NHS Estates' acting chief Peter Wearmouth has to please doctors, patients and contractors. How?
Stung by accusations of delay and disorganisation, NHS Estates is preparing to introduce a string of measures to make it a better client and transform hospitals into consumer-focused facilities.

It is responding to contractors' concerns over the time and cost involved in PFI bidding by proposing framework agreements to cover future PFI deals (see main story).

Poor briefing skills in the health service have been blamed for shortcomings in PFI hospitals, a criticism NHS Estates acting chief executive Peter Wearmouth accepts. "When the PFI was launched, I felt we went too far towards the private sector, and we ended up not having the right briefing skills," he says. "We now need to look at the skills within the NHS." To address this, a bespoke training programme has been established at Lancaster University, which all project directors must attend, and a "good client guide" has just been launched.

Another criticism Wearmouth accepts is the view that the PFI is incompatible with Egan principles. Whereas partnering involves a contract between client and constructor, a PFI contract is a deal with a special purpose vehicle – a consortium of financiers, contractors and facilities managers – making it impossible for the client to insist on Egan principles. To get round this, he proposes insisting on Egan-style contracting in PFI documentation. "You put it into the documentation and ask the SPV to tell the contractor to adopt Egan-style practices."

Following intense criticism of recent hospital architecture, a raft of initiatives aimed at improving design are being rolled out, from the appointment of the Prince of Wales as NHS design champion, to a joint statement of intent with the Commission for Architecture and the Built Environment, to be launched this month. A guide for NHS Trusts, Achieving Excellence in Design, is also out this month. Wearmouth promises to look at whether increasing capital budgets can lead to design improvement that will ultimately save money.

NHS Estates is also attempting to move away from the perception that it is only interested in lowest-common-denominator healthcare buildings designed for the convenience of hospital staff rather than patients. There are reports that senior clinical staff are dictating the layout of hospitals by insisting on large private offices with windows, placed close to operating theatres. This means the location of wards is often of secondary importance.

We’ve got to address the rising expectations of consumerism

"The bottom line is the NHS is more interested in practicalities than aesthetics," says the DoH's Peter Coates. "The NHS is always looking to get the maximum for its pound, so that creates tensions."

To tackle this perception, Wearmouth is initiating a drive to turn the NHS into a consumer-focused organisation. "In public health, we've got to address the rising expectations of consumerism. People demand better buildings. We've got to make sure our hospitals achieve patient satisfaction."

Hospitals do not stand comparison with the facilities on offer at supermarkets, he says, listing inadequate patient parking, lack of visitor amenities such as nappy-changing rooms, and vast, impersonal wards as among the relics of the utilitarian NHS. "If you go to Asda or Tesco, you can always get car parking. There's significant work to be done to modernise hospital design for the 21st-century consumer."

He accepts that this will mean bigger hospitals – and bigger budgets. "That's all going to cost. The building envelope is going to have to increase. It could cost up to 15% increase in capital," Wearmouth admits.