Prince Charles is expected to outline his agenda as the design champion of the NHS today. Stuart Black looks at the thinking behind his appointment, and what else is being done to make private finance compatible with a first-class health service
The appointment of the Prince of Wales as NHS design champion has understandably vexed some in the construction industry. But it seems that that was the point: the choice was a deliberate – and successful – ploy to focus attention on hospital design.

The Prince is due to outline his full agenda at a conference today, but he has fired an opening shot in last week's Mail on Sunday. He took that opportunity to criticise "factories for the sick" that look like "dreary concrete and glass office blocks", and called on architects to recognise the curative power of design.

Invited into the role by health secretary Alan Milburn, the Prince will spearhead a set of design initiatives intended to answer the criticism heaped on recent, high-profile, PFI schemes.

And as design tsar, Charles will have power over architects and contractors. The Department of Health has put two advisory boards and a centre of design excellence in place to assist him in his role, and six exemplary projects are planned.

The obvious concern among architects is that the Prince will use his position to stamp his neoclassical preferences on more than 50 upcoming projects. One architect says: "I think he's an inappropriate choice. He has always been one step behind contemporary architecture and I am concerned about his input."

Others are endorsing the appointment. Jon Rouse, chief executive of the Commission for Architecture and the Built Environment, says: "We expect [the Prince] to champion design in the widest perspective and to enthuse leaders. His role is evangelical and about getting on the road to raise awareness about what patients need."

Urgent case
From the point of view of the health service itself, it does not really matter whether hospitals look like Buckingham Palace or the Pompidou Centre.

The point is to have good design, meaning the kind that assists effective treatment and promotes patients' sense of well-being. And if this is to be achieved, it has to be soon. A quarter of Britain's hospitals are to be rebuilt in the next 10 years; if they are substandard, then the NHS will be, too. As Peter Wearmouth, chief executive of NHS Estates, says: "We have to get this right and so we have to start the debate right now."

Wearmouth rejects the idea that Charles' appointment is a gimmick. He believes that his design philosophy matches the patient-driven commitments set out in the NHS plan.

"Prince Charles may cause a disturbance with his views on architecture and alternative medicine, but he champions people. Health is a messy business: you have to deal with death, blood, joy and sorrow. The buildings have to be good for people and he can help promote that."

Charles may cause a disturbance with his views on architecture and alternative medicine, but he champions people

Peter Wearmouth, NHS Estates

Two advisory boards will be the key to keeping the Prince in check: the first will represent patients and doctors and will overlap with the second, a group of design and construction professionals chaired by Richard Burton, a director of architect Ahrends Burton and Koralek. A range of architectural and construction experts are being wooed to join.

Wearmouth describes this board as "the engine in the car" and rattles off a list of issues that it will address. For example, he hopes to gather advice on how to treat NHS patients as consumers with the right to expect and demand a high level of care, rather than sheep to be herded through a process.

Wearmouth wants a review of whether there should be increased standardisation in healthcare design. "At the moment, all our hospitals are bespoke and that costs money," he says. "Not all hospitals should look the same, but we should standardise what we can, especially operating rooms and wards. Only 20% needs to be about the local specifics and individual design flair."

So is this a move toward off-the-peg-designs that can be rolled out factory-style? Wearmouth responds: "What's wrong with that?"

Wearmouth also wants to hear more about the reorganisation of hospital facilities. He suggests that these could be broken up into pods across a larger site, rather than remaining in a single building. Accommodation would be set in a kind of hospital-hotel, somewhere cosy and homely in which people could rest and recover; equipment would be located in a separate building, making the replacement of worn-out technology or buildings easier and less disruptive.

The push for better design extends to two other initiatives: the setting up of a centre of design excellence to harvest ideas and information, and the five model PFI schemes that NHS Estates has launched with CABE. These developments will prioritise design from the outset, avoiding the perceived risk with privately financed projects that the architect is steam-rollered by the profit-conscious consortium.

On top of this, a comprehensive review of healthcare architecture is to be carried out next summer and a document called Achieving Excellence in Health and Design will be published. These will help establish best practice and are intended to build on a Design Development Protocol for PFI schemes, released six months ago, which set out some ground rules for PFI design.

Other initiatives
There will be a push to increase public involvement in hospital schemes on a local level. Computer-aided design will be the key to this. "It means we can show our ideas and give people an idea of what we're offering," says Wearmouth. "We want to have open days where we give local people the chance to have their say."

NHS Estates is keen to get the best value for money out of the private sector by establishing partnering programmes and appointing framework contractors and consultants. But with the rebuild programme demanding both quality and quantity from the firms involved, it remains to be seen whether construction can rise to the challenge – and with Milburn investigating hospital building in Spain last week, British firms should remain alert. "There are a lot of big European firms that could move in," says Wearmouth.

Healthy debate: What the industry thinks of the Prince’s appointment

We expect to see Prince Charles add to two areas – urban design and the quality of space. But we do not expect him to add to the efficiency of how hospitals are run. The NHS has a good history and is committed to further improvement. It has the skill base and the management expertise, and it is there that we have the most constructive conversations. Part-time amateurs are not needed in this area and, with all due respect to the Prince, he is part-time and he is an amateur. We welcome him and there is a role for someone of his eminence, but that is not to be confused with what needs to happen in and out of the buildings. Let’s not get everyone trying to solve everyone else’s problems – it’s not where we’ll get the best value for money from the Prince. He is not a management consultant. Keith Clarke, chief executive, Skanska UK

The Prince does have an uneasiness with modern architecture that has to be overcome. As practising architects we like to think we’re responding to the 21st century and being forward-looking rather than backward-looking. But I think the Prince and the architectural community share the same goals. There are two important things for a good project that he can help with. The first is getting a client committed to excellence, so it’ll be good if he helps people realise the importance of design, especially as in recent PFIs, costs have been more important than design. The second thing is budgets, and if he encourages design and gets people to invest more in this area, it will be a good thing. He has a history of being involved with the environment and how it affects people, which I think is appropriate. I’m not sure there’ll be a mandate to get things in that haven’t been there before … it will be more about the emphasis. Ken Schwarz, director, Anshen Dyer

We welcome having a figurehead because it will help champion the idea that environments can help people get better. What we want to see the Prince do is enthuse trusts so that they continue to champion design themselves. That does not mean dictating the style. The debate has moved on from the late 1980s and I am trusting that Charles has moved on, too. But it remains to be seen. If it’s about humanity, inclusiveness and sustainability, then those are excellent values for the Prince to champion. What the design community wants to see is clients taking design seriously and seeing it add value. The Commission for Architecture and the Built Environment has offered the NHS an enabling program that focuses on improving the quality of life for patients and staff. Sunand Prasad, CABE commissioner and partner in Penoyre & Prasad