Opinion - Healthcare buildings
The 1970s saw a huge hospital-building programme, yet just 30 years later many of these buildings have been found to be unsuitable for current clinical care. Hospitals built with deep plans and to nucleus designs are inflexible and do not let in enough natural light. One solution is to shut down these hospitals – like the planned closures of the University Hospital of North Tees and the University Hospital of Hartlepool – and move a proportion of the services out into primary care centres, providing care in a setting closer to people’s homes.
Primary care is changing rapidly to respond; there are now fewer single practices housed in new buildings on their own, and two, three or more practices are co-locating. They are being encouraged to federate by the Royal College of General Practitioners’ Roadmap initiative – which promotes working co-operatively.
Seven years ago we designed our first new primary-care building, Mowbray House in North Yorkshire. Now this building, built with 30 per cent expansion capacity, needs a significant expansion to be able to deliver this new care agenda. Many existing and new buildings are often designed in a very bespoke
way, unsuitable for expansion or adaptation – often nice buildings for architects but a cul-de-sac in terms of setting the trend for good sustainable buildings. They are often overdesigned and too expensive and represent poor value in the long term.
It is vital that these buildings are flexible and adaptable enough to respond as care delivery changes. We shouldn’t invest in new buildings now, only to find that they become outdated in seven years’ time. There are a number of key considerations which can help to create buildings which are suitable for the long term and justify the investment. Essentially, the main objective is to deliver buildings which are able to change with the NHS.
The starting point is location – key hub buildings have to be placed right in the centre of a town, close to excellent transport links. Primary care buildings need to be designed with simple shapes, open floors, minimal columns, good floor-to-floor heights and space for installation of future services. Circulation space needs to be the right size; many recent buildings have seen circulation
cramped down to save money. The spaces within the buildings need to be suitable for multiple uses, with space being shared by many clinicians and, wherever possible, with expansion space built in from the outset. These buildings can be adapted easily with changes in care standards and have residual value as they can transform from health to commercial or residential use.
Primary care buildings should be exciting places in which to work, providing a good healing environment but above all, they can change over the years to suit future demands.