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In the UK, although remaining free at the point of delivery, NHS care has been forced to behave as a business, with a network of commissioning bodies theoretically picking from a list of ‘providers,’ in other words, hospitals. However whether this has worked to provide more focused, tailored, or good quality facilities is debatable – in reality, contracts don’t tend to move much, it’s probably too complicated apart from anything else. And it’s certainly true that PFI/PPP has tended to replicate some of the older, district general hospitals – which have their pros and cons.

Do we need a much more incisive focus on measuring real return on investment from projects – not just health outcomes, but something more all-encompassing – to enable the more unusual, and yet fit for purpose solutions to emerge? Otherwise we risk creating more of the same, which hasn’t exactly created the perfect system.



James Parker Editor


ON THE COVER... Samson Assuta Ashdod University Hospital is the first public healthcare facility to be completed in 40 years in Israel. It combines a state of the art, wellness-oriented healthcare facility with a design offering a high degree of resilience against attacks. For the full report on this project, go to page 12 Cover Image © Itay Sikolski


ometimes, the term ‘healthcare,’ like many other conjoined business terms, can itself be part of the problem. The problem being that the corporatisation of such services that rely on embodying the crucial, tailored ‘care’ part of the term in order to be successful for patients may end up being too homogenised as a result.


‘Healthcare’ as an industry, brings health together with care, which in itself is of course not a major downside, in fact the care should always reflect the health of a patient, and looking after their health necessarily involves a caring approach. However when it comes to design, simply turning out ‘healthcare’ buildings according to a manual risks treating them with a cookie cutter approach, such as you could risk by simply bandying around terms like ‘wellness’ and ‘stakeholder’ without a discrete focus on at least smaller groupings’ needs, if not absolute individual customisation.

Of course there needs to be some systematisation, in designing a hospital with 500 beds in it. However when there are probably innumerable examples of designers performing gymnastics to please the often conflicting demands of clinical teams, it would be good to hope they will remain able to try and do the same for patients.

To use another slightly clunky business term, more and more design thinkers are beginning to think about how to ‘leverage’ measurement of the effect of buildings on healthcare users in order to introduce more patient-centred environments. One example, raised by Kelly Watson, ex-Arup and now of consultancy Hatch Regeneris, (in a round table debate report on page 7 of this supplement), is how professionals are looking at measuring ‘social value’ – in line with the 2013 Social Value Act requiring public bodies to seek wider social, economic and environmental benefits from projects. This is one way in which a ‘one-size fits all’ approach might be held at bay, with the focus always needing to be on a distinct set of benefits – benefits specific to their context.



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