Forget the fox in a box - Here's worsley Mesnes

I have always thought the fastest way to improve schools was to pay teachers significantly more. This would mean that a) the profession would attract able people who are doing less demanding jobs simply because the pay is better, and b) our increasingly consumerist children are more likely to pay attention if the person trying to teach them has a silver BMW stuck out in the car park.

The answer is definitely not to use the PFI to spend billions on the block development of charm-free school buildings. Is it the answer in health provision? Many of my university contemporaries have spent their working lives as hospital consultants. I can't say I have lost much sleep over their levels of remuneration, especially once they stop working (particularly as Gordon increased this by 20% without anyone even asking). I mean, it's not as if people otherwise working as estate agents are suddenly going to take up cardiovascular surgery where they left off, is it?

On the other hand, I'm slightly ambivalent about the amount spent on hospitals. My local - the Royal London in east London - is having a billion pounds spent on it. I am assured that it will be good value, but I always thought they could have got much better value by keeping the existing stock clean, but this doesn't tick any target boxes, so MRSA is now a big PFI briefing element.

Building on 3 February ran an article about Stephen Fox, a Lancashire GP who was being failed by the NHS provision for property improvements. For years (and I may be paraphrasing slightly here) he has been trying to run his practice from a site hut under three feet of water in a radioactive waste dump next to a slagheap in Wigan. Despite his best endeavours to obtain funding from the LIFT initiative over a period of three years, Dr Fox was still having to perform open-heart surgery on a wallpapering table while holding a torch in his teeth. I exaggerate of course, but conditions were pretty grim.

There was an immediate response from Wigan health authority. "LIFT is doing a great job improving health buildings in Wigan," it said, "and if you don't believe us come and have a look."

So I went up to see the other side of the story. Actually, I was also hoping to visit Help The Poor Struggler, the pub formerly run by Albert Pierrepoint, Britain's most prolific hangman, where he held forth as he drew the mild and bitter, but it turns out that that is not in Wigan. Neither did I see any sign of its most famous son, Sir Ian McKellen. However, I did see some spanking new health buildings procured under the LIFT initiative. Both the medical and the construction staff seemed to be entranced by their membership of a mutual admiration society. Hmmm, I thought. Seems a bit good to be true.

LIFT puts prospective users and prospective builders in touch with one another. The deal is that one tells the other what they need in the way of buildings for the next 25 years - everything from a five-storey state-of-the art renal dialysis unit to a replacement window pane in the cleaners' cupboard - and the other does it. And you and I pay for it.

In this instance the LIFT had been set up under the title Foundation for Life. The health authority owned a number of sites and buildings and wanted to centralise a number of GP surgeries and back-up facilities. One of the founders of Foundation for Life, Rita Chapman, a former physiotherapist in Wigan, showed me around the Worsley Mesnes (pronounced "Mains") centre, which had opened six months ago, and a renal treatment unit that was due to open in a few months. The construction partner in this case was the Eric Wright Group, a large private construction company with £100m turnover that mainly operated in the North-west. It is what we in London used to call a builder.

The distance between financial close (the go-ahead button) to the opening of the £8.5m centre was an impressive 17 months. With the PFI, the consortium provides a single facility which it runs, and possibly staffs, for a predetermined period. LIFT provides a much smaller consortium consisting of a contractor and the local primary care trust. This agrees to provide all the construction and facilities management over any number of buildings, as long as they are grouped in a small geographical area. The principle is that as each party gets to know the other better there will be a streamlining of the briefing and building process with attendant savings.

There was an instant response from Wigan health authority: ‘LIFT is doing a great job …’

"We've done PFI," Chapman told me. "And never again. There is no dialogue; you just get what they want to give you, and there is nothing you can do about it."

Michael Collier, Eric Wright's managing director, told me that his company had done both, and that "this is much better for us, it is less risky and we have a chance to develop a working relationship with an identifiable client, which provides us with continuity of work for a long time into the future. Also, it is much easier to help the cross-fertilisation of local authority provision".

I asked him to explain - the philanthropic contracting consortium not being a entity with which I was overly familiar.

"When you have a health centre as part of a sport and leisure centre, it is more likely that men will drop in for check-ups as part of a work-out regime. They're more likely to do that than make a special visit to see a doctor."

I asked how difficult it was to be appointed. "We are a local firm well known in the area and have considerable expertise and a good reputation. We really wanted this and were determined to get it."

"So you had to design three buildings as part of the tender?"

"Yes, but we have a good relationship with Hicks, a local firm."

"Who have been subsequently hoovered up by Nightingale Associates?" I said, demonstrating my impressive understanding of health construction economics.

People don’t realise that an architect’s job is not to
offer clients what they think they want …

"Yes, I suppose they have."

The completed building shows considerable ingenuity in its access. It is built on a slope so that each of the five GP's surgeries can be accessed at ground level, despite the fact that they are on two floors. The pharmacy, unlike the oversize medicine cupboard that most of us are familiar with from our local surgeries, was about as big as a snooker hall. And there was a physiotherapy unit and an audio treatment division and all sorts of management back-up. And hundreds of matching woodgrain desks and thousands of identical blue swivel chairs. What surprised me most was that at 1.30 on a weekday afternoon the whole place was practically empty. "They've all gone for their dinner," explained Collier.

"And does anyone else use this building when the health service isn't?" I asked, looking at the space provision, which seemed almost profligate. "Not yet but we'd like them to."

It was clear there was a good working relationship between the client and contractor. And there was an independent twice-yearly audit to look out for taxpayers' interests, to boot.

The relationship had been established in a such a way that it could only continue to improve over the years. I suppose that this is the most important aspect of a construction partnership. One hopes this is the sort of non-confrontational set-up that could produce really imaginative architecture.

However, the aesthetic here is of a 1980s business park. Striped brickwork, huge pitched roofs, enormous eaves boards and powder-coated metal windows. All perfectly decent but not very spirit-lifting or offering much in the way of a green agenda. And when you have a single contracting organisation building half the public funded buildings in a small area, architectural imagination and the attendant cultural resonance becomes more and more important.

I suppose a lowest common denominator blandness is inevitable when the architects are working for the contractor and not the client. People don't realise that an architect's job is not to offer their clients what they think they want, it is to offer them what they never dreamed could be possible. It is almost impossible to factor this often unrecognised aspect of the designers' skill into any sort of construction equation where the contractor is in charge. Particularly as for most contractors, bigger is better.

However, all parties seem to be so delighted with progress and results to date that it seems churlish to complain. The buildings I saw were certainly a vast improvement on Dr Fox's leaking site cabin. As long as he is happy to have his practice subsumed into one of these mega centres, no doubt he will have his needs met. But if he wants to maintain his independence and his geographical location? It's not yet quite clear how LIFT is going to make that work …