New public polling commissioned by Policy Exchange has found a preference for traditional hospital design that favours natural light and private rooms. This work in hospital design is part of a bigger project looking at the future of the hospital in Britain in the post COVID era, which will evaluate how new hospital building can better meet the needs of the NHS in the 21st century.
Like many kinds of architecture, hospital design saw massive changes in the years following the Second World War. Prewar hospitals featured large numbers of private rooms arrayed along long corridors, with high ceilings and tall windows facing out over courtyards. The facades of the buildings were faced with natural materials like brick and stone, and their windows and doors were carefully arranged to form complex patterns, the practice architects called ‘facade composition’.
In the postwar period, the development of artificial lighting and ventilation encouraged hospital designers to try alternative models that seemed to promise greater efficiency. Massive blocks were constructed, with patients sharing artificially lit and ventilated rooms, sometimes entombed deep within the building. These blocks tended to be marooned in enormous car parks, and their exteriors tended to be designed in the modernist style, with raw structural materials and repetitive grids of windows.
The wisdom of this shift has been challenged by a large and growing body of evidence, which suggests that both the physical and mental health of patients benefit from natural light, natural ventilation, quiet, privacy and access to greenery, and that people tend to prefer traditionally composed facades faced with natural materials to those favoured by the modern movement. The results of the poll commissioned this week by Policy Exchange suggest that public preferences support exactly the kind of hospitals that such evidence points towards.
The public has a clear preference for naturally lit private rooms: 15% of respondents chose natural light as the most important thing to them in hospital, while 18% chose private rooms. The corresponding figure for good food was only 7%. Considering the proverbial monotony of hospital food, this is a striking contrast. Providing large numbers of naturally lit rooms means having a relatively high ratio of surface area to building volume, which in turn points us back towards the courtyard plans of the traditional hospital rather than the block plans of the modernist one.
Another striking result here is the weight the public lays on the accessibility of hospitals. 26% of people said that convenient distance and accessibility via public transport was the most important thing about a new hospital, higher than any other feature. Again, this suggests that traditional urban sites should be preferred if at all possible: public transport networks radiate out from city centres, so the only way that hospitals can be made accessible to large numbers of people arriving by train, bus, bicycle or foot is if they are located there, not amidst an expanse of suburban car parks.
When it comes to the beauty of buildings’ exteriors, the clear winners were the two prewar designs, with St Andrew’s Hospital in Northampton and the Royal Victoria Hospital in Newcastle receiving 7.2 and 6.5 respectively. The 1950s classical building soon to open as the Cleveden Clinic in London also performed strongly (6.0). St Andrew’s and the Royal Victoria are both set amidst lawns and trees, and it is plausible that this was a factor in their strong result. Interestingly, traditional designs were especially preferred among women: 19% gave St Andrew’s ten-out-of-ten, as opposed to 15% of men; the corresponding figures for the Royal Victoria were 16% and 10%, while those for the Cleveden Clinic were 9% and 6%. For nontraditional buildings there was either no relationship to gender, or it was the other way round.
The two typically postwar hospitals included in the list, Sunderland Royal (3.0) and Watford General Hospital (3.0), performed least well. We do not have direct evidence on what it was about these buildings that people disliked, but obvious candidates include the surrounding car parks, the rather dirty facing bricks, and the repetitive and remorselessly horizontal facade patterns.
Results were more complicated when it came to hospitals from more recent decades. The neat but arguably monotonous exterior of the Great Western Hospital in Swindon performed better than the postwar hospitals, but still underwhelmingly (4.8). Interestingly, however, the design of the Richard Desmond Children’s Eye Clinic, often regarded as iconic, did notably worse (4.0). Facades certainly need creative attention, but this reminds us that not all kinds of creative attention are popular with the general public.
The remaining contemporary designs had some more interesting results. Royal Tunbridge Wells Hospital has rightly been praised for returning to a more traditional overall structure, with most patients accommodated in private rooms with views over interior courtyards. Its off-white rendered facades performed above the average for modern buildings, but still disappointingly (5.3). Bristol Southmead, with its stone facings, columned ground floor, and tall light atrium, scores rather better (6.2), though still below the prewar options.
As mentioned, we should be cautious in interpreting these results, because we do not know exactly which features of the different designs led people to vote the way they did. But several points look fairly clear here. People want hospitals to have features – natural light, private rooms and access to green spaces – that will be hard to deliver without a shift back towards traditional courtyard-based plans. They want buildings with a kind of accessibility that is much easier to give in an urban location, creating a tension with the desire for space and greenery that will need careful attention. They prize the exteriors of traditional hospital buildings, dislike those of the postwar period, and have mixed feelings about those more recently. Given its commitment to beautiful, popular design, these are points the Government ought to take seriously.