ARCHITECTS for HEALTH are delighted to invite you to our event

On 17 March 2011 at 6 for 6.30pm

Architecture in the Age of Austerity

It will be held at BDP offices

16 Brewhouse Yard

London EC1V 4LJ

We can use this current time of uncertainty to look afresh at the issues which were not addressed or resolved in the building boom that has just ended.

Speakers will give their take on the future and describe schemes undertaken within the framework of existing hospital estates or buildings.

Speakers include

John Cooper, Chair Architects for Health

Mungo Smith, MAAP Architects

Rosemary Jenssen, Devereux Architects

Jackie Cardiff, HCP

Nigel Greenhill, Greenhill Jenner Architects

Please register for a place by email at  events@architectsforhealth.co.uk

This is a members’ event.

If you would like to join AfH now please contact members@architectforhealth.com. The AfH Annual Subscription is £50.

Useful links:

www.architectsforhealth.com

www.bdp.com/Documents/Studio%20Directions/London.pdf

Architects for Health members included vists to the following hospitals:

Monday 20th

1 Comfort Suites Oscar Freire
2 INCOR Heart Institute
3 ICESP Cancer Institute

Tuesday 21st
4 Maternity Hospital Santa Joanna
5 Maternity Hospital ProMatre
6 Fleury Diagnostics & Polyclinic
7 Bross Architect Offices
Wednesday 22nd
8 Hospital Albert Einstein
Thursday 23rd
9 Paraisopolis Outpatients Unit
10 Real & Benemérita Hospital
11 Congonhas Airport

For more information see the News

Sunny place, exciting views, colourful art in white interiors, well designed buildings with state of the art technology: we were transported to Sao Paulo to revisit hospitals enjoyed by members of A F H on the International study trip 2010.

The evening was hosted at the Brazilian embassy and we became aware of the contradictions of a country with both money and poverty: wonderful fresh food but no heating! Brazil is one of the fastest growing economies in the world. Sao Paulo is a huge conurbation, second only to Mexico city, with 20 million population and x hospitals.

The A F H members shared their experience by showing a selection of the hospitals they visited. First Lara Kaiser introduced us to the healthcare system: All Brazilians have the right to receive health services as enshrined in the country’s 1988 Constitution. Modelled on the NHS, Brazil’s Unified Health System (“Sistema Único de Saúde”, or SUS) was created two decades ago to decentralise the delivery of services. Under the SUS, it is primarily the job of municipal administrators – Town and City Halls – to manage public health services, while more general administrative responsibilities are the preserve of the Federal Government. Arguably, the municipal administrations have been slow to adapt to their new role, partly as a result of Brazil having more than 5,000 cities, 25% of which have less than 5,000 inhabitants, and partly because a slew of economic, political and administrative issues remain unresolved. Brazil’s public healthcare services are underfunded, chaotic and poorely organised. Queues, lack of doctors for basic care services, lower levels of comfort and amenities than those found in private hospitals are the norm. Unsurprisingly, 28% of Brazilians, according to estimates, turn to the private system for healthcare, and are covered by private health insurance. The remaining 72% use public facilities or can access private hospital services – funded by the public sector – for specific treatments or surgery that the public sector cannot provide.

Roy Carroll started our tour with a look around the University Heart and Cancer institutes. Housed in an uncompromisingly early modernist building of some stature, the overall design had strong forms and resilient material eg marble floors and window surrounds. The spaces were clean, uncluttered and fitted with impressive technology and equipment. The world renowned institutes had been designed with care and attention to detail: we were assured that blue walls and red carpets were just the right background if you are viewing scanning images. However, these spaces were in stark contrast to the rest of the hospital with its soulless OPD, scary pharmacy and near sci-fi ramps in public spaces: but then as Neimeyer said
Architecture is not important: But important is life.

Claudia Bloom showed us two private maternity units: both light and welcoming with well detailed modern interiors. The Santa Joanna Maternity Hospital was arranged in single rooms with babies kept in bassinets in a communal nursery at night connected to their mothers through CCTV cameras: women able to practice multi- tasking by watching two TV screens simultaneously from their beds- one of their baby and the other showing soaps! Most activity was planned and the rooms personalised with the baby’s name. There was an impressive system for recycling water from the laundry to conserve the environment. The ProMatre Maternity Hospital, another unit belonging to the same private provider, had hotel like bedrooms painted and furnished ij white. The delivery theatres were fitted with windows to the corridors through which family members could observe the surgical deliveries.
Mariangela Zanini focused on Beneficência Portuguesa founded in October 1859, which is now one of the most advanced private hospital complexes in South America. With an impressive 2000 beds arranged in two- bed rooms and 64 operating rooms including transplant and cardiac , this was a machine for modern medicine.

We also saw around one of the 20 Fleury diagnostic centres, each accommodating services to suit their loacality. Almost exclusively white, this crisp and efficient layout provided all the necessary accommodation for basic diagnostic tests in a high street location.
The presentations concluded with an entertaining film composed by Phil Gousak that paid homage to Oscar Neimeyer and Brasilia. Organised and introduced by Vicky Braouzou we felt transported to another world for sure.
Clearly the trip had been a lot of fun. So was this event. And the question on everyone’s lips- where shall we go this year?
Send your suggestions to info@architectsforhealth.com.

Some more information on hospitals visited:

The University Heart and Cancer Institutes
The FMUSP-HC System is the oldest Brazilian academic health system and it originates from the Faculdade de Medicina e Cirurgia de Sao Paulo (established 1913). The new school, with support of the Rockfeller Foundation, established a new model of medical education in the country, with the reorganization of teaching and research, and the implementation in 1944, of a university hospital linked to the school.
Today, the FMUSP-HC System is the largest in the country, comprising – besides the Medical School – institutes specialized in tertiary care, a secondary care hospital, auxiliary hospitals, units specialized in full time care of H1V/AIDS patients, Health Centre School (primary core), Primary Care Units, Medical Investigation Laboratories (LIMs) and Support Foundations.

Maternity Hospitals ProMatre and Santa Joanna
The Maternity Hospitals ProMatre Paulista and Santa Joana have a team of doctors and nurses specialized in gynaecology and obstetrics. In its team, there are also university professors and PhD doctors in obstetrics, gynaecology, neonatology and foetal medicine. It also has the most advanced prenatal exams, intrauterine transfusion and foetal surgery.
The Hospital and Maternity Santa Joana was founded in 1948, as a Health Centre. In 1991, it was redesigned and got a new wing, designed around the modern concept of a hospital-hotel. Together with Pro Matre Paulista (they are part of the same group), it was the first maternity hospital to receive the accreditation stamp of the National Accreditation Organization (ONA), showing the security standards in hospitals.

ARCHITECTS FOR HEALTH

 Annual debate at the Reform Club

17 February 2011

The Motion:   “This house believes that architects know more about sustainability than engineers”

Proposer of the motion

Robin Nicholson Architect and Director of Edward Cullinan Architects;

Seconded by

            Benedict Zucchi Architect and Project Director BDP

Opposer of the motion

Greg Markham Chartered Engineer at G4S Integrated Services

Seconded by

Phil Nedin Chartered Engineer and Past President of IHEEM

Robin Nicholson began by setting the wider scene: he asked if we are sufficiently aware of the issue

• 2 buildings that are currently in the news for the Olympics use 5 tonnes of steel: by 2050 we will only have 20% carbon allowance : what matters most?
• Only one person in the audience admitted they knew their carbon footprint
• The NHS contributes 30% of public sector emissions- and hospitals are the most greedy building type. So it is crucial to address the issue

He suggested that the NHS had been good at solving the wrong problem for too long: health prevention gets only 4% of the NHS budget according to Marmott; NHS SDU has published a Route Map for Sustainable Health; and the CABE study for DH Sustainable design policy had called for ‘Halving the demand, doubling the efficiency and reducing the CO2’- using Bill Bordass work that was referred to in the Zero Carbon Schools Task Force. But was lost in the mist of government change.

A step change in thinking is required. Who is best placed to lead? He suggested that engineers know how to get from A to B; but architects can do better by going via C. Architects are best placed to challenge the status quo. They should lead an Integrated design process.

Greg Markham made the case for engineers to bring low carbon energies to the NHS; at least 15% of the NHS Estate is not fit for purpose; engineers can help to reduce the energy intensivness through technology- wind, solar ,PVs etc. He made the point that in an era of austerity there will be no investment without saving.

He suggested that engineers have a deep understanding and can bring about innovation, such as the windup radio. There are 35 professional institutions for engineers in the UK that have embedded a sustainability manual into their principles- and its not the same for architecture.

Benedict Zucchi seconded the motion taking a broad view of sustainability- that it is about creating places. He sited a 500 year old Hospital in Milan that is still being used- it is an integral part of the neighbourhood and much loved by the city. What could be more sustainable?

Successful enduring places that are local and specific are key to sustainable architecture.

He told a fairytale in which a spell of enlightenment had been cast at the end of the18th century: it heralded progress at any cost with the development of technology and mass production. As a result we now endure pollution, dehumanisation and a mechanistic world view. Engineers brought this about!

This thinking influenced architecture profoundly: Le Corbusier said we should behave like engineers and made the city, house and hospitals as machines; cities all look the same as road engineers show contempt for place and people. The Frankfurt kitchen reduced all variables of cooking to the making of an omlette: an approach that has been adopted in guidance.

We inhabit a mechanistic world as Einstein said:

 Logic can get you from A to B but imagination can take you anywhere.

Phil Nedin admitted that some architects know more than some engineers about sustainability but that architects are late to the table on this one.

In terms of education architects do space but not numbers. Engineers have plenty of opportunities for CPD with 4 major national magazines dedicating lots of space to sustainability; and numerous seminars etc to transfer knowledge.

The task is too big for architects and too much to expect one institute to lead. Architects have had more success in the housing sector but little impact in sectors that are more difficult. There is plenty of greenwash and eco-bling but more serious design issues have not been fully addressed: for health these include eg avoiding deep plan spaces, maintaining adequate ceiling heights, using solar shading, making comfort analyses, reducing the use of misplaced glass, dealing with exposed soffits and improving window design. There has been insufficient information in guidance with too slow adoption of single rooms.

However, the most significant failure of architects has been the lack of adoption of Post Occupancy Evaluation and the acceptance of re-inventing the wheel for each new project is not good enough.

Discussion from the floor pointed to the polarised positions.

Engineers have committed original professional sin by being inventors of the industrial revolution that has caused the environmental disaster: Architects are the Jonny-come –latelies that have designed cities that do not support healthy lifestyles and buildings that pollute.

This discussion became an arts versus sciences issue: quantification over creativity. Is sustainability an issue of place or technology? Who holds the ring?

Does any one profession know enough let alone know more than the other?

Peter Scher, in customary manner, urged us all to abstain on the grounds that survival was the most important issue and must take preference over professional warmongering.

Someone else offered to redesign the motion- it happens every year!

In summary, Robin urged us to think radical: the scale of change that is required is huge. Buildings account for 40% of the problem. Long life, loose fit and low energy is where we need to be and architects are better placed than engineers to get us there.

Greg acknowledged that survival is a common goal but engineers have essential knowledge that architects do not yet have.

The motion was defeated 17 to 12 with some abstentions! Well done engineers!

The debate was chaired by John Cooper and thanks given by Ann Noble.

Annual Reform Club Debate: “The inevitable cuts to the NHS budget, whichever party takes power, will destroy the work of the last ten years and not bring about the radical and patient centred reforms which UK healthcare requires”

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

An Architects for Health Event held on Thursday 19 June 2008 at The Building Centre, London

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.

An Architects for Health Event held on Thursday 17 April 2008 at The Kings Fund, London

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

The Reform Club, 104-105 Pall Mall, London, SW1Y 5EW
28 February 2008 – 6.00pm for 6.30pm start

“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

Presented by Architects for Health on Thursday 29 November 2007 at the RIBA, 66 Portland Place, London.

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