It is wrong that clinicians are overruled in hospital design process

READING about the delay in the construction of the new children’s hospital in Edinburgh (“Setback for £159m hospital”, The Herald, August 22) I was struck by the comment blaming “unavoidable technical construction problems”. Here I have to declare an interest, having been the most senior healthcare architect involved in designing the exemplar scheme on which the bids were based.

The NHS was warned that the exemplar scheme was not properly finalised prior to the bid stage but we were told the layouts had to be issued to meet a deadline. The view was that any construction issues would be resolved by the bidders during the competitive dialogue process. I am therefore struggling to understand why the winning bid is now encountering problems. However, I can hazard a guess.

During the exemplar design process I attended room layout meetings with clinicians where the comments on some layouts varied from “totally useless” to “completely unacceptable”. Yet at bid stage we were told that the clinicians had signed off the relevant department layouts so it had to be built that way.

The bid consortium I subsequently joined analysed the plans and concluded the exemplar scheme was indeed seriously flawed with, for example, columns in the middle of rooms, bedrooms lacking adequate daylight, and so on. Building an underground car park and service area on a flood plain is also not a good idea and adds significantly to costs. Our team therefore developed an alternative set of plans to remedy these issues. However this strategy was rejected by the project managers who reiterated that the exemplar design had to be followed. Judging by the plans submitted for planning this appears to be more or less what’s being built.

There is a fundamental problem in such projects whereby project managers – who are used to managing process and costs – can effectively overrule clinicians who manage the treatment of patients. A minor cost increase can often deliver disproportionate benefits that can be recovered via more effective delivery processes over the lifetime of the building. Unfortunately it is rare to encounter this level of foresight within project management teams.

Incidentally, our bid was the best clinical design solution in my view and had resolved many of the construction and technical problems. It was also the cheapest. Despite that we were placed last in the scoring. Robert Menzies, 2 Burnbrae Gardens, Falkirk.