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The Annual Reform Club Debate organised by Architects for Health ought to be an unmissable opportunity for architects to meet for a lively, well-prepared and expert discussion of healthcare architecture in a splendid environment. Although well attended this year the occasion disappointed, writes Peter Scher.

The motion: "This house believes that PFI has more to do with securing good deals than it has to do with producing good healthcare plans" was not about architecture but about money. As expressed the motion was so selfevidently true as to be undebatable and it had to be watered down at the last minute to something obscure about the present PFI undermining the "ability to do" something or other which I couldn't catch. This enabled one or two brave souls to oppose the motion as revised which entailed being against it if you were for PFI and vice versa.

Dr Deidre Cunningham of the Lambeth, Southwark and Lewisham Health Authority proposed the motion with an excellently argued case. Healthcare planning should be led by healthcare policy and health needs; the PFI was led by the Treasury. Present government policy as expressed in the recent document "Our Healthier Nation" proposes a partnership between members of the community and their health service; PFI operates in secret and does not share its aspirations, less still its profits, which to the NHS are a loss. Howard Goodman, seconding the motion, lamented the absence of dialogue between architects, clients and users, without which there cannot be a successful and creative outcome to the design process.

And on and on; all this in addition to last December's damning report by Allyson Pollock and Declan Gaffney (see Comment, HD Feb '98, p5). Opposing the motion the apologists for PFI accepted all its manifest defects as "flaws" but, having been through "a painful learning process" were confident it was all going to get better. Graham Johnson, of Tarmac plc, as a builder confirmed that he was not speaking about design and drew attention to the NHS Private Finance Act, rushed through Parliament only last year to make PFI contracts legal! Not, of course, before QCs had reaped untold amounts in fees for their opinions as a result of the Government's bungle. His seconder, architect Nic Allen of Devereux Architects, admitted that PFI had "got off to a bad start" and that "it was too early to judge the process". He did not see why healthcare buildings should be different from supermarkets and he had faith that the PFI's future development will produce well-designed, high quality healthcare buildings. These brief statements were followed by just eight even shorter contributions from the floor, which hardly adds up to a debate. The vote was 33 for the motion (ie against PFI) to nine for PFI.

Although so few voted in support of PFI almost every architect who attended the debate is currently involved with PFI projects for the NHS and thus had a vested interest. Very, very few architects are in a position to pick and choose clients and the need to survive makes us craven. But to describe PFI as "flawed" is to use a weasel word. PFI is not merely flawed, it is quite simply and demonstrably wrong, repeat wrong, for the NHS. However, as architects we have no real influence in the matter and we are having to make the best of a very bad job and pray things really will improve.

Once more I found myself doodling new words to fit the acronym during this Pitifully Feeble Interchange. Let us hope Architects for Health can arrange a good debate about healthcare architecture next year. In moving his vote of thanks to the organisers, chairman and speakers, Roger Walters opined that the vote would have gone decisively the other way if the debate had been held among builders, chartered surveyors or lawyers. That says it all.

Copyright Wilmington Publishing Ltd. Mar 1998
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