Clarity in brief for healthcare facility construction

It is critical that a health board formulates and then presents its requirements for the key building systems in a proposed healthcare facility (its "brief") in terms which are full, clear, and unambiguous, and that that brief is finalised before a contract is signed and Financial Close is achieved.

While development of the design can be carried over to a later phase, clarification of the health board's brief should not be. The health board, in consultation with relevant stakeholders and its clinical and technical advisers, is best placed to identify which output parameters of key building systems are required for the particular clinical uses it intends for the facility and its constituent parts (and how these uses may change and develop). These should be specified by the board as part of its brief and not left to the judgment of the project company and its subcontractors during the design phase. Identification of environmental output parameters should not be regarded as a matter of design; design should address how previously determined environmental parameters are to be achieved, not whether they should be achieved. In determining what the specified environmental parameters should be, the board should follow the recommendations in Scottish Health Technical Memoranda, including SHTM 03-01, in their most recent versions (which can and should be regarded as statements of current good practice), subject to any derogations agreed in writing by, in respect of ventilation, the board's Ventilation Safety Group (VSG). In the event of a derogation being proposed, the relevant recommendation should be specifically identified, and the derogation should only be agreed where there is convincing evidence that the proposal will provide a degree of safety no less than if the recommendation had been followed. If a proposed derogation is agreed, the reasons for it and any limitations on its application should be recorded, all as is currently required by SHTM 03-01 Part A Interim Version (February 2022) paragraph 4.10.

While a health board should follow the recommendations of the relevant current Scottish Health Technical Memoranda (subject to duly agreed derogations) in formulating its brief, and it may, separately, choose to include a general obligation on the contractor to comply with Scottish Health Technical Memoranda, it should never rely on reference to such a general obligation as a substitute for presentation of the brief in the manner set out below.

The purpose of the brief is to ensure that the facility and its building systems meet the clinical requirements of the board. Accordingly, the brief should include, as a minimum, a clinical output based specification for departments or other areas having a clinical function, setting out the patient cohorts and activities which these areas are intended to accommodate, together with a schedule of accommodation identifying how areas are to be laid out and their adjacency to other areas. In addition, the brief should include documentation identifying the environmental parameters of all spaces within such areas, including the ventilation parameters. There should be precisely specified references to air change rates, pressure differentials, levels of air filtration and temperature, the specifications being set out either in room data sheets or in an environmental matrix which comprehensively and exactly identifies every space within the proposed building.

While, as a matter of contract, design responsibility may lie with the Project Company, ensuring that the health board's requirements are met should be regarded as a joint objective of parties to be arrived at collaboratively. Accordingly, the procurement process should accommodate a gateway meeting prior to Financial Close at which a common understanding of the health board's brief is agreed and recorded.