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Architects for Health Seminar:
Strategic Planning and the NHS - Where are we going?

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Monday 27th September 1999 at the RIBA, London.

'Planning Practice: past, present and future'

By Professor Raymond Moss
Founder Partner, MPA International Health Strategy & Planning
Founder, Executive Member & Former Chair of Architects for Health

After the arrival of the NHS, the first 'official' mention of a hospital building 'programme' was the Hospital Building Operations Handbook, which appeared in 1953. This handbook required Regional Hospital Boards to meet with one another and prepare plans for capital development on a twelve month planning cycle. Following the preparation of these plans, the Boards engaged in a debate with the then Ministry of Health as a result of which a capital allocation for each Board was proposed. But, before these 'allocations' became 'programmes', a further round of Ministry / Board meetings took place, essentially to resolve problems round Regional Boundaries. In addition, and so that the Ministry knew exactly what was going on, plans for all projects costing more than £10K had to be submitted and receive formal approval.

However, it was not until the issue of Circular HM (61) (4) that all Regional Hospital Boards and Board of Governors who managed the teaching hospitals, were charged with the responsibility of looking at the long-term requirements, and submitting proposals for capital development for the following ten years, with reviews annually.

This ten year planning horizon, updated each year, had three main aims:

• To fit immediate needs into a longer, broader view over time;
• To give a clearer indication of priorities in terms of a particular scheme's place in the broader picture;
• To clarify the position of minor works proposals. What a good idea! It's all so obvious when one really thinks about it.

All these data were collected into a clear policy statement, and published as Command Paper 1604 1962, 'A Hospital Plan for England and Wales'. My early years in the NHS were spent managing one segment of a Regional Health Authority's programme. Looking back it was an amazing time - each year we would have a programme of schemes being processed - some at the building stage, some at the planning stage, and some at the research and briefing stage.

The plan brought some order within which there were times for thinking and times for action. It was not always smooth efficiency - of course there was chaos and confusion as ever, but there was also sharp focus. Because of the time allocations, especially in the design process, options were investigated in considerable detail in an attempt to achieve more efficient and economical ways of doing things. This is in sharp contrast to what happens all too often these days, when unrealistic pressures are put on design teams to produce solutions far too quickly.

This is frequently sickening to architects who know only too well that the planning and design process is not only the cheapest episode of the procurement process, but it is also the time when, by design, substantial savings can be made over the lifetime of the building.

But, planning horizons have broadened beyond the individual project and hence the accounting framework has broadened too, and these more recent political, financial and planning climates are reflected in the fact that Project Management Codes have become Capital Investment Manuals. Ceri Davies and his colleagues illuminated this landscape for us in the now famous report, 'Improving the Efficiency and Quality of the Government Estate', and in doing so have provided us with an idea of the Estate's real value as a National asset, and the Estate as a potential source of benefit for, and contributor to the Service. These issues are set out by Jonathan Millman in a recent issue of HD (10/98).

These are tools for the strategic planner, and the Mereworth exercises have become models of multi-disciplinary planning and problem solving, establishing clearly the links between planning for service delivery and physical outcome, and the role of physical planners within the whole process.

But, from what one sees and hears, after a decade of NHS reorganisation on the basis of the internal market, with introspective, semi-autonomous competing Trusts soon to be joined by the more ambitious Primary Care Groups, plus the pressures generated by a knotty Private Finance Initiative, former planners have had their roles reduced, or have been side-lined, or at worst, done away with altogether. Indeed, it is claimed by many that over the last 10 year or so, planners have practically been driven to extinction.

I mention this merely to underline the fact that even if we wanted to change our planning practice now, it might be painful to do so.

When deciding about the future, we should consider not only the fate of planners, but also what we have learned about the process itself, where in the past, the vision, impetus and innovation resulted from collaboration between the Centre and the Regions - and now, when change comes about largely as a result of the energy, entrepreneurship and determination of individual Trusts, in partnership with the private sector.

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