The estate we’re in Update Issue 5.pdfGerald Leeke whose company owns the Leekes out-of-town...

Issue 5Autumn 2003

A publication by Welsh Health Estates

for health estate personnel in Wales

UpdateUpdate

Disposal of Hensol

Continued on page 3

This IssueThis Issue

■ From the Director... 2

■ The NHS Estate in Wales Condition 6 and Performance Report 2002-2003

■ DDA October 2004 deadline 6

■ Design excellence in the health estate 8

■ Building project review 10

■ Hospital Patient Environment programme gets underway 14

■ Welsh support for the MGA 16 ■ Proposed changes in statutory fire safety legislation 17 ■ Environmental Award 18

■ The Land Registration Act 2002 18

■ Website News 18

■ Library News 19

■ Staff News 19

■ Capital Project Quarterly Reports 19

■ Cost Allowances 19

■ The Building Better Health Awards 2003 20

The estate we’re inThe estate we’re in

To the immense satisfaction, if not to say relief, of those involved, contracts for the sale of Hensol Hospital were exchanged on the 23rd September 2003 at an agreed sale price in excess of £5 million.

The hospital is being purchased by Gerald Leeke whose company owns the Leekes out-of-town department stores and the Vale Hotel, Golf and Spa Resort (which adjoins the Hensol hospital site) which is used by both the Welsh football and rugby teams and FA Cup finalists.

This milestone brings an extremely complex disposal process, which commenced in 1996, a step closer to a conclusion, with the completion of the sale scheduled for the 26th March 2004.

WHE, under the direction of Gareth Roberts and Clive Ball, managed the disposal process on behalf of the Welsh Assembly Government in partnership with Bro Morgannwg NHS Trust (the main occupiers of the site). It was

WELSH HEALTH ESTATES brings the disposal of Hensol Hospital a step closer

From the Director...

2 WHE intranet website: howis.wales.nhs.uk/whe

First of all I must congratulate both Pembrokeshire and Derwen NHS Trust and Bro Morgannwg

NHS Trust on their success in the Building Better Healthcare Awards 2003, held recently at London’s Café Royal. Pembrokeshire and Derwen were worthy winners of the Best Designed Mental Health Facility for the new Bro Cerwyn Development in Haverfordwest and Bro Morgannwg NHS Trust were highly commended in the Partnering category for their work with the Neath/Port Talbot Hospital PFI consortium.

Well done to all involved!

I am pleased to report that the Capital Investment Board and the Estate Development Panel are now established and I am confident that both will help to ensure that not only will estate matters be given the attention they deserve at the highest level within the Service, but also the process of decision-making will become more transparent and the quality and speed of policy development and implementation will improve. The involvement of NHS Estates and Facilities Directors in the Estate Development Panel is one of the most positive developments, as it will ensure that policy matters are founded on a clear understanding of the strategic and operational issues facing the NHS at the sharp end.

Many of you will be aware of Sir John Egan’s seminal report Rethinking Construction and the Government’s response, Achieving Excellence. The general thrust of both reports is that the traditional method of construction procurement will not deliver sustainable improvements and a new way of thinking is required. This new way of thinking involves the greater use of long-term partnering, key performance indicators, integrated supply chain management and continuous learning and improvement.

The Assembly requires all publicly funded bodies in Wales to embrace these concepts and consultants are currently being engaged to assist with the identification of construction procurement models that are compatible with the Egan agenda, the particular needs of the NHS in Wales and local market conditions. This work will be co-ordinated through the Estate Development Panel. A critical part of the option development process will involve capturing the views of the NHS, through questionnaires, structured interviews and discussion groups. Please take advantage of these opportunities, as your comments provide an important foundation upon which the new procurement process needs to be built.

Since the last edition of The estate we’re in, the review of Welsh Health Estates has been completed and the organisation has been restructured to reflect the changing demands of both the Assembly and the NHS. Full details of these changes are available on our website at http://howis.wales.nhs.uk/whe/

Neil DaviesDirector Welsh Health Estates

THE WELSH HEALTH ESTATES ORGANISATION

Welsh Health Estates was set up in 1996 to provide a core of professional and technical estate management expertise for the National Assembly for Wales and the Welsh NHS. It is organised into five Sections within two Divisions:

■ Policy and Performance Division Its remit is to ensure that the existing estate is managed and

maintained to a high standard and that the NHS in Wales has access to appropriate independent estates and facilities expertise and guidance. The Division consists of the following Sections:

● Environmental Management and Engineering Section Takes the lead role in Welsh Health Estates on all aspects of

environmental management and provides advice and support on specialist healthcare engineering systems. Services are provided in areas as diverse as decontamination, diagnostic imaging, high voltage systems, medical gases and specialist ventilation and air conditioning.

● Facilities, Performance Management and Information Section

Provides advice and support on a range of facilities management issues and co-ordinates performance management activities including the maintenance and development of the Estates and Facilities Performance Management System. The Section is also responsible for providing advice on fire safety and for overseeing the technical library service and WHE’s website facility.

■ Strategic Planning Division Its remit is to assist the Service in delivering strategic change in

the healthcare estate consistent with the policy of the Welsh Assembly Government as well as meeting local needs. The Division consists of the following Sections:

● Estates Development Section Provides advice and support on the development and

implementation of estate strategies, the procurement of capital assets and business cases. In addition the Section provides advice on architecture and design quality, and major scheme capital and revenue costs.

● Property Management Section Provides advice and support on all aspects of healthcare

property management expertise including acquisitions, disposals and landlord and tenant relations. In addition it maintains the Land and Property Portfolio for the NHS in Wales.

● Primary Care Section Takes the lead role in Welsh Health Estates on all aspects of

the strategic development of the primary care estate. The Section provides advice and support to Local Health Boards on the development and implementation of integrated estate strategies, the production of business cases, funding mechanisms and other more general aspects of property management.

More information on the services provided and contact details are available on our website at http://howis.wales.nhs.uk/whe/

Welsh Health EstatesPO Box 182, Bevan House24-30 Lambourne CrescentLlanishen, Cardiff CF14 5GS

Ystadau Iechyd CymruPO Box 182, Ty Bevan24-30 Cilgant LambourneLlanisien, Caerdydd CF14 5GS

Telephone/Ffôn: (029) 20315500Facsimile/Facs: (029) 20315501E-mail: [email protected]

This publication or any part of it may not be reproduced without the written permission of Welsh Health Estates.Feedback and comments should be addressed to:Peter WilesDeputy Director, Policy & Performance

extremely pleasing to experience the close co-operation of all parties involved in the disposal team working towards a common goal. Bob Croydon of King Sturge Property Consultants, responsible for marketing the site, said:“The co-operation of a number of organisations namely the National Assembly for Wales, Welsh Health Estates, Bro Morgannwg NHS Trust and the former Bro Taf Health Authority together with their professional advisers has brought about a successful conclusion to a complex sale.”

BACKGROUNDHensol Hospital is located in a pleasant rural setting in the Vale of Glamorgan, close to Junction 34 of the M4 motorway and some 12 miles to the west of Cardiff city centre. The site extends to some 63.06 hectares (155.8 acres) and comprises approximately 23,600 sq m (253,936 sq ft) of accommodation.The centrepiece of the Hensol site is the Grade I listed Castle, originally built in the 17th century as a stately home, together with its grounds and gardens (which are included [Grade II] in the Register of Landscapes, Parks and Gardens of Special Historic Interest in Wales). In addition, the sole access to the site is over a Grade II listed bridge.The attractive landscaped grounds incorporate not only extensive hospital buildings of varying ages and styles but also a 15 acre man-made lake, mill pond, playing fields and agricultural land.

3WHE intranet website: howis.wales.nhs.uk/whe

Continued from page 1… Although the site is primarily used for hospital purposes, many will know that the castle buildings provide conference centre facilities for both NHS and non-NHS bodies.

PLANNING STATUS AND POSSIBLE ALTERNATIVE USESThe disposal of the site was made more difficult by the restrictive planning regime surrounding the site. Whilst the use of the site as a hospital predated planning control, the primary use of the site fell within class C2 of the Town and Country Planning (Use Classes) Order 1987 and as such some alternative uses could be implemented without requiring an express grant of planning permission. These included:

■ Hospital or nursing home;

■ Residential school, college or training centre;

■ Provision of residential accommodation and care to

● Hensol Castle front elevation.

● Hensol Castle side elevation.


people in need of care. ➤

Although a plethora of planning policy guidance existed, little of this gave clear guidance in relation to the development potential of the Hensol site. The most recent, and deemed to be relevant, planning guidance was the Inspector’s report on the deposit Unitary Development Plan. The gist of the Inspector’s conclusions in relation to the Hensol site were:

■ The Hospital is in an open countryside setting.

■ Any reuse of the site would have to show great respect for the character of the listed buildings.

■ Because the site is not within a settlement, and because the local transport service is relatively sparse, residential development of the site could not be regarded as sustainable and would be inappropriate.

This view was confirmed by the Local Planning Authority which strongly indicated that it did not consider residential development of the Hensol site (by way of new build units or conversion of existing buildings) as appropriate and made it clear that it would oppose any such application.

Given these planning constraints, and the consequent difficulty in pre-determining what potential uses developers might have for the site, it was decided not to apply for a

specific planning consent. Rather it was decided to market the Hensol site, on the basis of its current and potential use, as a ‘development opportunity’.

MARKETINGAfter careful consideration of the Hensol site, the planning situation, the state of the property market, the area of likely purchaser interest and the disposal timescale, it was decided to market the site as one lot on an ‘expressions of interest’ basis.By selecting this basis of sale it enabled submissions to be considered and investigated and companies interviewed in order to obtain additional information, before a shortlist was drawn up. In reality 10 submissions were received with 4 companies being interviewed.Seven companies were then invited to submit ‘best and final offers’. Offers were received from all seven companies.

CONSIDERATION OF OFFERSDue to the uncertain planning and development potential of the Hensol site it was decided to encourage offers on an unconditional basis with an overage condition, should additional development be achieved. This was highlighted

Statutory designationsThe site contains two buildings that have been statutorily listed as being of special architectural or historic interest:

■ Hensol Castle was listed in 1993 as Grade I. This designation denotes a building of exceptional interest; only about 2% of all listed buildings are so graded (eg Windsor Castle). The entry in the list states “Listed Grade I as a major Welsh Country House which retains C18th fabric of national importance in the development of the Gothic style whilst also representing a fine example of early Victorian remodelling”.

■ The Bridge was listed in 1992 as Grade II, which denotes a building of special interest. The entry in the list states “Broad and ramped 4-arch bridge…included for group value with Hafod Lodge and Hensol Castle”.

Non-Statutory DesignationsThe land surrounding Hensol Castle was landscaped between 1774 and 1810 and this work included the excavation of the main lake and possibly the mill pond. The grounds are included (Grade II) in the Register of Landscapes, Parks and Gardens of Special Historic Interest in Wales, prepared by Cadw: Welsh Historic Monuments, the Countryside Council for Wales and ICOMOS.

*Although the Register was a non-statutory document, the Welsh Assembly Government’s guidance indicated that: “…The effect of proposed development on a park or garden contained in the Register of Landscapes, Parks and Gardens of Special Historic Interest in Wales, or on the setting of such a park or garden, may be a material consideration in the determination of a planning application.”

● Hensol Castle site.


in the marketing documentation and during the interview process.The reasoning behind this was in order to avoid having to consider a high offer, conditional on achieving planning consent for residential development, with little chance of success.The selected company submitted the highest unconditional offer, which was in excess of £5 million, together with the potential to achieve over £7 million more through overage (dependant on obtaining planning for timeshare, private healthcare and residential development).

WHE ROLEAlthough WHE had played a leading role in this disposal since 1996, in April 2002 (upon the abolition of the Health Authorities), WHE took on the responsibility for managing the disposal of the residual NHS estate in Wales, of which Hensol is part. This role involved managing the process of sale in conjunction with Bro Morgannwg NHS Trust.Due to the complexity of the site, contract negotiations were inevitably long and complicated, and at times highly technical, sometimes creating apparent impasses. However, through perseverance and goodwill on both sides, contracts were successfully exchanged on the 23rd September 2003.

VACANT POSSESSIONThe site was marketed on the basis of being offered with vacant possession on completion. However, due to the difficulties of identifying a suitable site and obtaining the necessary planning consent to construct new premises in which to relocate some of the healthcare services, it was necessary to negotiate with the prospective purchaser in order for the Trust to remain in one of the buildings on site under a lease (for a maximum period of two years).WHE together with the Trust and the Assembly’s Estates Department has been working for the past 3 years to ensure that the 15 or so occupiers (both public and private sector organisations) vacate the Hensol site by the end of 2003 in order to give the Trust sufficient time to decommission the site ahead of the 26th March 2004 completion date. ■

For more information contact:Gareth Roberts on 029 2031 5527 ore-mail [email protected]

The History of HensolFrom 1614 until 1721 Hensol was owned by the Jenkins family, and the core of the house, the centre of the south front, dates to the late 17th or early 18th century. In 1721 the estate passed to Charles Talbot, who served in Walpole’s government and in 1733 became Lord Chancellor, taking the title of Baron Talbot of Hensol.

The first major rebuilding was undertaken by Charles (died 1737) and his son William. William Talbot, who also became a prominent political figure, completely remodelled the house in gothic style in about 1735, pushing the north end of the south block out east to west, including the two towers, one of which has the date of 1735 on it. Hensol is a very early example of the adoption of the gothic style for domestic buildings in Wales.

On Williams’s death in 1782 the estate passed through several hands and in about 1790 to Samuel Richardson, who made further additions and alterations in gothic style, including the turrets, battlements, storeyed porch and porte-cochère, extensions to the east and west of the south front, and the north side of the main courtyard.

In 1815 the estate was bought by Benjamin Hall, and then in 1826 by William Crawshay (who went on to build Cyfartha Castle in Merthyr Tydfil) but neither made any alterations. The final phase of the building, which gave Hensol its present day appearance, took place after the industrialist Rowland Fothergill bought the estate in 1838. He employed the architects T H Wyatt & D Brandon in the 1840s to extend the east wing northwards and create the service court. Further changes were made to the main block. In 1927 the house and grounds were sold to Glamorgan County Council to be used as a hospital, which it remains today.

DISPOSAL TEAM● Welsh Health Estates – responsible for managing

the sale.

● Bro Morgannwg NHS Trust – the occupying Trust which provided healthcare services from the site and to which the majority of the land and buildings on the site were leased.

● Bro Taf Health Authority – responsible for the Hensol site on behalf of the National Assembly for Wales until April 2002.

● The National Assembly for Wales – through a representative of its Estates Division.

● Morgan Cole – legal advisers.

● Wyn Thomas Gordon Lewis – planning advisers.

● King Sturge – property consultants.

TIMETABLE OF EVENTSOnce the closure date for the Hensol Hospital site had been identified by Bro Morgannwg NHS Trust, the entire disposal programme was managed in order to ensure that completion of the sale coincided with the closure date, thus avoiding the need to secure and maintain an empty site.

The main events were:

Establishment of Disposal Team Dec 1996

Preparation for Sale Dec 1996-Dec 2001

Marketing Dec 2001-July 2002

Selection of Preferred Purchaser July 2002-Dec 2002

Negotiation of Heads of Terms Dec 2002-Feb 2003

Contract Negotiations Feb 2003-Sept 2003

Exchange of Contracts 23 September 2003

Completion programmed for 26 March 2004

The NHS Estatein Wales

Estate Condition & Performance Report 2002-2003

The latest Estate Condition and Performance Report on the NHS Estate in Wales has just been published by Welsh Health Estates. Based on data submitted

by NHS Trusts for years 2002-03, the report provides food for thought regarding progress being made to achieve performance targets against a number of Key Performance Indicators.

For the first time the report includes information on the whole estate rather than focusing on hospital sites only, though the data for non-hospital sites has been aggregated according the prescribed criteria.

Also, for the first time, the submission of hotel services data was made mandatory, enabling comprehensive data to be included in the report supplement. However, since Performance Indicators have yet to be agreed in respect of these services, the report does not include comments on performance.

It is clear from the report that, whilst significant reductions in backlog maintenance, totalling £41 million against hospital sites, have been made, the overall picture for Wales remains grim. Since last year, in fact, backlog maintenance costs have increased by £34 million across Wales, reaching an all-time high figure of £465 million, as illustrated in figure 1.


OCTOBER 2004, for many of us, means only one thing: the provisions of the Disability Discrimination Act, first introduced in

1995, will come into full force. Over the last few years column inches dedicated to DDA issues have increased at an amazing pace, to a point where we are at risk of switching off at the mere sight of another article on the matter. Be that as it may, Welsh Health Estates will, perhaps for the last time before October 2004, dare to mention this matter once more.So what has prompted this bold decision? Two issues:• Firstly the sobering data contained in the recently published

NHS Estate in Wales Estate Condition and Performance Report 2002-03;

• Secondly the recent focus by Welsh Health Estates and the Disability Rights Commission on the responsibilities of the Primary Care sector.

● FOCUS ON THE NHS SCENEAt the time of submitting data for the 2002-03 Estate Condition and Performance Report, two Trusts had yet to complete surveys to identify the extent of the work required to achieve compliance and several Trusts had yet to carry out surveys on their non-hospital estate.It is estimated that the cost of carrying out DDA work across the NHS estate in Wales is £41 million, of which almost £6 million is associated with the non-hospital estate. Chart 1 shows the estimated DDA implementation costs by

On a positive note, seven Trusts have already met the physical condition and statutory and safety compliance target of 75% of the estate to be in Estatecode category ‘B’ by 2005. Much more work needs to be done, however, to meet the 90% target by 2008. This will only be achieved by careful planning and early targeting of resources.

Disappointingly, the report points to an increase in energy consumption of 6.15% and a rise in CO2 emissions of 3.9%. Electricity consumption also continues to increase, suggesting that a focus on savings in the use of electricity should be given a high priority if CO2 emission targets are to be met. These increases, taken in the context of the primary energy usage over the last 13 years, as illustrated in figure 2, suggest that the NHS has yet to address seriously the need to achieve the all-Wales 15% reduction required by 2010.On a positive note, ten Trusts are within the primary energy reduction Performance Indicator target of 65GJ/100m3. Furthermore, on the energy front, eight Trusts are within or are close to the target of 75% of the estate to be in category ‘B’ or above by 2005.

DDAOctober 2004 deadline

Figure 2: Primary energy usage 1990-91 to 2002-03

So where does the NHS go from here? Clearly we all have a responsibility to ensure the limited resources available are carefully targeted where they can be used more effectively on the basis of robust estate strategies. As part of this process, early disposal of the non-essential estate, currently in the region of 265,000m2 of building area, is vital. This, combined with a commitment from the Assembly to start to address the shortfall in funding the NHS estate, will go a long way to reducing backlog maintenance, improve energy efficiency and generally revitalise and modernise the estate.The Estate Condition an Performance Report can be accessed on the Welsh Health Estate’s website. ■For more information contact: John Tidball on 029 2031 5517 or e-mail [email protected]

Figure 1: Graph showing trend in backlog maintenance costs 1995-2003.


Trust. Figures relating to the Cardiff & Vale and Pontypridd & Rhondda NHS Trusts are estimated. Chart 2 shows the estimated DDA implementation cost/m2 by Trust.It is clear that the NHS faces a huge challenge if it is to meet the requirements of the Act by October 2004. Trusts must complete surveys of all buildings from which services will be provided, prioritise and estimate the cost of the work to be carried out, and set out and implement an action plan. The Welsh Assembly Government should be kept appraised of progress in order that strategic decisions may be made.

● FOCUS ON PRIMARY CARE Pencerrig Gardens Hotel, close to Builth Wells in Mid Wales, was the venue for the DDA seminar organised by Welsh Health Estates specifically aimed at highlighting the implications of the Disability Dicrimination Act legislation on the primary care estate. Over 30 delegates from 20 Local Health Boards attended the event held on 22 October 2003. The seminar was presented jointly by Laura Jerram of the Disability Rights Commission and Caroline Lewis from the JMU Access Partnership.

Seminar part 1 - Duties of Service ProvidersThe first section of the seminar set out the duties that those providing services to the public already have under the DDA: a duty not to treat disabled people less favourably and a duty to make ‘reasonable adjustments’ to the way that the service is delivered. From October 2004 the duty to make reasonable adjustments will be extended to include adjustments to premises.

➤ Key messages emerged The duties are about access to services - not access to buildings per se. So the new duty to make reasonable adjustments to premises must be seen as one part of a wider agenda. To ensure that disabled people do not experience discrimination and can make use of services it is vital to: • continue to improve staff awareness• provide assistance • provide communication support • provide aids and equipment• review policies and proceduresLaura Jerram also explained that whether an adjustment to premises is reasonable will depend on a wide range of factors including: • the cost • the resources available • the practicality of making the changes• the size of the organisation What is reasonable for an individual service provider to do, will change over time as circumstances change.This highlighted the importance of developing an Access

Chart 1 – DDA implementation costs by Trust

Strategy, to set out intentions, devise action plans and record decision making processes. This Access Strategy needs to be kept under continuous review. As part of the process of developing a strategy, emphasis must be placed on seeking advice and consulting with disabled people, so that resources can be used effectively where they are most needed, on the basis of real rather than perceived need.

Seminar part 2 - Technical Standards to be AchievedThe second part of the seminar provided detailed information about the technical standards that need to be achieved in modifying buildings in order to improve access. It included considerable detail as to how significant improvements can be achieved through ongoing maintenance at little cost as well as advice on the importance of colour contrast, glare, floor coverings and signage, all of which are often overlooked. This section also focused on the wider environment outside the building, including pedestrian routes, car parking, and public transport links. A video presentation of two existing primary care premises provided a clear demonstration of how many common layouts and adaptations fail to meet the requirements of disabled people despite the best intentions of the service provider. Many of the issues identified related to a lack of awareness of disability issues and a failure to incorporate these values within the building management regime. This was followed by workshops for delegates to consider the impact of the DDA on their own work in Local Health Boards. Delegates explored some common scenarios and the challenges they face and were able to generate ideas and suggestions. Local Health Boards were encouraged to consider the ways in which they can use the procedures and mechanisms already in place to influence those delivering services in their areas.It is clear from events such as this that we all have a role to play to ensure that health services in Wales are accessible, appropriate and free from discrimination. ■

For further information on DDA in the NHS please contact:Nigel Davies on 029 20315543 or e-mail [email protected]

For further information on DDA in Primary Care please contact: Chris Cowburn on 029 20315537 or e-mail [email protected]

Chart 2 – DDA implementation costs/m2 by Trust


passion, drive, and a focus on objectives centred around patients, staff and all users of healthcare premises. Good design requires Design Champions, and the Framework makes it clear that the NHS has a responsibility to ensure that commissioning, design and provider teams identify Design Champions as part of the procurement of estate facilities. Over the last year the Framework’s focus on the promotion of quality environments has been translated into a Construction Procurement and Design Policy issued to the Service under Welsh Health Circular (2003) 56. This was followed by Welsh Health Circular (2003) 108, which sets out the responsibility of Trusts and Local Health Boards to appoint a member of their Board as their Design Champion. The circular also provides details of the role of Design Champions, details of which are set out in the insert above.

● Achieving Excellence Design Evaluation Toolkit

In support of design quality initiatives Trusts are encouraged to use the Achieving Excellence Design Evaluation Toolkit (AEDET) also introduced to the Service through Welsh Health Circular (2003) 56. Developed to assist those involved in the

The positive impact of good design on patient recovery and welfare is well documented and, generally, widely accepted. Good design, however, whilst not necessarily costly, rarely happens without real commitment to deliver quality environments. The Framework acknowledges that, in reality, “quality is best achieved when commissioners, designers and providers accept their collective responsibility in the estate procurement process”. Such collective responsibility requires

AT THE HEART of the National Estates Strategic Framework published in 2002 is the Welsh Assembly Government’s

vision To develop accessible, modern, comfortable and adaptable environments where patient-care can be delivered safely and efficiently. The framework acknowledges “serious deficiencies in the ability of the existing health estate to deliver the services required in the future, both in terms of fitness for purpose and condition”. In the light of the condition of the existing estate, the framework is clear that “The NHS must...foster amongst commissioners, designers and estate providers, a culture where innovative ideas can develop and thrive, and where best practice is acknowledged and effectively disseminated”. After all, the benefits of fulfilling such a vision for the generations to come must surely be incalculable.During the last year Welsh Health Estates has been working hard to develop the Framework’s strategic ideas on design excellence into practical applications for the Service. Whilst the design agenda is huge and will take time to develop fully, attention is currently being focused on three areas in particular: • Design Champions• The Achieving Excellence Design Evaluation Toolkit• The Health Estate Design Quality Panel This article provides an outline of the on-going work in these areas.

● Design Champions

Design excellence in the health estate

● Tonna Hospital, Neath.

Role of Design ChampionsDesign Champions are responsible for ensuring that the procurement of healthcare facilities takes into account the following strategic criteria:● Buildings must promote civic pride● Consumerism issues must be taken into account● Patients and staff must be consulted and their views

addressed● Buildings must fit into the local surroundings and

settings● Buildings are fit for purpose● Buildings take on board modern technology

Detailed responsibilities:● All procedures should encourage the achievement of

high design quality● The Achieving Excellence Design Evaluation Toolkit

(AEDET) should be used where appropriate● Ensure a Trust/LHB Design Action Plan is produced and

delivered● Evaluation of tenders should be based on best value and

not lowest cost● Budgets and timetables should be realistic● Ensure Trusts have the right skill mix to deliver the

design agenda● Ensure a design vision is established in order to produce

a clear brief● Involve the local community and staff

Design Champions will raise the profile of design excellence by:● Encouraging the selection of designers with a proven

track record of good design and design awards● Promoting awareness of national and international best

practice● Encouraging schemes to be put forward for local and

national competitions and awards● Maintaining a forum for regular review and feedback to

Trusts and Local Health Boards● Recognising the support, guidance and initiatives

available


procurement process to address design issues at key stages in the development of projects, the toolkit uses a series of non-technical questions to score designs against standard criteria. The Assembly will be requiring Trusts to demonstrate that the AEDET has been used during the Business Case process. An electronic version of the toolkit can be accessed from the Welsh Health Estates intranet website from the links section under NHS Estates - Achieving Excellence Design Evaluation Toolkit or from the Documents page, either by entering

● Cancer Treatment Centre, Ysbyty Glan Clwyd.

AEDET in the search field or searching the NHS Estates General Publications section.

● Health Estate Design Quality PanelThe National Estate Strategic Framework provides a commitment to investigate the development of a Health Estate Design Quality Panel whose remit will be to oversee the quality of architectural design in healthcare buildings in Wales. Such a panel is seen as an important component of the design quality agenda in Wales, complementing the appointment of Design Champions and the support provided by the AEDET.

Welsh Health Estates is currently investigating a number of options with a view to presenting them to the Estates Development Panel for its recommendation and direction on implementation. Clearly the investigation includes the need to establish the remit of the Quality Panel and its composition.

For the Panel to be effective and command the respect of the Service it will need to include members with considerable experience in architectural and urban design and discussions are ongoing with the Design Commission for Wales to explore opportunities for engaging with the NHS in this initiative. It will also need to include experts in health planning and engineering to ensure the promotion of good design is not done in isolation from the reality of clinical needs.

● Support for the NHSWelsh Health Estates recognises that the implementation of design quality initiatives requires appropriate skills that may not be widely available in the NHS. Design Champions, in particular, require training and support, and measures are being put in place to address these needs. Similarly the application of the AEDET, involving larger numbers of NHS staff from different professional backgrounds will necessitate training. Nigel Davies at Welsh Health Estates is currently co-ordinating the development of appropriate support for the service and will be pleased to offer advice. ■

For more information contact:Nigel Davies on 029 2031 5543 ore-mail [email protected]

AEDET – FunctionalityUsesIncluding: service philosophy, functional requirements and relationships, workflow, logistics, layout, human dignity, flexibility, adaptability and security.AccessIncluding: vehicles, parking, pedestrians, disabled people, wayfinding, fire & security.SpacesIncluding: space standards, guidance and efficient floor layouts.

AEDET – Build StandardsPerformanceIncluding: daylight, heating, ventilation, air-conditioning, acoustics, passive thermal comfort.EngineeringIncluding: engineering management systems, specialist & emergency systems, fire safety, engineering standardisation and prefabrication.ConstructionIncluding: phasing, maintenance, robustness, integration, standardisation, prefabrication, health & safety.

AEDET – ImpactCharacter and innovationIncluding: excellence, vision, stimulation, innovation, quality and value.Citizen satisfactionIncluding: external materials, colour, texture, composition, scale, proportion, harmony and aesthetic qualities.Internal environmentIncluding: patient environment, light, views, social spaces, internal layout and wayfinding.Urban and social integrationIncluding: sense of place, siting, neighbourliness, town planning, community integration and landscaping.


Building Project ReviewChepstow Community Hospital

● Chepstow Choice

CHEPSTOW COMMUNITY HOSPITAL was an easy selection for The estate we’re in centrespread review. Its status as the first PFI hospital in Wales

and three years completed service - it opened on St. David’s Day 2000 - provide plenty of interest and feedback from its users. Chepstow’s new hospital is a community hospital in a profound sense, providing primary, community and secondary care from one centre.Some half dozen purpose built community hospitals have been developed in Wales since the mid 1980s and their popularity is a matter of record. Chepstow is the first to accommodate primary and secondary care under one roof and houses two GP Practices (Mount Pleasant and Town Gate Surgeries), the Local Health Board and a Health Promotion Service. It is also the base for the District Nurses and Health Visitors that serve the Chepstow area.

● HeritageMany of the staff transferred to the new hospital from the former St. Lawrence and Mt Pleasant Hospitals, whose extensive grounds on prime development land provided the financial underpinning to the PFI contract. The PFI consortium - Kintra - by virtue of the development of several acres of private housing have provided an 84 bed community hospital incorporating two medium sized GP Practices without cutting corners on clinical space or specification.The Mt Pleasant Hospital legacy is evident throughout. Its sculpted pediment is prominently featured in the new hospital landscape and its Day Hospital is named after Dr Salkeld who worked in the Mt Pleasant facility.

● ServicesThe hospital services are wide ranging and in particular areas surpass the provision of care in earlier community hospitals. The nurse-led Minor Injuries Unit is a case in point, working 24 hours a day rather than the more usual 9 till 5 service. Operating a triage system with three well equipped treatment rooms - one dedicated to paediatrics - and with overnight accommodation for a doctor on the first floor, the unit is impressive. Eightyfour beds are housed in four wards, two at ground and two at first floor level. These are allocated for care of the elderly, elderly mentally infirm, rehabilitation and other GP referrals.

Diagnostic services include an X-ray department with new technology and remote imaging link with the Royal Gwent Hospital in Newport.

There are departments for Physiotherapy - acupuncture is available here - and Occupational Therapy and dedicated accommodation for Speech Therapy. Visiting Consultants from the Royal Gwent and Nevill Hall Hospitals run a range of specialty clinics from the Out-Patient Department’s five Consulting Rooms. These include: General Medicine (including Care of the Elderly), Rheumatology, Urology, Paediatrics, Ante Natal, Neurology, Dermatology, Child Psychiatry, General Surgery, Gynaecology, Orthopaedics, Ophthalmology, Learning Disabilities and Surgical Appliances.

Various community clinics are held in the same accommodation: Audiology/Hearing Aids, Psychiatry, Continence, Orthoptist, Community paediatrics, Podiatry and Family Planning.

Accommodation is provided in multi-purpose areas such as the Chapel for outside care agencies/charities such as St. David’s Foundation, Alcoholics Anonymous and Crossroads.

● Chepstow Community Hospital aerial photograph.


● The Building and its PerformanceDriving there, the hospital comes into view on the right hand side and with it a steel and glass canopy. This turns out not to be the main entrance but the Minor Injuries entrance point. In order to get to the main entrance it is necessary to continue onto a roundabout, and take a right turn which leads to the main entrance and carpark access.The hospital is predominantly single storey but includes a first floor for ancillary GP Practice accommodation and two of the wards - stacked over those on the ground floor. The fabric of the building is of rationalised traditional construction featuring buff brickwork, pitched roofs of Spanish natural slate and polyester finished aluminium windows and doors. This approach is reminiscent of the community hospitals in Wales previously built in the public sector. There is no hint of downgrading specification standards at Chepstow.The building layout is ranged around a large pentagonal area which is criss-crossed by link corridors which provide inter-departmental circulation and define four distinct courtyard areas. The ‘web’ of link corridors and the splayed junctions created by the pentagonal plan are costly forms with some awkward roof junctions.The link corridors have large sections of roof glazing which make them hot in summer and cold in winter. The two courtyards nearest the main entrance are rather small and regarded as a waste of space, whilst the two larger courtyards are generously landscaped with direct views out from the GP Practices and wards respectively. Whilst the chain link fence around the pond area detracts from its charm, this courtyard is used extensively by patients during fine weather. The areas of gravel paving are unsuitable for wheelchair users.The main entrance/reception with open sitting and dining areas adjacent presents an attractive, welcoming public space featuring a pitched timber boarded ceiling, pastel finishes and views into the courtyards beyond. However, the WCs located opposite the dining area are less than discreet and a screened access would be more appropriate.The wards incorporate a mix of four, two and single bedrooms and are generally regarded as a big improvement on the Nightingale wards at St Lawrence Hospital. Reservations were expressed about the difficulty for nurses giving support to patients in the assisted WCs due to the position of the wash hand basin. Bed cubicle curtains fouled access to the wash basins in the bed bays.

The two first floor wards reportedly overheat during hot weather - a temperature reading of 86°F was mentioned and, if this is so, a diagnostic and remedial exercise is warranted. The balconies accessed from these wards are generally the preserve of smokers.Staff who transferred from St Lawrence highlighted the lack of storage space in the new unit compared with the old hospital which latterly provided 84 beds in a hospital which originally accommodated 200 beds in its Nightingale wards. Given such an abundance of space previously, a negative comparison was by far the most widely expressed complaint. The on going programme of replacing the old furniture brought from St Lawrence Hospital exacerbates the problem of inadequate temporary holding space.Despite the niggles, staff were generally enthusiastic and took pride in the new hospital. The kitchen was originally planned around a cook/chill catering policy. The change of brief to conventional food preparation came late in the design stage, resulting in a tightly planned equipment layout. The freezer room is also smaller than normal, requiring regular, more frequent deliveries to maintain stocks. The catering team (part of the Kintra consortium) pronounced themselves happy with their facility, which possesses very efficient temperature and air handling characteristics. Moreover the food tasted fine!The 15 place day hospital, occupational and physiotherapy departments are logically located en suite and staff feedback, whilst generally positive, focussed on some shared problems: internal offices are too small and become oppressive over time, door closers are too fierce for elderly patients and sill ● Legacy from Mt. Pleasant Hospital.

● Detail.


heights are too high for seated patients to see out.The flat roof deck over the kitchen and chapel areas serves as a platform for several items of engineering plant. External ‘plantrooms’ are less commonplace these days and this one is screened from view by unusual decorative balustrading in white painted steel.The Pharmacy is one element in Chepstow’s ‘all under one roof’ policy that has never got off the ground due to objections from local pharmacists. Part of the space has been converted to a well stocked hospital shop accessed externally near the main entrance. The remainder of the space is in the process of being fitted out as offices for the Local Health Board - entirely consistent with the Chepstow policy.Making changes to the building is a protracted process according to its NHS Site Manager. The shop took over a year to get up and running and a proposal to install a cash machine has been aborted on ‘too much hassle’ grounds. Kintra provides catering, portering, domestic, reception as well as building and engineering maintenance services. A ‘handyman’ is permanently on site. Relations between NHS management and Kintra are generally good. Monthly meetings with individual services pick up routine snags and quarterly ‘service’ meetings encompass all Kintra’s activities.Whilst the building is well maintained management’s preference for dealing with their local Estates Department as they did at St. Lawrence Hospital demonstrates that NHS loyalties are enduring. Certainly, food and cleanliness standards are good and Kintra deserve credit in the range of services it provides.

Experience suggests that it is unlikely that Chepstow Community Hospital would have been bigger or better built, had it been conventionally financed in the public sector. This, after all, was a PFI deal where the housing development

potential made it a relatively straightforward financial proposition. Another design team may have anticipated some of the problems and produced more ingenious ward layouts, for instance, but we should not imagine that publicly financed hospitals always get it right.

What really impresses at Chepstow is the mix of primary and secondary care facilities, the range of its clinics, its hosting of outside agencies/charities, its base for community care workers and the Local Health Board. All under one roof, Chepstow Community Hospital sets the standard in Wales for weaving together so many strands of local health care delivery. ■

● Main entrance.

● Sitting and dining area by main entrance.


First Floor

Ground Floor

Project DetailsBuilding project completion date February 2000Building occupation date March 2000Building contract value £10 millionAnnual charge £1.7 million for 25 yearsFloor area Approximately 7000m2

Contract type Private Finance InitiativePFI Consortium KintraPFI Service Provider Select FMArchitect David Hutchinson

PartnershipServices Engineer Parsons BrinkerhoffStructural Engineer Parsons BrinkerhoffQuantity Surveyor Gwent Healthcare NHS TrustProject Manager King SturgeContractor Kvaerner

AcknowledgementsThe Project Review was carried out by Phil Withecombe on behalf of Welsh Health Estates. Phil is an Architect with many years experience in the health design sector.Welsh Health Estates is grateful for the assistance provided by Gwent Healthcare NHS Trust.● Courtyard with pond.

● Elevation with 1st floor terrace.

● Floor detail.

For more information contact:Peter Wiles on 029 2031 5542 ore-mail [email protected]


Background

THE SEEDS for the Hospital Patient Environment (HPE) initiative were sown in the Assembly document Improving Health in Wales: A Plan for

the NHS and its Partners published in 2001, which stated that ‘The people in Wales, and the health professionals who care for them, have the right to expect health care delivered in a modern, clean, well maintained environment’.Although undertakings from the Plan relating to technical standards such as the Nutrition/Catering Framework and the National Standards of Cleanliness were already being progressed by Welsh Health Estates, it was not until the ministerial announcement made in November 2002 that HPE Teams were to be introduced in Wales that attention was focused on the wider patient environment issues. Welsh Health Estates would pursue the delivery of this initiative as part of its Facilities Management remit to the Welsh Assembly Government for the NHS in Wales.The announcement confirmed that

the process would involve setting and verifying non-clinical national standards for the patient environment, and that there would be an initial focus on District General Hospitals in Wales. From here a multi-disciplinary Working Group facilitated by Welsh Health Estates developed proposals for the HPE Programme. This group had representation from Nursing and Facilities for NHS Trust Management, the Association of Welsh Community Health Councils (AWCHC), and the Welsh Assembly Government. Community Health Councils (CHC) would prove to be an essential component of the process as they represent the independent consumer council for the NHS in Wales. As such they have been set up to monitor and review the operation of local health services and to recommend improvements. Their statutory duties include the monitoring of health services, and CHCs have been conducting quality-monitoring visits to hospitals for more than thirty years. During 2002/3 the AWCHC has been in the process of standardising its approach to quality monitoring visits and welcomed the opportunity to work with the NHS and the Welsh Assembly Government to develop and deliver the HPE programme.In due course the HPE assessments will contribute to a process of continuous improvement and be reviewed regularly, with the expectation that in the first instance improved management action would result in improvements to the patient environment.

HPE PrinciplesThe following principles were agreed by the HPE Working Group in respect of the 18 major hospitals (Figure 1)

Hospital Patient Environment programme gets underway

selected for the initial HPE assessment: ● Trusts would be required to nominate a Board member

to take responsibility for patient environment issues, and become the HPE point of contact reporting regularly to the Board.

● Assessments were to be based on issues such as the decoration of patient areas, the adequacy of hospital signage, environmental cleanliness and the quality and availability of meals.

● Assessments were to complement technical standards such as the Nutrition/Catering Framework, and support other related NHS Wales initiatives including:

● Fundamentals of Care;● Health and Social Care

Guide;● Signposts - A practical

guide to public and patient involvement in Wales;

● Service and Financial Framework & Performance Improvement Framework.

● Assessments were to be made against set criteria relevant to the patient journey (Figure 2).

● The HPE process would not result in league tables but rather provide information to be used constructively to facilitate improvements. To this end the assessments would not be ‘scored’ but rather rated in terms of performance in meeting requirements for each criteria (Figure 3).

● Trusts would initially conduct a baseline self-assessment of the performance of their hospitals against the HPE, with supporting comments and details of actions planned wherever appropriate.

● Following a 3 to 4 month period, assessments would be conducted by external assessment teams made up from CHC members.

● The HPE external assessment teams would have access to the Trust baseline assessments and would sample areas for independent external assessment, and review progress made against the Trusts actions plans.

● The AWCHC would use the assessments from the visits and report to the Welsh Assembly Government.

● Reviews would take place on an annual basis and the results fed into the NHS Wales Performance Improvement Framework.

Current positionAll Trusts with participating hospitals have nominated a Board member responsible for the HPE process. Trusts completed their baseline self-assessments in May 2003 and

Fig. 1List of Hospitals

included in the firstround of HPEassessments

■ Royal Glamorgan■ University Hospital

of Wales■ Llandough■ Prince Charles■ Velindre■ Singleton■ Morriston■ Neath Port Talbot■ Princess of Wales■ Prince Philip■ West Wales General■ Bronglais■ Withybush■ Nevil Hall■ Royal Gwent■ Glan Clwyd■ Ysbyty Gwynedd■ Wrexham Maelor

Fig. 2HPE Assessment

Areas1. External areas2. Entrances and main

reception areas3. Common areas4. Ward areas5. Departments

HPE AssessmentCriteria

■ Public Transport■ Roads■ Pavements■ Signage■ Support (staff)■ Security■ Car parking■ Decoration■ Grounds■ Cleanliness■ Access■ Furniture■ Tidiness■ Toilets (incl visitors)■ Ambience■ Waste■ Linen■ Privacy and dignity■ Hospital food■ Smells


the returns entered into a central database maintained by Welsh Health Estates.The HPE baseline assessments have allowed Trusts to undertake a very detailed review of areas within their hospitals exclusively from the patient perspective, as part of a commonly adopted structured process, along with the opportunity to identify areas requiring attention and having associated action plans.The assessment returns indicate that there has been a wide variation in the time and effort put into this initiative by Trusts, with some providing extremely thorough assessments and action plans. A preliminary review of the Trust baseline self-assessments suggests there are some emerging themes highlighted in Figure 4.Following training provided by the AWCHC, HPE visiting teams, consisting of representatives from each of their constituent Community Health Councils, worked through a programme of external assessment visits completed in November 2003. The assessments included a review of progress by Trusts against their action plans. The findings are in the process of being submitted to Welsh Health Estates for collation and analysis to enable the AWCHC to prepare its report for the CHC Federations and the Welsh Assembly Government.

The FutureIt is anticipated that external assessments will continue to be carried out by CHCs on an annual basis and may extend beyond the original list of 18 hospitals.As well as providing the basis for monitoring continual improvement in the patient environment at a particular hospital, the results of the CHC assessments will identify common areas of concern and provide opportunities for the identification and sharing of good practice. The results will also be available to feed into the NHS Wales Performance Improvement Framework, a key element of which will be the Welsh Assembly Governments ‘balanced scorecard’.Work is also under way to form a Facilities Forum for the NHS in Wales. Its remit and structure is under discussion, but it is anticipated that each Assembly Regional Office will play an important role in monitoring the performance of organisations within its region using the HPE approach. In addition, in association with the appropriate Local Health Boards, it is likely that Regional Offices will have a responsibility for

Fig. 4

HPE Process – Emerging Themes■ In some hospitals specific single issues appear to

pervade, such as the need for improved signage across the hospital site.

This is an example of an aspect with requirements specific to Wales, where good practice may be shared from sites that excel in this respect.

■ In some hospitals it appears that the HPE assessment approach is highlighting isolated areas of weakness, such as the need for suitable waste receptacles, overlooked by other types of assessment.

The HPE process should prove to be a helpful additional mechanism for supplementing existing technical-based assessment processes.

■ In most hospitals the HPE assessment returns indicate that outcomes in similar areas within the hospital can be significantly different. For example, the returns for one ward may indicate that tidiness and privacy are acceptable while the returns for another may indicate that they are unacceptable.

It would appear that performance is often linked to issues such as an individual’s commitment and training, along with issues of culture, team working and ownership, rather than deficiencies in standards or resource issues.

■ Returns suggest that there is often a need for improved communication between different departments such as hotel services, ward staff and estates.

This appears to highlight the need for improved communication processes.

Fig. 3

HPE AssessmentCriteria Ratings

■ Poor – Does not meet theguidance criteria in almostall respects.

■ Fair – Meets the guidancecriteria in some respects.

■ Good – Meets theguidance criteria in mostrespects.

■ Excellent – Meets theguidance criteria in allrespects.

These ratings allow HPEassessments to feed into thePerformance ImprovementFramework.

monitoring the implementation of action plans arising from the HPE external assessments. ■

For more information contact:Sid Johnson on 029 2031 5516 ore-mail [email protected]


Welsh support for theMedical Gas Association

HARROGATE WAS THE VENUE for the annual Medical Gas Association (MGA) symposium held on 30 September 2003. As a delegate representing

Welsh Health Estates, Paul Wilkings, Principal Engineer and Authorising Engineer (Medical Gases), was disappointed at the poor level of support from NHS Trusts in Wales. It is possible that the apparent apathy is due to a lack of awareness of the Association’s existence.

Origin and role of the Medical Gas Association The vision for a MGA grew from the NHS Estates HTM 2022 Working Group and was first proposed in early 1999. That vision has been realised through the Association’s newsletter, website and working party reports. The MGA exists not only to provide a focal point for the dissemination of information but also as an organisation dedicated to the promotion of study, training, research and standards in all aspects of medical gases. The Association’s strap line Vital to Life reflects the critical role of medical gases as the hospital’s life support system.Membership of the MGA is open to all individuals engaged in occupations related to the use of medical gases in healthcare, or who are professionally interested in medical gas systems and their applications. Current membership includes personnel from Estates, Pharmacy and Microbiology Departments as well as the private sector, hence the knowledge spectrum is very wide.

Output of the AssociationThe 1st MGA Working Party Report, titled Oxygen Supply

Systems Design is now available to members on the MGA website. The document has been well received by the MGA membership and has been submitted to NHS Estates for consideration against the current advice given in HTM 2022. The Association is represented on the relevant British Standards Committee and is recognised as an expert consultative body by many organisations, including the Department of Health.

Five more working groups have now been set up to address the following issues:

● Medical Air

● Pipeline Materials and Jointing Techniques

● Overseas HTM2022

● Training in Medical Gases for Clinical Staff

● BS EN 737-3

Support for the Association

If you have a direct involvement with medical gas issues you should seriously consider joining the MGA, particularly in view of the likely changes concerning the appointment of future Approved Persons and the role of the Authorising Engineer. The appointment of future Approved Persons for medical gases is likely to be a lot more stringent than it has been in the past, with the rules of appointment clearly defined. Membership and annual subscription details are available on the MGA website www.mga.org.uk ■

For more information please contact: Paul Wilkings on 029 20315522 or e-mail [email protected]

Remit of the five MGA Working GroupsMedical Air Working Group* Examination and review of standards of current practice and levels of compliance* Suitability of current standards * European Pharmacopoeia Monograph* Plant and equipment review* Alternative sources* Pressure regimes and alternative motive gasesPipeline Materials and Jointing Techniques Working Group* Examination of physical and chemical properties of materials against a list of criteria produced by the Group * From those materials which meet the above criteria produce a refined selection based on cost and ease of installation* Produce a list of recommended materials* Financial and ergonomic implications will also be investigated. Overseas HTM 2022 (Climatic Extremes HTM) Working Group* Investigate how well HTM 2022 works in countries less climatically temperate than the UK. The Group aims to produce

guidance that will enable Pharmacists and Engineers cope with the effects of ambient climate and geography (and geology) on their medical gas systems.

Training in Medical Gases for Clinical Staff Working Group* The difficulty of ensuring that doctors and nurses are properly trained in aspects of medical gases, more particularly those

associated with emergency situations and safe working practices, is well known. The project is being undertaken in three stages:

1) Identification of the risks a) Medication incidents e.g. flowmeters/regulators on the incorrect cylinder, flowmeters left on with no patient

attached b) Therapy management observations e.g. poor cylinder management on wards, unrestrained cylinders, lack of

understanding about terminal units c) Senior clinical staff; HTM 2022 Operational Management non-compliances e.g. lack of understanding about Permit

to Work, isolation of AVSUs in emergencies 2) Production of a syllabus to address those risks 3) Recommendations on how to implement the trainingBS EN 737-3 Working Group* Review BS EN 737-3 and produce proposals to be carried forward to the next British Standards meeting* Review ISO 7396-1 and EN 737-3 and produce proposals for both.


REGULATORY REFORM (FIRE SAFETY) ORDER

The Regulatory Reform (Fire Safety) Order – likely to come into force in 2005 – is intended to review, consolidate and reform existing fire

safety legislation. It will repeal the following principle statutory fire safety legislation.■ The Fire Precautions Act 1971 (as amended);■ The Fire Precautions (Workplace) Regulations 1997 (as

amended);It will also remove other legislation, which contains references to fire safety.The principles of assessing fire risks embodied in the Fire Precautions (Workplace) Regulations 1997 (as amended) will underpin the new regime of fire safety.The Regulatory Reform (Fire Safety) Order requires that a responsible person should be appointed. That person is usually the employer or the person who is responsible for the overall management of the premises, such as the occupier or owner, who has responsibility for the safety of employees and every one on the premises that may be affected by fire.

Proposed changes inStatutory Fire Safety

Legislation and Firecode

The requirement to comply with the Regulatory Reform (Fire Safety) Order rest with the ‘Responsible Person’ who must maintain the premises in a safe condition. Where enforcing authorities are not satisfied that the fire precautions are adequate, rather than stipulate exactly what the ‘Responsible Person’ must do, it will be for the enforcing authority to

Prècis of the duties of the‘Responsible Person’

• Make arrangements as are appropriate for fire safety, having regard to the nature of the activities size of the undertaking, for the effective planning, organisation, control, monitoring and review of the preventative and protective measures.

• Ensure that fire risk assessments are undertaken and maintained up-to-date, and that appropriate steps are taken to ensure that risks are removed or reduced to an acceptable standard.

• Ensure that fire safety audits are undertaken to demonstrate that fire safety is being appropriately managed.

• Ensure that contractors who install, maintain or test fire safety equipment or systems are competent to carry out such work.

• Install fire-fighting measures in the premises, which are adapted to the nature of the activities carried out and the size of the premises concerned.

• Ensure that premises are, to the extent that is appropriate, provided with fire-fighting equipment, fire detectors/alarms, means of escape etc.

• Nominate employees to implement such measures and ensure they are given adequate training.

• Arrange any necessary contracts with external emergency services, particularly as regards rescue work and fire fighting.

• Ensure that where dangerous substances are present the risk assessment takes into account additional factors such as the quantities, its hazardous properties and the working process.

advise where the law has not been complied with, why they are of that opinion and, where necessary, require them to take action.

FIRECODE REVIEWAs a result of the forthcoming changes in statutory fire safety legislation a complete review of Firecode is being undertaken. The first phase has been completed with a review of Policy and Principles. It should be noted that the review takes into account the duties and responsibilities of the ‘Responsible Person’ outlined in the Regulatory Reform (Fire Safety) Order. The proposed draft document is titled ‘The Management of Fire Safety in Healthcare’ and will be circulated for consultation to the service (anticipated date Spring/Summer 2004) to coincide with Regulatory Reform (Fire Safety) Order.

The ongoing review of Firecode will change the existing ‘Prescriptive Requirements’ to ‘Functional Requirements’. For example, HTM81 Fire Precautions in New Hospitals currently has eighty ‘Requirements’. It is proposed that the ‘Requirements’ will be replaced with five ‘Functional Requirements’ supported by appropriate design solutions similar to the current Building Regulations. The proposed revisions will apply to all Firecode design publications.

The Firecode Fire Risk Assessment documents are also to be revised and reproduced in a format that will be compatible with the guidance produced by the Office of the Deputy Prime Minister, similar to other categories of buildings as required by the Regulatory Reform (Fire Safety) Order. The revisions will, where possible, give recommendations to avoid any possible conflict between fire safety provisions and the requirements of the Disability Discrimination Act 1995.

THE DISABILITY DISCRIMINATION ACT 1995The Disability Discrimination Act 1995 (DDA) places a duty on building managers/service providers to ensure access to services for all concerned. From October 2004, ‘reasonable adjustments’ should have been made to the physical features of all premises to ensure that appropriate access and egress is provided for all types of buildings.

Trusts will have to ensure that their Fire and DDA strategies are compatible when refurbishment or improvements are proposed. Consideration should be given to the provision of:

■ Voice, visual, tactile and portable alarms, the introduction of low-level signage etc.

■ The use of bed evacuation lifts or fire-fighting lifts may need to be given a higher priority to ensure people accessing the premises via a lift can also evacuate in a similar manor. Where lifts are not readily available specialist evacuation chairs may have to be incorporated into the evacuation strategies (subject to agreement).

■ The type of self-closing device used on fire doors may have to be reviewed, to limit the force required on the leading edge to opening fire doors. Greater use of magnetic door hold-open devices and electronic door opening devices etc. should also be considered.

It is not possible to give more precise guidance until a sufficient number of test cases have been heard and the findings analysed to determine what is considered by ‘Reasonable Provision’. ■

For more information contact:Paul Harrison on 029 2031 5530 ore-mail [email protected]


Website HelpIf you need advice on document searches or more general help

please contactAnn Konsbruck on

029 2031 5512 or e-mail [email protected].

Welsh Health EstatesIntranetWebsite

News

Number of documents currently published on the

website

◆ 279 NHS Estates documents (including 31 Quarterly Briefings going back to 1995)

◆ 206 Welsh Health Estates documents

◆ 251 National Assembly for Wales/Welsh Assembly Government documents

◆ 23 Other documents

759 documents in total – an increase of 111 since the last issue

■ Welsh Health Estates Organisational Changes

Full details of the new Welsh Health Estates organisational structure and services provided can be found under Services. Contact details are included should you require further information on services provided.

■ HelpFor those of you who are not used to navigating websites or may simply be unsure how to find a specific document, please remember that we will only be too pleased to assist you, including how to find our site in the first place! Help is only a phone call away, as Ann is semi-permanently glued to the screen and will guide you step-by-step to the information you need.

Environmental Award

Property News

Cardiff & Vale scoop the ‘green’ award

CARDIFF & VALE NHS Trust are the worthy winners of the new

ARENA Network Wales Environment Award for energy management best practice in the NHS, presented by Welsh Health Estates on 6 November 2003 at the Cardiff Marriott Hotel.Presenting the trophy on behalf of Welsh Health Estates, Stuart Fletcher of the Assembly NHS Wales Department said: “We are working very hard in the NHS to reduce and minimise any adverse impacts on the environment that arise from our activities. The very nature of our health services demand and consume a significant amount of energy resources but this is a major impact that we can manage and reduce through various energy efficiency schemes and the adoption of energy best practice. The good work at the University Hospital demonstrates clearly what can be achieved for the environment whilst saving costs at the same time.”

Whilst there could only be one winner, several Trusts entered the competition, and should be commended for their commitment to raise the profile of this important event. ■

● Stewart Fletcher (right) presents the trophy to Jonathan McGarrigle of Cardiff & Vale NHS Trust

The Land Registration Act 2002

The Land Registration Act 2002 came into force on 13th October

2003, replacing the statutory framework for Land Registration set out in the 1925 legislation. The Act is intended to put more information about land ownership in the UK on the public record.

Registration of LeasesNHS land holding bodies should note that all new leases over 7 years (rather than 21 years, as before) will have to be registered, bringing most leases, and therefore most commercial property transactions, within the scope of the Act. The information will then be made available to the public unless the owner or leaseholder convinces the registry that it is sensitive or contrary to public interest.

Anyone who considers that disclosure of certain details in the document would prejudice their commercial interests can apply to the Land Registry to have them blanked out of the copy of the document, which is made available to the public. If the application is successful, the Land Registry will only hand out an expurgated version of the document.

Effect of SquattersThe Act also gives registered title holders increased protection against the acquisition of title by squatters. A squatter will not be able to apply successfully to be registered as the owner of land on which he/she squats, however long he or she may have been in adverse possession, if the existing owner objects, except in very limited and clearly defined circumstances. ■

For more information contact:

Gareth Roberts on 029 2031 5527

or e-mail [email protected]

*** STOP PRESS ***


For more information call Ann on Cardiff 029 2031 5512 or e-mail Ann at [email protected]

Library News

■ TAN(03)06 - Building Better Healthcare Awards 2003

June 2003

Enclosing information on the NHS Estates Building Better Healthcare Awards on behalf of NHS Estates. We now know that Pembrokeshire & Derwen NHS Trust won the award under the category of Best Designed Mental Health Facility.

■ TAN03)07 - The NHS Estate in Wales Estate Condition and Performance Report & Supplement

Document 2002-2003 November 2003

Enclosing a copy of the 2002-2003 report for NHS Trusts in Wales on behalf of the National Assembly for Wales’ NHS Directorate.

■ TAN(03)08 Wales Public Sector Sustainable

Waste Management Guidance Manual - July 2003

Enclosing a copy of ‘Wales Public Sector Sustainable Waste Management Guidance Manual’ which represents the start of the Welsh Assembly Government’s Campaign to improve the management of waste throughout the Public Sector in Wales. Its distribution to the NHS in Wales recognises that it can play a major part in the realisation of the targets for the Public Sector, and in so doing contribute to the drive for a more sustainable environment whilst making the best use of available resources.

Recent TechnicalAdvice Notes

■ WHEL(03)08 - Achieving Excellence Design Evaluation Toolkit (AEDET) August 2003

Notifies Trusts that, in order to achieve design excellence, the Achieving Excellence Design Evaluation Toolkit (AEDET) has been developed, and its use by all property-holding NHS bodies is mandatory.

■ WHEL(03)09 Fire Practice Note 11 - Reducing unwanted fire signals in healthcare premises: Reporting procedures September 2003

Advises all NHS property holding bodies of the requirement to report all fire incidents and unwanted fire signals on the revised report form contained in Appendix E of FPN11 Welsh Edition.

■ WHEL(03)10 - Quarterly Briefing (08/2003: Volume 13 No 1) November 2003

Recent Welsh HealthEstates Letters

Staff News

Cost allowances for health buildings are set at:

■ MIPS Firm Price (FP) index level of 395

■ MIPS Variation of Price (VOP) index level of 385

The effective date for these allowances is 1st October 2003

■ The current location factor for Wales is 0.94

The effective date for this allowance is 1st April 2003

For more information contact:Kerry Ward on 029 2031 5540 ore-mail [email protected]

Cost AllowanceMIPSThe attention of Trusts is drawn to the requirement for them to submit quarterly CPQRs in accordance with WHC (2001) 101. The WHE website includes the WHC at documents/WAGCs and an electronically usable version of the CPQR form at documents/forms.The response rate and time compliance, of Trust submissions for the last quarter, were the best ever - but they were still not 100%! The Welsh Assembly Government is very keen for this feedback to be improved and we will be contacting the few Trusts that need to improve the quality of their returns.For more information contact:Gwilym Jones on 029 2031 5541 [email protected]

Capital ProjectQuarterly ReportsCPQRs

New appointmentWe are pleased to announce the appointment of Christopher Lewis to the Environmental Management Section. Chris, who has a degree in Environmental Engineering, has spent much of his career in the areas of environment and health & safety, principally in the manufacturing industry. He joins us as Environmental Management Advisor from LG Philips Displays in Newport where he was Safety & Environment Engineer. Away from work one of Chris’ main interests is watching rugby (Pontypridd RFC) and he tries to keep fit playing 5 a-side football.

Matrics 5-a-side Football TournamentCongratulations to the joint team of Welsh Health Estates Surveyors and GVA Grimley on winning the South Wales RICS Matrics 5-a-side Football Tournament on 24 October 2003 in Cardiff. After GVA Grimley’s disastrous result last year, our boys came to the rescue, clearly making all the difference! The team will now go on to compete in the national 5-a-side tournament.Representing Welsh Health Estates were Gareth Roberts, Clive Ball and Carl Waskiewicz.

The library at Bevan House holds a wealth of printed knowledge concerning both the health service and the built environment, comprising over 4,000 publications, 200 archived publications and 200 items of trade literature as well as CDs, videos and cassettes. In addition there are numerous reference documents and access to information services.

If you have a problem with any of your information requirements why not give the library a call, we may be able to help.


The Building Better Healthcare Awards 2003

WE ARE PLEASED to congratulate Pembrokeshire & Derwen NHS Trust on winning the award of Best

Designed Mental Health Facility in the NHS Estates Building Better Healthcare Awards 2003.The new 45-bed Bro Cerwyn Adult Mental Illness & Psychiatry of Old Age Unit, designed by the Powell Dobson Partnership and replacing accommodation in the Victorian St David’s Hospital, was completed in April 2003 and is situated in Haverfordwest, close to Withybush Hospital.

The site already contained a Day Centre and the positioning of the new structures created an entrance court, serving all three buildings and acting as a central entry/focal point. A covered way links each of the units and enables patients and staff to move in comfort between them. The new buildings, located on the quieter northern end of the site, are mainly single storey and provided with attractive outdoor spaces. Great care was taken with the internal treatment of both units particularly in the selection of colours and finishes.

Staff have noted an improvement in violent and aggressive

behaviour from patients and enjoy working in a modern facility. Patients have an improved degree of privacy in a less institutional environment that encourages good recovery.

St Caradogs (Adult Acute Unit)This building has a central spine angled at the entrance, with borrowed light from the communal lounge/dining and games rooms, which have full height glazing into the landscaped courtyard. All the staff and clinical rooms are on the ‘public’ side of the building with administrative offices on the first floor.

There are separate wings for male and female patients, thirty bedrooms in all, each with their own en-suite facilities, nurse call and panic alarm system. These are situated on the ‘private’ side of the building and overlook landscaped areas. Each wing has an informal lounge at the corner with full height glazing and access into the garden.

St Nons (Psychiatry of Old Age Unit)The fifteen large bedrooms in this unit, four of them en-suite, are situated around three sides of a central landscaped courtyard with windows looking out onto the enclosed external garden areas. The fourth side of the building contains the communal and clinical rooms. Full height glazing brings light into the circulation space and gives views across from one side of the unit to the other. Two small lounges give access to the courtyard containing a calming bubble fountain and patients can wander freely and safely within this area.

This Award highlights once again the contribution that a high standard of built environment can make in enhancing staff morale and improving patient care. ■

For more information contact: Peter Wiles on 029 2031 5542 or e-mail [email protected]

Pembrokeshire and Derwen NHS Trust win the award forBest Designed Mental Health Facility

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