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



Nonsuch House, assembled on the original London Bridge in 1579, was thought to be the earliest known building constructed offsite

Looking backwards can be valuable, but beware dwelling on the historical; there’s a place for post-occupancy evaluation – did it work out, what can we learn?

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)


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