Lively presentations and debate took place on 6 March at the RIBA:

3 expert speakers – Candace Imison, Acting Director of Policy, Kings Fund; Dr Adrian Crellin, Consultant Clinical Oncologist DH and NHS England National Clinical Lead for Proton Therapy; John Cooper, Director of John Cooper Architecture and AfH (Outgoing Chair) presented their views on the implications for the future design of the built environment.

Candace Imison took a long view: rising life expectancy is set to result in greater intensity and quantity of treatment that will increase the burden on health services and change the profile of their delivery. Other critical factors, like lifestyle and socioeconomic status serve to highlight the ongoing importance of environment and prevention. Amongst the various solutions, Candace emphasised the role of technology in treatment and diagnostics in parallel with better and more integrated community based care. She cautioned that the ‘one size fits all’ approach would not be appropriate: ‘self care’ is not for everyone and ‘caring’ very much continues to matter. The vision for Older People is that care continues to seek connection, personal authority, self-esteem ; in effect, ‘re-humanising’ the experience. In a nod to Susan Francis, there was an acknowledgement that ‘2020 Vision’ ( Building a 2020 vision published by the Nuffield Trust 2001) still holds. Whilst Candace recognised that larger organisations are better placed to respond to the current unprecedented financial constraint, she also made the point that the significant reduction in hospitals’ size can only happen if it corresponds with improved informal and community based care. It needs a whole system approach.

Dr Adrian Crellin stated clearly that we can’t just keep going – something has to change! UK Cancer survival rates are poor compared to the rest of Europe and the UK is at the bottom of the league in most cancers. Late diagnosis, poor quality treatment and low expectations are seen as main reasons for poor clinical outcomes. These factors are combined with outdated design and equipment in a number of hospitals. To facilitate complex procedures, make high tech imaging and intervention viable, create appropriate high dependency pathway and care, Adrian argued that larger specialist regional centres must be created. These need to be supported by linked satellite treatment delivery centres. In conclusion, 15-30 major centres are needed to serve all of England, in parallel with the letting go of local hospitals. But this requires patients’ acceptance of the need to travel and is not currently helped by desktop ‘save our hospital’ campaigners!

John Cooper dazzled with a wholesale re-evaluation of the healthcare provision, asked ‘What is the NHS?’. He suggested it is a public service with noble aspirations, now partially privatised, but without 21st century vision; though it has a strong ‘brand’, it is sadly lacking in leadership, ambition and design. Despite the investments of the last decade, the majority of acute buildings are over 30 years old. The Russell and Sheffield groups are seen as medical centres of the future, but the question is about how to modernise the built stock? The DGH is no longer an appropriate solution, PFI investments is based on an obsolete model: so what do we do? Do we keep closing? Do we accelerate moving services into the community?

As the outgoing chairman he saw the ongoing role (or perhaps mission) of AfH as that of a mentor, and advisor, able to encourage and review policies and proposals, postulating, for example, mandatory design reviews and a closer construction/design association.

The ensuing discussion focused on the AfH Executive Committee’s most recent quest – influencing procurement of design teams, currently all too often narrowed to technical support role, in recognition of their intellectual capital. Political will and vision are required from all stakeholders. All agreed that design value should be ‘allowed’ into the process; currently there’s no understanding on the side of the authorities and decision makers of what it brings, with new emphasis needed on bridging the gap between politics and design.

Joanna Mariott AfH Executive Member

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