Doctors and Architects: Who needs the medicine? and AGM

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

Building Better Health Care Awards 2007

The 2007 The Building Better Healthcare Award winners where announced on Thursday 8 November 2007 at The Brewery, London

Building Design Class

Best Hospital Design
Winner: Richard Desmond Children’s Eye Centre, Moorfields Eye Hospital, London – Penoyre & Prasad LLP
Highly commended: Royal Alexandra Children’s Hospital, Brighton – Building Design Partnership
Highly commended: Broadgreen Hospital, Liverpool – Nightingale Associates

Best Primary and Community Care Design
Winner: Lymington New Forest Hospital, Hampshire – Murphy Philipps Architects
Highly commended: Kaleidoscope. Children and Young People’s Centre, Lewisham, London – van Heyningen and Haward Architects
Highly commended: Heart of Hounslow Centre for Health, Hounslow, London – Penoyre & Prasad LLP

Design for Care at Home
Winner: Ellesmere House Elderly People’s Home, Chelsea – Pollard Thomas Edwards Architects and HLM Architects Mental Health Design
Highly commended: Bridge House, Lambeth, London – Devereux Architects Limited
Highly commended: Stone House Inpatient Addiction Unit, Dartford, Kent – Hunter & Partners

Best Sustainable Design
Winner: Breathing Space, Rotherham – Rotherham Construction Partnership
Highly commended: Artesian House, Bermondsey, London – Thompson House Hospital, Lisburn for South Eastern Health and Social Care Trust, Co Antrim, Northern Ireland

Best International Design
Winner: The Credit Valley Hospital, The Carlo Fidani Peel Regional Cancer Centre, Mississauga, Ontario, Canada – Farrow Partnership Architects Inc.

Patient Environment Class

Best Interior Design
Winner: London Oncology Clinic, Harley Street, London – Sonnemann Toon Architects
Highly commended: Valley Medical Centre, Washington, US

Best Landscape Design
Winner: Keats House, Heath Close, Inpatient Unit, Billericay, Essex
Highly commended: Moorfields Eye Hospital, London

Best Use of Art in Healthcare Facilities
Winner: Regional Acquired Brain Injury Unit (RABIU), Musgrave Park Hospital, Belfast
Highly commended: GO Create! Great Ormond Street Children’s Hospital
Highly commended: Architectural Art Glass Window and Film Installation, Nightingale Centre and Genesis Research Centre, Wythenshawe Hospital, Manchester – LIME

Best Future Design Concept
Winner: Barnstaple Local Hyper-Modern Hospital, MAAP Architects
Highly commended: Patient Care Room, RTKL

Products Class

Best Future Design Concept
Winner: Hygiene complacency Device
Highly commended: HBN04 Ensuite WC
Highly commended: Versatile Interactive Pan

Best Healthcare construction product or material
Winner: Trent Concrete, Royal Alexandra Children’s Hospital

Best Product for Hospital Interiors
Winner: Rimless pan, Twyford Bathrooms
Highly commended: Kelowna Sofa, Kirton Healthcare

Estates and Facilities Management Services Class

Excellence in healthcare catering
Winner: Hinchingbrooke Health Care NHS Trust, Catering Services Department, Cambridgeshire

Improving patient safety through the environment
Winner: Birmingham and Solihull Mental Health NHS Trust Estates and Facilities Department

Excellence in Facilities Management
Winner: South Staffordshire and Shropshire Healthcare NHS Foundation Trust
Highly commended: Birmingham and Solihull Mental Health NHS Trust Estates and Facilities Department

People Class

Best client team
Winner: PFI team – Royal Alexandra Children’s Hospital
Highly commended: Wayne Fyffe and The Credit Valley Hospital, Ontario, Canada

Best contractor of the year
Winner: HBG Construction for the Essex Cardiothoracic Centre

Design champion of the year
Winner: Hugh Steward, director of environment and client services at Newham University Hospital NHS Trust

Judges’ Special Award
Winner: Guys Approaches, South Essex Rape and Incest Crisis Centre, Thurrock, Essex – Featherstone Associates

Lifetime Achievement Award
Winner: Ray Moss

Mama Maria Wellness Clinic – Kenya

Sponsoring needed to help building a Health clinic in Kenya

Background – Mama Maria is a non-profit organisation that provides medical care in rural areas where no other health care is available. At present they are working out of a rented facility where they see over 50 patients a day in overcrowded conditions. It is being funded predominantly by a registered charity called Village Volunteers – http://www.villagevolunteers.org.

The Health Clinic Building -Due to the huge demand for medical services, Mama Maria Kenya has purchased 3.5 acres of lakefront land to construct a bigger, more effective clinic with expanded services. Compared to the current 6-room, rented clinic, the new clinic will belong to Mama Maria Kenya, and will be designed to grow as needs, services and funds allow in the future – http://www.mamamaria.org.

Architects without Borders have provided the schematic design for the Mama Maria Clinic. Construction costs for the first phase of the building have been estimated at £40,000 but so far only £8000 has been raised/ pledged. Construction was due to start in September but now that has been pushed back to December with the plans which have been modified so the clinic can be built in stages – which will be less satisfactory and less cost effective. For a schematic design proposal of the clinic, follow the contacts below.

Funding for the building of the clinic is a problem so if you feel that you can help by offering any sort of sponsorship or would simply like any further information please get in contact with either Jonty Craig at jontycraig@hotmail.com or Shana Greene on shana@villagevolunteers.org. Or you can sponsor directly through Village Volunteers’ website at http://www.villagevolunteers.org/donation/donate-info.php (be sure to select Mama Maria Wellness Clinic in the “program you would like to donate to” field).

Any little helps!

Zhi Jian Fann

Zhi Jian Fann, who is currently studying at the University of Sheffield, UK, was shortlisted in the Architects for Health’s First Student Health Design Award (2007) for the following submission. For contact please email: ara05zjf@sheffield.ac.uk

Elderly Corporation Brief – Conisbrough | The 21st Century Place

Introduction

Eighty is the new sixty-five. The project is entitled Elderly Corporation and it looks at new ways of growing old in Conisbrough.

Early studies uncovered the plight of the elderly and unpaid social carers within Conisbrough and unveiled the global phenomenon of an ageing population.

What if pensioners only get their pensions when they are 80? What are the possible new roles and places for the elderly?

With the growing popularity of Gerontology [study of ageing] and relating to living with my grandmother, the project investigates the design concerns of the elderly and approaches an ideal place to grow old in with a holistic approach to elderly healthcare.

Brief-ly

Located in the northern ex-mining town of Conisbrough, the studio envisions it to be a 21st Century place.

Working on a futures agenda, growing old in Conisbrough means being part of a network, a part of the community.

The Elderly Corporation adopts the structure of an enterprise to provide chances of interaction within the community through the provision of community services that tap on elderly life experiences.

The Elderly Corporation addresses the needs of the ‘young elderly’ to promote an elderly lifestyle while generating a means of financing this greater longevity through the sharing of life skills.

Located in a new linear green park, the studio evocates the collective nature of the different projects to work together to realise identified growth strategies to approach the regeneration of Conisbrough.

Strategy

Located at the slope of the Craggs, between the two separate communities of Conisbrough and Denaby Main, the urban strategy of the Elderly Corporation is one of a collective intensity, connecting the higher ground with the lower ground through a series of new civic spaces while overlaying the elderly routine as a means for chance encounters.

The design vehicle was the elderly design concerns. The effect was based on the notion of interfaces and daily rituals.

Considering the daily routine of the elderly user, addressing their needs through strategic considerations and support all while integrating environmental and sustainable concerns to create a new, brighter place to grow old in.

Specialism

The specialism of the project looked at an ideal elderly living environment at the scale of the apartment.

Support within the apartment for the elderly in their daily routine was translated into a strip of activity that provided infrastructure such as a bench, a place to hang one’s coat, to a seat to wear shoes and store them, storage space, display space, a work desk to a lounge seat in the balcony.

Materiality for the elderly was explored through understanding their preferences using interviews with locals and my grandmother back home in Singapore. Examining preferred colours, textures, functions using a series of play cards as a tool of investigation.

Summary

The intention of the Elderly Corporation is to provide a great place to live in after one’s conventional working life is over.

To be engaged in a fresher living and working environment in the later stage of life. In a brighter future engaged within a community, a part of Conisbrough, the 21st Century place.

The Architects for Health
First Student Health Design Award
was sponsored by

modulex

Tom Turner

Tom Turner, who is currently studying at The Glasgow School of Architecture, UK (RIBA Part 2), was shortlisted in the Architects for Health’s First Student Health Design Award (2007) for the following submission. For contact please email: TTurner@rickmather.com

Chinese Health Culture Exchange, Glasgow

Brief: The thesis is a vehicle for personal study, in which the topic is selected by the student in accordance with her or his particular interests and developed in association with the tutorial staff. The project is developed through from concept design to design in detail.

Project Description: The Chinese health culture exchange will be a centre of cultural exchange between East and West; Glaswegians and the Chinese Community in Glasgow. The pro¬gramme of the building focuses on social and health issues. It is both a community centre for the Chinese community and a centre of traditional Chinese health care. This health care includes traditional Chinese medicine as well as various forms of chi cultivation such as tai chi. It is a building that inspires its users to reflect on the way they lead their lives and offers alternative approaches to lifestyle. The idea draws on two existing phenomena; An increasing interest in the UK in the health aspects of traditional Chinese culture such as tai chi and Chinese medicine, and a decentralized, under resourced support network for the Chinese community.

By addressing these two situations the building brings together two communities and offers a platform for cultural exchange.

The relationship between landscape, building and courtyard is key to the success of my scheme with regards to the health aspects of the programme. Traditional Chinese medicine and health practice developed from Taoist thought which took many of its ideas from a close observation of nature. These practices still benefit from contact with the ground and a relationship with the natural world.

The combination of a building protecting a courtyard and stepping up in section suggests the form of a spiral. The idea of a spiral allows a continuous wall to wrap around the courtyard. This wall roots the building in the ground and lifts up whilst spiraling to create a public entrance at street level. From the motorway edge the building can be seen to wrap around a sunken courtyard suggesting to the viewer an inner world within.

Making people more aware of their bodies and the natural environment deals simultaneously with issues of health and sustainability. These issues are evident in the built form of my thesis. Natural ventilation, passive solar gains and rainwater harvesting lead to a healthy building that deals with issues of environmental sustainability.

The programme promotes social integration. The building is both a community cen¬tre for the Chinese and a Chinese health centre for all. The form suggests a private space whilst inviting the public in. Noise pollution from the motorway is dealt with whilst maintaining the view. A courtyard is carved out of the hillside providing an intimate relationship with nature for the privately orientated health practices. A wall emerges from the land¬scape and wraps around the courtyard protecting it and lifting up to create a public entrance. A public route is maintained through the site and is used to bring the public into meaningful contact with the building.

I am proposing a place in Glasgow where the local Chinese community can find help integrating into life in the UK whilst celebrating their rich cultural heritage. A place where Glasweigans can go to find alternatives to the NHS and alternative models for healthy living. Such a place would bring together two diverse cultures and celebrate the qualities that we can learn from each other.

The Architects for Health
First Student Health Design Award
was sponsored by

modulex

Stephanie Edwards

Stephanie Edwards, who is currently studying at The Architectural Association, UK (2nd year, RIBA part 1), was shortlisted in the Architects for Health’s First Student Health Design Award (2007) for the following submission. For contact please email: stephanieedwards@yahoo.co.uk

Reconfiguring St Clements Hospital (East London and The City Mental Health NHS Trust)

Brief:

Are hospitals the ultimate ecologies? Can the collision of healthcare and architecture really be analysed? Who are we to challenge the delicate processes of the institution?

Scientific research on the treatment of the mentally ill continually excludes spatial parameters. The project should instigate change within a mental health hospital in London. The year long experiment should shape the unit’s manifesto: to alter the spatial, psychological and organizational systems that defines life within the healthcare environment.

Project and proposal: Reconfiguring St Clements Hospital

Can the collision of healthcare and architecture really be analyzed? As students we were posed with this question at the start of the project. This provoked me to go beyond a formal study and to probe all aspects of the hospital environment, including the dark, but very real, details of everyday life in a mental ward -subjects such as suicide prevention and patient restraint. Throughout the year a host of professionals were consulted and corresponded with. These consisted of National Health Service psychiatrists, ward managers, estates and facilities staff, architects specializing in healthcare buildings, and potential users, in order to craft their individual research and responses. Drawings were then used as tools to reveal the relationship of how people interact with one another or how components make up an environment, where a specific visual representation was invented.

This project defines the conditions for the staff and patients who live and work in St Clement’s hospital, a former workhouse or ‘prison by a milder name’. It explores whether the 1849-era hierarchy extends throughout the hospital today. At the outset, the operational and behavioural aspects on one particular ward were analysed. The intended timetable initiated by the staff was compared with the actual timetable followed by the patients. This displayed the many physical and non-physical restrictions within the ward and its constant fluctuation throughout the day. The initial study probed efforts to flatten the hierarchy, for example through the removal of a formal uniform, and challenged the system within the ward as well as the relationships between staff, patient and visitor. In response to the insight gained, architectural, organizational and urban propositions were made. The process from admission to discharge was scrutinized and redirected to facilitate speedy recovery. The services located at St Clements are gradually being moved to purpose built sites. As areas are abandoned, an urban proposal aims to integrate the community through shared use.

The Architects for Health
First Student Health Design Award
was sponsored by

modulex

Sheffield Team

‘The Sheffield Team’ – comprising David Baldwin, Amy Cheung, Philip Daniels, Simon Grayson, Alexandra Jones, Jeremy Lodge, Anca Milache, Kay Robson and Basim Shamsuddin, all students studying at The School of Architecture at The University of Sheffield – where shortlisted in the Architects for Health’s First Student Health Design Award (2007) for the following submission. For contact please email: basim@glennhowells.co.uk

Genito-Urinary Medicine Clinic, Royal Hallamshire Hospital, Sheffield

Project brief:

Based on the Royal Hallamshire Hospital site, the Department of Genito-Urinary Medicine is the main provider of sexual health care for the city of Sheffield. In common with most G.U.M clinics in the UK, the Sheffield clinic has reached capacity.

The G.U.M Clinic has been allocated 300sqm of additional space to expand existing facilities and the proposed aim was to produce a strategy for expanding the clinic that could effectively link new and existing spaces in a way that was conducive to a positive experience for both patients and staff. As a potentially sensitive clinic a balance was necessary between being open and inviting whilst also retaining a high degree of privacy and confidentiality.

This project was part of the Live Projects programme, where Architecture students worked with a range of clients including local community groups, charities, health organisations and regional authorities. In some cases the projects involve actual building, in others design of urban masterplans, in others consultation exercises. In every case, the project is real, happening in real time with real people.

Project proposal:

Students worked with a client team of medical staff and patients through consultation workshops and meetings before producing a set of generalised G.U.M clinic conditions, aspirations and spatial relations. From this, the team developed a booklet that could be used by others involved in this specialised area of design.

The principles contained within this booklet were then used to develop proposals for the Hallamshire Hospital’s specific circumstances, using an ASPECT assessment tool [a linked research project in the Architecture Department] to understand the existing clinic’s weaknesses and compare improvements.

Having worked closely with the client through design development the student team created a series of proposals which were presented to the Hallamshire Hospital. The design proposals aimed to create a series of spaces, with varying layers of enclosure and privacy, striking a balance between patient and staff needs. The design offers a facility that shuns the institutionalised appearance of a hospital building and instead creates a building that seeks to dispel the stigma that is associated with Genito-Urinary conditions.

The Architects for Health
First Student Health Design Award
was sponsored by

modulex

Sarah Ernst

Sarah Ernst, who is currently studying at the University of Sheffield, UK (RIBA Part 1), entered the Architects for Health’s First Student Health Design Award (2007) with the following submission. For contact please email: ernst_sarah@yahoo.co.uk

A retirement community, Newfield Green, Gleadless Valley, Sheffield

Offering an alternative for older people

A brief

The brief was to design a site specific retirement community which addresses the new challenge for the profession and society at large of an ageing population. It required research into the needs; health and current accommodation of older people, and revealed the positive impacts of activity, exercise and stimulation on physical and mental well-being. The research generated a discussion on the nature of a retirement community and the implications of designing one as an entity in itself, or an element of a greater community.

A site

The inclusion of a site into the discussion had the potential to influence the brief and direction of the project. The site is Newfield Green in Gleadless Valley in the southwest of Sheffield, an area on the outskirts of the city, with the majority of its housing stock dating back to the 1960s. The existing housing typologies, amenities and landscape of the site surroundings influenced the brief. The brief evolved to focus on the design of a housing scheme for older residents within the Newfield Green area to enable them to remain living within their existing neighbourhood in a sheltered environment until they needed a greater level of care.

A proposal

The design is a scheme that is sensitive to the local environment, encouraging interaction with the landscape and creating a connection to the existing community. The buildings are spread across the landscape, responding to the slope of the land and respecting the existing trees. The key reason behind this approach was to encourage residents to circulate through the landscape for physical and mental health benefits.

The scheme includes accommodation, residents’ facilities, a café and a community centre. The residents’ facility provides social spaces, educational resources and an alternative therapy room while the community centre complements existing local amenities to benefit the wider community as well as residents. It offers multifunctional spaces to accommodate exercise classes, childcare, community cinema and meetings. The design of the community centre and residents’ facilities evolved as a series of layers of activity with varying degrees of enclosure determined by changes in materiality. The transition from public to private is marked by a series of thresholds as the materiality and connection to the ground changes.

Research into housing typologies suggested that terraced housing was environmentally and socially sustainable in terms of heat loss and promoting interaction and a sense of community. The accommodation is organised in two terraces, 6 units of serviced apartments which are closer to the residents’ facility and 12 independent accommodation units. The independent housing is organised as a staggered terrace in groups of two and four living units with shared sunspaces in between. Each unit has a south facing view of the valley, and shares an entry porch with their neighbour. The terrace minimises heat loss and the rammed earth construction acts as thermal mass absorbing heat during the day time and releasing it in the evening.

The Architects for Health
First Student Health Design Award
was sponsored by

modulex