A Vision of Health NHSScotland’s agenda for realising value in the developing healthcare estate A Vision of Health NHSScotland’s agenda for realising value in the developing healthcare estate Foreword Foreword The Better Health, Better Care Action Plan, published in 20071, affirmed the Scottish In this publication we celebrate the vision of some of Scotland’s healthcare leaders Government’s commitment to improving the physical and mental wellbeing of the people including the Chief Medical Officer and healthcare Design Champions and set out the of Scotland through supporting the provision of well designed, sustainable places. The practical measures being put in place to assist Scotland’s NHS Boards in guiding their Action Plan also articulated the Scottish Government’s vision of a mutual National Health projects to successful outcomes. 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. Throughout, we feature some current and future-planned projects within NHSScotland which look to provide the quality of environments to which we aspire. 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 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 Nicola Sturgeon MSP 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 outcomes and quality of life for all of Scotland’s people, it is important that the principles of designing new facilities, NHS Boards deliver not only high quality solutions but also of visionary leadership of those who contributed to this publication are embraced by NHS realise benefits for community development and the wider environment. 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. 4 5 Contents Introduction 09 how NHSScotland sees the developing estate 11 conversation between the three bodies 15 with an overarching influence on the healthcare estate practical steps to assist NHSScotland to 47 deliver their vision 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 Appendices 64 Dumfries Dental Centre, photos: Archial Group Archial photos: Centre, Dental Dumfries 6 7 Introduction 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. 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. Stobhill Hospital, photos: Reiach and Hall Architects Hall and Reiach photos: Hospital, Stobhill 8 9 1. The Vision The Government has set out, in Better Health Better Care, its vision for what “...an estate designed with ‘a level of the Health Service should be. In response, NHSScotland is developing a vision of the facilities needed to support the evolving service; a consensus being care and thought that conveys respect’; articulated by professionals from a range of disciplines that sets a clear and buildings that grow from the local history challenging agenda for those charged with delivery. and landscape, that are developed in partnership with the local community. A work of joint learning and joint responsibility that is particular to that Key community and that place; ‘Not off Dr Harry Burns, Chief Medical Officer for Scotland the shelf shoe boxes’.” 1 Helen Byrne, Director of Acute Services Strategy Implementation and Planning, 2 NHS Greater Glasgow and Clyde Jackie Sansbury, Director of Strategic Planning & Modernisation 3 NHS Lothian Maureen Coyle, Project Director 4 NHS Forth Valley Roelf Dijkhuizen, Medical Director 5 NHS Grampian Murray Petrie, Vice Chair 6 NHS Tayside 10 11 1. The Vision Royal Hospital for Sick Children Project Type: Children’s Hospital Client Body: NHS Lothian Location: Royal Infirmary of Edinburgh Little France Delivery Team: Advisors: Davis Langdon Leaders within NHSScotland are thinking strategically about the physical environment PSCP: BAM Construction Ltd for staff and patients and setting high aspirations not only for clinical efficiencies, but for Architect: Nightingale Associates buildings that are uplifting, improving the health and wellbeing of staff and patients alike. Completion: TBC Facilities that are the physical manifestation of the ethos of the Service. Value: £130.9m (Construction cost) Procurement Type: Frameworks Scotland 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’. 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. 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 Images: Nightingale Associates Nightingale Images: 12 13 1. The Vision New Stobhill Hospital 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 do not pay. A growing understanding, supported by research, that creativity is not Architect: Reiach and Hall expensive, in fact it more than pays for itself by improving productivity, wellbeing and Civil / Structural Engineer: SKM Anthony hunts recovery. Three very human, and healing, aspects sing out in NHSScotland’s vision for Mechanical & Electrical Engineer: DSSR the healthcare estate: Completion: March 2009 Funding: PFI buildings that people of the local area are proud of; that are a symbol Value : £65m (Construction cost) of the Service ethos and the staff; that convey respect to the patients and which Procurement type: PFI encourage respectful behaviour in return; which offer an ‘architecture of hope’. Awards: Roses Design Awards 2009 – Nomination for Best Public Building that one size does not fit all: that both the service configuration and the (Final judging October 2009) architectural expression of this should grow from, and support, the community needs and the unique characteristics of the place. 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. 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.