How much should a PFI care home cost? This study looks at where the money went on a £2.19m design-and-build contract for two day centres and sheltered housing for 50 elderly people in west London. Compiled by ECD Architects and Head Projects

<b>PFI contract</b>
The London Borough of Harrow sponsored a private finance initiative bid, incorporating a limited design competition for the 50-bed care home and two day centres. Under the deal, the council undertook to purchase 40 of the beds with full service over a 25-year period, transferring the risk for the rest to the PFI provider.
The PFI contract was awarded to Ealing Family Housing Association, which procured the building and took responsibility for running it.
The project is a new departure for the housing association, which has concentrated on general-needs housing financed by traditional funding methods. It subcontracted the provision of care to Fremantle Trust, which was not party to the PFI arrangement.
In order to be as sure as possible of delivery, Ealing Family Housing Association decided to appoint a consultancy team with a strong track record in healthcare buildings. A design-and-build contract was considered best suited to the strategy of transferring the risk of cost and time overruns to the contractor.

<b>Development brief</b>
The brief agreed between the London Borough of Harrow Social Services Department and Ealing Family Housing Association was for a new care home housing 50 elderly residents, primarily on two floors, linked to two day centres, each for 25 people, and with some staff accommodation but no resident warden. The design had to comply with registration standards for care homes and the requirements of the council's social services department. Dual registration as either a residential care home or a nursing home required full wheelchair access.

<b>Design strategy</b>
The design was developed in response to a restricted site – a backlands area surrounded by residential gardens and overlooked on each side. A physical model was used to explain the proposals to local residents and overlooking problems were resolved through the detailed design.
The scheme is a two-storey T-shaped block with an east-west main axis that allows most bedrooms to face south. On the ground floor are two "houses" of 10 bedrooms plus a day centre, with 30 more bedrooms and a smaller day centre on the first floor. The day centres on both floors are in the east wing.
The ground floor of the home is wrapped around a secluded garden to the south-west and is split into two houses at each end. Each house has its own living and dining rooms, which are located centrally to form the hub of the building and open on to the garden. The main entrance to the home affords a view through a communal sunroom and into the garden. A hairdressing room is provided at ground-floor level next to the sunroom.
The first floor of the home is arranged around a central, toplit circulation space. The day centre and one of the 10-bed units is for Asian residents. There is a roof terrace that provides shading to the ground floor and gives the upper-floor living rooms their own external space. The day centre has access to a garden terrace from the dining room to the rear.
Shallow monopitch roofs rise up to the south and west where the high ridges help to enclose the garden.
The services core is situated between the day centre entrance and care home, with access set back from the main facade. This location minimises hard landscaping for vehicular access and maximises the gardens for the amenity of residents.
Caring for elderly people involves a sensitive approach to the special needs of people suffering from dementia and Alzheimer's Disease. These have had an influence on the design and layout, particularly in enhancing circulation areas, sight lines for supervisory staff and security.
Midway through the design process, the Department of Health published Fit for the Future, a consultation paper on standards for residential and nursing homes for older people, which had a significant influence on the design, particularly in relation to space standards, wheelchair access and the specification of finishes.

<b>Project cost</b>
The project cost parameters were set at the outset of the bid. Construction costs were benchmarked at £620/m2 for private sector comparable buildings, plus an allowance for site-specifics and agreed operational and specification enhancements to reflect contract delivery compliance.
The out-turn cost was £2 134 090, a rise of 5.7%, which was within the fluctuation margins identified at the outset. Most of the increase was a result of changes in the care provider's desire to improve operational cost over the life of the building – mainly the upgrading of specifications for finishes and additional fixtures and fittings.

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