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John Radcliffe Hospital: Visit 7 December 2007

AfH visit to John Radcliffe Hospital Oxford December 7th 2006, an invitation from Carrilion Health.

Hosted by Carillion Health and the Oxford Radcliffe Trust on Thursday 7th December, at 6.00pm

The event took the form of a project overview (joint Trust / Carillion) in the project offices, followed by a site tour.

Key points of interest included:

• Specialist Head and Neck Centre
• Specialist Children's Hospital
• University Research Accommodation
• Consolidation of services from a city centre site onto the John Radcliffe site
• The first scheme designed to the SF3 form of contract

Numbers were limited to 30 visitors, members of AfH.

Report by Carole Crane:

It was a dark and stormy night yet several intrepid AfH members braved the elements to travel to Oxford for an open evening and tour of the new Oxford Radcliffe Children's Hospital and Head and Neck Centre.

The invitation to have a look at the building had been extended by Dale Sager of Carillion and a willing team was assembled to first ensure we were dried out, fed and watered and then to escort us around the facilities following two short presentations on the design and construction of the project.

We had learned in the warmth and comfort of the project office all the facts and figures relating to the scheme.

Children's Hospital

• Inpatient
• Daycare
• Adolescent services
• Out Patients department
• Childrens HEPAC Clinic
• Relatives and carers accommodation

Head and Neck Centre

• Neuroscience
• Head and Neck
• Plastic Surgery
• Adult services
• General Surgery
• Out Patients department

General Information

• 285 beds
• 55,00 sq m
• Nine floors with one level for car parking
• £135 k construction costs @ 2003 prices

Vickie Holcroft, the Trust project director.

• The hospital is a teaching hospital with links to the Universities of Oxford
• There were four hospital sites: - the infirmary dating from 1770 in the centre of Oxford and now closing with services to transfer; the Churchill, Horton and John Radcliffe, which forms the hub of clinical services from the Trust.
• The trust offers specialist and national services
  • Clinical safety
  • Neurosciences
  • Paediatrics, using shared services
• A combination of population growth, demographic changes, changes in clinical practice, old unsuitable buildings and new technologies had made it necessary to move the services forward.
• A new service strategy had evolved which clarified the management of emergencies and electives.
• Problems with recruitment and retention had been acknowledged and will be addressed.
• The new building promised significant environmental improvement.
• Immense effort and input from key members of the trust team had developed the SBC for issue in 1999, the OBC in 2001, FBC in 2003.
• The difficulties had been to fund the initial set up costs and to find resources to maintain the project and to take the team through the approval processes.
• Now the problems were to deal with the changes in revenue funding as PbR poses new risks for business cases.
• Transitional funding will be lost
• The Trust has no firm idea of how future funding will be obtained with the current financial climate or how resources will be managed, but in this respect they join forces with all NHS Trusts who share the same uncertainties and financial burdens.

• Explained how the SPV had been formed with RBS as financiers, the Hospital Company and Carillion as the D & B contractor.
• Other partners as before to create a framework familiar and common to many similar projects.

• The success factors were
  • An integrated team
  • An open collaborative relationship
  • Comprehensive "in-house" skills
  • Best whole life solution / value for money
  • M & E commissioning had provided a seamless transition to hard FM
  • Considerable planning / programming skills
  • Continuous improvement through "lessons learned"

• Sustainability
  • OGC recognised best practice
  • Biodiversity and sustainable plans were implemented
  • There was community engagement
  • Construction waste was diverted from landfill
  • There was a green transport plan
  • Lino floors
  • Ceiling tiles made from 30% industrial waste
  • Paint was supplied in tin cans
  • Biocide paints used
  • Sponsorship of local wildlife group

• Capital Works
  • £135 m over 3 years
  • 9 storeys
  • University accommodation
  • Re-located helipad
  • Car parks

• Key design Features
  • Clinical functionality
  • Separate clean and dirty routes
  • Two entrances - adults and children
  • Three level link to original John Radcliffe Hospital
  • Allowance for future flexibility and expansion
  • Crèche, retail, restaurants all provided
  • Sustainability designed in.
  • Conversion of 4-bed bays to single rooms designed in (drainage built in)
  • Soft space designed for future use as MRI / CT accommodation
  • Stronger colours and different approach to design in the children's hospital.
  • Way finding designed around the ideas form local schoolchildren who had been involved throughout the design process.

Carillion were justly proud of their soon to be opened hospital in which, even at the late hour of night, the finishing touches were still being applied.

The tour of the building then took place. Plans and photographs not published at present until after the official opening and publicity.

After crossing the windswept road from the project office we entered the building via the security entrance located by the lower ground floor 2 car park close to the adult's west block main reception. This took us into an imposing concourse from whence rose escalators to the lower ground floor 1 Out Patients' clinics. Such is the topography of the site that the lower ground floor 1 at this point actually appears to be the first floor; the ground slopes up steeply towards the existing hospital where existing floor levels dictate the designation of new.

The site constraints forced deep plan floor plates with four centralised courtyards, perhaps a solution that would not be so acceptable today (only five short years later) but that was required at the time of the PSC and was maintained throughout the project. Through the concourse to the full height atrium which dominates the children's entrance within which the children's radiology department juts out into the atrium from lower ground floor 1. A view of activity in the atrium and of proposed artworks on the opposite wall can be obtained from within this "pod". The works in the atrium are as yet unfinished; the intention is to place an artwork on the end wall which should make a dramatic impact on the view down the length of this large space. Signposting throughout seems to be very clear and straightforward though time will tell if this is in fact the case. How soon will paper notices appear on doors, walls and columns?

Up a single flight of stairs to the OPD level which has a large number of internal treatment and consulting rooms within the deep floor plan. Inevitably our party became lost in a maze of rooms but big bear footprints on the floor should have helped in our confused state. Rooms in the children's area are brightly painted in strong colours and are well fitted out with robust built in furniture and fittings; though filled with furniture awaiting unpacking they appeared to be of generous size. On this dark and gloomy night it was difficult to judge how much daylight would filter through to internal spaces but a large courtyard play area shared between the OPD and the HEPAC clinic with a central dividing screen should enable a good supply of sunshine to some clinic areas.

From children's OPD to the ophthalmology department in Head and Neck where a strangely high reception counter dominated the waiting room and this visitor, being short of stature, found the space somewhat intimidating. (Will the users regret their insistence on their lofty viewpoint?) Coloured lines on the floor assisted way finding in this department. From here in the lift to the upper floors to look at inpatient accommodation where we found a mix of single and four bed rooms in both adult and children's hospitals; again the result of decisions made five or more years ago but see "key design features" above. The single rooms were of good size, comfortable, with fitted furniture and all with a view of surrounding countryside or of internal courtyards. Once more the colour schemes in the children's hospital were strong and bright, those in the adult zones being muted but in the same range of hues. Theatres and specialist areas on these floors were out of bounds, having been cleaned ready for handover.

Down the impressive main staircase, a bright white steel structure which when lit creates a dominant focal point on the north elevation, across the upper level of the concourse where the smart idea of placing a café next to OPD pharmacy provides a pleasant sitting area to watch others below, and then back to the security desk to complete our all too brief visit.

This new hospital promises to be a significant addition to the healthcare estate and we look forward to an in depth appraisal.

Thank you, Carillion, for offering AfH a sneak preview.

Carole Crane
February 2007