Tony Redman has four decades of experience designing hospice buildings. Ten years ago, he was ordained priest and as part of his training he studied the relationship between spirituality and hospice care. Spending time in two hospice environments, in the UK and Romania, he now volunteers as a hospice chaplain. I met Tony at Church House in Westminster, “the parliament of the Church of England,” Tony tells me, where he attends General Synod.
As our conversation unfolds, it becomes clear that I am speaking to a person who has the rare ability (and opportunity) to translate his Christian conviction and spirituality into his practical work, in this case to the benefit of hospice patients.
Tony has been a partner in The Whitworth Co-Partnership LLP, a practice of chartered architects and surveyors for over thirty years. Within this time he has led design teams that have created nearly 20 new-build hospices or hospice conversions, both in the UK and eastern Europe. He has also advised the Serbian Government on the potential for the conversion of hospitals into palliative care centres.
It all began in 1984, when his then-vicar told Tony that he had had a message from God to build a hospice. Tony recalled this, saying: “I didn’t know what a hospice was then.” So he did his research and eventually designed and commissioned the first hospice building in Suffolk, UK, in 1985. As a result of this, commissions followed from other places, including a project working on Dartford hospice, where Graham Perolls, CEO of Hospices of Hope, was the director.
Following this work, Mr Perolls invited Tony to accompany the Hospices of Hope team to Romania, to commission the first teaching centre for palliative care in Transylvania, which eventually opened in 1997, followed by the first inpatient unit, which opened in 2003. Since then, Tony has developed other hospice buildings in Transylvania and Bucharest and advised on hospice design in Serbia and elsewhere.
Although ordained as a priest fairly recently, Tony has been a committed Christian since he was 18 years of age. Considering the complementarity of his faith and his profession, he said: “The first thing which encouraged me about the hospice movement is the way in which it links spirituality and quality design. I think the best hospices I’ve been in, both mine and other people’s, are those that actually appreciate that a building can encourage people to make steps spiritually as well as palliatively in terms of treating of pain.”
For Tony, the design of a building should contain a statement of its purpose. He said: “[Buildings should be] specifically designed around the core function, and in hospice care the core function is the dignity of the person who is coming in to have their symptoms controlled, or to prepare for their own death. So the building needs to be client-centred, rather than process centred. For example, in Bucharest, the main thing that we wanted to get across was that the way in which these people would be cared for would be transparent, it would be completely open. And so, as soon as you come into the entrance, you see straight through the building, you can see where everything is, it becomes a building which should be welcoming and encourages people to think that the whole ethos of the place is open and supportive.”
When asked about considering environmental and cultural elements when building a hospice, Tony emphasised the importance of being very conscious of the cultural context within which you are building. He said: “We are required to build within our buildings a certain sustainability in terms of limiting heat loss and making sure that the building works in a sustainable manner, which means that the bit which often gets left out is this holistic understanding of how people get better, how people feel well, how people are able to understand that they are being treated with dignity.
“There is something about the simple things, like the heights of rooms, the way in which every bed ought to be able to look out easily through a window or over a good scene. The way in which there should be a feeling that you are never far from somebody who can control your pain if you’re in pain.
“Colour is important. Buildings which are very bland tend to lower the spirits, whereas buildings that have colour and have art on the wall tend to lift the spirits and therefore people are much more likely to receive their palliation more quickly than they would in a building which is just magnolia and wood.”
According to Tony, the particular flows of movement and energy through the hospice building are a major part of what differentiates these projects from others. He said: “There are people coming in through a front door who are very seriously ill and at the other end there is what happens at death and so to have a place where people can be quiet, and having all these functions which interrelate at the appropriate level without tripping up, that is important. Also, the way in which your design flows through the building has to be thought through very carefully.”
Tony advised anyone considering building a hospice to choose their design team carefully, not only in terms of selecting people with whom they can work harmoniously, but also: “making sure you have people who understand the culture and the different types of pain– and that includes spiritual pain– and who can ensure that this will not be neglected. I have been in hospice buildings where the focus has been centred on the nursing care, so it becomes very similar to a conventional hospital. A hospice, I think, should have this certain something extra, which is focussed around the dignity of the patient and the need to encourage patients to see that all sorts of pain can be controlled, including spiritual pain, whatever their spiritual background.”
Before we end the interview, Tony ventures his opinion on the future of hospice design: “I think, in the future, there is an uncertainty about the way in which hospice care will go in any country. And it is will be different in each country.” He reflects on the movement in the UK, toward caring for people in their own homes, and therefore the decreasing need for inpatient hospices and increase in need for day-care facilities.
“In Europe,” says Tony, “I suspect that things will change more rapidly in the future. Maybe more bedded accommodation to begin with, but then in the future maybe they’ll follow the English lead, so our buildings need to be flexible, in terms of what we create. They need the ability to adapt and change as circumstances and philosophies change around palliative care.”