Public Health Articles

An architect’s blueprint for the NHS

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Why design is central to achieving spaces that can fit form to function no matter how demand shifts while feeling truly embedded in the local neighbourhood

“We have been working in the healthcare sector for the last eight years and remain continuously assured by the power that design can have in spaces built around the treatment of physical and mental health.

Through our work with the cancer charity Maggie’s we have seen what design can achieve when allowed to flourish. Connecting the outdoors with the interiors, harnessing the healing properties of fresh air and natural light, privileging warm and tactile materials, and employing emotionally engaging colours are all strategies conducive to nurturing the soul and aiding recovery. Now more than ever, we are determined to take our expertise and our learning into the public health sector and GP Surgeries.”
– Ab Rogers

The biggest challenge we encounter as designers working with the NHS is the misconception that design is a luxury rather than a necessity, a cosmetic fix that only serves to improve appearances. We want to communicate how much design can instead support patients and carers and ultimately benefit the NHS. We believe that design has a fundamental role to play in improving quality of life when life is at its most vulnerable and that designing environments that are truly fit for purpose is the most valuable use of our skills. Careless design intensifies difficult experiences – fighting disease, supporting a loved one in pain, receiving bad news – all these struggles are amplified when surrounded by a neglected or confusing space, and the impact of a hostile environment on mental health and patient recovery times – particularly in intensive care – is well documented. The culture of care is incredibly strong throughout the NHS, but this culture needs to be embodied by its physical spaces too, supporting doctors and nurses as a ‘third carer and protecting all users from the perils of sick building syndrome.

“Progress is perhaps the biggest challenge the hospital, in its current form, faces.”

The design problems we encounter in our hospital projects – lack of natural light, inadequate storage space, cluttered corridors, low ceilings, poor lighting and acoustics, and confusing signage, along with problems inherited from years of short-term fixes – only serve to convince us further that the healthcare sector is where design can make the most positive change. We are not alone, the doctors and nurses we have had the privilege to work within our projects for Charing Cross, St Thomas’ and St Mary’s Hospitals never failed to impress us with their vision, understanding and commitment to improving the lives of their patients and staff through environmental change.

Most frequently we are brought in by a small department with a small budget who desperately wants to make a change, we then struggle against the restrictions of bureaucracy, procurement and rigid funding structures that come with working as part of a large hospital for a larger NHS Trust that is but a minor part of the wider machinery of the NHS. Our experience to date has convinced us that there are two ways we could improve this process.

One is to find a way to garner support from the top and have policymakers put their faith in designers to enact real, long-lasting change, empowering us to cut through the red tape wrapped around everything, from door handles to ceiling heights, and restructuring the release of funds to allow implementation of the kind of holistic improvements – circulation and flow, orientation of patient rooms, acoustic protection and sound design – that will save money in the long term and prevent the constant need for quick fixes.

The second is to catalyse change from within, encouraging the NHS to assume a sector leadership role in championing the value of design and innovation, setting high-level agendas that identify problems across the sector rather than operating case by case, in a fragmented way. This could even mean imagining a new professional figure who understands the inner workings of hospitals and is also experienced in design in its most expanded sense, as a tool to improve the human experience. This specialist figure or department would be able to listen to and coordinate all relevant parties, and above all be empowered to make things happen.

Our dream client in the healthcare sector has the ability to make decisions and take responsibility for the outcomes, writing ambitious briefs and looking into the future. In the commercial sector this kind of power inherently belong to the client, but within the NHS we find this is often not the case: our clients are supportive and invested, but also restrained by access to funds and lack of critical support from hospital estate departments. No matter how strong and visionary the brief or how informed the client team are, if there is no open dialogue and cohesion within the wider hospital departments it is difficult to make progress.

“We imagine a health facility of the future that responds to the evolving needs of its patients, doctors and nurses, a collection of spaces that are flexible, able to move, respond, expand and contract, changing shape to fit form to function no matter how demand shifts”

Progress is perhaps the biggest challenge the hospital, in its current form, faces. It has been said that the minute a hospital finishes being built it is already out of date. There is some truth in the idea that while they are contained within rigid, immovable structures, hospitals will always struggle to keep pace with the changing needs of their staff and patients, and with an ever-evolving technology.

We imagine a hospital of the future that responds to the evolving needs of its patients, doctors and nurses, a collection of spaces that are flexible, able to move, respond, expand and contract, changing shape to fit form to function no matter how demand shifts, and it is our belief that design plays a critical part in realising such a vision.

ARD would leap at the chance to take the above thinking and learning and use it to challenge the primary care centre, applying it to unlocking its complex practical and operational requirements. As the widest-reaching portal into the healthcare system, it would make a fascinating site for design, an opportunity to create a connected, inclusive community hub, a welcoming and humanist anchor that nurtures the sick, comforts the elderly, stimulates children and supports staff.

Increasingly primary care centres will function as the centre of a network of connected satellites – pharmacies, tele-health, vaccination clinics – services that are not just for the sick but that support all of us in our daily lives, and design is central to achieving a family of spaces that can enable this multi-layered operation while feeling truly embedded in their local neighbourhood.

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