6.29 The NHSScotland body should not be too prescriptive about what facilities and infrastructure the private sector should provide. Although the NHSScotland body should refer to the preferred option (for example new build on greenfield site) set out in the Outline Business Case, it should not prevent participants putting forward alternative proposals that are consistent with the NHSScotland body's business objectives. However, the parameters of any potential solution must be sufficiently specified to prevent participants developing proposals which the NHSScotland body could not consider - for example, facilities and services outside the scope of the project or an unacceptable geographical location of the facilities.
6.30 Any constraints that will place restrictions on participants when they are developing solutions should be stated. For example: restrictions on planning permission, access to the site during the construction phase or the need to keep hospital services operational during the construction phase.
6.31 The NHSScotland body should set out the minimum building design quality, facilities and services required in terms of outputs and outcomes that are needed to provide an appropriate environment to deliver health care services to patients in a manner that is consistent with the NHSScotland body's objectives in terms of risk transfer and value for money.
6.32 Traditional procurement approaches allow a "trial and error" attitude during the development of the detailed design with solutions being created and modified in an iterative process. This is appropriate for a client organisation where the detailed design comes before a contractual commitment to build. It is hazardous in the PPP environment where increasing contractual commitments are being made with a private sector partner before the detailed design is complete. Some elements of evolution in design is both inevitable and healthy as different professionals discuss service needs and potential developments. But it should be possible to reduce uncertainty without stifling innovation and PPP requires clearer thinking from the outset. Time and effort invested by the NHSScotland body at this stage will greatly assist the PPP process and thereby improve potential value for money.
6.33 The requirements for the design should be defined by identifying the outcomes and outputs required. These requirements will set the framework for the design within which the more detailed requirements for the services to be provided as part of the scheme can be accommodated.
6.34 A good design makes the best use of valuable resources. It must also be achievable. A well designed building should do exactly what you need and will do it in an efficient manner. Within the basic cost of fulfilling the need, it will also provide as much extra added value to the lives of those who use it.
6.35 The output specifications should address issues of design and design quality that will be important to the scheme. One key area which should be addressed is the degree of flexibility and adaptability of buildings the NHSScotland body requires to allow for changes in the operations of the NHSScotland body throughout the contract period. These concepts can be very difficult for the NHS to articulate, given the potential for change in future patterns of service delivery, but factors to bear in mind include:
• flexibility - during a building's lifetime its constituent parts may have to fulfil more than one function due to technical advances and changes in medical treatment techniques. Flexibility should be an in built feature of the design to allow for minor adaptations and alterations to be undertaken without the NHSScotland body incurring excessive costs. The capacity for the building to respond to these changes will also assist in guarding against the risk of the structure becoming obsolete before the contract end;
• adaptability - the capacity for major change for any healthcare building in relation to either its expansion or contraction is a risk that should be estimated at the time of the initial design conception.
6.36 The NHSScotland body should give examples of key factors which will be considered when assessing flexibility and adaptability such as growth, change or contraction which the design will have to demonstrate that it can fulfil.
6.37 Flexibility and adaptability are achieved at a cost. The NHSScotland body should take the appropriate advice on the cost implications of requirements within the output specifications. The extent to which participants are asked to include an allowance for flexibility and adaptability in their designs should also be reflected in the CPAM.
6.38 The output specification for facilities which are fit for purpose require architectural and environmental standards that will have to be set in consultation with specialist professional and technical advisers and with reference to statutory requirements, the NHSScotland body's overall design philosophy and NHS guidance. Guidance should include Scottish Health Facilities Notes, Health Building Notes, Design Guides, Scottish Health Technical Memoranda, Scottish Health Guidance Notes, Scottish Hospital Technical Notes, Health Technical Memoranda (England and Wales), Health Guidance Notes (England and Wales). This guidance is available on the Health Facilities Scotland website. Other issues to be covered include:
• operational issues;
• spacial and functional relationships;
• clinical adjacencies;
• the type of environment - the use of natural light, external views, de-institutionalised atmosphere etc;
• access arrangements for staff, patients, visitors, suppliers and disabled people;
• use of labour-saving technology and designs;
• rationalisation of resources by use of flexible facilities (multi-purpose rooms, operating theatres etc), the grouping of facilities and extending the working day;
• the provision of staff amenities;
• links with community care providers and potential scope for integrating the use of facilities;
• site master-planning to allow for the possible down-sizing and/or expansion of clinical departments;
• environmental standards including, for example, the NHSScotland body's objectives in terms of energy efficiency and for reducing and recycling waste.
6.39 The NHSScotland body should have a clear idea before it commences the procurement of the extent to which it will need to approve the clinical functionality of the designs provided by the private sector prior to financial close.