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Case study: Nottingham Breast Institute

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Theme: building for health and disability

Situated in leafy suburbs, Nottingham City Hospital is a large teaching hospital campus and home to the Nottingham Breast Institute.

A new landmark building was considered essential to reflect the importance of the institute, which is recognised internationally as being at the forefront of clinical care and research into the diagnosis and treatment of breast cancer. It is a pioneer of the 'one-stop' breast clinic, which ensures that all tests are completed on the day of attendance. The new premises have contributed successfully to reducing waiting list times and number of patient return visits needed.

Following a series of interviews, Building Design Partnership's Bristol office was chosen as architect and lead consultant. Its challenge was to design one of the UK's first purposedesigned breast institutes. The building brings together all out-patient services for breast cancer patients under one roof for the first time, with the different specialists such as radiologists, surgeons, radiographers, nurse practitioners, data analysts and secretarial staff combined with education facilities, all benefiting from being close together. The institute accommodates outpatient diagnosis, treatment and follow-up clinics for 35,000 patients each year, and also offers counselling, education and research facilities. Since the staff moved into their new building, they have performed significantly better against their performance targets.

The site has a south-westerly facing slope with good views over Nottingham. An existing plateau remained following demolition of the previous building, and we made use of this to give the institute plenty of future flexibility. The surrounding embankments allow it to nestle comfortably into the hillside, while the existing mature trees were retained and complemented with new hard and soft landscaping concentrated at the main entrance, arrival points, and courtyard area. There is a loggia in the southeast corner with a discreet garden specifically for the counselling suite.

The new building is simple and elegant, with a non-institutional feel. It had to be economic, flexible, energy-efficient and sustainable, and also had to provide efficient delivery of healthcare by staff. The building form reflects the flows of its clinical function while the curved wings give a very soft and welcoming architecture, which is nonthreatening, and engenders a sense of calm amongst patients who could be in a state of extreme anxiety.

Moving around The atrium facade acts as a wayfinding focus to identify the entrance. Once inside, patients are directed to the Breast Screening or the Outpatients Clinics immediately after reporting to reception. There are distinct patient flows for new referrals, follow-up clinics, routine breast screening, and results clinics. The examination/consulting rooms, mammography rooms, ultrasound rooms, and staff areas are all located to maximise privacy for each clinic. The counselling rooms are accessible discretely from the outpatient's clinics and have a private exit route through a dedicated garden area. The building also contains teaching and administration functions, which are on the first floor.

It was felt the best flows could be accommodated through a plan form that allowed accommodation to be wrapped around a central atrium and external courtyard. All functions have access to and share the facilities of the atrium. The requirements meant that a two-storey solution would be the most effective, with all patient accommodation on the ground floor. Due to the slope of the site, staff and delivery access is also provided at first-floor level off a footbridge directly into the first-floor staff accommodation.

Parking is provided close to both entrances, for disabled patients and staff, as well as a convenient patient drop-off point. All doors are a minimum of 1,000mm wide to allow for wheelchair access. There are unisex accessible WCs throughout the building and a scenic lift provides access between floors.

There are hearing induction loops in the main training room and at reception, and signage consists of white lettering on a dark background to aid the visually impaired.

Material benefits Materials were chosen following a review for durability, infection control, aesthetic appearance, maintainability and life-cycle costing.

The building is steel framed with walls finished in a local red brick, Waingroves Smooth red by Hanson Brick, to match the typical buildings of the surrounding area. It has partial-fill mineral-fibre cavity insulation, and a concrete-block inner skin. Windows and curtain walling are steel framed which enables thin sightlines. They have a W40 profile and are double glazed with an argon-filled cavity.

Higher up the curved parapet, copings are of precast stone and the second-floor plant room is clad with vertically laid Kingspan cladding which is facetted around the curve. Eternit Alucomat sheet cladding was used for soffits.

The roof is clad in standing-seam millfinish aluminium to the higher-level plant room and atrium roof. As it is curved in plan, careful consideration was given to the setting out of the standing seam. Corus Kalzip 400 tapered roof sheets were used rather than systems that rely on site welding. There is a seam-supported Kal-Safe Latchway fallarrest system, which does not penetrate the sheeting. The lower-level flat roofs use an Alumasc ballasted warm-deck system screeded to falls and finished with rounded gravel on a Stevens EP waterproof membrane. This provides good thermal mass and reduces the risk of UV degradation. Walkway tiles provide surface protection.

The courtyard walls are rendered with a Snowcem proprietary coloured render which does not require repainting, and the external enclosures are clad in Canadian western red cedar from Vincent Timber.

Internally, the partitions are of plasterboard on metal stud to allow future flexibility of space, with glazed partitions and doors to staff offices provided by Komfort Office Environments. Glass block panels separate the waiting areas from the atrium, and Luxcrete Luxblocks were chosen for their 60 minutes fire integrity and insulation performance. A series of pivoted oak-veneered screens allows the outpatient waiting area to be subdivided so that different clinics can operate at the same time. Internal doors are timber-veneered and come from Leaderflush & Shapland.

The atrium has a timber floor by Tarkett Sommer. Local company B&D Fabrications made the feature staircase and balustrade.

The reception desk and coffee-shop counters were custom-made in oak by Dovetail Joinery. An Armstrong suspended-ceiling system is used throughout the building.

Artwork is located throughout the building.

The client commissioned it directly.

The construction contract value was ú3,750,000, funded partly by both local and national NHS funds and partly through the local 'Millennium Millions Appeal'.

An NEC/ECC form of contract was used with BDP acting as project manager. The contract enabled certain parts of the works to be designed by the employer's design team, and other areas to be the main contractor's design responsibility. Herbert Baggaley Construction was the main contractor, and construction began in July 2002. The institute opened to patients in September 2003 and was officially opened by Prince Charles in July this year.

Highly commended The design has attracted considerable interest. It was highly commended in the 'Best Designed New Hospital' category of the 2003 NHS Estates Building Better Healthcare Awards and has been commended by the Nottingham Civic Society. There have been numerous visitors to the institute from both architectural and NHS interests.

The staff say that 'working in a building like this is not only a pleasure on the eye but has also enormously improved relationships between staff and patients - the clinics are much calmer and the 'hassle' that used to prevail has been removed. The patients are constantly commenting on the internal and external wonders of the building'.

Emma Jarvis is a project architect with BDP.

Contact el-jarvis@bdp. co. uk

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