Health check: Kentish Town Health Centre by AHMM
Amanda Birch revisits AHMM’s Kentish Town Health Centre to find a building pioneering in daylight and ventilation. Photography by Ben Blossom
Nestled among the Georgian back streets of north London on a wet, blustery, winter’s day, the Kentish Town Health Centre’s (KTHC) stark white rendered walls and distinctive green window grills stand out. I am here, as part of the AJ Footprint building revisit series, to assess the success of this Stirling Prize shortlisted building, five years after completion.
My expectations are high, given the wave of accolades the building has received. The KTHC has been described as a precursor for a new breed of health centres which bring together a whole range of different services under one roof. It houses not only the James Wigg GP Practice, which as the largest tenant occupies nearly 40 per cent of the building, but also emergency dentists, district nurses, breast-screening, podiatry, acupuncture, children’s services, staff facilities, meeting rooms and a wide range of community health activities.
The KTHC is the fruit of many years of planning, led by a visionary client Dr Roy Macgregor. Now retired, Macgregor was a senior partner at Kentish Town’s James Wigg GP Practice when he initiated a RIBA competition for a health centre ‘where not only medicine, but health and art come together for the community’. AHMM won the 2002 competition by identifying flexibility as the key to the building’s design.
As I approach the KTHC, I am struck by how established the building looks. It appears lower than its three-storeys due to the way its external balconies and terraces cut into the massing. The mature trees which encircle the site, with branches almost touching the facade in places, reinforce the sense that the building belongs here. The health centre could be mistaken for a high-spec apartment block, were it not for the colourful KTHC letters at the entrance.
Macgregor has said that some visitors think the health centre is an art gallery, and Andrew O’Hagan writing for the London Review of Books in 2011 described the KTHC as ‘a north London satellite of Tate Modern’. It is easy to see why. An uplifting triple-height atrium is punctuated with bridges, voids and glazed circulation cores. Instead of the ubiquitous NHS pale blue walls and mean vinyl chairs, the spacious waiting area is adorned with colourful graphics by Morag Myerscough and stylish and comfortable Terence Woodgate seating.
Once inside, clear signage directs visitors along a 5m-wide internal ‘street’ to the main reception located at the building’s heart. Rooflights flood the interior with daylight, despite the grey day, while a double-height curtain wall overlooks a well-maintained external courtyard - a soothing view for even the most anxious of patients. The atmosphere is welcoming and calm, with an efficient buzz about the place.
Near the waiting area is an empty space designated for a café that has never opened, a real missed opportunity. Apparently the space is occasionally used for special events, but it is a low priority for the NHS and is unlikely to change in the short-term. Doors open from the waiting area onto the courtyard, where tables and chairs suggest that it is well used, weather-permitting.
One of the areas the KTHC serves is Camden, a London borough with the greatest prevalence of patients with mental health needs. Macgregor recalls numerous incidents in the former 1970s building when patients would come in drunk and aggressive. But Macgregor noted that the number of violent incidents dropped significantly after the move to the new building.
According to the James Wigg GP Practice, about 1,000 appointments are available every week - a figure which does not include those who use the centre’s other services. Despite the building’s intensive use, the graphics, seating and terrazzo flooring appeared clean and in good condition, with no visible fading or signs of wear. Given the amount of daylight in the building, it is surprising to see so much artificial lighting switched on.
By lucky coincidence, as I entered the staff lounge, I encounter Karen Andrew, the property manager for Camden and Islington Community Solutions who is KTHC’s landlord. She is reviewing the building’s annual maintenance programme. Andrew explains that lighting is often left on to help patients with impaired sight. The building is equipped with passive infrared sensors to control the lighting, which can also be switched manually.
At the time of its completion, the KTHC’s sustainability strategy was cited as fairly ground-breaking. Danny Campodifiori, a director at Peter Deer and Associates, the services engineer for the project, says the KTHC achieved a NEAT (NHS Environmental Assessment Tool that pre-dated BREEAM) rating of ‘Excellent’ and adds that: ‘The building provides natural ventilation over a 24-hour period, which was a newish concept at the time.’ Features like the perforated grills to opening casement windows, which allow windows to remain open for nighttime purging in summer, were pretty unusual.
However, it is questionable whether the occupants of the building fully understand how to use, for example, the windows for nighttime cooling: in the GP practice, Dr Stephen >> Yaxley, said that they cannot open the windows at night in the ground floor consultation rooms, because the blinds fluttering in the breeze set off the alarm. But Campodifiori confirms that most ground-floor rooms are mechanically ventilated, as it was considered a security risk to leave windows open at night.
Robert Stewart, a receptionist for Mosaic - the service for disabled children based on the first floor - was particularly disgruntled. He complained about the area often being too hot or too cold, with roof lights not automatically closing when it rains, and the lighting being inadequate. Unfortunately, Mosaic’s reception desk was never designed to occupy this space, which was formerly used for circulation. As a result, it looks cramped and ugly, with makeshift glass screens erected to stop children from falling.
Meanwhile, a space that does work artfully, and demonstrates the building’s flexibility and good communication, is the GP wing. With 78 staff, which includes 28 doctors serving 20,500 patients, the practice is large. The creation of a central room on the ground floor behind the reception desk, where duty doctors work in the same open-plan space as the reception team and others, has been instrumental in promoting clear communication. Also, the well-designed ‘hot-desking’ consultation rooms, which employ features like a Toprail wall furnishing system that enables spaces to be easily adapted from clinical use to counselling, contribute to the building’s overall flexibility.
A particularly imaginative proof of the building’s multi-functionality is The Free Space Gallery in the first floor GP waiting area. Organised by Melissa Hardwick, arts manager and curator at KTHC, the free hanging space for artists is over-subscribed with exhibitions that change monthly. Hardwick is also responsible for a programme of works to maintain the building’s outdoor spaces. Working with the Leighton Education Project and Transition Kentish Town, she plans to eventually grow produce for KTHC staff.
In contrast with so many depressing health facilities, KTHC is a welcome breath of fresh air. Despite some minor unfortunate interventions - a building management system which has proven challenging to fine tune and some occupants’ lack of understanding of how the building operates - these are small niggles. The KTHC is a well-used, flexible building that is obviously well liked by staff and patients, as Hardwick confirms.
‘I deal with a lot of people who come into the building for the first time and they are all so impressed,’ she says. ‘It is a positive space and the building always feels full of energy.’
AHMM director Paul Monaghan on KTHC
What were the key influences on the design?
I have always liked Berthold Lubetkin’s Finsbury Health Centre near Exmouth Market in London because it does not feel institutional. It is a celebration of light, art and space. Also, when I was in my first year at university, we visited Chester-le-Street Civic Centre - a High-Tech town hall by FaulknerBrowns Architects which had a street running through the building. I suppose that was also at the back of my mind when we were working on Kentish Town Health Centre.
Are there any aspects of the project that could have been better executed?
We visit the building five or six times a year, mainly to show clients because it is a great advert for us. The project was procured through the LIFT process. In this procurement method, the architect works for a contractor, rather than a client so we did lose some aspects of the design that were important to us.
I wanted the flooring to the ‘street’ to be brick, to create a feeling of a street in say, Cambridge, but for reasons of infection control, terrazzo was selected, which is still fine. Suspended ceilings to hide the services were installed in some corridors and this gives an unwelcome institutional feel.
The 2009 Stirling Prize judges said: ‘The project is exemplary in its approach to sustainability.’ What was exemplary?
By their very nature, healthcare buildings have a high energy consumption. So AHMM tried to design a healthcare building that has naturally ventilated rooms, window/panel openings that allow nighttime purging, rooflights over the street that open to create a stack effect for ventilation purposes, lighting controlled by sensors, wind catchers and a design that draws in daylight wherever possible. All of these things, which now seem quite standard, were actually considered exemplary at the time.
Are the spaces in the building being used as AHMM had originally intended?
The building was designed to be flexible. For instance, on the ground floor, a series of larger, multi-purpose rooms are used by staff, patients and the local community. Other large spaces on the second floor are less successful due to the closure of the Camden Primary Care Trust (PCT) and recent NHS changes. It is disappointing that the open-plan offices, designed to co-locate district nurses, community health officers and psychologists, have lost their funding as consequently these spaces are under-utilised.
Financially, the building works almost like an office building, where people let different spaces. So, for example the dental surgery rents a certain square footage and pays rent to the NHS, who in turn lease the building for a period of 25 years from the developer, Camden and Islington Community Solutions.
The NHS pays rent for both the property and building maintenance during this period. At the end of the lease, the building and the land on which it is located, return to the NHS. This Private Public Partnership is less flexible when it comes to accommodating design changes.
There is no reason why some of the space on the top floor could not be rented out to small businesses, which might help the NHS with rental income. There was also meant to be a café on the ground floor, but for financial reasons that didn’t happen. However, they still use the space for special events and offer free gallery space to promote artists’ work.
The anonymous engineer
Overall, Kentish Town Health Centre is an exemplar health building. What really strikes you is the superb quality of daylight and the views. The natural ventilation strategy is well thought through, despite being let down occasionally by technology. On energy use, the building meets best practice, but it is not pioneering.
We visited on an overcast January morning, but the quality of daylight throughout the building was wonderful. The glazed main ‘street’ is complemented by vertical voids, rooflights and courtyards with views through the building to the trees outside. Most spaces are lit from both sides, so there are very few dark areas. What is particularly effective is the use of clerestory rooflights to light internal walls in the top-floor offices, which meant that although light levels at the desks were not high, few lights were on.
The building is predominantly naturally ventilated with some mechanical ventilation and cooling in the densely occupied offices or areas with specific requirements; such as the dental practice or the rooms for large equipment such as breast-screening.
Manually-operated, inward-opening insulated window panels with external security grilles provide a simple, secure and effective means of naturally ventilating the majority of spaces. Automatic opening of rooflights allows for stack effect - good in principle, but slightly let down by the controls which mean that they are pretty much entirely open or closed - fine in the summer, but not so good mid-season when you only want a small amount of air through. One GP reported that if the panels are left open at night, the security alarm is set off. It is not clear how widespread this is throughout the building, but it does restrict night-cooling in these areas and could affect internal conditions in hot weather.
Those we spoke to seemed very happy with the level of comfort in the building, with no reports of overheating despite the comment about the opening panels. Wind funnels along the ‘street’ to the reception desk and waiting area, despite the lobbies at either end. A problem on the coldest of days, the centre is thinking about adding air‑curtains.
Although no formal post-occupancy evaluation has been undertaken - AHMM made an unsuccessful bid for Technology Strategy Board funding in 2011 - the outsourced facility manager monitors energy use monthly. User guides are given to all new staff to explain how the building operates.
The Display Energy Certificate (DEC) in the lobby shows that it is rated ‘D’, using 87 per cent of the energy benchmark for a typical healthcare building. This is best practice for a building with no renewables. By comparison, Feilden Clegg Bradley’s Woodland Trust is rated ‘B’. Only a zero-carbon building would achieve an ‘A’ rating. The DEC also displays the previous operational ratings, and we can see it has dropped from 103 in 2011 - indicating a 15 per cent improvement over a three-year period.
With an intelligent approach to sustainability, the Kentish Town Health Centre is a delight to visit and seemingly as delightful to work in.