Held on Tuesday 20 April 2010 at The Reform Club, 104 Pall Mall, London SW1Y 5EW.

Chair: to be announced

Speakers For: to be announced

Speakers Against: to be announced

Review of debate: not currently available

This half-day seminar assessed the implications of the imminent introduction, by the Government, of new sustainability requirements for all buildings. What will this mean for Hospitals? How should we respond? Expert sustainability advisors explained these changes and an introduction to the BREEAM Healthcare was presented.

Chair: Robin Nicholson, senior member of Edward Cullinan Architects

How are Hospitals Different from Other Buildings?
Dermot O’Reilly, Architect and RIBA Client Design Advisor; worked on a wide variety of both public and private sector buildings including PFI Hospitals, Education, Courts, Defence and many others; former executive of Architects for Health; worked with Carillion on the Great Western Hospital, Swindon, a benchmark of environmental performance in the construction industry; currently working on one of the London 2012 Olympics projects.

The Current Perception of Sustainability
Bill Gething, RIBA Sustainability Adviser and representative on the Architect’s Council of Europe; Chair of BRE Global Sustainability Board and Visiting Professor of Sustainability at the University of Bath.

The New BREEAM Healthcare
Virginia Cinquemani, Education and Healthcare Sector Manager for BREEAM at the Building Research Establishment (BRE).

The Effect of Zero Carbon Regulations on Hospital Design and Procurement
Brian Mark, advisor to the Department for Business, Enterprise and Regulatory Reform (DBERR) on all renewable energy technologies and Renewables Obligation policy; representative for the Chartered Institution of Building Services Engineers (CIBSE) on the Industry Advisory Group convened by Communities and Local Government (CLG) to advise on changes to the 2010 and 2013 changes to Part L of the Building Regulations.

Future Policy on Zero Carbon Hospitals
Jules Saunderson, panel member of the Mayor’s advisory Zero Carbon Housing Group; member of the Communities and Local Government (CLG) Non-domestic Industry Advisory Group; author of initial proposals for the UK Green Building Council (UK-GBC) and UK-GBC zero carbon task group report.

The purpose of the presentation/debate was to explore the issues and problems associated with the treatment and care of older people in an environment designed and operated with a younger population in mind.

There where four presentations with differing views and experience of looking after, or promoting the care of, older people in hospital.

Context

• Recognition of the special needs of the patient who may have dementia or limited physical capability and whose mental or physical well being must be addressed at the same time as medical or surgical treatment
• Discussion and comparison of the merits or disadvantages of single rooms with multi-bed spaces – C of I, privacy, dignity, loneliness, fear, depression compared with companionship, shared care, stimulation etc.
• Problems of mixed wards and inappropriate behaviour
• Space standards – social spaces, storage.
• Difficulties with and the precautions to be taken with the treatment of the older patient and their physical requirements.

Chair

Professor Russell Jones General Practice Principal of Chorleywood Health Centre. Director of the UKeHealth Association, and an Associate Professor, Department of Information Systems and Computing at Brunel University
http://www.chorleywood.org

Speakers

Ann Noble Chair of Architects for Health
http://www.architectsforhealth.com

Dr Graham Lister Sociologist and Economist, senior associate of the Judge Business School, Cambridge and a visiting professor at London South Bank University & Rosemary Glanville Head of the Medical Architecture Research Unit (MARU), London South Bank University
http://www.jbs.cam.ac.uk/research/associates/listerg.html
http://www.phonebook.lsbu.ac.uk/php4/person.php?id=1200

Judith Torrington Reader in Architecture, School of Architecture of the University of Sheffield. Judith is a researcher specialising in the design of living environments for older people, with a special interest in design for people with dementia. Her research focus is on the contribution design can make to well-being and a good quality of life. She has developed several tools for the evaluation of older people’s living environments
http://sheffield.ac.uk/architecture/people/staffpages/j_torrington.html

Dr Mike Gill Medical Director of the Newham University Hospital NHS Trust since 2002 and a Consultant Geriatrician in the Trust since 1989
http://www.newhamuniversityhospital.nhs.uk

Richard Smith Vice President and Chairman of The Royal College of Ophthalmologists Professional Standards Committee
http://www.rcophth.ac.uk/standards

“This House believes that better architecture will result when architects reclaim their position as leaders of the Design Team, and lead the integration of engineering into the building design process.”

Review of Event by Peter Scher

CHAIR: Chris Gilmour, of HBG Construction

Chris is an Architect and Marketing Director of HBG UK, one of the largest construction companies in the UK turning over £1billion per year and a leader in the delivery of major projects in both the public and private sectors. HBG is the UK arm of BAM the sixth largest construction services and property group in Europe.

He has over 35 years experience in the industry particularly in the commercial, retail, education and health sectors and has particular responsibility for the Education and Health teams within HBG.

He is a Director of BE the leading industry reform group in collaborative working as well as a Director of the BCO.

www.hbgc.co.uk

SUPPORTING THE MOTION

John Cooper, of Anshen & Alllen

John Cooper has been a Director of Anshen & Allen since 2001 and has led a number of ambulatory care and larger acute hospital projects, including the recently completed St. James’ University Hospital in Leeds, the largest cancer centre in Europe.

He has recently been the architectural director-in-charge of a number of large PPP bids, including the Royal Children’s Hospital, Melbourne, and the New Hospital Pembury for the Maidstone & Tunbridge Wells NHS Trust, which will be the first 100% single bed NHS hospital in the UK.

www.anshen.com

Jaime Bishop, of Steffian Bradley

Jaime Bishop completed his education at The Royal College of Art, after previously studying at University of Bath and TU Delft.

He has worked at Tectus and Coda before moving to Steffian Bradley Architects where he is an Associate Director.

Over the last six years Jaime has gained expert knowledge of healthcare design particularly primary care design and multiple tenancy regeneration projects typified by the LIFT program. Most recently Jaime was a primary designer for the new £151 million Walsall Manor Hospital PFI.

www.steffian.co.uk

OPPOSING THE MOTION:

Phil Nedin, of Arup

Phil, is a chartered mechanical engineer, leader of ARUP global healthcare business and building services group in Cardiff, UK, and President of the UK Institute of Healthcare Engineering and Estates Management (IHEEM).

He has a wide experience of working on healthcare facilities in both project management and technical advisory roles. Sustainability and developing low-energy alternatives are key drivers in his work.

His particular area of expertise is working on an integrated approach to create optimum therapeutic environments in the design of healthcare facilities.

www.arup.com

Chris Shaw, of MAAP Architects

Christopher Shaw is a registered architect with 25 years experience. In 1991, Christopher became a founding director of MAAP Architects.

Much of his recent energy has been directed towards business development. He speaks regularly on the design of environments for mental health and acute hospital care as well as acting as professional advisor to NHS Trusts.

www.medicalarchitecture.com

The Event was sponsored by: hbg

14th ANNUAL REFORM CLUB DEBATE – 28th February 2008

The annual Debate is one of the many innovative and valuable initiatives of Ray Moss, our organisation’s founding Chair. Ann Noble, the present Chair, opened this year’s event by congratulating Ray on his Award for Lifetime Achievement, an honour bestowed for the first time at the 2007 celebration of Building Better Healthcare. Her congratulations were warmly endorsed and applauded by the house. As it turned out this was the high point of the evening.

The formal debate is a game of words between two sides for a participating ‘house’, played according to well-established rules and under the control of the chairman, an official referee. A predetermined ‘motion’ is set for one side to propose and for the other to oppose in speeches to persuade the house to agree. The members of the house join in and then decide the game in a vote at the end. The quality of the game depends on the wording of the motion and the skill and determination of the players.

Many previous Reform Club Debates have examined important contemporary controversies, providing members with informed arguments by expert advocates in passionate verbal contests. HBG Construction sponsored the event this year and the motion proposed that “this house believes that better architecture will result when architects reclaim their position as leaders of the Design Team, and lead the integration of engineering into the building design process.” Chris Gilmour, A Director of HBG Construction, chaired the debate which was opened by John Cooper of Anshen and Allen proposing the motion. Opposing it was Phil Nedin of Arup UK. The seconders were Jaime Bishop of Stefian Bradley for the motion and Chris Shaw of MAAP against. About seven members contributed from the floor of the house eliciting some further responses from the platform.

The topics of design team “leadership” and “the integration of engineering” have been debated in architecture and construction circles for as long as I can remember with no notable outcome or clarity. As for “better architecture”, the term has no meaning that we could ever agree to debate. All the platform speakers are successful in practice and it was clear that they all shared the same values for architecture and the construction process. John Cooper made a good advocate for architects, drawing on extensive and well-analysed experience in a characteristically amusing chat. Phil Nedin, from an impressive engineering background, was also very sound and balanced in his argument. I could not discern any real disagreement between them or any need to vote one way or the other.

From the floor of the house Phil Gusack made his usual attempt to enliven the debate by bringing up “PFI” and “American business models” but to no avail. There were some forty people attending and since most were architects and already sure supporters of the motion the vote was a foregone conclusion. There were 28 for, seven against and four abstentions. But as a game it was the equivalent of a practice knock-up within the football club.

Peter Scher
March 2008

Both professions share lengthy formal courses of qualification – both are populated by dedicated and hardworking individuals, who work long hours for uncertain reward. Both professions come under fire for failing to live up to the challenges of change in the health service.

In our separate ways, architects and doctors dream of new futures for the service and believe them to be worthy. In reality, when service developments result in new buildings, architects and doctors seldom share their visions and passions. The process seems to get in the way.

Sunand Prasad, President of the RIBA, will welcome guests for the evening.

Chair: Duane Passman, Partnerships for Health

Speakers:

• Dr Charles Gutteridge, Medical Director, Barts and the London NHS Trust
• Andrew Barraclough, Director, HOK Architects
• Dr Frances Raphael, Consultant Psychiatrist, Springfield University Hospital NHS Trust
• Mungo Smith, MAAP Architects

The speakers will share their experiences of working with their opposite numbers – doctors with architects and vice versa. In progressing positively to pursue better outcomes, what is it that doctors expect from architects and what do architects expect from doctors.

Report on the Event by David Andrews of LSI Architects LLP (London, Norwich):

Dr Ann Noble opened the evening by stressing how important it is that AfH does more with other disciplines, as was to be the focus of this event.

Sunand Prasad extended a warm welcome to the non-architects and clinicians in the audience, who numbered a significant proportion. His opening statement recounted how learning with doctors could have powerful results, as witnessed on a recent Belfast project which involved a memorable healing process in Ireland!

Duane Passman noted how his background as an astrophysicist led to a personal reaction to the statement that ‘it’s not rocket science’ when used by the NHS. He reiterated the need to engage in discussions between professions about what has gone well and where there might be common ground for improvement – in the context of their being lots of work to do, with the ongoing shift in focus of healthcare delivery towards the community sector.

Dr Charles Gutteridge revealed his background as an anthropologist. He noted that his aim at Barts and the London was to influence the way his organisation works by encouraging the consultant body to engage in the formulation of local health policies. Reference was made to a book he inherited upon his appointment, which contained a history of Barts, along with an early diagram for the proposed demolition and redevelopment. This showed that thinking on the current redevelopment project could be seen to have first started in 1925 and has only recently resolved the different ways of working between the two sites. On joining the organisation in 2002 the current project had been in the 3rd version of a PFI scheme involving two bidders and a challenging planning context. The process involved doctors at the frontline of planning layouts and patient pathways, with resulting changes to the design to achieve fitness-for-purpose. However, the question was posed as to whether this will be a reflection of East London?

Andrew Barraclough qualified as an architect at a young age. He noted how the training for both professions involved a similar timespan but resulted in a diversity of output which was extreme, as though the two professions were differently wired. He saw the doctor’s education as being deep and narrow, with the architect’s shallow and broad. He commented that the process of arriving at a finished building was not a simple one and the way architects consulted often involved user groups which were too large and made up of the wrong people, rarely involving doctors and with a reliance on senior nursing staff, with the key issues generally not fully understood by all participants. Andrew’s message was to encourage openness to new ideas, rather than an institutional reluctance to change, as more frequently experienced.

Frances Raphael introduced herself as a jobbing psychiatrist with three experiences;

• Seeing St Stephens flattened and the Chelsea & Westminster built in its place
• Being presented with a new building and being told you’re moving to a pretty good facility
• Involvement on a project with Mungo for a new inpatient facility at Springfield

From these experiences she drew out that the architect needs to bear in mind where the doctor is coming from, often without any background knowledge of what is going on. She saw that the input from doctors and nurses is more generally concerned with practical issues, with the potential to feel that the outcome is one of compromise. Frances concluded that the process was inherently difficult, with uncertainty regarding the context and nature of the engagement by the doctors and nurses.

Mungo Smith described his first project working for a small practice with a Trust which was losing its beds to the community. He cited how at this time the doctors involved in the project were radical in their wholistic perspective of healthcare. Seeing this struggle within another profession has rubbed off on him with regards to carrying passion and commitment over the years. He described how when he arrived at MARU he met a social worker called Paul Rooney who was convinced that the way forward for mental health was to get out of large and into small community facilities. This was seen to be swimming against the tide at that time. Mungo’s closing point was made that there generally aren’t many people within the health environment looking at alternative models, due to the day-to-day reality of under-funding and lack of resources, and that the cross-over between architect and doctor is difficult, with the medical profession not trained in spatial relationships.

A lively session of questions and debate followed which covered issues including the following:

• Differences in doctors and architects education and training with regards to their experience of receiving positive and negative criticism, with doctors not having to face studio critiques of their work!
• Both doctors and architects sharing humanitarian values in a system which doesn’t necessarily support these aims, with problems of hanging on to ‘a bigger idea’ in the face of the system and its constraints.
• The ‘patient centred environment’ having had a focus on functionality in the past, but the emergence of more generic solutions now leading to an increasing focus on quality, with attention to daylight, ventilation, views, way finding and better spaces etc.
• What lessons are learned and how are these lessons passed on to others? There have recently been some good post project evaluations, though improvements in the process are needed to change the current culture of blame.
• PFI – a system in perfect balance, with output dependant on input and, in particular, the quality of the brief. A benchmark of ‘getting better buildings than we were before’ could be seen as a fairly low aspiration.
• The question of compatibility of the current management culture in the delivery of ‘the best’ in terms of health buildings and the message from the NHS to Trusts to ‘look out not up’.
• Who talks to who and when? The trend for less contact between architects and doctors over the years, with a plea to utilise the collective capacity with the room to direct this process.
• Pebble projects initiated in the USA with the aim of disseminating research and development on projects, with a ripple effect. The first pebble project in the UK is under consideration in Kent.
• Inconsistency in standard terms of reference for those involved in the process, with NHS directives at a detailed level rather than addressing the fundamental differences in approach by Trusts across the country. A national understanding?
• Pro and cons of smaller units versus larger projects, with challenges faced in delivering high quality large scale facilities, though equal challenges in effectively ‘joining-up’ healthcare at the small scale. Can the hospital experience be anything other than the equivalent of travelling by jumbo jet, functional yet never wholly enjoyable?

The following conclusions were made by the panel:

• Mungo; Design has to be the ideal, not today’s reality, and those involved in the process need to remain vigilant with a consumer’s hat on.
• Charles; We need to develop management structures to deliver clinical excellence and should also consider developing the AfH website as a social networking tool.
• Frances; In engaging doctors there needs to be a decision as to how to engage
• Andrew; There is an irony in that consistency removes innovation, and with no natural leader it should remain the architects responsibility to try and impact change

Duane concluded the session by reflecting on the importance of transparency to allow interaction between professionals.

Report by David Andrews of LSI Architects LLP (London, Norwich)
www.LSIarchitects.co.uk

Speakers: Karin Imoberdorf of Itten + Brechbuhl Architects AG, Karin is our invited speaker for the evening and will be talking about the Swiss Health Care System and the INO University Hospital, Claudia Bloom of Avanti Architects, Susan Francis of CABE – Commission for Architecture and the Built Environment, Mungo Smith of MAAP Architects, and Nigel Greenhill of Greenhill Jenner Architects.

20 September 2007