Unsupported browser

For a better experience please update your browser to its latest version.

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more

‘We were designing it for the patients’: Rogers Stirk Harbour + Partners’ Guy’s Cancer Centre

  • 1 Comment

At Guy’s Hospital Rogers Stirk Harbour + Partners has attempted to create a cancer centre focused on the patients, says Jay Merrick

CLIENT’S VIEW • HEALTHCARE SPECIALIST’S VIEW • PROJECT DATA • SPECIFICATION •  PLANS • SECTION

There are more than 400 NHS clinical commissioning groups and trusts, populated by 150,000 doctors and nearly half a million nurses and other scientific and technical staff. A significant proportion of them are focused on more than 360,000 newly diagnosed cancer patients every year, in hospitals whose physical developments often seem to be metaphors for chaotic cell-division. This is not surprising; in spending a projected £118 billion in 2016/17, the NHS will still generate a net deficit of nearly £2 billion.

Those numbers overwhelm any idealised musings about, say, the highly refined architecture of European sanatoriums designed between 1905-35 by Hoffman, Aalto, and Duiker and Bijvoet. Even the 300m-deep wards in the Solotvyno salt mine in Ukraine, which receive 4,000 short-stay asthma patients every year, might seem utopian compared with Planet NHS.

A substantial proportion of the £160 million cost of the newly opened Cancer Centre at Guy’s Hospital in London was, however, not centrally funded by the NHS. The top segment of the building’s 14 floors, originally designated as NHS space, had to become a cash-contributing private patients zone, and the centre remains subject to an ongoing funding shortfall.

The building, which receives up to 800 patients a day, sits on a triangular site 50m south of Guy’s dreary main entrance on Great Maze Pond near London Bridge. The two street-facing façades are not particularly engrossing because the external materiality and details look and feel oddly stripped-down. The support-struts for the steel-framed balconies are not as elegant as they might be; and the combination of metal louvres and brightly coloured panelling on the façades lacks RSHP’s characteristic high-res clarity.

There were specification strictures. For example, bacteria control precedent meant that only one type of ceiling tile could be used. Is there a hospital tile mafia? But RSHP’s scheme survives these incidentals, and is impressive in the way it has vividly humanised the non-treatment areas.

Two main forces guided the design: a top-down belief that patients should not feel immediately immersed in clinical spaces; and intense collaboration between the architects and the patients reference group.

The design brief was set out by the centre’s project director, Alastair Gourlay, who commissioned Hopkins Architects’ critically acclaimed Evelina Children’s Hospital in 2005. He wanted the centre to be equally innovative, both atmospherically and operationally. Hopkins’ UCH Macmillan Cancer Centre, with about half the floor area of Guy’s equivalent, set an architectural benchmark for British oncology buildings in 2012, but on a much more forgiving site. The north face of the Guy’s centre – entrailed with bulging colour-coded ductwork – is eight inches from an existing Guy’s building.

There was no question, we were designing it for the patients

Ivan Harbour

Contractor Laing O’Rourke led the delivery of a project whose compact street setting required 60 per cent of the structure to be prefabricated. ‘This wasn’t about squeezing programme in,’ says RSHP partner and lead designer Ivan Harbour. ‘And they didn’t say to approach things in particular ways. There was no question, we were designing it for the patients.’ Harbour acknowledges that Guy’s health strategist, Jackie Churchward-Cardiff, was a key player in developing the building’s design concept, as was RSHP associate partner Steve Martin.

The building is effectively a stack of four ‘villages’: a welcome village, with a stylish and palpably laid-back main reception and staff areas over the first two floors, with strikingly original seating modules commissioned by Futurecity and designed by Gitta Gschwendtner; a three-storey radiotherapy village, with Europe’s first array of linear accelerators (linacs) above ground-floor level; a two-floor outpatients village; and finally, a three-level chemotherapy, pharmacy and research laboratory beneath the private patients’ zone.

The base level of each village has a full-plan 1,750m² floorplate, and patients enter double-height reception volumes from glazed lift shafts projecting from the southern façade. The interiors of these volumes feel lively, without any sense of hospital typology, and the visual and tactile qualities of the plywood-clad staircases radiate architectural quality in a building where the opportunities for finely tuned surfaces and details were limited.

When patients enter a village, they encounter an open area with a two-level staircase, an oversailing bridge to the back of the plan, and a lectern-like reception console staffed by a volunteer. To their left is a wide section of double-height, floor-to-ceiling glazing with access on to balconies. ‘If you arrive 10 minutes early for, say, radiotherapy, you can sit outside on fine days,’ says Harbour. ‘It gives patients an immediate sense of ownership of the spaces.’

The functional programming of the remainder of the floorplates is essentially zonal: extremely light and airy consulting rooms along the leading edges of the ‘prow’ facing Great Maze Pond; then a reception layer; treatment, outpatients, or admin areas ranged along the back half of the village plans; and staff or medico-functional movement via lifts and stairs slotted into the plan’s south-east and north-west angles. The key outcome for patients is that their movement from reception areas into treatment or imaging zones is absolutely straightforward; in the case of radiotherapy, it is less than 20m from a patient’s arrival to walking, gowned, into a treatment bunker.

This programmatic clarity papers over the effects, on design details, of the cost and specification constraints.

‘Going through the stakeholders’ participation, you could see why a lot of hospitals are rubbish,’ says Harbour, ‘because the decision-making process is linear, so it’s hard to evolve a design. For example, you don’t get a second chance to rediscuss part of a design once you’ve gone past the point of clinical sign-off.’

Going through the stakeholders’ participation, you could see why a lot of hospitals are rubbish

Ivan Harbour

The cancer centre has several unusual structural and technical features. Typically, the radiotherapy units would have been at basement level, had it not been for the remains of a large 2,000-year-old Roman boat lying under the site. This required a protective 800m³ concrete bridge-slab 2.8m thick.

The six radiotherapy bunkers, with leadite-blocked walls up to 2.5m thick, contain 10-tonne TrueBeam linacs. This segment of the building weighs more than 6,000 tonnes and required a 9m x 4.5m supporting structural grid. The 14-floor centre is therefore heavier than its 72-floor neighbour, the Shard, with post-tensioned structural elements to absorb any vibration that might affect the precise targeting of radiotherapy and imaging equipment.

But, ultimately, the success of RSHP’s design is not about technics. It lies in the building’s internal logic and the sequencing of patient movement across the triangular floorplates; in the light-filled reception and transition spaces, the luxuriously comfortable sitting rooms for chemotherapy infusions; and on the partly-screened balconies overlooking the city.

The architecture is not Premier League RSHP, but it is exemplary in its attempt to erase that clinically efficient phrase ‘patient-processing’ from the minds of those concerned with other rather more fraught processes. 

Ground floor isometric plan

Rogers Stirk Harbour + Partners' Guy’s Cancer Centre

Rogers Stirk Harbour + Partners’ Guy’s Cancer Centre

Level one plan

Rogers Stirk Harbour + Partners' Guy’s Cancer Centre

Rogers Stirk Harbour + Partners’ Guy’s Cancer Centre

Level four plan

Rogers Stirk Harbour + Partners' Guy’s Cancer Centre

Rogers Stirk Harbour + Partners’ Guy’s Cancer Centre

Level five plan

Rogers Stirk Harbour + Partners' Guy’s Cancer Centre

Rogers Stirk Harbour + Partners’ Guy’s Cancer Centre

Level six plan

Rogers Stirk Harbour + Partners' Guy’s Cancer Centre

Rogers Stirk Harbour + Partners’ Guy’s Cancer Centre

Level seven plan

Rogers Stirk Harbour + Partners' Guy’s Cancer Centre

Rogers Stirk Harbour + Partners’ Guy’s Cancer Centre

Section 

Rogers Stirk Harbour + Partners' Guy’s Cancer Centre

Rogers Stirk Harbour + Partners’ Guy’s Cancer Centre

Client’s view 

Our vision for the new Cancer Centre at Guy’s Hospital was ‘a hospital that doesn’t feel like a hospital’.

When we welcomed our first patients on 26 September, there was a real sense that we had realised that vision through a unique partnership with Rogers Stirk Harbour + Partners, the rest of the design team, our patients and our staff.

Most cancer treatment at Guy’s and St Thomas’ will now be provided under one roof – previously it was provided in 13 different locations in eight different buildings on two hospital sites.

Together we successfully delivered the project on time without causing disruption to either the local community or patient care – no mean feat when constructing a 14-storey tower in a triangular corner of the Guy’s Hospital site, which is literally inches away from neighbouring buildings.

And we did this in a genuine partnership with our patients, which means that Ivan Harbour’s original design has changed in line with their views.

As Ivan says, ‘Everything has changed, and nothing has changed’. His vision of a cancer centre made up of treatment ‘villages’ to create a welcoming building of human scale has remained intact, while the final design reflects what our patients have told us they want. Diana Crawshaw, who chairs the Patient Reference Group, says: ‘Our views have been welcomed, listened to and acted on.’

We are proud that our cancer centre has been designed by patients for patients – with a little help from our architects, of course.

Alastair Gourlay, project director, Cancer Centre at Guy’s Hospital and director of asset management, Essentia at Guy’s and St Thomas’ NHS Foundation Trust 

Rogers Stirk Harbour + Partners' Guy’s Cancer Centre

Rogers Stirk Harbour + Partners’ Guy’s Cancer Centre

Source: Morely von Sternberg

Healthcare specialist’s view 

One of the key design aspects of the radiotherapy village has been the technical innovation required to place linacs (linear accelerators) on an upper storey. This required the use of 5,000 dense modular prefabricated lead concrete blocks, halving the width compared with the concrete walls conventionally used, and minimising the footprint.

The entry to the bunkers uses 10-tonne direct-entry swing doors with fast opening times, and a maintenance-free radial drive mechanism. The use of dry-lined prefabricated blocks will also allow for future dismantling if radiotherapy is no longer needed.

The ‘village’ vertical organising principle grew out of the desire to humanise the scale of a multi-storey tower, and in the same way the placement of the linacs emphasised a horizontal zoning concept: the hi-tech zone at the rear – ‘science of treatment’, housing all the larger technical areas – balanced by the triangular area to the front, ‘the art of care’, where the patient is in more control – consultation examination rooms, reception and waiting areas.

Key to the outpatient village was the multidisciplinary model of care, which brings together most services an outpatient might need, including minor procedures and imaging. The outpatient village includes an outside terrace and balcony, and shorter waiting times through use of IT-enabled appointment calling systems. The waiting areas are designed around a participatory model with elimination of unnecessary walls and space subdivisions. ‘No corridors’ was an early design goal.

The non-institutional design of the waiting areas is underlined by the central role of the ‘kitchen’ table with patient access to a small beverage bay where they can make drinks while they wait. The multidisciplinary staff area is placed in the heart of the floor plate directly accessible from the waiting areas and with easy access to all the clinical rooms.

The design team held lengthy workshops on the design of the examination consultation rooms with all the user groups. Every room has a full floor-to-ceiling window which provides views out and allows natural ventilation, as well as a bespoke joinery unit that integrates clinical storage.

The chemotherapy village is centered on providing intimate and flexible patient and staff interaction areas. Patients, who can spend up to eight hours in the unit, choose from either a larger day-lit communal area or a more private space, depending on the acuity of their disease or their mind-set on the day. The inclusion of an adjacent acute oncology unit, aseptic pharmacy and clinical trials base provides efficient care and an enhanced patient experience, cutting down frustrating waiting for patients.

Catherine Zeliotis, senior associate, Stantec 

Rogers Stirk Harbour + Partners' Guy’s Cancer Centre

Rogers Stirk Harbour + Partners’ Guy’s Cancer Centre

Source: Morley von Sternberg

Project data 

Start on site 2010
Completion 2016
Total project cost £160 million
Architect Rogers Stirk Harbour + Partners
Specialist healthcare architect Stantec
Client Guy’s and St Thomas’ NHS Foundation Trust
Structural engineer Arup
M&E consultant Arup
Quantity surveyor AECOM
Main contractor Laing O’Rouke
Landscape architect Gillespies
Planning GL Hearn
Clinical adviser Jackie Churchward-Cardiff
Approved building inspector Southwark Building Control
Acoustic consultant Sound Research Laboratories
Wayfinding and signage designer Signbrand
CAD software used Autodesk CAD/Revit in a collaborative BIM environment
CO2 emissions 116kgCO2/m2 (area estimates only, based on Part-L NCM templates and combine regulated and unregulated energy predictions)
On-site energy generation 19 per cent from Combined Heat and Power (CHP)
Annual mains water consumption 20,800m3/yr
Airtightness at 50PA 4.75m3/h/m2
Heating and hot water load 173Kwh/m2/yr (estimates only, based on Part-L NCM templates)
Overall area-weighted U-value 0.98W/m2K

Rogers Stirk Harbour + Partners' Guy’s Cancer Centre

Rogers Stirk Harbour + Partners’ Guy’s Cancer Centre

Source: Morley von Sternberg

Specification 

Cladding Structal UK
General lighting Whitecroft/Thorn
Feature lighting Sill Lighting/Lightworks
Lino flooring Tarkett
Vinyl flooring Polyflor
Internal partitions subcontractor Quad Building Services
Architectural metalwork PAD Contracts 
Ironmongery Laidlaw
Lifts KONE
Riser doors Leaderflush Shapland
Plant doors Selo
Other doors Marts-Roberts
Door/carpentry subcontractor SJ Eastern
M+E subcontractor Crown House

  • 1 Comment

Readers' comments (1)

  • Interesting that the floor plans illustrate just the NHS half of the building, and the section can't explain that much - what are the layouts like in the private patients' zone above level 7, or is publication not possible for some reason?

    Unsuitable or offensive? Report this comment

Have your say

You must sign in to make a comment

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions.

Links may be included in your comments but HTML is not permitted.

Related Jobs

AJ Jobs