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Make do and mend?

Eleanor Young

Keeping the ever-changing, cash strapped education and healthcare estates going is a Herculean task. Thank goodness for the creativity of architects, says Eleanor Young

Dyson Cancer Centre at the Royal United Hospital in Somerset, designed by IBI.
Dyson Cancer Centre at the Royal United Hospital in Somerset, designed by IBI. Credit: Courtesy of RUH

It’s so easy to get lost in hospitals. Not so much when you are looking for your colour-coded ward but around the edges, between temporary huts, specialist centres, stacks of plant and odd pools of parking. Zone Z: out of space and time and seemingly beyond any masterplanning rationale.

New hospitals promise answers to age-old extensions and long corridors, resolutions (and insulation) for activities and clinics hidden in temporary huts. So it was a surprise to see a new block of my local hospital, IBI’s Dyson Cancer Centre, being listed as one of the 40 ‘new hospitals’ in the latest hospital programme of £37 billion. With a central government grant of £40 million it is certainly a big investment. But it’s not how most people would define a new hospital.

It is one clue to why you may not have felt the benefit of the new hospital programme if you work in healthcare design. There is the huge process of agreeing and scoping out a new hospital or major upgrade, then the rescheduling of jobs and funding which has left some projects stranded amid the strain of maintenance on capacity and budgets. On the upside, the House of Commons Public Accounts Committee has found there is still £18.5 billion left to spend from 2025-26.

And then there are the 54 hospitals affected by reinforced autoclaved aerated concrete, better known now as RAAC. Though these have continued operating, unlike some 150 schools which closed until they could be made safe.

Piecemeal planning, poor maintenance and falling behind on major building programmes hit both the and education estates

There are many parallels between the health and education estates. Piecemeal planning, poor maintenance and falling behind on a major government building programme are just some of them, the latter both documented by the Public Accounts Committee’s calls for evidence last year. They also share a prevalence of private finance initiative-funded and run buildings, where every contract has its own pain points as payments keep going out, even as operational budgets get squeezed in real terms.

These two sectors also share the way they are bound up with their local populations and demographics; from supporting people who are living longer and needing more healthcare at one end, to dealing with population bulges at the other. The latest bulge reached its peak in 2022- 23 and now schools have fewer children coming through – total state pupil numbers are falling by an average of 1% a year, down from 7.57 million to 7.14 million in 2028-9. This reduction is not evenly distributed; London already has unfilled pupil places and school closures. Shrinking creates its own challenges – and perhaps opportunities. Some of those temporary classrooms might even be cleared away to make more play space.

It is natural to feel dispirited at the way our public buildings are compromised by circumstances of our own making, from ill-conceived procurement systems to political manoeuvring. We might take some comfort, though, from the way that architects continue to keep this patchwork together, adapting to circumstances, whatever they may be.