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Hospitals need architects

Opinion Does the NHS know its future depends on good architecture? Phil Gusack enquires

The current UK financial slow-down and its potential impact on the government’s spending capacity can only raise the clamour for better value from publicly funded schemes, and raise the bar for architects.

With close to £30 billion spent on capital investment since 1997, rebuilding the NHS is the biggest game in town. When I joined the then Department of Health and Social Security design team in 1971, it pursued innovation and involved doctors, nurses and managers at every stage. After a 25-year sabbatical, I returned to find that the money is still there, but everything else has changed.

Now most big hospitals are designed, built, equipped and maintained by PFI consortia. To win a place on a PFI team, architects play to the contractors as if playing to the cameras in the Big Brother house.

The £30 billion has generated less than its fair share of innovative and exciting buildings. One obvious exception is Hopkins’ Evelina Children’s Hospital at Guy’s and St Thomas’ in London. When it won the Stirling Prize public vote in 2006, it should have given a huge adrenaline shot to the hospital architects who argue that hospitals should be low-key. But they dismiss Evelina as a fluke, saying Hopkins forced function to follow form.

Superbugs don’t care about architecture either. They kill in hospitals old and new. So when Ted Cullinan and I competed in Latvia last year, our scheme for a teaching hospital put all inpatients in single rooms, each with its own infection-control lobby, in a highly adaptable aerodynamically active superstructure flanking a winter garden.

The need for safer flexible hospitals with expansion and exit strategies has been obvious for decades, but the supreme irony is that the 1968 DHSS innovation flagship in Greenwich has already been demolished and Llewelyn Davies Weeks’ Northwick Park Hospital, the biggest Brutalist building of them all, may also have its life-support pulled

Office and retail developers have their own ways to build in flexibility – they know that good design is good for business. The inconvenient truth is that NHS hospitals are businesses too – typically their £200 million turnover equals Arsenal FC’s. In the new era of patient choice, the question is: does the business really understand that its future depends on its architecture?

Phil Gusack has designed hospitals, offices and retail developments for a number of practices

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