David Lewis

David Lewis

Principal, NBBJ
David is a principal in NBBJ’s London studio and an architect with more than 20 years’ experience. His view is that the best designs can be distilled into a simple diagram, no matter how complex the building. Although David lives in London, was born in London, studied in London and works in London, he’s still not a proper Cockney.

What Does the Future of Urban Healthcare Look Like?

Thoughts on a ‘Healthcare Quarter’

August 6, 2018

Principal, NBBJ

Editor’s Note: This post derives from an NBBJ-hosted breakfast talk at the British Library in London focused on the future of the NHS. NBBJ Partner David Lewis was joined by speakers Jodie Eastwood, Chief Executive of the Knowledge Quarter; Peter Ward, Director of Real Estate Development at King’s College London: Guy’s and St Thomas’ NHS Foundation; and Richard Darch, Chief Executive of the healthcare consultancy Archus.

As we celebrate the 70th year of the NHS, the future of healthcare in the UK has arguably never been a hotter topic with no shortage of debate on how the world’s largest publicly funded health service will survive.

The people who work and care within the NHS remain its most valuable asset and they will continue to shape national pride in what polls have shown symbolises ‘what is great about Britain’.

But what about its places? How is the public healthcare estate adapting to the demands of an ageing population, new technologies and severe financial pressures? And how will it look in 10, 20 and 30 years’ time?

 

Creating ‘health engines’

Healthcare estates should be spaces where everyone comes together for the benefit of healthcare. Not in some utopian dream but in the form of ‘health engines’ that combine and convert the power of healthcare, research and development and industry to deliver positive progress. Instead of selling off surplus land for residential use and reducing the NHS estate, there is potential to create health ‘eco-systems’ in our cities — healthcare quarters with hospitals acting as anchor tenants surrounded by layers of research and wellness services, step-down care, commercial tenants and public social spaces.

These aspirations chime with the concept for a ‘health return’ from public assets, land and buildings to promote healthy lifestyle and wellbeing.

 

Everyone needs good neighbours

The Cambridge Biomedical Campus and Royal Liverpool University Hospital demonstrate how healthcare, research and commercial developments can benefit from being co-located. It’s important that spaces knit healthcare sites back into cities and their urban context, promote synergies between healthcare and education and create societal hubs that encourage public access and community use.

This is the point of view championed by Jodie Eastwood of the Knowledge Quarter, a partnership of more than 90 knowledge-rich organisations based around King’s Cross, St Pancras, Bloomsbury and Euston. Jodie espouses the power of cross-disciplinary partnerships saying “the real value of collaboration comes when you cross sectors.”

 

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At the Quadram Institute in Norwich, researchers and clinicians collaborate around an open atrium overlooked by research labs and balconies. (Photo courtesy of Sean Airhart/NBBJ)

Science on show

However, co-locating sectors alone is not enough. We must create buildings that actively promote formal and informal collaboration; spaces that showcase health and science in one place.

Blurring spatial boundaries can bridge the gap between fundamental research and application in practice, allowing those differing aspects of innovation to drive each other.

At the same time putting science on show, making it accessible to the public, helps to demystify scientific endeavour, while sowing seeds for education and future talent.

The Quadram Institute in Norwich is a case in point, incorporating an environment in which clinicians work alongside scientists at the forefront of food science, gut biology and healthcare research under one roof with one shared identity and entrance.

Bringing together the Institute of Food Research, the University of East Anglia and the gastrointestinal endoscopy facility of Norfolk and Norwich University Hospital, the Quadram Institute conducts bench-to-bedside research and clinical care related to health and diet.

Within a hierarchy of spaces, the clinical research facility and patient treatment areas are more private to protect patients’ and participants’ confidentiality, whilst the research space is open to showcase the science within.

 

Future proofing and flexible facilities

There are also many lessons the NHS needs to learn from when designing the next generation of healthcare facilities and buildings.

Purely clinically-led design isn’t working and must be supplemented by research-led thinking that inspires sustainable, adaptable buildings offering operational flexibility.

We must also champion strong and proven healthcare, research and technology hubs, such as the MaRS Discovery District in Toronto and UCSF Medical Center at Mission Bay, as the best breeding ground for future start-ups and world-leading innovation.

Yes, many garage start-ups have turned into multinational powerhouses but most new ventures will have a higher chance of success from being based in well-connected places that benefit from local cultural and heritage amenities.

 

Technology drives talent

Finally is the undeniable importance of digitalisation and AI to the future of healthcare and driving the talent that will drive healthcare forward. It will be fascinating to see how emerging technologies will advance the practice of medicine, improve health and empower patients to be active participants in their own care. Trends in digital diagnostics, robotics and data are allowing hospitals to put the human experience first.

For example, many hospitals in the United States are already being designed with extra-wide corridors, allowing robots to deliver medicine and other critical supplies directly to patient rooms. Meantime, IBM’s Watson is being utilized to diagnosis illnesses — especially those that are hard to detect — which then impacts the experience of patients and the quality of care they receive.

The NHS needs to sell a vision of the future now, instil public confidence and demonstrate it has a plan to create a future for itself. What’s needed is true collaboration, openness and innovation, inclusivity, community and a need to think flexibly. Don’t let’s design for just one need but let’s create a sustainable health and wellbeing community for the next 70 years.

Banner image courtesy of Timothy Soar/NBBJ.

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The Health Economy Is a Local Economy

Clustering Healthcare Services Isn’t Just Good for Patients, It’s Good for Local Communities — Like Liverpool — Too

March 2, 2015

Principal, NBBJ

For the latest in our ‘Lab’ talks in London, a panel on ‘The Health Economy’, we posed a question to a gathering of designers and healthcare professionals: how can healthcare developments impact the health and wealth of our cities?

The question comes at a time when the National Health Service (NHS) faces significant challenges in delivering effective local care, as John Kelly, director at Healthcare Partnering, told the group. The NHS, he said, is influenced by opposing forces, which he dubs ‘centrifugal’ and ‘centripetal’. The centrifugal forces — capacity, romantic localism, resilience and more — encourage the decentralisation of care services, whilst centripetal forces — NHS culture, individual behaviour, procurement routes and more — favour centralised care. (Forces such as finance and politics also compete for influence, but their effects are less predictable, encouraging consolidation in some instances and dispersal in others.)

Since the Health and Social Care Act 2012, the relationship between NHS hospitals and their local economies has worsened. The lack of connectivity between hospitals, social care and the community creates a wide gap in the quality of health in many areas. This would seem to argue against decentralisation.

Yet it is clear that the older, simpler model of the NHS and its organization — the centripetal, centralised model — is no longer applicable either. The NHS needs to take a wider view, to be more encompassing, more flexible and better networked. It will need to move beyond centralised healthcare if it truly wants to provide integrated, personalised services for patients.

Kelly quoted Simon Stevens, Chief Executive of NHS England, who produced the NHS Five Year Forward View to articulate what this change might look like. He proposes multi-specialty community providers, viable smaller hospitals and specialised care, with the goal ‘to dissolve the artificial barriers between prevention and treatment, physical health and mental health, and the historical silos of primary, community, social care and acute care — and the professionals who work across them’.

Fortunately the new Royal Liverpool University Hospital is moving in this direction, reported our second speaker, Helen Jackson, the Director of Strategy and Transformation for the new Royal and Broadgreen University Hospitals NHS Trust. Although Liverpool has some of the most deprived areas of the UK — life expectancy in the Kensington area is 10 years less than Kensington in London, and there are huge variations within Liverpool itself, in some places of up to 14 years — the new Royal represents an opportunity to build on the assets of the city and improve health and wealth.

The £1 billion development covers not only the hospital, but also research, education, public space and other opportunities for future growth. Its vision of an integrated campus is attracting key services and institutions such as the Liverpool School of Tropical Medicine and the Clatterbridge Cancer Centre. The aim of the Trust is to build a knowledge quarter: the hospital and the university will be closely linked to the cultural centre of Liverpool and the shopping district, making it attractive to researchers and clinicians alike.

And by siting research and healthcare on the same campus, the opportunity for clinical advancements is greatly increased. For the Trust, this represents a significant step change in the way they deliver services.

As Jackson puts it, the ambition for the new Royal is that job creation, investment, development, co-location and significantly improved health services will together improve the health of the city of Liverpool. Even more significant, if successful it will provide a roadmap for resolving the centripetal and centrifugal forces currently pulling healthcare in contradictory directions. In doing so it will provide a model for healthier, wealthier communities throughout the UK.

Image courtesy of Wikipedia.

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Let’s Get Back to Drawing

A Photo-Essay from a Panel and Exhibition on Architectural Drawing in London, 28 October

November 6, 2014

Principal, NBBJ

Last week we hosted an event in NBBJ’s London studio titled ‘Let’s get back to drawing’. We have noticed that, when it comes to design, clients and the public are ever more demanding in their requests for realism and photo-realistic CGIs. But we wanted to see if, as architects, we still need to be able to draw.

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Today we work in 3D to generate images and coordinate design. It’s practical and it’s visual. We’re constantly evolving and our tools are becoming ever more intuitive. We use computational design to rapidly prototype designs: these complicated algorithms allow us to explore multiple options for our clients so we can design the best building we can.

Crucially though, we still always start with a drawing. Sketchbooks and pencils are still very much part of the tool box; computational design is simply an additional tool. Drawing is a way of thinking through and working out problems. It too allows for rapid prototyping. And it’s a clear communication tool: we demonstrate a thought process, the evolution of an idea and a solution.

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Richard Rees, The Society of Architectural Illustration

Our guest Trevor Flynn, founder of Drawing at Work, often finds that architects are afraid of drawing. His classes, held in-house at practices, aim to dispel this fear. He uses a series of exercises to free his students up. Freehand drawing is a form of interpretation: he calls it ‘selective inattention to detail’. He might ask his students to sketch a subject 20 times in an hour: a kamikaze approach, fast and with a high failure rate. But out of this plenty he is looking for scarcity. The most simple of lines can offer the clearest view.

Our second guest, Richard Rees, former director of BDP and now President of the Society of Architectural Illustration, said the purpose of a drawing is to make you see the essence of something. The best drawings can be the most simple, a few lines which allow the viewer to interpret to form the image. CGIs, in all their accuracy and finesse, can dull a subject down: too much information and the mind doesn’t need to work. Flynn is concerned we have lost the idea of the present; we’re always looking down (usually at our phones) and missing something. He asks, ‘where did the view go?’ His goal is to reengage our spatial and visual intelligence, rewire us and help us draw once again.

Drawing is the ultimate communication tool. Since the time of the caveman, drawing has been used for thinking, recording, explaining, imagining, questioning, recollecting and expressing. It makes us inherently human.

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Installation view at NBBJ London.

 

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Worm’s-eye view axonometric of City Court, David Lewis, 1989.

 

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Flipping through Drawing on Architecture, a publication by Richard Rees and the Society of Architectural Illustration.

 

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Watercolor and pencil sketch of Dulwich College, Christian Coop, 2014.

 

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Listening to the panelists.

 

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Detailing for NBBJ’s iAlter installation at 100% Design, David Doody, 2014

 

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Listening to the panelists.

 

All images courtesy of Ming Lee/NBBJ.

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The Serendipity City

The City of the Future Won’t Just Be Smarter, It Will Make Us More Creative

April 17, 2014

Principal, NBBJ

There’s been a lot of talk recently about ‘smart cities’ — certainly we discussed them often at a recent New Cities Foundation meeting I attended in Stockholm. But I wonder whether the smart city is an incomplete vision of urbanism.

In Stockholm, we discussed the good city of the future, and two themes emerged. The first was the base environment: a good city meets basic needs for safety, education, proximity (that is, the ease of getting around), transport and so on. And the second theme, which we called the ‘soul’ of the city, included things like heritage, a free and creative environment and successful public spaces such as cafés. When you put those two things together, it forms a catalyst, the spark for chance encounters to happen.

That’s when we hit upon it: the goal isn’t a ‘smart city’ at all. The smart city is simply a means to an end. The actual goal is what I call the ‘serendipity city’.

Once the basic elements are in place, the serendipity city becomes about chance encounters and how people network. Data can make cities more efficient, but the differentiator of good cities has always been how they promote chance and new ideas. To use an obvious example, if you are sitting in a café and overhear something that interests you, that may lead to a new insight. Public spaces enable these chance encounters to happen.

Then data enhances public space to provide the infrastructure in terms of connectivity, in terms of getting ideas out and also collecting information. Here is where the smart city comes in. For instance, it’s estimated that 30 percent of traffic is people looking for a place to park. So if you could use an app to find parking, as they’ve started to implement in Barcelona, it would reduce driving. Using information in this way points not only to a safer city, with reduced traffic making it easier for people to walk around, but it also allows you to be more efficient in your day and free up more time for serendipitous encounters.

Data could enable encounters in other ways too. Take an office building, which is usually occupied only from 8:30 to 6:30. If that building constantly gave updates on whether the rooms were available, and if building management made that data public, it could open the space to a wider audience. Sensors already adjust temperature and lighting based on occupancy, but if that information were available more widely, who knows what kind of unexpected interactions would occur.

The best part? The serendipity city layers easily over existing cities. The built environment differs, in terms of time-scale, from data: it lasts a hundred years or more, instead of days or even minutes. Compared to the built environment, the information layer is relatively easy to implement. Where the serendipity city differs from existing cities is how it interacts with the streetscape and how it hands over its threshold to the public. In its physical context, especially at ground level, it offers more public space than private space, open to interaction with more people.

In a knowledge-based economy, ideas are crucial to competitiveness, which is the true value of the serendipity city. By using information to help people negotiate the built environment more efficiently, it brings them into contact with more people and catalyzes new, unexpected ways of thinking. Now that’s smart.

Image courtesy of Flickr.

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