Will Foster鈥檚 first hospital, the Circle Bath, revolutionise healthcare design (15 January, page 38)?

No, it won鈥檛! Scale is really the issue and 鈥渂outique鈥 is not easily scalable, if at all. Every single design practice out there already aspires to the quality of this design but cannot easily realise these ambitions within the current procurement framework in the UK. The Maggie鈥檚 Centres are also blessed with being tiny and independently commissioned by a strong client.

There are many examples of small, beautifully executed health buildings in the UK. Going back to the eighties, the Lambeth Community Care Centre by Edward Cullinan demonstrated that even a modest health facility could produce architectural sophistication. The Breast Cancer Care Clinic at St Barts and the Kidderminster Treatment Centre are in the same league as Circle Bath. But small is easy and large is not.

If you wish to see a large and wonderful world-class hospital, go look at the new St Olaf鈥檚 Hospital in Trondheim, Norway (www.arkitektur-n.no). It comprises about 13 new buildings in city blocks four to six storeys high. Each one responds to its context with individuality and flair. See also the Akershus Hospital in Oslo which is a fine example of a more conventional hospital.

Switzerland, France, Spain, Austria, Germany, Holland also have examples of fabulous publicly funded health facilities.

The focus for the past 20 years in the UK has been on quantity, not quality. We can improve health facilities in this country but only if the clients revolutionise their services and demand higher quality buildings.

Mungo Smith, director, MAAP Architects

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