What you will never see from Barts
DOCTORS AND ARCHITECTS
Phil Gusack comments on the AfH panel discussion at the RIBA on 30th November, 2007.
The best thing about the RIBA is its penthouse terrace. Every hospital should have one. It seems obvious: just the sort of thing on which doctors and architects could agree. But, as Paul Mercer’s event flyer put it, ‘they seldom share their visions and passions. The process seems to get in the way.’ Even if the original plans for the new Barts had proposed a rooftop terrace, it is hard to imagine anything quite so hedonistic surviving Treasury oversight and PFI rules of engagement.
Medieval illustrations of Aristotle’s theories of that the zodiac affects different parts of the human body.
We share much more than seven-years training and dexterity with scalpels. The trajectories of our professions arc from Aristotle, centuries of dependence on the church and, in post-war Britain, the welfare state.
In the golden age of the welfare state – 1948-78 - a majority of architects worked in-house in Whitehall and local government. They continued to do so until Margaret Thatcher got into her stride 20 years ago. Hell-bent on cutting public spending, she disbanded DHSS, Howard Goodman’s architects’ department. Spending on new hospitals was forcibly bungee-jumped. All that survived was whatever had made it to Her majesty’s Stationary Office.
The two casualties that have disabled NHS hospital design ever since are (a) the absence of experienced architects in Whitehall’s corridors of power and (b) the dissolution of the multidisciplinary collaboration that was intrinsic to Goodman’s modus operandi. Everything, from room data sheets to complete hospital masterplan, was developed by teams of administrators, architects, doctors, engineers, nurses and quantity surveyors.
Graph of NHS capital expenditure published in Patricia Hewitt’s Rebuilding the NHS, March 2007
Capital investment to rebuild the NHS dwindled until 1997 but since then close to £30 billion has already been spent. Obviously this led to a huge increase in the number of architects now designing hospitals. And whatever is right or wrong in the way the new NHS is conceived, planned, designed, financed and built, it is the only way most of them know.
Doctors have had to face their own brave new world too. One way or another they are all under the cosh of NHS red tape and reform, more science, more patients, more impatience, frenetic politicians and media frenzy. Despite all this they still top opinion polls as the most trusted of all professionals. In the Royal College of Physicians (RCP) poll politicians and journalists come last. Architects were not even on the questionnaire. The question of public trust in them remains moot. If the RCP think polls are worth doing, why doesn’t the RIBA?
Yes, British architecture has come a long way since 1984 when Prince Charles’ said that Ahrends Burton and Koralek’s extension to the National Gallery was ‘' like a monstrous carbuncle on the face of a much loved and elegant friend." But at RIBA they know that turkeys do not vote for Christmas.
Having been a very minor player on some of Howard Goodman’s multidisciplinary teams, having worked up-close and personal with many doctors on hospitals in the US and, more recently, being a patient of three NHS GP’s and six outpatient clinics, I am less sure than ever about the vision and passion that Paul Mercer thinks doctors and architects have to share. The evidence-base suggests serious motors. Architects want them. Doctors drive them!
I can only report that the consensus at this event reinforced Paul Mercer’s assertion about vision, passion and the system. But RIBA members knew this anyway, because it is all catalogued in last years RIBA Smart PFI policy proposal. In my view, Smart PFI is limited in vision and devoid of passion.
The two big issues that NHS hospital architects have to face today are (a) that the calculations and extrapolations that are used to transform demographic and epidemiological data into functional and spatial requirements are shrouded in mystery and off-limits to design teams and (b) although deviation from DH Guidance is not prohibited, the extra time, uncertainty and expense is prohibitive.
Doctors have the duty of care. Architects must make buildings fit for purpose. Doctors diagnose. Then they prescribe. Architects have to work their way through stages A and B. The one thing that architects do share with doctors is the imperative to ask questions. Architects need all the help they can get from doctors to restore the disabled art and science of architectural diagnosis.
The event itself was an evening of sang-froid, precision-guided by event chairman and former astro-physicist Duane Passman. He has found life signs in the NHS, but they are not as we know it. The bad news for 2008 is that DH still cannot tell us if MRSA is more prevalent in old or new hospitals. Until they do we can only pray that new hospitals really are better than the old ones, but the good news is that DH has the worrying question of fence colour sorted. Pantone 300 – Your Health, Your Care, Your Say, but our colour!
Merry Christmas.
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