/ Iain Monteith / Creative Workspace

Take a cross section through any mixed group and their state of health, and it is remarkable how dependent we are on our National Health Service. Our office cross section of maladies included a broken hand and ankle from a couple of games on the five a side pitch, various family visits to accident and emergency, prenatal appointments and variety of care for ageing parents.

What this slice through the lives of those in the office raised was the dichotomy, that the care we all received was good if not exemplary, but that the environments for that care left a lot to be desired. A vox pox of these experiences, ranged from the lack of aspect, clear orientation, poor acoustic and personal privacy, to hot stuffy and worn environments.

Of course across the vast estate of public health provision inevitably each individual touchdown experience will be a haphazard one and it is unfair to isolate any one experience as a norm. The debate between care and the environment, and determining what best houses that care is made all the more complicated when we consider the difference in ability to respond to human needs as opposed to built requirements. Operationally, an individual care package can be fine-tuned and revitalised in a relatively short period of time. In comparison there is a time lag with how environments can respond with cosmetic changes, decoration, re-organising rooms. That is nothing however in relation to how doggedly out of sync with these short term processes, major changes to the architecture and the environment are.

We need a strategy to overcome the worst excess of this misfit of operational activity and estates provision, one that provides a loose armature that can ride the inevitable vagaries of time and change – we have begun to evolve a three part form of intuitive binding between operation and estate.

As a starting point, we have talked about this before, but in our view any building needs to sit well within its environment, it should be seen metaphorically as the repairing the damaged tissue of a place. Our new medical centre at St Mary’s Cathedral Edinburgh explores this through an extended garden theme whilst at Woodside Health Centre in Glasgow we are seeking to reinforce the bisecting street typology in the form of the Glasgow ‘gushet’.

Then we need to make the internal movement through the building comprehensible and clear. Health building plans have the habit of seeming like circuit diagrams - for those that can read them all the bits are there, join up and work, but the question remains, how are they actually experienced? We have another take on it. We seek to use the sequentially experienced volumes of the building as a constructed mental map – an experiential plan not just a spread sheet of rooms.

And then we need to soften that experience, to introduce warmth into the expensive machine, to soften the edges, round the corners, make the materiality generous and natural. That can be about looking out to nature, trees and plants or bringing nature into the building in the warmth of the finishes, surfaces and fittings.

In a sense our three line approach to fit, to be comprehensible and to be human, echoes contemporary medical aspirations: the idea of quality of fit of our treatment to our needs, the journey to health and maintaining health as a product of a comprehensible plan of advice and guidance, and the experience as life enhancing and enabling as can be irrespective of the condition.

St.Mary's Medical Centre