doing for the people is another, so we need the right balance.”

Social value According to Tim Whitley, one answer to trying to drive better quality in the face of continuing cost pressures might be to work within the framework of legislation on ‘social value.’ If you look at the legislation, it’s a real opportunity in terms of how things can be measured by social value, because it’s quanti- fying stuff in a way people can understand.” He added: “We have to find new metrics to show it’s not just about cost, it’s about value, and positive outcomes.” Kelly Watson added: “Current thinking

© Richard Wakefield

incorporate as much of that as they could.” Anis Abou-Zaki told the audience

that Fosters + Partners was experiencing a “push” for wellbeing among users, but also staff and visitors, “at all scales.” He said that an increasingly ‘human’ focus in healthcare was backed by evidence: “There have been a lot of studies on impact of design on health and wellbeing in patients, but the challenge is how we combine that with science, and that will include not only environmental quality but things like HVAC and cladding systems.” Whitley added that there was a tendency to over-service healthcare facilities: “We’ve got operating theatres, therefore we’ll comfort cool the entire building.” In answer to a point from the chair on the

“challenge of the sheer number of stakehold- ers in healthcare design,” Kelly Watson said that while there is a trend for more “social spaces” in healthcare, these need to cater for “a wide variety of different users, from patients to staff to visitors.” She added: “Understanding how they are designed and fit with other functions is really important to getting the most of the end user experience.” Watson cited a further trend presenting the

challenge to “pull certain services out of larger developments into smaller, more ‘consumer-focused’ spaces,” such as wellbe- ing spaces within mixed-use developments, or outpatient services in the community. She said these could reduce anxiety for users, and be promoted as social spaces which add to community cohesion: a “challenging as well


as exciting” opportunity. Tim Whitley said that the carbon agenda

will increase the necessity for retrofitting existing buildings, and this was a “significant opportunity” to achieve other benefits: “when you retrofit for carbon, you can retro- fit to improve wellbeing and functionality.” He added however that it was “tougher – you are working in a live environment.”

Counting the cost Will MacDonald told the audience that while the NHS’ budget was only increasing 1 per cent year on year, its costs are increasing by 3 per cent. He said as a result hospital projects “push the cost too much at an early stage, and we don’t always get some of the good qualities we’d want.” Tim Whitley said: “There is a complete

disconnect between capex and opex costs; if we looked at them together we could make real progress. You can have as many early conversations as you want, but it always comes down to a capex number; there’s always significant value engineering.” He added: “As architects and engineers we know what can save significant costs long term, but also provide healthier, better environments, but so often that’s lost along the way.” Anis commented that healthcare “is

facing a big problem of staff retention, so focusing on providing a design people enjoy is becoming key.” Where it comes to the cost of providing it, he said “there should be directions from the Government, because cost is one side, and what we are

about ‘value’ tends to be quite construction supply chain-focused, such as apprentice- ships. The Social Value Act is a really interesting driver for adding value through the asset you’re building; what does it do over the long term for the end users and staff, and equally for the local community.” The Act will mean the “added value a new asset will pay back over time will be really key to making the business case,” she said, adding that community initiatives could be part of the methods to add value over time. Smart buildings was another topic covered

in the wide-ranging debate, with Tim Whitley saying that the concept had evolved from “automating everything” to a building that “uses a BMS to give as much control to users as possible while maintaining optimum efficiency.” He said that integrating wearable and personal tech would be an increasing feature in the future in helping users control their space. The panellists agreed that collect- ing data on users’ experience could usefully feed into post-occupancy evaluation to help show whether what was designed works in practice, and a new British Standard in this area would be a key driver in future. Tim Whitley concluded that there was a

need to avoid a purely codified approach and “going to the lowest common denominator,” in achieving people-focused healthcare design. “It’s of no use if people don’t feel their wellbeing has been improved, and that’s the bit that’s missing.” He added: “Unfortunately our procure-

ment routes and the way we focus on capex mean that gets lost.” A further problem was that: “Too many buildings are designed from the outside in; you have to create a mass of the building to show to the planners, and it doesn’t matter what’s happening inside. If we want human centred-design, we have to be focusing on the people and designing from the inside out.”


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