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aj building study

Good hospital design can help patients recover more quickly, a government conference was told recently. It seemed to be a matter of stating the obvious: a light, spacious, colourful environment, with attractive views out, is very likely to make you feel better. Not the least of the woes of the nhs, however, is its legacy of buildings, many of them relatively recently built, which might be guaranteed to have the opposite effect. Nobody expects hospitals to be attractive or visually interesting places: for too long their design has been driven by the functionalist fallacy. It is in this context that Avanti Architects' ambulatory care and diagnostic (acad) centre at Central Middlesex Hospital (cmh) in Park Royal, West London, stands out as a beacon of hope.

cmh, a 450-bed general hospital, serves a swathe of London (Acton, Harlesden and Willesden included) where the poverty of the built landscape mirrors the poverty which is endemic to the lives of many of its inhabitants. Sited amidst a random clutter of industrial estates, cmh operates from a depressingly dismal collection of buildings, some of them inherited from the nineteenth century Willesden Workhouse, out of which it grew. The hospital, however, has a reputation for innovative, community-based care - this helped it survive a closure threat in the mid 90s. cmh did not stand on past achievements, but looked hard at ways in which it could serve patients better. The acad centre is one outcome of that process. Much of the public's dissatisfaction with the nhs relates not to emergency care, which can be as good as any in the world, but to more routine treatments - for problems such as hernias, cataracts and varicose veins - which assume a low priority alongside cancer and heart surgery. The 'ambulatory' concept behind the acad centre provides for such treatments to be carried out in a building specially designed to handle them - patients go home at the end of the day. This is a hospital without beds. In addition, the centre is a place of referral for local gps and a vital tool in the rapid diagnosis of more serious illness using X-ray and other 'imaging' techniques such as scanners and ultrasound machines.

cmh had long resisted pressure to sell off undeveloped land adjacent to its campus. But by eventually selling 14ha of it (at up to £240,000 per hectare) the hospital was able to fund the £12.5 million acad building without recourse to a pfi scheme (though pfi was used to fund the supply of equipment, including a sophisticated it system). John Allan of Avanti believes that the special quality of the building stems from this decision (endorsed by the government - Paul Boateng, previously under secretary of state at the department of health, is a local mp and Tony Blair, no less, came to open the centre). Allan compares the cmh project with a pfi project in which Avanti has been involved - the 82 architect and client meetings which took place at cmh during the design briefing stage were, he argues, vital to the success of the completed building. pfi, Allan says, tends to keep architects at arm's length. Appointed early in 1995, as winners of a selection process over, amongst others, Edward Cullinan Architects and Sheppard Robson, Avanti Architects launched into the job immediately - planning permission was obtained at the end of 1995.

Avanti is best known - apart from the high-profile conservation projects led by Allan - for its 'social' architecture, a label too often associated with the epithet 'worthy but dull'. The cmh building is anything but dull. Indeed, it is inspiring, spirit-lifting and rather beautiful, and, judging by its immaculate condition a year after opening, it inspires those who use it. Given a bit of planting and some carpets, the reception area - flanked by a very welcome Costa coffee bar - could be the point of entry to a stylish hotel. But this is by definition a public space - of a quality unusual in London's threadbare inner suburbs - which extends 90m, north- south, along the 'street' which runs the length of the building. Top-lit and crossed by a series of bridges, with some modest gestures toward Modern roots, the 9m high galleria is the backbone of the centre. 'We wanted to make something special', says John Cooper of Avanti. 'Patients these days are more discerning, so we've treated them with respect.' The overall triangular form of the building follows closely the confines of the site. West of the public zone, two floors of imaging and 'intervention' (operating) facilities are topped by a layer of services. To the east, the E-shaped 'patient zone', formed around two open courts, includes reception areas, consulting and treatment rooms and a recovery area where people can sleep off the effects of anaesthesia. There were ideas of an enclosed landscaped area around this wing, shielding it from the bleak hospital environment beyond - 'but they liked the look of the new building so much, that they opted for a more open layout - a pity in my view', says Cooper.

Cooper is aware of some shortcomings in the finished building - the client's project manager drove the process hard to finish on time and on budget and there were some cuts. (A staircase, for example, where the treads have been made of glued timber pieces, rather than the single pieces of timber specified, and are not wearing well, and a space off the reception area, intended as a glazed news kiosk but which is now temporarily rather crudely walled off.) But these are the faults which architects, rather than the building's users, tend to notice.

It is the absolute clarity of the building which impresses most. Serving a catchment area where up to 60 per cent of the inhabitants do not speak English as a first language, the acad centre has to be visually comprehensible. There is a refreshing sparsity of notices. After the immediate visual pleasure of the interior spaces, what impresses a casual visitor like myself most is the commitment to providing dignified surroundings which would not be out of place in a bupa hospital. Somehow, out of a tight budget, for instance, the architects have conjured up good quality furniture for the public areas. An extravagance? No: it is touches like this which underscore the point that the nhs is the final touchstone of quality in care for Britons of every social class. And it was a brilliant touch getting in Costa to run the coffee bar - overworked medical staff deserve a decent cappuccino.

Built and occupied in two years, the acad centre does not (and could not) transform the look of an institution which badly needs a well-funded masterplan for future development - to go from the centre into other cmh blocks is to step back 50 years. Externally, the centre is very straightforward - only the reception 'prow' and the glazed staircases along the eastern elevation add emphasis to a restrained composition finished in render, reconstituted stone and timber. The revolution implicit in this building is to be found inside.

For Professor Charles Harvey, cmh's former chairman, this is right: 'what takes place within the building is ultimately more important than the building itself'. Harvey concedes, however, that the centre is 'a showcase for the nhs as a whole'. It is, in fact, a highly political building - as political, in its way, as Lubetkin's Finsbury Health Centre (of which John Allan has written so compellingly). Commissioned under a Tory government and adopted as an icon by Blairism, the acad centre has been used to promote the idea of a consumer-led, commercially underpinned nhs. Yet it provides an excellent example of a health project where two sets of professionals, architects and doctors, worked together, in defiance of prevailing political ideologies, to create a building designed with the patient in mind. This is a building which demonstrates what the nhs can become, given the leadership currently lacking in a party in which, amazingly, Nye Bevan was once a leading light.

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