It looks like a five-star-hotel, but Norman Foster's Circle hospital in Bath could revolutionise patient care.
The Circle hospital in Bath designed by Foster & Partners. Photograph: Nigel Young/Foster and Partners
"We wanted to put hospitality into hospitals" says Ali Parsa, the eloquent, confident managing partner of health company Circle, and "a night in a hospital costs more than in a five-star hotel, so why shouldn't people get a similar experience?" Indeed, the first reaction on entering Circle's new hospital outside Bath is that you've entered a hotel by mistake. There's a cheery brown-uniformed concierge, a scent of non-hospital food, and a clean-lined, light-filled, stone-paved modern interior with large cylinders of gauzy cloth hanging, like giant lamp shades, from the ceiling.
The last space I saw like this was the lobby of the Shore Club hotel on Miami Beach, also hung with gauzy cylinders (and whose bedrooms, as it happens, were so relentlessly minimal that they resembled those in a sanatorium). It's a comparison that would make Parsa happy. Circle's aim, according to one of his medical partners, is to "give people good health, not an experience of illness".
In most cities, if you look for the most lumpen, ungainly, charmless building, hospitals from the 1960s and 1970s will be near the top of the list. Gartnavel general in Glasgow, the Royal Liverpool, Addenbrooke's in Cambridge, the Royal Free and Guy's in London, to name a random few, all follow the same type. They are silos for the sick; multi-level garages for parking the unwell. Inside they are more like the interiors of aircraft carriers, vast unwindowed complexes linked by bewildering networks of corridors. You might have thought some decency and dignity would be suited to places where people are born and die, but the makers of these hospitals didn't seem to agree.
Places supposed to make you feel better start off by making you feel worse, and there are reasons, or excuses, for this. It's hard to justify a pound spent on an architectural nicety that might otherwise go on medical equipment, and hospital design is framed by guidelines about hygiene and efficiency to a greater degree than almost any other building type. If there were a contest for budget between aesthetics and saving lives, saving lives would naturally win, and never mind that administrative bureaucracy is rarely presented with the same challenge.
Yet, according to another Circle medical partner, Jonathan Boulton, people are healthier if they are relaxed. Their heart rate is lower, he says, they bleed less in operations, require less aggressive anaesthetisation, and are more likely to respond well to their treatment: "All the really bad outcomes tend to come with anxious patients." Good design can contribute to people feeling relaxed. For this reason, Circle hired Foster & Partners to design their Bath hospital, and are getting other celebrated architects, including the practices of Richard Rogers and Michael Hopkins, to design other hospitals now in the pipeline.
Circle is a business, the first of its kind, in which medical staff are partners, in order to "give them more control". It is planning other centres in places including Plymouth, Reading and Edinburgh. Its income comes mainly from private patients, either on insurance schemes or paying for themselves, but it also treats National Health patients, and expects to do so more.
Ali Parsa is a former investment banker with Goldman Sachs, and his approach is bracingly business-like – image consultants were brought in to create the Circle brand, "a sign of inclusion, continuity and perfection". The Bath hospital is located, practically but unsentimentally, in a business park, next to Audi and Mercedes Benz dealerships, albeit on the edge of rolling countryside.
Circle's aims include "no compromise on clinical outcome", a determination to "change how hospitals are run from the bottom up", and to be "relentless about changing patients' experience". So doctors were allowed to specify exactly the equipment they thought best, and sophisticated systems were installed for managing patient information and the supply of drugs. A chef was brought in from the Michelin-starred country house-hotel and spa, Lucknam Park.
The impressive thing is that the building does exactly what its makers say it does. It provides obviously good things that somehow get missed out of other hospitals. If we want our surgeons to be wakeful and happy, which I think we do, it can only help if they can see clouds and sky and sunshine when they take a break. And it can only be beneficial if patients are calm rather than bewildered on arrival.
We have learned to be wary of bankers bearing magic potions, but in Parsa's case there is no catch. Personally, I find the relentlessness of Circle's management-speak unnerving, but when they call their Bath building "one of the finest hospitals in Britain", they're right. I also think the idea of a humane architecture could be taken much further – there's still something mechanistic about the way it delivers its good things of light, nature and clarity – but it is still a triumph to have these good things at all.
The government is embarked on a many-billion-pound programme of rebuilding hospitals, under its little-loved private finance initiative. There is every reason to believe it will deliver the same kind of clunkers, with updated styling, that were built over a generation ago. The important question is whether the principles of Circle Bath can be applied to much bigger hospitals, in the less charmed world of the National Health Service.
The last space I saw like this was the lobby of the Shore Club hotel on Miami Beach, also hung with gauzy cylinders (and whose bedrooms, as it happens, were so relentlessly minimal that they resembled those in a sanatorium). It's a comparison that would make Parsa happy. Circle's aim, according to one of his medical partners, is to "give people good health, not an experience of illness".
In most cities, if you look for the most lumpen, ungainly, charmless building, hospitals from the 1960s and 1970s will be near the top of the list. Gartnavel general in Glasgow, the Royal Liverpool, Addenbrooke's in Cambridge, the Royal Free and Guy's in London, to name a random few, all follow the same type. They are silos for the sick; multi-level garages for parking the unwell. Inside they are more like the interiors of aircraft carriers, vast unwindowed complexes linked by bewildering networks of corridors. You might have thought some decency and dignity would be suited to places where people are born and die, but the makers of these hospitals didn't seem to agree.
Places supposed to make you feel better start off by making you feel worse, and there are reasons, or excuses, for this. It's hard to justify a pound spent on an architectural nicety that might otherwise go on medical equipment, and hospital design is framed by guidelines about hygiene and efficiency to a greater degree than almost any other building type. If there were a contest for budget between aesthetics and saving lives, saving lives would naturally win, and never mind that administrative bureaucracy is rarely presented with the same challenge.
Yet, according to another Circle medical partner, Jonathan Boulton, people are healthier if they are relaxed. Their heart rate is lower, he says, they bleed less in operations, require less aggressive anaesthetisation, and are more likely to respond well to their treatment: "All the really bad outcomes tend to come with anxious patients." Good design can contribute to people feeling relaxed. For this reason, Circle hired Foster & Partners to design their Bath hospital, and are getting other celebrated architects, including the practices of Richard Rogers and Michael Hopkins, to design other hospitals now in the pipeline.
Circle is a business, the first of its kind, in which medical staff are partners, in order to "give them more control". It is planning other centres in places including Plymouth, Reading and Edinburgh. Its income comes mainly from private patients, either on insurance schemes or paying for themselves, but it also treats National Health patients, and expects to do so more.
Ali Parsa is a former investment banker with Goldman Sachs, and his approach is bracingly business-like – image consultants were brought in to create the Circle brand, "a sign of inclusion, continuity and perfection". The Bath hospital is located, practically but unsentimentally, in a business park, next to Audi and Mercedes Benz dealerships, albeit on the edge of rolling countryside.
Circle's aims include "no compromise on clinical outcome", a determination to "change how hospitals are run from the bottom up", and to be "relentless about changing patients' experience". So doctors were allowed to specify exactly the equipment they thought best, and sophisticated systems were installed for managing patient information and the supply of drugs. A chef was brought in from the Michelin-starred country house-hotel and spa, Lucknam Park.
And the gigantic, award-laden practice created by Norman Foster was asked to design their very first hospital building. In recent years, the Foster company has been making headlines with extravagant blooms, like a project in Moscow seemingly made out of multi-storey orange segments, but the Circle commission brought them back to more strait-laced principles of 20 years ago.
The important things, according to Foster partner Spencer de Grey, are "the clarity of the basic diagram, generous space, easy orientation, natural light and natural materials". Corridors were abolished, where possible, and signs kept to a minimum, as the building is sufficiently clear for people to find their way about without them. Much of the floor is in oak, the architects having demonstrated that it would be no less hygienic than the more conventional lino. Lavender grows outside bedroom windows. Operating theatres, usually windowless, are here day-lit.The impressive thing is that the building does exactly what its makers say it does. It provides obviously good things that somehow get missed out of other hospitals. If we want our surgeons to be wakeful and happy, which I think we do, it can only help if they can see clouds and sky and sunshine when they take a break. And it can only be beneficial if patients are calm rather than bewildered on arrival.
We have learned to be wary of bankers bearing magic potions, but in Parsa's case there is no catch. Personally, I find the relentlessness of Circle's management-speak unnerving, but when they call their Bath building "one of the finest hospitals in Britain", they're right. I also think the idea of a humane architecture could be taken much further – there's still something mechanistic about the way it delivers its good things of light, nature and clarity – but it is still a triumph to have these good things at all.
The government is embarked on a many-billion-pound programme of rebuilding hospitals, under its little-loved private finance initiative. There is every reason to believe it will deliver the same kind of clunkers, with updated styling, that were built over a generation ago. The important question is whether the principles of Circle Bath can be applied to much bigger hospitals, in the less charmed world of the National Health Service.
Parsa and de Grey both insist that they can. They say that they worked to a budget similar to those of NHS hospitals, and that future buildings will be cheaper now they've learned from the experience of their first hospital. They say the principles of their Bath design can be adapted to bigger buildings, and even that the climate of the NHS is changing in favour of their approach. I hope they're right, and that someone in the National Health Service is paying attention.
Copy from: guardian.co.uk
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