Presentation on theme: "EVIDENCE-BASED DESIGN"— Presentation transcript:
1 Achieving the Client’s Objectives in PFI Projects John Cole Chief Executive , Health Estates
2 EVIDENCE-BASED DESIGN No longer simply intuitive – now research backedThe Health SectorUp to 20% reduction in post operative recovery / length of stayUp to 15% reduced use of analgesicsReduced hospital acquired infections, medical errors and patient accidents leading to claimsReduced aggression towards staff by up to 40%Easier recruitment and retention of staff – up to 56% increase in levels of staff moraleLower pulse rates and blood pressure readings leading to better outcomesImproved staff efficiencies – up to 20% more effective use of nursing resources
3 ACHIEVING DESIGN QUALITY Most fundamental requirement an informed client, who at the highest level is committed to design quality and understands its contribution to service delivery and better patient outcomesA comprehensive client brief that clearly articulates specific design quality objectives as key targets in the project deliveryBest practice design quality control tools / mechanismsThe ability to set design standards and evaluate design solutions prior to and after construction
9 HEALTH BUILDINGS North Croydon Medical Centre AHMM ArchitectsNorfolk and Norwich University HospitalAnshen Dyer Architects
10 HEALTH BUILDINGS ACAD Centre, Central Middlesex Hospital Avanti Architects
11 EDUCATION BUILDINGSInto a lobby like this…..School A - school street
12 EDUCATION BUILDINGS Or this…..? School D - entrance hall and school street
13 DESIGN QUALITY Has to meet the needs of 6 constituencies: Patients StaffHospital ManagementFacilities managementThe wider health systemThe general publicAll successful buildings must satisfy these various needs
14 Designing for People A Patient Focus human scale and a non-intimidating friendly environment that gives confidenceaccessibility, easily understood, good way-findingpersonal respect and privacycleanlinessproper space standards/ uncluttered/ uncrowdedenabling visitorscontrol over their personal environmentchoicetelephone / television / sound insulationoutlook / landscaping / natural light / art / colour / texturewell–chosen furniture and artificial lightingan environment that promotes healing
15 Designing for People A Staff Focus: patient flows through building correct adjacenciessupervision / observation / support / securitystorage spacecapacityproper space standards / functionality / / flexibilityappropriate technologyfacilities for administration / training / relaxation / changing / eating / overnight accommodation / exerciseoutlook / landscaping / natural lightambience / quality of building/ pride and ownership in their organisation
16 Designing for People The Public Experience: accessibility / car-parking and way-findingfriendly / inviting / non-institutionalclearly identifiable entrances / reception pointslong waits / range of seating / waiting areas/ space for private interviewsfacilitating families with childrendiversion / amenity / shopping / visitors / overnight staysart / landscaping / outlookpublic realm / buildings for peoplecommunity pride / enhancing the local environmentcontributing to social / economic / environmental sustainability
17 Designing for People The Management Experience: facilitating the required service modeldevelopment control plansite circulation / car-parking complaintsgood way finding / short travel distancesefficiency of layoutflexibility / adaptability / extendibility over lifeFuture - proofed for technologydesign for maintenance / long life / low energy/ whole life costssecurity / supervision / management of entrancesattracting and retaining staffpublic perception / first impressions / cleanlinesscost reductions / income generation opportunities
18 The Service Delivery Client’s Role Strategic Vision for the Service in TotalIntegrated Trust Service Vision across primary / community / acute sectorsQuantification of service need / Location of facilitiesSite identification, planning permission and acquisitionWhole building and departmental operational policiesFunctional content of buildings / Schedules of accommodationEquipment requirementsSpace standards / key functional relationships/ room data sheetsEnvironmental and engineering services requirementsDesign quality objectivesFlexibility / extendabilitySustainability standardsArticulation of concept design solution and ratification or refinement of briefAppropriate budget
19 An Integrated Services Model ThousandAcuteHospitalLocalHosp.41.7 MillionRegionalHospitalAcute100 Thousand+CTCC.LocalHosp.3Non-healthagenciesHCCTCC220 – 70 ThousandIndividualhomesHC12-10 ThousandOther CommunityFacilities.
20 Key Trends in Location of Services 1 - Local Health Centres2 - Community Health Centres3 - Local Hospitals4 - Acute Hospitals5 - Regional CentresMovement of out-patients diagnostics and treatments fromacute towards communityKey issue is the movement of chronic disease management to the community preventing unnecessary hospitalisationMovement of complex specialties or specialties benefiting from higher critical mass to Centres of Excellence
22 Level 3 - Local Hospitals BANGORNEWTOWNARDS180 km
23 Level 2 – Community Treatment and Care Centres 180 km
24 BENEFITS OF PPP/PFI Potentially earlier availability of funding Potential for innovationPotential benefits from related commercial development opportunitiesConsortium input to buildability / life-cycle managementGuaranteed maintenance over contract periodReplacement of equipment (if included)Payment related to availability of facility
25 PERCEIVED PROCESS PROBLEMS WITH PPP/PFI Poor Public Sector Comparators producedLack of clarity/understanding of strategic and specific needs of clientBidding costs to client and contractorWasted resourcesLength of time taken to closureAffordability gap due to lack of adequate work by client prior to bidding processInadequate definition of quality issues prior to formalisation of contractPotentially opposing objectivesOccasionally the quality of the final product
26 IMPACT OF DESIGN ON LIFE-COSTS Cost in Use to Client :Cost of Maintenance : 5Cost of Building : 1PFICost of Design : 0.1
27 MANAGING DESIGN DEVELOPMENT A 10% increased efficiency in capital and life-cycle maintenance equates to only 0.6 of the original capital costA 10% increased efficiency in costs-in use equates to up to 20 times the original capital costThe current payment mechanisms do not incentivise PFI consortia to focus on the user-client’s costs-in-useThe user-client must ensure the design facilitates its core needs and activitiesAll procurement models must enable the user client to properly establish the brief and control design quality of the final building
28 OWNERSHIP OF THE CONCEPTUAL DESIGN Only providers of complex services such as health services can fully understand implications of key issues for their populations such as:strategic development needsdeveloping models of caretechnological advancement / research requirementschanging medical and nursing practicepatients’ expectationsIn-depth dialogue between the user-client and the design team is essential for successful high-quality designThis is most important during the conceptual design stages
29 RELATIONSHIP ISSUESConsortium’s Design team are not able to properly research specific needs of clientLimited opportunity for in- depth dialogue / brief development with user-client during key design conceptualisation stage until after competitive stage of design process is completedInadequate time for initial design development and often inadequate allocation of fees to properly resource this stage of the projectPotential for mis-interpretation of ‘output’ specificationDesign quality aspirations sometimes not sharedIncomplete definition of productCompromises during construction
30 THE EXEMPLAR MODELFundamentally using this model the real client is much more specific about:The strategic and detailed needs of the clientThe quality aspirations of the clientThe type of design that would satisfy these needs and aspirationThe cost of such a facilityThrough appointing a creative design team on quality-based criteria to test the brief fully and produce an exemplar design fully reflective of the client’s requirements and which the client would be happy to accept as such
31 THE EXEMPLAR MODELClient produces Strategic Context and Outline Business Case 1 to gain approval-in-principle to project and funding approval for exemplar design processUser Client places advertisement for ‘Exemplar’ design team Client shortlists and issues preliminary brief to short-listed design teamCompetitive Design Interviews held to select ‘Exemplar’ design team and formal appointment on pre-determined fee.Period of research, dialogue with user clients and testing of project brief in parallel with site(s) analysis and planning investigations. Iterative refinement of brief.
32 THE EXEMPLAR MODEL6. Preparation by the ‘Exemplar’ design team working in close collaboration with the client of the following:Statement of client’s key quality objectives for the building Flow diagrams demonstrating key inter and intra department relationships, and main internal and external circulation routesFull performance specification including landscaping and art Schedules of accommodationM&E services requirements / Energy targets etc Specialist planning or equipment-related requirements Exemplar plans and sections to illustrate a high quality design solution which would meet user requirements and planning constraints Exemplar elevations demonstrating massing, modelling and external treatments indicative of the design quality expected by the client and which reflects discussions with planners Examples of buildings which may be used as bench-marks for the design quality threshold to be adopted Up-dating of the costs within Outline Business Case 1 to provide the Public Sector Comparator for inclusion in Outline Business Case 2
33 THE EXEMPLAR MODEL7. Issue of all the above information as part of the Information Document / Invitation to Participate in Dialogue explaining the use by the client of the exemplar as representing the design quality threshold. The consortia should be encouraged to seek to improve upon the exemplar by the introduction of innovative planning solutions that either build on the basis of the exemplar design or represent completely new design solutions.Range of formal and informal discussions with short-listed consortia on exemplar and related information, allowing the information to be interrogated fully and emphasising the non-prescriptive nature of the exemplar drawings.Submissions and presentations by consortia of design proposals through the competitive dialogue stages.Assessment of compliance with functional, spatial, planning, technical and quality requirements.
34 THE EXEMPLAR MODELAssessment of aesthetic and environmental design quality by separately appointed independent and experienced expert assessors.12. Preparation of Design Report on each submission, confirming whether or not it has met the required design thresholds. Those that have not should be excluded. (Possible request for further design work)Incorporation of design scores for those submissions which meet the design quality threshold into overall scoring leading to selection of preferred bidder.Compilation of an agreed formal Contractor’s Proposals document in sufficient detail to clearly define the extent and quality of all aspects of the proposed building to be incorporated into the PFI contract documentation. This should include a comprehensive product specification for all building, engineering and landscaping elements.
35 THE EXEMPLAR MODEL15. Preparation of full business case and approval to proceed16. Monitoring role by the ‘Exemplar’ design team during detail design development to ensure that agreed layouts, space allocations and quality of finishes, fittings and equipment are incorporated prior to formal contract signing. As detailed a definition of contract content as possible.17. Monitoring role by ‘Exemplar’ team during construction to ensure compliance with agreed standards.18. Post-project evaluation and formal report on degree of achievement of project objectives and any proposals for improvement in process.
36 OBJECTIVES OF EXEMPLAR MODEL User Client has properly agreed and signed off strategic medium to longer-term vision and current operational needProper research/visits carried out with exemplar design teamFull consultation and sign-off with key user-groups during brief development in iterative design processClear identification of required quality objectives and performance specificationConsultation with town-planners on specific site requirementsTesting of site infrastructure requirementsEstablishment of a design solution fully acceptable to users and signed off as suchPricing of site specific design solution and signed-off affordability test prior to market engagementReduced cost and time for bidding process, fewer barriers to entry
37 Managing Uncertainty through Exemplar Process Clarity for bidders onservice model,capacity requirements,space requirements,functional relationships,quality requirements,affordabilityuser buy-insite and planning issues
38 THE EXEMPLAR MODELUsed successfully on the Belfast Cancer Centre and Altnagelvin Laboratory and PharmacyLast week PAC report on the failed Paddington Hospital PFI asked why they hadn’t adopted the Northern Ireland Exemplar ModelCurrently being employed on:Enniskillen Hospital Omagh HospitalUlster HospitalRoyal Mothers’ and Children’s HospitalBeing used for Primary Care and Community Infrastructure for a potential PPP model for a significant element of £600M+ programmeDept of Health in England has recently introduced requirement to follow this approach in its PFI Design Protocol and Treasury currently reviewing its guidance
67 THE BENEFITS OF THE EXEMPLAR MODEL Client gets much better understanding of issues through involvement in design development process and is much better placed to assess bidders’ proposalsThe Public Sector Comparator is much more realistic in terms of actual costs and affordability as it is based on a well developed design reflecting the required quality, space standards, layouts and specific site–related issuesBidders get much better understanding of client’s strategic and specific needs and quality aspirationsBidders’ costs are reducedClient retains control of conceptual design, content and design qualityDesign proposals are much more informed and customer focussedReduces wasteful processesSpeeds up process from OBC to on-site
68 PPP – The FutureGreater use of private finance subject to affordabilityStrategic Partnership arrangements for smaller projectsFocus on real partnerships and less adversarial contractual relationshipsMajor emphasis on creating true ’Healing Environments’ using EBDDesign Excellence and Sustainability Objectives driven by exemplar processSeeking to further reduce time and costs of bidding process so as to allow greater entry to market thus improving competitionBest practice standardised without reducing innovation