Fat in the system

The planning stystem grew from the realisation that the built environment – the size and proximity of houses and their relation to sources of pollution – affects public health.

Watching ‘the hospital’ last night brought home the epidemic we’re facing as our children become increasingly obese; and the impact this is having on the NHS – the increased workload on staff who are tasked with helping. But there are hidden implications too – hospitals are having to plan to build wider doors and stronger beds and hoists to deal with the new field of bariatrics - the science of obesity. Despite the pressures for apparently easy fixes the NHS cannot offer a gastric band to everyone – and many of us would not want to live out our lives without a proper meal – so can planning help us out of this public health problem too?

Well the way we’ve built our towns – with suburbs a car’s drive from anywhere – has clearly been a significant contributor to this growing problem. We now have to have special initiatives to encourage children to walk to school, where once it was the obvious and probably only option. We need special festivals to reclaim the streets and change a traffic island into a place to meet and socialise. Once children would have played there daily...

How we build is a reflection of how we want to live. It influences - for better or worse - how we feel about ourselves and the life choices we feel are open to us. Our built environment is again determining how well, and how long, we live. But don’t take my word for it – the Chief Medical Officer for Scotland, Dr Harry Burns, has called on the development industry to tackle these issues and be the “vaccine for the 21st century” .

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To Dream...

As a motorbike rider, universally known within the Health Service as an ‘organ donor’, I’ve a vested interest in the NHS working really well. As an architect, I fundamentally believe that the design of our health estate can help our nurses and doctors in their work and help me feel better when I have to go there, and I’m happy to say that the NHS in Scotland believe this too.

But travelling the country - those conversations you have on the train or in a taxi - I’m often met by a feeling that nice hospitals are just for those who go private or even that nice buildings get in the way of clinical function. One person argued with me the length of the country that we shouldn’t be spending money on new hospitals, but on the drugs that offer hope to many...

This is the false dilemma that faces NHS Boards commissioning new facilities. They know that much of the old estate is getting in the way of modern care – of moving the service closer to the community; they understand how the built environment effects the morale and motivation of clinical staff and the wellbeing of patients, and that better, more efficient buildings can free up resources to use directly in patient care. However the development of a new hospital or health centre is not always greeted by the public as a welcome opportunity, but with the defence of the old and a suspicion that the board will waste money and take too long... all attention turns to cost and programme.

In this apparent dilemma is where my heroes work, seeking ‘the impossible dream’. Day in, day out, they work to consult and keep happy a myriad of stakeholders, political masters, auditors and advisors who all want to see their interests given prominence through the procurement, in an audited and accountable fashion – under constant press and public scrutiny – within a system that one such hero described as ‘treacle’. In such an environment some struggle to deliver a place that will offer hope – but some struggle on to do this for us. They do not get the sympathy the public reserve for nurses and doctors, in fact they’re often overlooked. But today I offer them a wee (borrowed) tribute – inspired by my love of bikes – “to dream the impossible dream”

The flip side of this is we need more heroes. Audit Scotland’s recent report identified a shortfall of estates professionals that is looking like worsening as many retire. Perhaps as many architects and other building professionals are joining the dole queues, some might want to take up the role of hero in a sector that’s investing in real change.

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