The Cole treatment

As head of estates planning at Health Estates in Northern Ireland, Cole provides design and procurement expertise to 19 health trusts in the region with a £650m portfolio of live development. Cole has revolutionised hospital procurement in Northern Ireland through innovations such as design benchmarks, architectural competitions and performance-related partnering.

The results are incontrovertible – the £10m Royal Belfast Hospital for Sick Children, completed in 1998, was the first public sector building to win the Royal Society of Ulster Architects' prize. The £42m Royal Victoria Hospital, the outcome of a major design competition, is four months ahead of programme and already widely admired – not least by the Commission for Architecture and the Built Environment. Its chairman, Sir Stuart Lipton, who described the first 15 PFI hospitals as "disastrously poor", has been picking Cole's brains on the subject.

CABE is determined that those responsible for procuring the next tranche of PFI hospitals – 18 over the next two years, worth £2bn – learn some lessons from his approach. And the political conditions have never been more favourable: the Treasury has undergone a Damascene conversion to best value and there is a growing consensus that good hospital design means faster patient recovery and greater financial efficiency. But what does the man himself think about the prospects for the 21st-century NHS? Cole divides the problem into two parts. The first concerns people – and here he is emphatic: "You can't do it for the first time and get it right. You need people who have learned from experience." Speaking as a former architect for Health Estates, he points out that one effect of the dismantling of the civil service in the 1980s was the amputation of in-house design departments.

Cole is hopeful that a series of think tanks, set up last September by health departments across the UK, will produce a fresh pool of specialist knowledge for those procuring hospitals. Cole is chairing one of six think tanks, on design and building of healthcare facilities, while others look at everything from engineering to IT. The research units include private and public sector clients, academics, architects and construction professionals. Their findings will feed into an information and learning centre to be set up in Leeds.

The second element is the extent to which quality is an explicit goal of procurement. "The key issue is that in order to procure a highly complex building like a major hospital, you need a focus on quality – and in too many cases the focus has been on cost.

"In the profession as a whole, there has been an element of deskilling. Architects have been working for less than the proper fees – the top 12 hospital architects were submitting 70% discounted fee bids to win work." So, six years ago, Cole devised a way of foiling this cut-throat fee bidding by building in a design quality threshold. This means that Health Estates sets a fee scale "somewhat below the RIBA scale but which we know would allow them to do the job properly", then invites architects to prequalify and attend design interviews. The client then selects an architect to work up an exemplar design over six months.

"This allows the architect to go through the full evolution of ideas and concepts until he can understand our needs. We turn that into an exemplar drawing and issue it as part of the briefing in the next stage tender. All the bids are then measured against that design quality threshold by independent assessors." This method has been identified by CABE as a solution to a fundamental problem of the PFI bidding process – the urgent, competitive scenario that prevents communication between architect and client, so that consortia have to produce detailed plans and costs on the basis of output specifications, for example the number of patients a facility has to serve, but not space standards or technical requirements. This, and the fact that they were working at risk, has generally precluded groundbreaking or stunning results.

"One of the expectations of PFI was that you would get innovation from the private sector. You cannot get innovation unless you invest in research over the design period," says Cole.

CABE has been so impressed with Cole's method that its project-enabling group is promoting it as best practice for PFI hospitals. Sunand Prasad, chair of the commission's project-enabling group, says: "He has a very intelligent approach to PFI and has put it into practice – he has devised workable solutions. The industry is crying out for practical solutions." What's more, the Treasury appears to be listening, and has published an article by Cole on exemplar design in its PFI Journal.

Cole has a similarly design-oriented take on the relationship between architects and contractors. "We don't integrate the contractor and design team from day one. I believe the architect and the client should create a vision and a concept before issues of buildability come in. If you integrate the design team too early, you compromise your design elements." "Once we have a conceptual design with a quality performance specification, we invite contractors to demonstrate how they will build it for a target cost. As long as they meet our guaranteed maximum price they will be offered up to three jobs in a row." Ultimately, clients must face up to paying the right fees for the right service, says Cole. "Input always equals output. Unless you put the resources into a project, you can't get the detail, design options, creativity that you are looking for." Let's hope that CABE and clients like Cole can spread this wisdom. If they do, the next wave of PFI hospitals will be as dazzling as their predecessors were dull.