Field Hospital

Finchley memorial hospital in north west London is operational, even though it is not finished. As I walk around across the car park four fast-moving diggers are shifting heaps of earth. This is not just for a few shrubs: the hospital is the centre of a 9ha health campus. 

It sounds ambitious and yes, there was a ‘vision’. But in some ways the campus is accidental. The old hospital sat on the corner of Granville Road and Bow Lane in Barnet in front of boarded-up playing fields, the legacy of some ancient land deal between boroughs.  As the Edwardian hospital started to crumble NHS Barnet examined the options either to bring it up to standard, or simply get rid of it. Demolition looked more expensive so the question arose of whether to build a new building on the playing fields next door. At this stage the project widened and the list of stakeholders expanded – from clinicians and planners to the local school, residents overlooking the site, Sports England and the Playing Fields Association. 

‘There was an infectious enthusiasm,’ says architect Marc Levinson of Murphy Philipps. He and Jan Charman, project manager for Barnet, agree that there was more than a degree of Olympic fever in the mix during the planning forums in summer 2009. And for Levinson it was a huge freedom. From looking at squeezing the replacement hospital into a tiny corner to minimise landtake, there was suddenly the whole space to play with. The planning permission however – supported as  required, when building on designated playing fields, by the Greater London Authority – stipulated that the same amount of green space be returned to the community. 

Working with the NHS SHINE network, which promotes and encourages sustainability in myriad ways, brought wider health issues to the fore. Perhaps this also foreshadowed the current move to shift more public health responsibility onto local authorities as Strategic Health Authorities are dissolved. Murphy Phillips was already working on Local Improvement Finance Trust (LIFT) projects in the borough through Elevate Partnerships. But the hospital’s feasibility studies were outside that. The plan that got the go ahead had the hospital set at the back of the site, bringing people to it through the green spaces, but also making the green of the campus more immediately accessible as an alternative route parallel to nearby streets. The sports pitches were sited alongside Our Lady of Lourdes Primary School to make it easy for pupils to reach them. 

The hospital itself was conceived with a soft edge to the campus. Initial ideas even suggested that therapy gardens might be open to the park land and changing facilities be shared. Neither of these came to pass but the echoes of that strategy can be seen in the simple 19cm high open fencing which is different from the 3m high recommended by Secured By Design. A café, conceived as a separate volume in glass and slate, sits outside the hospital’s front entrance, also to draw in casual visitors. In a residential area bordering the big industrial buildings that line the North Circular Road this is a significant development. How the ‘campus’ will be run and promoted, beyond immediate booking, will be up to the centre manager.

At £26m Finchley Memorial Hospital was an exception to the local LIFT contract. But an analysis of procurement options, including PFI (this project was too small) and traditional contracts (fine but no funding for this), showed that using LIFT as a vehicle via a bespoke contract would reduce procurement time and programme by about a year. This makes it the largest LIFT scheme so far.

Softer issues of working relationships don’t seem to have been included in this analysis but it is clear that the relationship built up over a number of projects between architect Levinson and NHS Barnet’s Charman smoothed the way. The briefing and consultation have been held up as a model both by SHINE and also by the RIBA in a forthcoming publication on the subject.

Neil McElduff, then NHS Barnet’s director of commercial and corporate services and now senior regional director at Community Health Partnerships (which took on all the LIFT relationships from 1 April this year), based the initial briefings on asset management principles. ‘I didn’t want a white elephant,’ he explains. And for all the concerns about programme the consultation process was a major part of formulating a robust brief.  McElduff recently toured the hospital with a private sector provider who commented that there was too much open space. But McElduff points out that the cost per metre unitary charge (in which capital costs are the largest part) is the second lowest for LIFT projects in London.  Although Barnet’s audit of green spaces showed it didn’t need any more Elevate Partnerships, as the LIFT company it took on the land and will maintain it as part of the deal.

The hospital is arranged with consulting rooms around the perimeter of two kinked blocks while the public enters the light and airy heart of the building before being fed out to GPs, imaging, physiotherapy and so on.  Upstairs are overnight rooms for those being transferred closer to home from larger hospitals and working on their rehab plus plenty of small social spaces including outside terraces overlooking the therapy gardens where they can practice stairs, ramps and the other complexities of urban life.

Flexibility, one of the key asset management and design principles, showed its value through the building process.  Instead of working to specific room dimensions for different services, each of which may preclude other services, the consulting rooms are all 16m2. Just six months before completion the walk in surgery and GP spaces were swapped around – without necessitating any changes to the construction. And, more significantly, the recommendations of the Darzi review High Quality Care for All in 2008 and the ‘Care closer to home’ agenda were able to be incorporated – even after the windows were already installed. As the first reduced the number of bedrooms from 54 to 49, the other made an infusion suite for intravenous drugs a critical part of the mix. It was all sorted out a few space swaps later, with very little disruption to construction. 

This flexibility will no doubt prove critical to the efficient use of the hospital through the frequent changes that seem to beset the NHS. Just like the campus itself, this building is not yet finished. 

THE COMMISSIONERS

Who would be the client for another Finchley Memorial Hospital? A month after a major NHS organisation has come into action we review who commissions what.

> Community Health Partnerships (Partnerships for Health until 2007) took responsibility for  the 49 LIFT partnerships which cover about 60% of England, mostly in the north. This Department of Health (DoH) owned body works closely with the clinical commissioning groups and NHS Commissioning Board. It will support individual trusts in LIFT areas, who want to do their own developments, on strategic estate issues. A Strategic Partnering Agreement allows local trusts and hospitals to use any LIFT company without going through extra procurement hoops. 

> Trusts, foundations and health providers who use most of a facility. Trusts and foundations have control over their destiny if they can fund it. There are also far smaller facilities where users that have 50% plus of a facility have been charged with its stewardship. McElduff points out the flaw though: the policy encompasses anything from a tiny surgery to major community hub that needs proactive management. 

> ‘Prop Co’ The DoH-owned NHS Property Services Ltd took on the residual NHS estate of around 3600 ‘assets’, valued at around £5bn, this April. It will focus in the first year on stability, working most closely with local NHS organisation. 

‘People say there is no money,’ says McElduff. ‘But there is. Existing buildings are used because they’ve always been there but if they’re not fit for purpose they just tie up capital.’ Reviewing estates and making them work harder continues to be at the core for areas covered by LIFT.