Back to the future

Back to the future

Stow, Derek

BOOK REVIEW

Derek Stow reviews the landmark study ‘Building a 2020 Vision’, published last year by the Nuffield Trust and the RIBA, and wonders whether it is ‘more of the same’, despite its significance.

In May 1999 a seminar of over 100 professionals explored the possibility of forming a vision of healthcare and its buildings as they could evolve by the year 2020. From this seminar Maru (the Medical Architecture Research Unit) developed an interdisciplinary research proposal, subsequently funded by the Nuffield Trust and RIBA Future Studies. The authors of the resulting published study, Building a 2020 Vision, are Susan Francis and Rosemary Glanville, head of Maru.

A steering committee drew on the deliberations of four interdisciplinary focus groups, each with its own set topic. These included ‘Organisation’, ‘Location’, ‘Design’ and ‘Construction’. In parallel Maru undertook a scan of existing policy, research and practice in respect of the same four topics.

The report comprises two sections, the first of which is entitled ‘Blueprint. This sets out to “illustrate ideas for future healthcare environments which are not offered as a rigid formula but rather as principles to stimulate a creative dialogue.” It assumes a “social model”, based on “patient’s experience”, enhanced by design, which is socially, economically and environmentally “sustainable” Given that the rapid advance in medical and information technology is predicted to continue, the home is proposed as a “strategic setting for patient-centred care”.

This would create a four-tier system comprising: the home, health and social care centres, community care centres, and specialist care centres.

The proposal re-configures the present healthcare delivery system in order to bring services closer to the patients. The future needs of the population, the mode of delivery, the perceived benefits, both to the patient and the environment as a whole, are set out in detail and the case for its adoption is argued with conviction.

The second section, “Scanning the changes in the healthcare and construction industries” sets out to give “a situational analysis of the two industries, which are both undergoing change leading to modernisation.” Rather than a review of current building models or procurement processes, the intention was to develop a vision based on a new approach. The scope of the material was generated by the focus groups and the issues raised were then researched. The outcome is given in the form of six papers, as follows.

‘Organisation of health care delivery looks at the likely changes in the delivery of healthcare driven by the modernisation programme, with the argument illustrated by exemplar models. ‘Location of healthcare buildings’ attempts to identify the influences that will determine their location in the future. It sets out the key issues and the government initiatives for the modernisation of the NHS. ‘Design and construction’ aims to give an introduction to the changing state of the construction industry and assumes that integration of design and construction is inevitable. ‘Design quality: enhancing the healing environment’ takes the form of a review of the agencies involved in the betterment of design and the initiatives that they have taken. ‘Sustainable construction’ sets out the current policy initiatives for sustainable construction illustrated by examples for the healthcare estate. ‘Standardisation, pre-assembly and customisation’ reviews the revival of interest in the rationalisation of design and construction methodology.

This is an optimistic vision, redolent with the euphoria of the new millennium, that looks forward to the benefits of the new economy. Clearly it is a work of considerable substance that makes a very significant contribution to the current debate by stressing the strong case for a redistribution of services based on “patient-centred care” The layman, however, may be puzzled to find that patients are present in only two out of the 17 stunning photographs, which presumably, were chosen to illustrate exemplar healthcare environments.

Some 30 years ago a similar study was carried out, sponsored by the Kings Fund with Brunel University. It arrived at the same view as to the direction that health and social services should take. The old Department of Health and Social Security, with its estate intact, had the opportunity to strategically plan a devolved but integrated service. It chose to go in the opposite direction. Now, with, on the one hand, PFI hospitals costing as much as 450m, and successful trusts being granted “earned autonomy”, and on the other hand, the purchase of private surgery and even hospitals, plus the import of doctors and nurses and the export of patients, (together with the proposal to invite overseas healthcare firms to develop hospital facilities in the UK), it is not easy to picture the form that the new modernised NHS is going to take.

It is no longer possible to strategically plan an integrated health and social service. Nevertheless the Prime Minister has called for, if not a plan, at least a strategy of devolution. If the Government is right to pursue a policy that encourages services to develop locally on an ad hoc basis then an overall vision of the outcome is required, and the publication of Building a 2020 Vision could not have come at a better time.

Indeed it seems to have achieved its first objective, to “stimulate a creative dialogue”; The Prince of Wales has been commissioned by NHS Estates to lead an initiative that will address functionality, construction standards, and sustainability. Building a 2020 Vision sets the criteria that projects will have to meet, and is thus required reading for all concerned with the building of healthcare environments for the future.

Building a 2020 Vision – Future Health Care Environments, R Glanville and S Francis, ISBN 011 7028010, Nuffield Trust, Royal Institute of British Architects and South Bank University, 2000, 162 pp, BEtW photographs, hardback.

Derek Stow is the head of healthcare specialist architects and planners, Derek Stow Et Partners.

Copyright Wilmington Publishing Ltd. Jan 2002

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