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NHS needs a shot in the arm to change design perceptions

editorial

This week's building study, Benenden Hospital, is typical of the type of healthcare projects that tend to receive coverage in the architectural press in that, a) it is smallscale and 'quirky', b) it is not by a specialist healthcare architect, and c) it is not for the NHS. Conventional wisdom suggests that these three points are interrelated. Small organisations commission small projects, and, being independent, are able to take risks. Bowed down by its own bureaucracy, the NHS commissions buildings that are large, uniform and executed by a small clutch of practices with experience in the field.

But this is faulty logic. At what point does a building become so large that it needs to be tackled by an expert? Healthcare buildings can be complex building types, but it is difficult to see why they should demand specialist skills. Universal design issues - circulation, legibility, space, light - are still of paramount importance. Technological and environmental requirements are simply components in the age-old architectural discipline of marrying function to form.

As with all building projects, there is a place for specialist expertise, but this can be broadly defined. Richard Murphy won two commissions for Cancer Care centres by demonstrating a talent for turning existing domestic buildings into highly-crafted gems. John McAslan won the Benenden Hospital commission on the basis of his experience of restoring and extending iconic modern buildings, notably the De La Warr Pavilion at Bexhill-onSea. Designing large buildings is, of course, a specialisation of its own, but hardly one that is beyond the experience of our most celebrated architects.

If leading architects are keeping away from the NHS, it is not because they have nothing to offer but because they have too little to gain. The health sector routinely pays up to 50 per cent less than RIBA recommended fee scales. The emphasis on process, as opposed to product, makes the sector less attractive to design architects, which means clients, in turn, become less interested in design. Aalto, Corbusier and Lubetkin placed healthcare firmly at the heart of the Modernist agenda. If they were practising in Britain today would they simply walk away?

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