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The right medicine for health buildings

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Ron Morgan, in response to the review of 'Building Futures 2020 Vision: our future healthcare environments', questions the warning that, unless we are aware of future changes in both healthcare and building procurements, we may be building problems for the future.

The report addresses the future of healthcare design politically by reviewing both changes in delivery of healthcare and buildings. It sets out the exciting challenges ahead, and identifies that a welldesigned environment has a role to play in patient well-being and healthcare productivity.

What I describe as 'worrying' are the implications of the current mode of PFI procurement, with an emphasis on 'risk transfer' and measurable value for money. These demands are militating a process of briefing, design, development and construction that does not easily allow for a flexible, interactive and iterative process of briefing.

The significant opportunities of the PFI approach is it aims to take a 30-year perspective, with the intent to ensure the best interest of the client's business over the life of the contract.

Design should respond not just to the output requirements predictable today, but also to the potential demands of the future.

The initial competitive stage of the current PFI process distances designers from clients and users, and results in overdetailed briefs with exact activity requirements, with straightjacket solutions, rather than opening up opportunities to provide solutions that can respond to future change.

I would agree with Ron Morgan about the value of good design in healthcare facilities. I also believe this can be achieved within PFI, provided it allows for iterative design and reflects wider social, demographic and technological trends.

The 2020 Vision sets a clear challenge for architects. The appropriate briefing, design and procurement process can be a catalyst for change, encouraging fresh approaches to both the organisation of healthcare and the design of the environments in which it takes place.

There needs to be an interactive exchange between informed clients and expert designers in order to explore the potential.

John Worthington, chairman, RIBA CABE Building Futures

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