Viewpoint: Phil Gusack on Wilmington’s PFI Conference
Conference held on 28 June 2006
Nobody interested in design should pass up a chance to go to an event at Denys Lasdun’s marvelous Royal College of Physicians [RCP] in Regents Park. Unlike many newer landmarks RCP looks better during the day than at night. Those of us at Wilmington’s conference on PFI Hospitals had the added bonus of spending all day in the sheer spatial delight of the council chamber. Originally a Tory formula but now New Labour’s turbo on the engine of UK plc, private finance initiatives have been dismissed by critics as a giant national credit card: buy now pay later. The end that justifies the means is government’s target of 100 new hospitals by 2010.
When my interests first returned to hospital design last year, I was completely out of touch. I finished my last hospital project in 1981. I went to an Architects for Health seminar at the RIBA assuming I would see exciting new applications and new interpretations of the ideas and methods that I had worked on in London, San Francisco and New York. I assumed too that the exchange of ideas across the Atlantic was bound to have increased since many A-list global design firms have thriving offices in London. Instead I was startled to learn that both Northwick Park and Greenwich DGH, the flagships of two completely different ways of accommodating growth and change, were slated for demolition. Margaret Thatcher, I soon learned, had axed funding, cast Howard Goodman’s team out of Euston Tower and , in effect, burned their books.
From the start NHS hospital building was tough going. With the best of intentions, architects still took years and years to design hospitals and contractors, with other intentions, took forever to build them. Invariably they claimed enormous extras. In 1997, I imagine, elderly Treasury mandarins warned Gordon Brown about the bad old days when planning took longer than the lifetime of the government which meant government couldn’t really get much done. What I don’t know is what the mandarins thought about Goodman’s Best-Buy, Harness and Nucleus programmes. Nor do I know if any of this was ever tabled for discussion. If anyone does know, please email.
Anyway this is my take on why Treasury not only insists on PFI but also on contractor-led design-build. It’s an extension of Tony Blair’s ‘tough on the causes of’ rhetoric: an ASBO for architects. No Scottish Parliaments in healthcare!
It’s hard to establish an informed independent overview. At AfH and CABE events I hear architects complain about the rules of the game – they can’t talk to end-users, DoH Activity Data is archaic, and creativity rarely survives the truth-drug of the Comparator. But after 35 years I know that no matter where they work or what they work on, architects always say the kitchen is too hot. Today, however, they are outnumbered by delegates from the public sector. We are addressed on a wide range of topics that illustrate the dark side of development: project credit ratings, consortia contracts, senior debt options and the workings of the Freedom of Information Act. It slowly dawns on me that, after a twenty-year funding drought, and the empowerment of countless trusts / fragmentation of responsibility, the 100-hospital deluge is largely in the hands of first-time buyers.
To complicate matters further, only a few weeks ago new Health Minister Andy Burton who 72 hours earlier had been in charge of design [?] at that other exemplar of numeracy, the Home Office, declared official endorsement of patient safety, patient-focused care and single-patient rooms. On that occasion, the ecclesiastical and academic hybrid architecture of the House of Commons was the perfect place to receive the gospel according to Ulrich. Having realized it no longer had a hospital design experience base, DoH has decided that it’s contribution will now be evidence-based. What I want to know is how many of the100 hospitals are open, on-site or beyond the point of no return, and if schemes now on the drawing board are being designed to be flexible superstructures to facilitate change, which is what we had been doing 35 years ago.
So, as hidden skylights splashed the afternoon sunshine on the flowing council chamber walls, and delegates began to slip away, I put my questions. Ironically, however, it was really my mention of Ulrich that set the cat among the pigeons. Wait ’till DoH launches SHAPE. This is a clinical planning methodology now being developed and my guess is it will present radical new ideas that will shakeup the parts of hospitals that Ulrich cannot reach. Ominously not one person still at the conference said they were actually working on projects that were ‘future-proof’. Is the future of the 100 new hospitals orange, or is it black?