The future is already here

Architect Paul Mercer discusses how designers and planners can learn from the past, as they contemplate how to adapt to the future of healthcare

Recently published, the 2018 Annual Report of the Chief Medical Officer is subtitled ‘Health 2040 – Better health within reach’. This 280-page document, overseen by Dame Sally Davies, with contributions from numerous health visionaries, explores potential health and care provision in 20 years’ time. Early on, the report suggests that much of what will be of relevance then is available now. From Prof Davies Report, “The management writer Peter Drucker once noted that the best way to predict the future is to look around you.” For designers and planners of healthcare facilities, this might come as a relief. The NHS in England is currently experiencing further organisational change as Primary Care Networks, STPs and other configurations move goalposts again. But these changes are irrelevant to a future in 2040. Looking backwards can be valuable but beware dwelling on the historical.

There’s a place for post-occupancy evaluation – what happened; did it all work out; what can we learn? Looking forwards armed with current best practice and systems will equip our newest facilities best. But best practice is often hard to pin down. Healthcare designers and planners are often under pressure to deliver quickly. Many clients are as transient as their organisational changes – and the temptation to repeat previous design models is pervasive. Healthcare designers and planners should be visionaries, understanding the present and future of health facility design, helping clients envision well beyond the couple of years it takes to build and open something new. This presumes that designers and planners have knowledge and skills to develop that narrative and, sadly, this is not always the case. So, designers and planners need to up their game. To be the forward thinkers in times of austerity and short-termism is a tough call but keeping on top of what is happening across nations and internationally is vital. To paraphrase Peter Drucker – look carefully at what is happening now (best practice) and devise healthcare environments that enable this.

Led by technology

Look around you – what do you see? Look for the positive, the innovative, the unexpected. We have a huge amount of clever tech, from big surgical and diagnostic to tiny personalised and even microscopic. Common factors with all of this tech are improved outcomes and better lives for people – often remotely from medics and nurses. However, it is not practical to conduct all consultations and treatment remotely. It is well understood that unwell people prefer to be at home. It is also well understood that face to face consultations should be as local as possible, whether at a health centre or hospital. As health centres and hospitals begin to adopt new tech, so will people at home. Something as simple as a telephone conversation between patient and GP is now much more common: video or Skype consultations are being trialled, and personal and wearable monitors are proving effective.

For designers and planners, there are implications not only in considering increasingly widespread tech but also the probability that what happens in community health buildings will change radically. There will inevitably be a receptionists’ desk and waiting room, but beyond these, a very wide range of facilities and professionals could be installed: from GPs, nurses, therapists and counsellors – much as now – to healthy food prep and cafe, exercise and yoga, voice coaching (aids breathing and lung function), discussion groups, reading groups, knitting groups, gardening and so on. These are all acknowledged to aid better physical and mental health. In the spirit of the future being already here – for example, the Bromley by Bow Centre has been offering many non-medical but highly beneficial health and wellbeing activities for some years. What are the implications for designers and planners? Three answers – location, space and flexibility. Technology will never fully surpass the experience of meeting other people, whether for health reasons, or doing something they enjoy. That has to happen within a local community, so locating community health facilities appropriately is vital, with proximity to other communal functions such as shopping, leisure and learning/libraries. As town centres suffer decline, there should be opportunities to make appropriate interventions by health and care bodies, working with social care and health promotion organisations and also charities and support groups.

Over time, as centres begin to flourish, they will need space to grow – and this is sometimes a challenge in town centres and urban environments. But availability of a garden as well as potential for extending the buildings should be considered as part of location. Flexibility to morph as services change can be a challenge but a good starting point is the suite of spaces set out in guidance HBN 11-01. This approach may appear rather modularised, and suggest formulaic built formats. It is tempting to assume that ‘modular’ is the same as ‘prefabricated’ – or using preferred terminology, off-site construction. Many health facilities are peppered with sad, grey sheds, serving as additional space for anything from offices to inpatient wards. These are inexpensive prefabricated buildings and are generally unappealing – but don’t be afraid of modular building when well considered and crafted. These techniques have been around for centuries – the earliest known off-site building was Nonsuch House, completed on the old London Bridge in 1579, having been prefabricated in Holland and shipped to England. So we can learn from the past as we contemplate the future – which is probably already here if we know where to look. A full reading of the 2018 Davies report should be required for anyone involved in thinking about the future of healthcare in 40 years’ time. If there is one limitation to Dame Sally’s work, there is no mention in all 280 pages of how the health estate might evolve.

Paul Mercer is a former director of Tangram Architects, and is a member of the Architecture and Design of the Built Environment Technical Platform at the Institute of Healthcare Engineering & Estate Management (IHEEM)