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Last Updated: Monday, 20 February 2006, 00:35 GMT
How design can be good for health
By Nick Triggle
BBC News health reporter

Last month, ministers announced more NHS care should be shifted from hospital to the community.

Campaigners say that one of the keys to delivering that pledge is well designed buildings. But why?

Grassroots in Newham
The centre is sited in a park in east London

Standing side on to Grassroots healthy living centre, you would not notice it was even there.

The 2.8m building's undulating roof is covered in grass, giving the impression there is a small hill nestled in the corner of Memorial Park in the east end of London.

But face on, the Newham centre - which will house nurses, healthy eating advisers, a cafe and childcare facilities when it opens fully in the spring - is the epitome of 21st Century design.

Glass-fronted, it comes equipped with solar panels to provide energy and concrete ceilings to cool the inside during the hot summer months.

Such a stylish design inevitably means there are unintended consequences - in this case motorbike riders are said to be eyeing up the grass roof.

Nonetheless, such centres represent the future of community health services, say campaigners.


John Sorrell, chairman of the Commission for Architecture and the Built Environment, believes well-lit, sustainable, welcoming health centres are key to the government's vision of providing more NHS services in the community as set out in the white paper last month.

"Good design is essential in improving access to facilities," he said. "It is all about getting people into centres and across the barriers that prevent the most needy from accessing health services.

"By having something like this with a variety of services we can attract people in. And once they are in, the environment is calming."

But it is not just about the building itself. The people behind Grassroots wanted to twin the centre with the park.

Chiddenbrook Surgery (Devon) - The GP practice is built into a hillside, surrounded by fields and trees, its buildings curve along the contours of the landscape. Surgery was built 13 years ago
Advance Dental Clinic (Chelmsford) - Nestled in a residential street, the pitched-roofed, brick and glass structure makes maximum use of the available natural light
Brent Birth Centre (London) - Housing six birthing rooms, the 3m centre claims to be more of a home from home than NHS facility. Vaulted roof lights, allow sunlight to stream in corridors
Walk-in Centre (Luton) - Situated in an old office block, just off the main shopping street, the centre demonstrates what can be achieved through refurbishing. The unit offers a combination of GP and hospital care
Pulross Intermediate Healthcare Centre (London) - A new-age cottage hospital, offering medical, nursing, rehabilitative and palliative care. It claims to have a rural feel with its surrounding gardens

Imran Devji, Newham's assistant director of primary care, said: "What we aimed to do was move towards a more integrated model of provision and deliver services closer to the community.

"Grassroots is sited in a park, and that is not a coincidence. We want people to see it as part of the community and tap into the potential for exercise it provides."

Mr Devji said he hoped to see the centre, which has been funded using government, EU and New Deal for Communities money, offering regular health checks and care for those with long-term conditions such as heart disease and diabetes.

But he also believes unique design, courtesy of Eger Architects, coupled with the variety of services on offer, will attract people in a way traditional GP practices sometimes struggle to.

And while the centre will not be fully open until the spring, it is already proving a hit with residents.

Moira Askew, a 34-year-old mother-of-three, said: "For so long this park has been a bit of a no-go area, but since the centre has been built things have started changing.

"I think it is good because it gets people thinking about the park in different ways. I also like the fact that it has got child care facilities, which will get you in and thinking about health."

Good design

Grassroots is one of 15 community health buildings across the country being highlighted in a report by Cabe on how good design is essential for the future of health care.

The centres range from dental practices to community hospitals, some of which were built over 10 years ago.

Many of them have a number of common characteristics - open public spaces, a single reception point, natural light, good storage space, the potential for out-of-hours community and flexibility to allow them to adapt to future changes.

We are reaching a point of significant change about how we deliver health services and the role of the health care environment
Susan Francis, Department of Health adviser

But the examples used do not just include facilities which have been built from scratch. Two are existing health centres which have been refurbished, while one involved converting an old office block into a NHS walk-in centre.

Report author Timothy Mason said: "It does not have to involve a big project, it can be just about refurbishing. GPs have tended not to think about design in the past because they are busy with other things.

"But it is about putting yourself where the patient is. Just simples things like having a welcoming reception and not having to undress several times while you are examined by a nurse and then again when a doctor sees you."

Cabe is using the report to push the government into paying more attention to design as it embarks on delivering a new vision for community health services.

The roof of Grassroots is covered in grass

Ministers have promised an extra 6bn for NHS buildings by 2007 and while much of it was assumed to be earmarked for hospitals, the recent white paper means significant funding will be made available for community services.

Announcing the out-of-hospital care white paper, the health secretary said she wanted to see a new generation of community hospitals offering a hybrid of hospital and GP care.

She also said she wanted to see services integrated in much the way Grassroots, designed by Eger Architects, is part of the London park.

Susan Francis, an architectural adviser to the Department of Health and NHS Confederation, which represents health service managers, said: "We are reaching a point of significant change about how we deliver health services and the role of the health care environment.

"It is not just about the building and the inside, but the surrounding neighbourhood. These can be important factors in delivering health care."

And she added while it was an "ambitious" vision, the NHS and architects were up to it.

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