TheThe estateestate we’rewe’re inin

Issue 5 Autumn 2003

A publication by Welsh Health Estates for health estate personnel in Wales UpdateUpdate ThisThis IssueIssue

■ From the Director... 2

■ The NHS Estate in Wales Condition 6 and Performance Report 2002-2003

■ DDA October 2004 deadline 6

■ Design excellence in the health estate 8

■ Building project review 10

■ Hospital Patient Environment programme gets underway 14

■ Welsh support for the MGA 16

■ Proposed changes in statutory fire safety legislation 17 Disposal of Hensol

■ Environmental Award 18 ELSH HEALTH ESTATES brings the

■ The Land Registration Act disposal of Hensol Hospital a step 2002 18 Wcloser ■ Website News 18 To the immense satisfaction, if not to This milestone brings an extremely say relief, of those involved, contracts complex disposal process, which ■ Library News 19 for the sale of Hensol Hospital were commenced in 1996, a step closer to ■ Staff News 19 exchanged on the 23rd September 2003 a conclusion, with the completion of at an agreed sale price in excess of £5 the sale scheduled for the 26th March ■ Capital Project Quarterly Reports 19 million. 2004. ■ Cost Allowances 19 The hospital is being purchased by WHE, under the direction of Gareth Gerald Leeke whose company owns the Roberts and Clive Ball, managed the ■ The Building Better Health Awards Leekes out-of-town department stores disposal process on behalf of the Welsh 2003 20 and the Vale Hotel, Golf and Spa Resort Assembly Government in partnership (which adjoins the Hensol hospital site) with Bro Morgannwg NHS Trust (the which is used by both the Welsh football main occupiers of the site). It was and rugby teams and FA Cup finalists. Continued on page 3 From the Director... THE WELSH HEALTH ESTATES ORGANISATION irst of all I must congratulate both Pembrokeshire and Derwen Welsh Health Estates was set up in 1996 to provide a core of professional and technical estate management expertise for the FNHS Trust and Bro Morgannwg National Assembly for Wales and the Welsh NHS. It is organised NHS Trust on their success in the into five Sections within two Divisions: Building Better Healthcare Awards ■ Policy and Performance Division 2003, held recently at London’s Café Its remit is to ensure that the existing estate is managed and Royal. Pembrokeshire and Derwen maintained to a high standard and that the NHS in Wales were worthy winners of the Best has access to appropriate independent estates and facilities expertise and guidance. The Division consists of the following Designed Mental Health Facility for Sections: the new Bro Cerwyn Development in ● Environmental Management and Engineering Section Haverfordwest and Bro Morgannwg NHS Trust were highly Takes the lead role in Welsh Health Estates on all aspects of environmental management and provides advice and support commended in the Partnering category for their work with on specialist healthcare engineering systems. Services are the Neath/Port Talbot Hospital PFI consortium. provided in areas as diverse as decontamination, diagnostic Well done to all involved! imaging, high voltage systems, medical gases and specialist ventilation and air conditioning. I am pleased to report that the Capital Investment Board ● Facilities, Performance Management and Information and the Estate Development Panel are now established Section and I am confident that both will help to ensure that Provides advice and support on a range of facilities management issues and co-ordinates performance management not only will estate matters be given the attention they activities including the maintenance and development of the deserve at the highest level within the Service, but also the Estates and Facilities Performance Management System. The process of decision-making will become more transparent Section is also responsible for providing advice on fire safety and for overseeing the technical library service and WHE’s website and the quality and speed of policy development and facility. implementation will improve. The involvement of NHS ■ Strategic Planning Division Estates and Facilities Directors in the Estate Development Its remit is to assist the Service in delivering strategic change in Panel is one of the most positive developments, as it the healthcare estate consistent with the policy of the Welsh will ensure that policy matters are founded on a clear Assembly Government as well as meeting local needs. The Division consists of the following Sections: understanding of the strategic and operational issues ● Estates Development Section facing the NHS at the sharp end. Provides advice and support on the development and Many of you will be aware of Sir John Egan’s seminal report implementation of estate strategies, the procurement of capital assets and business cases. In addition the Section provides Rethinking Construction and the Government’s response, advice on architecture and design quality, and major scheme Achieving Excellence. The general thrust of both reports capital and revenue costs. is that the traditional method of construction procurement ● Property Management Section will not deliver sustainable improvements and a new way Provides advice and support on all aspects of healthcare property management expertise including acquisitions, of thinking is required. This new way of thinking involves disposals and landlord and tenant relations. In addition it the greater use of long-term partnering, key performance maintains the Land and Property Portfolio for the NHS in indicators, integrated supply chain management and Wales. ● Primary Care Section continuous learning and improvement. Takes the lead role in Welsh Health Estates on all aspects of The Assembly requires all publicly funded bodies in the strategic development of the primary care estate. The Section provides advice and support to Local Health Boards Wales to embrace these concepts and consultants are on the development and implementation of integrated estate currently being engaged to assist with the identification strategies, the production of business cases, funding mechanisms of construction procurement models that are compatible and other more general aspects of property management. with the Egan agenda, the particular needs of the NHS More information on the services provided and contact in Wales and local market conditions. This work will be details are available on our website at http://howis. co-ordinated through the Estate Development Panel. A wales.nhs.uk/whe/ critical part of the option development process will involve capturing the views of the NHS, through questionnaires, This publication or any part of it structured interviews and discussion groups. Please take may not be reproduced without the advantage of these opportunities, as your comments written permission of Welsh Health provide an important foundation upon which the new Estates. procurement process needs to be built. Feedback and comments should be Since the last edition of The estate we’re in, the review addressed to: of Welsh Health Estates has been completed and the Peter Wiles Deputy Director, Policy & Performance organisation has been restructured to reflect the changing Welsh Health Estates Ystadau Iechyd Cymru demands of both the Assembly and the NHS. Full details of PO Box 182, Bevan House PO Box 182, Tyˆ Bevan 24-30 Lambourne Crescent 24-30 Cilgant Lambourne these changes are available on our website at http://howis. Llanishen, Cardiff CF14 5GS Llanisien, Caerdydd CF14 5GS wales.nhs.uk/whe/ Neil Davies Director Welsh Health Estates Telephone/Ffôn: (029) 20315500 Facsimile/Facs: (029) 20315501 E-mail: [email protected]

2 WHE intranet website: howis.wales.nhs.uk/whe ● Hensol Castle front elevation. Continued from page 1… Although the site is primarily used for hospital purposes, extremely pleasing to experience the close co-operation of many will know that the castle buildings provide conference all parties involved in the disposal team working towards a centre facilities for both NHS and non-NHS bodies. common goal. PLANNING STATUS AND Bob Croydon of King Sturge Property Consultants, responsible POSSIBLE ALTERNATIVE USES for marketing the site, said: The disposal of the site was made more difficult by the “The co-operation of a number of organisations namely restrictive planning regime surrounding the site. Whilst the the National Assembly for Wales, Welsh Health Estates, use of the site as a hospital predated planning control, the Bro Morgannwg NHS Trust and the former Bro Taf primary use of the site fell within class C2 of the Town and Health Authority together with their professional advisers Country Planning (Use Classes) Order 1987 and as such some has brought about a successful conclusion to a complex alternative uses could be implemented without requiring an sale.” express grant of planning permission. These included: BACKGROUND ■ Hospital or nursing home; Hensol Hospital is located in a pleasant rural setting in the ■ Residential school, college or training centre; Vale of Glamorgan, close to Junction 34 of the M4 motorway ■ and some 12 miles to the west of Cardiff city centre. The Provision of residential accommodation and care to site extends to some 63.06 hectares (155.8 acres) and comprises approximately 23,600 sq m (253,936 sq ft) of accommodation. The centrepiece of the Hensol site is the Grade I listed Castle, originally built in the 17th century as a stately home, together with its grounds and gardens (which are included [Grade II] in the Register of Landscapes, Parks and Gardens of Special Historic Interest in Wales). In addition, the sole access to the site is over a Grade II listed bridge. The attractive landscaped grounds incorporate not only extensive hospital buildings of varying ages and styles but also a 15 acre man-made lake, mill pond, playing fields and agricultural land. ● Hensol Castle side elevation.

WHE intranet website: howis.wales.nhs.uk/whe 3 ● Hensol Castle site. people in need of care. ➤ specific planning consent. Rather it was decided to market Although a plethora of planning policy guidance existed, little the Hensol site, on the basis of its current and potential use, of this gave clear guidance in relation to the development as a ‘development opportunity’. potential of the Hensol site. The most recent, and deemed MARKETING to be relevant, planning guidance was the Inspector’s report After careful consideration of the Hensol site, the planning on the deposit Unitary Development Plan. The gist of the situation, the state of the property market, the area of likely Inspector’s conclusions in relation to the Hensol site were: purchaser interest and the disposal timescale, it was decided ■ The Hospital is in an open countryside setting. to market the site as one lot on an ‘expressions of interest’ ■ Any reuse of the site would have to show great respect basis. for the character of the listed buildings. By selecting this basis of sale it enabled submissions to be ■ Because the site is not within a settlement, and because considered and investigated and companies interviewed in the local transport service is relatively sparse, residential order to obtain additional information, before a shortlist was development of the site could not be regarded as drawn up. sustainable and would be inappropriate. In reality 10 submissions were received with 4 companies This view was confirmed by the Local Planning Authority being interviewed. which strongly indicated that it did not consider residential Seven companies were then invited to submit ‘best and final development of the Hensol site (by way of new build units offers’. Offers were received from all seven companies. or conversion of existing buildings) as appropriate and made CONSIDERATION OF OFFERS it clear that it would oppose any such application. Due to the uncertain planning and development potential Given these planning constraints, and the consequent of the Hensol site it was decided to encourage offers on difficulty in pre-determining what potential uses developers an unconditional basis with an overage condition, should might have for the site, it was decided not to apply for a additional development be achieved. This was highlighted Statutory designations Non-Statutory Designations The site contains two buildings that have been statutorily The land surrounding Hensol Castle was landscaped between listed as being of special architectural or historic interest: 1774 and 1810 and this work included the excavation of ■ Hensol Castle was listed in 1993 as Grade I. This the main lake and possibly the mill pond. The grounds are designation denotes a building of exceptional interest; included (Grade II) in the Register of Landscapes, Parks and only about 2% of all listed buildings are so graded (eg Gardens of Special Historic Interest in Wales, prepared by Windsor Castle). The entry in the list states “Listed Cadw: Welsh Historic Monuments, the Countryside Council Grade I as a major Welsh Country House which retains for Wales and ICOMOS. C18th fabric of national importance in the development *Although the Register was a non-statutory document, the of the Gothic style whilst also representing a fine Welsh Assembly Government’s guidance indicated that: “… example of early Victorian remodelling”. The effect of proposed development on a park or garden ■ The Bridge was listed in 1992 as Grade II, which denotes contained in the Register of Landscapes, Parks and Gardens a building of special interest. The entry in the list states of Special Historic Interest in Wales, or on the setting of such “Broad and ramped 4-arch bridge…included for group a park or garden, may be a material consideration in the value with Hafod Lodge and Hensol Castle”. determination of a planning application.”

4 WHE intranet website: howis.wales.nhs.uk/whe The History of Hensol From 1614 until 1721 Hensol was owned by the Jenkins family, and the core of the house, the centre of the south front, dates to the late 17th or early 18th century. In 1721 the estate passed to Charles Talbot, who served in Walpole’s government and in 1733 became Lord Chancellor, taking the title of Baron Talbot of Hensol. The first major rebuilding was undertaken by Charles (died 1737) and his son William. William Talbot, who also became a prominent political figure, completely remodelled the house in gothic style in about 1735, pushing the north end of the south block out east to west, including the two towers, one of which has the date of 1735 on it. Hensol is a very early example of the adoption of the gothic style for domestic buildings in Wales. On Williams’s death in 1782 the estate passed through several hands and in about 1790 to Samuel Richardson, who made further additions and alterations in gothic style, including the turrets, battlements, storeyed porch and porte-cochère, extensions to the east and west of the south front, and the north side of the main courtyard. In 1815 the estate was bought by Benjamin Hall, and then in 1826 by William Crawshay (who went on to build Cyfartha Castle in Merthyr Tydfil) but neither made any alterations. The final phase of the building, which gave Hensol its present day appearance, took place after the industrialist Rowland Fothergill bought the estate in 1838. He employed the architects T H Wyatt & D Brandon in the 1840s to extend the east wing northwards and create the service court. Further changes were made to the main block. In 1927 the house and grounds were sold to Glamorgan County Council to be used as a hospital, which it remains today. in the marketing documentation and during the interview process. TIMETABLE OF EVENTS The reasoning behind this was in order to avoid having to Once the closure date for the Hensol Hospital site consider a high offer, conditional on achieving planning had been identified by Bro Morgannwg NHS Trust, consent for residential development, with little chance of the entire disposal programme was managed in success. order to ensure that completion of the sale coincided The selected company submitted the highest unconditional with the closure date, thus avoiding the need to offer, which was in excess of £5 million, together with the secure and maintain an empty site. potential to achieve over £7 million more through overage The main events were: (dependant on obtaining planning for timeshare, private Establishment of Disposal Team Dec 1996 healthcare and residential development). Preparation for Sale Dec 1996-Dec 2001 WHE ROLE Marketing Dec 2001-July 2002 Although WHE had played a leading role in this disposal Selection of Preferred Purchaser July 2002-Dec 2002 since 1996, in April 2002 (upon the abolition of the Health Negotiation of Heads of Terms Dec 2002-Feb 2003 Authorities), WHE took on the responsibility for managing the disposal of the residual NHS estate in Wales, of which Contract Negotiations Feb 2003-Sept 2003 Hensol is part. This role involved managing the process of Exchange of Contracts 23 September 2003 sale in conjunction with Bro Morgannwg NHS Trust. Completion programmed for 26 March 2004 Due to the complexity of the site, contract negotiations were inevitably long and complicated, and at times highly technical, sometimes creating apparent impasses. However, through perseverance and goodwill on both sides, contracts were successfully exchanged on the 23rd September 2003. DISPOSAL TEAM VACANT POSSESSION ● Welsh Health Estates – responsible for managing The site was marketed on the basis of being offered with the sale. vacant possession on completion. ● Bro Morgannwg NHS Trust – the occupying Trust However, due to the difficulties of identifying a suitable site which provided healthcare services from the and obtaining the necessary planning consent to construct site and to which the majority of the land and new premises in which to relocate some of the healthcare buildings on the site were leased. services, it was necessary to negotiate with the prospective ● Bro Taf Health Authority – responsible for the purchaser in order for the Trust to remain in one of the Hensol site on behalf of the National Assembly for buildings on site under a lease (for a maximum period of Wales until April 2002. two years). ● The National Assembly for Wales – through a WHE together with the Trust and the Assembly’s Estates representative of its Estates Division. Department has been working for the past 3 years to ensure ● Morgan Cole – legal advisers. that the 15 or so occupiers (both public and private sector ● organisations) vacate the Hensol site by the end of 2003 in Wyn Thomas Gordon Lewis – planning advisers. order to give the Trust sufficient time to decommission the ● King Sturge – property consultants. site ahead of the 26th March 2004 completion date. ■ For more information contact: Gareth Roberts on 029 2031 5527 or e-mail [email protected]

WHE intranet website: howis.wales.nhs.uk/whe 5 The NHS Estate in Wales Estate Condition & Performance Report 2002-2003 he latest Estate Condition and Performance Report on the NHS Estate in Wales has just been published Tby Welsh Health Estates. Based on data submitted by NHS Trusts for years 2002-03, the report provides food for thought regarding progress being made to achieve performance targets against a number of Key Performance Indicators. Figure 2: Primary energy usage 1990-91 to 2002-03 For the first time the report includes information on the whole estate rather than focusing on hospital sites only, So where does the NHS go from here? Clearly we all have though the data for non-hospital sites has been aggregated a responsibility to ensure the limited resources available are according the prescribed criteria. carefully targeted where they can be used more effectively Also, for the first time, the submission of hotel services on the basis of robust estate strategies. As part of this data was made mandatory, enabling comprehensive data process, early disposal of the non-essential estate, currently to be included in the report supplement. However, since in the region of 265,000m2 of building area, is vital. This, Performance Indicators have yet to be agreed in respect of combined with a commitment from the Assembly to start these services, the report does not include comments on to address the shortfall in funding the NHS estate, will go a performance. long way to reducing backlog maintenance, improve It is clear from the report that, whilst significant reductions energy efficiency and generally revitalise and modernise in backlog maintenance, totalling £41 million against hospital the estate. sites, have been made, the overall picture for Wales remains The Estate Condition an Performance Report can be accessed grim. Since last year, in fact, backlog maintenance costs have on the Welsh Health Estate’s website. ■ increased by £34 million across Wales, reaching an all-time For more information contact: high figure of £465 million, as illustrated in figure 1. John Tidball on 029 2031 5517 or e-mail [email protected] DDA October 2004 deadline CTOBER 2004, for many of us, means only one thing: the provisions of the Disability ODiscrimination Act, first introduced in 1995, will come into full force. Over the last few years column inches dedicated to DDA issues have increased at an amazing pace, to a point where we are at risk of switching off at the mere sight Figure 1: Graph showing trend in backlog maintenance costs of another article on the matter. Be that as it may, 1995-2003. Welsh Health Estates will, perhaps for the last time On a positive note, seven Trusts have already met the before October 2004, dare to mention this matter physical condition and statutory and safety compliance target once more. of 75% of the estate to be in Estatecode category ‘B’ by 2005. So what has prompted this bold decision? Two issues: Much more work needs to be done, however, to meet the • Firstly the sobering data contained in the recently published 90% target by 2008. This will only be achieved by careful NHS Estate in Wales Estate Condition and Performance planning and early targeting of resources. Report 2002-03; Disappointingly, the report points to an increase in energy • Secondly the recent focus by Welsh Health Estates and the consumption of 6.15% and a rise in CO2 emissions of 3.9%. Disability Rights Commission on the responsibilities of the Electricity consumption also continues to increase, suggesting Primary Care sector. that a focus on savings in the use of electricity should be ● FOCUS ON THE NHS SCENE given a high priority if CO emission targets are to be met. 2 At the time of submitting data for the 2002-03 Estate These increases, taken in the context of the primary energy usage over the last 13 years, as illustrated in figure 2, suggest Condition and Performance Report, two Trusts had yet to that the NHS has yet to address seriously the need to achieve complete surveys to identify the extent of the work required the all-Wales 15% reduction required by 2010. to achieve compliance and several Trusts had yet to carry out On a positive note, ten Trusts are within the primary energy surveys on their non-hospital estate. reduction Performance Indicator target of 65GJ/100m3. It is estimated that the cost of carrying out DDA work across Furthermore, on the energy front, eight Trusts are within or the NHS estate in Wales is £41 million, of which almost £6 are close to the target of 75% of the estate to be in category million is associated with the non-hospital estate. ‘B’ or above by 2005. Chart 1 shows the estimated DDA implementation costs by

6 WHE intranet website: howis.wales.nhs.uk/whe Trust. Figures relating to the Cardiff & Vale and Pontypridd & Rhondda NHS Trusts are estimated. Chart 2 shows the estimated DDA implementation cost/m2 by Trust. It is clear that the NHS faces a huge challenge if it is to meet the requirements of the Act by October 2004. Trusts must complete surveys of all buildings from which services will be provided, prioritise and estimate the cost of the work to be carried out, and set out and implement an action plan. The Welsh Assembly Government should be kept appraised of progress in order that strategic decisions may be made. ● FOCUS ON PRIMARY CARE Pencerrig Gardens Hotel, close to Builth Wells in Mid Wales, was the venue for the DDA seminar organised by Welsh Health Estates specifically aimed at highlighting the implications of the Disability Dicrimination Act legislation Chart 2 – DDA implementation costs/m2 by Trust on the primary care estate. Over 30 delegates from 20 Local Health Boards attended the event held on 22 October 2003. The seminar was presented jointly by Laura Jerram of the Disability Rights Commission and Caroline Lewis from the Strategy, to set out intentions, devise action plans and record JMU Access Partnership. decision making processes. This Access Strategy needs to be kept under continuous review. As part of the process of Seminar part 1 - Duties of Service Providers developing a strategy, emphasis must be placed on seeking The first section of the seminar set out the duties that those advice and consulting with disabled people, so that resources providing services to the public already have under the DDA: can be used effectively where they are most needed, on the a duty not to treat disabled people less favourably and a duty basis of real rather than perceived need. to make ‘reasonable adjustments’ to the way that the service is delivered. From October 2004 the duty to make reasonable Seminar part 2 - Technical Standards adjustments will be extended to include adjustments to to be Achieved premises. The second part of the seminar provided detailed information about the technical standards that need to be achieved in ➤ Key messages emerged modifying buildings in order to improve access. It included The duties are about access to services - not access to considerable detail as to how significant improvements can buildings per se. So the new duty to make reasonable be achieved through ongoing maintenance at little cost as well adjustments to premises must be seen as one part of a wider as advice on the importance of colour contrast, glare, floor agenda. To ensure that disabled people do not experience coverings and signage, all of which are often overlooked. discrimination and can make use of services it is vital to: • continue to improve staff awareness This section also focused on the wider environment outside • provide assistance the building, including pedestrian routes, car parking, and • provide communication support public transport links. • provide aids and equipment A video presentation of two existing primary care premises • review policies and procedures provided a clear demonstration of how many common Laura Jerram also explained that whether an adjustment layouts and adaptations fail to meet the requirements of to premises is reasonable will depend on a wide range of disabled people despite the best intentions of the service factors including: provider. Many of the issues identified related to a lack of • the cost awareness of disability issues and a failure to incorporate • the resources available these values within the building management regime. • the practicality of making the changes This was followed by workshops for delegates to consider • the size of the organisation the impact of the DDA on their own work in Local Health What is reasonable for an individual service provider to do, Boards. Delegates explored some common scenarios and will change over time as circumstances change. the challenges they face and were able to generate ideas This highlighted the importance of developing an Access and suggestions. Local Health Boards were encouraged to consider the ways in which they can use the procedures and mechanisms already in place to influence those delivering services in their areas. It is clear from events such as this that we all have a role to play to ensure that health services in Wales are accessible, appropriate and free from discrimination. ■ For further information on DDA in the NHS please contact: Nigel Davies on 029 20315543 or e-mail [email protected] For further information on DDA in Primary Care please contact: Chris Cowburn on 029 20315537 or Chart 1 – DDA implementation costs by Trust e-mail [email protected]

WHE intranet website: howis.wales.nhs.uk/whe 7 Design excellence in the health estate

T THE HEART of the National Estates Role of Design Champions Strategic Framework published in 2002 Design Champions are responsible for ensuring that the Ais the Welsh Assembly Government’s procurement of healthcare facilities takes into account the vision To develop accessible, modern, following strategic criteria: comfortable and adaptable environments ● Buildings must promote civic pride where patient-care can be delivered safely ● Consumerism issues must be taken into account ● Patients and staff must be consulted and their views and efficiently. The framework acknowledges addressed “serious deficiencies in the ability of the ● Buildings must fit into the local surroundings and existing health estate to deliver the services settings ● Buildings are fit for purpose required in the future, both in terms of fitness ● Buildings take on board modern technology for purpose and condition”. In the light Detailed responsibilities: of the condition of the existing estate, the ● All procedures should encourage the achievement of framework is clear that “The NHS must...foster high design quality amongst commissioners, designers and estate ● The Achieving Excellence Design Evaluation Toolkit (AEDET) should be used where appropriate providers, a culture where innovative ideas can ● Ensure a Trust/LHB Design Action Plan is produced and develop and thrive, and where best practice is delivered acknowledged and effectively disseminated”. ● Evaluation of tenders should be based on best value and not lowest cost After all, the benefits of fulfilling such a vision ● Budgets and timetables should be realistic for the generations to come must surely be ● Ensure Trusts have the right skill mix to deliver the incalculable. design agenda ● During the last year Welsh Health Estates has been working Ensure a design vision is established in order to produce a clear brief hard to develop the Framework’s strategic ideas on design ● Involve the local community and staff excellence into practical applications for the Service. Whilst the design agenda is huge and will take time to develop Design Champions will raise the profile of design excellence by: fully, attention is currently being focused on three areas in ● Encouraging the selection of designers with a proven particular: track record of good design and design awards • Design Champions ● Promoting awareness of national and international best • The Achieving Excellence Design Evaluation Toolkit practice • The Health Estate Design Quality Panel ● Encouraging schemes to be put forward for local and This article provides an outline of the on-going work in these national competitions and awards areas. ● Maintaining a forum for regular review and feedback to ● Trusts and Local Health Boards Design Champions ● Recognising the support, guidance and initiatives available

passion, drive, and a focus on objectives centred around patients, staff and all users of healthcare premises. Good design requires Design Champions, and the Framework makes it clear that the NHS has a responsibility to ensure that commissioning, design and provider teams identify Design Champions as part of the procurement of estate facilities. Over the last year the Framework’s focus on the promotion of quality environments has been translated into a Construction Procurement and Design Policy issued to the Service under Welsh Health Circular (2003) 56. This was followed by Welsh Health Circular (2003) 108, which sets out the responsibility of Trusts and Local Health Boards to appoint a member of ● Tonna Hospital, Neath. their Board as their Design Champion. The circular also The positive impact of good design on patient recovery provides details of the role of Design Champions, details of and welfare is well documented and, generally, widely which are set out in the insert above. accepted. Good design, however, whilst not necessarily costly, ● Achieving Excellence Design Evaluation rarely happens without real commitment to deliver quality environments. The Framework acknowledges that, in reality, Toolkit “quality is best achieved when commissioners, designers and In support of design quality initiatives Trusts are encouraged providers accept their collective responsibility in the estate to use the Achieving Excellence Design Evaluation Toolkit procurement process”. Such collective responsibility requires (AEDET) also introduced to the Service through Welsh Health Circular (2003) 56. Developed to assist those involved in the

8 WHE intranet website: howis.wales.nhs.uk/whe

● Cancer Treatment Centre, Ysbyty Glan Clwyd. AEDET – Functionality Uses Including: service philosophy, functional requirements and relationships, workflow, logistics, layout, human dignity, flexibility, adaptability and security. AEDET in the search field or searching the NHS Estates Access General Publications section. Including: vehicles, parking, pedestrians, disabled people, wayfinding, fire & security. ● Health Estate Design Quality Panel Spaces The National Estate Strategic Framework provides a Including: space standards, guidance and efficient floor commitment to investigate the development of a Health layouts. Estate Design Quality Panel whose remit will be to oversee AEDET – Build Standards the quality of architectural design in healthcare buildings Performance in Wales. Such a panel is seen as an important component Including: daylight, heating, ventilation, air-conditioning, of the design quality agenda in Wales, complementing the acoustics, passive thermal comfort. appointment of Design Champions and the support provided Engineering by the AEDET. Including: engineering management systems, specialist & Welsh Health Estates is currently investigating a number emergency systems, fire safety, engineering standardisation of options with a view to presenting them to the Estates and prefabrication. Development Panel for its recommendation and direction on Construction implementation. Clearly the investigation includes the need to Including: phasing, maintenance, robustness, integration, standardisation, prefabrication, health & safety. establish the remit of the Quality Panel and its composition. AEDET – Impact For the Panel to be effective and command the respect of the Service it will need to include members with considerable Character and innovation Including: excellence, vision, stimulation, innovation, experience in architectural and urban design and discussions quality and value. are ongoing with the Design Commission for Wales to explore Citizen satisfaction opportunities for engaging with the NHS in this initiative. It Including: external materials, colour, texture, composition, will also need to include experts in health planning and scale, proportion, harmony and aesthetic qualities. engineering to ensure the promotion of good design is not Internal environment done in isolation from the reality of clinical needs. Including: patient environment, light, views, social spaces, ● internal layout and wayfinding. Support for the NHS Urban and social integration Welsh Health Estates recognises that the implementation of Including: sense of place, siting, neighbourliness, town design quality initiatives requires appropriate skills that may planning, community integration and landscaping. not be widely available in the NHS. Design Champions, in particular, require training and support, and measures are procurement process to address design issues at key stages in being put in place to address these needs. Similarly the the development of projects, the toolkit uses a series of non- application of the AEDET, involving larger numbers of NHS technical questions to score designs against standard criteria. staff from different professional backgrounds will necessitate The Assembly will be requiring Trusts to demonstrate that training. Nigel Davies at Welsh Health Estates is currently the AEDET has been used during the Business Case process. co-ordinating the development of appropriate support for the An electronic version of the toolkit can be accessed from the service and will be pleased to offer advice. ■ Welsh Health Estates intranet website from the links section under NHS Estates - Achieving Excellence Design Evaluation For more information contact: Toolkit or from the Documents page, either by entering Nigel Davies on 029 2031 5543 or e-mail [email protected]

WHE intranet website: howis.wales.nhs.uk/whe 9 Building Project Review Chepstow Community Hospital

● Chepstow Community Hospital aerial photograph. ● Chepstow Choice ● Services HEPSTOW COMMUNITY HOSPITAL was an easy The hospital services are wide ranging and in particular areas selection for The estate we’re in centrespread surpass the provision of care in earlier community hospitals. Creview. Its status as the first PFI hospital in Wales The nurse-led Minor Injuries Unit is a case in point, working and three years completed service - it opened on St. 24 hours a day rather than the more usual 9 till 5 service. David’s Day 2000 - provide plenty of interest and Operating a triage system with three well equipped treatment feedback from its users. Chepstow’s new hospital is a rooms - one dedicated to paediatrics - and with overnight community hospital in a profound sense, providing accommodation for a doctor on the first floor, the unit is primary, community and secondary care from one impressive. Eightyfour beds are housed in four wards, two centre. at ground and two at first floor level. These are allocated for Some half dozen purpose built community hospitals have care of the elderly, elderly mentally infirm, rehabilitation and been developed in Wales since the mid 1980s and their other GP referrals. popularity is a matter of record. Chepstow is the first to Diagnostic services include an X-ray department with new accommodate primary and secondary care under one roof technology and remote imaging link with the Royal Gwent and houses two GP Practices (Mount Pleasant and Town Gate Hospital in Newport. Surgeries), the Local Health Board and a Health Promotion There are departments for Physiotherapy - acupuncture is Service. It is also the base for the District Nurses and Health available here - and Occupational Therapy and dedicated Visitors that serve the Chepstow area. accommodation for Speech Therapy. Visiting Consultants ● Heritage from the Royal Gwent and Nevill Hall Hospitals run a range Many of the staff transferred to the new hospital from the of specialty clinics from the Out-Patient Department’s five former St. Lawrence and Mt Pleasant Hospitals, whose Consulting Rooms. These include: General Medicine (including extensive grounds on prime development land provided the Care of the Elderly), Rheumatology, Urology, Paediatrics, Ante financial underpinning to the PFI contract. The PFI consortium Natal, Neurology, Dermatology, Child Psychiatry, General - Kintra - by virtue of the development of several acres of Surgery, Gynaecology, Orthopaedics, Ophthalmology, private housing have provided an 84 bed community hospital Learning Disabilities and Surgical Appliances. incorporating two medium sized GP Practices without cutting Various community clinics are held in the same accommodation: corners on clinical space or specification. Audiology/Hearing Aids, Psychiatry, Continence, Orthoptist, The Mt Pleasant Hospital legacy is evident throughout. Community paediatrics, Podiatry and Family Planning. Its sculpted pediment is prominently featured in the new Accommodation is provided in multi-purpose areas such as hospital landscape and its Day Hospital is named after Dr the Chapel for outside care agencies/charities such as St. Salkeld who worked in the Mt Pleasant facility. David’s Foundation, Alcoholics Anonymous and Crossroads.

10 WHE intranet website: howis.wales.nhs.uk/whe ● The Building and its Performance Driving there, the hospital comes into view on the right hand side and with it a steel and glass canopy. This turns out not to be the main entrance but the Minor Injuries entrance point. In order to get to the main entrance it is necessary to continue onto a roundabout, and take a right turn which leads to the main entrance and carpark access. The hospital is predominantly single storey but includes a first floor for ancillary GP Practice accommodation and two of the wards - stacked over those on the ground floor. The fabric of the building is of rationalised traditional construction featuring buff brickwork, pitched roofs of Spanish natural slate and polyester finished aluminium windows and doors. This approach is reminiscent of the community hospitals in Wales previously built in the public sector. There is no hint of downgrading specification standards at Chepstow. The building layout is ranged around a large pentagonal area which is criss-crossed by link corridors which provide inter- departmental circulation and define four distinct courtyard areas. The ‘web’ of link corridors and the splayed junctions created by the pentagonal plan are costly forms with some awkward roof junctions. The link corridors have large sections of roof glazing which make them hot in summer and cold in winter. The two courtyards nearest the main entrance are rather small and regarded as a waste of space, whilst the two larger courtyards are generously landscaped with direct views out from the GP Practices and wards respectively. Whilst the chain link fence around the pond area detracts from its charm, this courtyard is used extensively by patients during fine weather. The areas of gravel paving are unsuitable for wheelchair users. The main entrance/reception with open sitting and dining areas adjacent presents an attractive, welcoming public space ● Detail. featuring a pitched timber boarded ceiling, pastel finishes The two first floor wards reportedly overheat during hot and views into the courtyards beyond. However, the WCs weather - a temperature reading of 86°F was mentioned and, located opposite the dining area are less than discreet and a if this is so, a diagnostic and remedial exercise is warranted. screened access would be more appropriate. The balconies accessed from these wards are generally the The wards incorporate a mix of four, two and single bedrooms preserve of smokers. and are generally regarded as a big improvement on the Staff who transferred from St Lawrence highlighted the lack Nightingale wards at St Lawrence Hospital. Reservations were of storage space in the new unit compared with the old expressed about the difficulty for nurses giving support to hospital which latterly provided 84 beds in a hospital which patients in the assisted WCs due to the position of the wash originally accommodated 200 beds in its Nightingale wards. hand basin. Bed cubicle curtains fouled access to the wash Given such an abundance of space previously, a negative basins in the bed bays. comparison was by far the most widely expressed complaint. The on going programme of replacing the old furniture brought from St Lawrence Hospital exacerbates the problem of inadequate temporary holding space. Despite the niggles, staff were generally enthusiastic and took pride in the new hospital. The kitchen was originally planned around a cook/chill catering policy. The change of brief to conventional food preparation came late in the design stage, resulting in a tightly planned equipment layout. The freezer room is also smaller than normal, requiring regular, more frequent deliveries to maintain stocks. The catering team (part of the Kintra consortium) pronounced themselves happy with their facility, which possesses very efficient temperature and air handling characteristics. Moreover the food tasted fine! The 15 place day hospital, occupational and physiotherapy departments are logically located en suite and staff feedback, whilst generally positive, focussed on some shared problems: internal offices are too small and become oppressive over ● Legacy from Mt. Pleasant Hospital. time, door closers are too fierce for elderly patients and sill

WHE intranet website: howis.wales.nhs.uk/whe 11 heights are too high for seated patients to see out. The flat roof deck over the kitchen and chapel areas serves as a platform for several items of engineering plant. External ‘plantrooms’ are less commonplace these days and this one is screened from view by unusual decorative balustrading in white painted steel. The Pharmacy is one element in Chepstow’s ‘all under one roof’ policy that has never got off the ground due to objections from local pharmacists. Part of the space has been converted to a well stocked hospital shop accessed externally near the main entrance. The remainder of the space is in the process of being fitted out as offices for the Local Health Board - entirely consistent with the Chepstow policy. Making changes to the building is a protracted process according to its NHS Site Manager. The shop took over a year to get up and running and a proposal to install a cash machine has been aborted on ‘too much hassle’ grounds. ● Main entrance. Kintra provides catering, portering, domestic, reception as well as building and engineering maintenance services. A ‘handyman’ is permanently on site. Relations between NHS management and Kintra are generally good. Monthly meetings with individual services pick up routine snags and potential made it a relatively straightforward financial quarterly ‘service’ meetings encompass all Kintra’s activities. proposition. Another design team may have anticipated Whilst the building is well maintained management’s some of the problems and produced more ingenious ward preference for dealing with their local Estates Department layouts, for instance, but we should not imagine that publicly as they did at St. Lawrence Hospital demonstrates that financed hospitals always get it right. NHS loyalties are enduring. Certainly, food and cleanliness What really impresses at Chepstow is the mix of primary and standards are good and Kintra deserve credit in the range of secondary care facilities, the range of its clinics, its hosting services it provides. of outside agencies/charities, its base for community care Experience suggests that it is unlikely that Chepstow workers and the Local Health Board. All under one roof, Community Hospital would have been bigger or better built, Chepstow Community Hospital sets the standard in Wales had it been conventionally financed in the public sector. This, for weaving together so many strands of local health care after all, was a PFI deal where the housing development delivery. ■

● Sitting and dining area by main entrance.

12 WHE intranet website: howis.wales.nhs.uk/whe Project Details Building project completion date February 2000 Building occupation date March 2000 Building contract value £10 million Annual charge £1.7 million for 25 years Floor area Approximately 7000m2 Contract type Private Finance Initiative PFI Consortium Kintra PFI Service Provider Select FM Architect David Hutchinson Partnership Services Engineer Parsons Brinkerhoff Structural Engineer Parsons Brinkerhoff Quantity Surveyor Gwent Healthcare NHS Trust Project Manager King Sturge Contractor Kvaerner Acknowledgements The Project Review was carried out by Phil Withecombe on behalf of Welsh Health Estates. Phil is an Architect with many years experience in the health design sector. Welsh Health Estates is grateful for the assistance provided ● Courtyard with pond. by Gwent Healthcare NHS Trust.

● Floor detail.

Ground Floor

First Floor

For more information contact: Peter Wiles on 029 2031 5542 or ● Elevation with 1st floor terrace. e-mail [email protected]

WHE intranet website: howis.wales.nhs.uk/whe 13 Hospital Patient Environment programme gets underway Background selected for the initial HPE assessment: ● Trusts would be required to nominate a Board member HE SEEDS for the Hospital Patient Environment to take responsibility for patient environment issues, and (HPE) initiative were sown in the Assembly become the HPE point of contact reporting regularly to document Improving Health in Wales: A Plan for T the Board. the NHS and its Partners published in 2001, which stated Fig. 2 ● Assessments were to be that ‘The people in Wales, and Fig. 1 based on issues such as the HPE Assessment the health professionals who List of Hospitals decoration of patient areas, Areas care for them, have the right included in the first the adequacy of hospital 1. External areas to expect health care delivered round of HPE signage, environmental 2. Entrances and main in a modern, clean, well assessments cleanliness and the quality reception areas maintained environment’. ■ Royal Glamorgan and availability of meals. 3. Common areas ■ University Hospital Although undertakings from ● Assessments were to 4. Ward areas of Wales the Plan relating to technical complement technical 5. Departments ■ Llandough standards such as the Nutrition/ standards such as the Nutrition/ HPE Assessment ■ Prince Charles Catering Framework and the Catering Framework, and ■ Criteria Velindre National Standards of Cleanliness support other related NHS ■ Singleton were already being progressed by ■ Public Transport Wales initiatives including: ■ ■ Morriston Welsh Health Estates, it was not Roads ● Fundamentals of Care; ■ ■ Neath Port Talbot until the ministerial announcement Pavements ● Health and Social Care ■ Signage ■ Princess of Wales made in November 2002 that HPE Guide; ■ Support (staff) ■ Prince Philip Teams were to be introduced in ● Signposts - A practical ■ Security ■ West Wales General Wales that attention was focused ■ Bronglais guide to public and patient ■ Car parking on the wider patient environment involvement in Wales; ■ Decoration ■ Withybush issues. Welsh Health Estates ■ ● Service and Financial ■ Grounds Nevil Hall would pursue the delivery of this ■ Royal Gwent Framework & Performance ■ Cleanliness initiative as part of its Facilities ■ Glan Clwyd Improvement Framework. ■ Access Management remit to the Welsh ■ Ysbyty Gwynedd ● Assessments were to be made ■ Furniture Assembly Government for the ■ Wrexham Maelor against set criteria relevant to ■ Tidiness NHS in Wales. the patient journey (Figure ■ Toilets (incl visitors) The announcement confirmed that 2). ■ Ambience ■ the process would involve setting and verifying non-clinical ● The HPE process would not Waste ■ Linen national standards for the patient environment, and that result in league tables but ■ Privacy and dignity there would be an initial focus on District General Hospitals rather provide information in Wales. From here a multi-disciplinary Working Group ■ Hospital food to be used constructively ■ Smells facilitated by Welsh Health Estates developed proposals to facilitate improvements. for the HPE Programme. This group had representation To this end the assessments from Nursing and Facilities for NHS Trust Management, the would not be ‘scored’ but rather rated in terms of Association of Welsh Community Health Councils (AWCHC), performance in meeting requirements for each criteria and the Welsh Assembly Government. (Figure 3). Community Health Councils (CHC) would prove to be an ● Trusts would initially conduct a baseline self-assessment essential component of the process as they represent the of the performance of their hospitals against the HPE, independent consumer council for the NHS in Wales. As such with supporting comments and details of actions planned they have been set up to monitor and review the operation of wherever appropriate. local health services and to recommend improvements. Their ● Following a 3 to 4 month period, assessments would be statutory duties include the monitoring of health services, conducted by external assessment teams made up from and CHCs have been conducting quality-monitoring visits CHC members. to hospitals for more than thirty years. During 2002/3 the ● The HPE external assessment teams would have access to AWCHC has been in the process of standardising its approach the Trust baseline assessments and would sample areas to quality monitoring visits and welcomed the opportunity to for independent external assessment, and review progress work with the NHS and the Welsh Assembly Government to made against the Trusts actions plans. develop and deliver the HPE programme. ● The AWCHC would use the assessments from the visits In due course the HPE assessments will contribute to and report to the Welsh Assembly Government. a process of continuous improvement and be reviewed ● Reviews would take place on an annual basis and the regularly, with the expectation that in the first instance results fed into the NHS Wales Performance Improvement improved management action would result in improvements Framework. to the patient environment. Current position HPE Principles All Trusts with participating hospitals have nominated a The following principles were agreed by the HPE Working Board member responsible for the HPE process. Group in respect of the 18 major hospitals (Figure 1) Trusts completed their baseline self-assessments in May 2003 and

14 WHE intranet website: howis.wales.nhs.uk/whe the returns entered into Fig. 3 monitoring the implementation of action plans arising from a central database the HPE external assessments. ■ maintained by Welsh HPE Assessment For more information contact: Health Estates. Criteria Ratings Sid Johnson on 029 2031 5516 or ■ Poor – Does not meet the The HPE baseline e-mail [email protected] assessments have allowed guidance criteria in almost Trusts to undertake a very all respects. detailed review of areas ■ Fair – Meets the guidance within their hospitals criteria in some respects. Fig. 4 exclusively from the ■ Good – Meets the HPE Process – Emerging Themes patient perspective, as part guidance criteria in most ■ In some hospitals specific single issues appear to of a commonly adopted respects. pervade, such as the need for improved signage structured process, along ■ Excellent – Meets the across the hospital site. with the opportunity to guidance criteria in all This is an example of an aspect with requirements identify areas requiring respects. specific to Wales, where good practice may be attention and having These ratings allow HPE shared from sites that excel in this respect. associated action plans. assessments to feed into the ■ In some hospitals it appears that the HPE The assessment returns Performance Improvement assessment approach is highlighting isolated indicate that there has Framework. areas of weakness, such as the need for suitable been a wide variation in waste receptacles, overlooked by other types of the time and effort put assessment. into this initiative by Trusts, with some providing extremely The HPE process should prove to be a helpful thorough assessments and action plans. additional mechanism for supplementing existing A preliminary review of the Trust baseline self-assessments technical-based assessment processes. suggests there are some emerging themes highlighted in ■ In most hospitals the HPE assessment returns Figure 4. indicate that outcomes in similar areas within Following training provided by the AWCHC, HPE visiting the hospital can be significantly different. For teams, consisting of representatives from each of their example, the returns for one ward may indicate constituent Community Health Councils, worked through that tidiness and privacy are acceptable while the a programme of external assessment visits completed in returns for another may indicate that they are November 2003. The assessments included a review of unacceptable. progress by Trusts against their action plans. The findings It would appear that performance is often linked are in the process of being submitted to Welsh Health Estates to issues such as an individual’s commitment for collation and analysis to enable the AWCHC to prepare and training, along with issues of culture, team its report for the CHC Federations and the Welsh Assembly working and ownership, rather than deficiencies Government. in standards or resource issues. ■ Returns suggest that there is often a need for The Future improved communication between different It is anticipated that external assessments will continue to departments such as hotel services, ward staff and be carried out by CHCs on an annual basis and may estates. extend beyond the original list of 18 hospitals. This appears to highlight the need for improved As well as providing the basis for monitoring continual communication processes. improvement in the patient environment at a particular hospital, the results of the CHC assessments will identify common areas of concern and provide opportunities for the identification and sharing of good practice. The results will also be available to feed into the NHS Wales Performance Improvement Framework, a key element of which will be the Welsh Assembly Governments ‘balanced scorecard’. Work is also under way to form a Facilities Forum for the NHS in Wales. Its remit and structure is under discussion, but it is anticipated that each Assembly Regional Office will play an important role in monitoring the performance of organisations within its region using the HPE approach. In addition, in association with the appropriate Local Health Boards, it is likely that Regional Offices will have a responsibility for

WHE intranet website: howis.wales.nhs.uk/whe 15 Welsh support for the Medical Gas Association ARROGATE WAS THE VENUE for the annual Systems Design is now available to members on the MGA Medical Gas Association (MGA) symposium held website. The document has been well received by the MGA Hon 30 September 2003. As a delegate representing membership and has been submitted to NHS Estates for Welsh Health Estates, Paul Wilkings, Principal Engineer consideration against the current advice given in HTM 2022. and Authorising Engineer (Medical Gases), was The Association is represented on the relevant British Standards disappointed at the poor level of support from NHS Committee and is recognised as an expert consultative body Trusts in Wales. It is possible that the apparent apathy by many organisations, including the Department of Health. is due to a lack of awareness of the Association’s Five more working groups have now been set up to address existence. the following issues: Origin and role of the Medical Gas Association ● Medical Air The vision for a MGA grew from the NHS Estates HTM 2022 ● Pipeline Materials and Jointing Techniques Working Group and was first proposed in early 1999. That vision has been realised through the Association’s newsletter, ● Overseas HTM2022 website and working party reports. The MGA exists not only ● Training in Medical Gases for Clinical Staff to provide a focal point for the dissemination of information ● BS EN 737-3 but also as an organisation dedicated to the promotion of study, training, research and standards in all aspects of Support for the Association medical gases. The Association’s strap line Vital to Life If you have a direct involvement with medical gas issues reflects the critical role of medical gases as the hospital’s life you should seriously consider joining the MGA, particularly support system. in view of the likely changes concerning the appointment Membership of the MGA is open to all individuals engaged in of future Approved Persons and the role of the Authorising occupations related to the use of medical gases in healthcare, Engineer. The appointment of future Approved Persons for or who are professionally interested in medical gas systems medical gases is likely to be a lot more stringent than it and their applications. Current membership includes personnel has been in the past, with the rules of appointment clearly from Estates, Pharmacy and Microbiology Departments as defined. Membership and annual subscription details are well as the private sector, hence the knowledge spectrum is available on the MGA website www.mga.org.uk ■ very wide. For more information please contact: Output of the Association Paul Wilkings on 029 20315522 or The 1st MGA Working Party Report, titled Oxygen Supply e-mail [email protected] Remit of the five MGA Working Groups Medical Air Working Group * Examination and review of standards of current practice and levels of compliance * Suitability of current standards * European Pharmacopoeia Monograph * Plant and equipment review * Alternative sources * Pressure regimes and alternative motive gases Pipeline Materials and Jointing Techniques Working Group * Examination of physical and chemical properties of materials against a list of criteria produced by the Group * From those materials which meet the above criteria produce a refined selection based on cost and ease of installation * Produce a list of recommended materials * Financial and ergonomic implications will also be investigated. Overseas HTM 2022 (Climatic Extremes HTM) Working Group * Investigate how well HTM 2022 works in countries less climatically temperate than the UK. The Group aims to produce guidance that will enable Pharmacists and Engineers cope with the effects of ambient climate and geography (and geology) on their medical gas systems. Training in Medical Gases for Clinical Staff Working Group * The difficulty of ensuring that doctors and nurses are properly trained in aspects of medical gases, more particularly those associated with emergency situations and safe working practices, is well known. The project is being undertaken in three stages: 1) Identification of the risks a) Medication incidents e.g. flowmeters/regulators on the incorrect cylinder, flowmeters left on with no patient attached b) Therapy management observations e.g. poor cylinder management on wards, unrestrained cylinders, lack of understanding about terminal units c) Senior clinical staff; HTM 2022 Operational Management non-compliances e.g. lack of understanding about Permit to Work, isolation of AVSUs in emergencies 2) Production of a syllabus to address those risks 3) Recommendations on how to implement the training BS EN 737-3 Working Group * Review BS EN 737-3 and produce proposals to be carried forward to the next British Standards meeting * Review ISO 7396-1 and EN 737-3 and produce proposals for both.

16 WHE intranet website: howis.wales.nhs.uk/whe advise where the law has not been complied with, why they Proposed changes in are of that opinion and, where necessary, require them to Statutory Fire Safety take action. FIRECODE REVIEW Legislation and Firecode As a result of the forthcoming changes in statutory fire safety REGULATORY REFORM (FIRE SAFETY) ORDER legislation a complete review of Firecode is being undertaken. The first phase has been completed with a review of Policy he Regulatory Reform (Fire Safety) Order – and Principles. It should be noted that the review takes into likely to come into force in 2005 – is intended account the duties and responsibilities of the ‘Responsible to review, consolidate and reform existing fire T Person’ outlined in the Regulatory Reform (Fire Safety) Order. safety legislation. It will repeal the following principle The proposed draft document is titled ‘The Management of Fire statutory fire safety legislation. Safety in Healthcare’ and will be circulated for consultation to ■ The Fire Precautions Act 1971 (as amended); the service (anticipated date Spring/Summer 2004) to coincide ■ The Fire Precautions (Workplace) Regulations 1997 (as with Regulatory Reform (Fire Safety) Order. amended); The ongoing review of Firecode will change the existing It will also remove other legislation, which contains references ‘Prescriptive Requirements’ to ‘Functional Requirements’. to fire safety. For example, HTM81 Fire Precautions in New Hospitals The principles of assessing fire risks embodied in the Fire currently has eighty ‘Requirements’. It is proposed that Precautions (Workplace) Regulations 1997 (as amended) will the ‘Requirements’ will be replaced with five ‘Functional underpin the new regime of fire safety. Requirements’ supported by appropriate design solutions The Regulatory Reform (Fire Safety) Order requires that a similar to the current Building Regulations. The proposed responsible person should be appointed. That person is revisions will apply to all Firecode design publications. usually the employer or the person who is responsible for the The Firecode Fire Risk Assessment documents are also to be overall management of the premises, such as the occupier or revised and reproduced in a format that will be compatible owner, who has responsibility for the safety of employees and with the guidance produced by the Office of the Deputy every one on the premises that may be affected by fire. Prime Minister, similar to other categories of buildings as Prècis of the duties of the required by the Regulatory Reform (Fire Safety) Order. The ‘Responsible Person’ revisions will, where possible, give recommendations to avoid any possible conflict between fire safety provisions and the • Make arrangements as are appropriate for fire safety, having regard to the nature of the activities size of requirements of the Disability Discrimination Act 1995. the undertaking, for the effective planning, organisation, THE DISABILITY DISCRIMINATION ACT 1995 control, monitoring and review of the preventative and The Disability Discrimination Act 1995 (DDA) places a duty protective measures. on building managers/service providers to ensure access to • Ensure that fire risk assessments are undertaken and maintained up-to-date, and that appropriate steps are services for all concerned. From October 2004, ‘reasonable taken to ensure that risks are removed or reduced to an adjustments’ should have been made to the physical features acceptable standard. of all premises to ensure that appropriate access and egress is • Ensure that fire safety audits are undertaken to demonstrate provided for all types of buildings. that fire safety is being appropriately managed. Trusts will have to ensure that their Fire and DDA strategies • Ensure that contractors who install, maintain or test fire are compatible when refurbishment or improvements are safety equipment or systems are competent to carry out proposed. Consideration should be given to the provision such work. of: • Install fire-fighting measures in the premises, which are adapted to the nature of the activities carried out and the ■ Voice, visual, tactile and portable alarms, the introduction size of the premises concerned. of low-level signage etc. • Ensure that premises are, to the extent that is appropriate, ■ The use of bed evacuation lifts or fire-fighting lifts may provided with fire-fighting equipment, fire detectors/ need to be given a higher priority to ensure people alarms, means of escape etc. • Nominate employees to implement such measures and accessing the premises via a lift can also evacuate in ensure they are given adequate training. a similar manor. Where lifts are not readily available • Arrange any necessary contracts with external emergency specialist evacuation chairs may have to be incorporated services, particularly as regards rescue work and fire into the evacuation strategies (subject to agreement). fighting. ■ The type of self-closing device used on fire doors may have • Ensure that where dangerous substances are present the to be reviewed, to limit the force required on the leading risk assessment takes into account additional factors such edge to opening fire doors. Greater use of magnetic door as the quantities, its hazardous properties and the working hold-open devices and electronic door opening devices process. etc. should also be considered. It is not possible to give more precise guidance until The requirement to comply with the Regulatory Reform (Fire a sufficient number of test cases have been heard and Safety) Order rest with the ‘Responsible Person’ who must the findings analysed to determine what is considered by maintain the premises in a safe condition. Where enforcing ‘Reasonable Provision’. ■ authorities are not satisfied that the fire precautions are For more information contact: adequate, rather than stipulate exactly what the ‘Responsible Paul Harrison on 029 2031 5530 or Person’ must do, it will be for the enforcing authority to e-mail [email protected]

WHE intranet website: howis.wales.nhs.uk/whe 17 *** STOP PRESS *** Property News Welsh Health Estates Environmental Intranet Website Award The Land News Registration Act 2002 Number of documents currently published on the he Land Registration website Act 2002 came into ◆ 279 NHS Estates documents force on 13th October (including 31 Quarterly Briefings T going back to 1995) 2003, replacing the statutory ◆ 206 Welsh Health Estates framework for Land documents Registration set out in the 1925 ◆ 251 National Assembly legislation. The Act is intended for Wales/Welsh Assembly to put more information about Government documents ◆ 23 Other documents ● Stewart Fletcher (right) presents the land ownership in the UK on trophy to Jonathan McGarrigle of Cardiff the public record. 759 documents in total – an & Vale NHS Trust increase of 111 since the last issue Registration of Leases Cardiff & Vale NHS land holding bodies should note ■ Welsh Health Estates that all new leases over 7 years (rather Organisational Changes scoop the than 21 years, as before) will have to Full details of the new Welsh Health be registered, bringing most leases, and Estates organisational structure ‘green’ award therefore most commercial property and services provided can be found transactions, within the scope of the under Services. Contact details are ARDIFF & VALE NHS Act. The information will then be made included should you require further information on services provided. Trust are the worthy available to the public unless the owner winners of the new or leaseholder convinces the registry ■ Help C For those of you who are not used ARENA Network Wales that it is sensitive or contrary to public to navigating websites or may simply interest. Environment Award for be unsure how to find a specific energy management best Anyone who considers that disclosure document, please remember that we practice in the NHS, presented of certain details in the document would will only be too pleased to assist you, prejudice their commercial interests can including how to find our site in the by Welsh Health Estates on 6 first place! Help is only a phone call November 2003 at the Cardiff apply to the Land Registry to have them blanked out of the copy of the away, as Ann is semi-permanently glued to the screen and will guide Marriott Hotel. document, which is made available Presenting the trophy on behalf of you step-by-step to the information to the public. If the application is you need. Welsh Health Estates, Stuart Fletcher of successful, the Land Registry will only the Assembly NHS Wales Department hand out an expurgated version of the said: “We are working very hard in document. the NHS to reduce and minimise any adverse impacts on the environment Effect of Squatters that arise from our activities. The The Act also gives registered title very nature of our health services holders increased protection against demand and consume a significant the acquisition of title by squatters. amount of energy resources but this A squatter will not be able to apply is a major impact that we can manage successfully to be registered as the and reduce through various energy owner of land on which he/she squats, efficiency schemes and the adoption of however long he or she may have been energy best practice. The good work in adverse possession, if the existing at the University Hospital demonstrates owner objects, except in very limited clearly what can be achieved for the and clearly defined circumstances. ■ Website Help environment whilst saving costs at the If you need advice on document same time.” searches or more general help Whilst there could only be one winner, please contact several Trusts entered the competition, For more information contact: Ann Konsbruck on 029 2031 5512 or e-mail ann. and should be commended for their Gareth Roberts on 029 2031 5527 [email protected]. commitment to raise the profile of this or e-mail gareth.roberts@whe. important event. ■ wales.nhs.uk

18 WHE intranet website: howis.wales.nhs.uk/whe For more information call Ann Library News on Cardiff 029 2031 5512 or e-mail Ann at [email protected] Staff News The library at Bevan House holds a wealth of printed knowledge Recent Technical concerning both the health service Advice Notes and the built environment, comprising ■ over 4,000 publications, 200 archived TAN(03)06 - Building Better publications and 200 items of trade Healthcare Awards 2003 literature as well as CDs, videos June 2003 and cassettes. In addition there are Enclosing information on the NHS numerous reference documents and Estates Building Better Healthcare access to information services. Awards on behalf of NHS Estates. If you have a problem with any of your We now know that Pembrokeshire New appointment & Derwen NHS Trust won the award information requirements why not give We are pleased to announce the under the category of Best Designed the library a call, we may be able to appointment of Christopher Lewis Mental Health Facility. help. to the Environmental Management ■ TAN03)07 - The NHS Estate Section. Chris, who has a degree Recent Welsh Health in Wales Estate Condition in Environmental Engineering, and Performance Report & has spent much of his career in Estates Letters Supplement the areas of environment and ■ WHEL(03)08 - Achieving Document 2002-2003 health & safety, principally in the Excellence Design Evaluation November 2003 manufacturing industry. He joins us as Environmental Management Toolkit (AEDET) Enclosing a copy of the 2002-2003 Advisor from LG Philips Displays in August 2003 report for NHS Trusts in Wales on Newport where he was Safety & Notifies Trusts that, in order to behalf of the National Assembly for Environment Engineer. achieve design excellence, the Wales’ NHS Directorate. Away from work one of Chris’ Achieving Excellence Design ■ TAN(03)08 main interests is watching rugby Evaluation Toolkit (AEDET) has Wales Public Sector Sustainable (Pontypridd RFC) and he tries to keep been developed, and its use by all Waste Management Guidance fit playing 5 a-side football. property-holding NHS bodies is Manual - July 2003 mandatory. Matrics 5-a-side Football Enclosing a copy of ‘Wales ■ WHEL(03)09 Fire Practice Note Public Sector Sustainable Waste Tournament 11 - Reducing unwanted fire Management Guidance Manual’ Congratulations to the joint team signals in healthcare premises: which represents the start of the of Welsh Health Estates Surveyors Reporting procedures Welsh Assembly Government’s and GVA Grimley on winning the September 2003 Campaign to improve the South Wales RICS Matrics 5-a-side management of waste throughout Football Tournament on 24 October Advises all NHS property holding the Public Sector in Wales. Its 2003 in Cardiff. After GVA Grimley’s bodies of the requirement to report distribution to the NHS in Wales disastrous result last year, our boys all fire incidents and unwanted fire recognises that it can play a major came to the rescue, clearly making signals on the revised report form part in the realisation of the targets all the difference! The team will now contained in Appendix E of FPN11 go on to compete in the national for the Public Sector, and in so doing Welsh Edition. 5-a-side tournament. contribute to the drive for a more Representing Welsh Health Estates ■ WHEL(03)10 - Quarterly Briefing sustainable environment whilst were Gareth Roberts, Clive Ball and (08/2003: Volume 13 No 1) making the best use of available Carl Waskiewicz. November 2003 resources.

Capital Project MIPS Cost Allowance CPQRs Quarterly Reports

Cost allowances for health buildings are set at: The attention of Trusts is drawn to the requirement ■ MIPS Firm Price (FP) index level of 395 for them to submit quarterly CPQRs in accordance with WHC (2001) 101. The WHE website includes the WHC at ■ MIPS Variation of Price (VOP) index level of 385 documents/WAGCs and an electronically usable version of The effective date for these allowances is 1st October the CPQR form at documents/forms. 2003 The response rate and time compliance, of Trust submissions ■ The current location factor for Wales is 0.94 for the last quarter, were the best ever - but they were still The effective date for this allowance is 1st April 2003 not 100%! For more information contact: The Welsh Assembly Government is very keen for this Kerry Ward on 029 2031 5540 or feedback to be improved and we will be contacting the few e-mail [email protected] Trusts that need to improve the quality of their returns. For more information contact: Gwilym Jones on 029 2031 5541 or [email protected]

WHE intranet website: howis.wales.nhs.uk/whe 19 The Building Better Healthcare Awards 2003 Pembrokeshire and Derwen NHS Trust win the award for Best Designed Mental Health Facility behaviour from patients and enjoy working in a modern facility. Patients have an improved degree of privacy in a less institutional environment that encourages good recovery. St Caradogs (Adult Acute Unit) This building has a central spine angled at the entrance, with borrowed light from the communal lounge/dining and games rooms, which have full height glazing into the landscaped courtyard. All the staff and clinical rooms are on the ‘public’ side of the building with administrative offices on the first floor. There are separate wings for male and female patients, thirty E ARE PLEASED to congratulate bedrooms in all, each with their own en-suite facilities, nurse Pembrokeshire & Derwen NHS call and panic alarm system. These are situated on the ‘private’ side of the building and overlook landscaped areas. Trust on winning the award of Best W Each wing has an informal lounge at the corner with full Designed Mental Health Facility in the NHS height glazing and access into the garden. Estates Building Better Healthcare Awards 2003. St Nons (Psychiatry of Old Age Unit) The new 45-bed Bro Cerwyn Adult Mental Illness & Psychiatry The fifteen large bedrooms in this unit, four of them en- of Old Age Unit, designed by the Powell Dobson Partnership suite, are situated around three sides of a central landscaped and replacing accommodation in the Victorian St David’s courtyard with windows looking out onto the enclosed Hospital, was completed in April 2003 and is situated in external garden areas. The fourth side of the building contains Haverfordwest, close to Withybush Hospital. the communal and clinical rooms. Full height glazing brings light into the circulation space and gives views across from The site already contained a Day Centre and the positioning one side of the unit to the other. Two small lounges give of the new structures created an entrance court, serving all access to the courtyard containing a calming bubble fountain three buildings and acting as a central entry/focal point. A and patients can wander freely and safely within this area. covered way links each of the units and enables patients and staff to move in comfort between them. The new buildings, This Award highlights once again the contribution that a high located on the quieter northern end of the site, are mainly standard of built environment can make in enhancing staff single storey and provided with attractive outdoor spaces. morale and improving patient care. ■ Great care was taken with the internal treatment of both units For more information contact: particularly in the selection of colours and finishes. Peter Wiles on 029 2031 5542 or Staff have noted an improvement in violent and aggressive e-mail [email protected]

20 WHE intranet website: howis.wales.nhs.uk/whe