Architecture in the Age of Austerity March 2011
The theme of this meeting was to consider how to best 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.
John Cooper reminded us of the Department of Health estimate that it will take £65-75 billion investment to bring the current estate up to standard.
Mungo Smith described his project devised together with Andy Black of Durrow Consulting and Johannes Egen from Trondheim in Norway for a new model hospital that will provide acute care locally. The project focuses on looking at alternative ways of using space and different ways of organizing services. Key themes include integrating the hospital into the townscape; better engagement of hospital and GP services; more overlap between patient pathways, patient flows and special sequences; provisions of flexible and adaptable spaces; and making a hub for a wide range of clinical staff to come together.
Jackie Cardiff told the tale of the health strategist in which the nature of the investment process has become highly mechanistic with adequate investment focus on capital but too little on revenue consequences.
She suggested that
- patients feel that hospitals are dangerous
- relatives are scared
- patients are very informed
- but respect must be earned
- professionals and organizations annoy patients
- and everyone has to fight for decent care
The NHS is better at treatment (the science) and worse at care (the art). We need to give more thought about how to do less harm and to do more good. She invited us to imagine a utopian project: one that is not out of date on opening; has built in adaptability; and is a place about which people would be proud.
Rosemary Jennsen talked about the art of the possible.- a ‘people -should -smile –more’ approach to masterplanning. Addenbrookes Hospital in Cambridge was a case study for intervening in a complex existing hospital site that moved from the city site almost 50 years ago. The hospital is located in a Growth Area, is a Centre of Excellence and has a campus with bio-medical research that is part of a major infrastructure development. The masterplan looked ahead in stages: 5, 10 20 and 30 years and took account of areas immediately outside the site boundaries. It was designed to facilitate translational research and generate more public facilities and places. It has brought a rationale to a site that has developed in an evolutionary and organic way over the years and has taken the opportunity to propose how to develop the site over time to keep the principles of people and place to the fore.
Nigel Greenhill presented four delightful case studies of upgrades to existing buildings. The award winning Cancer Centre at Barts had set the principles and high quality standards for working with constraints and making the most of opportunities.
In the Macmillan scheme at Medway Hospital all the main rooms in the chemotherapy unit enjoy courtyard space; the refurbished physiotherapy gym at Mile End Hospital has bright and open spaces for treatment; the integration of teaching and research with patient treatment is explored in the adaptation of the Urology department at Guys Hospital; and the Chemotherapy day centre at Guys Hospital is trialing ideas for a new purpose built centre: each tumour group has a double bay and the integration of artwork in the glass screens helps to provide good patient privacy.
Nigel identified key design themes in their approach:
- strive for bright, open, generous waiting areas
- keep scale intimate in patient rooms and offices
- attend to detail, proportion, and scale
- insist on handsome, comfortable furniture
- invent details which give pleasure
- seek art which is integrated with the architecture
The wide ranging discussion acknowledged that 1 in 20 people in the UK are employed in the NHS; that most people become patients at some point in their lives; designers have a responsibility to help support quality care in environments that are well designed for patients, visitors and staff. In this age of austerity, it will mean making design work harder to help deliver good care within the constraints of existing buildings and smaller budgets.
Mungo Smith, Dip. Arch MAAP Director
Mungo is a founding director of Medical Architecture, a former head of design at the Medical Architecture Research Unit (MARU) in London and was project architect for the pioneering Lambeth Community Care Centre with Edward Cullinan Architects. Whilst he continues to be actively involved in research through consultancy with the Department of Health, and is a member of their Design Review Panel for major capital projects, he is also regularly invited to speak on the design of healthcare environments in the UK, Europe and Australasia. Recently, he has been involved in developing the reference design for the New Royal Adelaide Hospital, South Australia and the latest master plan for the Sunshine Coast University Hospital, Queensland, Australia
Jackie Cardiff CEO for HCP Social Infrastructure (UK) Ltd
Along with operational management, Jackie has undertaken major service redesign work as part of Trust mergers and capital development projects as well as service developments. Examples of this work include: redesign of Major Incident protocols, development and implementation of Air Rescue Services (HEMS), relocation and service re-design of a Children’s hospital, service reconfiguration across multiple sites, establishment of Trauma care facilities and establishment of dedicated Day Surgery services. Jackie has a commitment to Evidence Based Design and has led the HCP work with the Centre for Health Design for the Company to become the first Global Pebble Partner and she has delivered the first UK and Canadian Pebble Project.
Rosemary Jenssen BSc Hons B Arch Dist RIBA, Senior Director, healthcare team, Devereux Architects.
Rosemary has been involved with the production of design proposals for a number of award winning healthcare projects, ranging from refurbishments to major new build redevelopments. She has successfully delivered projects under a variety of different procurement routes including traditional, develop and construct, PFI and the ProCure 21 framework. Rosemary’s special interests include Mental health design, Maternity design (including neo-natal) and Community health design
Nigel Greenhill MA, AA Dipl RIBA
is a founding Director of Greenhill Jenner Architects, London.
He has over 30 years experience in the design and delivery of buildings in the public and voluntary sector in housing, education, health and community and arts projects. Nigel was the Director in charge of the new Urology Centre at Guy’s Hospital and the Breast Care Centre in the Grade 1 West Wing at St. Bartholomew’s Hospital ( both NHS Award winning schemes). He has just completed the new Chemotherapy Day Treatment Unit at Guy’s.