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The Teenage Cancer Trust Ward, Birmingham Children's Hospital, by Lifschutz Davidson Sandilands

The Teenage Cancer Trust Ward is a light and informal environment for its young patients, says Felix Mara

Clients and building users often regards architects’ challenges to their guidelines as obtuse or insubordinate. Should architects be more deferential in projects where operational constraints are exacting? Lifschutz Davidson Sandilands doesn’t think so, as evidenced by its Teenage Cancer Trust Ward at Birmingham Children’s Hospital, opened in January.

The Teenage Cancer Trust (TCT), founded in 1997, is a charity dedicated to teenagers with cancer and related diseases. Patients in this age range have very specific needs that can’t be provided for by children’s or adults’ wards, so the charity’s target is to increase the number of TCT units in NHS hospitals to 22 by 2012 – enough for every teenager in Britain who needs support.

TCT, acting as joint client with Birmingham Children’s Hospital, wanted the new unit to challenge orthodoxies. Although Lifschutz Davidson Sandilands wasn’t explicitly briefed to confront received wisdoms, like other architects working on TCT projects, the practice was chosen for its questioning approach and pursuit of design quality. As more funding became available, Lifschutz Davidson Sandilands’ brief expanded from the TCT to an extension to the existing oncology unit, adding two single wards, one four-bed ward, social and activity facilities and a dining area.

As an NHS Foundation Trust hospital, Birmingham has more financial and managerial independence than NHS hospital trusts. This allowed more freedom in the development of the unit’s brief and design, so the architect was relieved of certain rigid guidelines that can make healthcare design frustrating.

Lifschutz Davidson Sandilands’ radical approach is immediately apparent as one approaches the unit: a tube clad in metallic-silver profiled steel, with acid green highlights to window surrounds and the tube’s ends, which emphasise its expression as a sliced extrusion.

When I mention the similarity to ExCeL Phase 2 (AJ 17.06.10), Julian Gregson, associate director at Lifschutz Davidson Sandilands, puts me right: the highlights on Grimshaw’s exhibition centre are yellow, not green.

Colourful cosmetic touches convey a youth-culture persona

Though it had limited healthcare experience, the practice became part of a dynamic of conflict resolution, involved in continuous debate with the client and specialists. Derwent encouraged communication with architects working on other TCT units, including ORMS and Allford Hall Monaghan Morris. Like ORMS’ TCT unit in Cardiff (AJ 04.06.09), the Birmingham ward is clad in metal and perched on stilts; in Birmingham these provide access to A&E below.

The architect eschewed standard-practice square exposed grid tiles to all ceilings. Typically, ceilings are monolithic and access is only provided where absolutely necessary. It looks stunning, although there are cosmetic touches, for example the cut-outs. ‘The one on the soffit identifies the entrance and guides visitors to the existing hospital,’ says Gregson.

‘Translucent screens mounted across the elevation disrupt the non-rhythmical distribution of windows and provide modesty for patients when curtains are withdrawn.’ From a distance, these can be mistaken for the expression of a Vierendeel truss. You could take exception to these cosmetic touches or you could say they convey a youth-culture persona.

Internally, a long corridor from the children’s first-floor oncology ward leads to the TCT unit. Although the practice wanted to avoid replicating the institutional corridored world of NHS hospitals, you then enter an elongated den.

But the contrast couldn’t be more pronounced. You’re not immediately confronted by a policing reception but are aware of entering patient territory. To the right, an ‘inhabitable wall’ with undular cut-outs is lined with bright green soft polyurethane upholstery. To the left is a wall with vinyl supergraphic wallpaper.

This leads to a sky-lit nursing station at the unit’s core. It overlooks the four-bed ward, which can be adapted as a pair of two-bed wards, enabling patients to cohabit with a degree of privacy. The single rooms are for patients whose condition is acute.

On the other side of the station are dining and social activity areas, with a billiards table, a jukebox and colour-change ceiling lights, visible through the glazed end of the tube. In order to maximise flexibility, there are no internal columns.

The detailed design raised eyebrows. The architect wanted to conceal the extensive equipment and services so the ward would feel more domestic and encourage visitors to stay. But there were concerns that it would be difficult for staff to locate equipment, so there are visibility gaps between the double doors of bedside cupboards that contain vital equipment.

The architect won the battle over the curtains surrounding the beds, extending to ceiling level rather than hanging from suspended rails, so they are more difficult to remove for cleaning but look less institutional.

For similar reasons, there are recessed skirtings, despite hygiene concerns. Artemide bedside task lights were accepted instead of utilitarian clinical lamps because they cost less. But Lifschutz Davidson Sandilands also had to make concessions. High ledges are inclined to shed dust, and fixed bedside furniture has a light oak-effect Formica laminate finish rather than timber, to control infection.

It would be pedantic to say the strategy of concealing equipment and services conflicts with a healthcare philosophy that promotes openness and transparency. A more serious criticism is that it’s difficult to see how the unit could be extended without compromising the architectural concept, especially as there is a busy road to the east. However, the unit is remarkable for its constructive and practical outlook, its informality and the quality of light.

Project Date

Start on site December 2008
Contract duration 55 weeks
Gross internal floor area 400m2
Form of contract JCT SBC 05/XQ revision 1 2007 with bespoke amendments
Total cost £2.2 million
Cost per m2£5,500
Client Teenage Cancer Trust and Birmingham Children’s Hospital
Fundraisers Laurie Engel Fund and Derwent London
Architect Lifschutz Davidson Sandilands
Structural engineer Heyne Tillett Steel
M&E consultant Norman Disney & Young
Main contractor Vinci
Quantity surveyor/project manager CDM coordinatorJackson Coles
Lighting consultant GIA Equation
Annual CO2 emissions Not supplied

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