Hitching a Lift

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Building Design, 26 September 2003

The NHS’s Lift programme is promising to improve healthcare facilities nationwide, but will it deliver? asks Lia Hattersley.

Ill health is bad enough, but what can really tip the balance for sick people is if they feel let down by their healthcare. The inconvenience of outpatient visits, hours spent in dingy, uncomfortable waiting rooms and poor communications between different areas of patient care can be extremely distressing.

Having spent a year in a wheelchair myself, I know how depressing it is to be ferried from one hospital appointment to another, wrestling narrow corridors and heavy swing doors. In my case I also had a new baby to care for but my GP’s surgery had no established route for arranging help from social services. I found the whole system pretty arbitrary and chaotic.

Things could be set to improve however, as the government is trying to address problems like mine as part of the new nationwide NHS Lift programme (Local Improvement Finance Trusts). The whole country has been divided into 42 areas, each targeting priority schemes set to revolutionise local healthcare facilities.

As well as commissioning new buildings, the NHS is bringing more practitioners, such as dentists, school nurses, alternative therapists and social services under one roof with GPs and establishing better working practices between them. With new modern facilities, GPs will be able to oversee simple operations and diagnostic procedures such as endoscopies and ultrasound scans, relieving pressure on hospitals and saving patients from having to travel so much.

Communities in west London will be among the first to benefit from £47 million of investment under the new programme. Architects Buschow Henley and Penoyre & Prasad are working together on seven projects, with the first three of these due to start on site next year. The projects are Wandsworth Bridge Primary Care Centre in Fulham, Thelma Golding Health Centre in Hounslow and Cloister Road in Acton.

The practices are part of a consortium, Building Better Health, which has secured preferred bidder status for the Ealing, Hammersmith & Fulham and Hounslow Lift.

Like other consortiums around the country, it is awaiting the results of its bid for other Lifts, due in coming weeks. Nationally, 16 Lifts have reached preferred bidder status, with one scheme in the East London & City Lift, having reached financial close.

Craig Linnell of Buschow Henley, project architect on the Fulham project, sees Lift as a great opportunity for the practice’s “people-centred” design approach and explains how architecture will be central to plans to enhance local surgeries.

“We want to make the process of being cared for as easy as possible,” he says. “To use light in wonderful ways, to have double-height waiting spaces, lots of colour and to make the buildings much more visible in the community.”

While Linnell acknowledges that costs and time are tight, he says that by applying the same overall structural grid and design of clinical areas to all three projects, money has been made available for better quality finishes, internal gardens and extra public space.

“For all clinical spaces there are NHS standards, but there aren’t standards for things like how the building deals with physiological and emotional well being,” he says.

By concentrating on what Linnell calls the “in between” spaces the architects want to make the buildings calming and uplifting. They aim to provide a simple and legible layout with as few obstructions as possible and space to ensure privacy.

While it is too early to measure their achievements, the architects’ enthusiasm to respond to patients’ needs appears irrepressible.

“It’s amazingly refreshing,” says Linnell. “It feels good to be working in the process of making people well.”

But others working in the healthcare design field raise concerns about Lift, which if valid suggest Buschow Henley and Penoyre & Prasad may find themselves working against the odds. Even if they achieve their goals, these projects may not be typical of what is built nationally if the process is as vulnerable as some believe.

At a recent seminar, entitled Lift Going Up or Going Down?, the Architects for Health group, most of whose members are involved in Lift, discussed these problems. Ann Noble of Ann Noble Architects, the group’s chair, explains that with a general election in the offing, the Lift programme is driven by a political timeframe that is already impacting on design.

“The waiting process is very long, the design process is very short,” she says.

Indeed, others frustrated by the timeframe include Sunand Prasad of Penoyre & Prasad as he expressed in Building Design earlier this month [see Design teams in a hurry for Lift, BD September 5]. Noble describes how lack of time is even pressurising some consortiums into choosing unsuitable sites because these are certain to be made available quickly.

Each Lift shortlists three consortiums which then work up three sample schemes, before a preferred bidder is announced and the other schemes are ditched, meaning some architects may not be properly recompensed.

“Everything else is thrown away,” says Noble. “It’s a most irresponsible way of wasting resources. I think it’s quite upsetting.”

Noble is also concerned that the public sector user groups that help brief designers and select schemes may have limited architectural understanding. She worries they will make decisions based on the “wow factor” rather than appreciating that qualities such as sufficient air changes and provision of private space are vital in healthcare design.

Crucial to Lift is the idea of harnessing private money to improve public healthcare. While the government has invested an initial £200 million through a specially set up body, Partnerships for Health, a further £800 million will come from the private sector, with more investment due as new projects are announced. As each Lift company is jointly owned publicly and privately, relationships are complex.

Tim Challis, a senior Partnerships for Health official, accepts that timeframes are short, but argues that later projects will benefit from what is learnt today.

Month by month, Lift areas are now choosing the consortiums they will be contractually obliged to work with for at least the next 20 years. Important relationships and standards are being set. With so much at stake for NHS patients, surely the timeframe must be set to a process-led agenda rather than a political one, if something truly worthwhile is to come out of Lift.

This article is reproduced here by kind permission of Building Design.

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