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Planning the healing process

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Richard Burton, inaugural partner of Ahrends Burton and Koralek and design adviser to the NHS, outlines the current thinking in healthcare design and argues that signature architects have much to contribute Charles Jencks' Maggie's Centres have brought a range of signature architects into the healthcare sector, and various lead names are currently working for the NHS - a prime example being Hopkins Architects, which is working on the Evalina Children's Hospital at St Thomas' Hospital, London. But these remain the exceptions rather than the rule.

There are various problems that discourage signature architects from tackling healthcare buildings in the UK. One is that NHS budgets only allow for relatively cheap buildings, probably limiting the kind of innovation that is to be expected. Another is that the professional competition is extreme, dragging fees down to 4.5 per cent or even, on occasion, less than 3 per cent.No one who wants to remain in business and provide a proper service will countenance the lower end, let alone those who are paid adequately for their talent in other fields.

There is also a myth that healthcare architecture is so highly specialised that only the initiated can enter. You may not need experience but you do need staying power - the architect is there from the start, and is usually the last person left at the end of the building process.

Hospital briefing does not always encourage design excellence, but this is beginning to change.NHS Estates and the public are beginning to focus on the subject through design review panels. And the fast-developing discipline of evidence-based design (EBD) is revealing more about the beneficial effects of design on patients and staff (see box below).

Healthcare architects are working in a dynamic field. I am put in mind of the situation in office design 30 years ago, before DEGW got hold of the subject. The conditions were dire. Certainly DEGW looked to the US and the Continent, but actually it battled through the intellectual problems encountered here and worked out processes to produce a better workplace. From the moment Stanhope raised the curtain on quality office design with Arup Associates, things have changed out of recognition, with many famous architects being involved in office design - names such as Piano, Rogers, Foster and many more. With the involvement of such architects we have seen really innovative work.

My favourite is Swiss Re by Foster, whose spiral section and plan is designed to give natural light in and views out from deep in the building. These are the very qualities that we are seeking in our health buildings because they engender faster healing and less analgesics, quite apart from a feeling of wellbeing in the staff. Instead we are being pushed further towards air-conditioned, unnaturally lit deep-plan solutions argued for by clinicians on the basis of adjacency of uses and US precedent. This is an almost direct parallel of the popular deep-plan, artificially lit offices of the '60s and '70s dependant on Bureaulandschaft. Swiss Re has come a long way but it has taken very innovative thought, a world-class architect and 20 years of changing workplace culture.

With health buildings in the UK we just don't have that long, and there is probably a more complicated set of issues.

In 1982 ABK became the architect for St Mary's Isle of Wight (AJ 10.7.91).We worked with the late Howard Goodman of the NHS, a key figure in setting new standards for hospital design. We had no hospital experience and produced what most have agreed was an iconic hospital that used nearly 50 per cent less energy than a comparable hospital of the time and, due to Goodman's encouragement, incorporated the arts and landscape from a very early stage.With the help of an exemplary client, we helped change hospital design. Powell and Moya produced some outstanding hospitals in the '60s, '70s and '80s. Also with Goodman's involvement, the practice built hospitals in Swindon, Wexham Park, Slough, Maidstone and Hastings - all buildings of quality. Powell and Moya became the pathfinders who ABK, among others, followed.

Things hit a very low ebb in the '90s, although the end of the decade saw a few remarkable achievements such as the ACAD Centre at Central Middlesex Hospital by Avanti Architects (AJ 20.4.00) and the brilliant surgery in Hammersmith by Guy Greenfield (AJ 26.10.00). But today there are some excellent architects involved in health building design. I think of Penoyre & Prasad, Edward Cullinan, John Allan of Avanti and John Cooper of Anshen Dyer.

Health buildings have come a long way in the transformation from military-based establishments to people-centred therapeutic organisations. There is certainly room for architects who will generate a different approach - and there is plenty to be done. The health building programme is immense and although the accent is on large Private Finance hospitals, there are many smaller PPP and LIFT projects such as diagnosis and treatment centres, community hospitals and surgeries. It is a fast-developing field, and as trusts and design champions become increasingly aware of the practical, psychological and financial advantages of exemplary environments (see box, right), trusts and their design champions might well favour bidders who have employed architects of international renown.

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