A Vision

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

The Better Health, Better Care Action Plan, published in 20071, affirmed the Scottish
Government’s commitment to improving the physical and mental wellbeing of the people
of Scotland through supporting the provision of well designed, sustainable places. The
Action Plan also articulated the Scottish Government’s vision of a mutual National Health
Service, a shift to a new ethos for health in Scotland that sees the Scottish people and the
staff of the NHS as partners, or co-owners, in the NHS.
These policy changes place health and wellbeing and the over-arching issue of sustainability
at the centre of the lives of the people of Scotland as the NHS strives to become more
accountable and patient-focused. If we are to deliver on our commitment to create a
Nicola Sturgeon MSP
healthier, wealthier, fairer, safer and stronger Scotland we must ensure that in the context
of designing new facilities, NHS Boards deliver not only high quality solutions but also
realise benefits for community development and the wider environment.
In this publication we celebrate the vision of some of Scotland’s healthcare leaders
including the Chief Medical Officer and healthcare Design Champions and set out the
practical measures being put in place to assist Scotland’s NHS Boards in guiding their
projects to successful outcomes.
Throughout, we feature some current and future-planned projects within NHSScotland
which look to provide the quality of environments to which we aspire.
As the Scottish Government’s Purpose and National Performance Framework take ever
greater effect in the day-to-day focus for our public services and on improving the
outcomes and quality of life for all of Scotland’s people, it is important that the principles
of visionary leadership of those who contributed to this publication are embraced by NHS
Boards in Scotland and all others involved in the delivery of our healthcare infrastructure.

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

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

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.

Stobhill Hospital, photos: Reiach and Hall Architects

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.

8 9
 1. The Vision

“ ...an estate designed with ‘a level of The Government has set out, in Better Health Better Care, its vision for what
the Health Service should be. In response, NHSScotland is developing a vision

care and thought that conveys respect’; of the facilities needed to support the evolving service; a consensus being
articulated by professionals from a range of disciplines that sets a clear and

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
1
the shelf shoe boxes’.” 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

R o y a l H o s p i t a l f o r S i c k C h i l d re n
Project Type: 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

Images: Nightingale Associates

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

12 13
 1. The Vision

N ew S t o b hi l l H os pi t al
Project Type: Ambulatory Care Hospital
Client body: NHS Greater Glasgow and Clyde
Location: North Glasgow
Delivery team:
Developer: Canmore Partnership
Contractor: Balfour Beatty Construction Limited
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.

Photos: Reiach and Hall Architects

14 15
 2. The Challenges

Mike Baxter, Deputy Director (Capital Planning and Asset Management),

Scottish Government Health Directorates; Paul Kingsmore, Chief Executive,
Health Facilities Scotland and Gareth Hoskins, Scotland’s Healthcare Design
Champion and Board Member Architecture and Design Scotland talk about
the challenges faced in delivering the vision.

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

16 17
 2. The Challenges
Mike - I think as a policy document the design quality policy is clear in articulating our
aims and vision for the design of NHS facilities. I think the effects have been very positive
both in terms of raising awareness of the importance of design, not just from an aesthetic
point of view but in supporting the effective delivery of healthcare. The reaction from
Boards has been largely positive to its introduction and application. I think that since the
policy’s been in place for three years it is time to have a review, take stock and refresh.
We have already undertaken a review of the policy’s implementation in the last six months
focussing on the implementation of Design Action Plans. I think therefore it’s important
that we take the opportunity to use that information to refresh and give more impetus and
direction to design quality. The other reason for review I think is clearly in terms of the
relationships that we have with key stakeholders in influencing the design agenda, both
Architecture and Design Scotland and Health Facilities Scotland. Taking forward the design
agenda in a tripartite way I think is extremely important, together with the NHS Boards.
18
2. The Challenges
Gareth - The policy document is very important within the health sector, particularly
in terms of acknowledging and setting out to Boards the benefits and value that design
quality can bring to healthcare environments. I think also, the leadership the Health
Directorates are showing in putting this forward is very important as an example of the
‘client patron’, in this case through an over-arching role, identifying the benefits of design
quality and requiring Boards to address the issue of design through their projects. The
development and implementation of a Design Action Plan identifying how Boards will
enshrine design quality within their estates is a mandatory requirement of the policy.
However, when working with client and estates teams on the ground, it is evident that
many of the people responsible for the everyday management of the Boards’ built
environment and the commissioning of new projects see this as a difficult issue. They’re
either unsure how they go about making it inherent within the work they are doing, or
sometimes they feel that their Board will not support them in doing what is needed.
Paul - Implementation has been the most difficult part; I don’t think the Service is
necessarily bought into the policy yet. The work we’ve done, A+DS and ourselves, will
help support that. We will get better understanding from the Health Boards by working
together in this tripartite way, I think this has been missing over the last couple of years
and we’re now on the right path. So I would expect probably if you asked me that
question in a couple of years time, would be much more positive than it is at the moment.
19
 2. The Challenges

D u m f r i e s D e n t a l C e n t re
Project Type: Primary Care / NES Dental Facility
Client body: Dumfries and Galloway Health Board
Location: Bankend Road, Dumfries
Delivery team: Davis Duncan (now Archial)
Ashleigh Construction
Completion: January 2008
Funding: Exchequer / NES
Value: £4.48m (construction and fit out cost)
Procurement type: Traditional
Awards: NHSScotland Environment, Estates
and Facilities design award (received) Mike - I think the picture is mixed in that regard but I don’t think it’s because of any sort
Paul Taylor Award (received) of resistance to design or to the importance of design as a concept. I think it’s more to do
with our communication of the value of design and I think it’s important that we do look
at design from a number of angles including how effective design can support high quality,
effective and efficient healthcare in the future.

Paul - It’s probably understood among healthcare professionals in general. Where we

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

Gareth - The point about communication is important, it’s about implanting that
understanding that design quality is an essential part of the means of delivering effective
services; we certainly see in working with the different Boards across Scotland a very
different level of understanding and attitude towards the issue and benefits of design

Photos: Archial Group

quality. Whilst the high level policy sets out good ambitions, I agree with Paul that until
there is the means of establishing criteria that can be clearly implemented and enforcing
mandatory requirements it will always be a little hit or miss in terms of how people are
taking this up.

20 21
 2. The Challenges

C ha l m e r s R e de v el o p m en t
Project Type: Sexual Health Clinic
Client Body: NHS Lothian – Edinburgh CHP
Location: Lauriston Place, Edinburgh
Architect: Campbell & Arnott
Completion: December 2010
Value: £6.5m (Construction cost)
Procurement Type: Traditional

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

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

Gareth - Although there’s a developing body of research globally4, it’s not used or tested

Image: Campbell and Arnott

with any real rigour in many projects; therefore much of the evidence within the UK is
very much anecdotal. There is an interesting question here about the connection between
the Health Board staff that are involved in the commissioning and procurement processes
for projects and the assessment of the actual outcomes they achieved. The lack of formal
evaluation being carried out across Boards leaves a major gap in our learning from the
way projects are designed and implemented and the resulting evidence base from which
we can improve and develop future projects.

22 23
 2. The Challenges
Mike - That’s a key piece of work for us and a number of stakeholders are involved with
this and, and taking forward that work. What we’re keen to see is a holistic view in terms
of the planning, operation and management of the asset base of NHSScotland, and that
we can demonstrate effective governance and performance around that, and that’s what
we’re in the business of putting in place at this point in time.
What we’re concerned with is not simply a technical assessment of the estate or medical
equipment but of how it affects and supports the quality agenda and the safe delivery of
healthcare. So work around Healthcare Associated Infection (HAI); risks around the estate;
around the effective management of medical equipment. These are all issues that we’re
seeking to put in place arrangements to support and substantiate the good practice that’s
going on out there.
There’s also an opportunity I think that we can demonstrate that we’re making best use of
resources by targeting investment at areas where there are risks around the estate or
whether there are more significant service issues that need to be addressed.
Gareth - As Mike’s saying, seeing the estate not simply in terms of technical performance
but also very much in terms of how they support the quality of service delivery and the
impact in relation to the wider communities is hugely important. How that’s then brought
through is actually a fundamental question because historically these aspects have been
very much more compartmentalised, seeing the technical service delivery as separate from
24
2. The Challenges
the quality of the built environment. In the past, many Boards have also worked on a
piecemeal basis looking at the estate as and when change demanded rather than in terms
of the longer term planning and development of a valuable asset. Often the reason cited
for this approach has been that clinical services change continually therefore it is not
possible to plan estates in a more comprehensive and effective manner. I would question
that as a reason; partly because I don’t think that evolving service delivery necessarily
stops you from thinking in that wider strategic way and also because I think that this is
only part of the reason and that piecemeal development of health estates has also been
very evidently driven by short term funding strategies. Good masterplanning can cut
across a lot of these aspects of asset management, from property, service delivery, and
impact on the wider community, and a well considered development framework can
provide an inherent flexibility to accommodate changes to service delivery as well as
giving a more effective long term approach to planning the ongoing funding and
development of estates.
Paul - At the moment we’re procuring an asset management system. We are proposing
a uniform system so that has everybody doing the same across the country. This will
support Boards in their role and HFS will provide guidance on how they can actually
manage this system to support strategic healthcare management. I think operationally
we need to develop understanding and foster commitment to this area within Boards.
25
 2. The Challenges
Mike - I think this is key for us in a number of regards. The Scottish Government’s
agenda in terms of efficient government, and joined up service delivery is central to
this. We are seeing record levels of investment of capital expenditure across the NHS
and indeed across Scotland. I think it’s important that we’re making best use of that
investment and the best way to do that is by looking across the public sector at how we
deliver services for communities and localities, and make sure the infrastructure base
that we put in place is actually supportive of a broader agenda, not just individual ones.
We’ve taken forward the hub initiative as a delivery vehicle for community based
premises and that’s extremely important to us in a sense of providing a systematic
approach to premises development coming from a service driven agenda rather than
simply a replacement of existing premises. The other dynamic around hub, that I think
is different, is that from the start it’s been about a wider public sector agenda; it’s not
simply been about primary care. It is about looking at maximising opportunity within
communities for, premises development.
26
2. The Challenges
Gareth - I think the aspect of joint working between Local Authorities and Health Boards
is fundamental to the strategic ambitions for creating a nation that has wellbeing at the
heart of its future development. There are very practical aspects of hub in terms of the
sharing of resources and more effective service delivery between Local Authorities and
Health Boards. And there are also more fundamental and far reaching impacts in terms
of the perception of health buildings within our communities. Currently they are seen
as places that you go to be fixed, where as they could be associated with say leisure or
educational facilities to create the civic buildings of today and enhance their role as
community assets focused around wellbeing and awareness. There needs to be that
higher level consideration about how those benefits can underpin and support the very
practical issues of co-locating facilities to make efficient buildings that provide and
engage the communities they serve.
Paul - An initiative alone will not make the required change. In some cases we require
a culture shift. Local Authorities, Health Boards and other public bodies recognise areas
where co-operation can improve services to get the best value out of the estate. I don’t
know if hub alone will do that. Quite frankly, there needs to be some fundamental culture
change. It’s not just about the public buildings it’s about the services they deliver.
27
 2. The Challenges

P l e a n S t re e t C e n t r e f o r H e a l t h
Project Type: Community Health Centre and
Dental Outreach Centre
Client body: NHS Greater Glasgow & Clyde
Location: Plean Street, Yoker, Glasgow
Architect: Archial Architects
Completion: 2008
Value: £1.85m (Construction cost)
Procurement type: Traditional

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

Paul - I think Frameworks Scotland gives a high level of quality and potential opportunity
for innovation with the private sector and the NHS working closely together in order to
try and deliver things more cost effectively. For example, if we’re going to build a
children’s unit in Dumfries and Galloway and we use a partner and it’s very successful;
has real benefits and it is innovative, we need to consider how we can learn from that.
We could consider using the same team in a new location for a similar development.

Photo: Graeme Duncan Photography

They should be thinking about it as a real opportunity for bringing in the same team.

28 29
 2. The Challenges 2. The Challenges

Gareth - There’s obviously benefits in terms of standardising the procurement process
as that gives the opportunity for selection criteria and in particular the ambition for
improved design quality to be more consistent across the Boards. Other benefits are that
because of the relatively quick selection process within models such as the Frameworks
Scotland, the selected team are brought on more quickly allowing the NHS to get the
benefits of the close engagement between the design team and the users that you would
get in a traditional process; also that the make up of the consortia gives the opportunity
for early contractor input into the design process which should bring benefits in terms of
editing out potential issues before a project goes on site.
There are, however, a couple of fundamental questions in relation to these procurement
processes. Firstly, the consortia working within Frameworks Scotland, and potentially
those also leading the hubCos, are contractor led. Secondly, the design teams are always
chosen and employed by the contractors without the client having as much say in the
skills set of the people responsible for transforming their brief into a building. These two
factors can combine to form a team whose focus is solely on cost and delivery, with little
skill applied to outcome, or a truly integrated, effective and inspirational team and result.
Prior to the development of the new initiatives Boards were regularly tendering contracts
at, or below, the lowest guide quality:cost ratios. Frameworks Scotland has placed a
greater emphasis on performance in the selection criteria, however we are yet to see
design capacity regularly feature as a prominent factor in selection. This is something
that we [the central agencies] are looking to see change to help improve the end result
of projects.
We will support Boards to assess and assign value to design skills and imaginative thinking
in the selection process and will work to educate the consortia on what is expected of
them in delivering NHSScotlands’ vision. The consortia are free to bring in the best skills
available and should be encouraged to do that – why should NHSScotland settle for
anything less?
In addition, however, I think that there is still an important place for the procurement
for smaller scale projects outwith these central procurement systems, both to act as a
benchmark and challenge for those delivering through the new initiatives and as an
opportunity to develop the breadth of talent out there of which the Health Boards could
take advantage of.

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

30 31
 2. The Challenges

G i r v a n C om m un i t y H o s p i t a l
Project type: Community Hospital
Client Body NHS Ayrshire & Arran
Location: Land at Bridgefield, Girvan
South Ayrshire KA16 9PL
Delivery Team:
Project Management: NHS Ayrshire & Arran
Architect: Austin-Smith:Lord LLP
Quantity Surveyor: Currie & Brown
Civil/Structural Engineer: Scott Wilson
Mechanical & Electrical Engineer: RSP Consulting Engineers
Planning Supervisor: Scott Wilson Mike - I think the key issues for us are about better delivery and a better “bang for our
Clerk of Works: John Arnott Associates buck”. It’s about delivering a better product at the end of the day. It’s about supporting
Main Contractor: Barr Construction better healthcare and having that kind of focus as we move forward. The benefits that
Planning / Property Advisor: Drivers Jonas we see aren’t simply technical in terms of the energy rating of buildings or indeed the
Equipping: Health Facilities Scotland – quality of building material that’s used or the sustainability of building materials that are
Equipping & Technical Branch used but about also what the impact is on improved healthcare delivery and therefore
Art Consultant: StudioLR what are the wider benefits for patients and staff.
Completion: February 2010
Funding: Public I think one of the things that we’ve done through Frameworks Scotland in particular, and
Value: £20m (Construction cost) we will do through hub, is about emphasising to those private sector partners and delivery
Procurement type: Public procurement agencies that there is a commitment from Scottish Government to training and employment.
We have also had recent announcements about apprenticeships, and that’s something
that we’re keen to focus on and develop within these procurement frameworks.

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

Image: Austin-Smith:Lord LLP

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

32 33
 2. The Challenges 2. The Challenges

Gareth - This comes back to the need for the NHS to clearly set out what their aspirations
are within their project criteria and selection mechanisms as the reality is that the market
place will respond to whatever is set out as necessary to get the work. There is a growing
recognition from the contractor teams about the importance of design in helping them
make a distinction between their competitors and there’s a high availability of skills out
there at the moment. There are therefore huge opportunities for NHSScotland to embed
aspirations for sustainability and a high level of design quality within the requirements
and scoring of these processes. This still isn’t being done clearly enough so it is evident
that the market are unclear how best to respond.
Mike - I think clearly there have been challenging times for the market in the current
economic circumstances, but we’ve done a lot I think to improve our relationship and
understanding with the private sector, particularly in terms of the deal flow that’s coming
through and better information about future projects, around trying to give people a
better picture of how they need to gear up and skill up to respond to NHSScotland’s
requirements.
sustainability and how the private sector providers can feed into that is really, really
important to us. Ongoing engagement dialogue with the market is essential and I think
the fact that we have a central unit looking after the Frameworks Scotland agenda means
that that interface actually becomes a lot more straightforward than hitherto it was.
Paul - Well the market has got to learn what our drivers are much better than they did
before. I think we also need to make sure that they don’t react in an inappropriate way by
coming in and saying, “ah well it’s tight times now so let’s give them a cheap job.” We,
as clients, will have to be much cleverer and make sure design doesn’t get taken off the
agenda. We’re certainly being very clear with the Frameworks Scotland consortia about
our expectations on this. Working together and innovating we can reduce cost but not
make the major compromises on quality.

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

34 35
 2. The Challenges

N e w S o ut h G l a s g o w H o s p i t a l s
Project Type: New hospital and laboratory facilities
Client body: NHS Greater Glasgow & Clyde
Location: Govan, Glasgow
Delivery team: NSGH Project Team
Completion (Stages):
1-Laboratory Block - Dec 2011
2-Design of Adult & Children’s Hospitals – Oct 2010
3-Adult Acute Hospital and Children’s Hospital – Jan 2015
3-A-Infrastructure and landscaping – Summer 2016
Funding: Scottish Government
Value: Project approved budget £841.7m Paul - No is the answer, the estates and planning professionals have had a difficult time
Design and construction contract value in taking this concept forward. They were all very much seen as supporting the main act.
c.£600m ex VAT and equipment We have also been too technically focused: we can be good at advising people what
Procurement type: Two stage design and build technically needs to happen but haven’t always put it in a context which shows how this
contributes to the bigger picture. I think we’re getting better at that but we still need to
improve.

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

Images: NSGH
36 37
 2. The Challenges
Gareth - I think the skill levels certainly vary greatly across the Boards and often Boards
have been stretched in terms of resources within estates departments to manage their
procurement processes. I think a positive side of the standardisation of procurement
processes could and should be to give a unity across the Boards in terms of expectations,
criteria and scoring and that this might also allow for and encourage a sharing of
experience between Boards as to how best to manage these processes and achieve the
quality of projects NHSScotland are aspiring to. Having worked with many of the Boards
across Scotland it is evident that more centralised support and training needs to be given
to many estates departments, particularly in terms of understanding the assessment and
benefits of design quality, the implications of sustainability best practice and the reality of
construction budgets and programmes to achieve these aspirations. Whilst this level of
skill is clearly essential within estates department, it is also extremely important that those
responsible at Board level also have a good understanding of these issues to ensure the
aspirations are delivered.
Paul - I think the private sector, which is now contracting, will actually send people
into our world. It is currently easier to get those skills, the difficulty will be retaining them.
When the cycle comes back again and the construction industry starts to expand people
may start to drift back to the private sector for financial reasons. We need to prepare for
that by developing people internally and giving them exciting career paths which will
help retain them.
38
2. The Challenges
We are doing some work already in conjunction with the Scottish Government towards
developing a plan for career progression so that we get the right people and when we
get them in, they see an opportunity for a career. We get them in younger so that they
start to develop their career in this field and we can take them from an estates
professional architect right through to somebody who is sitting at Board level.
Mike - What we’ve also done within Scottish Government is provide specific support to
projects and project teams in terms of resources for training and development. We have a
skills framework that’s been created to assess whether Boards and their project teams are
capable of delivering major capital investment, what those gaps might be and also
supporting a training and development programme to help support those needs. We’ve
also supported the facilities management MSC course and a number of undergraduate
places so it’s something that we are committed to.
39
 2. The Challenges 2. The Challenges

Paul - If you look at the Scottish Government objectives of healthier, fairer, wealthier, Gareth - The development of a new healthcare facility is an important moment in the
safer, etc. there’s probably none of those we don’t contribute to. The opportunity is there life of the community it serves; it offers significant opportunities to impact regeneration,
for healthcare facilities to be places where patients feel safe, be treated safely in an estate community pride and perceptions of the public services. The location and design of the
which helps support that agenda, etc. The opportunity exists for estates professionals and facility can either support or undermine the developing infrastructure; erode or improve
planners to link to the wider agenda, develop evidence of this and help support others in the appearance of the town. These aspects are key to delivering greater impact through
the delivery of their services. the necessary investment but are rarely evident in briefing. It’s very much back to that
understanding of the engagement between the Health Boards and the local communities
Mike - I think it’s important that for any investment that we make or undertake or
that they’re serving; that it is not simply about delivering services, it is about proactively
indeed how we provide our services that we’re thinking about the wider impact and that’s
encouraging wellbeing and access to health awareness. That, of course, inevitably means
something that we’re focused on and do focus on through, for example the assessment
a more accessible Health Service, a Health Service that’s more permeable, in a sense, in
of business cases in terms of objectives, the government’s agenda in terms of the strategic
terms of the communities it’s serving.
outcomes and national priorities. I think it’s important the NHS as an organisation makes
.
those links across simply from being about healthier Scotland to looking at the Scottish
Government outcomes agenda. There’s a real opportunity given the record levels of
investment that we’re putting in to make sure that we have a much wider impact than
simply direct level on healthcare, although that’s vital.

40 41
 2. The Challenges
Mike - It’s extremely important because it’s one of the policy areas for which I’m responsible.
In terms of looking at the impact, not just simply looking at our role within Scottish
Government around capital allocations and monitoring of expenditure, it’s about starting
to get a better handle on impact and what we’re getting for the investment that’s being
made, from a healthcare and a health benefit perspective, but also in terms of the quality
of the facilities that are being developed. So this agenda’s really important. Ministers and
the Chief Executive and Director General, Health and Wellbeing, Kevin Woods, have
publicly shown their support of this agenda.
Paul - The design agenda is important to us because we’re supporting NHS Boards
on a whole range of things and the design agenda is fundamental in that. The guidance
we produce is technical and operational guidance. It actually it would be crazy if that
technical and operational guidance flew in the face of the design agenda. The work
we are doing with A+DS and SGHD will help ensure a joined up approach.
Gareth - It’s very encouraging that Health Directorates and Health Facilities Scotland
are acknowledging the benefit design quality can have on the delivery of the services
and the environments they’re creating. What I do feel is important, however, is better
communicating the value that’s placed on this agenda to Board Members, to allow those
that are performing well to be rewarded and those that could do better to be encouraged
and supported to do so and for this to be more strongly championed within the Boards
themselves.
42
2. The Challenges
Gareth - The level of the support, in particular from Dr Kevin Woods, that has been
given to the initiatives that have been developed over the past three years has helped
immensely. The commitment at ministerial level to embed design quality within the
business case process is extremely important and shows real leadership by the health
sector in Scotland. It is an extremely important recognition and support for the ambitions
we all have in terms of realising the benefits of design quality. I think it is key to helping
Boards across the country raise the game in terms of healthcare environments and the
quality of that we’re creating across Scotland.
Mike - I think we’ve already taken some really positive steps in terms of the new
Scottish Capital Investment Manual (SCIM)6 as it stands at the moment of incorporating
sustainability into the core business. It’s important that we embed these as part of the
way we do our business, so the development of the business case process for new
buildings or for refurbishment buildings, the incorporation of design, and the technical
nature of the solution that was chosen is extremely important. It’s important that we
think about these early in the process and therefore our approach is to embed design
and a technical review from the outset of a project’s development so that design
principals are embedded from the start and that can then be reinforced and monitored
as we develop and deliver projects.
43
 2. The Challenges
Paul - I think actually it’s also going to come the other way where people on the ground
are actually starting to look at sustainability much more widely and, and there is a big
drive in the community. If you talk to people in the community they want sustainability,
people will ask about buildings and is it sustainable and so on. I think the public are
much wiser about sustainability than we give them credit for.
I think things like HAI also has elements of the bottom up approach. The public have an
expectation that we provide appropriate environments for their care and we need to
ensure this is the case. Some of our planning guidance will support this agenda very well.
44
2. The Challenges
Mike - If I can answer the second question first. The value is about improved delivery of
healthcare and a better environment for patients to be treated, recover, and for staff to
work within. In terms of the support of the agenda, I think we’ve already seen through the
Design Champions Network - through a number of events that have been held that Boards
are supportive of the design agenda and it’s important that we, from both a policy and a
policy perspective, can drive that through and raise the profile of design and the
importance of design through our ongoing engagement with NHS Boards.
I think, coming back to the previous issue around how we imbed design within our core
business processes, I think raising awareness of design as an issue is important and we’re
doing things around that, but it’s also about Boards being able to challenge effectively how
design is being considered within the proposals that are presented in front of them, and I
think we’ve a bit of work to do in terms of supporting Board Members in their undertaking
that challenge function in a constructive way.
From a Government perspective we need to create the right kind of policy framework and
environment to support that but what we’re wanting to do or what we are doing is about
fostering those kind of key relationships and making sure that, that we have a common
agenda going forward and that we can all work towards it.
45
 3. The Direction

Th e c o n t e x t t o s u pp o r t b et t er ou t c o m es

“ In developing Scotland's There are great and broad reaching expectations for what must be delivered through
infrastructure, the Scottish NHSScotland’s infrastructure investment programme, and the recognition that Health
Government recognises that Boards must be expert and demanding clients to achieve these. The following section
good building design should
details how the central support structures are changing to assist Boards and the crucial
be responsive to its social,
role of Board Members in directing infrastructure projects.
environmental and physical
context. It should add value The Government’s focus, from the five strategic objectives, through Better Health Better
and reduce whole life costs.
Care to the Infrastructure Investment Plan 2008 is to achieve better outcomes, across a
Good building design should
broader range of issues, through all public sector actions and investment. Inter-agency,
be flexible, durable, easy to
cross-sectoral, joined-up thinking are the buzzwords. However, in basic terms, public
maintain, sustainable,
sector development must deliver more “bang for the buck”. This is not done simply by
attractive and healthy for users
and the public; and it should spending no more than is needed initially; in fact driving down capital costs too far can
provide functional efficient prove a false economy by raising lifetime costs. True value is obtained in seeking ‘economies
adaptable spaces ... Equally of benefit’; by making the money that must be spent on a new hospital or health centre
important to the design of have the broadest and best impact possible on all the other outcomes from community
individual buildings is the regeneration, jobs and pride through sustainability and lifelong learning. The Good
design of sustainable places. Corporate Citizenship Assessment Model8, being promoted by the Scottish Sustainable
Well-designed buildings and Development Commission and piloted within two NHSScotland Boards, embodies this
places can revitalise

Dumfries Dental Centre, photos: Archial Group

concept.
neighbourhoods and cities;
reduce crime, illness and
truancy; and help public
services perform better.”
Infrastructure Investment Plan 20087

46 47
 3. The Direction
Health Boards, particularly working in partnership with Local Authorities, have a primary
role in delivering these objectives, and therefore both policy context and procurement
guidance has developed to support Boards in fulfilling this responsibility.
The Scottish Government Health Directorate (SGHD), Health Facilities Scotland (HFS)
and Architecture and Design Scotland (A+DS) are committed to delivering tripartite,
integrated support to commissioning Health Boards through developing policies and
processes and through project specific advice. The SCIM has been updated to more
clearly link business decisions to strategic outcomes and will be supplemented to map
design into the process so that the anticipated benefits and qualities of the built product
can be more readily assessed and valued in the business case approvals process.
HFS and A+DS are developing a process whereby an integrated evaluation of a project’s
potential benefits (considering the sustainable, technical and human aspects of design)
will be provided to Boards commissioning developments above the delegated value, and
verified to the Capital Investment Group, to support both bodies in their decision to fund
building projects.
Stobhill Hospital, photos: Reiach and Hall Architects
Framework Advisors are made available to Boards by Health Facilities Scotland to assist in
managing projects procured using Frameworks Scotland and this can involve significant
input in assessing the particular skills of the Principal Supply Chain Partners bidding for a
project. Guidance and assistance in the use of design tools such as AEDET9 and BREEAM10
can also be provided where required. In addition, a central database of projects and good
practice information is being developed to support Boards in learning from what has
gone before.
48
“A relevant environmental
health agenda for the 21st.
century is as much about the
creation of places which
engender good physical and
mental health, as it is about
protection from hazards.”
Annual Report of the Chief Medical
Officer Scotland 2006 (pg.40)11
3. The Direction
A+DS are looking for ambitious Boards who are willing to engage positively and openly
in the development of demonstration projects, particularly those around cross-sectoral
working where A+DS’s remit and influence are most relevant. As the systems and
processes of procurement become streamlined and more clearly encourage and value a
well designed outcome, the focus of support shifts from that solely within the control of
NHSScotland to those factors that rely on external bodies, such as land allocation within
the planning system, and on to where the work of others impacts the health of the
communities serve.
With the arrival of Single Outcome Agreements, and the opportunities for more readily
co-ordinated investment in community infrastructure through hub, there is emerging
great potential for co-ordinated working and more efficient Strategic Asset Management.
Further, the impact of Planning Reform is working through Local Authorities; as they
consider the shape and structure of communities and plan ‘what goes where and why’
there is a significant opportunity for Health Boards to engage and influence the emerging
Local Development Plans both to provide potential sites in the location that is needed
to serve the developing community, and bring the Board’s expertise on the factors
influencing population health into the process of planning a healthier community.
49
 3. The Direction

St r at h e de n H o s p i t al ,
Elmv ie w Wa rd
Project Type: 18 bedroom Dementia unit
Client body: NHS Fife Health Board
Location: Stratheden, Cupar
S u p p o r t a n d L e a d e r s h i p f ro m t h e
Delivery team: C e n t r a l P ro c u re m e n t A g e n c i e s
Contractor: Interserve Project Services Ltd In response to pressures for greater efficiency in procurement, central procurement
Architect: Richard Murphy Architects agencies and centres of expertise have been established to support public sector
M&E consultants: Capita Symonds clients in delivering infrastructure investment.
Project Manager: Gardiner & Theobald
Cost Advisor: Gardiner & Theobald Frameworks Scotland
Structural Engineers: URS Frameworks Scotland is a strategic and flexible partnering and collaborative approach
CDM Co-ordinator: Capita Symonds to the procurement of healthcare buildings in Scotland. Launched in November 2008,
Project Supervisor: NHS Fife Estates and Facilities it is aimed predominantly at the delivery of acute care projects through direct capital
Completion: July 2009 investment and as such complements other procurement initiatives. The framework is
Funding: Public Funding from NHS Fife’s administered centrally by Health Facilities Scotland who provide training and guidance
Capital Programme to all parties involved in the initiative on both the processes involved and the
Value : £4.6m (Contruction cost) expectations of NHSScotland in terms of delivering better outcomes through well
Procurement type: NEC 3 Contract. This project was the designed facilities. This central resource also monitors the performance of framework
pilot for the development of partners in regard to these objectives and provides a forum to share learning from all
Frameworks Scotland the projects undertaken. The Principal Supply Chain Partners as the ’contracting‘
partners in healthcare developments bring together integrated teams of design
professionals and constructors whose early involvement can support the local NHS
Board to ensure that the design development work is robust and provided earlier in
the process than has historically been the case.

In addition to achieving the benefits of streamlining and simplifying procurement,

bringing advantages in programme and cost certainty, the framework provides the

Photos: Richard Murphy Architects

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

50 51
 3. The Direction

B a r r h e a d H e a l t h & C a re C e n t r e
Project Type: Health Centre
Client body: NHS Greater Glasgow & Clyde with
East Renfrewshire Council
Location: Main Street, Barrhead
Architect: Avanti Architects
Completion: Late 2010
Scottish Futures Trust (SFT) and hub
Value: £11.2m (Construction cost)
The Scottish Futures Trust was established by the Scottish Government in 2008 to
Procurement type: Traditional
maximise value for money through the effective and efficient delivery of public sector
infrastructure. Sustainability in the widest sense is a key driver for the SFT when developing
infrastructure and delivery solutions. Economic, environmental and social sustainability
will be addressed in the early stages of project development and will become an inherent
part of procurement and delivery in order to facilitate sustainable economic growth locally
and nationally, to minimise adverse environmental impact, and to promote the development
of sustainable communities. The positive impact of high quality design will be supported
at all stages of procurement, and through to delivery.

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

The approach being taken to procurement is to attract and appoint an inventive

development partner in each hub territory to bring expertise and innovative thinking to
bear on the development of projects being commissioned by public sector bodies within
the territory. However, as with any procurement, the client’s team will be crucial in
describing the objectives of the development and in steering the result. The central hub
team, within the SFT, will scrutinize the performance of the territorial hubCos in relation

Images: Avanti Architects

to SFT’s own objectives. Key Performance Indicators (KPIs) will be used as means of
incentivising and monitoring good performance, including targets for sustainability and
achievement of design quality.

52 53

FREQUENTLY OCCURING
BLOCKAGES TO REALISING
VALUE THROUGH INVESTMENT
BLOCKAGE:
Piecemeal Campus Development
RISKS:
Increasing inflexibility and
operational inefficiencies;
decreasing quality of environment
impacting staff and patient
wellbeing; inefficient investment
in infrastructure.
SINK PLUNGERS:
> Evaluation of existing facilities
(including the quality of the
environment) to understand
the problems and value of
existing assets.
> A thorough masterplan to test
opportunities and devise a
robust but flexible long term
plan around which informed
decisions can be made on
individual projects and site
wide infrastructure and
amenities (such as usable
external space).
54
3. The Direction 3. The Direction
Th e Bo a rd ’s R o le - The Best Start To Projects
However all the described policy and support accounts to very little without the leadership BLOCKAGE: For example, if the Service objective is to develop an integrated care facility, the integration
and action of the commissioning Board. The Health Board is responsible for the success of Poor site availability or choice might be described in terms such as:
project, and rightly so as the body uniquely positioned to understand the local context
RISKS: for the clinical staff “a place where I regularly encounter colleagues of other disciplines
and the needs of community which they serve. Although the role of developer can appear
Low proximity to transport and
tangential to the core business of the Board, and many Board Members have little personal providing ready opportunities to discuss matters”
other infrastructure impacting
expertise in commissioning buildings, it is the Board’s responsibility to ensure the project accessibility and sustainability; for patients “a single entrance and reception point irrespective of which service I’m
gets the best start possible. By recognizing the value of a well designed estate in delivering site size requiring deep plans using first”
the core business of the Health Service, and the responsibilities inherent in building with increasing lighting and ventilation
public money, the complexity and importance of this work, and the value of estates staff, costs, and/or constraining future for facilities management “ consulting rooms that can be used by a number of services
becomes clear. The Board provides leadership by establishing an environment which flexibility and expansion; noise – space as a resource not a territory”
and air pollution impacting
encourages and supports project teams in delivering developments that are truly effective;
ventilation strategies and Having established the core aims of the project – the elements that are not negotiable –
that fulfill the vision.
increasing capital and running it is helpful to understand what success might look like. Benchmarking against the best
costs.
With new working methodologies and greater technical standards to be met, no project that has delivered, or is in the pipeline, is perhaps the single most helpful tool available to
is likely to be just like one the Board has commissioned before. But that does not mean improve both the standard of care environment and the image of the NHS in the community.
SINK PLUNGERS:
starting with a blank sheet of paper. Learning from what has gone before both within Planning new similar developments using these as a benchmark, and improving even
> Engagement with Local
NHSScotland and elsewhere – and particularly by visiting exemplars - can very quickly start Authorities in development slightly by learning the lessons from the last, will result in a spiral of continuous improvement
a conversation to establish the critical success factors for the project. These will obviously of Local Development Plan to across Scotland. To this purpose, it is anticipated that a statement describing the project
be built from the needs of the Service but, in design terms, are most helpfully described pre-prime land use allocation objectives and benchmarks established by the Board will form a key part in the assessment
and comprehended in terms of the needs of the people that the project is to and area regeneration of design in the developed business case approvals process.
accommodate – the user experience. strategies.
> Design feasibility studies on
potential sites to allow informed
decisions to be made on site
selection; either avoiding
problematic sites or planning
strategies (allowing sums) to
mitigate identified issues.
55

BLOCKAGE:
No Identifiable Vision (hopes and
aspirations are kept under wraps)
RISKS: lack of trust and
engagement from stakeholders;
inability to attract and secure
skills needed from market;
difficulty in valuing the vision in
the decision making process;
outcome does not live up to
needs or expectations.
SINK PLUNGERS:
> Client Leadership - create an
understanding that ‘design is
the intelligent allocation of a
scarce resource’ not simply
visual embellishment,
challenging misplaced pre-
conceptions with evidence and
prior experience.
> Visit examples of well designed
environments both within the
NHS and wider to raise the
understanding of the ‘art of the
possible’ and, conversely, the
56
3. The Direction 3. The Direction
The Board’s R ole - Checking all is well, lessons learnt
Having developed an agreed vision of what’s to be commissioned, and benchmarks impact of failure – there’s The design of a new or reconfigured facility is a complex task, requiring the input and
against which to check progress, the Board must satisfy itself that the project is on track nothing more convincing than expertise of many stakeholders to be captured and synthesized. For many involved in the
not only in terms of programme and budget but also in terms of the outcome. This will your own eyes and the chance process it will be a new experience, and one carried out in a context of significant change.
to talk to the people who’ve
require an understanding of when design risks occur and the information and skills Staff are likely to require support to imagine new ways of working the physical environment
been there.
needed to make decisions at these risk points. needed to support this work. Design is therefore a process of change management, and
> Establish, in partnership with tools such as AEDET have been found to be most helpful in promoting cross discipline
NHSScotland Boards, through the actions of their Design Champions, have been discussion in the development of a design solution, though this process does require
stakeholders, core objectives
developing Design Action Plans to look at some of these issues and develop general some training or design expertise to assist staff to translate drawings and other graphic
and set robust benchmarks for
approaches, such as developing a peer design review panel within the Board, that are the type of environment needed information.
particular to their circumstances. The advent of new procurement options and the to deliver these. Such a vision is
developed SCIM marry neatly to require a more full understanding of the development, realistic and grounded in the Once the facility is built and occupied, and the rewards of the Board’s leadership and the
and easier access to design and construction expertise, earlier in the business case business need, it is not fanciful. labours of its team are been felt, there is one final task that is needed to allow greater
approvals process than has historically been the case. understanding and efficiency in future investment. It is essential that both Post Project
> Communicate the vision to
Evaluations (PPE) and Post Occupancy Evaluations (POE) are undertaken and the results of
For each project, there will need to be an understanding of the design risk points, which build confidence within the
them shared. For these to be of any real value they must be planned from the beginning
may not always coincide with financial risk points, and a clear strategy for dealing with community, among key
and relate to the core objectives of the project.
these. Irrespective of the project scale, nature, or procurement there are certain decision decision makers (such as the
planning authority) and in the
points that are key such as site selection, the choice of design and delivery team, the Building is essentially research project – no two facilities are entirely alike - and without
market to attract the skills you
completion of the brief, the preferred site strategy, the design that is submitted to the knowledge of what has gone before we cannot effectively recognize, value and
need. Allow time and resources
Planning and that is built. The commissioning Board will be living with the consequences celebrate the critical aspects that resulted in success.
to manage any unrealistic
of decisions made at these points and therefore must be able to recognize and ascribe expectations.
significant value, in these decisions, to the factors and skills necessary to deliver core
objectives described above. The Board’s plans and actions in this regard will therefore be > Value, in your selection
part of the developed business case approvals process and HFS, with A+DS, will support processes, the skills needed to
the Board at key points. develop and translate your
vision into a working reality.
57
 4. Concluding Remarks

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

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

With so much being demanded of development projects in both the technical sense –
low carbon high cleanliness – in supporting new working methodologies, and in terms of
a broader impact; new skills are needed to work with clients. Soft skills such as listening
and communication are needed to help the client imagine the physical environment to
support their new working practices. These in themselves though are not sufficient
without the highest degree of design sensibility to imagine and construct a solution that
effortlessly supports both the operational agenda and the very human needs of our most
vulnerable people, whilst also delivering on high policy expectations for flexibility

Dumfries Dental Centre, photos: Archial Group

sustainability and community benefit.

Already bidding teams are seeing that they must expand their scope of knowledge to win
projects. This direction will need to be strengthened: truly co-ordinated, talented and
expert teams are sought to deliver NHSScotland’s Vision of Health.

58 59
 Appendices Appendices

R e f e re n c e s F u r t h e r R ea d i ng

1 Better Health Better Care Action Plan Scottish Government 2007 Better Public Building - HM Government/CABE 2006
www.scotland.gov.uk/Publications/2007/12/11103453/0748 www.cabe.org.uk/publications/better-public-building

2 Policy on Design Quality for NHSScotland Case Notes: Client Leadership - A+DS 2009
www.sehd.scot.nhs.uk/mels/HDL2006_58.pdf www.ads.org.uk/documents/564/564.pdf

3 Pebble Project Creating Excellent Buildings: A Guide for Clients

www.healthdesign.org/research/pebble/ Commission for Architecture and the Built Environment (CABE) 2003
4 e.g. The Role of the Physical Environment in the Hospital of the 21st Century: Summary – http://www.cabe.org.uk/AssetLibrary/2280.pdf
A Once-in-a-Lifetime Opportunity. Roger Ulrich and Craig Zimring, September 2004 Full report – http://www.cabe.org.uk/AssetLibrary/4037.pdf
www.rwjf.org/files/publications/other/RoleofthePhysicalEnvironment.pdf
Ideas Website - Department of Health
5 Asset Management in the NHS in Scotland. Audit Scotland 2009 www.ideas.dh.gov.uk/
www.auditscotland.gov.uk/docs/health/2009/nr_090129_asset_management_nhs.pdf
Masterplanning Health - A+DS 2008
6 Scottish Capital Investment Manual (SCIM) www.ads.org.uk/documents/380/380.pdf
www.scim.scot.nhs.uk/

7 Infrastructure Investment Plan 2008

www.scotland.gov.uk/Publications/2008/03/28122237/0

8 The Good Corporate Citizenship Assessment Model

www.sd-commission.org.uk/publications.php?id=

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

10 BREEAM
www.breeam.org/

11 Annual Report of the Chief Medical Officer for Scotland 2006

www.scotland.gov.uk/Publications/2007/11/15135302/11

60 61
 Appendices
S o u rc e s o f I n f o r m a t i o n a n d S u p p o r t
Architecture and Design Scotland (A+DS)
www.ads.org.uk T: 0131 556 6699
Health Facilities Scotland: Frameworks Scotland Advisors
www.hfs.scot.nhs.uk T: 0141 332 3455
hub Initiative
www.hubscotland.org.uk
Scottish Futures Trust
www.scottishfuturestrust.org.uk T: 0131 510 0800
Scottish Government Health Directorate
www.sehd.scot.nhs.uk
The Sustainable Development Commission UK
www.sd-commission.org.uk
62
Image Credits:
Published in 2009 by Architecture and Design Scotland (A+DS) Front cover: Stobhill Hospital, Photo Reiach and Hall
Inside front cover: Dumfries Dental Centre, Photo Archial
Architecture and Design Scotland (A+DS) is Scotland’s champion for excellence in
place-making, architecture and planning. It is an NDPB of the Scottish Government.
This Publication has been produced as part of the work undertaken with and for
NHSScotland, in association with the Scottish Government Health Directorates and
Health Facilities Scotland.
With thanks to those interviewed and to the teams responsible for the featured
developments.
Interviews by Marian Borde (NHSScotland figures in ‘vision’ section).
Photographs by Wattie Cheung (‘challenges’ section), taken at Stobhill Hospital.
Some rights reserved.
No image or graphic from this publication may be reproduced, stored in a retrieval
system, copied or transmitted without the prior written consent of the publisher
except that the material may be photocopied for non-commercial purposes without
permission from the publisher.
The text of ‘Vision of Health’ is licensed under a Creative Commons Attribution 2.5
Scotland License.
Designed and produced by REPUBLIC
www.republicproductions.com
Architecture and Design Scotland
Bakehouse Close, 146 Canongate,
Edinburgh EH8 8DD
T: 0131 556 6699
F: 0131 556 6633
E: info@ads.org.uk
www.ads.org.uk
63
“ In this publication we celebrate the vision of some of Scotland’s
healthcare leaders including the Chief Medical Officer and healthcare
Design Champions and set out the practical measures being put in
place to assist Scotland’s NHS Boards in guiding their projects to
successful outcomes.”
Nicola Sturgeon MSP

Architecture and Design Scotland

Bakehouse Close, 146 Canongate,
Edinburgh EH8 8DD

T : 0131 556 6699

F : 0131 556 6633
E : info@ads.org.uk

www.ads.org.uk

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