De Syllas - Integrating care : the architecture of the comprehensive health centre

This book provides a timely review of the contemporary interpretation of the 'comprehensive health centre', a building type that was originally advocated by health reformers in the UK in the first half of the twentieth century. The book discusses the development of this idea, the failure under the NHS to apply the idea in practice in the second half of the century and the recent emergence, in all four regions of the UK, of comprehensive health centres providing a wide range of health and social services, often linked to other community facilities.

A review of the latest developments in comprehensive health centre design forms the core of the book in the form of detailed case studies of ten exemplary recent projects. Generously illustrated in full colour, the case studies include plans, diagrams, photographs and analytical text, providing the reader with detailed information about a range of design approaches.

Following devolution, NHS health policies in England, Scotland, Northern Ireland and Wales have begun to diverge and the role of the comprehensive health centre in the current health service of each country is assessed. Aimed at professionals, healthcare facilities providers and policy makers, the book also considers the opportunities for and obstacles facing the further development of the comprehensive health centre as an integral part of the infrastructure of the NHS in the future.

Justin De Syllas trained at the AA and the Bartlett Schools of Architecture in London. After working for a number of leading architectural practices and teaching for several years he joined Avanti Architects in 1985, where he was a director for 26 years. He acted as lead consultant for the Barrhead Health and Care Centre in Scotland and was the Avanti director in charge of the development, with Kennedy FitzGerald Architects, of designs for the Grove Health and Wellbeing Centre in Belfast and Portadown Health Centre, both in Northern Ireland. These, alongside seven projects by other architects, are featured as case studies in the book.

First published 2015
by Routledge
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and by Routledge
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Routledge is an imprint of the Taylor & Francis Group, an informa business

2015 Justin De Syllas

The right of Justin De Syllas to be identified as author of this work has been asserted by him in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers.

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British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library

Library of Congress Cataloging-in-Publication Data
De Syllas, Justin, author.
Integrating care: the architecture of the comprehensive health centre /
Justin De Syllas.
p.; cm.
Case studies contributed by: Allford Hall Monaghan Morris Architects, London; Avanti Architects, London; Henley Halebrown Rorrision Architects, London; Holder Mathias Architects, London; Holmes Miller Architects, Glasgow; Kennedy FitzGerald Architects, Belfast; MBLA Architects and Urbanists, Manchester; Penoyre and Prasad Architects, London.
Includes bibliographical references and index.
I. Title.
[DNLM: 1. Facility Design and ConstructionGreat Britain. 2. Health Facility EnvironmentGreat Britain. 3. Hospital Design and ConstructionGreat Britain. WX 140 FA1]
RA967
725'.51dc23
2014037611

ISBN: 978-0-415-60857-2 (hbk)
ISBN: 978-0-415-60858-9 (pbk)
ISBN: 978-1-315-73532-0 (ebk)

Typeset by Alex Lazarou

The architecture of the comprehensive health centre

Justin De Syllas
with case studies contributed by:
Allford Hall Monaghan Morris Architects, London
Avanti Architects, London
Henley Halebrown Rorrison Architects (formerly Buschow Henley), London
Holder Mathias Architects, London
Holmes Miller Architects, Glasgow
Kennedy FitzGerald Architects, Belfast
MBLA Architects and Urbanists (now part of Buttress Architects), Manchester
Penoyre and Prasad Architects, London

The comprehensive health centre was developed as an idea in the first half of the twentieth century and, although much smaller and more limited versions of the health centre have become common, the much larger comprehensive version failed to become established as a part of the standard infrastructure of the National Health Service (NHS) and seemed, in the second half of the twentieth century, to have been all but forgotten. But it has re-emerged at the beginning of the twenty-first century in all four corners of the British Isles. The extent to which this was a conscious revival of an earlier idea is not clear and, in its new form, it has not been referred to as the Comprehensive Health Centre, but a recent generation of large health centres have been designed to serve the same social, clinical and practical functions as the earlier comprehensive model. It therefore seems appropriate to try to understand the origins of this building type and its intended role in a state healthcare system. This is therefore both a study of the architecture of the contemporary comprehensive health centre and of the economic, political and social circumstances in which this building type was conceived.

At the time the book was being prepared, as well as a continuing debate about the future of the NHS, a parallel public discussion was taking place on the increasing disparity in wealth between a few very rich and the very many poor people living in Britain and other countries. It has been suggested that this disparity may soon approach the level of gross ineguality that was found in Edwardian Britain, a situation that led to the first of the twentieth century's great social reform initiatives. National Health Insurance was introduced in Britain in 1911, in part as a response to a humanitarian crisis and in part in order to forestall social unrest. The NHS was later built, in the mid-century on this foundation and is a key example of how the tendency of the free market to respond to demand rather than need Can be managed by a degree of state intervention. The NHS helped, with other welfare measures, to transform the opportunities of the majority of the population in the United Kingdom and Northern Ireland in the second half of the last century.

The measures that were developed to mitigate some of the negative effects of the great, positive force that is Capitalism, including the redistribution of wealth through taxation and the provision of state welfare services, helped to bring about one of the most peaceful and civilised periods in British history, at least at home. My generation was born at the right time in the right place to be the privileged beneficiaries of late-twentieth-century British welfare capitalism. It has therefore come as a surprise and a shock to those who grew up taking welfare provision for granted to find that the protection it provided has been under sustained attack in recent decades as a 'nanny state' imposition on the freedom of the individual.