John Osbourn

John Bernard Howard Osbourn ARIBA AA Dipl.

John Osbourn’s name appears amongst those Obituaries listed in the February issue of the RIBA Journal.

By nature a very modest person, he was outstanding for the contribution he made to architectural education and for his life long dedication to the protection and enhancement of the environment that we have inherited. Whilst remaining true to the principles of the Modern Movement he had an abiding passion for traditional English, Art, Architecture, and Landscape Design.

After serving his time as an articled student he came up to London and completed the Diploma Year at the AA before working with Derek Stow on the Miller Hospital and the Woodlands Nurses Home. Both projects were part the overall development of the new Greenwich Hospital.

Having found that his true vocation lay in the complimentary fields of Architectural Research and Education, in 1966 he decided to cross the river and join Raymond Moss, firstly at Southend School of Architecture then subsequently moving to the Northern Polytechnic to become one of the two founding members of MARU. When he was appointed to set up and run a Course for Part-time Students, with whom he had a natural affinity he entered the happiest and most rewarding period of his career. The Course was a great success in terms of the professionalism that the Graduates acquired and John excelled in the pastoral care of his students.

Living, working and teaching in North London he felt at home and was able to participate in the activities of the vibrant local architectural community of which he had become a member. However the halcyon days came to an end when the School of Architecture was absorbed into what is now known as London Metropolitan University and the Part-time Course closed.

John decided to return to his roots, to move back to Canterbury, which still had a School of Architecture that was independent, and to buy a small house close to the Cathedral. Once established in his new home he devoted his time to supporting the School, various Conservation bodies, The Environment Forum, and similar enterprises.

John Osbourn, who never married, will be sadly missed by all who knew him, friends and colleagues alike.

Derek Stow / Raymond Moss

GUPHA Forum

Reporting the 5th Gupha Forum at the University of Tokyo, November 2007

Gupha meet in Tokyo

The Gupha Forum 1 consisted of many speakers from all parts of the globe addressing both macro and micro forms of health care design from world health provision and massive hospitals in Malaysia to the new Community Facilities in Northern Ireland. Introducing the proceedings Professor George Mann of Texas A&M University 2 outline the main trends in facility design and described the challenge for the next generation would be the rise in population from a current 6.6 to 10 billion mostly in developing countries. He then proceeded to present the Gupha international student design awards for innovation. For his special lecture based on his considerable achievements and international experience, Professor Yasushi Nagasawa, described the lessons of the two Gs, – Global and Geography.

Including design for health in a global context is a complicated issue. The World Health Organisation is now attempting to update its knowledge base and capacity for guidance to meet 21st Century needs and patterns of care requirements. Enlightening the forum on WHO’s work on health care infrastructure, facilities and technology Dr Andrei Issakov made an appeal for assistance from Gupha delegates for current guidance. We appear to have arrived at a fragmented stage where central advice is no longer available and delegates found themselves unable to respond adequately to the invitation. In a culturally diverse world of such inequality in life expectation and access to health care, it is difficult to know where to begin, but the basic principles are straight forward. Consider first the subject, – the sufferer and all the individual citizen of this planet suffer at some time in their life. The aim is the well-being of the world’s population by aspiring to the public health objectives as defined in the WHO’s constitution. 3 Between the subject and the object are the means of delivery and availability, for instance the degree of inclusiveness and whether access is based on ability to pay and is affordable at the point of service. To establish a fair health infrastructure is a considerable undertaking with numerous stakeholders, politicians, clinical consultants, nursing carers, financial sponsors, drug companies, contractors and the service users. With an extraordinary commitment and investment each stakeholder believes they have a significant role to play in the health service delivery. At this stage the whole process becomes very muddled as each of the contributors compete for the territory and control over the programme and influence over the end product. In other words the means of the process begin to determine the outcome. The contractor for example believes the building is the subject and the object is to profit from their investment, when in fact it may not be appropriate or even necessary to build a permanent monument. Due to a lack of universal resources there is serious ethical imbalance where the privilege few have access to the specialist teaching hospitals and increasingly cosmetic surgery whilst elsewhere millions still don’t have access to clean water, the most common cause of disease and sickness. When it comes to achieving health care benefits across the whole population each independent country with variable ability to govern and regulate has different political, social and financial priorities. Overwhelmed with such dilemma all of this complexity compromises WHO’s effectiveness in delivering best practice guidance.

Considering the Geography 4

From the UK Architects for Health colleagues 5 and myself attended and although the majority of the delegates were from Asia, it was the Americans who were most vocal. Under the Chairmanship of Professor Kazuhiko Nishide, we were treated to two days of highly efficient communication support. The chair was assisted by the irrepressible Professor Nagasawa and his extraordinary capability to switch instantly between Japanese and English keeping everyone informed. Translation was simultaneous and even the Japanese volunteers were transforming spoken English directly into Japanese sign language. The only presentation throughout by a speaker from a disabled user’s viewpoint, Dr Toshinobu Obata from Honda Motors spoke on behalf of the deaf and appealed for their inclusion in environmental decision making. He informed the international gathering that sign language is by no means universal and that there were differences even between Tokyo and Osaka.

The conference provided a much needed platform and morale support for the various university departments who specialise in design for health care, and there were exchanges on the various educational structures. The conference however offered far more than approaches to curriculum, such as the Development of Guidelines for the Design and Construction of Health Care Facilities presented by Joe Sprague the Director of Health Facilities at HKS Inc.. On one hand there was the USA demand driven model with $43 billion pa worth of business and the mass care systems rapidly appearing in the Asia Tiger Economies. We were shown plans for a 3000 bed hospital in Malaysia by Professor Norwina M Nawawi and mega hospitals in China by architect Dr Huang Xi Qiu whose office has designed over a hundred such hospitals. In the mass orientated Asian countries there was little evidence of an individual patient focused service. (The sight of such mammoth hospitals being rolled out were beginning to make your reporter feel sick with despair, but of course huge swathes of users were likely to benefit from such enormous institutions, so it would be churlish to criticise such ambition!). Architects for Health Chairperson Dr Ann Noble presentation proved when it comes to health provision small is beautiful, and care in the communities of Belfast finished the day on a note of cautious optimism particularly in the aftermath of the troubles.

As a non-academy based delegate the Singapore and Single Room study were the most informative. Considering hospitals within the urban and cultural context we learnt about the phenomena of the edge and the importance of boundaries. In her presentation On the Edge Zone between Urban and Hospital Domain Dr Ruzica Bozovic Stamenovic presented a range of border conditions and how such segregation encourages stigma. Temporary Triage Tents systems erected on the perimeter during the recent SARS scare reinforced fear and did little to encourage confidence. Such separation of clinical services from the population was described as an anathema to the spirit of hospitals as healing environments.

Patient Room Prototypes

For a more specific scheme Professor David Allison presented the single room research, the joint Clemsom University and Carleton University Patient Room Prototype Project. a virtual interdisciplinary R&D collaboration with the Spartanburg Regional Health Care System. An elegant functional scheme offering essential nursing sight lines from the ward circulation the forum was able to get their teeth into the detail of this project. Your reporter questioned access to the wc, and it was suggested there were no mandate to provide double loaded disabled access. Although the twin mirrored single room arrangement did offer the disabled a choice, US regulations unfortunately seem to favour a single handed room orientation. Currently there is a mandate in the USA towards all single rooms in new facilities, but a Berlin based delegate pointed out that Germany was now moving away from single rooms. It appears single bed rooms are too expensive and there simply wasn’t a demand due to insurance companies reluctance to underwrite the tariffs on such services. Within the rooms it was noted the window elevations were least resolved, and it is unclear whether the outer walls were within the designer’s brief. This seemed a surprising omission as a permeable perimeter would connect the patient to the geography and natural phenomena which provides daylight and encourages the healing process.

Graham Cooper November 2007

Author Art and Nature: Healing


Footnotes:

  1. Gupha is short for Global Universities Programmes in Healthcare Architecture.
  2. Texas A&M University is short hand for the Texas Agriculture and Mechanics University.
  3. WHO Definition: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The definition has not been amended since 1948.
  4. Geography is a reference to The Geography of the Hospital, (a planning principle identified by the late John Weeks).
  5. AfH Colleagues included Ann and Paul Noble, Junko Iwaya, Rosemary Glanville and Giovana Romero from MARU.

The 5th GUPHA Forum Schedule

  • Opening Remarks and Presentation Prof. George Mann, Texas A&M University
  • Clemson/Carleton Patient Room Prototype Projects Prof. David Allison, Clemson University
  • Can We Rely on Robots to Guide Users in Hospitals? Healthcare Facilities Wayfinding Studies Akikazu Kato, Mie University
  • Development of Guidelines for the Design and Construction of Health Care Facilities Mr. Joseph G. Sprague HKS, INC.
  • The Best Communicating Environment for Inclusive Education (to Get over the Handicap of Hearing.) Dr. Toshinobu Obata, Honda Motor Co., Ltd
  • Update on the WHO’s Work on Healthcare Infrastructure, Facilities and Technology Dr. Andrei Issakov, World Health Organization
  • Current Development of Healthcare Architecture in China Dr. Huang Xi Qiu, Institute of Project Planning and Research
  • A Master in Architecture Course with Specialization in Architecture for Health in the University of the Philippines Prof. Prosperidad C. Luis, Luis and Associates
  • Recent Development of Healthcare Architecture in Malaysia – Reflecting the 50th Year of Independence Prof. Norwina M Nawawi, International Islamic University Malaysia
  • National Development Program of Hospital Premises in Finland Prof. Kari Reijula, Finnish Institute of Occupational Health
  • On the Edge – Zone between Urban and Hospital Domain Prof. Ruzica Bozovic-Stamenovic, National University of Singapore
  • What Do Clients Mean When They Ask for: Flexibility, Sustainability And Whole Life Costings Dr. Ann Noble, Ann Noble Architects
  • Special Lecture Prof. Yasushi Nagasawa, Kogakuin University
  • Proposed Center for Health Facilities Design and Testing Prof. David Allison, Clemson University
  • A Holistic Approach to the Perception of Healthcare Environments Dr. Sanja Durmisevic, Delft University of Technology
  • Healthcare in Sri Lanka after the Tsunami Ms. Junko Iwaya, Nightingale Associates

Chairman’s Annual Report 2007

Last year I reported that the high level of activity that we had achieved overstretched the available time of executive members and were arranging an away day for the executive members early this year to review and clarify AfH’s objectives, to prioritise these, to develop achievable strategies and the means to resource them.

The Wellcome Trust generously provided us with accommodation in their building for the workshop, which was early in February.

The key priorities which emerged from the workshop are:

  • Contributing to promoting and improving the quality of healthcare buildings
  • Strengthening our links with likeminded organisations overseas
  • Being pro-active in developing the interest of UK Schools of Architecture in healthcare buildings
  • Maintaining our regular programme of events for members
  • To strengthen links with other disciplines
  • To raise the funds needed to achieve these objectives

During the course of the year we have begun to achieve success in developing these. In addition to the contributions from our events which meet these objectives, other developments have taken place during the year.

  • We have had discussions with the RIBA on their proposal for knowledge groups in their new Knowledge Management System.
  • We have also had meetings with the President and other representatives of Institute of Healthcare Engineering and Estate Management (IHEEM ) to discuss ways in which we can work together. To date this has predominantly focused on AfH having significant input to the IHEEM annual Harrogate Conference and to hold joint workshops with members of AfH and IHEEM on integration of architecture and engineering in designing healthcare buildings.

In addition to presenters from other countries at our regular events, AfH members participated in the Netherlands ideas competition this summer. For the 5th Design & Health Academy Congress held in Glasgow, AfH members contributed with articles for publication, presented papers, and sat on the judging panel for their design award.

AfH was also represented on the selection of the Wilmington’s Awards, the Building Better Healthcare Awards. At this point I would like to congratulate Ray Moss for receiving the Lifetime Achievement Award in the Best Class for People category. In addition to his many other roles he was founder and director of MARU and founder and first chair of AfH.

Just a few weeks ago AfH was well represented at the Global University Programmes in Healthcare Architecture (GUPHA) meeting in Tokyo and members presented three papers.

We continue our support of the Howard Goodman Fellowship of Imperial College.

Since the initiation of this study significant changes have taken place. Imperial College became one of the University Research Departments that are undertaking HACIRIC, a major project for the Department of Health (Health and Care infrastructure research and Innovation Centre). Our study has been incorporated into this. The outcomes are not what we expected but are promising to be useful and interesting.

Our Programme of Events:

November 2006

The event following our AGM in November addressed the topic Education: Opening the Debate. Three presenters from overseas: one from America, one from Holland, Sweden, and only one contributor from England presented their programmes. This demonstrated an important focus on healthcare design in other countries which is not offered in UK Schools of Architecture.

February 2007

The Reform Club Debate: “This House believes that contract requirements to comply with Department of Health Guidance Notes stifles innovation and inhibits good practice.”

The motion was carried – 16 for and 15 against

May 2007

Two-Day Study Visit to Belfast, hosted by John Cole, chief executive of Health Estates in Northern Ireland. Visited very well designed Primary and Acute healthcare buildings.

Knowledge Transfer Partnerships. Joint event with AfH and South Bank University

AfH: Hospices – at the King’s Fund. The event covered the principles of hospices and presented a wide range of projects and some excellent design.

AfH: Operating Theatres of the Future – Professor Eric Fosse of the University of Oslo, Norway. We were very privileged to have the expert on Future of Surgery and also an excellent presentation on the new Barn Theatre in Liverpool with presentations by surgeons and the architect.

July 2007

AfH: Switzerland 3-day Study Tour, arranged with the cooperation of Karen Imoberdorf of IImoberdorf of Itten + Brechbuhl AG

August 2007

AfH First Student Health Design Awards – We received 45 submissions. Twenty of which from UK. Others from USA, The Netherlands, Australia, Germany, Finland, and Peru. 14 were short listed of which 3 winners were selected. First winner Jonathan Pugh of Mackintosh School of Architecture in Glasgow, and the joint second winners: Elizabeth Makinson of University of Newcastle upon Tyne, and Stefan Kolen of Eindhoven University of Technology (Holland)

September 2007

AfH presentation of the Switzerland Study Tour

October 2007

AfH Stand at Harrogate Exhibition – This year we included on display the students submissions of our First Student Health Design Awards.

We are indebted to many people for their support and to thank them. I specific would like to thank our event sponsors and Yuli Toh who is leaving her position on the Executive. We are very grateful to her for everything she has done.

I wish to thank Polyflor for their continuing support and to Draëger Medical for their two years as associate sponsors which terminated last spring. This does mean that we very much need some more associate sponsors to enable us to continue with our developing activities. If there is anyone here who would like to consider this please speak to one of us this evening. We are also pleased to hear from anyone who might be interested in sponsoring one of our events.

We have achieved a great deal this year and I thank all of the members of the executive committee for their hard work.

I must finish with a serious plea for a small dedicated group of members to support the executive in a number of different ways. If you can offer a little of your time please let us know. We really need some help.

Ann Noble
29.11.07

Chairman’s Annual Report 2005

Organisational Development

Several years ago the executive committee held an away day to set activities and priorities for Architects for Health. The potential for developing existing and new initiatives were identified and priorities were discussed. It was unanimously recognised that the essential first step to implementing these initiatives was the provision of some management and administrative support for the organisation. Since then we have been seeking the means of funding this.

I am very pleased to be able to report that, thanks to new sponsorship from Dräger and the ongoing sponsorship from Polyflor, this has been achieved this year. Liane Friedrich was appointed Executive Co-ordinator in April, to work for three days a week. The benefits to Architects for Health have been significant and appreciated by us all. We are now in a position to do more and to organise the resources of our members to be able to contribute to future developments. We also need to continue our search for further sponsorship.

Meanwhile, we have been working on initiatives for more comprehensive and accessible records of our events, on developing links with regions outside London, and on some educational initiatives. One good example of the latter was the seminar on health buildings, requested by the Anaesthetic Department of Charing Cross Hospital, held on the 6th June. We plan to develop all of these initiatives in the coming year.

Events

As always, our key activity has been our programme of events. This has been varied and popular, with attendance numbers frequently reaching 100. Details of the events are available on the website.

The motion for the Reform Club Debate in February, sponsored by HBD, was ‘The Public Sector Comparator has become more of a liability than an asset’. The motion was defeated.

The April event was entitled, ‘Innovative Developments in Briefing’, and was sponsored by NHS Estates.

The June event, ‘City Hospitals’, was sponsored by Dräger Medical Limited.

Unfortunately, the session planned for July, when Professor Roger Ulrich was going to present a talk entitled, ‘What I have learnt about health care buildings in the UK: Personal observations after eight months of immersion’, had to be cancelled, but has been rescheduled for January 2006.

In September there was a visit to the Evelina Children’s Hospital.

The October event, ‘Designing against Cross Infection’, was held at the Building Centre to coincide with the ‘New London Architecture’ exhibition, which included a hospitals section, showcasing hospital buildings of recent years, and currently under development.

Our final event, ‘Sense & Sensibility’ will be taking place here this evening, and is sponsored by Dräger.

I would like to thank all participants for their contributions in enabling us to offer a programme of events of consistently high quality.

Other Activities

Architects for Health continues to support the Howard Goodman Fellowship: Innovation and Adaptability in Healthcare Facilities at Imperial College.

Architects for Health also had stands at several conferences and exhibitions, including the Healthcare Estates/IHEEM Conference & Exhibition, and at Japan Hospex in Tokyo earlier this month.

This year we have been able to strengthen our links with the Japan Institute for Healthcare Architecture (JIHA). We first made formal contact with them when, as part of the National Japan 2001, we hosted hospital visits, presentations, and a reception at the RIBA. They subsequently invited us to visit them, and we organised a one week study tour in Japan for twenty four members in November this year. Our hosts were extremely generous with their time and the visit was a great success. Reports and photos of all the hospitals are being collated in preparation for the publication of a record of the visit. Our March event for next year is provisionally programmed for a presentation of the Japan visit. Many people contributed to the success of the visit, but in particular I would like to thank Junko Iwaya, for her major contribution to the preparations and during the visit itself, Graham Cooper, Liane Friedrich and Paul Mercer for everything they did.

Finally I would like to thank all of our sponsors for their support, and all of the executive members for their hard work. Mike Nightingale, Sue Francis, Doug Wantling and Femi Santos all retire this evening by rotation from the executive. I am sincerely grateful to each of them for their valuable contributions to Architects for Health and hope that they will continue to support us in varying roles.

For your diaries, the Reform Club Debate will be held on Thursday 16th February.

Ann Noble
24th November 2005

The Howard Goodman Bursary Update July 2005

Howard Goodman Fellowship: Innovation and Adaptability in Healthcare Facilities

Increasing demand for healthcare and changing trends in healthcare delivery pose challenges for healthcare infrastructure. Shorter technology lifecycles and evolving service models stand in sharp contrast to the long lifetime of physical building structures. These trends are creating new and increasing pressures on the requirements for future healthcare facilities.

This relationship between innovation and rapid change in clinical operations within the hospital and the supporting built infrastructure is of particular interest. The problems of meeting the resulting requirement for flexibility – defined in its broadest sense as the ‘ability to accommodate future changing healthcare needs’ – are amplified through the use of PFI because of the contractual obligations to use, or at least pay for, facilities over the long period of the contract. Change during this time is certain but unpredictable.

The aim of the research project is to develop an understanding of the impact of the delivery mechanism for healthcare infrastructure on the flexibility of healthcare facilities. In short, what approaches to the delivery of healthcare facilities are best able to accommodate continuous innovation in the healthcare sector?

Besides generating insights into the delivery of ‘flexible’ hospital facilities, the project will produce practical recommendations for policy makers and the healthcare sector generally.

The project is still evolving, drawing on input and feedback from expert discussions, and its objective and direction is subject to further definition. Over the summer exploratory interviews are planned in order to refine the project focus and to establish a comprehensive approach for the subsequent data collection process.

Architects for Health at Charing Cross Hospital

Ann Noble, chair of Architects for Health writes:

Architects working in the health sector frequently express concern that they have limited opportunities to talk directly to and explore and exchange information with clinical staff who will be working in the buildings they are designing. They also find that when the opportunity does occur it is usually too late to reap the maximum benefits from it: fundamental issues being already frozen and not available for reconsideration.

It was therefore both a delight and a rare opportunity for Architects for Health to be contacted by Dr John Pickard of the Anaesthetic Department at Charing Cross Hospital, London and to be invited to present at one of their in-house CPD meetings. Once every six weeks the theatres are closed for the afternoon so that staff can attend.

The interest in the design of hospitals was generated by recent discussions on the possibility of Charing Cross Hospital being closed and the services relocated on the existing Hammersmith Hospital site. Dr Pickard felt that if this should happen, the better informed clinicians are before being required to input to a development process, the better the input they were able to make would be. An opinion that we wholeheartedly endorse.

The meeting began with a ‘conversation’ from Dr David Bamber who talked about the dramatic developments in anaesthesia that have taken place during his professional life and referred to his involvement in the development of the current hospital which opened in 1972. (Providing another example of a hospital; being considered for demolition after 30 years of being in use.)

Architects for Health‘s presentation covered three topics. Roger Ulrich spoke about his work on the importance of the Internal Hospital Environment: including the impact of the internal environment on clinical outcomes, reduction of stress, patient and staff wellbeing, reduction of stress and the spread of infection. Ray Moss focussed on the geometry of hospitals: explaining why different forms were developed and how they have been able to respond to growth, change, shrinkage and adapt to different circumstances. For those hospitals that have been happily occupied over long periods, adapting in a stress free way to different circumstances, Ray identified three key parameters: The necessity of an envelope which encloses a large flexible area, of which the traditional pavilion blocks are a prime example, the importance that the dimensions of the envelope can accommodate different combinations of corridors and rooms and an engineering services strategy which allows easy access to services when the inevitable service changes are required.

The final presentation was given by Tony Monk. Tony selected some case studies of hospitals from his recently published book ‘Hospital Builders’ and thereby introduced the range and scope of health buildings that are available to be learnt from, and to inspire future builders and clinicians to aspire to achieve the best possible buildings. He emphasised the importance of being able to participate knowledgeably in the briefing process if this is to be achieved.

We hope that this seminar may mark a beginning of more direct exchanges between clinicians and architects from which the design of future hospital developments will undoubtedly benefit.

Ann Noble

The future of the Private Finance Initiative

Edited by Ann Rossiter
Report of the Social Market Foundation
Seminar series 2004
1. Cost and value for money
Overall, PFI initiatives have proved to deliver timely and cost-effective projects. Concerns regarding the costs of PFI have sometimes been overstated and have diverted attention away from am ore considered view of problems with PFI programmes. Some of those, associated with early PFI project, have now been resolved, particularly since the Treasury has ruled some areas as being unsuitable for PFI (such as IT projects). Issues that remain often relate to procurement expertise and the management of markets. The Treasury’s new guidance on Value for Money Assessment1 has been broadly welcomed by those involved in the PFI procurement, in particular earlier decision-making at the strategic level, and the introduction of qualitative assessment to decision-making.

The structure of some PFI contracts, with penalties for failure but without rewards for success, is one case of problems with the PFI. A more qualitative assessment of performance with the option of contract negotiation in the operational phase is needed to address this problem.

2. The evidence for PFI
An evidence-based approach to decision-making about PFI schemes is vital. This is one of the major areas of concern for PFI’s critics. It would be helpful for all parties to the debate around PFI to have more evidence on performance and costs, to justify, and improve, existing and future PFI projects. At present, some information is available on the construction phase of PFI schemes, but more evidence on on-going operation would be valuable. Publication of evidence should be encouraged.

3. The Public Sector comparator (PSC)
Some of the problems with the PFI have arisen because of the way in which the Public Sector Comparator (PSC)2 has been used. It is designed to provide a way of comparing the value of a project delivering through the PFI with a project delivered through conventional procurement. However, the PSC has often been credited with a level of scientific accuracy which is not warranted, since it is based on a sometimes arbitrary set of assumptions. While there still a role for the PSC it should not be regarded as a precise estimate but instead should inform the qualitative assessment of projects. The Outline Business Case3 is the correct stage at which to use the PSC.

4. Improving procurement practice
Establishing a pattern of excellence in PFI procurement has been hampered by the failure to always spread best practice across the public sector, due to poor skills transfer and knowledge management. This has been a particular problem for local authorities. Central govenment has not always struck the right balance between giving local authorities responsibilities for their procurement, and supporting them when they lack the necessary skills.

5. Long term contract management
Managing ongoing PFI projects over a 20 or 30-year term emerged as the greatest unsolved problem. Greater attention needs to be paid to long-term management at the strategic and procurement stages. The successful delivery of services through a PFI scheme depends on a number of factors, including clarity at contract stage. However the creation of effective long-term relationships between the parties is also
important. These may not be best addressed through the contract. Instead, good knowledge transfer, mutual understanding of needs, and trust between the parties need attention. However it should be said that failure to adapt in the long-term is a problem for public sector institutions, as well as those provided through PFI.

6. The need to manage the PFI market
Running a PFI tender is expensive. Under traditional procurement, tender costs may be 0.1% or less of total costs; under PFI, this figure may be 0.5% or higher.4 In addition, PFI can involve protracted negotiation, drawing the process out, and inflicting risk and cost on all parties concerned. Obtaining a sufficient number of bidders for real competition can also be troublesome and requires government to
take an active role in managing the market for PFI.

7. Competing in the PFI market
Bidding is a complex and costly process, and the prospect of investing in a PFI bid and losing it discourages all but the largest and best finances companies. The range of skills required – building, maintaining and services projects – means companies often have to form consortia to be able to meet al requirements. The returns for an individual company who must raise a large amount of equity to invest in a consortium are often slow to materialise and small, giving individual companies little incentive to maximise collective profits by ensuring they operate effectively.

8. Encouraging Competition
Those factors encouraging competition include:
• a stable market and visibly successful private sector firms. This should take precedence over encouraging competition in the short-term
• a shorter, sharper procurement process which lowers bidding costs
• well organised procurers with a clear conception of good value
• providing clarity about forthcoming procurement, for example by being transparent about where significant procurement programme will follow.

9. Market Innovations and the future of PFI
If PFI is to deliver projects in areas such as urban regeneration and social housing, more flexible models of PFI partnership, to allow smaller company involvement, need to be created. This may include allowing public sector partners to join private sector consortia to boost available capital.

Possible future methods of reducing bidding costs include:
• more LIFT-style partnerships5, with shorter procurement times increased standardisation of contracts
• fewer small PFI deals, where bidding costs are a high percentage of the total

10. Shortages of capable suppliers might be address by:
• partnerships like LIFT, needing less private sector equity
• direct government equity investment in PFI schemes
• stable markets attractive to bidders
• measures to make to UK construction industry in general appeal to international suppliers
• transparency about the pipeline of future work

11. (missing)

12. The Failing PFI schemes
Government’s response to failure on the part PFI has yet to be tested. This is of concern, since it raises questions over the correct assessment and allocation of risk by the market. The government should be willing to allow failure of PFI project, while ensuring the delivery of core public services through other means. (The Social Market Foundation’s main activity is to commission and publish original
papers by independent academic and other experts on key subjects in the economic and social fields, with a view of stimulating public discussion on the performance of markets and the social framework within which they operate. The foundation is a registered charity and a company limited by guarantee. It is independent of any political party of group and is finances by the sale of publications and by voluntary donations from individuals, organisations and companies. The views expressed in publication are those of the authors and do not represent a corporate opinion of the Foundation.)


Footnotes:

1 Value for money guidance is one of the key requirements a PPP project must meet. It must be able to be demonstrated through he Public Sector Comparator, that the PPP option represents the most effective method of delivering the output specification at the most affordable cost.

2 The Public Sector Comparator is a benchmark used in the course of procurement against which the value for money of bids is assessed by the Pubic Partner. It represents a notional cost estimate of the Project based on the assumption that the facilities and services which are the subject of the project are procured through traditional means with the Public Partner retaining managerial responsibility and exposure to risk.

3 The Outline Business Case is prepared by the procuring authority to establish the need for the project, and consists

4 Constructing the team, BEC and Sir Michael Latham, reproduced in Seize the Initiative, Dr Eamonn Butler and Allan Stewart MP, Adam Smith Institute, 1996.

5 The local Improvement Finance Trust initiative is the vehicle with which the Government intends to enhance primary and community healthcare by creating a strategic partnering arrangement between the private sector and NHS participants.

The Howard Goodman Bursary

Martina Köberle-Gaiser has been appointed Howard Goodman Research Fellow at the Innovation Studies Centre at Imperial College on the basis of the Howard Goodman Fellowship.

Martina Koberle-Gaiser trained as an architect in Germany and started her career in an architectural practice in Stuttgart, Germany. Amongst various other project types, she had the opportunity to work on a redevelopment project of one level of a University hospital in eastern Germany.

The technical challenges, social implications and the functional complexity of healthcare facilities initiated her lasting interest in this field.

In order to gain international experience and exposure, she moved to San Francisco, CA and joined The Design Partnership. There she was involved in the technical aspects of a major 5-storey hospital addition, the planning of a remodel of an emergency department of a children’s hospital and the project management of the design phases for the new construction of a social services building.

In addition, she studied project management in a modular programme at the University of California Berkeley Extension in order to strengthen her practical experience and to learn the underpinning theoretical tools and concepts.

After moving to London, Martina worked with Anshen/Dyer as a healthcare architect on the Children’s Hospital of the Manchester Joint Hospitals PFI scheme. During this time she gained valuable experience and became more and more interested in questions regarding the provision of healthcare facilities and healthcare delivery in general. In order to explore these issues further she finally decided to join the Innovation Study Centre at the Tanaka Business School, where she is currently also studying for a Master of Business Administration in the executive programme.

We are pleased to congratulate Martina on her appointment. She will introduce herself to Architects for Health at our AGM on November 25th.

Architects for Health November 2004