"Architecture has no meaning unless in relation to nature". 

— Alvaro Siza [1]

We used to build in quite sensible ways.

Before industrialisation in Western Europe, we mainly built relatively simple structures of load-bearing walls using materials sourced in the locality. These materials – stone, brick, earth, timber, lime, plant fibre – required very little energy to produce. The walls were generally formed of one or two materials and the craft skills required were passed from one generation to the next. These vernacular buildings responded to local climatic conditions, making careful use of volume, the sizes and positions of apertures, cross ventilation, the thermal mass of the wall materials, thermal buffers to the most hostile orientations, and rooms of differing temperatures, to moderate the climate and achieve a relatively comfortable indoor environment without requiring significant additional heating or cooling. The buildings worked with nature and made the most of the natural conditions.

The industrialisation of construction over the last two centuries has created a change, from buildings as assemblies of materials based on craft practices to buildings as sums of subsystems, elements, and specialised layers of proprietary products. This change from materials to products greatly increased the embodied energy of building, as the standardisation of products requires significantly more complex manufacturing. Bricks, once produced locally from terracotta and fired at low temperatures, now require homogenised clay, must be fired at very high temperatures to meet industrial standards, and are transported large distances from centralised production facilities. Wood is now subjected to shredding, gluing, and shaping under pressure to homogenise its properties in the required formats [2]. We have also developed an ever-increasing number of industrial materials – steel, aluminium, PVC, concrete – that need vast quantities of energy to produce.

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In parallel with these changes in construction, we have created a situation where buildings are increasingly isolated from the natural environment, relying on technology to achieve comfort, instead of working with the local climate and conditions, as buildings did historically. In this era of the hermetically sealed building, the architecture discipline has surrendered responsibility for the design of the internal environments to engineers and other specialists. Key architectural issues affecting the well-being of inhabitants, such as air-quality, temperature, and humidity, are delegated to specialists and handled by technology. These issues, which should be central topics of the architectural project, are treated as merely problems to be solved. The construction industry and design professionals have become obsessed with the idea that we can completely isolate the insides of our buildings from the natural environment, like habitable thermos flasks. Yet, as Kiel Moe describes in his book Insulating Modernism, Isolated and Non-isolated Thermodynamics in Architecture, this isolation is illusionary and denies the physical reality of the building and the way it acts in the world: "literal isolation is thermodynamically impossible to achieve in the context of buildings" [3].

Based on this flawed thinking we have developed policies and regulations aimed at ever greater levels of insulation and airtightness, pursuing the holy grail of zero-energy buildings. Passivhaus is perhaps the most extreme version of this, creating buildings so airtight that they rely on expensive and complex technologies to provide ventilation.

The goal of these policies is energy conservation above all else, drowning out any more balanced discussion about how carbon emissions can be reduced to combat climate change. A new industry of simulation and certification has been created to drive a massive technological upgrade of buildings, but the promised successes will never be realised in real life. We have rushed to encase all our housing in thick layers of polyurethane and other oil industry by-products without consideration of the destructive impact of this practice. We don’t consider that having the bulk of our energy generated via renewable sources will reduce the need to insulate [4]. We are caught in a mindset that believes that more and more industrialised production and technology will solve any cost, quality, or time problem in the construction industry while helping to resolve a climate crisis that is the direct result of industrialisation and technological growth.

In recent years an increasing number of architects have begun to realise that we are making buildings too complex to design, too expensive to build, and too difficult to operate. Worse still, we are slowly becoming aware that the indoor environments we are creating, the settings for an increasing proportion of our lives, are not healthy. We realise that buildings are not empty shells, that they are filled with air, in the physical sense, and that this air is the main source of nourishment for the human body.

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Alarmed by these realisations, some architects are returning to first principles. They are beginning to study how vernacular architecture managed to create buildings that intrinsically required very little energy to heat in winter and that did not overheat in summer. A change of mindset is emerging, from the modernist isolation of the building and reliance on technology to a new sensibility about simpler, more robust forms of construction that engage in a dialogue with the natural environment.  

One example of this new mindset is the work of the IBAVI in the Balearic Islands. This government housing agency has developed a whole series of really interesting social housing projects that rediscover vernacular materials and construction techniques such as the use of the local Mares stone, and a seagrass called Posidonia as insulation. In their projects, thick stone walls and vaults are deployed to stabilise the indoor environment without needing any applied technology.  

These architects have been leading a rediscovery of how the fundamental spatial elements of architecture – walls, roofs, floors, ceilings, and apertures – can generate an environmental performance in which the building is not isolated from its surroundings, but instead takes advantage of the innate opportunities they offer to achieve comfort without the need for complex technologies. There is also a growing realisation that buildings inherently require a great accumulation of matter and energy to exist and persist, that they can never be zero-energy, and that a building’s success in ecological terms is characterised by its capacity to exchange and harvest energy from the natural environment. This emerging school of thought has the potential to establish a more coherent agenda for architecture and to reestablish its relevance and importance to contemporary society.

Picture the last hospital you were in – there are reasons it looked like that. At any moment, a healthcare setting is balancing the needs and priorities of patients, clinicians, management, and administrative and support staff. Efficiency, servicing, privacy, infection control, comfort, safety, and cost add further complexity. Design guides, evidence-based solutions, and building regulations are guide rails for the architectural process. But established processes often engender established solutions.

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Now, picture an oncology day ward. A row of treatment chairs and drip stands separated by curtains, buzzing overhead lights, nursing staff filling notes on their knees. But what if those treatment chairs were more comfortable, more functional? What if jump seats [1] created useful spaces within a corridor, taking advantage of city views while maintaining required clear widths? What if instead of tired divider curtains, privacy came in the form of beautiful, artist-designed screens?

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This is the kind of 'fresh perspective' design students offer, says Cathal Mac Dhaibhéid, doctor and 2022-23 Innovation Fellow with HSE Spark Innovation. HSE Spark is a frontline, staff-led initiative to improve healthcare using design principles and innovation methodologies [2], which has run many successful partnerships with students of design. Mac Dhaibhéid cites the example of Interaction Design Master’s students who whittled a 'fifty or sixty' page nursing admission form to just twelve pages, through a series of user interviews and prototyping. 'These students look at problems through a design lens', says Mac Dhaibhéid, 'and they’re not jaded by working in the public health system'.

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But up until the recent ‘Healing Spaces’ elective – delivered with TU Dublin School of Architecture, Building and Environment (SABE), the Mater Transformation Team, and the Mater Hospital’s Oncology Day Ward and Inpatient Unit – HSE Spark hadn’t collaborated with architecture students. Like many good ideas, Mac Dhaibhéid’s engagement with schools of architecture was borne of frustration. Galvanised by the spaces he encountered in medical practice – some illogically laid out, some poorly functioning, some merely uninspiring – and Christine Nickl-Weller and Hans Nickl’s 2013 book, Healing Architecture [3], he became increasingly interested in the therapeutic potential of space, and the missed opportunity that is unimaginative design. He says, 'You have all these advances in how cancer is treated, but where it’s treated hasn’t really changed'.

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For Emma Geoghegan, architect and Head of Architecture at SABE, Mac Dhaibhéid’s proposal to collaborate was too good to miss. There are established postgraduate programmes in healthcare architecture, but a focused module on healthcare spaces is absent from most undergraduate architecture syllabuses. Geoghegan notes that this is a 'gap', saying the design of healthcare environments is 'not just about typology, it’s about how you engage with people'. User engagement is key to the profession of architecture, and though many final-year architecture students have worked in practice, few have much experience of engaging with end users – this task generally falling to more senior team members.

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In designing and delivering ‘Healing Spaces’, it made geographical and ideological sense for Geoghegan and Mac Dhaibhéid to work with the Mater Hospital. The hospital is within TU Dublin's direct community, and 'Community Engaged Research and Learning' is a stated aim of the university [4]. Critically, the Mater is, according to Mac Dhaibhéid, 'fertile ground for doing things a bit differently', as evidenced by the existence of Mater Transformation, an embedded unit within the hospital that’s dedicated to working with frontline staff to co-design and deliver change [5].

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Regularly collaborating with both HSE Spark and the National College of Art and Design, Mater Transformation has extensive experience of running collaborative problem-solving processes. ‘What we’ve done is set up structures that can bring people together,’ says Aileen Igoe, Mater Transformation’s Lean and Systems Thinking Lead. These structures were critical to tackling potentially sensitive issues related to working in a functional hospital, such as GDPR and access, says Geoghegan. 'Things that might normally be challenging, we were able to resolve very quickly' [6].

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Healing Spaces 'definitely felt like something special', Igoe says. Students were tasked with the redesign of the Mater Hospital’s Oncology Day Ward and Inpatient Unit, which sits within a building that’s less than ten years old, and is, as Igoe – who studied architecture – points out, generally well designed and considered. But the service has expanded, and healthcare architecture is often constrained by budgets, timelines, and HBN (Health Building Notes) standards [7]. Whereas by listening very carefully to staff needs, and through them, the needs of the patients [8], the SABE students gained a 'nuanced understanding of service' that allowed them to achieve 'the attention to detail that you might see in a domestic extension'.

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Geoghegan, Mac Dhaibhéid, and Igoe all stress that the project’s success would not have been possible without the enthusiasm and openness of the Mater’s 'fantastic' clinical staff. Alongside oncology staff consultation, the SABE students received expert advice from Jennifer Whinnett, Senior Healthcare Planner at Guy’s and St. Thomas’ NHS Foundation Trust; Ailish Drake, an architect and landscape designer at Drake|Hourigan Architects with extensive user engagement experience; and Clare White, Director at O’Connell Mahon Architects.

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Nine students – eight studying architecture and one studying interior design – [9] worked collaboratively, each tackling different issues to develop a cohesive solution. Daniel Herbst considered how spatial efficiency could be maximised to create more staff workstations. Alannah Hayes redesigned the bridge corridor to incorporate glare-free recessed lighting and jump seats with views of the city. Balancing the therapeutic value of nature, against the maintenance and infection control issues that planting brings [10], Isobel Walsh proposed commissioning Irish artist Sasha Sykes [11] to make operable resin privacy screens, embedded with flowers. The breadth of the students’ thinking surprised and impressed Mac Dhaibhéid: 'The final presentation was incredible'.

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It’s likely that Healing Spaces will have a life beyond the module’s twelve-week duration, both in terms of the students’ actual proposals and in fostering future collaborations. Geoghegan says that within a few days of the students’ final presentation, Tracy Fitzpatrick, the Mater’s Directorate Nurse Manager for cancer, had sourced quotes for different aspects of the proposals: 'That really impressed me'. This being Mater Transformation’s first time working with architecture students, they don’t have established pathways for delivering architectural projects, but Igoe’s undaunted: 'We’ve manged it with NCAD in other design disciplines, and there’s various funds we can apply to'. She stresses that they’d like to keep the SABE students involved in some way, as the designs are theirs. Of working with Mater Transformation, Geoghegan says, 'It feels like a natural partnership for SABE. My hope is that we will continue to run an elective like this and build on it'.

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As for the module’s first run, the SABE students have shown that, with focused, informed imagination, a healthcare environment can be both clinical and beautiful. An oncology ward environment can stimulate and comfort patients who may be there for extended periods, distressed, fatigued, or bored, awaiting or receiving treatment. There is so much energy and innovative thought in architecture schools, often applied in the abstract. Healing Spaces allowed students to channel their energy and creativity towards 'something really useful"', says Geoghegan.

It is a strange time. Conflict is general, but there is one area of surprising consensus: Una Mullally and Michael McDowell are writing columns that agree with each other [1]. The cause of this congruence between left and right is the proposed reworking of the St Stephen’s Green shopping centre – a design both correspondents decry for its blandness and generic expression [2]. In the absence of full-time built environment critics in the Irish popular press, Mullaly and McDowell have each written extensively, with different emphases, about matters of architecture, urban form, and planning. Their critiques of the proposed development express views common in our society. While James Toomey Architects’ shopping centre might not be the most important building, with its clip on "Mississippi river boat façade" [3], the journalists’ point stands: so many facades, reworkings, and new builds betray a lack of consideration of threshold, of contribution to public space, of the linking to and protection of communities, or of seeking to create humane and delightful places to live. This is not a critique of architects per se, but of our planning system.

It is worth briefly setting out the status quo: most buildings are constructed by private individuals or companies, each acting in its own self-interest. These individuated projects become the public faces of our cities and towns, shaping our movement patterns, our ability to find repose or respite, and the network of social encounters that constitute a society. Acting to regulate and temper these disparate development processes is our planning system. ‘Forward planning’ teams within local authorities shape policies in the short, medium, and longer terms, while ‘development management’ departments consider specific applications for development permission. Beyond this, An Bord Pleanála adjudicates on appeals to planning decisions throughout the state.

There is something quaint about this, a simple system for a simpler age. It assumes an episodic pace of development – where extant works can be reasoned against proposed, at a pace which allows things to cohere. It’s a system ill-equipped to respond to the contemporary pace of development. While pre-planning systems exist, feedback tends to be high-level, strategic. Points raised may often be set aside by the applicant in the aspiration that a higher body may overrule local planners. Tactics shape decisions. Sometimes a flat refusal is not in the public interest; conditions requiring the omission of a floor, or even an entire block, are reasonably common. But these retroactive measures are probably the least useful ways to ‘manage’ development.

Applicants, for their part, assemble ever more complex design teams with specialisms added as tools to bolster a case, not necessarily to improve design. Many anticipate An Bord Pleanála as the final adjudicator. There is little incentive to justify the increased time (and therefore fee) an architect or landscape designer requires for a more thoughtful approach, as this will rarely have demonstrable impact on the planning decision or the financial modelling of the proposal. None of this is the planners’ fault, but a product of the system. As we consider a major overhaul of planning regulation here [4], it is curious that there is not more debate about this aspect. The primary effect of the proposed planning reform will be a more robust and streamlined system, but not one necessarily delivering better design.

It is time to consider using design review panels. These exist in many forms in various parts of the world. Some, such as those common within universities or major corporations, are specific to institutions, or to special planning areas, while in countries such as the UK these panels form part of the general infrastructure of the planning system. Design review panels bring together diverse specialisms to critique designs as they develop. A panel may include architects, landscape architects, housing experts, community engagement experts, and many more as required. These experts, paid for their time, review applications at early and late stages and provide non-binding feedback. Review events may resemble a design review in university, with a verbal presentation and conversational feedback.

The best design review processes are timely, occurring at an early design stage. They are proportionate, recognising that not every project warrants the process: perhaps key sites, streets or scales of work are identified as triggering a review. They involve rotating panels of diverse and skilled experts, offering objective feedback in a transparent and accessible manner. Most importantly, they are advisory: they do not act to design, but to inform a design process. However, their impact can be profound, allowing decisions taken early on to greatly improve anything from a proposal’s integration within an area, to the nature of housing layouts, and even aesthetic expression. Planners naturally draw on the transcripts of these sessions – and developers, knowing this, seek to bolster the design strength of their proposal. Conversations led by design review panels can, say, make a case for increased density coupled with clear qualitative improvements. In other cases, panels may act as powerful advocates against demolition, or champion the adjustment of early ideas to cater for the full breath of diverse needs that exist within our communities.

Design review can be malleable, recruiting and developing expertise across local authority boundaries and making space for arguments which may greatly improve the built environment over time. They also make explicit to applicants a requirement for skilled, adequately resourced designers. This impact ripples beyond the specific sites being reviewed and modifies the entire development eco-system over time. Substantial literature exists internationally on the benefits of the system [5], literature which will be vital in designing a successful Irish approach. Trials are key, to allow the new system to adjust and develop in light of how it is working.

None of the above is a panacea, but it might be a way to begin responding to the valid critiques raised by commentators left and right. Design review panels have the potential to positively reshape our cities and towns, setting out a new vision of our country for decades to come.