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Flair in the community

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The architect for Edgware's Community Hospital has been involved in one of the biggest consultation processes ever Edgware Hospital in north London has been at the centre of political controversy for some considerable time. In 1996, local MP Sir John Gorst resigned the Tory whip as a result of concerns at the hospital's closure. A strong and vociferous campaign throughout the following years kept the issue of medical provision in Hendon and Edgware high on the agenda.

In 1999, the Minister of State at the Department of Health, John Denham, explained that 'the first phase of the redevelopment of the hospital has already been completed, at a capital cost of £11 million, and I understand that a full business case for phase two is due for submission to the National Health Service Executive shortly.We have therefore given significant backing to the future of the Edgware Hospital.' (Hansard, 4.5.99: Column 699) As a politically sensitive project, albeit with government support, Edgware Hospital has needed to be treated with repsect for the concerns of the local residents, staff and patients; especially since 'Save Edgware Hospital' has been a particularly vociferous campaign.

For this reason, the client, Barnet Healthcare NHS Trust (now the Barnet Primary Care NHS Trust), initiated a major consultation exercise to achieve as broad a consensus as possible on the services that the hospital should deliver, and the future of the site.

The site comprises typical health authority 'housing stock' - a mix of buildings, from turn-of-the-century construction to post-war stock, with a variety of ad hoc infill structures dating from the 1960s. In general, it has suffered from the usual malaise of underfunding, poor maintenance and general end-of-life disrepair.As a matter of urgency, debate has centred on the need to sell off land and to restructure the service provision in line with national policy. One of the main questions for local discussion concerned the sell-off and/or demolition of the structures; how much land would be available for reuse, and which services would be retained. The local health authority decided to consult with service users.

The consultation process, called the Edgware Review, was unique in NHS procurement. The Barnet Primary Care NHS Trust and the Barnet and Enfield and Haringey Health Authority facilitated two large meetings at the RAF Museum in Hendon, at which 240 people, representing a cross section of interests, including local residents and patients, were consulted.

An external facilitator was appointed to chair the meetings and the results were translated into a brief by professional health planners, directors and the design team headed by architect Nightingale Associates.

The health services have stringent guidelines on essential specification and design criteria, so the consultation process was not able to challenge these rules, but they did provide input into land use policy, internal layouts and scheme aesthetics.

Four separate schemes have been developed by the architect for consideration by the Edgware Review group, comprising the client body, several delegates from the original consultation process, and the architect. The lay members of the review group were given limited authority, but their primary role was to audittrail the scheme development, to ensure that designs were progressing satisfactorily in line with earlier discussions. These audit committees are separate to design team, client liaison and site meetings.

Edgware Hospital's acute department has had to move to New Barnet, as part of the general shake-up of medical services, and the Edgware site will be retained as a community hospital. To carry out the works satisfactorily, staff will be decanted to accommodation within the existing building stock on site rather than to temporary accommodation at offsite locations. Services at the proposed Edgware Community Hospital will include a day nursery, treatment facilities, chiropody, minor surgery, and mental healthcare, and although the maternity wing has been relocated, a low risk birth unit has been retained.

The architect, which has carried out much of the consultation exercise without any increase in its fees, is dedicated to the idea that quality of design is an essential factor in lifting health care buildings above a 'basic' standard of provision. Nightingale Architects believes that the ability to provide better facilities through consultation with users, is an extremely valuable lesson from this scheme.

The chosen design option is a 'village' concept, featuring a main entrance opening on to a circular courtyard, a dramatic entrance canopy, and a massing which reflects the slope of the site and the existing buildings.

The scheme, provisionally valued at about £17 million, is scheduled to be put out to a single-stage selective tendering process in six weeks.

Enabling works have already started, and the main contract works should start on site by October and be completed in autumn 2003. The Building Research Establishment intends to use the building as a pilot study for the development of a hospital BREEAM standard.

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