The real challenge of 21st-century healthcare design is ennobling the ordinary hospital to project the ethos of care, says Miles Glendinning
The decade prior to the recession witnessed an increasing polarisation between extravagant iconic architecture laden with metaphoric references and commercialised generic buildings driven by naked market forces. These amounted, in effect, to two branding levels within architecture’s competitive individualism – an architectural expression of the economic system that has now collapsed. In the UK, one of the most stereotypically downmarket of all building systems has been the Private Finance Initiative (PFI) of social building, in which the principle of cost-cutting competition has scattered shoddy, banal public buildings across the country.
Hitherto, attempts at reforming the deficiencies of PFI have perpetuated its competition-led system by adding design quality as a new factor within the competitive process – with predictable (dire) results. Reiach and Hall’s newly completed Ambulatory Care and Diagnostic Centre (ACAD) at New Stobhill Hospital, Glasgow, suggests a radically different way out of this quandary: not by ‘adding design’, but by curbing competition. In this way, hopefully, many of the best features of the golden age of welfare state building, including its consistency and originality, could be revived without also reviving the organisational chaos of many projects of that period.
Hospital design in the neo-capitalist age became increasinly polarised
The 1960s and ’70s were years of very high aspiration and debate in hospital architecture, with innovation sustained by a system of negotiated building contracts. No sooner had the Nuffield pattern of highly serviced ward towers been generally accepted, than a new generation of architects got to work on a more horizontal, courtyard-centred design. This was pioneered in RMJM’s Ninewells Hospital in Dundee (built 1963-74), the UK’s first post-war teaching hospital; its stately building mass comprising a central concourse flanked by hospital and medical school. But at the same time, these often innovative hospital designs, with their constantly changing values of community and scientific management, sometimes proved almost impossible to get built and (if completed) alienated many users. The Ninewells project took nearly 20 years to design and construct, and included disastrous feuding between contractors and designers, while the first stage of RMJM’s in-situ redevelopment of Edinburgh Royal Infirmary took 20 years to commence, whereupon the scheme was completely abandoned.
In response to these protracted controversies, UK hospital design in the neo-capitalist age became polarised between PFI projects emphasising slick, hotel-like corporate complexes on greenfield sites, and the exaggerated stylistic individualism found in Maggie’s Centre cancer support buildings, each thumbing its nose at a nearby NHS hospital – as with Frank Gehry’s jabbing roofs at Ninewells. But the real challenge of 21st-century healthcare design is how to ennoble the ordinary hospital, often a haphazard complex requiring partial or multi-phase redevelopment, to project the ethos of humane care.
Reiach and Hall’s Stobhill project provides a pointer towards an alternative way forward: to moderate the competitive process of PFI with its cost-cutting vagaries by nominating a single contractor, allowing the designers the freedom to develop innovative solutions to the challenges of multi-phase development.
Reiach and Hall designed a building that would be distinct from a traditional hospital
Scotland’s first example of the American concept of a non-residential hospital, New Stobhill ACAD is the first part of a staged redevelopment of a typical suburban hospital. It was originally built in 1904 as a grid of low, banal brick and timber with the sole architectural accent of a water tower, now in a state of dilapidation. The site for the ACAD has been created by demolition of the southernmost ‘slice’ of this grid – three Nightingale wards – on a site that, significantly, faces not a bright open view but a featureless embankment, soon to be shielded by tree planting. To the north, a potentially panoramic outlook is blocked by the residue of the old hospital.
Although originally envisaged as a standard PFI project with three competing consortia, the only consortium which entered the bidding process was the one in which Reiach and Hall were involved. Thus the architects were able to reshape the project at an early stage, free from anxieties about competitors. Their approach was to design a building that would be ‘distinct’ from a traditional hospital, yet which would also avoid an image-led, gestural approach. And the two parallel purposes of the project – as ACAD unit and as first-stage redevelopment – had to each be appropriately expressed. As a result, an externally modest and open-ended (even unfinished) project was designed, allowing for extension, with the main unifying architectural elements reserved for the interior: Reiach and Hall’s own practice heritage, rooted in the Scandinavian and Eastern Scottish modernism of the 1950s and 60s, ruled out in principle any signature or iconic approach. Structurally, too, a relatively lightweight system of steel framing with cladding would allow for easy adaptation and extension; the practice had learned from its first major hospital commission in the 1980s, Borders General Hospital in Melrose, that a highly self-contained plan and monumental construction risked rapid obsolescence.
New Stobhill ACAD combines two main blocks: a massive, deep-plan, four-storey treatment block at the north and a long, three- storey linear block of clinics to the south, the two linked by a full-height, top-lit concourse. In any future hospital redevelopment, the potential is obvious for a matching linear block to the north, with the treatment block becoming the core of any completed hospital. The two external faces of the ACAD clearly reflect their purpose. The more public north face of the clinic slab and the whole of the treatment block, which overlook the core of the new hospital, feature a combination of low-cost materials and elements that project a considerable Bauhaus-like elegance: off-white render, horizontal window-banding and subtle, three-tone grey cladding panels.
Stobhill is integrated from the inside out through the central circulation arcade
The north-west and north-east corners of the clinic, overlooking the concourse entrances, are formed by partly-glazed, partly brick-clad stair-towers of a restrained monumental character. By contrast, the rear faces of the clinic block, to south, west and east (their only public function being the entrance to a minor injuries clinic) are treated in a utilitarian manner, rendered and dotted with small windows and cropped harshly at the top; a dark brick ground floor links this otherwise stark rear section to the two front stair towers. The slightly jarring contrast in external treatment is not a matter of PFI cost-cutting – the other facades were just as economically built – but an architectural structuring device to focus attention on the public north face of the complex, where any future additions will be made. Already, a 60-bed ward block has been authorised, using similar materials but emphasising a more domestic character with two-storey angled oriel windows.
The Stobhill project is integrated from the inside out, through the device of the central circulation arcade. Crucially, this planning element emerged from the unexpected non-competitive bidding process: in 2004, during the official bid period, the absence of competitor consortia allowed Reiach and Hall to embark on an ambitious programme of user research and to propose the abandonment of the sprawling circulation system suggested by the contractor, Balfour Beatty (a standard PFI solution, applied in a parallel ACAD project at New Victoria Hospital, Glasgow, by HLM Architects), in favour of a stacked system arranged intensively around a vertical arcade. To make this arrangement viable, departments on either side would also have to be stacked vertically, including the novel feature of a minor-injuries clinic at first floor level. The concept of the arcade stemmed from the modern movement’s concern with designing spaces that encourage community interaction.
‘This isn’t an architectural statement - it’s a nice quiet place that helps people’
In contrast to the shopping-mall-style atria of standard PFI complexes, the intention was to design an individualised sequence of spaces that would help calm visitors and patients. And unlike the gestural egotism of Maggie’s Centres, or the polarisation in US hospitals between showy public spaces and pinched treatment rooms, the architects were determined that Stobhill should not be ‘dressed up as something else’. Their research convinced project architect Andy Law that ‘people want, in a hospital, light, air and cleanliness. They want it to look not like a hotel or shopping centre, but a hospital. So we aimed to give them a sequence of spaces that would provide reassurance through quality. Our hospital emphatically doesn’t want to be a thrusting architectural statement – we simply wanted to design a nice, quiet place that could help and calm people.’
As a result, the arcade was designed to lead visitors unobtrusively from the hubbub of the central circulation space to the contemplative quiet of the flanking clinics and treatment departments on the first and second floors. The architects were especially influenced by the humanistic ethos of Medplan’s Rikshospitalet University Hospital in Oslo (2001), although they thankfully avoided the excesses of its ‘Italian hill town’ planning. To accentuate this contrast, the arcade was articulated in a forcefully architectonic form, with balconies, bridges and a bold, full-height staircase tower in the centre. The unifying effect of the rendered walls is offset by the differentiated treatment of the side walls, with small, banded openings fronting the clinical departments, but a more open, framework-like front to the clinics. The transition from arcade to clinics is particularly cleverly handled, with archway openings leading into lower, quieter waiting areas, each overlooking one of six larch-clad internal courtyards. As part of the effort to alleviate the anxieties of waiting, artworks
of an unobtrusive character, such as video installations of imperceptibly moving trees, are dotted around the waiting areas.
Could the New Stobhill Hospital, then, be an indication of a potential post-recession way forward for public architecture, drawing on the best of ‘original’ modernism while avoiding the pitfalls of its often interminable development processes? In quietly idealistic projects such as this, we can begin to discern a way out of the quagmire of iconic modernism, re-ennobling everyday collective architecture.
Tender date August 2006
Start on site date November 2006
Main contract duration 28 months
Gross internal floor area 28,000m²
Form of contract Bespoke PFI contract
Total cost £65 million excluding fit-out; £100 million including fit-out
Client Balfour Beatty Construction Ltd/Canmore Partnership/NHS Greater Glasgow and Clyde
Architect Reiach and Hall Architects
Structural engineer SKM Anthony Hunts
M&E consultant DSSR
Quantity surveyor Balfour Beatty
Planning supervisor Capita
Main contractor Balfour Beatty
Glazing AC Yule
External render and timber cladding Grattan and Hynd
Annual CO2 emissions 175.9kg/m² (unverified)