Susan Francis obituary


Susan Francis 1952 – 2017

Susan FrancisSue Francis was a determined pioneer whose achievements as a woman, an architect, an educator, a writer and a strategist are woven into many lives. Sue was an amazing person to work with, always generous with her knowledge and expertise while sensitive, clear and very organised. She drew on a multitude of skills and cultures, which allowed her to work across disciplines very successfully.

She also had a rich personal hinterland and many at her funeral were surprised and gladdened to hear of an interest or a skill of which we knew little. Sue designed her own clothes. She designed and built her house in Shepherdess Walk, London, along with friends who became family, raising their children together under one roof. She also designed her singular career path and guided those of many others.

History will judge Sue kindly because she was right about so many of the big issues in healthcare strategy and design. The book – she co-wrote in 2000 for the Nuffield Trust – Building a 2020 Vision: future health care environments – set out a 20-year development strategy for the NHS, a design primer and an approach that grounded these in the context of broader social and public health structures. It identified and addressed virtually every element that forms the current debate about healthcare provision and reform. Had politicians and strategists followed her precepts, the country would be in much better health.

Sue began her professional life in the cooperative movements of the late 70s and early 80s and was a founder member of the Matrix Feminist Design Cooperative, working across disciplines as an architect, enabler, writer and occasional political firebrand. Following the birth of her three children Sue ran a course in Women in Architecture and Building and then in 1991 joined the staff of the Medical Architecture Research Unit (MARU).

In Thatcher’s Britain many on the left took refuge in academe or embraced private practice. Her career change could have gone wrong – this was a time of turmoil for MARU, funding was scarce and the unit’s leadership had left. It could have also ended in academic sterility, but Sue, with Rosemary Glanville, secured the future of the course and under their leadership the unit flourished to provide a generation of NHS and international students with a unique education. Sue built a reputation as a highly effective advocate for design quality in healthcare and moved to the national stage. She drew on a multitude of skills and cultures which allowed her to work across disciplines very successfully. She was a brilliant chair and a very effective organiser with a network of contacts across the world.

After 15 years, Sue stepped down from her day-to-day involvement and joined CABE, heading its healthcare design team at a time when billions were channelled annually into capital investment. She also joined the Future Health Network at the NHS Confederation as design lead, working with Sylvia Wyatt on developing a learning network and a knowledge base to integrate health system design and architecture. It was a time of over-rapid and often ill-considered development, which Sue had foreseen and warned against in Building a 2020 vision. Nonetheless, she excelled in these roles and succeeded in mitigating or overturning many poor decisions, and secured the role of CABE as an essential component in the design process, improving the quality of a host of projects.

Sue had been involved in Architects for Health from its earliest days. In 2011 she was invited to become its programme director. She brought all her skills to bear and turned AfH around, galvanising the committee and creating the successful organisation you see today. Her last five years were tough, but her inner strength proved tougher, as she calmly dealt with everything that her illness and fate flung her way with equanimity and her faith in the power of the human intellect.

The European Healthcare Congress is one of several fitting memorials to her vision, the network of contacts and bonds of friendship she had developed across Europe and her ability to bring people together in common cause. Sue will be remembered by her three sons, by the whole extended family of Shepherdess Walk, and by friends and colleagues across the world.

John Cooper is a director of healthcare specialist John Cooper Architecture

Ann Noble Obituary


Ann Noble9th December 1942 – 9th December 2016

PhD, B Arch, MA Sociology,
Dip. Town Planning, RIBA

AfH Past President

An original founder member of Architects for Health, Former Chair and subsequently Life President, Dr Ann Noble has died peacefully after a long illness. She had a distinguished career in practice, teaching and lecturing internationally and had collaborated with and advised many leading practices including Ted Cullinan, SOM and HOK.

Ann Peerless was brought up in Somerset and studied at Bristol University, where she met her future husband, Paul, both reading architecture. She gained an MA in Sociology from the University of Essex in 1967, registered as an RIBA Chartered Architect in 1971, gained a Diploma in Town Planning from the then Polytechnic of Central London in 1974 and a PhD from Bristol in 1988.

Following three years working in Libya on social housing, Ann began Research & Development work for the Department of Health and Social Security (DHSS) Hospital Building Programme. Thus began a lifelong interest and passion for healthcare architecture, taking her to the very top of that profession and international acclaim.

For thirteen years from 1976, Ann was engaged with research and teaching at the Medical Architecture Research Unit and there established an advisory and facilitating service for General Practice Premises, and other primary care building developments for Inner London. At MARU, she was pivotal in teaching and mentoring the Masters Degree course in health facility planning, attracting students from across the globe.

Ann Noble Architects was established in 1989 and became renowned for expert advice and sound knowledge as well as designing and delivering a range of highly regarded healthcare buildings. The practice continued to gain commissions for assessment and evaluation, a mainstay of Ann’s belief in the value of structured research to inform decisions and future schemes.

Ann’s research portfolio is extensive and a continuing thread through her career, from a survey of shantytown dwellers in Benghazi and Tripoli for the Libyan Ministry of Housing in 1970 through to evaluation of wards, whole hospitals and dozens of primary care centres to patient safety research in 2007. Many of her papers were published by MARU and the Nuffield Trust book “50 Years of Ideas in Health Care Buildings” which Ann co-authored in 1999 is a definitive review of healthcare over the lifetime of the NHS.

Around 1990, as most in-house healthcare design services were abolished by the government, a small group of likeminded architects and others set up Architects for Health, as a means of continuing a thread of mutual learning and information sharing across the professions. Ann was among those early pioneers and the organisation grew in stature and membership. Professor Raymond Moss held the chairmanship until 1998 when Ann Noble was elected to that position, which she held for ten years.

During Ann’s tenure, Architects for Health developed a vibrant and varied programme of events for members, attracting guest speakers from across the healthcare world. The international visit programme was inaugurated by Ann, the most notable of which was a study visit to Japan in 2005 by a group of members and hosted by the Japan Institute of Healthcare Architects. That relationship is particularly poignant as the lead host was Professor Yusushi Nagasawa, who had been one of Ann’s students on the MARU course some years earlier.

In 2009, Ann received the Lifetime Achievement Award at the Building Better Healthcare Awards. Her citation includes this sentiment; “Ann has devoted her professional life to promoting excellence in healthcare environments”. Those words reflect a career, a lifelong passion and a depth of knowledge and dedication which her friends and colleagues will recognise. Ann’s influence and determination, imparted with kindness and good humour, has been the inspiration for many in the professions she worked with and knew.

Ann married Paul Noble in 1966 and they had a son, Jacob and a daughter Sophie, both of whom practice as professionals in the built environment. Behind the consummate professional, Ann was the caring matriarch of a loving and close family who enjoyed each other’s company at home and on fondly remembered holidays. The birth of her grandchildren was a source of great pleasure to Ann in her latter years.

Ann gave of her time and experience freely, mentoring and advising colleagues and protégés alike. She had the rare capacity of understanding healthcare architecture comprehensively and the rare gift of encouraging and enthusing others towards greater excellence in that field.

To make a donation to the Alzheimers Research Trust in Ann’s memory, please go to this web address where detailed instructions are available.

2018 Study Tour to Northern Ireland

Architects for Health Study Tour – Northern Ireland

4-6 July, 2018
Health Infrastructure for the NHS in Northern Ireland has followed a distinctive path from the rest of the UK. Under the control of the Northern Ireland Department of Health for much of the last 30 years, buildings have been commissioned placing a high value on quality and local partnerships. As a result, the province has some of the best recent health buildings developed to provide NHS services. The Architects for Health 2018 study tour organised with the generous support of sponsors Axis Entrance Systems and contractors, McLaughlin & Harvey Construction visited a range of Acute, Sub-acute and Community Health Facilities.

Welcome and Introduction
HLM Architects hosted the welcome event at their central Belfast office. As the 21 members of the Study Tour gathered there was time for networking in a convivial setting with wine and food. The event was kicked off by John Cole, who had been a huge support in helping arrange some of the visits. John’s presentation gave a wide-ranging overview of his time as head of Northern Ireland Health Estates, the objectives and what they had achieved. This focussed minds and provided an excellent starting point for the tour.

Omagh Hospital and Primary Care Complex, Western Health & Social Care Trust
The first full day commenced with a visit to Omagh Hospital and Primary Care Complex in the west of the province. Opened in 2017, the new £105m complex reprovides services from the old Tyrone County Hospital bringing together GP’s, Urgent Care and a range of Treatment Services with 40 step up/down beds. We were met by Andrew Murray and Paul Crowe of Todd Architects and Donna McFarland of the Western Trust who have an overview of the development and features of the impressive new development. The party split into smaller groups to tour the building. Inevitable with such an interesting building, the visit overran and we were late for the lunch hosted by McLaughlin and Harvey at Omagh Golf Course.

The South West Acute Hospital, Enniskillen. Western Health & Social Care Trust
The South West Acute Hospital opened its doors to patients on 21 June 2012. The new PFI Hospital re-provided services from the old Erne Hospital and is one of the most attractive large hospitals in the UK in a terrific lakeside setting. The new hospital has up to 210 in-patient beds and 22 day-case beds. The hospital delivers a full range of acute services for the south west of the province, a largely rural population where road travel times limit access. We were met by Anita McConnell of the Western Health & Social Care Trust who have polished overview of the history of the development of which staff are clearly proud. Burkhard Musselman of Stantec provided an overview of the layout and the party was greatly helped by Jane McElroy’s oversight of the development. After the visits to the emergency department, wards, outpatient and engineering areas, the party returned to Belfast.

Ulster Hospital, Dundonald, Belfast. South Eastern Health & Social Care Trust
After visiting facilities planned for rural populations the visit to the Ulster Hospital is the major acute hospital for the Trust and delivers the full range of acute services for the more urban population around Belfast. The visit to the new 6 storey 30,000m2 Inpatient Ward block designed by Avanti Architects with Kennedy Fitzgerald Architects provided an overview of the planned comprehensive redevelopment of the hospital. Kieran Quinn and Maureen Toner of the South Eastern Health & Social Care Trust who provided an insight of the integration of clinical services across the hospital during the multi-phase redevelopment. Andrew McKeown of Avanti described the evolution of design and features with modesty and understatement. Circulation through this complex medical environment is a pleasure with daylight and views of gardens with artwork whilst the clinical spaces and patient rooms showcase exceptional detailed design.

Bambridge Health and Care Centre, Southern Health & Social Care Trust
After a picnic lunch on the banks of the River Bann the party visited the award winning Bambridge Health and Care Centre. The primary and community health centre model is a distinctive feature of health and social care in Northern Ireland. Although a small building the architects have used the sloping setting to create layers of overlapping functions with stepped and beautifully landscaped courtyards making an exceptionally rich environment. We were welcomed by Sharon Radcliffe of the Southern Health & Social Care Trust and Damian Day of Kennedy Fitzgerald Architects who with Andrew McKeown of Avanti led the tours of this exceptional new facility. Short of time the party headed north for the final visit of the tour.

Ballymena Health and Care Centre, Northern Health & Social Care Trust
The excellent new Health and Care Centre for the Northern Trust area, provides a one-stop centre for assessment, treatment and provision of care to the local population. Services in the facility include 6 GP practices and a local pharmacy as well as a mix of locally accessible acute, primary and community care clinics. Arriving a little late we were met by Tim Harland of Hoskins Architects who with co-creators Keppie Design planned and designed this beautiful and rich new facility. Alison Renfrew and Diane Power of the Northern Health & Social Care Trust introduced and facilitated tours of this building which brings together a wide range of services in a modern and attractive setting.

Phil Gusack Talk at AGM 2018

Henry Marsh “Why are Hospitals so often Horrible?”

Mr Henry Marsh CBEOur speaker this evening is Henry Marsh one of the UK’s most eminent neurosurgeons. After graduating with a First in PPE, at Oxford he studied Medicine in London, subsequently training as a neurosurgeon.

His work has been the subject of two major BBC documentaries – “Your Life in their Hands” in 2003 and “The English Surgeon” in 2009 which was described in the New York Times as “Enthralling, astonishing…agonizingly human” and in the London Times as “the most moving and honest film about surgery I have ever seen.”.

His book Do No Harm, published in 2014, became an international best seller with more than 30 foreign editions and translations. It has been described as:

“Riveting … extraordinarily intimate, compassionate and sometimes frightening …”
(New York Times)
“Why has no one ever written a book like this before? …what a bloody, splendid book…”
(The Guardian)

In 2017 he published a second book Admissions, which became a Number 1 Sunday Times best seller and received reviews as enthusiastic as for his first book.
Although retired from full-time work in the NHS he continues to work in diverse countries such as Ukraine, Nepal, Albania and Pakistan.

He is a passionate defender of the NHS and has a long-standing interest in the influence of the hospital environment on patient health and staff morale. He doesn’t speak too highly of healthcare architects but can only be an ally and a friend when he challenges on patients in NHS hospitals who ‘rarely get peace, rest or quiet and never a good night’s sleep’.

He was made a Commander of the Order of the British Empire by HM the Queen in 2010. A man who talks about stage fright at the start of a case; whose profound quotes on quality of life and death are too many to mention.

Henry Marsh has a passion for healthcare environments, mostly because he has worked in them for over 40 years but also because if he hadn’t have been a doctor he suspects he would have studied architecture.

“Hospitals are places where peace, rest and quiet (all essential to recovery) are impossible.”

He started his neurosurgical career at the Atkinson Morley Hospital which was founded by a philanthropist who had suffered a hospital stay at Charing Cross and been disturbed by the sound of carriages at Trafalgar Square so gave money for the building of a hospital in the leafy suburbs of south London. Now the site of the Atkinson Morley is ‘rich trash housing’ and the patients and staff suffer the unpalatable scale of St George’s Hospital, Tooting.

Henry took us on a rapid journey from the pseudo-science of the ancient Egyptians to the pseudo-science of cryogenics and invited us to consider having our heads stored in dry ice for the future.

In fact medicine is now ‘a secular religion. We want long life rather than eternal life; we fear dementia more than we fear the devil; we fervently exercise rather than pray.’

We now have an insatiable appetite for healthcare. In the USA it will consume 20% of income by 2020 and we spend 26% of the cost in the last year of life.

Both the pyramids and Chartres Cathedral are built expressions of our fear of death. As are Hospitals.

So why are hospitals so horrible?

Hospitals are biological hazard areas; they are full of windowless spaces or high windows; multi bed bays are grotesque.


Who is the client and is he informed?

Take the Aga Khan Hospital in Karachi. Beautiful and aesthetically pleasing because the Aga Khan acted as client. But it doesn’t function as a hospital.

We have an ideological faith in technology and hospitals are becoming so complex they are no longer humane.
The knowledge is there to do better. Take intensive care at the Karolinska (or anywhere) where the sound levels were intolerable and the patients felt as if the nurses were just waiting for you to have a heart attack to spring into action. A project to change the ceiling tiles improved rest and recovery of patients and was shown to reduce readmission rates.

Much of modern medicine is palliative care not cure; it is changing all the time and is technologically complex. In recent times alone stents and statins have made cardiothoracic surgeons redundant. Change is occurring at an unrelenting pace.

So where is the incentive to build a well-designed, sympathetic hospital?

How about the hotel model? That, says Henry, is the ‘peacocks tail of evolutionary theory.’

It is extraordinary how much difference can be made by windows with views and natural light.

And size matters – as a neurosurgeon it makes sense to consider Dunbar’s Number; the size of the human brain correlates to the ideal social group size in which humans function well.

For humans that number is about 150 numbers, reflected apparently by the typical number of Christmas cards or mobile phone contacts lists. Staffs in hospitals need to feel comfortable amongst the team; they need to feel a responsibility for what is happening.

Hospitals need to function more like regiments which generate institutional pride. Good offices and good coffee rooms are important because people need to talk. Surgeons need to learn detachment but not be too detached.

Finally, Henry turned to art with a not very complimentary view of Arts Officers or Arts Committees. His proudest achievements at the end of his career? Placing art on walls in waiting rooms and fighting for 7 years to get a ward balcony turned into a garden. That is how to demonstrate ‘care.’

There was time after Henry finished talking for a few questions. It was noted that he had poked a bit of a stick at healthcare architecture and it was clear that the audience enjoyed the presentation – available on SlideShare.

Phil Gusack Talk 2017 at AGM

Reshaping NHS Infrastructure: Will integrated care centres do the trick?

Dr Patricia Oakley is a woman on a mission. Having qualified originally as a pharmacist and becoming London Chief Pharmacist in the early 1980s she didn’t stop there. She has a masters and a doctorate; teaches and undertakes research at Kings College, London and is a Director at Practice Makes Perfect. She splits her time between London and the West Country.

On talking about building the case for change Pat told us that she talks from experience having been involved in policy making for integrated care centres. More usually she works every summer building forecasting models of the clinical workforce and particularly doctors, dentists and pharmacists in order to inform the Joint Investment group of the student numbers they need to admit to support the future workforce. These models look forward 20 years which is the time it takes for a student to become fully effective in the workforce. Continue reading

Healthcare Architect Needed for New Hospital in Georgia

We have had an enquiry from a German-Georgian construction company based in Tbilisi, searching for a strategic partner for the planning and design of a new hospital in Georgia

The basic requirements are as follows:-

  • Services for preparation of design-cost estimation documentation for infectious pathology, HIV and clinical immunology located in Tbilisi / Georgia
  • Support needed for engineering-design services required for construction
  • Land plot area is 5 000 m2
  • Estimated rentable area of the design building(s) is 10 567 sqm
  • Design should provide for accommodation of 100 beds
  • Design-cost estimation documentation shall be prepared in line with construction norms and regulations effective in Georgia, and in accordance with European Standards.
  • The design-cost estimation documentation shall provide for the measures of adapting the building to the needs of disabled

If any members are interested in taking up this challenge please send your statement of interest to us at General Enquiries on our Contact page. Your details will be forwarded to the company for their information and action.

European Healthcare Design 2017



The European Healthcare Design 2017 – Call for Papers – have now been launched.
Organised by Architects for Health with SALUS Global Knowledge Exchange.

More information can be found here

LGHN website goes live!

The exciting news that the Landscape, Gardens & Health Network website is now live. Please visit at

Landscape Gardens and Health Network is an online resource for anyone interested in the role of gardens and designed space for health. It features current research and events that show the therapeutic value of gardens and green space. Landscape is taken in its broadest sense, embracing the natural and designed environment, highlighting its many relationships to human health and wellbeing.