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One of the most important issues for those involved in PFI schemes is design. Design has an immediate impact: it is the first thing you notice before you enter a building. Once inside, design is apparent in the way in which the building is planned, the ease with which you move around, the effect on you of your surroundings and so on. Design issues are of particular interest in health sector PFI projects at the moment, given the recent media furore.

Key guidance can be found in Design Development Protocol, a document issued by the Department of Health and NHS Estates in January. In addition, there is the Treasury guidance note How to Achieve Design Quality in PFI Projects and the Department for Culture, Media and Sport document Better Public ºÃÉ«ÏÈÉúTVs. The thoughts of these documents can be summarised as follows:

• "value for money" does not necessarily equal "lowest cost";
  
• good design can have beneficial effects on whole–life costs;
  
• good design can have beneficial effects on users, staff and the wider community.

The intention is to emphasise the need for the NHS trust to ensure that design issues are brought up early in the PFI procurement process and are kept in the foreground throughout.

For the private sector, of course, it is always a matter of expense. The various levels of design that have to be submitted throughout the bidding process can cost a considerable amount of money and will, for all but one of the bidders, prove to be unrecoverable.

There are, of course, complicating factors for everyone. While the standard NHS project agreement and, to some degree, the design development protocol are based on the premise that NHS PFI developments take place on greenfield sites, the reality is that most developments occur on congested sites that are operational throughout the build stage. Planning issues and local authority limitations, in terms of access routes, development lines, building mass and height, listing issues and, sometimes, external appearance and finishes, add further constraints.

Government concerns about design standards have resulted in initiatives to ensure that trusts engage with the Commission for Architecture and the Built Environment and NHS Estates as they move through the procurement stage. Undoubtedly, both CABE and NHS Estates will offer the opportunity for trusts to benefit from wider and deeper experience of design issues, but it is not yet clear exactly how this will work in practice. Hopefully, the involvement of these bodies will not endanger what is often a very tight project timescale.

Further, a vital issue for trusts when considering design is the need to ensure that design sign-off proceeds efficiently. Once the preferred bidder has been selected, it will want to ensure that its design meets the trust's requirements and get it signed off as quickly as possible, before financial close.

In practice, of course, there will probably be some overrun past financial close when the remaining design elements have yet to be formally signed off. But on any PFI scheme it is important that the key elements of the design and, at least, representative drawings for all areas of the hospital will have been agreed by the parties before close. It is vital that the trust has a sign-off procedure in place involving multiple users and is ready to adhere to a disciplined timescale for response to the design.

To summarise, there is a great deal of pressure regarding the development of design on both public and private sectors in the PFI process. The steps that have been taken in health sector PFI to provide guidance and regulate the design process are to be welcomed, and no doubt we will see similar processes working their way through into other sectors in which PFI is developing.

There is always a balance to be struck between overall design quality, the public sector's desire for innovation, and the constraints placed on this by planning and affordability. The constraints of affordability often make the process a difficult compromise for everyone. It is, however, obvious that design is a crucial element in the PFI process not only in terms of its affordability but also the wider impact it makes on those that use the facilities.