Heathcare in Bath

Together with other members of the EOA (Employee Ownership Association) ECA's Community Healthcare Team enjoyed a tour of CircleBath Hospital last week. As members of an architectural cooperative we were interested to see another cooperatively run company in action. Circle is co-founded, co-run and co-owned by clinicians. The consultants and healthcare professionals who work for the organisation own the facilities they work in and from what we were told and shown this seems to motivate and empower the staff to put patients first in everything that they do.

The project was designed by Foster and Partners and some of the ambitions of the building reminded us of our Maggie's Centre North East in Newcastle which is due to start on site later this year. Circle has a calm domestic feel with lots of natural light (even in the operating theatres), great views to open countryside and, in contrast to typical healthcare facilities, a palette of warm and textured materials. Institutional corridors and signage are avoided as much as possible, and many of the rooms are multi-use and can be allocated to staff as required. Interestingly, the hospitality side of things is run by a former hotel manager in tandem with a Michelin star chef. The food, rooms and views are so good that many patients literally don't want to leave.

sustainable housing update courtesy of NHBC conference

1. The coaltion want to reduce regulations but some anxieties/upcoming activities from CLG included:

• CLG (Building Regs) Minister Andrew Stunnell very exercised by compliance failure 
• Zero Carbon now means CSH 5 but 'Code 6 is not dead' 
• security 
• rainwater-harvesting 
• ecology 
• embodied carbon 
• ventilation and over-heating 
• health and lifetime homes 

Watch for the release of the National Planning Policy Framework proposals, soon

2. Some news form the Zero Carbon Hub included:

• Carbon compliance is a minimum standard of fabric and technologies but this is now based on emissions/m2 rather than percentage improvements - much better! But the variation in UK weather is a huge problem; SAP assumes we all live in Nottingham 
• Cyril Sweett have reported that the extra over cost of a Code 5 (ie new ZC) home will have come down to £10k by 2016.

3. BRE have studied Greenwatt Way in Slough and concluded, among other things, that MVHR can be problematic:

• the need for a better research into how MVHR works (or doesnt)
• need to insulate MVHR ductwork in cold roofs 
• watch out for noise from fans 
• it can cost £20 to change the filters 
• better not to put the MVHR in the attic for ease of maintenance access - think about putting it in a cupboard, although this can conflict with need for storage space; dont forget the condensate pipe
• try to minimise the duct runs and ensure the flexible ducting isnt kinked etc

4. Lessons from Joseph Rowntree Floundation's Elm Tree Mews in York included:

• Airtighness target was 3m3/m2 but it measured bewteen 6 and 9m3; luckily the ventilation had been designed thinking the target was 10! 
• Co-heating tests showed up massive fabric failure in part due to construction of presinsulated timber cassettes in a wet summer; wet warmcell insulation had to be replaced and there was much more timber in the cassettes than anticipated leading to U-value deteriorating from 0.18 to 0.3 
• locally sourced windows claimed a u-value of 1.5 but that was mid-point not overall as specified, so rated 2.0 overall 
• complex shapes and contextual arts and crafts detailing led to extensive cold bridging 
• solar thermal only worked in one home - problems included a nail through a pipe, kinked pipework and one with the flow and return fitted the wrong way round 
• tenants didn know how to use the winter gardens and used them for storage 
• each dwelling had 4 controllers - heat pump, space heaing, solar hot water and immersion heater! 

Let me know if you want to see the powerpoints.

Lambeth Community Care Centre Open Day

On Saturday 21st May a group from the office went to the Lambeth Community Care Centre annual garden open day, to see the building in action and to enjoy some tea and cake. It was great to see how this innovative centre has been used and the garden has matured, over 25 years on from when it was first opened.

Robin Nicholson, senior partner at Cullinans and the project architect of the Care Centre, took us on a tour of the building and its extensive gardens, pointing out his mature fig tree, laden with fruit, and stories behind many of the plants. The local community got a warm welcome from staff and volunteers and from the gardener Millie who was there encouraging everyone to buy plants to help fund the next year’s work in the garden.

For the opening by Charles and Diana on a cold winter afternoon in 1985, Ted took the newly wed Di around the ground floor to meet the patients and those involved in making the Centre happen. Meanwhile Robin introduced Charles to the design and construction teams in the upper conservatory including the foremen plumber and electrician, while their bosses were out in the rather chilly garden.  All the guests were invited to bring bulbs to plant in the garden.

The wonderful first senior nurse Sheila Woodward, now retired but devoted to the Centre, showed us around the 1st floor ward areas, pointing out various design features that made an impact in the lives of the patients. For example, Sheila told us how the clerestory windows bathed the wards in the dawn light, and helped patients connect with passing of time each day. Apparently dawn is one of the most common times for people to pass away, at the most peaceful time of the day.

The wards look out over the verdant garden, allowing patients to enjoy the greenery and wildlife from their beds. A terrace runs along the ward where patients can sit and double doors enable beds to be wheeled out onto the terrace from the wards if a patient wants to be outside.

Sheila had had the unenviable task of taking over the building from a passionately determined group of doctors, therapists, administrators and architects who had lived and breathed the design for 5 years and it had taken the founders 5 years before that to get the money.  The plan had been to make a model place where patients would be looked after by the Centre’s nurses and therapists and visited by their GP as though they were in their own home.  The story of the early years is beautifully recorded by Gillian Wilce in ‘A Place Like Home’.

After huge initial success, Sheila moved on and inevitably there were some changes but the Tomlinson report in 1992 thrust the Lambeth CCC right back on the agenda as a model for the future of Community healthcare in London.

The centre is based around an innovative approach to patient care, where patients have an active role in their own care and the running of the centre. It was very interesting to see these principles in practice, innovative in its time and still very much relevant to current healthcare projects such as our current Maggie’s Cancer care centre project in Newcastle, where visitors are encouraged to feel ownership of the building and enabled to help themselves to cups of tea and participate in the gardening.

North East Maggie's Cancer Caring Centre

A special issue of the Architects Journal was devoted to the building 16th Oct 1985.