we can demonstrate effective governance and performance around that, and that’s what we’re in the business of putting in place at this point in time. What we’re concerned with is not simply a technical assessment of the estate or medical equipment but of how it affects and supports the quality agenda and the safe delivery of healthcare. So work around Healthcare Associated Infection (HAI); risks around the estate; around the effective management of medical equipment. These are all issues that we’re seeking to put in place arrangements to support and substantiate the good practice that’s going on out there. There’s also an opportunity I think that we can demonstrate that we’re making best use of resources by targeting investment at areas where there are risks around the estate or whether there are more significant service issues that need to be addressed.

Gareth - As Mike’s saying, seeing the estate not simply in terms of technical performance but also very much in terms of how they support the quality of service delivery and the impact in relation to the wider communities is hugely important. How that’s then brought through is actually a fundamental question because historically these aspects have been very much more compartmentalised, seeing the technical service delivery as separate from

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2. The Challenges

the quality of the built environment. In the past, many Boards have also worked on a piecemeal basis looking at the estate as and when change demanded rather than in terms of the longer term planning and development of a valuable asset. Often the reason cited for this approach has been that clinical services change continually therefore it is not possible to plan estates in a more comprehensive and effective manner. I would question that as a reason; partly because I don’t think that evolving service delivery necessarily stops you from thinking in that wider strategic way and also because I think that this is only part of the reason and that piecemeal development of health estates has also been very evidently driven by short term funding strategies. Good masterplanning can cut across a lot of these aspects of asset management, from property, service delivery, and impact on the wider community, and a well considered development framework can provide an inherent flexibility to accommodate changes to service delivery as well as giving a more effective long term approach to planning the ongoing funding and development of estates.

Paul - At the moment we’re procuring an asset management system. We are proposing a uniform system so that has everybody doing the same across the country. This will support Boards in their role and HFS will provide guidance on how they can actually manage this system to support strategic healthcare management. I think operationally we need to develop understanding and foster commitment to this area within Boards.

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2. The Challenges

2. The Challenges

Mike - I think this is key for us in a number of regards. The Scottish Government’s

Gareth - I think the aspect of joint working between Local Authorities and Health Boards is fundamental to the strategic ambitions for creating a nation that has wellbeing at the heart of its future development. There are very practical aspects of hub in terms of the sharing of resources and more effective service delivery between Local Authorities and Health Boards. And there are also more fundamental and far reaching impacts in terms of the perception of health buildings within our communities. Currently they are seen as places that you go to be fixed, where as they could be associated with say leisure or educational facilities to create the civic buildings of today and enhance their role as community assets focused around wellbeing and awareness. There needs to be that higher level consideration about how those benefits can underpin and support the very practical issues of co-locating facilities to make efficient buildings that provide and engage the communities they serve.

agenda in terms of efficient government, and joined up service delivery is central to this. We are seeing record levels of investment of capital expenditure across the NHS and indeed across Scotland. I think it’s important that we’re making best use of that investment and the best way to do that is by looking across the public sector at how we deliver services for communities and localities, and make sure the infrastructure base that we put in place is actually supportive of a broader agenda, not just individual ones. We’ve taken forward the hub initiative as a delivery vehicle for community based premises and that’s extremely important to us in a sense of providing a systematic approach to premises development coming from a service driven agenda rather than simply a replacement of existing premises. The other dynamic around hub, that I think is different, is that from the start it’s been about a wider public sector agenda; it’s not simply been about primary care. It is about looking at maximising opportunity within communities for, premises development.

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Paul - An initiative alone will not make the required change. In some cases we require a culture shift. Local Authorities, Health Boards and other public bodies recognise areas where co-operation can improve services to get the best value out of the estate. I don’t know if hub alone will do that. Quite frankly, there needs to be some fundamental culture change. It’s not just about the public buildings it’s about the services they deliver.

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2. The Challenges P l e a n S t re e t C e n t r e f o r H e a l t h Project Type:

Community Health Centre and Dental Outreach Centre Client body: NHS Greater Glasgow & Clyde Location: Plean Street, Yoker, Glasgow Architect: Archial Architects Completion: 2008 Value: £1.85m (Construction cost) Procurement type: Traditional

Mike - We have in the past had quite a diverse approach to procurement. In driving greater efficiency and utilisation of our capital resources we are looking at improved and standardised ways of procuring buildings. It’s about driving faster more efficient procurement, building up a more effective client base and about having a more consistent approach to procurement from which we can recycle the lessons much better than we have done in the past. It’s important that we do focus on using investment not simply to put up boxes but actually to look at the content and the nature of the facilities that we’re creating. Building up client capacity across hub and across Frameworks Scotland is extremely important and something that we’re committed to.

Photo: Graeme Duncan Photography

Paul - I think Frameworks Scotland gives a high level of quality and potential opportunity

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for innovation with the private sector and the NHS working closely together in order to try and deliver things more cost effectively. For example, if we’re going to build a children’s unit in Dumfries and Galloway and we use a partner and it’s very successful; has real benefits and it is innovative, we need to consider how we can learn from that. We could consider using the same team in a new location for a similar development. They should be thinking about it as a real opportunity for bringing in the same team.

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2. The Challenges

Gareth - There’s obviously benefits in terms of standardising the procurement process as that gives the opportunity for selection criteria and in particular the ambition for improved design quality to be more consistent across the Boards. Other benefits are that because of the relatively quick selection process within models such as the Frameworks Scotland, the selected team are brought on more quickly allowing the NHS to get the benefits of the close engagement between the design team and the users that you would get in a traditional process; also that the make up of the consortia gives the opportunity for early contractor input into the design process which should bring benefits in terms of editing out potential issues before a project goes on site. There are, however, a couple of fundamental questions in relation to these procurement processes. Firstly, the consortia working within Frameworks Scotland, and potentially those also leading the hubCos, are contractor led. Secondly, the design teams are always chosen and employed by the contractors without the client having as much say in the skills set of the people responsible for transforming their brief into a building. These two factors can combine to form a team whose focus is solely on cost and delivery, with little skill applied to outcome, or a truly integrated, effective and inspirational team and result.

2. The Challenges

Prior to the development of the new initiatives Boards were regularly tendering contracts at, or below, the lowest guide quality:cost ratios. Frameworks Scotland has placed a greater emphasis on performance in the selection criteria, however we are yet to see design capacity regularly feature as a prominent factor in selection. This is something that we [the central agencies] are looking to see change to help improve the end result of projects. We will support Boards to assess and assign value to design skills and imaginative thinking in the selection process and will work to educate the consortia on what is expected of them in delivering NHSScotlands’ vision. The consortia are free to bring in the best skills available and should be encouraged to do that – why should NHSScotland settle for anything less? In addition, however, I think that there is still an important place for the procurement for smaller scale projects outwith these central procurement systems, both to act as a benchmark and challenge for those delivering through the new initiatives and as an opportunity to develop the breadth of talent out there of which the Health Boards could take advantage of.

Client teams have the core role in directing the agenda for their projects – ensuring good working relationships where intelligent design will be seen to be an important part of successful delivery; where every pound is spent wisely rather than historical ‘cost cutting’ that impacts both the design, functionality and lifecycle costs heavily. The direction and priorities for a project are most clearly set out in the selection criteria for delivery partners.

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2. The Challenges G i r v a n C om m un i t y H o s p i t a l Project type: Client Body Location:

Community Hospital NHS Ayrshire & Arran Land at Bridgefield, Girvan South Ayrshire KA16 9PL

Delivery Team: Project Management: NHS Ayrshire & Arran Architect: Austin-Smith:Lord LLP Quantity Surveyor: Currie & Brown Civil/Structural Engineer: Scott Wilson Mechanical & Electrical Engineer: RSP Consulting Engineers Planning Supervisor: Scott Wilson Clerk of Works: John Arnott Associates Main Contractor: Barr Construction Planning / Property Advisor: Drivers Jonas Equipping: Health Facilities Scotland – Equipping & Technical Branch Art Consultant: StudioLR Completion: February 2010 Funding: Public Value: £20m (Construction cost) Procurement type: Public procurement

Mike - I think the key issues for us are about better delivery and a better “bang for our buck”. It’s about delivering a better product at the end of the day. It’s about supporting better healthcare and having that kind of focus as we move forward. The benefits that we see aren’t simply technical in terms of the energy rating of buildings or indeed the quality of building material that’s used or the sustainability of building materials that are used but about also what the impact is on improved healthcare delivery and therefore what are the wider benefits for patients and staff. I think one of the things that we’ve done through Frameworks Scotland in particular, and we will do through hub, is about emphasising to those private sector partners and delivery agencies that there is a commitment from Scottish Government to training and employment. We have also had recent announcements about apprenticeships, and that’s something that we’re keen to focus on and develop within these procurement frameworks.

Image: Austin-Smith:Lord LLP

There’s a much wider benefit in terms of the strategic outcomes that the Government had set from our capital investment agenda, than simply about a healthier Scotland, but also about employment opportunities, about equity of access. These are the kind of things that we want to see driven through the investment programme.

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Paul - It’s about better public buildings which should be improving the built environment. I think there are also opportunities for us in public services to be setting the examples to others around procurement in terms of energy performance, sustainability and ensuring the public buildings do have a part to play in the community including the regeneration of the community.

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2. The Challenges

Gareth - This comes back to the need for the NHS to clearly set out what their aspirations are within their project criteria and selection mechanisms as the reality is that the market place will respond to whatever is set out as necessary to get the work. There is a growing recognition from the contractor teams about the importance of design in helping them make a distinction between their competitors and there’s a high availability of skills out there at the moment. There are therefore huge opportunities for NHSScotland to embed aspirations for sustainability and a high level of design quality within the requirements and scoring of these processes. This still isn’t being done clearly enough so it is evident that the market are unclear how best to respond. Mike - I think clearly there have been challenging times for the market in the current economic circumstances, but we’ve done a lot I think to improve our relationship and understanding with the private sector, particularly in terms of the deal flow that’s coming through and better information about future projects, around trying to give people a better picture of how they need to gear up and skill up to respond to NHSScotland’s requirements.

2. The Challenges

sustainability and how the private sector providers can feed into that is really, really important to us. Ongoing engagement dialogue with the market is essential and I think the fact that we have a central unit looking after the Frameworks Scotland agenda means that that interface actually becomes a lot more straightforward than hitherto it was.

Paul - Well the market has got to learn what our drivers are much better than they did before. I think we also need to make sure that they don’t react in an inappropriate way by coming in and saying, “ah well it’s tight times now so let’s give them a cheap job.” We, as clients, will have to be much cleverer and make sure design doesn’t get taken off the agenda. We’re certainly being very clear with the Frameworks Scotland consortia about our expectations on this. Working together and innovating we can reduce cost but not make the major compromises on quality.

I think the systematic approaches that we’re introducing through hub and Frameworks Scotland really assist us in doing that, and indeed the hub initiative’s really founded on the basis of having a pipeline of projects coming through that the private sector then responds to. I think we can’t be complacent though in terms of what our aspirations are for the private sector. We have to be clear about what our requirement is both in terms of the point of view of design and design quality but also we’ve a really big agenda in terms of

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2. The Challenges N e w S o ut h G l a s g o w H o s p i t a l s Project Type: New hospital and laboratory facilities Client body: NHS Greater Glasgow & Clyde Location: Govan, Glasgow Delivery team: NSGH Project Team Completion (Stages): 1-Laboratory Block - Dec 2011 2-Design of Adult & Children’s Hospitals – Oct 2010 3-Adult Acute Hospital and Children’s Hospital – Jan 2015 3-A-Infrastructure and landscaping – Summer 2016 Funding: Scottish Government Value: Project approved budget £841.7m Design and construction contract value c.£600m ex VAT and equipment Procurement type: Two stage design and build

Paul - No is the answer, the estates and planning professionals have had a difficult time in taking this concept forward. They were all very much seen as supporting the main act. We have also been too technically focused: we can be good at advising people what technically needs to happen but haven’t always put it in a context which shows how this contributes to the bigger picture. I think we’re getting better at that but we still need to improve. Mike - I think the overall estates and facilities agenda has become increasingly important

Images: NSGH

and the work that we’re doing around asset management will put the whole estates facilities agenda kind of front and centre in terms of the responsibilities of Boards in terms of governance and indeed performance around the asset base which is approaching £5billion in value. It’s important that estates and facilities professionals play their part in supporting that, that broader corporate agenda. Not simply as a technical discipline.

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2. The Challenges

Gareth - I think the skill levels certainly vary greatly across the Boards and often Boards have been stretched in terms of resources within estates departments to manage their procurement processes. I think a positive side of the standardisation of procurement processes could and should be to give a unity across the Boards in terms of expectations, criteria and scoring and that this might also allow for and encourage a sharing of experience between Boards as to how best to manage these processes and achieve the quality of projects NHSScotland are aspiring to. Having worked with many of the Boards across Scotland it is evident that more centralised support and training needs to be given to many estates departments, particularly in terms of understanding the assessment and benefits of design quality, the implications of sustainability best practice and the reality of construction budgets and programmes to achieve these aspirations. Whilst this level of skill is clearly essential within estates department, it is also extremely important that those responsible at Board level also have a good understanding of these issues to ensure the aspirations are delivered.

2. The Challenges

We are doing some work already in conjunction with the Scottish Government towards developing a plan for career progression so that we get the right people and when we get them in, they see an opportunity for a career. We get them in younger so that they start to develop their career in this field and we can take them from an estates professional architect right through to somebody who is sitting at Board level.

Mike - What we’ve also done within Scottish Government is provide specific support to projects and project teams in terms of resources for training and development. We have a skills framework that’s been created to assess whether Boards and their project teams are capable of delivering major capital investment, what those gaps might be and also supporting a training and development programme to help support those needs. We’ve also supported the facilities management MSC course and a number of undergraduate places so it’s something that we are committed to.

Paul - I think the private sector, which is now contracting, will actually send people into our world. It is currently easier to get those skills, the difficulty will be retaining them. When the cycle comes back again and the construction industry starts to expand people may start to drift back to the private sector for financial reasons. We need to prepare for that by developing people internally and giving them exciting career paths which will help retain them.

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2. The Challenges

2. The Challenges

Paul - If you look at the Scottish Government objectives of healthier, fairer, wealthier, safer, etc. there’s probably none of those we don’t contribute to. The opportunity is there for healthcare facilities to be places where patients feel safe, be treated safely in an estate which helps support that agenda, etc. The opportunity exists for estates professionals and planners to link to the wider agenda, develop evidence of this and help support others in the delivery of their services.

Gareth - The development of a new healthcare facility is an important moment in the life of the community it serves; it offers significant opportunities to impact regeneration, community pride and perceptions of the public services. The location and design of the facility can either support or undermine the developing infrastructure; erode or improve the appearance of the town. These aspects are key to delivering greater impact through the necessary investment but are rarely evident in briefing. It’s very much back to that understanding of the engagement between the Health Boards and the local communities that they’re serving; that it is not simply about delivering services, it is about proactively encouraging wellbeing and access to health awareness. That, of course, inevitably means a more accessible Health Service, a Health Service that’s more permeable, in a sense, in terms of the communities it’s serving. .

Mike - I think it’s important that for any investment that we make or undertake or indeed how we provide our services that we’re thinking about the wider impact and that’s something that we’re focused on and do focus on through, for example the assessment of business cases in terms of objectives, the government’s agenda in terms of the strategic outcomes and national priorities. I think it’s important the NHS as an organisation makes those links across simply from being about healthier Scotland to looking at the Scottish Government outcomes agenda. There’s a real opportunity given the record levels of investment that we’re putting in to make sure that we have a much wider impact than simply direct level on healthcare, although that’s vital.

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2. The Challenges

2. The Challenges

Mike - It’s extremely important because it’s one of the policy areas for which I’m responsible.

Gareth - The level of the support, in particular from Dr Kevin Woods, that has been given to the initiatives that have been developed over the past three years has helped immensely. The commitment at ministerial level to embed design quality within the business case process is extremely important and shows real leadership by the health sector in Scotland. It is an extremely important recognition and support for the ambitions we all have in terms of realising the benefits of design quality. I think it is key to helping Boards across the country raise the game in terms of healthcare environments and the quality of that we’re creating across Scotland.

In terms of looking at the impact, not just simply looking at our role within Scottish Government around capital allocations and monitoring of expenditure, it’s about starting to get a better handle on impact and what we’re getting for the investment that’s being made, from a healthcare and a health benefit perspective, but also in terms of the quality of the facilities that are being developed. So this agenda’s really important. Ministers and the Chief Executive and Director General, Health and Wellbeing, Kevin Woods, have publicly shown their support of this agenda.

Paul - The design agenda is important to us because we’re supporting NHS Boards on a whole range of things and the design agenda is fundamental in that. The guidance we produce is technical and operational guidance. It actually it would be crazy if that technical and operational guidance flew in the face of the design agenda. The work we are doing with A+DS and SGHD will help ensure a joined up approach.

Gareth - It’s very encouraging that Health Directorates and Health Facilities Scotland are acknowledging the benefit design quality can have on the delivery of the services and the environments they’re creating. What I do feel is important, however, is better communicating the value that’s placed on this agenda to Board Members, to allow those that are performing well to be rewarded and those that could do better to be encouraged and supported to do so and for this to be more strongly championed within the Boards themselves.

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Mike - I think we’ve already taken some really positive steps in terms of the new Scottish Capital Investment Manual (SCIM)6 as it stands at the moment of incorporating sustainability into the core business. It’s important that we embed these as part of the way we do our business, so the development of the business case process for new buildings or for refurbishment buildings, the incorporation of design, and the technical nature of the solution that was chosen is extremely important. It’s important that we think about these early in the process and therefore our approach is to embed design and a technical review from the outset of a project’s development so that design principals are embedded from the start and that can then be reinforced and monitored as we develop and deliver projects.

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2. The Challenges

2. The Challenges

Paul - I think actually it’s also going to come the other way where people on the ground

Mike - If I can answer the second question first. The value is about improved delivery of

are actually starting to look at sustainability much more widely and, and there is a big drive in the community. If you talk to people in the community they want sustainability, people will ask about buildings and is it sustainable and so on. I think the public are much wiser about sustainability than we give them credit for.

healthcare and a better environment for patients to be treated, recover, and for staff to work within. In terms of the support of the agenda, I think we’ve already seen through the Design Champions Network - through a number of events that have been held that Boards are supportive of the design agenda and it’s important that we, from both a policy and a policy perspective, can drive that through and raise the profile of design and the importance of design through our ongoing engagement with NHS Boards.

I think things like HAI also has elements of the bottom up approach. The public have an expectation that we provide appropriate environments for their care and we need to ensure this is the case. Some of our planning guidance will support this agenda very well.

I think, coming back to the previous issue around how we imbed design within our core business processes, I think raising awareness of design as an issue is important and we’re doing things around that, but it’s also about Boards being able to challenge effectively how design is being considered within the proposals that are presented in front of them, and I think we’ve a bit of work to do in terms of supporting Board Members in their undertaking that challenge function in a constructive way. From a Government perspective we need to create the right kind of policy framework and environment to support that but what we’re wanting to do or what we are doing is about fostering those kind of key relationships and making sure that, that we have a common agenda going forward and that we can all work towards it.

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3. The Direction

Th e c o n t e x t t o s u pp o r t b et t er ou t c o m es “ In developing Scotland's

There are great and broad reaching expectations for what must be delivered through NHSScotland’s infrastructure investment programme, and the recognition that Health Boards must be expert and demanding clients to achieve these. The following section details how the central support structures are changing to assist Boards and the crucial role of Board Members in directing infrastructure projects.

infrastructure, the Scottish Government recognises that good building design should be responsive to its social, environmental and physical context. It should add value and reduce whole life costs. Good building design should be flexible, durable, easy to maintain, sustainable, attractive and healthy for users and the public; and it should provide functional efficient adaptable spaces ... Equally important to the design of individual buildings is the design of sustainable places. places can revitalise neighbourhoods and cities; reduce crime, illness and truancy; and help public services perform better.” Infrastructure Investment Plan 20087

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Dumfries Dental Centre, photos: Archial Group

Well-designed buildings and

The Government’s focus, from the five strategic objectives, through Better Health Better Care to the Infrastructure Investment Plan 2008 is to achieve better outcomes, across a broader range of issues, through all public sector actions and investment. Inter-agency, cross-sectoral, joined-up thinking are the buzzwords. However, in basic terms, public sector development must deliver more “bang for the buck”. This is not done simply by spending no more than is needed initially; in fact driving down capital costs too far can prove a false economy by raising lifetime costs. True value is obtained in seeking ‘economies of benefit’; by making the money that must be spent on a new hospital or health centre have the broadest and best impact possible on all the other outcomes from community regeneration, jobs and pride through sustainability and lifelong learning. The Good Corporate Citizenship Assessment Model8, being promoted by the Scottish Sustainable Development Commission and piloted within two NHSScotland Boards, embodies this concept.

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3. The Direction

Health Boards, particularly working in partnership with Local Authorities, have a primary role in delivering these objectives, and therefore both policy context and procurement guidance has developed to support Boards in fulfilling this responsibility.

3. The Direction

“A relevant environmental health agenda for the 21st. century is as much about the creation of places which

The Scottish Government Health Directorate (SGHD), Health Facilities Scotland (HFS) and Architecture and Design Scotland (A+DS) are committed to delivering tripartite, integrated support to commissioning Health Boards through developing policies and processes and through project specific advice. The SCIM has been updated to more clearly link business decisions to strategic outcomes and will be supplemented to map design into the process so that the anticipated benefits and qualities of the built product can be more readily assessed and valued in the business case approvals process.

Stobhill Hospital, photos: Reiach and Hall Architects

HFS and A+DS are developing a process whereby an integrated evaluation of a project’s potential benefits (considering the sustainable, technical and human aspects of design) will be provided to Boards commissioning developments above the delegated value, and verified to the Capital Investment Group, to support both bodies in their decision to fund building projects.

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Framework Advisors are made available to Boards by Health Facilities Scotland to assist in managing projects procured using Frameworks Scotland and this can involve significant input in assessing the particular skills of the Principal Supply Chain Partners bidding for a project. Guidance and assistance in the use of design tools such as AEDET9 and BREEAM10 can also be provided where required. In addition, a central database of projects and good practice information is being developed to support Boards in learning from what has gone before.

engender good physical and mental health, as it is about protection from hazards.” Annual Report of the Chief Medical Officer Scotland 2006 (pg.40)11

A+DS are looking for ambitious Boards who are willing to engage positively and openly in the development of demonstration projects, particularly those around cross-sectoral working where A+DS’s remit and influence are most relevant. As the systems and processes of procurement become streamlined and more clearly encourage and value a well designed outcome, the focus of support shifts from that solely within the control of NHSScotland to those factors that rely on external bodies, such as land allocation within the planning system, and on to where the work of others impacts the health of the communities serve. With the arrival of Single Outcome Agreements, and the opportunities for more readily co-ordinated investment in community infrastructure through hub, there is emerging great potential for co-ordinated working and more efficient Strategic Asset Management. Further, the impact of Planning Reform is working through Local Authorities; as they consider the shape and structure of communities and plan ‘what goes where and why’ there is a significant opportunity for Health Boards to engage and influence the emerging Local Development Plans both to provide potential sites in the location that is needed to serve the developing community, and bring the Board’s expertise on the factors influencing population health into the process of planning a healthier community.

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3. The Direction St r at h e de n H o s p i t al , Elmv ie w Wa rd Project Type: 18 bedroom Dementia unit Client body: NHS Fife Health Board Location: Stratheden, Cupar Delivery team: Contractor: Interserve Project Services Ltd Architect: Richard Murphy Architects M&E consultants: Capita Symonds Project Manager: Gardiner & Theobald Cost Advisor: Gardiner & Theobald Structural Engineers: URS CDM Co-ordinator: Capita Symonds Project Supervisor: NHS Fife Estates and Facilities Completion: July 2009 Funding: Public Funding from NHS Fife’s Capital Programme Value : £4.6m (Contruction cost) Procurement type: NEC 3 Contract. This project was the pilot for the development of Frameworks Scotland

S u p p o r t a n d L e a d e r s h i p f ro m t h e C e n t r a l P ro c u re m e n t A g e n c i e s In response to pressures for greater efficiency in procurement, central procurement agencies and centres of expertise have been established to support public sector clients in delivering infrastructure investment.

Photos: Richard Murphy Architects

Frameworks Scotland Frameworks Scotland is a strategic and flexible partnering and collaborative approach to the procurement of healthcare buildings in Scotland. Launched in November 2008, it is aimed predominantly at the delivery of acute care projects through direct capital investment and as such complements other procurement initiatives. The framework is administered centrally by Health Facilities Scotland who provide training and guidance to all parties involved in the initiative on both the processes involved and the expectations of NHSScotland in terms of delivering better outcomes through well designed facilities. This central resource also monitors the performance of framework partners in regard to these objectives and provides a forum to share learning from all the projects undertaken. The Principal Supply Chain Partners as the ’contracting‘ partners in healthcare developments bring together integrated teams of design professionals and constructors whose early involvement can support the local NHS Board to ensure that the design development work is robust and provided earlier in the process than has historically been the case.

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In addition to achieving the benefits of streamlining and simplifying procurement, bringing advantages in programme and cost certainty, the framework provides the opportunity to ensure that buildings are designed to the highest standards. The framework embraces the principles of collaborative working to ensure that teams within the public and private sectors work together effectively, avoiding the adversarial attitudes that can make projects more difficult to deliver. Working repeatedly with the clients across the health sector, the supply chains obtain a better understanding of Boards’ needs and can build stronger working relationships to provide continuous improvements in the design and construction quality of the buildings that are commissioned throughout Scotland. 51

3. The Direction B a r r h e a d H e a l t h & C a re C e n t r e Project Type: Client body:

Health Centre NHS Greater Glasgow & Clyde with East Renfrewshire Council Location: Main Street, Barrhead Architect: Avanti Architects Completion: Late 2010 Value: £11.2m (Construction cost) Procurement type: Traditional

Scottish Futures Trust (SFT) and hub The Scottish Futures Trust was established by the Scottish Government in 2008 to maximise value for money through the effective and efficient delivery of public sector infrastructure. Sustainability in the widest sense is a key driver for the SFT when developing infrastructure and delivery solutions. Economic, environmental and social sustainability will be addressed in the early stages of project development and will become an inherent part of procurement and delivery in order to facilitate sustainable economic growth locally and nationally, to minimise adverse environmental impact, and to promote the development of sustainable communities. The positive impact of high quality design will be supported at all stages of procurement, and through to delivery.

Images: Avanti Architects

Boards may work with the SFT in procuring large hospital developments and will undoubtedly be involved in their local hubCo. hub is an SFT initiative that brings together major public service providers and a private sector partner in a long term partnership to deliver community infrastructure. It aims to facilitate joint working and the community planning procedure by putting in place a joint venture vehicle, hubCo, to deliver the infrastructure to support essential public services.

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The approach being taken to procurement is to attract and appoint an inventive development partner in each hub territory to bring expertise and innovative thinking to bear on the development of projects being commissioned by public sector bodies within the territory. However, as with any procurement, the client’s team will be crucial in describing the objectives of the development and in steering the result. The central hub team, within the SFT, will scrutinize the performance of the territorial hubCos in relation to SFT’s own objectives. Key Performance Indicators (KPIs) will be used as means of incentivising and monitoring good performance, including targets for sustainability and achievement of design quality.

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3. The Direction

3. The Direction

FREQUENTLY OCCURING BLOCKAGES TO REALISING VALUE THROUGH INVESTMENT

BLOCKAGE: Piecemeal Campus Development RISKS: Increasing inflexibility and operational inefficiencies; decreasing quality of environment impacting staff and patient wellbeing; inefficient investment in infrastructure. SINK PLUNGERS: > Evaluation of existing facilities (including the quality of the environment) to understand the problems and value of existing assets. > A thorough masterplan to test opportunities and devise a robust but flexible long term plan around which informed decisions can be made on

Th e Bo a rd ’s R o le - The Best Start To Projects However all the described policy and support accounts to very little without the leadership and action of the commissioning Board. The Health Board is responsible for the success of project, and rightly so as the body uniquely positioned to understand the local context and the needs of community which they serve. Although the role of developer can appear tangential to the core business of the Board, and many Board Members have little personal expertise in commissioning buildings, it is the Board’s responsibility to ensure the project gets the best start possible. By recognizing the value of a well designed estate in delivering the core business of the Health Service, and the responsibilities inherent in building with public money, the complexity and importance of this work, and the value of estates staff, becomes clear. The Board provides leadership by establishing an environment which encourages and supports project teams in delivering developments that are truly effective; that fulfill the vision.

BLOCKAGE: Poor site availability or choice RISKS: Low proximity to transport and

for the clinical staff “a place where I regularly encounter colleagues of other disciplines providing ready opportunities to discuss matters”

other infrastructure impacting accessibility and sustainability; site size requiring deep plans

for patients “a single entrance and reception point irrespective of which service I’m using first”

increasing lighting and ventilation costs, and/or constraining future flexibility and expansion; noise

for facilities management “ consulting rooms that can be used by a number of services – space as a resource not a territory”

and air pollution impacting ventilation strategies and increasing capital and running

With new working methodologies and greater technical standards to be met, no project is likely to be just like one the Board has commissioned before. But that does not mean starting with a blank sheet of paper. Learning from what has gone before both within NHSScotland and elsewhere – and particularly by visiting exemplars - can very quickly start a conversation to establish the critical success factors for the project. These will obviously be built from the needs of the Service but, in design terms, are most helpfully described and comprehended in terms of the needs of the people that the project is to accommodate – the user experience.

For example, if the Service objective is to develop an integrated care facility, the integration might be described in terms such as:

costs. SINK PLUNGERS: > Engagement with Local Authorities in development of Local Development Plan to pre-prime land use allocation and area regeneration

Having established the core aims of the project – the elements that are not negotiable – it is helpful to understand what success might look like. Benchmarking against the best that has delivered, or is in the pipeline, is perhaps the single most helpful tool available to improve both the standard of care environment and the image of the NHS in the community. Planning new similar developments using these as a benchmark, and improving even slightly by learning the lessons from the last, will result in a spiral of continuous improvement across Scotland. To this purpose, it is anticipated that a statement describing the project objectives and benchmarks established by the Board will form a key part in the assessment of design in the developed business case approvals process.

strategies.

individual projects and site wide infrastructure and

> Design feasibility studies on

amenities (such as usable

potential sites to allow informed

external space).

decisions to be made on site selection; either avoiding problematic sites or planning strategies (allowing sums) to mitigate identified issues.

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3. The Direction

3. The Direction

The Board’s R ole - Checking all is well, lessons learnt BLOCKAGE: No Identifiable Vision (hopes and aspirations are kept under wraps) RISKS: lack of trust and engagement from stakeholders; inability to attract and secure skills needed from market; difficulty in valuing the vision in the decision making process; outcome does not live up to needs or expectations. SINK PLUNGERS:

Having developed an agreed vision of what’s to be commissioned, and benchmarks against which to check progress, the Board must satisfy itself that the project is on track not only in terms of programme and budget but also in terms of the outcome. This will require an understanding of when design risks occur and the information and skills needed to make decisions at these risk points. NHSScotland Boards, through the actions of their Design Champions, have been developing Design Action Plans to look at some of these issues and develop general approaches, such as developing a peer design review panel within the Board, that are particular to their circumstances. The advent of new procurement options and the developed SCIM marry neatly to require a more full understanding of the development, and easier access to design and construction expertise, earlier in the business case approvals process than has historically been the case.

> Client Leadership - create an understanding that ‘design is the intelligent allocation of a scarce resource’ not simply visual embellishment, challenging misplaced preconceptions with evidence and prior experience. > Visit examples of well designed environments both within the NHS and wider to raise the understanding of the ‘art of the possible’ and, conversely, the

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impact of failure – there’s nothing more convincing than your own eyes and the chance to talk to the people who’ve been there. > Establish, in partnership with stakeholders, core objectives and set robust benchmarks for the type of environment needed to deliver these. Such a vision is realistic and grounded in the business need, it is not fanciful. > Communicate the vision to

For each project, there will need to be an understanding of the design risk points, which may not always coincide with financial risk points, and a clear strategy for dealing with these. Irrespective of the project scale, nature, or procurement there are certain decision points that are key such as site selection, the choice of design and delivery team, the completion of the brief, the preferred site strategy, the design that is submitted to Planning and that is built. The commissioning Board will be living with the consequences of decisions made at these points and therefore must be able to recognize and ascribe significant value, in these decisions, to the factors and skills necessary to deliver core objectives described above. The Board’s plans and actions in this regard will therefore be part of the developed business case approvals process and HFS, with A+DS, will support the Board at key points.

The design of a new or reconfigured facility is a complex task, requiring the input and expertise of many stakeholders to be captured and synthesized. For many involved in the process it will be a new experience, and one carried out in a context of significant change. Staff are likely to require support to imagine new ways of working the physical environment needed to support this work. Design is therefore a process of change management, and tools such as AEDET have been found to be most helpful in promoting cross discipline discussion in the development of a design solution, though this process does require some training or design expertise to assist staff to translate drawings and other graphic information.

build confidence within the community, among key decision makers (such as the planning authority) and in the market to attract the skills you need. Allow time and resources to manage any unrealistic

Once the facility is built and occupied, and the rewards of the Board’s leadership and the labours of its team are been felt, there is one final task that is needed to allow greater understanding and efficiency in future investment. It is essential that both Post Project Evaluations (PPE) and Post Occupancy Evaluations (POE) are undertaken and the results of them shared. For these to be of any real value they must be planned from the beginning and relate to the core objectives of the project. Building is essentially research project – no two facilities are entirely alike - and without the knowledge of what has gone before we cannot effectively recognize, value and celebrate the critical aspects that resulted in success.

expectations. > Value, in your selection processes, the skills needed to develop and translate your vision into a working reality.

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4. Concluding Remarks

Thus far the concentration has been on the role of the public sector in improving outcomes realised through infrastructure investment, but it is not the clients that design and deliver buildings. The public sector no longer routinely carries out this work in-house and is reliant on private sector organisations to pick up this agenda and to deliver on it.

Dumfries Dental Centre, photos: Archial Group

As Dr Harry Burns clearly indicated, ‘off the shelf boxes’ will no longer be good enough. NHSScotland is developing an appetite and an appreciation for better skills and smarter solutions, however there are some lingering suspicions of the value that design professions can bring; perceptions that some designers bring imposed solutions and memories of where style triumphed over substance.

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With so much being demanded of development projects in both the technical sense – low carbon high cleanliness – in supporting new working methodologies, and in terms of a broader impact; new skills are needed to work with clients. Soft skills such as listening and communication are needed to help the client imagine the physical environment to support their new working practices. These in themselves though are not sufficient without the highest degree of design sensibility to imagine and construct a solution that effortlessly supports both the operational agenda and the very human needs of our most vulnerable people, whilst also delivering on high policy expectations for flexibility sustainability and community benefit. Already bidding teams are seeing that they must expand their scope of knowledge to win projects. This direction will need to be strengthened: truly co-ordinated, talented and expert teams are sought to deliver NHSScotland’s Vision of Health.

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Appendices

Appendices

R e f e re n c e s

F u r t h e r R ea d i ng

1

Better Health Better Care Action Plan Scottish Government 2007 www.scotland.gov.uk/Publications/2007/12/11103453/0748

Better Public Building - HM Government/CABE 2006 www.cabe.org.uk/publications/better-public-building

2

Policy on Design Quality for NHSScotland www.sehd.scot.nhs.uk/mels/HDL2006_58.pdf

Case Notes: Client Leadership - A+DS 2009 www.ads.org.uk/documents/564/564.pdf

3

Pebble Project www.healthdesign.org/research/pebble/

4

e.g. The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity. Roger Ulrich and Craig Zimring, September 2004 www.rwjf.org/files/publications/other/RoleofthePhysicalEnvironment.pdf

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

5

Asset Management in the NHS in Scotland. Audit Scotland 2009 www.auditscotland.gov.uk/docs/health/2009/nr_090129_asset_management_nhs.pdf

6

Scottish Capital Investment Manual (SCIM) www.scim.scot.nhs.uk/

7

Infrastructure Investment Plan 2008 www.scotland.gov.uk/Publications/2008/03/28122237/0

8

The Good Corporate Citizenship Assessment Model www.sd-commission.org.uk/publications.php?id=

9

AEDET www.dh.gov.uk/en/Procurementandproposals/Publicprivatepartnership/Private financeinitiative/InvestmentGuidanceRouteMap/DH_4132945

Ideas Website - Department of Health www.ideas.dh.gov.uk/ Masterplanning Health - A+DS 2008 www.ads.org.uk/documents/380/380.pdf

10 BREEAM www.breeam.org/ 11 Annual Report of the Chief Medical Officer for Scotland 2006 www.scotland.gov.uk/Publications/2007/11/15135302/11 60

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Appendices

S o u rc e s o f I n f o r m a t i o n a n d S u p p o r t Image Credits:

Architecture and Design Scotland (A+DS) www.ads.org.uk T: 0131 556 6699

Published in 2009 by Architecture and Design Scotland (A+DS) Architecture and Design Scotland (A+DS) is Scotland’s champion for excellence in

Front cover: Stobhill Hospital, Photo Reiach and Hall Inside front cover: Dumfries Dental Centre, Photo Archial

place-making, architecture and planning. It is an NDPB of the Scottish Government.

Health Facilities Scotland: Frameworks Scotland Advisors www.hfs.scot.nhs.uk T: 0141 332 3455 hub Initiative www.hubscotland.org.uk

This Publication has been produced as part of the work undertaken with and for NHSScotland, in association with the Scottish Government Health Directorates and Health Facilities Scotland. With thanks to those interviewed and to the teams responsible for the featured developments.

Scottish Futures Trust www.scottishfuturestrust.org.uk T: 0131 510 0800 Scottish Government Health Directorate www.sehd.scot.nhs.uk

Interviews by Marian Borde (NHSScotland figures in ‘vision’ section). Photographs by Wattie Cheung (‘challenges’ section), taken at Stobhill Hospital. 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

The Sustainable Development Commission UK www.sd-commission.org.uk

except that the material may be photocopied for non-commercial purposes without permission from the publisher. The text of ‘Vision of Health’ is licensed under a Creative Commons Attribution 2.5 Scotland License. Designed and produced by REPUBLIC www.republicproductions.com

Architecture and Design Scotland Bakehouse Close, 146 Canongate, Edinburgh EH8 8DD T: 0131 556 6699 F: 0131 556 6633 E: [email protected]

www.ads.org.uk

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“ In this publication we celebrate the vision of some of Scotland’s healthcare leaders including the Chief Medical Officer and healthcare Design Champions and set out the practical measures being put in place to assist Scotland’s NHS Boards in guiding their projects to successful outcomes.” Nicola Sturgeon MSP

Architecture and Design Scotland Bakehouse Close, 146 Canongate, Edinburgh EH8 8DD T : 0131 556 6699 F : 0131 556 6633 E : [email protected]

www.ads.org.uk

The publication sets the agenda for the development of the healthcare estate and highlights the actions needed from all parties, particularly Board Members, in delivering a Vision of Health.