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Introduction
This report relates to proposals for the re-provision of the Royal Hospital for Sick Children (RHSC), Edinburgh, incorporating the Department for Clinical Neurosciences, in a new building within the Royal Infirmary of Edinburgh (RIE) campus. The project was discussed at an A+DS Design Review Workshop held on the 12th July 2011 in The Lighthouse, Glasgow and an interim report was issued on the 2nd August 2011. Following a submission to Edinburgh City Council on the 29th July 2011 for Planning Permission in Principle, A+DS reviewed the associated drawings and information again, and have updated the report accordingly.

History of A+DS Involvement
A+DS has had some previous involvement with the project through the Healthcare Programme, with two Enablers being made available to the Project Team in the early part of 2008. One was appointed to help commission a masterplan for the wider RIE site whilst another was appointed to assist the Client Team through the briefing and early procurement stages; however their involvement was very limited in comparison to the scale of the project.

Since the Enablers’ commissions ended there has been some further engagement with the project. A+DS staff engaged in the AEDET sessions, providing comments on the developing proposals in October 2009 and May 2010.

A previous scheme was then presented to A+DS on the 24th August 2010, with a subsequent workshop on the 9th September 2010, presentation meeting on the 6th October 2010 and a further Design Review meeting on the 2nd November 2010. The last interim report on this scheme was issued along with two supplemental notes on the 10th December 2010.

Some of the main issues arising from the reviews of the scheme in 2010 were as follows:

• We supported NHS Lothian’s aspirations for the re-provision of the RHSC, particularly the vision that it should be unique, enduring and a landmark.
• Concern regarding the legibility of the RHSC proposals from outside the site, clear wayfinding being essential to fulfil the objective of lowering stress, and the need for the arrival sequence to better accommodate parents bringing children to the hospital by car.
• RIE arrival sequence being significantly amended with the ‘front door’ largely reversed, bringing the buildings eastern elevation into the experience of the city’s public realm through amending bus routes. This requiring to be managed via adequate subliminal and actual signalling.
• Need for landscaping to create external spaces of continued amenity for the children, young people and their families.
• Potential for courtyards and roof gardens to create distinctive and usable spaces for therapy, play and respite provided these are adequately daylit and sensitively designed.
• Commended the concept of the ‘ozone’ and the language being developed for that, encouraging the Project Team to take this further to allow greater connectivity with the landscape, external spaces and A+E.

Current Proposals
Since proposals were seen at Design Review in 2010, we note the following significant alterations have been made to the Project Brief:

• Re-introduction of the Department of Clinical Neurosciences (DCN) to the scheme, requiring approximately 12,000sq.m of additional accommodation.
• Incorporation of an autonomous Energy Centre in response to the requirement for the facility to be ‘self sufficient’ in terms of energy (i.e. not relying on existing site service infrastructure) due to the potential for contractual issues between different private sector developers.
• Relocation of the existing helipad within the RIE campus on to the roof of the proposed RHSC building.
• Proposal for Facilities Management Services and some of the RHSC car parking provision to be accommodated underground in a basement storey, subject to testing for flooding etc.

Out with the development site boundary, we also note that a single storey extension to the existing Chancellor’s Building for a Neurology Clinic has been consented adjacent to the proposed RHSC building.
A+DS Views

1 General
1.1 We understand the reference design submitted for PPP is intended to test the likely impact of the development on the RIE campus, including the implications on transport and movement around the site, wayfinding and views etc, and that the Project Team’s approach thus far is not intended to be a definitive design proposal. As advised within the Design & Access Statement, ref NA/10727/X(100)X/15, we note the intent behind this design to be “that either a fully developed version of this reference design or an entirely new version (maintaining the core principles of the clinical functionality of the reference design) will be submitted by the successful NPD bidder”. The following comments are therefore intended to highlight strengths and risks in the reference design, as well as areas of focus for future work with regard to both the planning process and the brief given to the bidding teams.

2 Response to the indicative scheme presented
2.1 Relationship to Wider Context
The RHSC site sits at the bottom of a landscape basin; the slopes of which we highlight are consented for significant development changing the nature of place from semi-rural to urban intensities of form and use. Either side of this basin are landscape and historic features that are visible at parts of the route along Old Dalkeith Road, particularly from higher elevations. Similarly, the site is visually prominent along this route, particularly from the broad vistas at the two existing main entrances to the RIE. We therefore believe the development of the RHSC provides an opportunity to significantly improve the nature of this area of the city and the experience of arriving in the city. As part of a co-ordinated and three-dimensional approach to development within the basin, this site offers greatest potential to break the uniformity of scale and massing to provide articulation and focus to the new area through the use of height and parallax, and sculpting out places with identity and amenity. However, the current Planning Policy appears to be prioritising the maintenance of views over this area, above the creation of place within this developing urban context.

We acknowledge that the reference design has been developed within the existing policy context. It shows that providing the required accommodation within the height restrictions on the site tends towards the development of a compact form with small courtyards and limited access to daylight, views and landscape (including external play areas) for many of the patients. We note that it also includes approximately 2,500sq.m of the required accommodation within a basement. It is still to be demonstrated that this is a viable option considering the flood risks inherent in the site and we highlight it is possible that the volume of accommodation above ground may have to increase, thus exacerbating the pressures on proposed plan of the building.

We believe the reference design demonstrates that there are significant risks and disadvantages associated with the constraints of the current policy approach to context. Further, we suggest that there are potential benefits to the local context in allowing the development to have greater visual prominence; provided of course that the scheme design is of sufficient quality to be a positive landmark in this area of the city.

2.2 Site Navigation
We consider that the approach described to the main site entrance, by creating a sequence of urban spaces - one linking the RHSC parking and the RHSC building, the next conceived as a heart linking the adult areas of the campus - has significant potential to provide both clarity of wayfinding and a positive arrival experience. Realising this concept will require the existing transport and landscaping provision to be unpicked, and re-planned along with careful consideration of the proposed extension to the Chancellor’s building through a public realm masterplan for the entire RIE campus. Notwithstanding ownership boundaries, such a masterplan should:

• Assist wayfinding
• Resolve pedestrian/vehicular interface, including access to the underground car park (if delivered)
• Create usable quality spaces
• Consider the nature of the public realm proposed towards the entrance point to the site in light of the limited number of people who are likely to arrive by foot

We also refer the Project Team to the latest Scottish Government guidance on Designing Places and Designing Streets in this regard.

In contrast, the current sketch proposals for the south entrance to the site demonstrates less potential than previous schemes, with the combination of two A+E entrances and an energy centre unlikely to provide a welcoming impression approaching the hospital campus, and the city, from the south. We suggest there are opportunities to connect the landscape in this area at different levels by utilising the existing burn, trees and topography as features to enhance the initial view and the amenity for users of the facility. This aspect of the proposals should be developed significantly in terms of routes, landscape and built form as the scheme develops.

In addition to the above notes, we refer to our previous comments on the nature of the RIE arrival sequence with the ‘front door’ largely reversed, bringing its eastern elevation into the experience of the city’s public realm through amending bus routes.

2.3 Building Diagram
The building diagram was described as having 3 zones: a public zone containing consulting areas and the less technical parts of the hospital; a clinical zone containing theatres, diagnostics and inpatient accommodation; and a service zone. We acknowledge the idea of pulling out the public functions of the children’s hospital into a distinct element and it has significant potential to break down the mass of the RHSC building, hence making the experience of visiting less daunting. It may also allow opportunities to ‘normalise’ the experience of prolonged periods as an inpatient – for example creating a ‘journey’ to school.

However, we feel the clinical zone is less successful. It contains both RHSC and DCN functions and as such maintaining the identity of each and the connection of children’s wards to the public zone (rather than feeling like part of the DCN/adult hospital) will require very careful planning and design. The routes, spaces and opportunities for views within the clinical area appeared highly constrained by both the intensity of the proposed floorplate and the proximity of the service zone, which present a barrier between the occupied areas and the landscape rather than allowing a ‘softening of the building to the south to connect with the landscape’ as described in the presentation.

In the scheme originally presented in August 2010, we were encouraged by the clarity and amenity of the ‘o-zone’, which was particularly strong as a welcoming, non-institutional space. Such qualities need to be re-introduced into the developing proposals providing connection, child scaled spaces, and common identity between young people’s inpatient areas and the rest of the RHSC. It should also extend to and link with the landscape/external spaces which provide amenity and breakout for young people both inpatient and, preferably, out patients. Furthermore, onward connection of the ‘o-zone’ to A+E would add to the sense of a single young people’s hospital and provide easy access for those at A+E to external spaces for respite and to facilities such as catering.

2.4 Indicative Images
The 3D sketches provided as supporting information to the PPP application are helpful in explaining the intent of the reference design; however in some there appears to be confusion between what is drawn in plan and what is included in sketch form. In particular, the sketch of the public realm strategy does not show the ramp down to the basement parking area and its effect on the main entrance area.

Further, the sketches provided of both the external spaces and the ‘o-zone’ suggest an environment (both in articulation of elevations and the use of art) that might appeal more to pre-school children than older children. We encourage the Project Team to develop a language that is more cognisant of the range of young people who will use the facility, and refer to the concept design proposals presented by the Project Team during the earliest discussions as being more successful in this regard.

3 Recommendations
3.1 The Planning Authority
We recommend the Planning Authority:

• Consider the PPP application in masterplanning terms only, leaving significant latitude for the RHSC’s eventual designers to respond to the issues described above rather than be constrained by the envelope drawn in the reference design.
• Establish a firm rationale for view corridors in relation to this new urban setting; describing where views must be retained, and where they might be interrupted along a route in order to meet the other objectives described above such as aiding wayfinding, providing identity, and improving the landscape and visual amenity for patients, families and neighbouring developments.
• Provide strong design guidance on the spaces, routes and landscape corridors across this area of significant change - across boundaries of use and ownership - to provide co-ordination within this important new city district.

3.2 The Project Team
We recommend the Health Board and the Project Team:

• Address the masterplan of the whole ERI site with regard to creating a coherent place considering not only the proposed building but also the consequential reorientation of the adult hospital.
• Consider how areas with non-critical adjacencies, evident in the clinical adjacencies diagrams presented at the meeting in July 2011, might be clearly expressed as such in the briefing given to bidders, allowing room for manoeuvre in the developing design rather than simple adoption of the plans provided as part of the reference design. Further, allowing adjacencies to be accommodated vertically (as was shown to be beneficial in planning the new Stobhill Hospital) could free up opportunities for greater connectivity with landscape for play and respite, positive views to existing features around the site and beyond, good quality daylight in occupied spaces; all of which have been shown to have a material impact on patient outcomes.
• Compliment the clinical briefing being established with strong design standards, describing: core aspects of the patient’s, staff and visitor’s experience; what the development must achieve at these key points, and benchmarks (views of what success might look like) based on recent good practice. The achievement of these should be a fundamental consideration in the assessment and selection of the preferred bidder.

Conclusion
We welcome the chance to engage in this important project at such a formative and exciting stage and look forward to further engagement as the project develops. Above all, we advise that our recommendations above be implemented in order to allow, subsequent to PPP approval, flexibility for innovation in the development of the building and landscape designs, to better enhance the wellbeing of patients and staff alike. In addition, the A+DS Healthcare Design Programme would also be happy to assist in developing design briefing for the proposals (perhaps along the lines of Design Statements in SCIM) and also a means of communicating those requirements to bidding teams.
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