The Scene

In 1997 the NHS embarked on the biggest hospital building programme in its history and had opened or begun construction on 88 new hospital schemes, including mental health and community facilities. Since 2000, when the NHS Plan was launched, over £68m has been invested to make improvements to the hospital environment which will directly benefit patients and visitors.

58% of all health expenditure is being spent through hospitals. The country is divided into a couple of hundred managerial districts, and each such District Health Authority provides hospital and community based health care for a population of around 250,000 people. CABE is calling for the built environment to be part of the debate on health and well-being. All new health centres, polyclinics and redeveloped community hospitals should provide high quality facilities recognizing the importance of integrating the planning and development of neighbourhoods with the design of individual healthcare buildings. The campaign is accompanied by a new report, Designed with care: Design and neighbourhood healthcare buildings and will include the first built environment Health Week (15-20 May 2006), a week of debates and high level discussion involving health professionals and all those concerned with the built environment. Although there is constant change and redesign in policy, the reality on the ground is a spectrum of inequality and inefficiency. Delays in government level decision making ensure St Barts hit the news as £25,000 per hour is lost on the biggest PFI scheme ever undertaken by the NHS.

Andrew Lansley, the shadow health secretary, has asked the government to comment on the increased costs the delay is incurring. "The risk is that government is examining value for money and affordability," he said. "But every day of delay is undermining both value for money and affordability."

Specific work developed for the hospital

In this context, Miessen and Murphy set up a working relationship with two Mental Health wards in London, trying to understand the realities and needs in terms of design in a specific situation. The main emphasis in this scenario was focusing on low-budget, easy to introduce designs that would change existing physical conditions and deliver measurable benefits to both patients and staff.

Meeting spaces were spatially changed in order to cater for their outlined functions, one ward was extended into an Annex, in general terms, the changed model for the ward was developed on the basis of creating a more open space, bringing more natural light into the corridors in order to achieve a more relaxing and less tense atmosphere. It was also suggested to re-use areas within the ward that were previously closed off, introducing changes in terms of programme to specific zones, decreasing the amount of hermetic space by simple techniques, often taking components away rather than adding new ones, and punching holes into walls where natural light needed to penetrate into corridors.

The overall scheme is based on the idea that by creating a more suitable environment both for patient and staff, the general tension amongst inpatients would decrease. In order to achieve this, the team introduced a number of zones for negotiation in which patients and staff could interact more informally, establishing an interface through which patients can pro-actively seek conversation with members of staff. Further, it was proposed to reduce the amount of hidden corners and sharp edges throughout the entire ward.

Rather than proposing spatial change on the architectural scale of a building, the team, in this scenario, decided that both for economic as well as practical reasons, the design needed to react locally to specific situations within the ward instead of coming up with a completely re-designed masterplan.