Hopkins Architects’ design for a London hospital is a vivid demonstration of how design and healthcare can be combined to make a healing environment.

The huge high-level conservatory is a magnet for sunlight, fresh air and views into the neighbouring mature parks
The huge high-level conservatory is a magnet for sunlight, fresh air and views into the neighbouring mature parks

Instead of a maze of narrow corridors, it has a conservatory the size of a football pitch beneath a great over-arching glass roof. Instead of artificial lighting, mechanical ventilation and a pervading claustrophobia, it has daylight, space, fresh air and wide vistas. Instead of insipid off-white wall panels and suspended ceilings, it has scarlet lift towers and depictions of fish, butterflies and birds and flowers set into the floors. And instead of an NHS hospital building, it has the appearance of a well-endowed private arts foundation.

Yet an NHS hospital building is precisely what it is. This is the £60m, 140-bed Evelina Children’s Hospital and it forms part of St Thomas’ Hospital just across the river from the Houses of Parliament. Its 16,000 m2 of floor area contains one of the most intensively equipped children’s hospitals in the country, with three operating theatres, an MRI scanner, kidney dialysis unit and 20 intensive care beds.

Acute hospital buildings present an acute design challenge.

As treatment for severe illnesses such as kidney or heart failure become ever more technically intensive, so do the buildings that must accommodate the treatment. But as more and more high-tech equipment is stuffed into the hospitals, the more intimidating they appear to the patients. For children, who are the among most vulnerable of healthcare patients, the problem is even more acute.

Evelina is a particularly inspired solution. The design is by an architect with no experience of hospital design, Hopkins Architects, and it was designed to answer a self-contradictory brief laid down by Ted Baker, the medical director of the NHS hospital trust, which was to create “a hospital that does not feel like a hospital.” This highly unorthodox approach was helped by £50m of funding from the hospital’s charitable trust, which was established by Edward VI. This allowed the usual NHS procurement routes to be circumvented: instead, the design was arrived at through a limited architectural competition.

“We were attracted to the Hopkins team, because they didn’t come up with preconceptions,” says Baker. Right from the competition stage, the design process also involved extensive consultation with medical staff and even the hospital’s child patients themselves, who came up with remarkably enlightened suggestions. “No long scary corridors,” warned one, while a 13-year-old girl reasoned: “When I’m in hospital, I wish I were in the fresh air.”

The building’s centrepiece is the great four-storey-high conservatory. Admittedly, it contains no high-tech equipment for medical treatment, but it does combine several key features of a healing environment. For a start, it serves as the social heart of the building. Its facilities include a school where children can continue their education in three or four classes separated by age group. Alongside that are a cafe where children can relax with their families and a playground that can stage special performances. A taster came last month, some five months before the hospital is due to open to patients, when the London Philharmonic Orchestra put on a concert for more than 100 local schoolchildren.

The conservatory is also the key to Hopkins’ architectural concept, which in the words of director Andy Barnett is of “a building in the landscape”. As viewed from outside, this seems like a severe case of architectural self-delusion, as there is barely a blade of grass in sight in the congested city-centre hospital complex, and even the river is shut off from view. Nor is there any view into the spacious conservatory, as this has been pushed upstairs to the third floor.

But when you at last arrive on the third floor, the landscape wooshes in dramatically. At this height, a mesmerisingly wide vista opens up over the adjoining main road and a high garden wall to the lush mature parkland of the Archbishop of Canterbury’s Lambeth Palace and a public park alongside it. As Barnett says, “We’ve borrowed the landscape from the parks.”

Even the interior of the conservatory is more landscape than architecture, though it contains little planting. It is four storeys in height and surrounded on three sides by clear glass, which means that it fulfils the schoolgirl’s dream of standing on an open-air terrace. The effect is enhanced by fresh air ventilation and shafts of sunlight. Loose furniture and low screen partitions, which are currently being installed for the school and play area, add to the sense of spaciousness. Little wonder, then, that the conservatory floor has been dubbed The Beach.

The height of the conservatory brings another important benefit. Four floors of children’s wards are stacked up along one side behind a window wall. To those children who are confined to their beds, this offers unobstructed views of conservatory and the activities going on in it, as well as refreshing vistas of the parkland and open sky beyond.

The wards accommodate six, four or single beds. They come with neat melamine-faced bedheads that conceal all the necessary medical equipment and supplies. And to one side of each bed, an extra bed can be folded down to allow a parent to stay overnight.

There are no long dark corridors that could turn treatment into a daunting experience. After checking in at the child-height reception desk, a child and family reach their allotted ward by rising up through the conservatory on one of two scarlet lifts. From the lift landing, a short, curving, daylit vestibule leads them past a play area, where children can see others enjoying themselves.

The welcoming ambience is enhanced by a refreshing lack of signage. Conscious that a babel of 140 languages are spoken within the catchment area, the hospital uses pictorial symbols and colours instead of written signs to help patients find their way around the hospital. These symbols were designed by a storyteller and artists, and in the spirit of the fresh air and daylight, the natural world was adopted as the overall theme for the building. Each floor represents a different aspect of nature, from the ocean on the ground floor to the sky on the sixth. Easily recognisable symbols for each aspect of nature, such as a fish for the ocean, a leaf for the forest and a bird for the sky, have been inlaid into the linoleum flooring. In addition, the decor for each floor is in its appropriate colour, from blue for the ocean to purple for the night sky.

The three lowest floors occupy the full width of the site. However, large gaps in the floor of the conservatory draw daylight down into these deep-plan areas. As for the medical treatment areas themselves, the three operating theatres, recovery unit and 20-bed intensive care unit are all combined on the capacious second floor. As Baker points out, “All the sickest patients are brought together on the same floor,” making for efficient use of specialist staff and equipment. For the same reason, this intensive floor is connected by a bridge link to the operating theatres of the main hospital on the same level. The ground and first floors house the MRI scanner, day centre and outpatient department.

Talking about the building as a whole, Baker enthuses: “It’s so bright, light and airy that children coming here will have something to look forward to. And because it makes them feel better, they’ll recover better too. So it really is a healing environment.”

A lesson that more mature heads than schoolchildren have still to learn.

Evelina Children’s Hospital project team

client Guy’s & St Thomas’ NHS Foundation Trust
architect Hopkins Architects
healthcare strategist Rawlinson Kelly Whittlestone
structural engineer and fire safety consultant Buro Happold
services engineer Hoare Lea Consulting Engineers
employer’s agent and quantity surveyor Davis Langdon
design-and-build contractor Gleeson

Architecture

Some 16,600 m2 of hospital accommodation is contained within a seven-storey building. In the lower three floors, treatment areas and outpatients department occupy the full deep-plan footprint of 100 × 36 m. In the upper four floors, a bank of wards overlook a south-facing conservatory that serves as a social focus and source of daylight, fresh air, space and views.

Structure
The building is supported on a concrete frame on a grid of 7.2 × 9 m. The curving conservatory roof, which spans 18 m and rises 20 m, is supported on a diagrid of 273 mm diameter steel tubes. To provide a fire-engine access bay, two structural bays on the ground floor were replaced by a warren transfer truss in tubular steel to span 22 m and support the storeys overhead.

Environment and services
To create a healthy environment for healing, the conservatory is naturally ventilated through automated high and low-level openings; in winter it is warmed by underfloor heating. The wards are mechanically ventilated using displacement ventilation.

Fire safety engineering
The building is divided into several fire compartments so that patients can be quickly evacuated to an adjacent compartment. For the glazed compartment wall between the conservatory and the wards, toughened glass combined with sprinklers saved £1m on the insulated glass that would otherwise would have been necessary.

Procurement
The design was procured through a limited architectural competition. The construction was procured through a two-stage design-and-build tender, with the entire competition design team novated to the contractor.

Cost
The total project cost was £60m and, after reducing costs by some £10m through value-engineering, the contract sum (excluding post-contract design fees) was agreed at £41,821,000. Adjusted to first quarter 2005 prices, the contract sum equates to £2480/m2; the usual cost range for acute services hospitals is of £1700/m2 to £2500/m2.

Construction
The curved section of the tubular steel diagrid to the conservatory roof was delivered to site in three parts. They were then supported on scaffolding and welded together while glazing was installed on the completed sections from a temporary gantry. Even so, contractor Gleeson has admitted that the complexity of the project and the drastic value-engineering necessary contributed to its loss of £16.6m last year and the sell-off its main contracting division.