Calls for standardisation of healthcare building design

Architects and estates managers are calling for the partial standardisation of healthcare building design in an effort to drive down costs and improve the environment for patients, visitors and staff.

They claim millions of pounds is wasted and build times are significantly increased as NHS trusts approach new build and refurbishment schemes from scratch without looking at existing examples of innovation and best practice.

“There is a lot of innovation happening out there in terms of healthcare estates. The challenge is to make sure we share that and do not keep reinventing the wheel,” said Trevor Payne, director of estates and facilities at University College London Hospitals NHS Foundation Trust.

He was speaking at this week’s Healthcare Estates 2012 conference and exhibition in Manchester, which was organised by the Institute of Healthcare Engineering & Estate Management (IHEEM).

There is a lot of innovation happening out there in terms of healthcare estates. The challenge is to make sure we share that and do not keep reinventing the wheel

Omar Jomeen, framework manager for ProCure21+ principal supply chain partner, Miller HPS, added: “The way we currently design our healthcare buildings is like buying a Saville Row suit rather than an off-the-peg design.

“How many times, for example, do we find ourselves designing dirty facilities for hospitals? Can we please stop doing it? We need to find a design that works, get the evidence to support why we designed it that way and not just start from the beginning every single time.

“Every place is different, but that doesn’t mean we have to do things differently every time. If the design is already proven, then let’s not change it. All these trusts who work autonomously have got to start looking very closely at the value they are delivering.”

And Simon Kydd, health sector manager for developer, Mansell, said standardisation would lower the cost to private companies of delivering healthcare schemes and these savings could be passed on to the trusts.

Comparing the issue of standardisation in healthcare design to buying a car, he told delegates: “If you specify that you want an Audi A3, with climate control and heated seats and you want it in white with matching bumpers, then you are going to pay a premium for that. If you specify a mid-engine, four-door saloon with leather seats, then you are going to be able to find the best solution for your money.

All these trusts who work autonomously have got to start looking very closely at the value they are delivering

“We are not selling a one-size-fits-all solution, but we would be taking the standard and then adapting it, rather than every time procuring something bespoke. Often, when you look at something bespoke your expectations are very high and then when you have to adapt this to suit your budget, everyone is disappointed. I would rather get to a point where we have a generic standard based on best practice that we know works and then move up from that.”

This approach could work for both new-build projects and refurbishments, he added.

“There are those who say you can’t standardise when dealing with refurbishment projects, but you can when it comes to things like fixtures and fittings, or ceiling types or floor finishes, rather than using 80 to 100 different types of door handle, for example. If you stick to the same products, then the cleaning procedures are the same and so are the maintenance demands and that also saves you money. In additions, doctors, nurses and patients know what they are going to get.

“We have got to make pockets of innovation the norm in the future.”

Currently, the Department of Health sets some standards in its Health Building Notes and Health Technical Memoranda, which lay out best practice standards for specific areas of the healthcare building process.

However, these were widely criticised at the conference.

We are not selling a one-size-fits-all solution, but we would be taking the standard and then adapting it, rather than every time procuring something bespoke

Jomeen dubbed them ‘over-engineered’ and claimed many trusts couldn’t afford to follow them, while others admitted ignoring them amid concerns they did not create the best environment for patients or staff.

“We have got to make sure the standards we have are fit for purpose,” Jomeen said. “It is about how we can use the environment we are in to bring about improvements in care delivery.”

Rory Coonan, former director of architecture, design and planning at independent provider Circle Healthcare, said Circle was using many elements of its award-winning development in Bath on a current scheme in Reading and urged the NHS to follow suit.

“Every time Circle builds another hospital it does it better and it does it for less money. Like a fine wine it matures and it improves,” he added.

But he warned: “While there is no harm in having prescriptions for specific formations, what we do not want is for the Government to start telling architects how to put those buildings together.”

If we were to follow in healthcare the dire prescription of education that would be retrograde indeed. Do not let it become a design straightjacket

And there are fears it could lead to standard one-size-fits-all design guidance similar to that recently unveiled by the Government for the education sector. It effectively sets out the blueprint all architects must follow for various educational establishments, leaving very little room for movement.

Rory Coonan, former director of architecture, design and planning at Circle Healthcare, said: "In education the Government has said that in order to reduce costs they have published a pattern book design guide and you are not allowed to move from that. They are just anonymous patterns all concerned with floor area as if that alone directs price. No curves are allowed and it is actively hostile to architecture as a profession.

"If we were to follow in healthcare the dire prescription of education that would be retrograde indeed.

"The NHS should be focusing on services and letting others provide the buildings in which these services are carried out. Do not let it become a design straightjacket."