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Shining light on the plight of NHS architecture

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Prince Charles'new mission is to inspire the chairs and chief executives of hospital trusts to pay more attention to healthcare design. From flicking though the architectural press (AJ included) you could be forgiven for thinking that there was not much room for improvement.

The current crop of Maggie's Centres combine domestic scale and feel with the Midas touch of world-class architects. Guy Greenfield's The Surgery in Hammersmith shows that NHS buildings can be executed with enough panache to make it to the shortlist for the Stirling Prize.

Such mavericks are generally attributed to visionary clients - hailed as a rarity in the NHS. This is unfair. NHS executives know the impact of the environment both on patient recovery and staff morale. They suffer from a legacy of outdated hospitals, often lumbered with the modular cruciform plan developed in the 1980s. Like so many prototypes, it promised flexibility, but transpired to be a straitjacket. The courtyard layout, which works so well at Oxbridge colleges with their semi-outdoor cloisters, is deeply problematic when circulation space needs to be environmentally-controlled. Corridors end up being squeezed into accommodation blocks, while ad hoc extensions 'reclaim'the courtyard space.

New-build hospitals can, of course, address these problems, but with constant organisational and technological flux, it is impossible to predict the needs of future generations. Economies of scale demand vast buildings, with a gestation period which means that they are often out of date by the time they are complete. The NHS needs procurement, funding and design strategies which allow for evolution and change. It needs the freedom to move away from the idea that designing a hospital is a single isolated event, establishing contractual relationships with architects, based on the assumption of ongoing work. The Prince may discover that focusing on aesthetics is futile in the face of more fundamental structural constraints. But high-profile ineffectiveness can be valuable - if only to highlight the obstacles which stand in the way of change. The Prince has already proved his worth in his new role by bringing hospital architecture out of the shadows and firmly into the headlines.

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