Achieving the Clients Objectives in PFI Projects John Cole Chief Executive, Health Estates.
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Transcript of Achieving the Clients Objectives in PFI Projects John Cole Chief Executive, Health Estates.
Achieving the Client’s ObjectivesAchieving the Client’s Objectivesin PFI Projectsin PFI Projects
John Cole John Cole Chief Executive , Health EstatesChief Executive , Health Estates
EVIDENCE-BASED DESIGNEVIDENCE-BASED DESIGN
No longer simply intuitive – now research backed
The Health Sector
Up to 20% reduction in post operative recovery / length of stay Up to 15% reduced use of analgesics Reduced hospital acquired infections, medical errors and
patient accidents leading to claims Reduced aggression towards staff by up to 40% Easier recruitment and retention of staff – up to 56% increase
in levels of staff morale Lower pulse rates and blood pressure readings leading to
better outcomes Improved staff efficiencies – up to 20% more effective use of
nursing resources
ACHIEVING DESIGN QUALITYACHIEVING DESIGN QUALITY
Most fundamental requirement an informed client, who at the Most fundamental requirement an informed client, who at the highest level is committed to design quality and understands its highest level is committed to design quality and understands its contribution to service delivery and better patient outcomescontribution to service delivery and better patient outcomes
A comprehensive client brief that clearly articulates specific A comprehensive client brief that clearly articulates specific design quality objectives as key targets in the project deliverydesign quality objectives as key targets in the project delivery
Best practice design quality control tools / mechanismsBest practice design quality control tools / mechanisms
The ability to set design standards and evaluate design The ability to set design standards and evaluate design solutions prior to and after construction solutions prior to and after construction
ACHIEVING DESIGN QUALITYACHIEVING DESIGN QUALITY
AEDETAEDET
FUNCTIONALITYFUNCTIONALITY
UsesUses AccessAccess SpacesSpaces
BUILDBUILDSTANDARDSTANDARD
PerformancePerformance EngineeringEngineering ConstructionConstruction
IMPACTIMPACT
Character andCharacter andInnovationInnovation
Citizen SatisfactionCitizen Satisfaction InternalInternal
EnvironmentEnvironment Urban & SocialUrban & Social
IntegrationIntegrationAddedAddedvaluevalue
ExcellenceExcellenceAddedAddedvaluevalue
AddedAddedvaluevalue
DESIGN EVALUATION PROFILEDESIGN EVALUATION PROFILE
FUNCTIONALITYFUNCTIONALITY
URBAN &URBAN &SOCIALSOCIAL
INTEGRATIONINTEGRATION
11
22
33
44
55
USESUSES
CITIZENCITIZENSATISFACTIONSATISFACTION
CHARACTERCHARACTERANDAND
INNOVATIONINNOVATION
INTERNAL INTERNAL ENVIRONMENTENVIRONMENT(PATIENTS & STAFF(PATIENTS & STAFF))
ACCESSACCESS
SPACESSPACESENGINEERING ENGINEERING
PERFORMANCEPERFORMANCE
CONSTRUCTIONCONSTRUCTION
PoorPoor
66 ExcellenExcellentt
IMPACTIMPACT
BUILD BUILD STANDARDSTANDARD
HEALTH BUILDINGSHEALTH BUILDINGS
Hospital ‘A’ Ward corridorHospital ‘A’ Ward corridor
Would you prefer to go to a ward in a corridor like Would you prefer to go to a ward in a corridor like this?this?
HEALTH BUILDINGSHEALTH BUILDINGS
Ward Corridor, Intermediate Care Centre, London Ward Corridor, Intermediate Care Centre, London
Or this?Or this?
HEALTH BUILDINGSHEALTH BUILDINGS
HEALTH BUILDINGSHEALTH BUILDINGS
North Croydon Medical CentreNorth Croydon Medical Centre
AHMM ArchitectsAHMM ArchitectsNorfolk and Norwich University HospitalNorfolk and Norwich University Hospital
Anshen Dyer ArchitectsAnshen Dyer Architects
HEALTH BUILDINGSHEALTH BUILDINGS
ACAD Centre, Central Middlesex ACAD Centre, Central Middlesex HospitalHospital
Avanti ArchitectsAvanti Architects
EDUCATION EDUCATION BUILDINGSBUILDINGS
Into a lobby like this…..Into a lobby like this…..
School A - school streetSchool A - school street
EDUCATION BUILDINGSEDUCATION BUILDINGS
Or this…..?Or this…..?
School D - entrance hall and school streetSchool D - entrance hall and school street
DESIGN QUALITYDESIGN QUALITY
Has to meet the needs of 6 constituencies:
Patients Staff Hospital Management Facilities management The wider health system The general public
All successful buildings must satisfy these various needs
Designing for PeopleDesigning for People
A Patient Focus
human scale and a non-intimidating friendly environment that gives confidence accessibility, easily understood, good way-finding personal respect and privacy cleanliness proper space standards/ uncluttered/ uncrowded enabling visitors control over their personal environment choice telephone / television / sound insulation outlook / landscaping / natural light / art / colour / texture well–chosen furniture and artificial lighting an environment that promotes healing
Designing for PeopleDesigning for People
A Staff Focus:
patient flows through building correct adjacencies supervision / observation / support / security storage space capacity proper space standards / functionality / / flexibility appropriate technology facilities for administration / training / relaxation / changing / eating / overnight
accommodation / exercise outlook / landscaping / natural light ambience / quality of building/ pride and ownership in their organisation
Designing for PeopleDesigning for People
The Public Experience:
accessibility / car-parking and way-finding friendly / inviting / non-institutional clearly identifiable entrances / reception points long waits / range of seating / waiting areas/ space for private interviews facilitating families with children diversion / amenity / shopping / visitors / overnight stays art / landscaping / outlook public realm / buildings for people community pride / enhancing the local environment contributing to social / economic / environmental sustainability
Designing for PeopleDesigning for People
The Management Experience:
facilitating the required service model development control plan site circulation / car-parking complaints good way finding / short travel distances efficiency of layout flexibility / adaptability / extendibility over life Future - proofed for technology design for maintenance / long life / low energy/ whole life costs security / supervision / management of entrances attracting and retaining staff public perception / first impressions / cleanliness cost reductions / income generation opportunities
The Service Delivery Client’s RoleThe Service Delivery Client’s Role Strategic Vision for the Service in Total Integrated Trust Service Vision across primary / community / acute
sectors Quantification of service need / Location of facilities Site identification, planning permission and acquisition Whole building and departmental operational policies Functional content of buildings / Schedules of accommodation Equipment requirements Space standards / key functional relationships/ room data sheets Environmental and engineering services requirements Design quality objectives Flexibility / extendability Sustainability standards Articulation of concept design solution and ratification or refinement of
brief Appropriate budget
An Integrated Services ModelAn Integrated Services Model
1.7 Million RegionalHospital
Acute Hospital
Acute Hospital
Other CommunityFacilities.
Non-healthagencies
Individualhomes
HC
1
2-10 Thousand
150-300 Thousand
Acute Hospital
LocalHosp.
LocalHosp.
4
HCCTCC
2
20 – 70 Thousand
100 Thousand+
CTCC.
LocalHosp.
CTCC.3
Key Trends in Location of Services Key Trends in Location of Services
1 - Local Health Centres
2 - Community Health Centres
3 - Local Hospitals
4 - Acute Hospitals
5 - Regional Centres
Movement of out-patients diagnostics and treatments fromacute towards community Key issue is the movement of chronic disease management to the community preventing unnecessary hospitalisation
Movement of complex specialties or specialties benefiting from higher critical mass to Centres of Excellence
ALTN AG ELVIN
C AUSEWAY
AN TRIM
ENN ISKILLEN
C RA IG AVO N
M USG RAVE
BC H
D A ISY H ILL
ULSTER
Level 4 - Acute Hospitals
180 km
OMAGH
M IDULSTER WHITEABBEY
MATER
SOUTH TYRONE
LURGAN
LAGANVALLEY
DOWN
Level 3 - Local Hospitals
180 km
BANGOR
NEWTOWNARDS
BELLEEK
ENNISKILLEN
IRVINESTOWN
FINTONA
OMAGH
CASTLEDERG
CARRICKMORE
STRABANE
COOKSTOWN
MAGHERAFELT
LIMAVADY
CITY CENTRE
SHANTALLOW
WATERSIDE
COLERAINE
ROBINSON
DALRIADA
BRAID
ANTRIM
NEWRY
S ARMAGH
ARMAGH BANBRIDGE
HILLSBOUROUGHPORTADOWN
DUNGANNONBROWNLOW
KILKEEL
NEWCASTLE
BALLYNAHINCH
LISBURN
DUNMURRAY
LARNE
WHITEABBEYCARRICKFERGUS
DOWNPATRICK
PORTAFERRY
COMBER
HOLYWOODDONAGHADEEBANGOR
ARDS
Level 2 – Community Treatment and Care Centres
180 km
BENEFITS OF PPP/PFIBENEFITS OF PPP/PFI
Potentially earlier availability of funding
Potential for innovation
Potential benefits from related commercial development
opportunities
Consortium input to buildability / life-cycle management
Guaranteed maintenance over contract period
Replacement of equipment (if included)
Payment related to availability of facility
PERCEIVED PROCESS PROBLEMS WITH PERCEIVED PROCESS PROBLEMS WITH PPP/PFIPPP/PFI
Poor Public Sector Comparators produced Lack of clarity/understanding of strategic and specific needs of
client Bidding costs to client and contractor Wasted resources Length of time taken to closure Affordability gap due to lack of adequate work by client prior to
bidding process Inadequate definition of quality issues prior to formalisation of
contract Potentially opposing objectives Occasionally the quality of the final product
IMPACT OF DESIGN ON LIFE-COSTSIMPACT OF DESIGN ON LIFE-COSTS
Cost of Maintenance : 5
Cost of Building : 1
Cost of Design : 0.1
Cost in Use to Client : 50 - 200
PFI
MANAGING DESIGN DEVELOPMENTMANAGING DESIGN DEVELOPMENT
A 10% increased efficiency in capital and life-cycle maintenance equates to only 0.6 of the original capital cost
A 10% increased efficiency in costs-in use equates to up to 20 times the original capital cost
The current payment mechanisms do not incentivise PFI consortia to focus on the user-client’s costs-in-use
The user-client must ensure the design facilitates its core needs and activities
All procurement models must enable the user client to properly establish the brief and control design quality of the final building
OWNERSHIP OF THE CONCEPTUAL DESIGNOWNERSHIP 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 needs
developing models of care
technological advancement / research requirements
changing medical and nursing practice
patients’ expectations
In-depth dialogue between the user-client and the design team
is essential for successful high-quality design
This is most important during the conceptual design stages
RELATIONSHIP ISSUESRELATIONSHIP ISSUES
Consortium’s Design team are not able to properly research specific
needs of client
Limited opportunity for in- depth dialogue / brief development with
user-client during key design conceptualisation stage until after
competitive stage of design process is completed
Inadequate time for initial design development and often inadequate
allocation of fees to properly resource this stage of the project
Potential for mis-interpretation of ‘output’ specification
Design quality aspirations sometimes not shared
Incomplete definition of product
Compromises during construction
THE EXEMPLAR MODELTHE EXEMPLAR MODEL
Fundamentally using this model the real client is much more specific about:
The strategic and detailed needs of the client The quality aspirations of the client The type of design that would satisfy these needs and
aspiration The cost of such a facility
Through 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
OBJECTIVES OF EXEMPLAR MODEL User Client has properly agreed and signed off strategic medium to
longer-term vision and current operational need Proper research/visits carried out with exemplar design team Full consultation and sign-off with key user-groups during brief
development in iterative design process Clear identification of required quality objectives and performance
specification Consultation with town-planners on specific site requirements Testing of site infrastructure requirements Establishment of a design solution fully acceptable to users and
signed off as such Pricing of site specific design solution and signed-off
affordability test prior to market engagement Reduced cost and time for bidding process, fewer barriers to entry
Managing Uncertainty through Exemplar Managing Uncertainty through Exemplar ProcessProcess
Clarity for bidders on service model, capacity requirements, space requirements, functional relationships, quality requirements, affordability user buy-in site and planning issues
THE EXEMPLAR MODELTHE EXEMPLAR MODEL Used successfully on the Belfast Cancer Centre and Altnagelvin Laboratory and
Pharmacy Last week PAC report on the failed Paddington Hospital PFI asked why they
hadn’t adopted the Northern Ireland Exemplar Model Currently being employed on:
Enniskillen HospitalOmagh Hospital
Ulster HospitalRoyal Mothers’ and Children’s Hospital
Being used for Primary Care and Community Infrastructure for a potential PPP model for a significant element of £600M+ programme
Dept of Health in England has recently introduced requirement to follow this approach in its PFI Design Protocol and Treasury currently reviewing its guidance
THE BENEFITS OF THE EXEMPLAR MODELTHE 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’ proposals
The 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 issues
Bidders get much better understanding of client’s strategic and specific needs and quality aspirations
Bidders’ costs are reduced Client retains control of conceptual design, content and design
quality Design proposals are much more informed and customer
focussed Reduces wasteful processes Speeds up process from OBC to on-site
PPP – The FuturePPP – The Future
Greater use of private finance subject to affordability Strategic Partnership arrangements for smaller projects Focus on real partnerships and less adversarial contractual
relationships Major emphasis on creating true ’Healing Environments’ using
EBD Design Excellence and Sustainability Objectives driven by
exemplar process Seeking to further reduce time and costs of bidding process so
as to allow greater entry to market thus improving competition Best practice standardised without reducing innovation
Better Health Buildings Heal BetterBetter Health Buildings Heal Better
Achieving the Client’s ObjectivesAchieving the Client’s Objectivesin PFI Projectsin PFI Projects
John Cole John Cole Chief Executive, Health EstatesChief Executive, Health Estates