Between the crowded GP’s surgery and the impersonal hospital lies a new type of health care building, executed here with warmth and understated elegance
Pulross Intermediate Health Care Centre is that rare sighting in the UK: a public building of excellence, commissioned via competition. An open invitation drew more than 150 expressions of interest. Penoyre & Prasad beat seven shortlisted practices to win the south London project.
A relatively new type in health care, the intermediate centre works at a scale between a hospital and a GP’s surgery.One of the pioneers in this field is Ted Cullinan’s neighbouring Lambeth Community Care Centre. Such a centre has facilities for minor operations, but its main concept is to welcome specialist consultants and therapeutic clinics into a local setting.
Among the recognised benefits is GPs’ continuity of medical responsibility; the centre serves 23 GP practices. Relatives and friends are nearby; outpatients come and go; and an unbureaucratic sense of informality, foreign to most hospitals, informs the whole. Restricting numbers to a maximum of 20 in-patients allows 24-hour medical care provision between hospital and home - both in terms of scale and urban geography.
The centre sits at the cul-de-sac end of a typical inner-London street of small-scale housing. Once the site of the now demolished SouthWestern Hospital, the area has a surprisingly long tradition of medical use, and there is a new Greenhill Jenner mental health care facility in a neighbouring street.
The urban challenge was to establish enough of a civic presence to make a positive contribution to the neighbourhood without overwhelming the delicate scale of the adjoining houses and the characteristic London sense of domestic seclusion (notwithstanding a nearby railway line).
In this, as in the rest of the building, the plan generates the solution. Placed on the first floor, the lofty communal dining room forms a double-height beacon at the end of the street, illuminated for much of the day.
The practice bravely rejected conventional planning wisdom that such spaces should form an internal, social hub. The response means that from the outside a local facility for local people is displayed with decorum; and that from within patients look out and beyond the confines of the centre.
Entry to the building is through an underplayed gateway and into a forecourt that is effectively a segment of a circle. The understatement to the street is reminiscent of a Modernist school rather than a grandiose symbol of community. But the building’s external message is more subtle and more playful than this would suggest.
The strong reflective white of the forecourt’s high-quality concrete paviors is most successful in giving a snow-like setting to a building resonant of Scandinavia. Approached around sunset, the timber and glass facade emanates confident warmth.
Job architect Bob Wills says the elevation works with a palette of favoured materials and constructional elements developed by the practice for a civic language appropriate to sustainable building. The materials include unfinished Douglas fir, which will develop its colour with age, and a triple glazing system. The practice is happy to use aluminium on the grounds that it is easy to recycle - and, more controversially, steel, for the reason that it too may be used again. Be that as it may, in this building’s elevations a language of sustainability has come into its own: it does not proselytise or shout its right-on origins. There are no gimmicks here, but no po-faces either.
For partner Sunand Prasad, the ideal - rather than model or precedent - behind the centre’s concept is the house. The house, but definitely not the home, as in children’s home or old people’s home, rife with connotations of grim cheerfulness. Is the house he has in mind the stately pile? In part maybe, but if so, it is Lutyens and Norman Shaw rather than Adam or Vanbrugh.
In this context, one can understand the hall as the key to the building’s organisation.
The entrance into a lofty space, which presents and explains the organisation of a public building, is a consistent theme in the work of the practice. The suppleness with which this is achieved is reminiscent of the deftness and originality of a Lutyens.
You slip in behind the facade, in an almost Miesian move. On entering, to your right is a reception desk: security is noticeably low-key and welcoming for a public facility.
Beyond it is the staff wing and offices - beyond the green baize door, as it were.
In front of you the cafe and waiting area are centred around tables. When you sit down at a table, the building spells itself out.
There is a public stair behind you and another at the far end of a curving corridor to your left; a nurses’ station on the first floor overlooks the entrance.
The plan brings together two contrasting worlds. The first is the orthogonal, bestpractice planning of treatment rooms, recorded in NHS design manuals and painstakingly evolved since the health service’s inception. The second carries the building’s message, expressed in the relaxed curvaceous flow of its social, circulation and administrative spaces. There is hierarchy but, appropriately for a building with democratic aspirations, no servant space.
Eschewing symmetry, Prasad equally emphatically rejects any description of the building as ‘episodic’. Rather, the spaces are distinct and memorable: you are not likely to enter the wrong room by mistake. This is achieved partly by the bending circulation which runs on both floors along the front of the building. The visitor is unmistakably and immediately orientated in relationship to the outside world. The curve itself makes the most of the movement of the sun which gives the corridor an ever-changing character. All along it, deep low sills invite sitting, lingering and inhabitation. This certainty of orientation and invitation to dwell breeds swift confidence and a sense of possession of the building in its users.
Distinction rather than difference also characterises a rare sureness about colour - an unsung and important talent. It is easy to forget that Le Corbusier’s profound involvement with colour is one of the most striking aspects of seeing his work in the flesh for the first time. Here the choices are all the more remarkable in that they were made with the centre’s clinical users group - the heads of nursing and therapeutic services. As in Corbusier’s work, blocks of colour discriminate architectural place - underlining light sources, bed spaces, ante spaces.
Attention to colour is echoed in the treatment of other less tangible and often overlooked aspects of architecture: acoustics and touch.Within the hall space, the combination of timber elements, carpeting and the asymmetric overhang of the nurse’s point gives the place a pleasing sound of inhabitation in place of the recognisably institutional cacophony of reflected noise or a depressing hush. The ubiquitous crash rails, so necessary to medical use, have been refined over the years by Penoyre & Prasad into a sleek stainless steel and timber continuous rail that provides both protection to the wall and a handrail for support. It is consistently coded with timber at its centre to help orientate the user.
On the first floor, the plan itself can be felt through the feet. You move from the inflection of timber floor construction and finish to the solidity of the rectangular medical core, constructed in concrete and finished in lino and rubber. This noticeably high quality of finishes is, in part, a quiet testament to the financing of the centre, which greatly benefited from contributions from charitable trusts, including Guy’s and St Thomas’Hospital and a medieval City guild, the Honourable Company of Mercers. To the tangible relief of those involved, the contributions meant PFI was not an option.
This centre has been designed with a warily optimistic eye on the future. The Scandinavian impression is underlined by a distinctly unEnglish and luxurious sense of physical comfort: low U-values mean electricity is an economic alternative for heating, which they hope will eventually be generated from renewable sources. The intention is that the building blurs artificial boundaries between medicine and the rest of life. For example, the gym exudes a serious and generous hedonism to be shared. Other local uses are already occupying rooms part-time: alcohol counsellors, an Eritrean community group, social services training and a playground association. Both programme and layout of the Pulross Centre sound a welcome note of elegant, understated hope that is heartening to experience.
Our initial intention was to reuse the footings of the Victorian hospital, but the new building’s position meant the required network of ground beams would have negated any savings. Instead, we used new concrete pad footings to support the reinforced concrete frame, founded through the fill overlying the site.
At the ground floor, a level access was required for the suspended slab. This precluded the use of economical precast concrete planks as a sub-slab void could not be vented and the planks could not withstand any heave. Instead, we used an in situ concrete slab cast on to a compressible layer of insulation which lay directly on the fill.
The planks, though, could be used for the first floor, while timber rafters were used for the roof. These upper storeys were supported on exposed fair-faced concrete beams and columns. In addition to the stringent detailing for exposed concrete, service ducts were cast into the beams which required careful co-ordination within the design team.
Around this main frame sat the timber and steel structure of the gym, gallery and facade.
In the facade, the original idea was to use the timber mullions to support the roof, first floor and facade. The fire rating required to do this, though, could not be achieved as any fireproofing or enlargement of the mullions for charring was architecturally unacceptable. The mullions therefore only carried the roof while an exposed steel frame supported the first floor. Like the facade, the timber-framed lantern over the gym had the always-challenging exposed timber connections. Using recessed steel flitch plates at the joints, we provided the strength without compromising the appearance. Behind the building, reclaimed railway sleepers form an eco-friendly retaining wall with the help of geotextile anchors and buried steel angles.
Services were designed for simplicity, flexibility and low-energy consumption. The building is highly insulated and well sealed to minimise air filtration. The use of natural light is maximised. Natural ventilation is used throughout with mechanical extract limited to the toilet and kitchen areas.
The services provision was carefully assessed to avoid unnecessarily complex systems and to provide a simple, flexible building. All services are locally controlled, without the use of a building management system.
For flexibility and ease of access the services for both floors are grouped and distributed in a services spine at high level on the ground floor, with appliances requiring pipework connections located near the spine.
This minimalist approach to servicing offers lower capital costs, reduced maintenance, the reduction of visual clutter and greater freedom for the client to create the desired environment - in this case one that was holistic and non-institutional.
Costs based on tender sum
SUBSTRUCTURE FOUNDATIONS/SLABS £70.03/m2 Concrete pads and ground beams; power floated reinforced concrete slab
SUPERSTRUCTURE FRAME £34.68/m2 Fair-faced reinforced concrete and structural Douglas fir posts
UPPER FLOORS £19.38/m2 Pre-cast concrete planks with screed; timber joists with OSB boarding ROOF £81.31/m2 Timber joist, 150mm rigid mineral wool insulation, single-ply polyolefine membrane; lower roof ballasted
ROOFLIGHTS £10.95/m2 Double-glazed low-e coated continuous rooflights over wards; double-skinned polycarbonate domes over corridor
STAIRCASES £31.15/m2 In situ reinforced concrete staff stair; steel main stair with glass balustrade and beech treads; timber access/physiotherapeutic
EXTERNAL WALLS £47.55/m2 Insulated brick and block cavity walls (fully fitted 150mm cavity); Douglas fir weatherboarding on 150mm insulated studwork
WINDOWS £107.99/m2 High-performance triple-glazed openable timber windows; double-glazed low-e coated fixed site glazing
EXTERNAL DOORS £14.88/m2 High-performance timber
INTERNAL WALLS AND PARTITION £14.58/m2 Plastered dense blockwork; acoustic folding/sliding partitions
INTERNAL DOORS £78.56/m2 Plywood-faced solid core timber doors; fire glazed steel doors
INTERNAL FINISHES WALL FINISHES £28.49/m2 Ceramic tiling to showers and splashbacks; painted plaster/dry lining elsewhere
FLOOR FINISHES £36.90/m2 Fully vitrified ceramic tiling to showers; sheet rubber to treatment rooms, linoleum to wards; cork tiling to living dining rooms, vinyl to wet areas, carpet on staff rooms, entrance foyer and corridor
CEILING FINISHES £39.00/m2 Painted dry lining
FITTINGS & FURNISHINGS FURNITURE £116.11/m2 Linoleum-faced, beech-lipped worktops
SERVICES SANITARY APPLIANCES £23.28/m2 Specialist healthcare appliances including hydrotherapeutic bath
DISPOSAL INSTALLATIONS £29.75/m2 Aluminium rainwater goods; clayware below ground for rainwater, greywater and foul water
WATER INSTALLATIONS £49.73/m2Complete hot and cold water installations including mains
SPACE HEATING/AIR TREATMENT £41.59/m2 Electrical ceiling heating
ELECTRICAL SERVICES £81.48/m2 General power; low voltage distribution system; internal, emergency and external lighting; earthing and bonding; electrical heating and controls
LIFT AND CONVEYOR INSTALLATIONS £25.27/m2 Hydraulic active lift
PROTECTIVE INSTALLATIONS £43.58/m2 Access control; fire detection and alarm; security and CCTV; lighting protection
COMMUNICATION INSTALLATIONS £18.55/m2 Voice and data; patient and staff call; TV
BUILDERS’ WORK IN CONNECTION £28.96/m2
PRELIMINARIES AND INSURANCES
PRELIMINARIES, OVERHEADS AND PROFIT £131.11/m2
EXTERNAL WORKS LANDSCAPING, ANCILLARY BUILDINGS £229,959 Stepped sleeper retaining wall; garden walls; brick paved staircases; block paving; bound gravel; coated macadam; bonded chippings; turf; trees; shrubs and bulbs; furniture and signage; fences; railings and gates
Cost per m2 Percentage (£) of total
SUBSTRUCTURE 70.03 5.81
Frame 34.68 2.88
Upper floors 19.38 1.61
Roof 81.31 6.75
Roof lights 10.95 0.91
Staircases 31.15 2.58
External walls 47.55 3.95
Windows 107.99 8.96
External doors 14.88 1.23
Internal walls and partitions 14.58 1.21
Internal doors 78.56 6.52
Group element total 441.03 36.60
Wall finishes 28.49 2.36
Floor finishes 36.90 3.06
Ceiling finishes 39.00 3.24
Group element total 104.39 8.66
FITTINGS AND FURNITURE 116.11 9.64
Sanitary appliances 23.28 1.93
Disposal installations 29.75 2.47
Water installations 49.73 4.14
Space heating and air treatment 41.59 3.45
Electrical services 81.48 6.76
Lift and conveyor installation 25.27 2.10
Protective installations 43.58 3.62
Communication installations 18.55 1.54
Builders’work in connection 28.96 2.40
Group element total 342.19 28.41
PRELIMINARIES 131.11 10.88
TOTAL 1,204.86 100.00
Costs supplied by Dobson White Boulcott
Pulross Centre www.lslha.nhs.uk
Dewhurst Macfarlane & Partners www.dewmac.com
Max Fordham & Partners www.maxfordham.com
TENDER DATE November 1998
START DATE January 1999 C
ONTRACT DURATION 12 months
FORM OF CONTRACT JCT Intermediate IFC 1984, amended for a fixed price
GROSS EXTERNAL FLOOR AREA 1,754m2
TOTAL COST £2,343,450
CLIENT Community Health South London (NHS) Trust: Catherine Buckley, Andy Prill
ARCHITECT Penoyre & Prasad Architects: Sunand Prasad, Greg Penoyre, Bob Wills, Stephen Coleman (associate), Sally Mackay, Simon Jones, Rachel Pattinson, Andrew Siddall
STRUCTURAL ENGINEER Dewhurst Macfarlane & Partners
MECHANICAL AND ELECTRICAL ENGINEER Max Fordham & Partners
QUANTITY SURVEYOR Dobson White Boulcott
LANDSCAPE ARCHITECT Livingston Eyre Associates
PLANNING SUPERVISOR Eidetic
CONTRACTOR Neilcott Special Works
SUBCONTRACTORS AND SUPPLIERS pre-cast concrete planks Birchwood Concrete Products; facing bricks FLB from Taylor Maxwell; steelwork & handrails P&R Engineering; main stair steelwork Femco Moulds; M&E services RTT Engineering Services; lift Horizon; ceiling heating Flexel International; lighting Zumtobel/Concord; Sarnafil roof membrane Fenland Roofing; Douglas fir posts Chelsea Timber; Douglas fir weatherboarding L&G Forest Products; windows and external doors Scandinavian Window Systems; mineral wool insulation Owens Corning Building Products; continuous rooflights Vitral; doors Soundcraft; fire screens Fendor Hansen; automatic openers Geze UK; block paving Marshalls; soft landscaping TLC; fitted furniture Deanestor Healthcare; fitted furniture joinery Ascot Joinery; sanitaryware Twyfords; specialist sanitaryware Arjo; rainwater goods Alumasc Building Products; paint Akzo, Nobel Coatings; linoleum Forbo-Nairn; rubber Freudenberg UK; carpet Gradus; blinds Merlin; safety line system Safesite; signage Stocksigns