Striking design suits St Andrews skyline

Good design cannot take place in a vacuum, and the evaluation processes involved throughout this project – alongside the close relationship developed with the contractor Morrison and ourselves – helped NHS Fife achieve its vision on time and on budget. The commitment to measurement of the effectiveness of the design throughout the concept stage and through commissioning has been a real distinguishing feature. On a building as complex as a hospital, and with as much at stake in terms of performance, this approach is vital to achieve a sustainable, high quality building. The factors involved in creating a sustainable hospital range from the physical, through the economic, to the personal experience of patients and staff. It is a heady mix – embedded carbon, passive design, whole-life cost, flexibility to accommodate changing treatment needs and increasing numbers, energy efficiency, staff turnover, uplifting and healing environment for patients, transport planning – and one that needs to be tackled head on through engagement and design.

Constraints addressed

All design has constraints, so the first stage of the process is finding out what aspects are fixed, and where there is room for manoeuvre. Site, cost, and programme, are generally fixed early. The difficulty of locating a suitable site to achieve the size of hospital NHS Fife needed within the historic townscape of St Andrews led to the selection of a greenfield site on the southern edge of the town. Use of a greenfield site meant a low score for sustainability at the outset, with immediate implications for all other assessment criteria, which had to be optimised to meet the then current target of NEAT “excellent”. Design began in summer 2006, before BREEAM for healthcare was introduced, but the principles behind the NEAT assessment are similar. NEAT was a selfassessment tool, whereas BREEAM is undertaken by BRE-licensed assessors. The AEDET – Achieving Excellence Design Evaluation Toolkit – process was championed by NHS Fife to provide feedback on how the design as a whole was performing. This involved a structured two-day assessment to evaluate the impact, build quality, and functionality of the design at two key stages in the design process. The valuable feedback received from both the users, and from within the design team, reinforced early principles in terms of ease of wayfinding, accessibility, and the use of traditional vernacular materials. It also informed the use and design of social and waiting spaces within the hospital, and their relationship to the external environment. A thorough understanding of the requirements of building users is vital; get this wrong and many years of dissatisfied patients, higher staff turnover, and expensive retrofit, can be the result.