NHS Estates Patient Environment Workshop

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Jane Riley, Director of Policy & Development, NHS Estates

Leeds, 24 June, 2003

Recent and current research presented at this workshop included several presentations by Roger Ulrich which, with one exception, are currently available as published papers.

In introducing the workshop Jane Riley, Director of Policy & Development, NHS Estates, gave an overview of the current context within which the patient environment is being considered. She has kindly made this available to AfH to publish on our website.


1. Thank you Bill. Good morning ladies and gentlemen.

2. I would like to echo Bill’s thanks to you all for coming. When the NHS Plan was launched three years ago this week, the “patient environment” seemed like a new idea, a wholly revolutionary concept. Many at the time dismissed it as a gimmick, flavour of the month, something that would soon pass.

3. Looking round the room at the people who are here today, both on the platform and in the audience, I believe we have the evidence that it is not a gimmick to want to provide a decent environment for staff and patients. It is not a fad to want to make the most of our investment. It is not a passing phase to want to create buildings we can be proud of. Today I can see many of you who have worked for many years to demonstrate the value of good design. And many of you have been an essential part of the progress we have been able to make in just three years. I would like to thank you all for your commitment.


4. Later, we will be talking about what more we can do, but I think it is worthwhile us considering what progress we have been able to make so far.

5. Many of you here today will be familiar with our programmes to deliver a better patient environment. The NHS Plan sets out a 10 year programme for investment in the NHS. It is the first government strategy to put such a great emphasis on the environment for patients and staff. It was built on the results of a consultation exercise with patients, the public and staff. They told us that they wanted decent buildings in which to work and to receive their care.

6. We have responded by producing a design action plan – raising the profile, developing partnerships, providing support to the NHS, and improving the processes.

7. In delivering that action plan, we are very fortunate to have the considerable support of a range of Design Champions. Our Ministerial Design Champion, Lord Hunt, was wholly committed to raising the standards of design, and I have no reason to think that his replacement will be any less committed. Each Trust has been asked to nominate a Design Champion at Board level, and we have held events to support them. And HRH Prince Charles has done us the honour to be the NHS Design Champion.

8. In addition, we have forged a range of partnerships, for instance with CABE, the Prince’s Foundation, the King’s Fund and many individuals through the establishment of the Patient Environment Steering Group of which a number of you are members.

9. The Commission for Architecture and the Built Environment has set itself the agenda to make design count right across government. We welcome the involvement of CABE. Indeed for over two years now we have had a joint initiative with CABE, making use of their enabling service to help NHS Trusts work through the complex issues that design raises. Although CABE has rightly been critical of some of our hospitals, I am glad to say that they are seeing more examples of hospitals that they like. Jon Rouse, CABE’s chief executive, recently publicly praised the process by which one Trust had developed its design specification, and the results that they had achieved. That Trust is Southern Derbyshire Acute – and I am delighted to see many members of the team here today.

10. We have produced a range of documents for the NHS. Better Health Buildings sets out a strategy for the NHS. The AEDET – our design evaluation tool – was launched in 2001, and is now being refined to reflect feedback from users. We are adapting it for primary care. This tool aims to help non-specialists understand design decisions and to explain what they want to see in a building.

11. We are also responding to feedback from the NHS about the type of guidance people want. As a result, we have set up a Modernising Guidance project, with the steering group chaired by Professor Ray Moss, whom many of you will know. Ray is joined by a number of NHS project directors and policy makers who are keen to help us ensure that we provide the support that the NHS needs.

12. We have also set up the Design Review Panel, which brings a wide range of experts – with more years of expertise than I think some of them wish to admit to – to help NHS Trusts evaluate designs for our new hospitals. Feedback from the NHS has been good. People want to talk about design. They want to get it right. And we have to work out how can help them.

13. One such initiative is the work of the Design Brief Working Group. The Group has produced the “Advice” document – the chairman of that group, Richard Burton, is here today, along with Kate Trant who did much to pull it together. Richard is now a design adviser to NHS Estates and is currently looking at another publication, on the environment to support those who are suffering.

14. I was very heartened to see at the weekend that there is yet more evidence of the important of a good environment, in the perhaps unlikely covers of JK Rowling’s new Harry Potter, the Order of the Phoenix. In this book, she explains that whilst the Ministry of Magic is buried deep underground, the wizard hospital cannot be so buried – for health reasons – a clear indication that the wizarding world also recognises the importance of a natural environment.

15. We must translate our ideas into reality. To that end, we have in NHS ProCure 21 a construction programme that focuses more on design quality. That programme has identified integrated supply chains with which the NHS can work. Those chains include leading architects, such as Nightingale Associates – I know Richard Mazouck is here today. We are working closely with the author of the report on which the Government’s Achieving Excellence programme is based, Sir John Egan, now President of the CBI. We are also working with the RIBA and Architects for Health on an initiative to raise standards and bring greater numbers of architects into the healthcare field through accreditation, mentoring and other support.


16. Unprecedented changes are taking place within the NHS landscape. They present us with an exciting opportunity to make innovative improvements to often outdated hospital accommodation. The drive for modernisation has never been more determined than under the current programme. We are supporting the delivery of a massive redevelopment of the NHS’s infrastructure. We are working to deliver the largest building programme in the NHS. Within 10 years, over a quarter of our healthcare buildings will have been replaced or upgraded.

17. I know that some of you will feel that some of the most recent examples of hospital architecture are not the leap forward we had all hoped. There is more to do. Today, we are talking about how we can make that move forward. I believe we have the environment for change. I also believe we can demonstrate that the environment is a significant tool in the clinician’s armoury, in fighting disease and distress.

18. The advent of Foundation Hospitals and the rise in public expectations will both have major impacts on the way we operate. Citizens will be more involved and have a greater say in the running of their local health services. They will increasingly expect care to be delivered in well-designed, managed and maintained environments. This rising demand has stimulated considerable debate on the kinds of environments most appropriate for healing. It has raised issues about the environments for staff, to help them do their jobs well and to give them the most supportive environment we can.


19. We are starting to see more and more facilities where design is making a more obvious contribution to better clinical results. NHS Estates is working with the King’s Fund to make their initiative available across the country. Many of you will be familiar with the work of the King’s Fund’s Enhancing the Healing Environment initiative. If ever it was true that “a picture paints a thousand words” it is true of the results of their work with the NHS.

20. I cannot stress enough the importance of having sound evidence on which to base our arguments if we are to combat those who see “the price of everything and the value of nothing”. And today is very much about that evidence, and how we can use it.

21. NHS Estates and our colleagues and partners in bodies like the Modernisation Agency and the National Patient Safety Agency are aiming to improve decision-making in the NHS by identifying best practice. In our discussions with NHS Trust Design Champions, one of the most frequently heard requests is for evidence with which to argue for a design and an environment that reflects these aspirations. I look forward to the time when we do not have to argue the case for good design.

22. Today’s workshop is an opportunity for you to hear about some of the latest research. And for you to share your reactions, and to give us your thoughts on how we can take it forwards.


18. Before we move on, I should like to say something about someone who has devoted his entire career to making the environment fit for purpose. The purpose of supporting patients and staff.

19. Whilst it is difficult to pick out one person when there are so many people here today who have made such significant contributions to the debate and to driving forward change, I should like to say a few words about our chairman today – the chairman of NHS Estates – Bill Murray. Bill will be embarrassed by this, but I feel safe with so many witnesses here.

20. I must say that Bill has been an example to us all. By profession, Bill is an engineer. In addition, for some years he has been one of our leading General Managers, a figure greatly respected by his peers. Someone who knows a considerable amount about how you create the environment, and what happens if you cut corners. Bill has recently spent a considerable amount of effort in developing the new James Cook University Hospital for Middlesbrough. Bill retires from the Trust later this year, but I hope that he will continue to work with us. Given his life-long commitment to this area, I felt it was appropriate today to pay tribute to Bill’s contribution.

21. As I said, we have much more to do. I am sure that today we will be given much to think and talk about. Please let us have your views on how we can continue to shape the programme, and take it forward.

22. I hope that you enjoy your day.



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