HRH The Prince of Wales

HRH The Prince of Wales
At the NHS Estates Conference, November 16, 2001 at the Prince's Foundation, HRH The Prince of Wales delivered the following address:

I hope that you ay have had a chance to have a taste of some of the work that goes on here, in the programmes that span the arts and building crafts, urban regeneration projects and the reuse of some of our very best industrial building heritage. This building, situated in the heart of one of the most interesting and diverse communities in London is, I hope you agree, an inspirational place in which to bring these endeavours together.

I am especially pleased that the partnership between my Foundation and NHS Estates is working on a very practical level, initially with five commissioning NHS Trusts in Lewisham, Sunderland, Salford, Middlesex and Wakefield. I have no illusions as to the complex challenges that lie ahead, but my hope is that by working together with users, patients and the design team and other stakeholders we will find it possible to create health care buildings that truly stand the test of time.

Perhaps, before going any further, I could just explain that my own interests in architecture and health care stem from the simple fact that I believe our environment- which in this country is very largely manmade- has profound influence over our physical, psychological and spiritual well-being.

Oscar Wilde when touring the United States was asked why he thought America was such a violent country. "You are violent," Wilde replied, "because your wallpaper is so ugly." Although at first glance that appears to be a facile comment, what he meant I think is this. When any of us beholds Nature, it is always unconditionally beautiful. Whether you look at the deserts, the artic wastes, the forests or the plains, all that you can see is a powerful and eternal beauty. The only ugly things we ever see are things made by man.

If we grow up to believe ourselves as a species only capable of uglifying everything around us, then naturally we grow up with the kind of self-hatred that does lead, if not to actual violence, then at least to the kind of desolation and despair that breeds it.

For various complicated reasons, which I am sure you all know better than I, the 20th Century became one of the ugliest and most brutal of all. For some equally strange reason, which I have never understood, the conventional approaches to the way we build became dominated by a desire to uproot history and to start again with a "tabula rasa" placing the purely machanical and functional at the centre of our experience. Let me just remind you of what Miles van der Rohe said in 1924 - "The individual is losing significance; his destiny is no longer what interests us. The decisive achievements in all fields are impersonal....therefore part of the trend of our time towards anonymity." And then, in similar vein, Sir Nicholas Pensier wrote at a later date that "the artist who is representative of this century of ours needs be cold, as he stands for a century cold as steel and glass, a century the precision of which leaves less space for self expression than did any period before." I mention these two quotes because in my view, such thinking dominated the major proportion of the 20th Century and led to the baby being thrown out with the bath water - something which, I maintain, has profoundly affected the way we design our healthcare buildings, apart from anything else. As I said, the aim of this forthcoming partnership between NHS Estates and my Foundation is to bring the baby back and to restore the "soul" - the psychological and spiritual element if you like, - to its rightful place in the scheme of things. In other words, as with the need in a new century to emphasise the pedestrian rather than the car as the central feature in the design of new settlements, so there is a need to place the patient at the centre of hospital design. As the individual patient has a unique character, so should the building that provides the healing environment.

Having explained very briefly - and probably rather badly - where I am coming from - I would further suggest that in our restless search for new ideas for both building and health care, we have tended to ignore some of the more traditional, or timeless truths that can complement the remarkable progress in building and health care technologies and techniques and help create the benign environments that will engender a sense of ease, harmony and, dare I say, health. There is little doubt, it seems to me, that in both the built environment and in health care, there is room for both the best inherited wisdoms and techniques and the best of new methods.

I believe that the mutual influence between our physical environment and our deeper psychological or physical health, has profound implications for the design of health buildings. Nowhere is it more crucial to design well, than in those places that are constructed precisely for curing our illnesses. It is now more widely acknowledged that many of the root causes of ill health are likely to lie with factors that are as much to do with our emotional, psychological and spiritual well-being as they are with our physiological condition. As in so many other areas of human enquiry, symptoms very often mask their causes! And just as the cause of an illness may lie at a deeper or more complex level so, too, the process of healing can also be greatly influenced by those other factors that lie beneath the diagnosed condition. Way back in 1860, Florence Nightengale - in so many ways the precursor of modern health care - wrote about precisely this point when she said:

"It is often thought that medicine is the curative process. It is no such thing; medicine is the surgery of functions, as surgery proper is that of limbs and organs. Neither can do anything but remove obstructions; neither can cure; nature alone cures."

None of this, of course, is to deny the wonders that modern medicine and healthcare have made possible. New surgical techniques, modern drugs, and developments in diagnostic skills, have all helped to give health and, indeed, life itself to millions who previously suffered or perished, and one of the main challenges in new building designs must be to cater efficiently for the needs of these new technologies and practices. Yet, amidst this scientific miracle, there remain many elements of healthcare that continue to require a nuturing of the soul and the spirit, just as much as the body. Achieving the conditions for individual patients to help heal themselves is a crucial requirement in every kind of successful health care. As I think Florence Nightengale acknowledged, all medical healing ultimately involves processes whereby something from outside is brought to the patient so that he or she can make their own inner steps that can trigger recovery. In this sense, I think hte process of helaing is quite distinct from the process of treatment. Yes, the wonder of modern treatments makes health possible, but not necessarily inevitable. Recovery will always require the patient to respond and that, in turn, requires them to have not just the physical, but also the emotional and psychological resources to do so. It is precisely this need for a complete, or whole, range of sensory awareness that has increased interest in complementary, or holistic, healthcare. I prefer to call it integrated healthcare and which is also, I am pleased to see, generating new interest in holistic building design.

Now, as soon as the word "holistic" is out of my mouth, I am aware that many people are overcome by a desire to tiptoe to the door and head for the bar to recover. Holistic is one of those words, rather like "sustainable", that has become freighted with unfortunate connotations of flabby thinking and antiscientific hogwash, as have phrases like "alternative therapy". So be it. Perhaps though, it is easier to think of holistic thinking in terms of its classical opposite, atomistic thinking. Atomistic thinking believes there is no society, just individuals colliding like particles. No one these days truly proposes an atomistic approach to hospital building or anything else. Health, after all, means literally "wholeness". A holistic approach, in simple terms, recognises, that just as the thigh-bone is connected to the hip-bone and the hip-bone is connected to the breast-bone, so the land is connected to the building and the building is connected to the people and the people are connected to each other - Hear the word of the Lord!

One doesn't have to look very far to see how diseased much of our built environment has become. Worse still, it is very often health buildings, particularly some hospitals, that exemplify everything that is most damaged in our recent architectural heritage. So many of the hospital designs of the 1960s and 1970s offer both a stark brutality from the outside and, very often, the inside too. Designed in the hey day of professional arrogance, they frequently present themselves to both the patient, the visitor and the passing public as colossal machine-like structures; intimidating, harsh and, like aliens from outer space at odds with their surroundings. These are hardly the best environments for welcoming and healing those who are being admitted at precisely the moment they are most vulnerable and nervous! Their design was nevertheless part of a well meaning effort to cater for the technological and functional requirements of an increasingly high-tech health service, where patients were all too often regarded as passive recipients upon whom medical or surgical techniques were administered, rather then individuals with very human needs and profound capabilities for assisting their own recovery processes. Challenging this point of view involves a thorough transformation in the practice of healthcare design and architecture, which has itself been largely conditioned by the conventional notion of buildings being designed as 'machines'. Just as Le Corbusier considered that homes should be regarded and designed as "machines to live in", so too, hospitals became almost "machines to treat people in". In fact, it was precisely this approach, with its emphasis on mechanical and technological innovation, that left so many NHS buildings divorced from any integration with the natural processes and human scale that can, I am convinced, aid the healing process. It is ironic that so many of this generation of buildings are themselves often described as having so-called "sick building syndrome".

How many people do you know who say they cannot bear hospitals? The atmosphere. THe institutional corridors. The signage, the chairs, the sounds, the smells, the views into pieworked courtyards from which arises a steam that turns your stomach.

The housing crisis of the nineteen sixties should be a lesson to us. The need for urgent housing was all we focused on and the result is well known. We have an extraordinary opportunity now, when building hospitals, to learn from those mistakes. Views, landscaping, light, proportion and atmosphere are not optional extras, they are as integral a part of a hospital as the operating theatres and trolleys.

Fortunately, there is now a move away from the worst mega-structures of the past, and towards establishing health care facilities at a smaller, more domestic and diverse range of centres. This is all very welcome, and better reflects the changing needs of the population. And yet, I remain intrigued by the word 'hospital' which emerged from the 'hospitality' provided for the infirm in medieval times by religious institutions. Perhaps this original meaning, which according to the Oxford Dictionary means "friendly and generous reception and entertainment of guests, visitors, or strangers" holds some inspiration for the future design of hospitals, health centres and clinics. Maybe, too, some traditional architectural typologies and techniques can help inspire the new generation of architecture? Not to slavishly copy the past, but to draw inspiration from established techniques that perhaps offer some timeless principles that are quite capable of adaptation to become a living tradition. There are, it seems to me, at least three such sources of inspiration....

Firstly, and most intriguingly, there is the human body itself. For it is precisely the proportions and geometry of the human body that have been held as the standard of wholeness and perfection, and that have served as a template for architectural discipline, in diverse societies and cultures, for millennia. It is, of course, the human body too, that is precisely the crucial subject of our clinics and hospitals. To seek to recover this sense of scale and proportion, to re-instate this human scale of geometry to buildings, should not be dismissed, as some tend to, as a clarion call for classicism. That, in my view, merely betrays the ignorance of those who fail to see the universality and timelessness of human proportion in all manner of traditional architectures, whether classical or vernacular.

A belief in harmony and proportion doesn't mean architecture has to speak Greek and Latin. Nor does it mean I want to see doric operating theatres, Corinthian columned hospital wards or ionic intensive care departments.

Secondly, I would appeal for more care in how buildings are designed for sensory stimulation; how they can help - or indeed hinder - the human spirit. I have already talked about the problems of seeing buildings as machines, and the importance of the psyche in the healing process. How buildings are ventilated, illuminated, their access to nature and landscape, the texture of materials and the careful use of colour are all crucial ingredients. So, too, is the absence of clutter and noise. We live in a noisy world, and yet silence, peace and stillness are often the keys to recovery, perhaps the greatest of the natural healing forces.

Next, it seems to me, we need once again to take proper care of the external appearance of our buildings. By this, I mean both the exterior appearance of the buildings themselves, and their setting in the wider landscape or townscape. For many reasons, we seem to have almost entirely lost the ability to plan and design public buildings as truly dignified architectural compositions, that frame and articulate the land and townscape around them. Historically, such buildings took their place in a hierarchy of building types, and stood as landmarks that provided a clear sense of order to residents and visitors alike. All too often, more recent buildings have become segregated from their surroundings by car parks, pointless open spaces or inappropriate building materials and methods.

Ladies and gentlemen, I would end these remarks by making an appeal to bring about a renewed sense of artistry and, if I may say so, of beauty into our buildings. The value of art is widely appreciated in the world of healthcare, and I have seen some interesting examples of good work done to integrate art into the life of hospitals and clinics. But I would go further than this, and ask if we cannot truly integrate art into the very buildings themselves, since there can be no doubt that being surrounded by beauty is likely to assist our health, as indeed, a growing body of evidence seems to suggest. Today we need a fresh generation of health facilities that will meet the needs of our communities, and it is heartening to know that the resources seem to be in place to commission them. Let us not forget though, that, in the words of the great arts and crafts teacher William Lethaby, "Art is the well being of what needs doing" and in that spirit, let us try and make this new generation of health care centres truly fit for the healing of both body and soul.