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Healthcare: make or break for status of profession

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A key message from this year's AJ100 survey is that healthcare is where it's at. BDP, the biggest of them all, predicts that healthcare work will offset its decline in commercial work, while practices that are already known as health specialists are reporting impressive growth. Investment in the NHS is a golden opportunity;

programmatically and ideologically more appealing than the commercial work that has traditionally kept large practices afloat, healthcare buildings offer a rare opportunity to practice proper 'social'architecture and still make a profit.

It is also a heavy responsibility. Hospitals are built to last. Failure to pay due consideration to urban design, civic presence and the relationship between buildings and their landscaped spaces will have a lasting impact on our cities. A legacy of buildings that are difficult to navigate, costly to maintain and depressing to use would be catastrophic and potentially fatal. It is easy to fall back on PFI as an excuse for sub-standard design - but not particularly productive.Whether we like it or not, PFI is here to stay, and it is a key factor behind the largest building programme in the history of the NHS.

NHS Estates has confirmed its commitment to highquality design and it is up to the construction industry to rise to the challenge within the framework of PFI.The fact that practices such as Edward Cullinan Architects, with impeccable design credentials, are prepared to bid for PFI projects, dispels the myth that healthcare is best left to specialists and demonstrates a conviction that the system can deliver buildings to make the best architects proud. It is essential that it does.

It is rather heartening that, in order to survive, the giants of the architectural world are snuggling up to the public sector and the caring professions, as opposed to cavorting with the sharp-suited custodians of the commercial world.But the stakes are altogether higher.

If architecture fails to deliver, it could face a public relations disaster on a par with the failed social housing experiments of the 1960s. If it succeeds, it may finally regain its reputation as a humanitarian and publicspirited profession.

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