Hospitals That Are Bad for the Health; A Pleasant Environment Is Essential to Patients' Wellbeing. Why, Then, Does the Government's Scheme for New Buildings Put Budget before Design?

Article excerpt

Byline: ROWAN MOORE

IT IS hard to argue for aesthetic niceties when it comes to the design of hospitals. Aesthetic niceties can cost money and every penny spent on them, it would seem, is a penny not spent on dialysis machines, or cancer screening or saving lives. An elegant glazing detail or a human life, possibly your own? Put like that, it is not much of a contest.

But the results of this logic can be seen all over London, and they are not edifying: the grey stump of Guy's next to London Bridge station, smoking at one end like a cigarette butt, or the Royal Free in Hampstead, apparently a multi-storey car park retrofitted for healthcare, or the brute lumps of St Mary's, Paddington. All are monuments to efficient clinical planning, none to the human spirit.

Now a new wave of hospitals is hitting London, thanks to Chancellor Gordon Brown's munificence, and there is every sign that the philosophy that gave us the Royal Free and Guy's has been perfected, strengthened and enhanced in the generation since they were built. To judge by the nearly complete University College Hospital on Euston Road, and the [pounds sterling]1 billion proposals for the Royal London in Whitechapel, Britain's biggest hospital redevelopment, these new buildings will make the older ones resemble ballerinas in their delicacy.

Recently, the design of the Royal London drove Mayor Ken Livingstone to threaten refusal of planning permission unless it is significantly improved, and for the Commission for Architecture and the Built Environment (Cabe) to pronounce the plans "seriously flawed". Such opposition takes courage. "Mayor opposes hospital" is not the sort of headline to win the hearts and minds of voters, while a publicly funded quango such as Cabe, in attacking a flagship of the Government's health programme, is biting the hand that feeds it. In other words, it must have been a shockingly bad design to drive the Mayor and Cabe to be so outspoken.

It is. In essence, the plan is for a group of blocks, rising to 19 storeys, lurking behind the Georgian and Victorian frontage of the hospital. The blocks are obese and close-set, cramming as much as they can into a constricted site, and lacking any positive visual quality. Skanska Innisfree, the consortium that will build and manage the hospital, claims that the proposalsare "sympathetic" to their urban surroundings and to neighbouring historic buildings, but there is nothing to suggest that they are.

There is a shift in angles in the blocks, dictated by the geometry of the site, which presents a mild compositional challenge most architects can rise to, but not here. The shift is handled with a complete absence of grace.

Instead, the architects, the American practice HOK International, offer some perfunctory gestures on the block's facades, changing colours on different sides in a way that is currently vaguely fashionable, and applying some random red stripes to the external walls. These are inadequate to the scale of the problem. They are like a few strips of Elastoplast stuck on a patient in intensive care.

These blocks are silos for the sick, whose only guiding principle seems to be to pile 'em high and cure 'em cheap. Inside they have deep floors, which sometimes put patients and staff 30 or 40 yards from a window that might look only on to a light-well (euphemistically described as an atrium) or on to another of the blocks a short distance away. Such deep-plan buildings are beloved of the more ruthless big banks, but even they do not expect people to exist in such spaces for 24 hours a day, as patients will have to. …

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