The use of Department of Health Standards and Guidance: Effects on and Benefits to Healthcare Accommodation

The Department of Health (DH) is responsible for one of the largest estates in Europe. In this capacity, the DH produce and disseminate estates-related Standards & Guidance (S&G) to provide support to the briefing and design processes for new, and refurbishment projects in old healthcare buildings. The estate is made up of a variety of buildings, many ageing and in need of extensive refurbishment or replacement. It is therefore important to the stakeholders in the procurement and provision of healthcare environments that the DH S&G provide them with the information and data they need at the relevant time in the process to enable them to design and construct healthcare facilities that are safe and fit-for-purpose. Policy changes over the past 20 30 years have had a profound effect upon the estate. The estate was seen to be in need of modernisation, but Government lacked the extensive funding necessary to achieve anything like the extent of redevelopment required. The introduction of private sector funding to achieve this resulted in a major shift in the ownership of the estate, and latterly the regulation of the estate, both private sector and National Health Service (NHS). The NHS Constitution, introduced in 2009, was the first Government document explicitly to recognise the estate and the importance of it being fit-for-purpose. This research seeks to establish the importance of the DH S&G, and their benefits and dis-benefits to stakeholders using them, including organisations and individuals from the private and public sectors. The groups have differing roles and priorities and the research seeks to establish how these affect their requirements for S&G, how effectively the S&G meet those requirements and how they contribute to the overall provision of healthcare environments. Moreover, hospital accommodation has been proven to have an effect on the patients and staff, therefore, the provision of useful and helpful S&G could be seen to have an indirect influence on patient outcomes, and also on providing a pleasant and efficient environment for staff. The research has identified three major strands: Policy; the DH S&G themselves; and what is important to users about them and any benefits or dis-benefits incurred. Policy is viewed as the driver for the need for DH S&G. The changing political environment, amongst many other factors, affects how the S&G have been operationalized. This study of the application of DH S&G aims to establish how users view the benefits and dis-benefits and their effects on the healthcare environment. Research in the construction industry sector spans the scientific and social worlds, and the methodology is deductive research orientated, exploiting a range of data. Qualitative and quantitative data have been collected through open interviews with known experts and an on-line survey of the stakeholders using the S&G from private and public sector organisations involved with the provision of healthcare accommodation. Reference to the DH S&G and related unpublished DH documents traces their development and examines their content. The results have been mapped to the stakeholder categories (Designers, Service Users, Estates and Facilities Managers, Contractors and the DH/NHS), thus enabling comparisons to be made between each group, and between the public and private sectors. Analysis of the data identified the characteristics users found to be of importance and of benefit or dis-benefit. On balance, it was clear that the DH S&G are beneficial, but not universally. Of prime importance to its users is the DH endorsement of the S&G and its independence from commercial influences. However, the classification of the DH S&G, defined as best practice is often regarded and applied as mandatory. The content of the S&G varies in its scope, content and characteristics, being perceived as incomplete, inconsistent and out-of-date. Taking all these factors, therefore there is a danger that the DH S&G may contribute to healthcare buildings being unfit-for-purpose or out-of-date.