When I am old

The ‘warning’ of Jenny Joseph circled through my mind. Experts from across Scotland were gathered to discuss how we can cope with an aging population who no more wish to live in care homes than we can afford to pay for them to do so. The problem is huge and, like the number of older people, it is growing. If we don’t change the way we do things, by the time I’m part of the problem practically every school leaver will be needed to service the care industry!

The workshops centred on how we can shift the balance of care from the state to the individual and their community - how we better support people to stay in their homes as they age. The solutions ranged from:

• the technical – fridges with avatars that suggest healthy recipes using the ingredients they hold and lock the fridge till you do the required exercise.
  
• to the attitudinal – either we’re “young till we die” or we have to expect less from our old age.
• to the procedural – the holy grail of interagency-joined-up-thinking where perhaps we can make enough efficiency savings to make room in the budget for carers to spend 5 minutes each day asking how the object of care happens to be.

So I sat there looking at two potential visions of my later life – one where I wear purple, ride a motorbike and maybe still do a bit of paid consultancy – the other I’m sitting alone with a nagging fridge as my only company and wondering how long I have to go without food before a real person comes to check on me.

We’re planning the system that we will inherit – lets develop a nation that we’ll want to live in as we age.

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Recognition

We’re not very good at recognising achievements and holding up our successes, but others see what we do and come to learn. Recently the successes of NHSScotland have been drawing international attention. Delegations from Norway have come to look at recently completed hospitals, and the Royal Institute of British Architects shortlisted NHS Greater Glasgow and Clyde for 'Client of the Year' – an award honoured on BBC2 during the Stirling Prize.

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Better by Design?

One of the golden rules for architects is not to cram an idea into a scheme if it doesn’t fit. I learnt this as a student visiting an ‘architecturally interesting’ building in Amsterdam. As I watched the students standing in the street taking photos of the glass fronted circulation space I wondered how secure and private the women in the refuge felt – how well the architect had addressed their needs. When style and ego is allowed to triumph over the very real substance of our human needs we – as a profession – take a step further away from being relevant and useful to society, and become further devalued by clients.

I wonder how a parent, sitting with their very ill baby in this new neonatal facility, feels about the architect’s design decisions - about the sensitivity demonstrated to their needs - as they take a momentary glance out through the (north facing) mesh covered windows and try to raise their hopes...

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PULSE LAUNCHED

Architecture and Design Scotland has been working with the Scottish Government Health Directorates and Health Facilities Scotland to produce a web resource to house information on good healthcare design to assist boards in brief development and to raise awareness of the good practice being developed and delivered across NHSScotland and elsewhere.
The www.healthierplaces.org web site holds a project resource called ‘Pulse’ which showcases a growing collection of innovative and well designed healthcare environments. This resource is designed to enable and improve learning and ambition amongst healthcare clients in two main ways. It can be searched by project type to find out about similar developments in NHSScotland and beyond, raising awareness of what has been achieved elsewhere and facilitating contact to promote shared learning. It can also be searched by area to find images of different parts of developments (such as entrance areas and consulting rooms) to aid benchmarking of qualitative objectives, particularly within the new Design Statements which form a key part of the new process of assessing design in the business case.
This resource will be continually developed by A+DS. Case studies of completed developments will be developed and added. Additionally, new NHSScotland projects will profiled using key information and images information submitted to the Design Assessment Process (once the Business Case is in the public realm) and, once completed, key learning such as post occupancy evaluations. NHS Boards, and others, are also encouraged to upload photographs taken during visits to inspirational developments to assist knowledge transfer between project teams.

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A+DS introduce ‘Design Assessment in the Business Case’

NHSScotland is to lead the way in public procurement by introducing a system of design assessment into the business case approvals process. Following the Cabinet Secretary’s announcement in 2009, A+DS’ healthcare programme has been working with partners at Health Facilities Scotland, SGHD and with selected Health Boards to develop a methodology of defining design objectives for projects and valuing these in the decision to fund the proposed development. The resultant process, which is being piloted in during 2010/11, was introduced to NHSScotland’s Capital Investment Network at a meeting this week at Victoria Quay. The move was received as a welcome focus on the long term benefits that can be realised through public clientship. Further guidance, and a supporting web-based resource, are to follow at the begging of June.

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Process and Product

As a client for a new development you want to make decisions that are best for the project, and as a representative of a public body you have to show these are transparent and fair. Tailoring the decision making criteria to represent the particular circumstances of the project can open you up to accusations of amending them to suit what you want to do; of ignoring other’s opinions in that choice. So scoring mechanisms are established that must be used unaltered on any project, even if they miss the mark... even if they limit or even destroy the potential of the project.

So here’s the catch 22 that public servants sometimes face... be accountable in the process and avoid challenges, or be accountable for the product.

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Form and function

The tension between the needs of the internal function and the desire for a form that enhances its location is often given as the reason for hospitals appearing somewhat forbidding. However hospitals are not alone in having an exacting internal agenda; and truly marvellous ideas can be born in the creative tension between function and form.
Stockton-on-Tees bio-energy plant by Heatherwick Studios

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The Design of Everyday Things

The absence of good design is often more keenly felt than the appreciation of a well crafted work. If you watched Ben Elton in the 90’s you may recall his theory that there must be a “Ministry of Crap Design” behind such idiotic commodities as hand scalding teapots and water repelling paper napkins.

The ministry of clever design – the Design Council - set about using design to make our hospitals safer places in their 2009 work Design Bugs Out. This project worked with both clinicians and manufacturers to re-consider the design of everyday objects, such as mattresses and pulse Oximeters, to reduce the risk of infection transfer via such items. The furniture, as well as being easy to clean, looks comfortable and attractive with chairs that might entice you out of your bed and towards recovery. When applied to such common place but nevertheless important objects we see that good design is not a luxury – it’s just good sense. The Design Council are now turning their attentions to how design can improve patient dignity including improvements in ward design and a Ben de Lisi designed surgery gown! Results are due out in March.

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It's personal....

I've been away for a while - let's just call it practical research - and I wish it'd been to a place more like this promises to be......

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