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An emergency case

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TECHNICAL & PRACTICE: Rather than specialising in impersonal, utilitarian modern health buildings, perhaps architects should leave well alone

There are numerous features of hospitals built since the 1960s that make them profoundly enervating and alienating to work in.

Right from the time of arrival, one is stressed by the draconian charges for parking. I find it quite immoral that visitors, called to an emergency, have to pay to visit relatives. I have yet to see a hospital that offers a discount or free parking.

It is a major task to find one's way around hospitals. Despite the recent introduction of help desks, there may be no signpost to one's destination or it might be highly ambiguous. The lifts cause huge queues at visiting times which dislocate hospital life as well. What about elderly people or those with disabilities? Why not install escalators?

My particular bete noir in modern hospital designs are the long, alienating corridors, straight out of Kafka, painted stark white (is white paint cheaper than any other? ), with no decorative or directional variation to break the utter monotony. One can only speculate about the impact that such visual tedium has on the mood of staff and visitors alike.

There is a well-advertised national agency which lends paintings to hospitals; to hire a few would be an act of compassion towards those who have to traverse such corridors of disempowerment.

Of course, long corridors allow horizontal development, but they cut off departments from each other. It is noticeable that in modern hospitals there is much less interdepartmental contact. As a consequence, I believe that patient care, professional life and the bonhomie that oils the working day suffer as departments become more isolated and introspective.

My particular opprobrium is reserved for the architects at one hospital where I worked, who designed some of the secretaries' rooms looking out against blank walls - and some without windows at all!

In contrast, anyone who has worked in one of the extant Victorian, or 'war' hospitals could teach today's architects a thing or two about how to create a pleasant working ambience. For a start, there is a helpful, symbiotic staff culture which seems to be produced by a work milieu that is not scrupulously uniform or authoritarian. With the erosion of professional boundaries comes interdepartmental intercourse - then the consultants knew the first names of the staff right down to the kitchen ladies.

The whole spatial environment in old-time hospitals facilitates contact between staff, with unpretentious cafeterias where the staff can mix. In modern hospitals the consultants often eat separately.

The contours of corridors in these antediluvian institutions are broken by little alcoves of haphazard passages. The decoration might be askew pictures of the 'Monarch of the Glen', but somehow these enhance, rather than detract from, the informal ambience.

One may get soaked when commuting between blocks but this permits the taste of invigorating fresh air, which attenuates the stress.

The wind blowing into the blocks regulates their temperature in stark contrast to the modern hospital's temperamental temperature controls. Somehow, it all seems to contribute to a delightful informality.

In a generation's time, when a few architects have been prosecuted for inducing sick building syndrome by the design of their hospitals, I predict that they are going to rediscover 'the therapeutic wheel':

Patients prefer 'Nightingale wards' where they feel more observed and where they have more privacy during clinical consultations.

Staff prefer a working environment that is comfortable, rather than that resembling a submarine ready for action. The barren, utilitarian, internal desecration beloved of contemporary architects is shown to be bad for sentient life.

Patients eminently prefer a homely, reassuring hospital environment rather than an impersonal, antiseptic ambience.

There are 22 hospitals in England and Wales that are currently completed (or nearing completion) under the Private Finance Initiative.

Early intelligence indicates that these edifices, driven by the monetarism of private enterprise, have not taken on board the self-evident truths that I have spelled out above.

Dr Martin Gaba is a psychiatrist

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