I have been working as a healthcare planner on NHS buildings for many years and every building I have worked on has been designed from scratch. Everyone in the team always sagely agrees that the brief is the most important element- get that right and everything else will flow. For an NHS with huge revenue and volume pressures getting the brief right is even more critical today, with targets and KPIs measuring the value of the capital investment for the overall health economy. One of the main challenges in creating the brief for a building is that what is needed today may not be needed tomorrow, whilst the building lasts for at least 30 years. The response has been increasingly to say that what is needed is greater flexibility and standardisation. Everyone conducting an OPD appointment needs the same facilities in the room, why design it afresh on every project? This led to the P21+ Repeatable Rooms which were enthusiastically accepted by the Department of Health. Pre-designed facilities seemed to be the logical next step.
When you look around the country there are myriad variations on a theme in more recent community buildings. The menu of clinical activities may vary but the demands on the building are fairly consistent. There are relatively few room types or specialist requirements – generally the requirements are for public space, clinical spaces from consulting to diagnostics, plus some admin and support areas. There is a paucity of research but it is unlikely that individual design at departmental level of itself has improved health outcomes for patients. And it comes with a heavy price tag in terms of money and precious clinical time taken from the frontline to user group meetings. Might extending repeatable rooms into a full pre-design work for relatively simple community buildings?
We decided to create clinical modules of 200m2 with content based on reviews of existing projects, incorporating standard rooms so that any clinician, whether GP, consultant, nurse practitioner etc. could use them. The overall building design enables customers to choose which and how many modules match their requirements and join them together to suit their operational policies and their site. The building incorporates the light and space and efficiency that are most frequently valued in post project evaluations. Pre-design means that once the Trust have selected their modules they can move swiftly to a fixed price and a programme. And there is still scope for individualisation in the external appearance and internal finish.
What is the future? We are experiencing initial interest and are delighted to discover how readily our modules can deliver a brief drawn up entirely separately. We know we can deliver cost, programme and quality benefits from our experience on pre-designed schools. It might not be the right solution for every circumstance. But it is a solution to cost and programme pressures and to the changing environment where services change many times in the life of a building with service providers often working across multiple sites, not permanently in the same room.
And will anyone miss those endless 1:50 user groups?