Graham McCorkindale, who heads the Health and Wellbeing strand at multi-disciplinary architecture, town planning, interior design, and landscape architecture practice, Keppie Design, examines how architects can best support the NHS at a time of major change by refocusing design skills hitherto focused on creating new healthcare facilities on the need to work within the existing estate – ‘maximising utilisation and getting best value from any available spend’.
There are currently significant challenges within the NHS estate in the UK; radical changes to commissioning in England, and a UK-wide need to reduce the overall cost of services. The healthcare architecture community needs to contribute to the changing climate; the challenge we must set ourselves is to support the NHS through this difficult journey. As healthcare architects involved in designing hospitals since before the inception of the NHS, the nature of Keppie’s workload has significantly changed in the last two years, corresponding directly to the changing needs of the NHS. While the 1990s, and the first decade of the 21st century, saw an unprecedented programme of large-scale new-build hospital projects, the focus now is on working with the NHS to realise its targets of reducing the size of the estate and associated running costs, while looking to optimise utilisation of the existing facilities. This article describes a range of themes, drawn from our current workload, which is focused on assisting the NHS to achieve best value for the available spend.
Phased developments
As available capital funds reduce in line with constrained budgets, many NHS clients need to consider solutions which require a spread of funding across several years, and the procurement of projects which are developed in a phased manner. The challenge for the NHS client and its Design Team is to optimise the availability of capital spend against clinical need to ensure that the benefits of the new or reconfigured services provided (and the benefits to patients and staff) are being made available in the shortest possible timescales, without detriment to the overall project ambitions. One such example that Keppie is involved in is the Aberdeen Cancer Care project, which was originally envisaged as a single £35 m development. Budgetary constraints are such that the project is now being developed in four phases. The original designs have been significantly modified since the project’s inception, to ensure that a logical clinical solution has been developed to allow key services to be brought ‘on stream’ while the remainder of the project is procured. Key issues for us have been:
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