The Health Secretary’s announcement that £13bn will be spent on hospital infrastructure projects, including six new hospitals, is an opportunity for a radical rethink about health and the built environment says Lord Andrew Mawson OBE
The NHS is in a mess, the silo’d machinery of the state is outdated and broken. Hospital sites across England are cluttered with buildings which have depended on NHS five year cycles for years, enabling the well meaning architect to earn a crust but leave behind too often a depressing, fragmented built environment. Frankly, I feel ill whenever I walk on to hospital sites in the areas we are working in.
But now there’s a golden opportunity for a new approach. My colleagues and I at the Bromley by Bow Centre in the East End of London have been at the cutting edge of the integration and ‘place making’ agenda for 35 years. We are generating a national and international movement and infecting NHS culture, encouraging new thinking linking health, cultural transformation and entrepreneurship.
Last year we welcomed leaders from 23 countries to see our buildings and their operating culture. Four years ago, the CEO of Public Health England asked me to take our experience into 10 towns and cities in the north of England, through the Well North programme. This has now evolved into a new social business called Well North Enterprises.
In the health projects we have built, the architect has always been an integral partner. We have encouraged them to challenge traditional NHS briefs, engage with local people and explore with us the fundamental questions about how, why and by whom buildings will be used.
As social entrepreneurs we are also bringing the private sector on board, working with leading practices like YEME Architects in Bradford, led by Amir Hussain, and Ibstock plc who are rethinking their role in a changing industry. These firms are at the cutting edge of the place making agenda. We are encouraging a programme of Corporate Social Opportunity (CSO), seeking “win win” opportunities, both economic
and social, with businesses.
Our prescription for the future If we are to have an NHS in 70 years’ time, we suggest the following steps, based on hard-won practical experience in East London and emerging experience in Well North areas across the country.
First, design teams must return to the fundamental question raised by the Peckham experiment in 1948, “What is health?” The NHS closed this amazing and well- designed building in 1952, saying that its services would now be delivered by them. They were wrong. Our integrated team discovered many years ago that 50% of patients who used the local GP surgery in Bromley by Bow did not have a biomedical problem, they had a housing, education or employment problem, or they were simply lonely. We’re finding similar percentages in the North of England today. The Bromley by Bow Centre is Peckham Mark ll, but this time with a business plan.
Secondly, we should stop designing and building new health centres. Today Bromley by Bow offers a vast array of services to our local community and 40,000 patients, in buildings and gardens that feel more like a monastery than a primary care centre. They stretch from conventional healthcare for local residents to opportunities to set up your own business or work with artists, from support with tackling credit card
debts to help with learning to read and write and scaling the career ladder.
Architects should stop designing and building health centres yes, but that is not to denigrate clinical health. On the contrary, we need to design imaginative integrated buildings that position clinical health within a broad range of services that drive well being in communities. Buildings should encourage a locally blended offer, where doctors sit alongside others, including patients and local residents, to provide what people actually need. It’s not about “what’s the matter with you”, it’s all about “what matters to you”, quite different.
Our health centres should be more like a John Lewis store, where the customer is welcomed in and offered a host of choices. Successful department stores know that a diverse product range makes complete sense for the customer and financial sense for the business – and design their stores accordingly. It is the same principle in integrated holistic centres, where health is about life and living, not just disease and illness.
Whether in the NHS or wider society, it's about developing integrated communities. We have built hundreds of projects, focused around health, housing, education and business enterprise. We run site visits entitled ‘A Place, A Street, A City’ showing what can be achieved and introducing the local people who did it with us.
We are breeding a massive dependency culture in the NHS in an institution that is far from well, aided and abetted by architects. Architects need to help us drop the sentimentality about the NHS and return to the fundamental question: what is health in our increasingly fragmented modern society? Our buildings need to reflect a joined-up world where the campus or cluster becomes the integrating norm and people and relationships matter more than process, strategies and plans.
This article was published on Architects Datafile in Oct 2019