Tim Rich: Given the right treatment

Designers should benefit from the five-year cash injection to the NHS. But Tim Rich says design’s reputation will be affected if the correct diagnosis isn’t made

The recent Budget probably made many readers wince. The National Insurance Contributions increase will hit plenty of us where it hurts. But the £40bn-over-five-years increase in NHS spending it will produce will also create huge opportunities. This giant organisation now needs to commission more excellent design talent than ever before if it is to make that money work for the nation.

To date, public discussion about design standards in the NHS has focused on architecture and interiors. In November last year, for example, Prince Charles told a conference of hospital managers that the NHS must adopt a holistic approach to design, but cited only ‘good access, natural light, views, landscaping and atmosphere’ as core aspirations.

Such qualities are important, but design is about much more than aesthetics. Design, in its broadest sense, should sit at the heart of an organisation, informing everything from its culture to its actions and communications. In fact, the NHS now has the opportunity to become the most genuinely holistic design client in the UK. It already uses the services of designers across disciplines as diverse as organisational change, service design, equipment design, branding and identity, graphics and print, way-finding, new media, IT, people and traffic flow, as well as architecture and interiors. Now it must get these activities to work together as one.

Design must be understood within the entire NHS service as something beyond a make-over. Recruitment is a major problem; communication design can play a role in improving that. Waiting lists are a huge issue; imaginative service design solutions and better IT can help. And so on.

Perhaps we are naive to believe that such a large and embattled organisation can be turned around in less than 2000 days. Perhaps I’m overstating the case for design within such a transformation. What is fact, however, is that in five years time the general public will no longer accept ‘under-funding’ as a reason for ugly wards, confusing forms, inefficient IT systems, inept signage schemes and a muddled NHS corporate brand. Indeed, the new funding programme has effectively changed the very idea of NHS-wide design excellence from an internal aspiration to a national expectation.

It is encouraging that management already acknowledges publicly that its attempts to create an effective, respected, value-for-all service are dependent on the services of designers. Indeed, the key NHS ProCure21 procurement programme has placed enormous importance on raising the design standards, and is establishing forums and research programmes, developing quality guidelines, promoting the benefits of excellence and applying comprehensive benchmarking methods.

It is also interesting to note that the challenges have already attracted leading design thinkers. For example, in October 2001 Jane Priestman became a design advisor to the Central Middlesex Hospital.

It is also important to recognise that significant improvement in design quality has already been achieved in recent years (see www.nhsdesign portfolio.nhsestates.gov.uk for some examples).

Management will certainly have to work hard to overcome the service’s long-term culture of design mediocrity. The modest identity programme introduced in 1999 is still meeting resistance in many of the service’s in-house design departments, for instance. But a real determination to transform standards is cascading from the top. Secretary of State for Health Alan Milburn wasn’t mincing his words at the November conference when he described traditional hospital design as a ‘national disgrace’.

There is more riding on the effectiveness of NHS design than people’s well-being, however. The Labour Government has identified its approach to health as a key differentiator between it and the Conservatives. The Prime Minister has even staked his credibility on delivering a better NHS. If design fails to have a substantial impact on NHS performance Labour will face pressure at the polls.

In effect, designers commissioned by the NHS are now the most empowered people in our industry. Their work is not only playing an increasingly important role in improving (or potentially worsening) our health, but may also help to decide who governs us next. Who believes design is a marginal activity now? Let’s hope the designers engaged by the NHS succeed in making the most persuasive case possible for the value of design.

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