This year’s edition of the Wolfson Economics Prize – described as the second-biggest economics prize in cash terms in the world – coincides with a period of soaring NHS waiting lists and many NHS trusts reporting concerns about staff wellbeing, stress and burnout as a result of the pandemic.

The Prize was launched in February and invited design submissions that would address the following question: ‘How would you design and plan new hospitals to radically improve patient experiences, clinical outcomes, staff wellbeing, and integration with wider health and social care?’

The five finalists have responded to the challenge by taking inspiration from living systems and the healing qualities of nature; integrating innovative, smart technologies to create staff efficiencies and improved patient outcomes; and supporting the reconfiguration of healthcare to create a more unified, integrated and streamlined system.

Nature and healing

Many of the shortlisted entries acknowledged the link between human health and the planet. A team led by John Simpson Architects – and featuring Ruggles Mabe Studio Architecture + Interiors; Create Streets and Create Streets Foundation; Dr Hervey Wilcox; and Natalie Ricci – has drawn on neuroscience and the symmetry and shapes found in nature to argue that hospitals need to shift from “factories for fixing” to “places for healing”.

Their entry suggests hospitals adopt principles so healthcare facilities are: green with gardens; enclosed and secure; naturally lit and ventilated; beautiful places of which to be proud; built with variety within a pattern; adaptable and resilient; and interwoven with neighbourhoods. The framework also encourages the adoption of new key performance indicators, such as: self-reported patient wellbeing; self-reported happiness of hospital staff; and self-reported happiness of hospital visitors.

John Simpson, of John Simpson Architects, said: “We’ve identified seven key components essential to the creation of a modern hospital, which are capable of transforming patient experiences, clinical outcomes and staff wellbeing. We call this the Complete Hospitals Framework, which is devised to provide guidance so that modern hospitals can change from the simple factories for fixing we have today to places of healing, able to work alongside the science and technology of medicine, to help in the recovery and rehabilitation of patients.”

Shapes found in nature are also the inspiration for another of the shortlisted entries: the Starfish Hospital. Developed by Deirdre King, with support from David Leonard of Leonard Design Architects, the concept proposes a total redesign and modernisation of hospital activity, which would be divided into three settings: starfish-shaped hospital hubs; satellite specialist health centres; and a ‘hospital at home’.

Starfish-shaped hospitals would divide up five core hospital activities – A&E, diagnostics, operating theatres, ICUs, and laboratories – into each ‘ray’ of the five-ray starfish. A new ‘front-stage/back-stage’ workflow would be implemented to increase productivity and reduce infection control, with separate staff and visitor/public entrances created. Central hubs would provide acute care, with smaller satellite centres providing non-acute care, while virtual visits and assessments would support patients to recover faster at home.

Said King: “Our big idea is a Starfish hospital, designed for life, with modern hubs, connected rays, and satellites. This will empower staff to provide optimal clinical services in a calm and welcoming environment, enhance hospital experiences for all, and offer a vision to build a healthier population.” 

Architect of the Maggies’ at the Royal Marsden, Ab Rogers has also been shortlisted for its ‘Living Systems’ concept, which seeks to nurture body and mind, and care for the sick, the well and everyone in between. Taking an innovative, multi-sensory approach, which considers the smell and sound of the space, the design features an in-house marketplace of local produce, a rooftop urban farm, and accessible pocket gardens between each ward.

Describing their entry’s vision as a “celebration of health”, Ab Rogers said: “Inspired by the adaptive qualities of living systems, it’s a connected and forward-looking institution that grows and changes in response to its environment and the needs of its users.”

Addressing system failure

Recognising the need to address what it calls “the operational confusion between health and social care, particularly the relationship between residential nursing home care and hospital care for elderly citizens”, another shortlisted entry, the Well-Placed Hospital, looks to “bring the hospital back into the town” to better serve the local community.

It incorporates ideas such as: smaller, more convivial hospitals that better integrate health and social care; bringing GPs into hospitals with the unification of general and hospital medical practice in a single “unified clinical faculty”; reducing the NHS’ carbon footprint by removing the need for car journeys to out-of-town hospitals; and moving much of elderly care into reformed residential nursing home care and housing-for-life units.

The team includes: Andy Black – healthcare planning and management; Anthony Farnsworth – social care planning and management; Mungo Smith – MAAP Architects; Jaime Bishop – Fleet Architects; and Tim Kershaw of Place and Purpose CIC. Said Black: “We say bring the next generation of NHS hospitals and their economic muscle right back into the centre of town. Integrate hospital and residential nursing care facilities and staff.”

The final shortlisted entry focuses in on the emergency department, co-authored by a senior NHS doctor who has been in A&E during the Covid-19 pandemic. 

The entry, the Smart Emergency Department, proposes innovations to reduce crowding in A&E, including first-class airline-style pods for patients with less serious conditions. The design would be able to accommodate a threefold increase in capacity without having to convert additional NHS estate or use tents. The model would also look to give patients control over lighting and easy access to mobile phone chargers, all with the aim of making A&E a less “frightening and overwhelming experience”.

Dr Susan Robinson, a consultant in emergency medicine at Cambridge University Hospitals, said: “The Wolfson Economics Prize gave us an opportunity to radically rethink the emergency department using real world, here-and-now technology, and operational concepts that seek to reduce waiting times significantly, provide a safe and efficient work environment, be carbon neutral over their life cycle, be fiscally responsible, and provide a way of testing new, advanced operational and architectural concepts before they’re deployed systemwide.”

Entrants were asked to answer the design question in a primary submission of up to 10,000 words. A panel of world-renowned experts was tasked with whittling down the near-100 entries – received from more than 15 countries – to five finalists, who will now work on a secondary submission of up to 25,000 words in competing for the £250,000 cash prize, which will be announced in November.

Informing policy and practice

Commenting on the importance of the Prize in the context of the UK Government’s New Hospital Programme, Health Secretary Sajid Javid said: “Hospitals are an intrinsic part of local communities, helping to save lives and keep people healthy.

“We’re on track to deliver 48 hospitals by 2030, which will give staff the facilities needed to continue providing top-quality care for years to come. All our new hospitals will prioritise sustainability, digital technology and the latest construction methods, delivering state-of-the-art facilities for patients while maximising value for taxpayers’ money.

“This year’s Wolfson shortlist is packed full of innovative ideas to help inform these plans and I wish all the finalists the best of luck.”

The Wolfson Economics Prize judging panel is chaired by Lord Kakkar, professor of surgery at University College London, crossbench peer in the House of Lords, and chair of the King’s Fund.

Praising the quality of all the submissions as remarkably impressive and representing examples of brilliant thinking, he said: “Out of an exceptionally strong field, the shortlisted entries demonstrate particularly ingenious approaches. With a renewed focus on hospital building in the UK, these finalists have a really exciting opportunity to shape how NHS hospitals look, feel and function.”

The judging panel also includes Professor Brian Donley MD, chief executive of Cleveland Clinic, London; Dame Elaine Inglesby-Burke CBE, former chief nurse at Salford Royal; Dame Laura Lee, chief executive of the cancer charity Maggie’s; Robert A M Stern, founding partner of Robert A.M. Stern Architects; and Nigel Wilson, chief executive of Legal & General. The Prize was founded by Lord (Simon) Wolfson, chief executive of Next.