Typologies and Change: Humanising Hospitals by Jamie Brown

Semester 1 2014/2015

Typologies and Change: Humanising Hospitals

K14THS Master of Architecture 2014/2015 Arch i t e c t u r e a n d t h e B u i l t E n v i r o n m e n t The University of Nottingham

Jamie Brown M a k i n g

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A s p e c i a l t h a nk you to Studio MARS tutors f o r t h e i r c o m mendable dedicated input t h r o u g h o u t t his experience. Tu t o r s : P r o f e ssor Michael Stacey, Sheldon B r o w n a n d L aura Gaskell. A s s o c i a t e Tu tors: Mike Ramwell, Rachael D e l a r g y a n d Frances Stacey.

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This thesis document, and related r e s e a r c h d o c u m e n t s , r e p r e s e n t t h e i t e r a t i v e l e a r n i n g p r o c e s s which I have undertaken within th e M A R S S t u d i o i n t h e f i r s t s e m e s t e r. B y n o m e a n s a l i n e a r progression, the process has draw n u p o n m a n y r i c h s o u r c e s o f i n f o r m a t i o n a n d e x p e r i e n c e s , such as drawing and making works h o p s , f i e l d t r i p s a n d g r o u p r e s e r a c h , a l l c o n t r i b u t i n g t o t h e synthesis of my ideas and eventua l d e s i g n t h e s i s p r o p o s a l . I t i s w i t h i n t h i s r i c h s t u d i o c u l t u r e , process of critical analysis and re f e l c t i o n t h a t m y i n t e r e s t s a n d a s p i r a t i o n s w e r e a l l o w e d t o flourish. My interest began distinctly in the r e a l m o f t e c t o n i c s a n d m a t e r i a l i t y w i t h a s t r o n g e m p h a s i s on human experience. This was the n d e v e l o p e d w i t h i n t h e s u b s e q u e n t t h e s i s d o c u m e n t w h e r e an indepth theoretical and physica l t y p o l o g i c a l a n a y s i s w a s u n d e r t a k e n f u n d a m e n t a l l y g r o u n d e d within the current context and hum a n n e e d . T h i s f o u n d a t i o n o f k n o w l e d g e a n d e x p e r i e n c e i s then taken forward and tested, in t h e s e c o n d s e m e s t e r, w i t h i n t h e p r o p o s e d d e s i g n , w o r k i n g o n key studio themes in the attempt t o b a l a n c e f u n c t i o n a l i t y w i t h p o e t i c s i n r e l a t i o n t o t e c t o n i c s , materiality but most importantly a t m o s p h e r e o f â&#x20AC;&#x2DC; p l a c e â&#x20AC;&#x2122; . The Thesis Research Document, al o n g w i t h t h e o t h e r b o o k s l i s t e d b e l o w, b u t m o s t s p e c i f i c a l l y t h e Thesis Design Document, should b e r e a d i n c o n j u n c t i o n t o s h o w t h e j o u r n e y o f t h o u g h t a n d d e s i g n to its eventual synthesis in my pro p o s e d a r c h i t e c t u r e . A d d i t i o n s t o t h i s e d i t i o n o f t h e T h e s i s Research document are: Explanatio n s o f w h a t I g a i n e d f r o m v a r i o u s e x p e r i e n c e s . T h e e x p l a n a t i o n of modernisms role within hygiene , a n d i t s i n f l u e n c e o n a r c h i t e c t u r e . T h e i m p o r t a n t r e l e v a n c e of Paimio Sanatorium by Alvar Aal t o a n d M a s i o n d e Ve r r e b y P i e r r e C h a r e a u w h e n c o n s i d e r i n g horizonal arrangements vs vertical a r r a n g e m e n t s . T h e i m p o r t a n c e o f t h e d o m e s t i c r e a l m a n d w h a t it means to most people.

Note: S e e B o o k : r e -Think the Region, Typologies a n d C h a n g e - Brown, Grout, Mohammad, 2014 S e e B o o k : R ooms and Chairs, Constructing S i m p l i c i t y : Making Without Rhetoric B r o w n , G r o u t , Mohammad, 2014 S e e B o o k : D esign Thesis Document - Brown, 2015

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J u h a n i P a l l asmaa, The Eyes of the Skin ( We s t S u s s e x, England: Wiley & Sons, 2005).

“Instead of an existentially ground e d p l a s t i c a n d s p a t i a l e x p e r i e n c e , a r c h i t e c t u r e h a s a d o p t e d t h e psychological strategy of advertisi n g a n d i n s t a n t p e r s u a s i o n ; b u i l d i n g s h a v e t u r n e d i n t o i m a g e products detached from existentia l d e p t h a n d s i n c e r i t y. ” 1

F i g u r e 1 O p p osite and Right: Identical white c u b e s a n d ‘ t he black cube’. F i g u r e 2 A b o ve: 3 Identical white cubes w h i c h f r o m a ppearance look the same i n e v e r y w a y. Only once you ‘look’ past t h e s u r f a c e can you understand their differences. F i g u r e 3 O v e rleaf: Physical interaction i n v o l v i n g m i nd and body to reconnecting b o t h t o f u l l y judge the sincerity and depth of the cube.

The first task was to outline our o w n a r c h i t e c t u r a l s t a n d p o i n t t h r o u g h t h e c r e a t i o n o f a n ‘artefact’. By taking a human and s e n s o r y a p p r o a c h I w a n t e d t o c r e a t e s o m e t h i n g t h a t w o u l d appear a certain way, but to be fu l l y u n d e r s t o o d w o u l d r e q u i r e d a f u l l e n g a g e m e n t w i t h t h e objects of both mind and body. Aft e r a f e w i t e r a t i o n s I c r e a t e d 3 w h i t e c u b e s i d e n t i c a l , v i s u a l l y, in every way, dimension, colour, m a t e r i a l a n d t e x t u r e . O n l y o n c e t h e c u b e s c o m e i n t o c o n t a c t w i t h the body can their secrets be reve a l e d , t h e b o d y s e n s e s s o m e t h i n g b e y o n d w h a t t h e e y e c a n s e e .

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Whilst all are created from cast re s i n t h e m e t h o d i n w h i c h t h e y a r e c a s t g i v e s t h e m t h e i r u n i q u e quality. The first is hollow achieve d b y p o u r i n g a s m a l l a m o u n t i f r e s i n i n t o a s e a l e d n e t w h i c h was then constantly rotated to coa t e a c h s u r f a c e u n t i l s e t . T h e s e c o n d i s j u s t a n o r m a l s o l i d r e s i n block, ‘the original or authentic bl o c k ’ . T h e t h i r d i s w e i g h t e d w i t h i n t h e c e n t r e w i t h m e t a l m a k i n g it significantly heavier than the pr e v i o u s t w o . I n t e r e s t i n g l y i m p e r f e c t i o n s b e c a m e a p p a r e n t w h e r e the weighting of the cubes was sl i g h t l y o f f c r e a t i n g a m o r e i n t e r e s t i n g i n t e r a c t i o n a n d p l a y w i t h the cubes in contrast to their appa r e n t p e r f e c t e x t e r n a l f o r m . T h e B l a c k c u b e i s e x a c t l y t h e s a m e as one of the white cubes, in dime n s i o n a n d w e i g h t , a c t i n g a s a c o u n t e r p o i n t r e l a t i n g t o t h e image and how the simple use of c o l o u r c a n m a k e o b j e c t s a p p e a r d i f f e r e n t . I n t h i s c a s e s m a l l e r. This highlighted my interest in the n e e d f o r p h y s i c a l i n t e r a c t i o n w i t h i n a r c h i t e c t u r e o v e r t h a t o f a purely visual one. It was also te l l i n g h o w i n d i v i d u a l l y e a c h c u b e d o e s n o t s a y m u c h , b u t w h e n experienced together the individua l e l e m e n t s c r e a t e s o m e t h i n g g r e a t e r t h a n t h e s u m o f m e r e parts.

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A b s t r a c t Using my developed typological re a d i n g s a n d s t u d i e s o f t h e h e a l i n g e n v i r o n m e n t , t h i s t h e s i s document challenges the medicalis e d s t a n d p o i n t o f h e a l t h a n d t h e h e a l t h c a r e i n d u s t r y a n d i t s use as a justification for a bias to w a r d s a n i n s t i t u t i o n a l i s e d h o s p i t a l t y p o l o g y f o c u s e d o n p u r e l y curing illness of patients as oppos e d t o c a r i n g f o r p e o p l e . T h e h e a l i n g e n v i r o n m e n t i s m o r e t h a n just a container to house the ill w h i l s t t h e y a r e c u r e d . T h e h e a l i n g e n v i r o n m e n t i s s o m e t h i n g that goes hand in hand with techn i c a l a n d m e d i c a l s o l u t i o n s w h e n t r e a t i n g p e o p l e a t t h e i r m o s t fragile and susceptible, to allow t h e m t o h e a l m e n t a l l y a s w e l l a s p h y s i c a l l y. In the current NHS crisis the medi c a l i s a t i o n o f t h e w a y i n w h i c h w e s e e o u r h e a l t h g i v e s u s some certainty within our uncertai n w o r l d , h a n d i n g o v e r o u r c o n t r o l t o m e d i c i n e i n w h i c h m o s t people feel safest. In turn the resu l t a n t m e d i c a l i s e d h o s p i t a l t y p o l o g y, w h i c h c o m p r i s e s t h e majority of NHS stock, fully caters f o r t h e n e e d s o f s p e c i a l i s t s , d o c t o r s a n d o t h e r h e a l t h c a r e professionals who increasingly giv e g o o d p u b l i c i t y t o t h e i r n e w s t a t e o f t h e a r t ‘ s u p e r h o s p i t a l s ’ . This centralised ideological typolo g y h a s p e r s i s t e d f r o m t h e m i d t w e n t i e t h c e n t u r y t h i n k i n g a s a result of the modern movement a n d e x t e n s i v e s l u m c l e a r a n c e s t h r o u g h o u t B r i t a i n a n d I r e l a n d . Whilst facts and figures are ever p r e s e n t , p a t i e n t s a r e c u r r e n t l y a b s e n t i n t h e d e s i g n p r o c e s s represented as anonymous entities w h i c h r e q u i r e a c u r e a n d s p a c e , p r o d u c i n g h o m o g e n o u s ‘ o n e size fits all’ typologies. Where a cure can be found or is re a d i l y a v a i l a b l e , a p p r o p r i a t e m e d i c a l t r e a t m e n t i s u s e d a s a justification for functional and gen e r i c a r c h i t e c t u r e. D e s i g n a p p e a r s t o o n l y b e c o m e s p e c i f i c as a last resort, only once medicin e h a s f a i l e d t o d o i t s j o b . A l r e a d y a n u m b e r o f p r e c e d e n t s have been built exploring healing t h r o u g h a r c h i t e c t u r e . T h e y t a c k l e c o m m o n i s s u e s f o u n d in institutionalised hospitals today a n d a l l c a t e r f o r o n e d e p a r t m e n t o f m e d i c i n e b e c o m i n g a specialist unit. But most importa n t l y t h e y c a r e f o r t h e p a t i e n t s a n d e x p l o r e t h i s i d e a o f architectural place making through d e v i c e s w h i c h h o l d n o f u n c t i o n a l p u r p o s e , o r b e t t e r d e f i n e d as non hospital specific functiona l p u r p o s e w h i c h h a s d r a s t i c p o s i t i v e e f f e c t s u p o n p a t i e n t s a s well as staff. The one size fits all t y p o l o g y n e e d s t o b e r e t h o u g h t a n d d i s a g g r e g a t e d t o r e c l a i m appropriate patient specific desig n e d c o n d i t i o n s c u r r e n t l y h e l d b y t h e r i c h a n d t e r m i n a l l y i l l . Healing people and places go hand i n h a n d , w h i c h i s w h y t o a p p l y m y d e v e l o p e d u n d e r s t a n d i n g , this thesis discusses the opportun i t i e s p r e s e n t e d b y t h e c i t y o f B e l f a s t . H a v i n g s o m e o f t h e best facilities in the UK yet having t h e l o w e s t l i f e e x p e c t a n c y i n N o r t h e r n I r e l a n d , B e l f a s t i s fundamentally a sick city. The Belf a s t l i f e s t y l e a n d d i s c o n n e c t e d c i t y f a b r i c p l a y a h u g e r o l l in these statistics. Whilst receivin g a n e w e x t e n s i o n i n 2 0 0 0 t h e B e l f a s t C h i l d r e n ’s h o s p i t a l i s nearly 100 years old with conditio n s n o t f i t f o r p u r p o s e . T h i s p r e s e n t s t h e o p p o r t u n i t y f o r a n e w children’s hospital integrated with i n t h e c i t y o f B e l f a s t i n w h i c h t o a p p l y m y d e v e l o p e d t h e o r i e s . It also specifically target the youn g p e o p l e o f B e l f a s t i n t h e h o p e t o h e l p c a r e f o r a n d n u r t u r e the existing inherent qualities of p l a c e , w h i l s t p o s i n g t h e c h a l l e n g e o f d e s i g n i n g a h o s p i t a l environment in which children can f e e l c o m f o r t a b l e , s a f e a n d n o t a l i e n a t e d .

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Part I Thesis Research Document

1.0 Introduction 1.1 Background 2.0 Medicalisation of Health care 2.1 The Religion of ‘Healthism’ 2.2 NHS in Crisis - Current Context 3.0 The Placebo Effect 3.1 Healing Machine 3.2 One Size Fits All- QMC 3.3 Value of Good Design 3.4 Therapeutic Making 3.5 Healing Architecture - Precedent Studies 3.6 The Meaning of Domesticity 4.0 Place Deficit Disorder 4.1 Belfast - An Ill City 4.2 Degeneration 4.3 Existing Hospitals 4.4 Void Spaces 4.5 Intervention Site 5.0 Typologies and Change 5.1 Belfast Children’s Hospital 5.2 Disaggregation Precedents 5.3 Child Specific Design Precedents 6.0 Conclusion 6.1 Reflection 6.2 Position 6.3 Thesis Progression 7.0 Bibliography 7.1 Reference List 7.2 Figure Reference List

1 .0

Introduction

B o r a s i G i o v anna and Mirko Zardini, eds., I m p e r f e c t H e alth, The Medicalization o f A r c h i t e c t ure (Canadian centre for a r c h i t e c t u r e : lars muller publishers, 2012). 2 Ib i d . 3 W i l t o l d R y b czynski, Home: A Short History o f a n I d e a ( New York: Penguin Books, 1986). 4 G a s t o n B a c helard, Poetics of Space, trans. M J o l a s ( B o s ton: Becon press, 1969) . 1

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In the modern age health has beco m e a n o b s e s s i v e p a n d e m i c , m a i n l y a m o n g u r b a n p o p u l a t i o n s within the western world. Hypocho n d r i a h a s c a u s e d u s t o b e c o m e a n x i o u s o f o u r w o r l d , a n d t h e world we are creating for ourselve s c r e a t i n g a m u l t i t u d e o f f e a r s t r a i n i n g u p o n o u r c o n s c i o u s n e s s such as Terrorist attacks, pollution , u s i n g n a t u r a l r e s o u r c e s , d e c l i n i n g b i o d i v e r s i t y, h a r m f u l industrial processes, food hygiene , o b e s i t y, a g e i n g a n d o u r c o n s u m e r i s t l i f e s t y l e . “ A l m o s t everything in our surroundings is p e r c e i v e d a s a p o s s i b l e s o u r c e o f d i s e a s e , t h e h e a l t h , d e f e n c e and fortification of the body is an o b s e s s i v e p u r s u i t ” . 1 W h i l s t i t h a s n o t b e e n i m m e d i a t e , t h e concern with our personal health h a s c a u s e d a s w a y t o w a r d s t h e “ m e d i c a l i z a t i o n ” 2 o f h o w w e perceive and treat our own health . W i t h i n a n u n c e r t a i n w o r l d t h e c e r t a i n t y w i t h i n m e a s u r a b l e maths and science or a ‘medical fr a m e w o r k ’ s e e m s v e r y a p p e a l i n g o n t h e r o a d t o c u r i n g o r fortifying our bodies against exter n a l s o u r c e s t h a t w i s h t o d o u s h a r m . I n t u r n t h e f o c u s o n c u r i n g patients and the medicalization of h e a l t h c a r e h a s d e v e l o p e d a f u n c t i o n a l h o s p i t a l t y p o l o g y t h a t forgets about caring for its inhabi t a n t s , c r e a t i n g v a s t c i t y l i k e s p r a w l s i n w h i c h ‘ o n e s i z e f i t s a l l ’ with a cure for everyone. “The idea of the home as a refuge i s a s a n c i e n t a s h u m a n i t y ” 3 a n d i t i s n o s e c r e t t h a t t h e h o m e is the centre of pretty much every o n e ’s w o r l d 4 , a c o m f o r t a b l e , s a f e a n d s e c u r e p l a c e f r e e o f anxiety in which to rejuvenate. Th i s i s w h e r e p e o p l e w a n t t o b e w h e n t h e y a r e u n w e l l . H o w e v e r many people believe hospital to be t h e s a f e s t p l a c e t o b e w h e n a t t h e i r w e a k e s t , w h i c h i s t r u e in many ways. Where medicine fai l s , t h e d e s i g n o f b u i l d i n g s i s c a l l e d u p o n t o t r y a n d h e l p t h e patients to recover mentally and p h y s i c a l l y. B y s t u d y i n g a r a n g e o f ‘ c a r e n o t c u r e ’ p r e c e d e n t s I hope to discover how the quality o f d e s i g n c a n a i d a n d c a r e f o r p a t i e n t s , o n t h e i r r o a d t o recovery, on a larger scale and no t j u s t b e i n g p r i m a r i l y f o r t h e t e r m i n a l l y i l l o r t h e r i c h . I n conjunction to thinking about the q u a l i t i e s o f t h e h o m e I a i m t o a n a l y s e t h e f a i l u r e s o f m o d e r n hospital typologies at multiple sca l e s a n d t h e a f f e c t s t h e s e h a v e n o t o n l y o n p a t i e n t s b u t a l s o o n the staff treating these patients.

2 .1 Medicalisation Healthcare

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Ib i d . 2 P e t e r C o n r a d, The Medicalization of S o c i e t y : O n t he Transformation of Human C o n d i t i o n s i nto Treatable Disorders ( B a l t i m o r e : J ohn Hopkins University Press, 2007). 3 J o n a t h a n M . Metzl and Anna Kirkland, eds., A g a i n i s t H e a lth: How Health Became the N e w M o r a i l t y (New York and London : NYU Press, 2010). 1

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‘ H e a l t h i s m ’

The process of medicalisation is a t t h e c o r e o f t h e i s s u e f o r t h e f a i l i n g s o f m o d e r n h o s p i t a l s . I will not only outline what this term m e a n s b u t a l s o w h a t i t m e a n s i n t e r m s o f m o d e r n p s y c h o l o g y towards our own health and how t h i s h a s n e g a t i v e l y i m p a c t e d u p o n t h e d e s i g n o f h o s p i t a l s a n d their ultimate medicalisation. This s h i f t i n p s y c h o l o g y h a s d r i v e n t h e ‘ c u r e ’ c u l t u r e w e l i v e i n today where we ultimately ignore a f u n d a m e n t a l e l e m e n t o f r e c o v e r y w h i c h i s c a r i n g f o r p e o p l e . The design of hospitals is a intrins i c p a r t o f t h i s c a r e a n d r e c o v e r y p r o c e s s a l m o s t a l w a y s overlooked because of its immeasu r a b l e q u a l i t i e s . Medicalisation - A process in whic h o r d i n a r y p r o b l e m s a r e d e f i n e d i n m e d i c a l t e r m s a n d identified through a medical frame w o r k . 1 As a result of feeling constantly a t r i s k f r o m i n d e f i n a b l e s o u r c e s o f c o n t a m i n a t i o n a n d i l l n e s s , w e find ourselves more than ever putt i n g o u r t r u s t i n r a t i o n a l a n d s c i e n t i f i c s o l u t i o n s o f m e d i c i n e . The appeal being, a ‘cure’ or ‘quic k f i x ’ t o f o r t i f y o u r s e l v e s a g a i n s t e n o r m o u s l y c o m p l e x h e a l t h issues that are even more difficult t o p i n p o i n t , l e t a l o n e c u r e , t h a n t h e p o t e n t i a l s o u r c e s o f o u r uncertainties and fears. Medical s o c i o l o g i s t P e t e r C o n r a d p o i n t s o u t t h e s h i f t i n t h e m e d i c a l identification of illnesses and diso r d e r s b e t w e e n t h e e a r l y t w e n t y f i r s t c e n t u r y a n d t h e 1 9 7 0 s . Alcoholism nor obesity were seen a s d i s e a s e s w i t h i n t h e m e d i c a l p r o f e s s i o n b u t a r e n o w w e l l know as such today. 2 Even from my o w n e x p e r i e n c e t h e c l a s s i f i c a t i o n o f n e w d i s o r d e r s a n d diseases seems to be taking medic a l i s a t i o n e v e n f u r t h e r i n a n a t t e m p t t o f i n d a c u r e f o r a l m o s t everything that is ‘not the norm’. I t h a s g o t t e n t o s u c h a p o i n t t h a t e v e n n a t u r a l p s y c h o l o g i c a l phenomena have been pinpointed a s a t y p e o f d i s o r d e r, s u c h a s s e a s o n a l a f f e c t d i s o r d e r ( S A D ) . With the number of disorders and d i s e a s e s c o n t i n u o u s l y e x p a n d i n g o u t o f c o n t r o l t h e o b s e s s i o n with our health has never been str o n g e r. T h i s t r u s t w e h a v e g i v e n o v e r t o m e d i c i n a l c u r e s f o r almost everything, has spawned a n e w m o r a l i s t i c p h i l o s o p h y o f ‘ H e a l t h i s m ’ . 3 A l m o s t l i k e a religion it is has become a primary v e n t u r e w i t h i n o u r d a y t o d a y l i v e s i n o p p o s i t i o n t o t h e s e unknown threats that harbour worr y a n d d o u b t . W i t h a l l o f t h e n e w i n f o r m a t i o n o n f o o d s , hygiene, exercise ect. Plastered al l o v e r t h e m e d i a , w e n o w s e e i t a s a n o b l i g a t i o n t o t a k e i t upon ourselves to fortify our own b o d i e s a g a i n s t p o t e n t i a l d i s e a s e s i n a c o n t i n u o u s r i t u a l o f exercising, eating healthily, taking s u p p l e m e n t s a n d v i t a m i n s , u s i n g c r e a m s a n d l o t i o n s a n d s o on.

G i o v a n n a a n d Zardini, Imperfect Health, T h e M e d i c a l i zation of Architecture. 5 Iv a n I l l i c h , Limits to Medicine. Med ical N e m e s i s : T h e Exploration of Health. ( L o n d o n : M a r ion Boyars, 1976). 6 E d w i n H e a t h cote, The Meaning of H o m e ( L o n d o n: Frances Lincoln Limited P u b l i s h i n g s , 2012). 7 Ib i d 4

The expansion of diagnosable cond i t i o n s h a s a l s o e x p a n d e d o u r s c o p e o f o u r o w n h e a l t h and well-being. We are no longer j u s t w e l l o r u n w e l l t h e i d e a o f t o t a l h e a l t h h a s b e c o m e an ideological position to strive fo r a t t h e p i n n a c l e o f a s c a l e o f w e l l n e s s [ T h e c a r r o t a n d stick]. “Our health-obsessed socie t y, h o w e v e r, o f f e r s d i v e r s e i n t e r p r e t a t i o n s o f h e a l t h . F o r example, the idea of health is no l o n g e r i d e n t i f i e d p r i m a r i l y w i t h t h e a b s e n c e o f i l l n e s s , b u t has expanded to include a state of g e n e r a l w e l l - b e i n g c o n c e r n i n g a l l t y p e s o f f u n c t i o n i n g , from physical and biological to soc i a l a n d c u l t u r a l . ” 4 A l l a s p e c t s o f l i f e a r e i n r i s k o f b e i n g medicalised and measurable to giv e p e a c e o f m i n d t o o u r o b s e s s i v e n e e d f o r c o n t r o l o f o u r d a y to day lives. Medicine, like law an d r e l i g i o n , d e f i n e s w h a t i s n o r m a l a n d d e s i r a b l e i n e v e r y society. 5 The modern movement played a ke y r o l e w i t h i n t h e p r o c e s s o f m e d i c a l i s a t i o n . W i t h s t r o n g i d e a s of centralisation and new found kn o w l e d g e a n d t e c h n o l o g y i n t o c l e a n l i n e s s i t i s n o s u r p r i s e why health is now approached and d e a l t w i t h i n s u c h a s t e r i l e w a y, w i t h t h e ‘ o n e s i z e f i t s a l l ’ typology being born. These points w i l l b e e x p l o r e d m o r e i n - d e p t h l a t e r w i t h i n t h e t h e s i s , b u t my main point here is that not only i n s t i t u t i o n s h a v e s u f f e r e d f r o m t h i s i d e a o f m e d i c a l i s a t i o n . The humble home, if anything, the a n t o n y m t o t h e i n s t i t u t i o n , h a s a l s o b e e n i n v a d e d . “ W h e r e modernist architects did need to re t a i n w a l l s , t h e b a t h r o o m s o r k i t c h e n s f o r e x a m p l e , t h e y t i l e d them. Tiles represent a measure of c o n t r o l , t h e y i n s c r i b e a n a b s t r a c t g r i d o n t h e w a l l , t h e y map it. Just as the creation of map s w i t h t h e i r c a r e f u l l y m e a s u r e d g r i d s i m p o s e o w n e r s h i p o n a piece of land, a grid of tiles insc r i b e s o w n e r s h i p o n a w a l l . T h e c l e a n j o i n t s a n d e d g e s , t h e easy-to-wipe glossy surface is a d e n i a l o f t h e r o u g h n a t u r e o f t h e c o n s t r u c t i o n b e n e a t h , t h e earthy bricks and irregular mortar, t h e m a t e r i a l s s m e l l i n g o f t h e i r c o n n e c t i o n t o t h e e a r t h a n d the underground. To tile is to impo s e o r d e r. 6 M u c h o f p h y s i c a l i t y ’s w e c a l l h o m e h a v e r e m a i n e d relatively unchanged for centuries w i t h t h e o n l y t e c h n o l o g i c a l a r c h i t e c t u r a l i n t e g r a t i o n appearing in the bathroom and kitc h e n . T h e t r a d i t i o n a l ‘ r i t e s o f p a s s a g e ’ s u c h a s B i r t h , i l l n e s s and dying have also been moved o u t o f t h e h o m e 7 , m e d i c a l i s e d i n t h e n o n - p l a c e s o f h o s p i t a l s giving an ever stronger prominenc e o f e x p e r i e n c e , m e a n i n g a n d m e m o r y t o t h e s e n o n - p l a c e s w e resentfully find ourselves in.

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2 .2 Medicalisation Healthcare

o f

S a n j a y Ta n d ay, “Midwife-Led Units Safest f o r S t r a i g h t Forward Births,” NewsArticle, N a t i o n a l I n s titute for Health and Care E x c e l l e n c e , ( 2014), http://www.nice.org.uk/ n e w s / a r t i c l e /midwife-led-units-safest-fors t r a i g h t f o r w ard-births. 2 C a t h y Wa r w ick, Giving Birth At Home “ S a f e r ” F o r Many Mums, interview by R a c h e l Yo u n ger, December 3, 2014, http:// n e w s . s k y. c o m/story/1384667/giving-birtha t - h o m e - s a f er-for-many-mums. 3 R h i a n n o n D avies, Giving Birth At Home “ S a f e r ” F o r Many Mums, interview by R a c h e l Yo u n ger, December 3, 2014, http:// n e w s . s k y. c o m/story/1384667/giving-birtha t - h o m e - s a f er-for-many-mums. 4 N I C E , “ A c t i on Needed to Reduce Ho spital F a l l s : A ‘ O n e Size Fits All’ Approach Will N o t Wo r k , Warns NICE,” PressRelease, N a t i o n a l I n s titute for Health and Care E x c e l l e n c e , ( June 12, 2013), http://www. n i c e . o r g . u k / news/press-and-media/actionn e e d e d - t o - r e duce-hospital-falls-a-one-sizef it s - a l l - a p p r oach-will-not-work-warns-nice. 5 Ib i d . 1

F i g u r e 4 O v e rleaf: Recent Ebola and A&E h e a l t h c r i s i s in UK: (from left to right) The G u a r d i a n 3 0 / 12/14, The Observer 28/12/14 a n d T h e B e l f ast Telegraph 05/01/15. F i g u r e 5 R i g ht Top: Front Page of The Times We d n e s d a y June 5th 2013 F i g u r e 6 R i g ht Bottom: Front Page of The Ti m e T h u r s d ay October 23rd 2014.

N H S

i n

C r i s i s

C ur r e n t

C o n t e x t

Currently the National Health Serv i c e s u f f e r s f r o m t h e c o n d i t i o n o f m e d i c a l i s e d d e s i g n a n d i t is clear why this is the case. The p r o b l e m i s m o n e y. U n d e r t h e c u r r e n t g o v e r n m e n t t h e N H S i s constantly under pressure to save a n d m a k e m o n e y t o k e e p a f l o a t . W h e n s p e a k i n g t o a m e m b e r of staff at the Queen’s Medical Ce n t r e N o t t i n g h a m I w a s t o l d t h a t s t a f f m e m b e r s a r e a c t i v e l y encouraged to put forward any mo n e y s a v i n g s u g g e s t i o n s t o h e l p t h e t r u s t . W i t h t h e c o n s t a n t fears of privatisation and closing h o s p i t a l s w h o c a n b l a m e t h e m . A l o n g w i t h p r e s s u r e f r o m specialists, smaller local hospitals a r e a l s o c l o s i n g a n d b e i n g i n t e g r a t e d , a s s p e c i a l i s t u n i t s , i n t o central ‘Super Hospitals’ which ca t e r f o r a w i d e r p o p u l a t i o n a s o p p o s e d t o b e i n g c o n v e n i e n t f o r people to access. This is another m o n e y s a v i n g m e t h o d b y r e d u c i n g i n i t i a l c o n s t r u c t i o n c o s t s , b u t also one which is pushed by speci a l i s t d o c t o r s a s t h e y w a n t a l l s p e c i a l i s t e q u i p m e n t t o b e i n o n e local place creating a one size fits a l l t y p o l o g y. Recent articles show this resistan c e t o c h a n g e b u t a l s o t h e m o v e m e n t i n f a v o u r o f e i t h e r h o m e treatment or smaller specialist uni t s . R e c e n t p u b l i c a t i o n s f r o m t h e N a t i o n a l I n s t i t u t i o n f o r H e a l t h and Care Excellence suggest that i t i s i n f a c t s a f e r f o r l o w r i s k p r e g n a n t m o t h e r s t o g i v e b i r t h in Midwifery-led Units (more simil a r t o a h o m e b i r t h ) a n d b a b i e s a r e d e l i v e r e d i n a m o r e n a t u r a l way. 1 At the moment 9/10 babies a r e d e l i v e r e d i n h o s p i t a l s , t h e r e a s o n b e i n g s u g g e s t e d b y C a t h y Warwick, chief executive of the Ro y a l C o l l e g e o f M i d w i v e s , i s t h a t m o t h e r s f e e l t h a t h o s p i t a l s are safest. 2 In contrast Rhiannon D a v i e s w h o l o s t h e r b a b y s i x h o u r s a f t e r g i v i n g b i r t h i n a midwifery unit (miles away from th e n e a r e s t h o s p i t a l ) s u g g e s t t h a t i t i s a d a n g e r o u s p o l i c y a n d puts woman’s lives at risk just to s a v e m o n e y o n t h e N H S . 3 W h e t h e r t h i s i s t o s a v e m o n e y o r n o t the evidence suggests that giving b i r t h i n a m i d w i f e r y - l e d u n i t i s s a f e r a n d b e t t e r f o r b o t h b a b y and mother with reduced infection s a n d l e s s n e e d f o r m e d i c a l i m p l e m e n t s a n d m e d i c i n e s . I n t h e case of Rhiannon Davis it would s e e m i m p o r t a n t t o h a v e m i d w i f e r y - l e d u n i t s o n a h o s p i t a l s i t e like many are already. Having a multitude of specialisms o n s i t e i s c l e a r l y i m p o r t a n t b u t t h e o n e s i z e f i t s a l l institutionalised hospitals we see i n c r e a s i n g l y t o d a y n e e d t o b e r e t h o u g h t . A n o t h e r p u b l i c a t i o n from the National Institution for H e a l t h a n d C a r e E x c e l l e n c e p i n p o i n t s t h e p r o b l e m o f f a l l i n g within hospitals specifically withi n t h e a g i n g p o p u l a t i o n . N I C E s t r e s s e s t h a t a o n e s i z e f i t s a l l policy will not work meaning large h o s p i t a l s c a n n o t c a t e r f o r e v e r y p a t i e n t w i t h o n e s o l u t i o n resulting in inappropriate conditio n s f o r s o m e p a t i e n t s . 4 F a l l s c o s t t h e N H S a n e s t i m a t e d £ 2 . 3 billion per year, the sufferers bein g p r i m a r i l y t h e e l d e r l y. 5 T h i s a g a i n i s a s i m p l e c a s e o f d e s i g n . By specifically engaging with the p a t i e n t s y o u a r e t r e a t i n g y o u c a n d e s i g n f o r t h e i r n e e d s a n d provide a far more appropriate and p l e a s a n t e n v i r o n m e n t f o r t h e m t o r e c o v e r i n . T h e l a s t t h i n g you want is to go to hospital for o n e a i l m e n t t o r e c e i v e a n o t h e r. 9

N I C E , “ D o c t ors and Nurses Must R e d o u b l e H y giene Efforts to Bring down ‘ U n a c c e p t a b l e and Avoidable’ Infection R a t e s , ” P r e s s Release, National Inst itute f o r H e a l t h a n d Care Excellence, (April 17, 2 0 1 4 ) , h t t p s : //www.nice.org.uk/news/ p r e s s - a n d - m edia/doctors-and-nurses-mustr e d o u b l e - h y g iene-efforts-to-bring-downu n a c c e p t a b l e-and-avoidable-infection-rates. 7 B e a u m o n t H ospital. “Beaumont H o s p i t a l , D u blin, Ireland.” Beaumont, M a y 7 , 2 0 0 7 . http://web.archive.org/ w e b / 2 0 0 7 0 5 07051257/http://www. b e a u m o n t . i e / about/. 8 P r o f e s s o r D Coakley. “History.” St. James’s H o s p i t a l , N . D. http://www.stjames.ie/ A b o u t U s / H i s tory/. 9 N H S . “ R o y a l Infirmary of Edinburgh.” NHS L o t h i a n , 2 0 1 1. http://www.nhslothian.scot. n h s . u k / G o i n g ToHospital/Locations/RIE/ P a g e s / d e f a u l t.aspx . 10 B B C , “ E u r o pe’s Largest Hospital to O p e n , ” B B C , June 7, 2011, sec. London, h t t p : / / w w w. bbc.co.uk/news/uk-englandl o n d o n - 1 3 6 8 3630. 6

F i g u r e 7 R i g h t: Front Page of The Guardian T h u r s d a y 3 r d July 2014.

Infection is another major concern w i t h h o s p i t a l s w e l l d o c u m e n t e d i n t h e n e w s . O v e r 3 0 0 , 0 0 0 patients a year receive infections w h i l e b e i n g t r e a t e d b y t h e N H S , w i t h a c t i o n b e i n g t a k e n , recently documented by NICE, to r e d o u b l e h y g i e n e s t a n d a r d s t o r e d u c e a v o i d a b l e i n f e c t i o n s i n mid 2014. 6 Large precautions of in f e c t i o n c o n t r o l a r e i m p l e m e n t e d w i t h i n h o s p i t a l s s u c h a s h a n d sanitisers, high temperatures and c l o s e d w a r d s / s i d e r o o m s . O n e o f t h e m a i n i s s u e s i s t h e h i g h concentration of patients with com p r o m i s e d i m m u n e s y s t e m s i n o n e b u i l d i n g r e s u l t i n g i n f a s t spreading infections which are ver y h a r d t o c o n t r o l . I t a l s o m e a n s l a r g e n u m b e r s o f v i s i t o r s v i s i t common areas further spreading in f e c t i o n s . The homogenisation and centralisa t i o n o f h o s p i t a l s i s n o t u n c o m m o n . T h r o u g h o u r r e s e a r c h w i t h i n the re-Think the Region Document I c o n c e n t r a t e d o n Ty p o l o g i e s a n d C h a n g e , s p e c i f i c a l l y l o o k i n g at the evolution of hospitals over t i m e t h r o u g h o u t S c o t l a n d a n d I r e l a n d . H o s p i t a l s o r i g i n a l l y started as small specialist or gene r a l u n i t s r u n b y t h e c h u r c h o r g o v e r n m e n t b o t h p r i v a t e a n d f o r the sick poor. A larger developmen t o f t h e h o s p i t a l t y p o l o g y c a m e i n t h e a g e o f e n l i g h t e n m e n t parallel to education with many te a c h i n g h o s p i t a l s b e i n g f u n d e d b y u n i v e r s i t i e s . T h e s e w o u l d comprise large general hospitals o u t s i d e o f c i t i e s b u t s t i l l w i t h s p e c i a l i s t u n i t s i n t e g r a t e d w i t h i n the city as part of educational est a b l i s h m e n t s i n m o s t c a s e s . In the late 19th century and early 2 0 t h c e n t u r y a l a r g e m o v e m e n t o c c u r r e d a c r o s s B r i t a i n a n d Ireland with the demolition of inne r c i t y s l u m h o u s i n g . I m p o r t a n t l y t h e t h i n k i n g o f t h e t i m e w a s to move residents into new orbital h o u s i n g e s t a t e s m o v i n g t h e m o u t o f t h e i n n e r c i t i e s . T h i s thinking also occurred in the hosp i t a l t y p o l o g y w h e r e c e n t r a l i s a t i o n w a s a m a i n d r i v e r c a u s i n g the closure of inner city specialis t u n i t s i n t e g r a t i n g t h e m i n t o l a r g e h o m o g e n o u s g e n e r a l hospitals situated in the city edge s u b u r b s p r o v i d i n g f o r a l a r g e r c a t c h m e n t a r e a o f p e o p l e . T h i s is still the situation today, just a f e w e x a m p l e s b e i n g N o t t i n g h a m ’s Q u e e n ’s M e d i c a l C e n t r e which I will talk about later in thi s d o c u m e n t . O t h e r s b e i n g B e a u m o n t H o s p i t a l ( 1 9 8 7 ) a n d S t . James’s Hospital (1994) in Ireland w h e r e a n u m b e r o f s m a l l e r i n n e r c i t y u n i t s w e r e i n t e g r a t e d into these new larger hospitals. 78 I n S c o t l a n d a n o t h e r e x a m p l e b e i n g R o y a l I n f i r m a r y o f E d i n b u r g h which has historic routes within th e c i t y o f E d i n b u r g h . T h e H o s p i t a l w a s m o v e d o u t o f t h e c i t y t o the suburbs of Little France in 200 3 i n t e g r a t i n g a n u m b e r o f s m a l l e r s p e c i a l i s t u n i t s w i t h i n i t , o n e being the Hospital for Sick Childre n . M o s t r e c e n t l y i n L o n d o n t h e l a r g e s t h o s p i t a l i n E u r o p e h a s just been built in 2011 showing a p r e f e r e n c e s m a l l e r s p e c i a l i s t u n i t s i n t e g r a t e d w i t h i n t h e c i t y. The persistence of the homogenise d h o s p i t a l t y p o l o g y c r e a t e s a l a r g e n u m b e r o f i s s u e s m a i n l y being the one size fits all typology. 1 0

The Placebo Effect

3 .1

The

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N a n E l l i n , “ Your City Yourself,” in I m p e r f e c t H e alth: The Medicalization of A r c h i t e c t u r e , ed. Giovanna Borasi and Mirko Z a r d i n i ( C a n adian centre for architecture: l a r s m u l l e r p ublishers, 2012).

F i g u r e 8 ( To p ): Film still from Gravity Was E v e r y w h e r e Back Then by Brent Green 2010. T h e s t o p m o t ion animation tells the story o f h o w L e o n ard Wood, hardware clerk, o b s e s s i v e l y built and modified his crazy q u i l t h o u s e t o act as a healing machine i n a d e s p e r a te attempt to cure his wife’s t e r m i n a l c a n cer.

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Where a cure can be found or is re a d i l y a v a i l a b l e , a p p r o p r i a t e m e d i c a l t r e a t m e n t i s u s e d a s a justification for functional and gen e r i c a r c h i t e c t u r e . B u t w h a t h a p p e n s w h e n t h e r e w a s o r i s no cure? Ironically, or maybe not, t h e m a j o r i t y o f m y s e l e c t e d p r e c e d e n t s t h a t a l r e a d y b e g i n t o practice a care not cure ethos are f o r t h o s e t h a t a c u r e i s n o t a v a i l a b l e , w i t h c a r e b e i n g t h e only alternative in the attempt to t r e a t o r m a k e t h e p a t i e n t c o m f o r t a b l e . D e s i g n a p p e a r s t o o n l y become specific as a last resort on l y o n c e m e d i c i n e h a s f a i l e d t o d o i t s j o b . W h y s h o u l d d e s i g n only be considered as a last resort w h e n i t h a s s u c h a s t r o n g i m p a c t u p o n u s m e n t a l l y a s w e l l as physically? As discussed in the p r e v i o u s c h a p t e r t h e r e i s n o q u e s t i o n w e l l d e s i g n e d s p a c e s influence us in a positive way. “W h i l e g r e a t p l a c e s n o u r i s h b o d y a n d s o u l , p o o r e n v i r o n m e n t a l and urban quality challenges us ph y s i c a l l y a s w e l l a s e m o t i o n a l l y. ” 1 The precedents I have selected wi l l c o m p r i s e a c a s e s t u d y o f m y l o c a l h o s p i t a l , T h e Q u e e n ’s medical centre Nottingham, which w i l l r e p r e s e n t a o n e s i z e f i t s a l l m e d i c a l i s e d e x a m p l e o f health care. In contrast to this I w i l l l o o k a t w h a t I c l a s s a s g o o d e x a m p l e s o f h e a l t h c a r e , accommodating for a range of ailm e n t s b o t h s p e c i f i c a n d g e n e r i c a n d a l s o c a t e r f o r a v a r i e t y of different times spent within eac h . M y b a s i s f o r a g o o d p r e c e d e n t i s o n e w h i c h p r o r i t i s e s t h e patient and their needs in the desi g n r e s u l t i n g i n a m o r e h u m a n e a r c h i t e c t u r a l a r t i c u l a t i o n w e , as humans, are more familiar with . T h e s e q u a l i t i e s a r e r e f l e c t e d w i t h i n t h e a r c h i t e c t u r e t h r o u g h a variety of design drivers ranging f r o m l e g i b i l i t y a n d p r o t e c t i o n t o s a f e t y a n d c o m f o r t . A f t e r studying in my opinion a poor exam p l e o f h e a l t h c a r e e n v i r o n m e n t I h o p e t o f i n d s o m e i n s i g h t i n good examples where the idea of c u r e a n d m e d i c i n e i s a l m o s t t o t a l l y r e m o v e d f r o m t h e e q u a t i o n s relying totally on the physical and m e n t a l w e l l b e i n g o f t h e p a t i e n t a s a r e s u l t o f g o o d d e s i g n .

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P a u l R , S w i ft, “The University H o s p i t a l N o t tingham, Queen’s Medical C e n t r e , ” N o t tingham University H o s p i t a l A r c hives, 2011, http://www. n o t t i n g h a m h ospitalshistory.co.uk/pa ge21. html. 1

F i g u r e 9 O p p osite: Aerial view of the QMC 2014. F i g u r e 1 0 To p: Original Condition of the D e r b y R o a d s ite containing housing estates a n d i n d u s t r i al workshops.

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So far we have seen that in the cu r r e n t c l i m a t e , h o s p i t a l s s u f f e r f r o m t h e o n e s i z e f i t s a l l m o d e l not caring for patients specific ne e d s . T h i s h a s c o m e a s a r e s u l t o f m e d i c a l i s a t i o n w h i c h i n turn has been caused by a change i n o u r p e r s o n a l p e r c e p t i o n o f o u r o w n h e a l t h a n d u l t i m a t e l y money. With the threat of privatis a t i o n a n d t h e n e e d f o r e c o n o m y w e s e e m o r e a n d m o r e t h i s one size fits all model with large c e n t r a l i s e d h o s p i t a l s c o n t i n u i n g t o b e b u i l t r e s u l t i n g i n t h e closure of smaller local specialist u n i t s . B u t h o w d o e s a l l o f t h i s m a n i f e s t i t s e l f p h y s i c a l l y w i t h i n the architecture? By studying the Q u e e n ’s M e d i c a l C e n t r e N o t t i n g h a m I w i l l u s e i t t o c r i t i c a l l y appraise the institutionalised hosp i t a l t y p o l o g y a n d h o w i t w o r k s a l o n g s i d e u s i n g i t a s a foundation of how the hospital an d i t s s p e c i a l i s t u n i t s a r e f o r m a l l y a r r a n g e d . The Queen’s Medical Centre Nottin g h a m w a s o r i g i n a l l y c o n c e i v e d i n 1 9 6 4 a n d w a s s e t t o b e the first medical school outside th e c a p i t a l i n t h e 2 0 t h c e n t u r y. I n i t i a l l y a f e a s i b i l i t y s t u d y w a s carried out to see whether the me d i c a l s c h o o l c o u l d b e i n t e g r a t e d i n t o t h e e x i s t i n g N o t t i n g h a m general hospital. The feasibility st u d y s h o w e d t h a t t h e e x i s t i n g h o s p i t a l d i d n o t h a v e t h e infrastructure to sustain the medic a l s c h o o l s o a n e w h o s p i t a l w a s t o b e p r o p o s e d , d e s i g n e d b y Nottingham City Council. After ma n y l e g a l d i f f i c u l t i e s w i t h p r o c u r i n g a s i t e t h e i s s u e w a s f i n a l l y settled in 1971 for the hospital to b e s i t u a t e d o n t h e 1 7 h e c t a r e s i t e o f f D e r b y R o a d w e k n o w today. 1

Ib i d Ib i d 4 Ib i d 5 Ib i d 6 B B C , “ E u r o p e’s Largest Hospital to O p e n , ” B B C , June 7, 2011, sec. London, h t t p : / / w w w. bbc.co.uk/news/uk-englandl o n d o n - 1 3 6 8 3630.

The Site was originally home to a s m a l l h o u s i n g e s t a t e a n d i n d u s t r i a l w o r k s h o p s w h i c h w e r e used for joinery and carpentry. The s i t e w a s i d e a l f o r t h e h o s p i t a l b e i n g f l a n k e d o n a l l s i d e s b y roads for easy access. It was also i n c l o s e p r o x i m i t y t o t h e U n i v e r s i t y f o r t h e m e d i c a l s c h o o l a n d offered enough space for the size o f h o s p i t a l p r o p o s e d . A f t e r t h e p l a n n i n g s t a g e t h e p r o p o s e d hospital was to be the largest hos p i t a l i n t h e U K w i t h 1 4 0 0 b e d s , 1 0 0 0 o f w h i c h w o u l d b e f o r the acutely ill, 144 children beds, 1 6 8 a n d 3 0 c o t s f o r n e w b o r n b a b i e s s p e c i a l c a r e , 8 4 b e d s f o r generic patients and 175 bed for t h e m e n t a l l y i l l i n c l u d i n g 1 5 f o r c h i l d r e n . T h e r e w o u l d a l s o b e 9 theatres with respective observati o n w a r d s , A & E d e p a r t m e n t a n d r a d i o l o g y d e p a r t m e n t . 2

F i g u r e 1 1 O p posite Clockwise From Top Left: E x i s t i n g i n d u strial site of the QMC looking d o w n s p r i n g terrace, Phase one building the m e d i c a l s c h o ol and west block, QMC front w e s t b l o c k e ntrance upon completion 1977, s i x b a y b e d ward. F i g u r e 1 2 / 1 3 Overleaf: Development and i n i t i a l u s e o f the QMC proposed site (18841976).

The hospital was proposed to be a c e n t r a l a r e a o f s h a r e d s p e c i a l i s t s a c t i n g a s a c e n t r a l i s e d point of call for City Hospital and R o p e w a l k H o s p i t a l o f w h i c h t h e N H S t r u s t o f N o t t i n g h a m is now made. The proposal came u n d e r s t r o n g o p p o s i t i o n f r o m m a n y r e s i d e n t s s a y i n g i t w a s far too big and impersonal, who al s o r e s i s t e d t h e c l o s u r e o f o l d e r l o c a l m u c h l o v e d h o s p i t a l s . However something had to be done t o r e d u c e t h e p r e s s u r e o n t h e N o t t i n g h a m N H S s e r v i c e s . T h e hospital design came when much o f N o t t i n g h a m ’s i n n e r c i t y s l u m s w e r e b e i n g d e m o l i s h e d . M u c h like a lot of England, Ireland and S c o t l a n d d u r i n g t h e s l u m c l e a r a n c e s t h e i d e a o f m o d e r n i s m and centralisation were at the fore f r o n t o f t h i n k i n g . T h i s r e s u l t e d i n t h e e x i s t i n g h o s p i t a l s being centralised in a new ‘high ri s e ’ h o s p i t a l d e v e l o p m e n t . T h e H o s p i t a l p h a s e d c o n s t r u c t i o n programme overran by 4 years due t o N H S f u n d i n g i s s u e s b e i n g c o m p l e t e d i n 1 9 8 4 c o s t i n g a n estimated £70 million which is the e q u i v a l e n t t o £ 2 9 7 m i l l i o n t o d a y. J u s t t o p u t i t i n p e r s p e c t i v e today you could buy the whole Not t i n g h a m N H S t r u s t ( Q M C , C i t y a n d R o p e w a l k H o s p i t a l s ) , t h e new biomedical research unit and t h e n e w r a d i o t h e r a p y s p e c i a l i s t u n i t f o r j u s t £ 4 2 m i l l i o n . 3

2 3

The first phase of the Hospital wa s o p e n e d b y H e r M a j e s t y t h e Q u e e n , Q u e e n E l i z a b e t h I I i n 1977. The hospital upon competiti o n s u f f e r e d i n i t i a l t e e t h i n g p r o b l e m s . W h i l s t m e m b e r s o f t h e CHC said the hospital was ‘design e d f o r t h e p a t i e n t s ’ t h e H o s p i t a l h a d f u n d a m e n t a l i s s u e s w i t h way finding due to its sheer size t h a t n o a m o u n t o f s i g n p o s t i n g c o u l d r e m e d y. I t a l s o h a d i s s u e s with overheating on hot days, inap p r o p r i a t e c o m m u n i c a t i o n s y s t e m s , p o o r c a r p a r k i n g a n d a busy A&E department with long wa i t i n g t i m e s . T h e H o s p i t a l a l s o h a d o n s i t e a c c o m m o d a t i o n f o r staff said to be a complete contras t t o t h e h o s p i t a l b e i n g a n a t t r a c t i v e a n d l i v e l y h u m a n s c a l e building space. 4 When reading bet w e e n t h e l i n e s t h e s i z e a n d i m p e r s o n a l n a t u r e o f t h e h o s p i t a l was only favoured by health care p r o f e s s i o n a l s n o t t h e p u b l i c . T h e f i n a l s t a t e m e n t a b o u t t h e accommodation also raises concer n s a s t o w h y t h e h o s p i t a l w a s b u i l t a t s u c h a n o n h u m a n s c a l e and not being lively or attractive. B a s e d o n c o s t a l o n e S w i f t p r e d i c t e d t h a t h o s p i t a l s o f t h i s s i z e would never be seen again. 5 The Q M C w a s t h e l a r g e s t h o s p i t a l i n E u r o p e w i t h 1 4 0 0 b e d s h o w e v e r it was overtaken by The Royal Lon d o n i n 2 0 1 1 w h i c h c l a i m s t h e t i t l e b y f l o o r s p a c e b u t o n l y h a s 727 beds. 6 In 1984 the estimated c o s t o f t h e Q M C i n t o d a y s m o n e y w a s n e a r l y 3 0 0 m i l l i o n , b u t the royal cost a staggering 650 mi l l i o n s h o w i n g t h e s e s u p e r h o s p i t a l s a r e s t i l l b e i n g b u i l t a n d favoured over smaller developmen t s .

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F i g u r e 2 6 O p posite Left to Right: Entrance s e q u e n c e : A r rival via bus to the main e n t r a n c e , O f f axis pedestrian access, C o v e r e d s m o king area, Cranked approach to entrance. F i g u r e 2 7 R i ght: View back towards bus stop.

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At one time or another in our life m o s t o f u s w i l l h a v e b e e n t r e a t e d i n h o s p i t a l a n d I a m s u r e most would agree it is not the mos t p l e a s a n t p l a c e t o b e , l e t a l o n e r e c o v e r f r o m a m a j o r i n j u r y o r illness. I still remember my experi e n c e o f m y l o c a l h o s p i t a l n e a r l y 1 5 y e a r s a g o v i v i d l y i n g r a i n e d upon my memory. The endless hard p l a s t i c s u r f a c e s h a r s h l y l i t b y a r t i f i c i a l l i g h t i n g . T h e l a b y r i n t h of corridors with a multitude of id e n t i c a l d o o r s l e a d i n g o f f o f t h e m . T h e c o u n t l e s s s t a f f a n d patients in and around the corrido r s a n d w a i t i n g r o o m s w i t h n o n o t i c e a b l e v i e w s o u t . T h e h o t a n d dry open wards in which you â&#x20AC;&#x2DC;slep t â&#x20AC;&#x2122; [ b e t w e e n h o u r l y r o u t i n e c h e c k s ] u n p r o t e c t e d w i t h 5 o t h e r people one of which was a boy scr e a m i n g f r o m e x c e s s i v e b u r n s t o h i s b o d y. I a m n o t s u r e y o u c a n call that an ideal environment in w h i c h t o r e c o v e r. H o w e v e r w h a t I a l s o r e m e m b e r i s t h e g r e a t work the staff did and how friendl y a n d s u p p o r t i v e t h e y w e r e . H o w e v e r I c o u l d n o t h e l p t h i n k i n g this would have all been easier if t h e b u i l d i n g r e f l e c t e d t h e i r e s s e n c e . After all of the research and draw i n g i t w a s i m p o r t a n t f o r m e t o g e t a f i r s t h a n d f e e l f o r t h e conditions in the QMC. Having alre a d y b e e n t h e r e a n u m b e r o f t i m e s a s a p a t i e n t i t w a s n o w time for me to view it in a differen t m o r e c r i t i c a l l i g h t a s a n a r c h i t e c t . B e i n g a p u b l i c g e n e r a l hospital most areas were easily ac c e s s i b l e b u t I f e l t i t v e r y i m p o r t a n t t o b e s e n s i t i v e t o p a t i e n t s and nature of the work carried out w i t h i n t h e b u i l d i n g . I w a s l u c k y e n o u g h t o b e s h o w n a r o u n d b y hospital Pharmacist Alisha Patel w h o e x p l a i n e d t o m e t h e w o r k i n g s a n d f i n e r d e t a i l s o f c e r t a i n areas within the hospital and expl a i n c e r t a i n a r e a s o f s p e c i a l i s m t h a t I w a s u n f a m i l i a r w i t h . T h i s section will be my own personal a c c o u n t o f m y o b s e r v a t i o n s a n d e x p e r i e n c e s w h i l s t v i s i t i n g t h e QMC hospital. The first thing to notice was the e n t r a n c e s e q u e n c e . I a r r i v e d b y c a r b u t m a d e s u r e t o e n t e r the way patients would via the bu s , a s I w a s l a t e r t o l d t h a t d u e t o l i m i t e d p a r k i n g o n s i t e t h e bus was the most common access t o t h e h o s p i t a l . T h e e n t r a n c e i s i n i t i a l l y o b s c u r e d b y a s l i g h t effort at landscaping with pedestr i a n a c c e s s l e a d i n g d o w n e i t h e r s i d e . T h e e n t r a n c e i s a l m o s t entirely dominated by vehicular ac c e s s a n d p a r k i n g w i t h p e d e s t r i a n s b e i n g p u s h e d t o t h e s i d e s in a functional manner. As you wal k p a s t t h e f i r s t c o r n e r o f t h e v a s t s t r i p w i n d o w a n d b r i c k c l a d facade the first threshold in the fo r m o f a r o o f i n g c o v e r p r e s e n t s i t s e l f g r e e t i n g y o u w i t h t h e smell of the unofficial smoking are a a n d t h e f i r s t o f m a n y s i g n s i n f o r m i n g y o u t o w a s h y o u r h a n d s to prevent infection. Under the cov e r i s d a r k a n d o p p r e s s i v e w i t h y e t m o r e p e d e s t r i a n s p a c e eaten into by a corner bike store a s y o u a b r u p t l y c h a n g e d i r e c t i o n t o t h e e n t r a n c e . T h e e n t r a n c e is very understated again being co m p r i s e d b y a s e t o f f u n c t i o n a l e l e c t r i c d o o r s e n c l o s i n g a n empty lobby space. The entire surr o u n d s o f t h e s i t e i s d o m i n a t e d b y v e h i c u l a r a c c e s s a n d s t a f f parking, one making pedestrian ac c e s s d i f f i c u l t a n d t w o l e a v i n g n o p l e a s a n t e x t e r n a l s p a c e s f o r patients to use or even look at. 35

F i g u r e 2 8 O p posite. Aerial view of Q MC site. F i g u r e 2 9 R i ght Top: ‘Rest Seat’. F i g u r e 3 0 R i ght Bottom: Extensive use of signage.

The actual structure of the buildin g , s h o w n i n t h e p r e v i o u s p l a n s a n d p h o t o g r a p h s , s h o w i t is a frame structure with hung ext e r n a l c l a d d i n g . T h i s t y p e o f c o n s t r u c t i o n m e t h o d , w h i l s t revolutionary at the time, creates a r e p e a t i n g e x t r u d e d f l o o r p a t t e r n p r o v i d i n g f u n c t i o n a l s p a c e s . However it also provides a change a b l e f l o o r p l a n w h i c h i s v e r y i m p o r t a n t t o t h e h o s p i t a l t y p o l o g y and its future use. The constructio n m e t h o d a l s o f r e e d u p t h e f a c a d e e n a b l i n g t h e s u p p o r t f r e e strip windows most commonly ass o c i a t e d w i t h L e C o r b u s i e r. U l t i m a t e l y t h e s e t w o m a i n p o i n t s create generic non- specific space s w h i c h w o r k p u r e l y f u n c t i o n a l l y i n t h e c o m p o s i t i o n o f t h e hospital not engaging with the spe c i f i c u s e o f t h e i n t e r n a l s p a c e s m u c h l i k e a n o f f i c e b u i l d i n g which is how it appears from the o u t s i d e . From the outside the repeated ele m e n t s a n d h o m o g e n o u s l o o k c o n t i n u e . T h e e a r l i e r i s s u e s f o u n d at its opening of way finding still, e v e n t o t h i s d a y, p r o v e t o b e p r o b l e m a t i c . W i t h t h e Q M C having an estimated 27 miles of co r r i d o r s i t i s n o w o n d e r w h y t h i s i s t h e c a s e , a l o n g w i t h t h e fire risk assessment and works sa i d t o b e e q u i v a l e n t t o t h a t o f a s m a l l t o w n . I n s o m e a r e a s the corridors have uninterrupted ru n s o f a r o u n d 1 5 0 m e t e r s w i t h a m u s i n g l a b e l l e d y e t e n t i r e l y necessary ‘rest seats’. As oppose d t o u s i n g t h e a r c h i t e c t u r e t o a s s i s t w a y f i n d i n g m e t h o d s nothing has appeared to change in o v e r 3 0 y e a r s w i t h e x t e n s i v e s i g n a g e b e i n g p o s i t i o n e d a l l o f the hospital. With the majority of c o r r i d o r s b e i n g v e r y h o m o g e n o u s i n l o o k a n d a t m o s p h e r e a n d having very few views out the sign s a r e o n o f t h e o n l y w a y s t o i n f o r m p e o p l e w h e r e t o g o i n the vast complex. Whilst looking a r o u n d t h e h o s p i t a l A l i s h a a c t u a l l y g o t l o s t e v e n a f t e r w o r k i n g there for a number of years and sa i d “ I s t i l l f r e q u e n t l y g e t l o s t b e c a u s e a l l o f t h e c o r r i d o r s look the same”. The endless numb e r o f c o r r i d o r s s e e m e d l i k e l a b y r i n t h s . T h e m a j o r i t y o f d o o r s where left open which I feel helpe d u s f i n d o u r w a y b u t a l s o h e l p e d w i t h i n f e c t i o n c o n t r o l a s y o u were actively encouraged to touch t h i n g s o n l y w h e n n e c e s s a r y. A s a n a b l e b o d i e d p e r s o n t h i s increased my feeling of alienation a n d r e i n f o r c e d t h e i n h u m a n n a t u r e a n d s c a l e o f t h e h o s p i t a l which must have been far worse fo r t h o s e a s a c t u a l p a t i e n t s .

F i g u r e 3 1 O p posite Top: Hospital corridors i n r e l a t i o n t o block. F i g u r e 3 2 O p posite Bottom: Views to i n t e r n a l c o u r tyards from wards. F i g u r e 3 3 R i ght Top: Corridor laminated handrail. F i g u r e 3 4 R i ght Bottom: Staircase handrail detail.

In some areas the corridors were c o l o u r e d i n r e l a t i o n t o b l o c k s t h e y r e l a t e d t o g i v i n g s o m e i d e a of where you were positioned with i n t h e h o s p i t a l . H o w e v e r t h i s s t i l l d i d n o t s o l v e t h e i s s u e o f what floor you were on, or where y o u w e r e w i t h i n t h e b l o c k s w h i c h i n t h e m s e l v e s w h e r e v a s t . I n figure 30 we can see the variety o f d i f f e r e n t b l o c k a s a l l o c a t e d b y c o l o u r : w h i t e b e i n g c e n t r a l , rainbow being paediatrics and gre e n b e i n g m e d i c a l . A s i d e f r o m a i d i n g t h e w a y f i n d i n g p r o b l e m I can only see the colours being us e d i n a f u n c t i o n a l w a y. P e r h a p s t h e r a i n b o w c o l o u r s a r e i n some way appropriate for the paed i a t r i c w a r d s b u t f u n d a m e n t a l l y i t w a s s t i l l a n a d u l t h o s p i t a l with painted walls. As seen in the c e n t r a l c o r r i d o r s t h e y a l s o u s e y e l l o w s p o t s t o g u i d e p e o p l e to the medical school. However as A l i s h a p o i n t e d o u t u n l e s s y o u k n e w t h a t i s w h a t t h e y w e r e f o r there was no way of knowing. I kn o w t h i s i s a s i m i l a r m e t h o d u s e d b y o t h e r h o s p i t a l s w h e r e t h e y paint lines on the floors to guide p e o p l e a s t h e r e i s v e r y l i t t l e p l a c e m a k i n g a n d r e f e r e n c e p o i n t s within the actual architecture to o r i e n t a t e y o u r s e l f . In relation to the corridors and blo c k s I a l s o l o o k p i c t u r e s o f t h e i n t e r n a l c o u r t y a r d s w h i c h a r e positioned below their respective b l o c k s ( w h e r e t h e r e w e r e t h e o c c a s i o n a l v i e w s ) . A l l o f t h e courtyards seemed to be used for a p u r e l y f u n c t i o n a l r e a s o n s l i k e c a r p a r k i n g o r d e l i v e r i e s . T h e y also lacked any distinction, making i t d i f f i c u l t t o u s e t h e m a s n o d a l p o i n t s o n y o u r j o u r n e y. A p a r t from occasional light the courtyard s a d d e d n o t h i n g t o t h e a t m o s p h e r e o f t h e h o s p i t a l a n d g a v e no sense of place. Not being able t o p h o t o g r a p h w a r d s A l i s h a i n f o r m e d m e t h a t t h e p a t i e n t s v i e w was external as opposed to intern a l w i t h t h e m a j o r i t y o f o f f i c e s f a c i n g t h e c o u r t s . B u t l o o k i n g at the plans and knowing the area , w h i l s t s o m e w h a t i m p r o v e d , I a m n o t s u r e t h e v i e w o f t h e A52, Derby road and surrounding e s t a t e s a r e m u c h b e t t e r. E v e n w i t h t h i s a s t h e c a s e i t f e l t l i k e a severely missed opportunity not o n l y t o a i d t h e w a y f i n d i n g t h r o u g h o u t t h e h o s p i t a l b u t a l s o t o improve to feeling of the place. In terms of the atmosphere and fe e l i n g o f p l a c e t h e h o s p i t a l s m a t e r i a l p a l e t t e w a s v e r y l i m i t e d . The materials used throughout the e n t i r e h o s p i t a l w e r e e x a c t l y t h e s a m e a l l o w i n g f o r t h e occasional colour change adding t o t h e h o m o g e n o u s a n d g e n e r i c f e e l i n g . T h e m a i n m a t e r i a l s where vinyl flooring, painted plast e r w a l l s a n d c e i l i n g , m e t a l f o r b u t t o n s a n d p u s h p l a t e s , t h e occasional use of timber where it w o u l d n o t b e t o u c h e d a n d l a m i n a t e d s u r f a c e s t o b e m a d e t o look like timber or stone. I unders t a n d t h a t t h e s e m a t e r i a l s a r e c h e a p a n d f u n c t i o n a l i n t e r m s o f infection control. However this lea v e s t h e b u i l d i n g f e e l i n g d a t e d a n d i n h u m a n a s e v e r y s u r f a c e is harsh and hard. The limited num b e r o f h a n d r a i l s a n d h a n d l e s o f w h i c h w e r e a c t u a l l y m e a n t f o r touching were again very cold and h a r d t o t o u c h i n c o m p a r i s o n t o t h e d r y w a r m t h t h r o u g h o u t t h e hospital.

F i g u r e 3 5 O p posite: New refurbished high d e p e n d e n c y ward. F i g u r e 3 6 R i ght Existing general ward.

A large part of a hospital is the w a r d s i n w h i c h p a t i e n t s w i l l s p e n d t h e m a j o r i t y i f n o t a l l o f their time laying in a bed. Aside fr o m b e i n g g e n e r i c a n d f u n c t i o n a l I w a n t e d t o k n o w h o w m u c h control patients had of their envir o n m e n t i n r e l a t i o n t o c o m f o r t a n d p r i v a c y. A l i s h a t o l d m e w a r d s consist of bays which in turn conta i n s i x b e d s ( f o u r f o r s p e c i a l i s t w a r d s ) a m o u n t i n g t o o n a v e r a g e 24 beds per ward. The wards woul d t h e n h a v e a l i m i t e d n u m b e r o f s i d e r o o m s f o r p r i v a t e u s e but these would only be used for q u a r a n t i n i n g o f i n f e c t i o u s d i s e a s e s . B o t h t h e w a r d s a n d s i d e rooms have very little control espe c i a l l y f o r t h e p a t i e n t s . T h e e x t e n t o f c o n t r o l e x t e n d s t o p u l l i n g a curtain around your bed for sligh t l y u n d i g n i f i e d p r i v a c y a n d b e i n g a b l e t o a d j u s t y o u r b e d b u t that was all. Patients could not ch a n g e t h e h e a t i n g o r e v e n o p e n a w i n d o w. I m p o r t a n t l y o n a w a r d unlike other buildings striking a ba l a n c e b e t w e e n p r i v a c y a n d o b s e r v a t i o n a r e k e y. F r o m p e r s o n a l experience when visiting my grand a d i n h o s p i t a l t h e p r o x i m i t y o f t h e b e d s f e l t v e r y i n v a s i v e a n d not private at all. With limited pri v a c y o r e v e n c o n t r o l w i t h i n t h e e n v i r o n m e n t o f t h e p a t i e n t s t h e space again feels alien. Nothing is m e a n t t o b e t o u c h e d c r e a t i n g a d e t a c h m e n t f r o m n o t o n l y t h e outside world but the world within t h e h o s p i t a l a s w e l l . Although The Queen’s Medical cen t r e i s n o t a s t a t e o f t h e a r t h o s p i t a l b u i l t i n t h e 1 9 8 0 s i t h a s been established that the one size f i t s a l l t y p o l o g y h a s b e e n i n c r e a s i n g l y u s e d a s t h e p r i m a r y health care typology for hospitals a n d t h e N H S . A s o n e o f t h e f l a g s h i p N H S h o s p i t a l s i n t h e country the QMC suffers from the s a m e p r o b l e m s a s m o s t o f t h e N H S h o s p i t a l s t o c k . A l t h o u g h I already had good idea of the fail i n g s o f t h e Q M C t h e v i s i t t o l d m e a l o t a b o u t k e y i s s u e s w i t h this typology and allowed me to e x p e r i e n c e i t , c r i t i c a l l y, f i r s t h a n d f r o m a n a r c h i t e c t u r a l p o i n t of view. Initially from drawing the Q M C i t a p p e a r e d t o h a v e a c l e a r s e p a r a t i o n o f s i x b l o c k s a n d functions within these blocks. Wh e n a n a l y s i n g t h e a g g r e g a t i o n o f i m p o r t a n t f u n c t i o n s i t f o l l o w e d a clear logic, typically with integra t e d s p e c i a l i s m s w i t h i n t h e s a m e b l o c k o r e v e n f l o o r a n d t h e more general departments either c e n t r a l l y o r i n a n o t h e r b l o c k . H o w e v e r w h e n e x p e r i e n c e d i n reality this does not seem to trans l a t e . I h a v e f o u n d m a n y o f t h e e l e m e n t s w i t h i n t h e h o s p i t a l are employed to mediate against i t s a r c h i t e c t u r a l f a i l i n g s . W h i l s t i t h e l p s t o s o m e d e g r e e i t does not cure the fundamental ing r a i n e d i s s u e s t h a t c o m e o f l a r g e h o m o g e n e o u s l y b u i l t g e n e r a l hospitals. Through the lack of arch i t e c t u r a l a r t i c u l a t i o n a n d c o n s i d e r a t i o n t h e p u r e l y f u n c t i o n a l homogenised internal and external f e a t u r e s o f t h e h o s p i t a l c r e a t e d i f f i c u l t l y w i t h o r i e n t a t i o n and connection. But more importan t l y t h i s t y p e o f d e s i g n l e a v e n o n - s p e c i f i c ‘ s p a c e s ’ i n w h i c h patients are treated with chronic i s s u e s o f p r i v a c y, w h i c h a s w e h a v e f o u n d m a k i n g i t d a n g e r o u s for some patients, rather than spe c i f i c ‘ p l a c e s ’ i n w h i c h p e o p l e c a n f e e l c o m f o r t a b l e w h e n recovering from significant life ch a n g i n g i l l n e s s e s .

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C A B E , “ R a d i cal Improvements in Hospital D e s i g n C A B E Healthy Hospitals” (CA BE, 2003). 2 F l o r e n c e N i ghtingale, Notes on Nursing ( L o n d o n : L o n don Harrison and sons, 1860). 3 C A B E , “ R a d i cal Improvements in Hospital D e s i g n C A B E Healthy Hospitals” (CA BE, 2003). 4 C A B E , “ T h e Value of Good Design: How B u i l d i n g s a n d Spaces Create Economic and S o c i a l Va l u e ” (Bartlett School of Planning, 2002). 5 Ib i d . 6 C A B E , “ R a d i cal Improvements in Hospital D e s i g n C A B E Healthy Hospitals.” 1

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“For decades, the design environm e n t h a s p l a y e d a m a r g i n a l r o l e i n t h e h e a l t h c a r e i n d u s t r y, w i t h the focus being on clinical needs. H o w e v e r, t h e r e i s i n c r e a s i n g u n d e r s t a n d i n g a n d e v i d e n c e t h a t the design of the healing environm e n t i m p a c t s o n p a t i e n t r e c o v e r y a n d o n s t a f f ; a n d t h a t g o o d quality staff environments impact p o s i t i v e l y o n p a t i e n t c a r e , a n d v i c e v e r s a ” 1 The understanding of the importan c e o f t h e h e a l i n g e n v i r o n m e n t i s r e l a t i v e l y n e w i n t e r m s of research but has always know t o b e i m p o r t a n t , b e i n g w r i t t e n a b o u t o v e r 1 5 0 y e a r s a g o b y Florence Nightingale. 2 The amount o f s c h o l a r l y w r i t i n g s a n d r e s e a r c h o n t h e t o p i c i s r e l a t i v e l y limited but quickly expanding. CAB E p r o v i d e a c o h e s i v e a n a l y s i s o f t h e b e n e f i t s o f w e l l d e s i g n e d healing environments backed up by v a s t a m o u n t s o f d a t a c o l l e c t e d r e c e n t l y w h e r e t h e y a n a l y s e new and old hospital units and me a s u r e t h e a f f e c t s i t s h a s o n b o t h s t a f f a n d p a t i e n t s i n t e r m s o f factors such as recovery, well bein g a n d d r u g i n t a k e . Looked at ‘clinically’ the overall co n s t r u c t i o n c o s t o f t h e l i f e t i m e o f a h o s p i t a l w i l l b e 0 . 3 - 0 . 5 % with the running of this type of pu b l i c s e r v i c e s i t t i n g a t a r o u n d 8 5 % . I t w o u l d t h e n m a k e s e n s e that the design process will have t h e l a r g e s t i n f l u e n c e o v e r t h i s 8 5 % . 3 A f e w e x a m p l e s t h a t rightly or wrongly ‘quantify’ the pe r f o r m a n c e o f h o s p i t a l s s h o w h o w t h e q u a l i t y o f d e s i g n c a n benefit both patients and hospital s . T h e p u r p o s e b u i l t M i l l v i e w p s y c h i a t r i c h o s p i t a l i n H o v e w a s compared with two older units in F r e s h f i e l d M e n t a l H e a l t h U n i t w i t h i n B r i g h t o n M e d i c a l H o s p i t a l , located in a former Victorian work h o u s e a n d s a w a r e d u c t i o n i n s t a y t i m e o n n e w w a r d s b y 1 4 % (36.5 days compared to 42.4 days a v e r a g e s t a y ) . 7 9 % o f p a t i e n t s m a d e g o o d p r o g r e s s u p f r o m 60% and verbal outbursts and thre a t e n i n g b e h a v i o u r r e d u c e d b y 2 4 % a n d 4 2 % r e s p e c t i v e l y. 4 Similarly at the Queen’s Medical C e n t r e c a r d i o l o g y w a r d N o t t i n g h a m , a t e s t w a s d o n e w h e r e t h e ward was refurbished with enhanc e d l i g h t i n g , b e t t e r d e s i g n e d s e a t i n g , b e d a n d f a c i l i t i e s a n d larger windows and waiting area. T h i s r e s u l t e d i n p a t i e n t s w i t h l o w e r h e a r t r a t e s , l o w e r b l o o d pressure and lower prescribed dru g i n t a k e s r e s u l t i n g i n a p o s t o p e r a t i o n s t a y o f 8 d a y s d o w n f r o m 11. 5 Whilst looked at clinically thr o u g h t h e r e s u l t i n g n u m b e r s t h i s s h o w s t h a t a m o r e c o n s i d e r e d design results positively both phys i c a l l y a n d m e n t a l l y u p o n p a t i e n t s a n d s t a f f . H o w e v e r t h e examples from CABE cater for indi v i d u a l c a s e s o r u n i t s o f a h o s p i t a l a n d t h e d e s i g n o f h o s p i t a l s that cater for a multitude of clinic a l c a r e n e e d s i s v e r y c h a l l e n g i n g , p a r t i c u l a r l y g i v e n t h e p a c e o f technology. 6

P r o f e s s o r B r yan Lawson and Dr Michael P h i r, T h e A r c hitectural Healthcare E n v i r o n m e n t and Its Effects on Patient H e a l t h O u t c o mes. 8 Ib i d 9 Ib i d 10 Ibid 11 Ibid 12 Ibid 7

Brain Lawson is one of the leading a r c h i t e c t s i n t h e f i e l d o f t h e h e a l i n g e n v i r o n m e n t . H e p r o v i d e d much of the research regarding the M i l l v i e w p s y c h i a t r i c h o s p i t a l a n d B r i g h t o n M e d i c a l H o s p i t a l case study and has contributed ma s s i v e l y t o t h e r e s e a r c h w i t h i n t h i s f i e l d . B y l o o k i n g m o r e deeply into the case of Mill View a n d B r i g h t o n H o s p i t a l s L a w s o n , o v e r a f o u r y e a r p e r i o d a t N H S Trust Poole, demonstrates the ben e f i t s o f a p a t i e n t d r i v e n d e s i g n e t h o s a s o p p o s e d t o a m e d i c a l one to improve the current state o f m o d e r n h o s p i t a l d e s i g n . W h i l s t r a i s i n g n e w o n e s , m a n y o f the points made in this section rep e a t p o i n t s f r o m m y o w n f i r s t h a n d f i n d i n g s a t Q M C b u t m o r e importantly back up the common is s u e s f o u n d a c r o s s h o s p i t a l s t o d a y. From the outset of the investigatio n t h e f a m i l i a r r e s i s t a n c e t o t h i s i d e a r a i s e d i t s h e a d a g a i n coming from one of Lawson’s Colle a g u e s . “ I t h i n k w e w a s t e a l o t o f e f f o r t a s k i n g p e o p l e i n t h a t state (ill in hospital) what they th i n k o f t h e a r c h i t e c t u r e . I t ’s v a i n o f u s a n d w e d o n ’t a c t u a l l y find out very much“ 7 This was base d o n t h e a s s u m p t i o n t h a t p a t i e n t s w o u l d h a v e f a r t o o m u c h on their minds to focus or even no t i c e t h e i r e n v i r o n m e n t . 8 H o w e v e r a s t h e r e s u l t s w i l l s h o w this was a false generalisation wi t h p a t i e n t s a c t u a l l y b e i n g m o r e s e n s i t i v e a n d s u s c e p t i b l e to their environments due to long p e r i o d s s p e n t l y i n g d o w n w i t h i n f r e q u e n t c o n t a c t o r v i s i t s . 9 It also ignore the fact that the env i r o n m e n t d o e s n o t h a v e t o b e a c t i v e l y c o m p r e h e n d e d t o b e experienced. From the findings a number of inte r e s t i n g p o i n t s c a m e t o l i g h t r e i n f o r c e d b y t h e e v i d e n c e f r o m the study. Aside from discovering t h a t p a t i e n t s a r e i n f a c t m o r e s u s c e p t i b l e t o t h e i r e n v i r o n m e n t (reinforcing CABE’s 85% figure) th e s t u d y s a w a n a v e r a g e 2 1 % i m p r o v e m e n t i n r e c o v e r y t i m e s in non- operative patients. Staff tr e a t m e n t s a n d c a r i n g w a s a l s o r a t e d m o r e h i g h l y a n d t h e r e was less need for class A analges i c m e d i c a t i o n . 1 0 A s a b e n e f i t o f c r e a t i n g a b e t t e r e n v i r o n m e n t compared to the older units the at m o s p h e r e f o r p a t i e n t s w a s g r e a t l y i m p r o v e d p r o v i d i n g b e t t e r quality of life during their recover y p e r i o d . T h i s w a s c a u s e d b y g e n e r i c p l a c e m a k i n g a r c h i t e c t u r a l features rather than hospital spec i f i c o n e s . 1 1 W h i l s t n o t f u n c t i o n a l i n t h e h o s p i t a l e n v i r o n m e n t the simple act of considered desig n a n d p l a c e m a k i n g s e e m s t o h a v e h a d a d r a s t i c e f f e c t o n patients across the new units in co m p a r i s o n t o t h e o l d e r o n e s . Another key point found in the stu d y w a s t h e i s s u e s w i t h p r i v a c y a s w e l l a s c o m m u n i t y. P a t i e n t s had strong opinions on privacy in f a v o u r o f c o m m u n a l w a r d s , w i t h p a t i e n t s d o i n g b e t t e r i n t h e i r own preferred selection of ward/ a c c o m m o d a t i o n . T h i s w a s a l s o r e i n f o r c e d b y t h e i r p r e f e r e n c e for comfort and control over their i m m e d i a t e e n v i r o n m e n t w i t h n o i s e b e i n g a s p e c i f i c p r o b l e m a t the old Brighton Hospital. 12 As fou n d i n t h e Q M C p r e c e d e n t a s w e l l a s m a n y o t h e r h o s p i t a l s w a r d s come in 6 bed bays with a variety o f d i f f e r e n t n u m b e r s o f b a y s o n a w a r d . T h e o n l y p r i v a c y a n d protection on the wards is a pull c u r t a i n w h i c h s u r r o u n d s t h e b e d p r o v i d i n g a s l i g h t l y u n d i g n i f i e d level of privacy cutting out no nois e a n d t h e b e d s b e i n g a d i s t a n c e a p a r t t h a t f e e l s t o i n f r i n g e upon other peoples privacy. The cu r t a i n i s t h e o n l y l e v e l o f c o n t r o l f o r a p a t i e n t s e n v i r o n m e n t aside from sometime being able to a d j u s t t h e b e d w i t h a d i s p r o p o r t i o n a t e l e v e l o f s i d e r o o m s

R o g e r S U l trich, “View Through a Window M a y I n f l u e n c e Recovery from Surgery,” S c i e n c e , n o . 224 (1984): 420–21. 14 P r o f e s s o r B ryan Lawson and Dr Michael P h i r, T h e A r c hitectural Healthcare E n v i r o n m e n t and Its Effects on Patie nt H e a l t h O u t c o mes. 15 N a n c y G e r l ach-Spriggs, Richard Kaufman, a n d S a m B a s s Warner Jr, Restorative G a r d e n s : T h e Healing Landscape (New H a v e n : Ya l e University Press, 2004). 16 C A B E , “ R a d ical Improvements in Hospital D e s i g n C A B E Healthy Hospitals.”. 17 bid. 18 G i o v a n n a a nd Zardini, Imperfect Health, T h e M e d i c a l i zation of Architecture. 13

provided for single patients. As fo u n d i n t h e s t u d y t h e c o n t r o l a n d c o m f o r t o f a p a t i e n t s environment makes them feel psyc h o l o g i c a l l y b e t t e r a n d m o r e c o m f o r t a b l e a n d h e l p s t h e m o n t h e road to recovery. Control of an environment can be a s s i m p l e a s b e i n g a b l e t o o p e n a w i n d o w. I n a S t u d y b y R o g e r S. Ultrich found that patients that c o u l d o p e n a w i n d o w w e r e m o r e l i k e l y t o b e d i s c h a r g e d f r o m hospital earlier than those withou t . 1 3 I m p o r t a n t t o t h i s w a s a l s o t h e q u a l i t y o f t h e v i e w o u t o f the window. Bryan Lawson found t h a t p a t i e n t s p r e f e r r e d v i e w s o u t o f a w i n d o w a n d t h a t q u a l i t y views of nature had a calming effe c t . 1 3 I n a m o r e s p e c i f i e d s t u d y o f t h i s p h e n o m e n a G e r l a c h Spriggs, Kaufman and Bass in Rest o r a t i v e G a r d e n s : T h e H e a l i n g L a n d s c a p e s a y “ Vi e w s o f n a t u r e seem to provide the preferred form o f p h y s i o l o g i c a l l y m e a s u r a b l e s t r e s s r e d u c t i o n . T h e r e l a x a t i o n occurs remarkably quickly - almost w i t h i n m i n u t e s . ” 1 5 S i m p l e e l e m e n t s o f c o n t r o l f o r p a t i e n t s through a considered design can h a v e e n o r m o u s l y p o s i t i v e e f f e c t s o n p a t i e n t s r e d u c i n g s t r e s s a n d helping them recover. From the Vic t o r i a n e r a , a s f o u n d i n m y t y p o l o g i e s a n d c h a n g e s t u d y, t h e integration of nature (Gardens) an d h e a l t h h a s b e e n t o t a l l y l o s t , n o t b e i n g s e e n a s a v a l u a b l e asset to the health care profession . The studies by CABE and Bryan Law s o n l o o k a t a n u m b e r o f h o s p i t a l s i n v e s t i g a t i n g t h i s correlation between design, patien t r e c o v e r y a n d e x p e r i e n c e o f t h e s p a c e . “ A h o s p i t a l i s t h e site of some of our best and worst e x p e r i e n c e s , t h e s i t e o f d e a t h a n d b i r t h , h e a l i n g a n d l o s s . Of all the public buildings, they sh o u l d b e t h e o n e s t h a t a r e b u i l t w i t h t h e g r e a t e s t c a r e a n d imagination.” 16 From the studies C A B E g o o n t o s u g g e s t i m p o r t a n t c h a n g e s n e e d e d t o b e m a d e in the health care typology: Urban i n t e g r a t i o n , c o n v i v i a l , u n c l u t t e r e d , c a l m a n d w e l l s c a l e d entrances, high quality landscape, e a s y n a v i g a t i o n , p l a n n e d s t o r a g e , s e c u r e a n d c o m f o r t a b l e private and public spaces and the n e e d f o r a d a p t a b i l i t y. 1 7 A l l o f t h e s e s e e m f a i r l y o b v i o u s w h e n thought about and move towards a n i m p r o v e d h e a l t h t y p o l o g y b u t t h e k e y i s s u e o f s p e c i f i c i t y f o r patients is not addressed. Realisti c a l l y i t i s d i f f i c u l t t o i n t e g r a t e h o s p i t a l s i n t o a n u r b a n r e a l m due to their sheer size which is wh y m o s t o f t h e t i m e t h e y a r e s e t w i t h i n s u b u r b s o r f r i n g e s o f cities. When thinking in terms of u r b a n i n t e g r a t i o n , h u m a n i s t i c s c a l e , i n f e c t i o n c o n t r o l a n d t h e rethinking of the one size fits all a p p r o a c h , p e r h a p s a d i s a g g r e g a t e d h o s p i t a l t y p o l o g y w o u l d b e more appropriate in the current de m e d i c a l i s a t i o n o f t h e i n s t i t u t i o n a l i s e d h o s p i t a l m o d e l . B u t o n e thing is certain the “quality of “Tr e a t m e n t ” l i e s n o t o n l y i n t h e s o l u t i o n t o a p a r t i c u l a r p r o b l e m or assumption of a directly therape u t i c r o l e - m o r e s o i n t h e a d d e d v a l u e c r e a t e d w h e n s o c i a l a n d environmental assets are incorpor a t e d i n t o t e c h n i c a l o r m e d i c a l s o l u t i o n s . ” 1 8

3 .4

Therapeutic

Ma k i n g

R L S t a r i c o f f and J Duncan, “A Study of the E f f e c t s o f t h e Visual and Performing Arts in H e a l t h c a r e , ” Hospital Development 6, no. 32 ( 2 0 0 1 ) : 2 5 – 2 8. 1

F i g u r e 3 7 O p posite: Two collograph prints of t h e G i a n t ’s C auseway. F i g u r e 3 8 To p: Two Collograph plates using c u t t i n g , s c o r ing, sanding, pva gluing, t e x t i l e s a n d waxing to achieve a variety of print effects. F i g u r e 3 9 R i g ht: Printing detail showing the d i f f e r e n t e f f ects of cutting and applying p o l i s h i n g w a x to create contrasting dark a n d c r a c k i n g patterns.

P r i n t

M a k i n g

Wo r k s h o p

On a slight tangent, one I will not l i n g e r o n f o r l o n g , i s t h i s i d e a s t a t e d p r e v i o u s l y t h a t t h e healing environment plays a large r o l l o n t h e p a t i e n t s b e c a u s e o f t h e i r c o n d i t i o n b u t a l s o b e c a u s e they have a large amount of time t o c o m p r e h e n d i t . I n c o n j u n c t i o n t o r e - T h i n k t h e R e g i o n a n d t h i s thesis document we, as a unit, und e r t o o k a n u m b e r o f w o r k s h o p s a n d f i e l d t r i p s . T h i s p r o m p t e d the title of therapeutic making as a w a y i n w h i c h m a k i n g c a n b e b e n e f i c i a l t o p a t i e n t s r e c o v e r y by giving them something to keep a c t i v e m u c h l i k e S t a r i c o f f ’s a n d D u n c a n ’s p a p e r o n t h e s t u d y o f the effects of the visual and perfo r m i n g a r t s i n h e a l t h c a r e . 1 When I took part in the print maki n g w o r k s h o p w i t h P a t r i c i a F e r g u s o n I w a s s u f f e r i n g f r o m w h a t later turned out to be Tonsillitis. A f t e r a r r i v i n g a t t h e w o r k s h o p a n d f e e l i n g t e r r i b l e t h e a c t o f making in this way took my mind o f f t h e i l l n e s s a n d h e l p e d m e f e e l m e n t a l l y a l o t b e t t e r. T h e process of collography (layering a n d c u t t i n g i n t o a c a r d p l a t e ) d i d n o t t a k e m u c h s t r e n g t h o r effort at all and the process and a l m o s t b e n e f i t t e d f o r a m o r e s u b t l e s e n s i t i v e h a n d .

3 .4

Therapeutic

Ma k i n g

R u t h M o r r o w, “Tactility Factory” (In formal D i s c u s s i o n , Belfast, April 11, 2014). 3 Ib i d . 2

F i g u r e 4 0 O p posite: Curved concrete panel a n d v e l v e t t extile. F i g u r e 4 1 R i ght top: Concrete and crystal panel. F i g u r e 4 2 R i ght bottom: Concrete panel i n l a i d w i t h c otton.

R u t h

M o r r o w

Ta c t i l i t y

F a c t o r y

“The aim to make all hard things s o f t ” - R a t i o n a l i s i n g m a d i d e a s t h r o u g h t e c h n o l o g y. The tactility factory run by Ruth M o r r o w ( A r c h i t e c t ) a n d Tr i s h B e l f o r d ( Te x t i l e s ) a l s o f o c u s e s o n printing technologies, but not the t y p i c a l p r i n t i n g m o s t w o u l d i n s t a n t l y t h i n k o f . T h e t a c t i l i t y factory uses chemical and mechan i c a l d i s t o r t i o n w i t h i n t h e s p e c i f i c c o m b i n a t i o n o f t e x t i l e s a n d concrete to create tactile objects t h r o u g h p r o c e s s r e s u l t i n g i n t h i n g s t o t o u c h . 2 T h i s b r i n g i n g together of contrasting cultures cr e a t e s a s h i f t i n a r c h i t e c t u r e r e a w a k e n i n g a s t r a t e g i c l i n k to material experience. Through ‘T h e r a p e u t i c m a k i n g ’ 3 a k n o w - h o w h a s b e e n d e v e l o p e d w i t h i n this unique field of research. Whe n I s a y k n o w - h o w I m e a n a k n o w l e d g e t h a t h a s a c u l t u r a l a n d practice basis such as the relation s h i p a m e c h a n i c o r c a r p e n t e r h a s w i t h t h e i r o w n p e r s o n a l workshop. I found this visit particularly inter e s t i n g b e c a u s e o f t h e i d e a o f b r i n g i n g t o g e t h e r c o n t r a s t i n g cultures to create innovative resul t s . T h i s b r o u g h t t o m i n d t h e a n a l o g y o f t h e s o f t n e s s o f h o m e combining with the hard harsh env i r o n m e n t o f a h o s p i t a l b u i l d i n g a n d h o w s e l e c t e d a r e a s c a n b e revealed, contrasting the functiona l h a r d e l e m e n t s w i t h t h e t a c t i l e s o f t e l e m e n t s b u t , w o r k i n g together to produce an overall ma t e r i a l e x p e r i e n c e . I a l s o f o u n d t h e t e c h n i c a l a n d p r a c t i c a l aspects interesting, specifically th e a p p l i c a t i o n s t h a t t h e t e c h n o l o g y c o u l d b e u s e d f o r s u c h a s having the textile coated with tita n i u m o x i d e t o a b s o r b p o l l u t i o n d i s c o l o u r i n g t h e m o r e p o l l u t i o n is absorbed. Another important aspect was the o v e r a l l m a n u f a c t u r i n g p r o c e s s t h a t t h e t a c t i l i t y f a c t o r y had developed. All trades and spe c i a l i s t s k i l l s / e q u i p m e n t w e r e a v a i l a b l e o n s i t e c r e a t i n g a level of control and autonomy with i n t h e p r o c e s s b u t m a i n t a i n i n g t h e i r o w n s p e c i f i c i d e n t i t y. When thinking of hospitals in term s o f a p r o c e s s , t h e s a m e p r i n c i p a l o f h a v i n g a l l s p e c i a l i s t departments and skills aggregated w i t h i n o n e a r e a t o c r e a t e t h i s a u t o n o m y a n d c o n t r o l s e e m s appropriate but with an emphasis o n m a i n t a i n i n g t h e i r o w n s p e c i f i c i t y i n t e r m o f d e s i g n . The Tactility Factory was quite ins i p i r a t i o n a l f o r m e . T h r o u g h t h e m e d i u m o f m a t e r i a l i t y t h e hardness of concrete was redefine d u s i n g a v e r y i n t i m a t e h u m a n p r o c e s s a n d o b j e c t ; Te x t i l e s . Process and object became one an d t h e s a m e i n f o r m i n g e a c h o t h e r t o p r o d u c e s o m e t h i n g u n i q u e to experience at a human level. As i d e f r o m t h e n u m e r o u s l y i n t e r e s t i n g t e c h n i c a l a n d c r e a t i v e aspects, it really opened my eyes a s t o h o w t w o o p p o s i n g t e c h n o l o g i e s a n d c u l t u r e s c a n w o r k together to create something truel y r e m a r k a b l e .

F i g u r e 4 3 O p posite: Various tile sam ples t e s t i n g d i f f e rent materials. F i g u r e 4 4 To p: MARS at the Tactility F a c t o r y. F i g u r e 4 5 C e ntre: Soft door handle detail. F i g u r e 4 6 R i ght: Ruth Morrow and th e Martians.

3 .5

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Effe c t

P r o f e s s o r B ryan Lawson and Dr Mic hael P h i r, T h e A r c hitectural Healthcare E n v i r o n m e n t and Its Effects on Patient H e a l t h O u t c o mes (Sheffield: School of A r c h i t e c t u r a l Studies, University of Sheffie, 2 0 0 3 ) , h t t p : / /www.wales.nhs.uk/sites3/ d o c u m e n t s / 2 54/ArchHealthEnv.pdf. 2 A r c h i t e c t s Journal, “Royal College of P h y s i c i a n s , ” Architects Journal, 2012, h t t p : / / w w w. ajbuildingslibrary.co.uk/ p r o j e c t s / d i s play/id/2962. 1

F i g u r e 4 7 O p posite: Lower Ground Floor P l a n o f D e n i s Lasdun’s Royal College of P h i s i c i a n s B uilding. F i g u r e 4 8 To p: Section Taken Through .

H e a l i n g

A r c h i t e c t u r e

P r e c e d e n t

S t u d i e s

As hinted at in a round about way i n t h e l a s t c h a p t e r w h e n l o o k i n g a t R u t h M o r r o w ’s w o r k t h e difficulties and opportunities will l i e i n s p e c i f y i n g w h e r e t h e a r c h i t e c t u r e l i e s a s a n a c t o f general place making in contrast t o h o s p i t a l s p e c i f i c e l e m e n t s a s L a w s o n s t a t e d p r e v i o u s l y. 1 This is clearly shown in Denys Las d u n ’s R o y a l C o l l e g e o f P h y s i c i a n s w h e r e t h e b r i e f c l e a r l y defined functional spaces, being t h e s t r a t i f i e d l a y e r i n g f r o n t i n g t h e s t r e e t , a n d t h o s e w h i c h would benefit from architectural p l a c e m a k i n g , s u c h a s t h e c o n n e c t i v e c i r c u l a t i o n s p a c e s a n d auditorium. 2 As stated before I have studied alo n g s i d e N o t t i n g h a m ’s Q u e e n ’s M e d i c a l C e n t r e a m i x e d variety of what I class as good pre c e d e n t s t h a t e x p l o r e h e a l i n g a r c h i t e c t u r e . M u c h l i k e t h e QMC these represent a physical m a n i f e s t a t i o n o f ‘ g o o d d e s i g n ’ d i s c u s s e d i n T h e Va l u e o f G o o d Design chapter. Previously my choi c e o f p r e c e d e n t s w a s d e f i n e d b y S t e v e P a r n e l l ( L e c t u r e r a n d Researcher at Nottingham Univers i t y ) a s m e c h a n i c a l a n d n e e d e d t o b e r e t h o u g h t . H o w e v e r a s I hope you will find in this chapter t h e p r e c e d e n t s I h a v e c h o s e n c o n t r a s t t h e o n e s i z e f i t s a l l model becoming very specific in d e s i g n a n d r e s p o n s e t o p a t i e n t s n e e d s . T h e y t a c k l e c o m m o n issues found in institutionalised h o s p i t a l s t o d a y a n d a l l c a t e r f o r o n e d e p a r t m e n t o f m e d i c i n e becoming a specialist unit. But mo s t i m p o r t a n t l y t h e y c a r e f o r t h e p a t i e n t s a n d e x p l o r e t h i s i d e a of architectural place making throu g h d e v i c e s w h i c h h o l d n o f u n c t i o n a l p u r p o s e , o r b e t t e r d e f i n e d as non hospital specific functional p u r p o s e .

3 .5

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A n d e r s o n S t anford, Gail Fenske, and David F i x l e r, e d s . , Aalto and America (Singapore: Ya l e U n i v e r s ity Press, 2012). 4 Ib i d . 5 Ib i d . 3

F i g u r e 4 9 O p posite: External approach view of Paimio. F i g u r e 5 0 R i ght top: Handrail detail and c a r e f u l c o l o ur selection. F i g u r e 5 1 R i ght bottom: Silent wash basin.

P a i m i o

S a n a t o r i u m ,

b y

A l v a r

A a l t o ,

1 9 2 8

Paimio Sanatorium was specificall y d e s i g n e d f o r t u b e r c u l o s i s p a t i e n t s i n t h e e a r l y t w e n t i e t h century before a definitive cure to t h e d i s e a s e h a d b e e n e s t a b l i s h e d . P l a c e d o u t s i d e o f u r b a n environments it was a way to not o n l y t r y t o t r e a t t h e s e p e o p l e b u t a l s o q u a r a n t i n e t h e m f r o m t h e rest of society. The building was the main contribu t o r t o t h e h e a l i n g p r o c e s s a n d d e s c r i b e d a s a m e d i c a l instrument in itself. Aalto designe d P a i m i o a f t e r a n e x t e n d e d o b s e r v a t i o n p e r i o d o f t h e p a t i e n t s , and their ritualistic habits, that w o u l d u s e h i s b u i l d i n g . H e c a r r i e d o u t a s e r i e s o f e x p e r i m e n t s using the patients auditory, sensor i m o t o r, t a c t i l e , p r o r i o c e p o t i v e a n d p s y c h o l o g i c a l e x p e r i e n c e s to be the main driver of room desi g n b y g a u g i n g t h e i r r e a c t i o n t o m u l t i p l e s t i m u l i r a g i n g f r o m sound to light intensity. 3 These ex p e r i m e n t s c r e a t e d a h u m a n a n d p e r s o n a l t y p e o f d e t a i l i n g throughout but specifically within t h e i n d i v i d u a l r o o m s . T h e u s e o f l i g h t a n d a i r w a s t h o u g h t t o be the best treatment for tubercul o s i s a t t h e t i m e a n d t h i s w a s r e f l e c t e d w i t h i n t h e d e s i g n b y multiple sun rooms and good venti l a t i o n w h i c h c o u l d b e c o n t r o l l e d b y t h e p a t i e n t . Most importantly Aalto revolutioni s e d t h e w a y w e t h i n k o f p e o p l e w i t h i n a b u i l d i n g d e s i g n . Still practiced today we tend to al w a y s t h i n k o f p e o p l e i n b u i l d i n g s o n a t r a n s i e n t v e r t i c a l a x i s [always standing up and moving]. S p e c i f i c a l l y i n P a i m i o d u e t o t h e n a t u r e o f t h e i l l n e s s t h e patients would spend the majority o f t h e i r t i m e l a y i n g d o w n , r e s t i n g , o n a s t a t i o n a r y l o w s l u n g horizontal axis. 4 This in turn flippe d t h e f o c u s o f t h e s p a c e . W i n d o w s n e e d e d t o b e l a r g e r t o achieve views out, this raised the i s s u e o f g l a r e a n d t h e c o n t r o l o f l i g h t w i t h i n t h e s p a c e a n d ceiling compositions and colour [o f t e n i g n o r e d ] w h e r e n o w v i s u a l l y v e r y i m p o r t a n t . A l l o f t h e s e aspects were considered to create a n a p p r o p r i a t e a n d u n i q u e s p a c e f o r t h e p a t i e n t s w h i c h t h e y could control and use easily. Silence reigned within Paimio crea t i n g a c a l m a n d p l e a s a n t a t m o s p h e r e e m p h a s i s i n g t h e e s c a p e from urban life. This was achieve b y e x t e n s i v e s o u n d i n s u l a t i o n t h r o u g h o u t s e r v i c e s a n d w a l l s . But most ironically was achieved w i t h i n h i s d e s i g n o f t h e s i l e n t s i n k . T h i s a s p e c t w a s i m p o r t a n t as rooms were shared between on l y t w o p e o p l e . B y c r e a t i n g t h e s i l e n t s i n k e a c h c o u l d w a s h a n d bath without disturbing the other w h e n g o i n g a b o u t t h e i r d a y t o d a y r i t u a l s w i t h i n P a i m i o . 5

F i g u r e 5 2 O p posite: Site and ground floor plan. F i g u r e 5 3 C e ntre: The horizontal man. F i g u r e 5 4 R i ght top: Patient room window detail. F i g u r e 5 5 R i ght bottom: Just one of many d o o r h a n d l e designs throughout Paimio.

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N o t M a d e T V, Pierre Chareau - Maison de Ve r r e , 2 0 1 0 , http://vimeo.com/11636468. 7 N a l i n a M o s es, â&#x20AC;&#x153;9 Architects Reflect on t h e H o m e s T hat Most Inspired Them,â&#x20AC;? A r c h D a i l y, M ay 1, 2014, http://www. a r c h d a i l y. c o m/?p=499363. 8 N o t M a d e T V, Pierre Chareau - Maison de Ve r r e . 6

F i g u r e 5 6 O p posite: Patient, Family a n d S e r v a n t Interaction and Routes R e s p e c t i v e l y. F i g u r e 5 7 R i ght top: Exploded Axo and Plans. F i g u r e 5 8 R i ght Centre: External View of G l a s s F a c a d e at Night. F i g u r e 5 9 R i ght Bottom: External View Prior t o D e v e l o p m ent.

M a s i o n

d e

Ve r r e ,

b y

P i e r r e

C h a r e a u ,

1 9 3 2

Maison de Verre in contrast to the p r o l o n g e d s t a y p a t i e n t s w o u l d h a v e a t P a i m i o w a s d e s i g n e d a s a doctors clinic specialising in obs t e t r i c s [ p r e a n d p o s t p r e g n a n c y ] . T h e i n t e r e s t o f t h e b u i l d i n g design comes not only from the co m p l e x s t a c k i n g o f a h o u s i n g u n i t [ f o r t h e d o c t o r a n d h i s f a m i l y ] on top of the clinic but also from t h e u s e o f i n d u s t r i a l m a t e r i a l s w i t h r e f e r e n c e t o a t r a d i t i o n a l home. The clinic was also revoluti o n a r y f o r b e i n g i n d u s t r i a l m o d e r n i s m w h i c h m o v e d a w a y f r o m pure functionalism to give more of a p l a s t i c e f f e c t . I t t a c k l e s k e y i s s u e s r a i s e d w i t h t h i s i n t i m a t e multifunctionality such as privacy, c o n t r o l o f s p a c e s a n d s e c u r i t y. O r i g i n a l l y t h e b u i l d i n g w a s meant to be a replacement of an e x i s t i n g b u i l d i n g w i t h i n t h e c i t y o f P a r i s b u t n o w a p p e a r s a s a n infill section protruding through th e P a r i s i a n h o u s i n g b l o c k . Chareau tackles this issue of thres h o l d i n a n u m b e r o f i n n o v a t i v e w a y s a l m o s t e m p h a s i s i n g t h e idea of retreating from the city or h i s o w n w o r k . A f t e r e n t e r i n g t h e c o u r t t h e e x t e n s i v e g l a s s brick wall is the first thing to noti c e . T h e f a c a d e t u r n s i t s b a c k u p o n t h e u r b a n r e a l m o f P a r i s providing restricted views into the p r o p e r t y. T h e f i r s t t h r e s h o l d i s t h e f r o n t d o o r, r a i s e d b y o n e step from the courtyard covered by t h e g l a s s b r i c k s a b o v e . Tw o b u t t o n s d e n o t e t h e f r o n t d o o r, o n e for the house and one for the clini c . A s a p a t i e n t y o u e n t e r a n d a r e g u i d e d r o u n d b y l e v e l a c c e s s being drawn towards the light to t h e w a i t i n g r o o m t h a t a w a i t s y o u . L i t t l e d o y o u n o t i c e t h e handed staircase to your left leadi n g t o t h e f l a t s a n d t h e c u r v e d m e t a l d o o r t h a t h a s j u s t c l o s e d funnelling you round to the waitin g r o o m a n d s e r i e s o f p r i v a t e c o n s u l t a t i o n r o o m s . To w a r d s t h e back of the building the extensive w a l l o f g l a s s b r i c k s o p e n s u p t o r e v e a l v i e w s a n d t e r r a c e s o u t to a private garden retreat. 6 While Chareau did not design man y h o u s e s t h e b o u n d a r i e s a n d r e g a r d f o r o t h e r s a r e m a d e t o measure within this project and no t w o c o n n e c t i o n s a r e a l i k e . 7 N u m e r o u s s l i d i n g d o o r s a n d partitions are positioned througho u t t h e s c h e m e g i v i n g a s e n s e o f p r i v a c y c o n t r o l b e i n g a b l e t o shut off and open up spaces. Subt l e f e a t u r e s a l s o a p p e a r s u c h a s t h e m o v e m e n t o f s e r v i c e d o o r s creating an ever present notion of t h e w o r k i n g s o f t h e b u i l d i n g w i t h o u t s e e i n g t h e a c t u a l w o r k . 8 This control and privacy is also co n t i n u e d w i t h i n t h e h o u s e w h e r e n o t o n l y a r e m u l t i p l e o p t i o n s of circulation are available details s u c h a s d o u b l e s i d e d w a r d r o b e s a r e u s e d s o s h e e t s a n d l i n e n can be changed without disturbing t h e o c c u p a n t o f t h e r o o m s . T h e a l m o s t o b s e s s i v e l e v e l o f c r a f t elevates the industrial materials t o a r e i n t e r p r e t e d h o m e l i k e s t a t e h a r p i n g b a c k t o a n a r t s a n d crafts style of approach.

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H o r i z o n t a l

v s

Ve r ti c a l

O r g a n i s a t i o n s

Paimio Sanatorium and Maison de Verre demonstrate horizontal and vertical arrangements of health care facilities respectively. The first thing to note, and probably the most obvious, is the location in which they are situated. Paimio sits in a large woodland site east of Turku allowing it to spread into the surrounding areas. Similarly to modern hospitals in the UK today it is placed on a large open site enabling a free reign over the organisation creating a more horizontal arrangement, with the difference of making the most of its natural surroundings within the healing process. This horizontal arrangement allows public, semi public and private spaces to be separated laterally into individual blocks in quite a functional way. After medicines were developed for tuberculosis the sanatorium was converted into a general hospital but has not lost its architectural qualities. Masion de Verre however is situated within the heart of Paris in a dense urban environment. The result is a vertical arrangement where programmes are stacked keeping semi public spaces confined to the ground floor and private spaces above. The challenge of creating privacy creates interesting threshold conditions within the architecture. Creating privacy from neighbouring buildings also creates similar thresholds in some respects cutting the scheme off from the city but also enriching it with the addition of green spaces. Fundamentally both have distinctly different functions with Paimio being a hospital, in one for or another, and Maison de Verre being an obstetrics clinic with a private house above. But in some ways the private house of Maison de Verre could be seen as the private areas of a hospital such as wards where patients spend a prolonged period of time and the clinic below seeing to a number of different patients each day. Each arrangement lends itself appropriately to these differing conditions. One utilises the existing natural environment preferring isolation and a type of escapism whilst recovering (Paimio Sanatorium was originally designed to deliberately isolate and quarantine tuberculosis patients from society but this is a familiar sight in hospitals today). Whilst the other integrates back into the urban realm providing a more local service giving back to the richness of the city not only in what it is but more importantly what it does. Similarly people can go about their day to day lives more readily not feeling totally cut off from society and stigmatised, or living in a bubble where day to day routines are attempted to be recreated in a strange way. Supposedly the question then is not whether a horizontal or vertical arrangement is better. It is more of a question of where should a health care facilities be situated. Taking into account the flaws and benefits of centralisation but also this idea of patient control and isolation, bringing health care facilities back into the locality of the city seems to make sense. The opportunity to give back to the urban realm is reopened and patients can figuratively and literally feel more integrated and not isolated from society and their every day lives when undergoing potentially life changing events.

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“ H E R Z O G & DE MEURON,” accessed N o v e m b e r 2 3 , 2014, http://www. h e r z o g d e m e u ron.com/index/projects/ c o m p l e t e - w o rks/151-175/165-rehab-centref o r- s p i n a l - c o rd-and-brain-injuries/IMAGE. html.

R e h a b c e n t r e o f s p i n a l H e r t z o g a n d D e m e u r o n ,

c o r d a n d 2 0 0 2

b r a i n

i n j u r i e s ,

b y

F i g u r e 6 0 O p posite: Green Courtyard. F i g u r e 6 1 R i ght Top: Blurring the Boundary B e t w e e n I n s i de and Outside. Wooded Courtyard. F i g u r e 6 2 R i ght Centre: Pool Courtyard. F i g u r e 6 3 R i ght Bottom: Patients Room.

“The client’s express wish, from th e b e g i n n i n g , w a s n o t t o h a v e t h e n e w R E H A B c e n t r e l o o k o r feel like a hospital. So, what were w e n o t s u p p o s e d t o d o ? W h a t i s a h o s p i t a l ? E l e v a t o r s a n d indoor corridors flanked by countle s s d o o r s l e a d i n g t o r o o m s o r e x a m i n a t i o n r o o m s a w a i t i n g lounge at the end of the hall or ne x t t o t h e e l e v a t o r. T h e s a m e p a t t e r n r e p e a t e d o n a s m a n y f l o o r s as permitted by zoning regulations - a n e c o n o m i c s o l u t i o n b e c a u s e i t i s r e p e t i t i v e t o t h e e x t r e m e , and requires no modification of sta f f b e h a v i o u r. ” 9 Whilst a reoccurring theme, the av o i d a n c e o f t h e i n s t i t u t i o n a l i s e d h o s p i t a l t y p o l o g y i s particularly important in this insta n c e . A t t h e R e h a b c e n t r e o f s p i n a l c o r d a n d b r a i n i n j u r i e s patients spend 18 months within t h e c o n f i n e s o f t h e s c h e m e c a r r y i n g o u t t h e i r d a y t o d a y l i v e s in one place coping with significan t c h a n g e s t h e y h a v e u n d e r g o n e . I n t h i s i n s t a n c e t h e s c h e m e tackles a larger range of issues an d t h e n e e d f o r a m u t l i f u n c t i o n a l i t y. T h e b u i l d i n g w a s c o n c e i v e d on the concept of a small town or v i l l a g e i n w h i c h t h e p a t i e n t s c o u l d g e t e v e r y t h i n g t h e y n e e d e d in a dignified and self sufficient w a y. T h i s w a s a l s o r e i n f o r c e d w i t h t h e i n t e r p l a y b e t w e e n inside and out and specific views t o n a t u r e b o t h e x t e r n a l l y a n d i n t e r n a l l y. E a c h i n t e r n a l c o u r t i s significantly different not only get t i n g l i g h t i n t o t h e s c h e m e b u t a l s o p r o v i d i n g o r i e n t a t i o n i n t h e larger scale of floor plan. Warm materials [specifically wood ] a r e u s e d t h r o u g h o u t a n d t h e s p a c e s a r e h e a v i l y d a y l i t . Particular attention is also paid to t h e u s e r s o f t h e s c h e m e , m u c h l i k e P a i m i o , i n a s e n s e t h a t there are multiple connection to th e s a m e p l a c e w h e t h e r i t b e v i a a r a m p o r s t a i r. T h e o r i e n t a t i o n of patients is also considered payi n g p a r t i c u l a r a t t e n t i o n t o t h e h o r i z o n t a l a x i s b y e n a b l i n g v i e w s out over to the sky and also the ab i l i t y t o l a y o u t s i d e w h e n t h e w e a t h e r i s g o o d . T h e r e i s a l s o a large number of communal space s i n w h i c h t o i n t e r a c t c o u p l e d w i t h m o r e i n t i m a t e s p a c e s f o r peace and quiet working all the w a y u p t o t h e m o s t p r i v a t e l e v e l o f t h e p a t i e n t s r o o m s a b o v e .

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W i l l i a m J R Curtis, “Alzheimer’s Respite C e n t r e , D u b l i n, by Niall McLaughlin A r c h i t e c t s , ” Architects Journal, October 2, 2 0 1 1 , h t t p : / / www.architectsjournal.co.uk/ a l z h e i m e r s - r espite-centre-dublin-by-niallm c l a u g h l i n - a rchitects/8611134.article.

D u b l i n ’s o r c h a r d re s p i t e M c l a u g h l i n , 2 0 1 0

c e n t r e ,

b y

N i a l l

F i g u r e 6 4 O p posite top: Section through main spaces. F i g u r e 6 5 O p posite bottom: Plan showing t h e w o n d e r i n g paths returning to familiar surroundings. F i g u r e 6 6 C e ntre: External garden sequence. F i g u r e 6 7 R i g ht top: Views out to the garden f r o m t h e c o m munal space. F i g u r e 6 8 R i g ht bottom: Places to stop on t h e w o n d e r i n g route.

Much like the rehab centre the Alz h e i m e r ’s R e s p i t e C e n t r e c a t e r s f o r a l o n g s t a y p a t i e n t responding an ageing population. W i t h t h i s c o m e a n u m b e r o f s o c i a l p h y s i c a l a n d e m o t i o n a l issues that need to be addressed a n d i n t h i s c a s e s p e c i f i c a l l y t h a t o f m e n t a l h e a l t h . A l z h e i m e r ’s affects memory and the sense of b e l o n g i n g c r e a t i n g c o n f u s i o n a n d a l o s s o f a s e n s e o f p l a c e . The scheme focuses on the creatio n o f a h o m e t o s t a y w h i l s t c r e a t i n g a p r o t e c t i v e e n c l o s u r e avoiding the feeling of imprisonme n t . T h e c o n c e p t r e v o l v e s a r o u n d t h e i d e a o f t h e w o n d e r i n g without getting lost. The plan repr e s e n t s a n i n t e r l o c k i n g p i n w h e e l o f g a r d e n s , p l a n a r w a l l s , pavilions and rooms gently guiding t h e p a t i e n t s b a c k t o f a m i l i a r s u r r o u n d i n g s . 1 0 The centre again focuses on the n o t i o n o f h o m e a n d i t s h u m a n s c a l e , a v o i d i n g r e f e r e n c e s t o hospitals and clinics. This with th e u s e o f n a t u r a l l i g h t , c a r e f u l s e l e c t i o n o f c o l o u r s a n d w a r m material palette creates a calm an d p l e a s a n t e n v i r o n m e n t f o r p a t i e n t s t o c a r r y o u t t h e i r d a y t o day lives. The building also suffer s a f e w f a i l i n g s o n e b e i n g a c r i t i c i s m o f t h e e n t r a n c e l o b b y being too much like a cheap hotel. T h e o t h e r b e i n g t h e l e n g t h o f p l a n e s i n s o m e a r e a s c r e a t e s discontinuities between spaces ca u s i n g t h e p r i v a t e b e d r o o m s t o f e e l q u i t e c e l l l i k e .

3 .5

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O M A , “ M A GGIE’S CENTRE, GARTNAVEL, U K , G L A S G O W, 2008: A Cancer Care Centre o n t h e G r o u n ds of Gartnavel Hospital,” 2 0 0 8 , h t t p : / / www.oma.eu/projects/2008/ m a g g i e - s - c e ntre-gartnavel/. 12 G i o v a n n a a nd Zardini, Imperfect Health, T h e M e d i c a l i zation of Architecture. 13 Ibid. 14 T h e M a g g i e Keswick Jencks Cancer C a r i n g C e n t r es Trust is a company l i m i t e d , “ M a ggie’s,” 2014, https://w ww. m a g g i e s c e n t res.org/. 15 G i o v a n n a a nd Zardini, Imperfect Health, T h e M e d i c a l i zation of Architecture. 16 T h e M a g g i e Keswick Jencks Cancer C a r i n g C e n t r es Trust is a company limited, “ M a g g i e ’s . ” 17 G i o v a n n a a nd Zardini, Imperfect Health, T h e M e d i c a l i zation of Architecture. 18 O M A , “ M A GGIE’S CENTRE, GARTNAVEL, U K , G L A S G O W, 2008: A Cancer Care Centre o n t h e G r o u n ds of Gartnavel Hospital.” 11

F i g u r e 6 9 O p posite: Richard Murphy’s first M a g g i e ’s c e n tre in Edinburgh creating a d o m e s t i c s c a le and intimacy. F i g u r e 7 0 R i g ht top: Plan of OMA’s maggies c e n t r e i n G l a sgow creating intimacy and o p e n n e s s t h r ough removing traditional corridors. F i g u r e 7 1 R i g ht centre: OMA Model. F i g u r e 7 2 R i g ht bottom: Views to nature in t h e c e n t r a l c ourtyard.

M a g g i e ’s

C e n t r e s ,

b y

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1 9 9 6

P r e s e n t

“Maggie’s Centres rely on the fund a m e n t a l p r e c e p t , o f t e n o v e r l o o k e d , t h a t e x c e p t i o n a l architecture and innovative spaces c a n m a k e p e o p l e f e e l b e t t e r - t h e r e b y k i n d l i n g t h e c u r i o s i t y and imagination fundamental to fe e l i n g a l i v e . ” 1 1 “Maggie’s cancer caring centres w e r e e s t a b l i s h e d b y M a g g i e K e s w i c k J e n c k s a n d C h a r l e s J e n c k s in 1993, when Maggie was diagno s e d w i t h b r e a s t c a n c e r. ” 1 2 T h e c e n t r e ’s m a i n p r i n c i p a l s w h e r e based on the ethos that exception a l d e s i g n c a n m a k e a d i f f e r e n c e i n t h e t r e a t m e n t p r o c e s s i n contrast to the typical institutiona l i s e d h o s p i t a l e n v i r o n m e n t . T h e s e s p a c e s p r o v i d e p a t i e n t s and their families with physical an d p s y c h o l o g i c a l s u p p o r t f r e e o f c h a r g e w i t h i n a d o m e s t i c a t e d environment. 13 Both domestic in scale and arrang e m e n t t h e M a g g i e ’s c e n t r e s p r o v i d e a c o m f o r t a b l e a n d s a f e environment to meet others, reduc i n g s t r e s s a n d p r o v i d i n g p s y c h o l o g i c a l s u p p o r t . I n f o r m a t i o n is more readily received and accep t e d b e c a u s e o f t h i s e n a b l i n g p a t i e n t s t o m a k e m o r e i n f o r m e d participation in their medical care n o t ‘ l o s i n g t h e j o y o f l i f e i n t h e f e a r o f d e a t h ’ . 1 4 T h e f i r s t Maggie’s centre built in Edinburgh s o r t t o c r e a t e t h i s f e e l i n g o f d o m e s t i c i t y a n d i t s c o n n e c t i o n with ‘the garden’. 15 The plan is a d u a l i t y b e t w e e n t h e o p e n a n d c l o s e d i n t e r m s o f s p a c e w h i c h also reflects the nature of being o p e n w i t h y o u r e m o t i o n s w h e t h e r i t i s l a u g h t e r o r s a d n e s s b u t having the option to retreat into s m a l l n i c h e s f o r p e a c e a n d q u i e t . T h i s o p e n a n d c l o s e d a s p e c t is also controllable creating totall y o p e n s p a c e s o r b e i n g a b l e t o c l o s e t h e m o f f i n t o s e p a r a t e rooms. 16 Another interesting example that t a c k l e s a s p e c i f i c i s s u e w i t h i n s t i t u t i o n a l i s e d h o s p i t a l b u i l d i n g s is OMA’s Maggie’s centre in Glasg o w. T h e b u i l d i n g a v o i d s t h e f u n c t i o n a l l o n g c o r r i d o r s a l o n g a series of isolated rooms of traditio n a l h o s p i t a l s b y p o s i t i o n i n g m o r e c a s u a l o p e n a r e a s a r o u n d a central courtyard. The rooms and t h e i r i n t e r s e c t i o n s c r e a t e o p e n a n d m o r e i n t i m a t e s p a c e s w i t h the nooks and crannies created em p h a s i s e d b y t h e s u b t l e p l a y o f c e i l i n g l e v e l t h r o u g h o u t . 1 7 T h e seemingly haphazard arrangement o f r o o m s n o t o n l y r e d u c e s t h e s e c o r r i d o r s b u t c r e a t e s p e r s o n a l intimate encounters with those go i n g t h r o u g h s i m i l a r e x p e r i e n c e s s o t h a t p e o p l e c a n l e a r n a n d connect with one another. The buil d i n g a l s o r e f e r s t o t h e i d e a o f ‘ t h e g a r d e n ’ a g a i n b o t h o n t h e internal courtyard and external vie w o u t t o n a t u r e a n d G l a s g o w. 1 8

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S e e M a g g ie Keswick Jencks, A View f r o m t h e F r o nt Line (London: Maggie’s C a n c e r C a r i n g Centre, 1995). 19

R e f l e c t i o n All of the above precedents arose f r o m a f u n d a m e n t a l n e e d o f t r e a t m e n t t h a t m e d i c i n e c o u l d not achieve. The treatment is not a d i r e c t c u r e b u t a c a r i n g o f p e o p l e w h e t h e r i t b e f o r a ‘ s h o r t chat’ or a prolonged period of reha b i l i t a t i o n . A l l o f t h e b u i l d i n g s a l s o o n l y t r e a t o n e a r e a o f ailment which I think is one of the s t r o n g e s t a s p e c t s . B y t r e a t i n g a m u l t i t u d e o f i l l n e s s e s c r e a t e s a generic building typology in whic h e v e r y i l l n e s s a n d d i s e a s e c a n b e t r e a t e d . B y s p e c i f i c a l l y treating only one or two aliments n o t o n l y d o e s a n i n t e r a c t i o n o f s i m i l a r e x p e r i e n c e o c c u r between patients, the building ins t a n t l y b e c o m e s m o r e s p e c i f i c m a k i n g t h e p e o p l e f e e l t h a t they are important and that they a r e u l t i m a t e l y b e i n g c a r e d f o r o v e r p u r e l y j u s t b e i n g c u r e d . I n medical terms the building could i t s e l f b e e n s e e n a s a p l a c e b o e f f e c t s t r o n g l y i n f l u e n c i n g p e o p l e in these cases positively on their r o a d t o r e c o v e r y. “Charles Jenks maintains that the M a g g i e ’s c e n t r e s h e e s t a b l i s h e d w i t h h i s w i f e M a g g i e K e s w i c k Jenks act as a placebo on many le v e l s , s u p p o r t i n g b o t h c a r e g i v e r s a n d p a t i e n t s . A n d t h e s t u d y of David Spiegel, professor of psyc h i a t r y a n d b e h a v i o u r a l s c i e n c e s , S t a n f o r d U n i v e r s i t y s c h o o l o f medicine, suggest that psycho-soc i a l i n t e r v e n t i o n s i n c r e a s e o n e ’s c h a n c e s o f l i v i n g l o n g e r. ” 1 9 The key idea is an alternative appr o a c h , a n d e v e n a t o t a l a v o i d a n c e o f t h e i n s t i t u t i o n a l i s e d hospital typology we see today an d i n t h e Q M C c a s e s t u d y. M a n y, a n d i n m y o p i n i o n t h e m o s t successful, tackle the topic of hom e a n d h e a l t h c a r e t o c r e a t e a b u i l d i n g o f h u m a n s c a l e a n d comfort to care for patients. This i s a l s o l i n k e d w i t h t h e n o t i o n o f b e i n g a b l e t o c a r r y o n y o u day to day life and not feel restric t e d o r o u t o f c o n t r o l o f y o u r s u r r o u n d i n g s w h i c h r e i n f o r c e this feeling of comfort and not ali e n a t i o n . A d e t a i l e d k n o w l e d g e o f t h e i l l n e s s a n d p a t i e n t s also informs a more personal arch i t e c t u r e m a k i n g t h e p a t i e n t f e e l i m p o r t a n t a n d u l t i m a t e l y cared for through the architecture. T h e s t u d y b y B r y a n L a w s o n r e i n f o r c e s t h e p o i n t t h a t w h a t patients need, and actually want, i s i g n o r e d o r j u s t n o t t a k e n i n t o a c c o u n t w i t h i n t h e d e s i g n o f a hospital. The premise is purely fun c t i o n a l a n d t h e c l i n i c a l l y f u n c t i o n a l w o r k i n g s o f a h o s p i t a l i s e d environment, alien to most people . N a t u r e a l s o p l a y s a n i m p o r t a n t r o l e w i t h i n a l l o f t h e s c h e m e s as a place to view and experience f o r r e l a x a t i o n p u r p o s e s a n d a s e n s e o f c o n n e c t i o n w h i c h was one of the main failings withi n t h e Q M C . W h i l s t a l l o f t h e s e a r e g o o d e x a m p l e s , t h e r e a r e still numerous issues with directly a p p l y i n g t h i s t o l a r g e r s c a l e h e a l t h c a r e t y p o l o g i e s s u c h a s infection control, scalability, mult i f u n c t i o n a l i t y, p r o g r a m m e , s p e c i f i c i t y, c a t e r i n g f o r d i f f e r e n t illnesses and many more. From wh a t I h a v e l e a r n t s o f a r, r e g a r d i n g t h e f a i l i n g a n d s u c c e s s e s o f varying hospital typologies, disagg r e g a t i o n o f t h e c u r r e n t a g g r e g a t e d h o s p i t a l t y p o l o g y w o u l d seem appropriate. The inherrent fl a w s I h a v e f o u n d a r e a d i r e c t r e s u l t o f t h e d e v e l o p m e n t o f ‘super hospitals’. As a key move I w o u l d l i k e t o t a k e t h e i d e a d i s a g g r e g a t i o n f o r w a r d i n t o m y design to test its merrits in solvin g t h e s e n u m e r o u s p r o b l e m s , w i t h t h e m a i n a i m b e i n g t h e creation of a more human and man a g e a b l e s c a l e w i t h s p e c i f i c i t y a n d a u n i q u e c h a r a c t e r o f e a c h department and whom they treat.

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F i g u r e 7 3 To p: Scotland’s housing ex po 2 0 1 0 , I n v e r n ess, StudioKAP, referencing t h e d o m e s t i c pitched roof vernacular with m o d e r n d e s i gn. F i g u r e 7 4 R i ght: Modest breakfast table v i e w i n g o u t over the garden.

T h e

M e a n i n g

o f

D o m e s t i c i t y

By studying the home, as the most i n t i m a t e p l a c e t o h u m a n s , a n d i t s m e a n i n g , I h o p e t o f i n d the counterpoint to the hospital ty p o l o g y, f u n d a m e n t a l l y a n o n - p l a c e , i n w h i c h p e o p l e c a n f e e l more comfortable and safe within a f a m i l i a r e n v i r o n m e n t . B y p r i m a r i l y u s i n g E d w i n H e a t h c o t e ’s book ‘The Meaning of Home’ and m y r e s e a r c h u n d e r t a k e n i n ‘ Ty p o l o g i e s a n d C h a n g e : H o u s i n g ’ I will focus on the creation of a fa m i l i a r e n v i r o n m e n t , i n t h e h o p e o f f i n d i n g w h a t f u n d a m e n t a l components make a home and how t h e s e c a n b e u s e d , l i k e i n t h e M a g g i e ’s c e n t r e s , w i t h i n a hospital environment. These wil l b e e x p l o r e d i n t e r m s o f f o r m , m a t e r i a l i t y / t e c t o n i c s a n d atmosphere.

E d w i n H e a t h cote, The Meaning of H o m e ( L o n d o n: Frances Lincoln Limited P u b l i s h i n g s , 2012). 2 Ib i d 3 B o r a s i G i o v anna and Mirko Zardini, eds., I m p e r f e c t H e alth, The Medicalization o f A r c h i t e c t ure (Canadian centre for a r c h i t e c t u r e : lars muller publishers, 2012). 4 E d w i n H e a t h cote, The Meaning of Home. 5 Ib i d 1

“Our home is our base, a place tha t r o o t s u s t o t h e e a r t h ; t o t h e c i t y o r t h e l a n d s c a p e ; i t g i v e s us permanence and stability and a l l o w s u s t o b u i l d o u r l i f e a r o u n d i t a n d w i t h i n i t . W h e n w e are away from it we pine, we are h o m e s i c k . We h a v e l e a r n e d t o d i m l y d e s p i s e t h e n o n - p l a c e s o f airports and offices, of malls and m o t o r w a y s , p l a c e s t h a t a r e e v e r y w h e r e a n d n o w h e r e , p l a c e s that are globally familiar and unne r v i n g l y s i m i l a r. We y e a r n t o r e t u r n t o t h e f a m i l i a r r o o t e d n e s s of our sofas and our own beds, pla c e s w i t h w h i c h w e a r e c o m f o r t a b l e a n d i n w h i c h w e f e e l w e are safe.” 1 The home is the most important pl a c e t o m o s t p e o p l e a n d o n e w h i c h a l m o s t e v e r y o n e h a s i n common regardless of ethnicity, re l i g i o n , a g e o r c u l t u r e . I t i s w h e r e w e h a v e m o s t c o n t r o l and feel safe from the flux and un c e r t a i n t y o f t h e o u t s i d e w o r l d . I t i s t h e n o d e a r o u n d w h i c h life revolves. In British culture the c o n s e r v a t i o n , r e t e n t i o n a n d r e u s e o f o l d b u i l d i n g s t o c k i s probably stronger than in any othe r c o u n t r y, e s p e c i a l l y w h e n t a l k i n g a b o u t d w e l l i n g s . E d w i n Heathcote describes the home as a m u s e u m i n w h i c h h i s t o r i a n s p e a l b a c k t h e w a l l p a p e r a n d paint dating each ingrained layer t o s p e c i f i c m o m e n t s i n t i m e . 2 ‘ C h a r a c t e r ’ i s s o m e t h i n g u s B r i t s cherish fundamentally captured th r o u g h m a t e r i a l i t y a n d t i m e . H o w e v e r w i t h i n t h i s c u l t u r e o f preservation and regeneration the h u m b l e h i s t o r i c h o u s e i s o f t e n a d a p t i v e l y r e u s e d t o r e s p o n d to changing lifestyles. It is import a n t t o n o t e t h i s t r e a s u r i n g o f h i s t o r y f o u n d i n B r i t i s h c u l t u r e , but by changing a dwelling right d o w n t o i t s v e r y c o r e w i t h e x t e n s i o n s , r e f u r b i s h m e n t s a n d reconfigurations, what does the id e a o f d o m e s t i c i t y m e a n t o m o s t p e o p l e a n d w h a t f u n d a m e n t a l elements make the familiar place o f h o m e ? Interestingly over the centuries th e f o r m a l c o m p o n e n t s o f o u r h o m e s h a v e c h a n g e d v e r y l i t t l e . When compared to that of technol o g y, w h i c h h a s i n v a d e d o u r h o m e s , 3 i t i s a l m o s t a s i f t h e y have been frozen in time. True arch i t e c t u r a l i n t e g r a t i o n o f t e c h n o l o g y h a s c o n f i n e d i t s e l f t o t h e bathroom and kitchen as a result o f h y g i e n e i n t h e m o d e r n m o v e m e n t . H e a t h c o t e s u g g e s t s t h i s comes from a need for continuity b e t w e e n t h e s p a c e s a r o u n d u s i n c o n t r a s t t o t e c h n o l o g y w h i c h increasingly dominates our work a n d l e i s u r e t i m e . 4 T h i s c e r t a i n f a m i l i a r i t y a n d q u a l i t y a h o m e provides is unique, rooted within t h e v e r y w a l l s i n w h i c h w e d w e l l . B u t w h e n l o o k i n g a t w h a t happens within our homes as a res u l t o f t e c h n o l o g y a l o t m o r e h a s c h a n g e d . “Our homes were once the centres o f a l m o s t e v e r y i m p o r t a n t e v e n t i n o u r l i v e s , i t s r o o m s m a r k e d the rites of passage involved in be i n g b o r n a n d g i v i n g b i r t h , i n g r o w i n g u p a n d i n w o r k , i n getting married, getting old and dy i n g . M o s t o f t h e s e h a v e n o w b e e n t a k e n o u t o f t h e h o m e . T h e medicalization of birth, death and i l l n e s s , a n d t h e h o n e y m o o n h o l i d a y, h a v e t a k e n a l l o f t h e s e major rites of passage out of the h o m e . ” 5 In Heathcote’s book ‘The Meaning o f H o m e ’ H o s p i t a l s a r e p o r t r a y e d a s a n a t h e m a s , o f t e n u s e d as contrasts to that of the domest i c . T h e l a n g u a g e o f t h e d o m e s t i c a n d t h a t o f t h e i n s t i t u t i o n could not be further apart with the m e d i c a l i z a t i o n o f c e r t a i n a s p e c t s o f l i f e s e e n i n b a d l i g h t . I t

Ibid Ib i d 8 A l i s o n B l u n t and Ann Varley, “Geographies o f H o m e , ” i n Cultural Geographies, 2004, 3–6. 6 7

F i g u r e 7 5 R i ght: Domestic Entrance, Ti m b e r y a r d H ousing by O’Donnell and Tu o m e y.

has also become common practice t o d e s c r i b e p o o r p i e c e s o f a r c h i t e c t u r e w i t h t h e u s e o f c l i n i c a l words such as sterile or functiona l . H o s p i t a l s a r e p u r e f u n c t i o n a l i s m w h e r e a s h o m e s a r e f u l l o f meaning and memory, yet more an d m o r e o f o u r d a i l y l i v e s o r ‘ r i t e s o f p a s s a g e ’ w i t h i n l i f e a r e being moved away from the home i n t o t h e c o l d s t e r i l i t y o f t h e m e d i c a l i s e d h o s p i t a l . W h e t h e r w e like it or not the hospital is becom i n g a n e v e r m o r e i m p o r t a n t ‘ p l a c e ’ w i t h i n o u r l i v e s a n d t h i s should be reflected and celebrated w i t h i n i t s a r c h i t e c t u r e , n o t l e f t i n t h e i n s t i t u t i o n a l r e a l m o f the ‘non-place’. A Building of Necessity Both hospitals and homes are built o f n e c e s s i t y y e t e x i s t a t p o l a r e n d s o f t h e s c a l e . D w e l l i n g s are places of total control where a s i n h o s p i t a l s w e f e e l o u t o f c o n t r o l . B o t h h a r b o u r m e m o r i e s of past events with dwellings reta i n i n g a n d c h e r i s h i n g t h e m w h e r e a s h o s p i t a l s a r e c o n t i n u o u s l y ‘wiped clean’. Much control, comfo r t a n d f a m i l i a r i t y l i e s i n o u r a b i l i t y t o d e f i n e o u r e n v i r o n m e n t through decoration, definition of p r i v a c y o r e v e n t h e s i m p l e a c t o f o p e n i n g a w i n d o w. H e a t h c o t e defines dwelling as both a place a n d a p r o c e s s d e f i n e d a n d r e a d t h r o u g h t h e i r d e c o r a t i o n , d e s i g n and contents with every object hav i n g a m e a n i n g a n d a p l a c e . 6 A a l t o a c k n o w l e d g e d t h i s a t P a i m i o taking a specific focus on the day t o d a y b e h a v i o u r s o f t h e p a t i e n t s w h i c h d r o v e t h e d e s i g n . Admittedly much control and faith h a s t o b e p l a c e d w i t h t h e d o c t o r s t o d o t h e i r d u t y, b u t a t o t a l lack of control is alienating and de g r a d i n g . T h r o u g h s i m p l e a c t s a l l o w e d w i t h i n t h e a r c h i t e c t u r e patients will be able to define the i r e n v i r o n m e n t m o r e r e a d i l y h a v i n g a p s y c h o l o g i c a l a n d eventually physical benefit. Great importance also lies within t h e m a t e r i a l o f t h e b u i l d i n g . A l l m a t e r i a l s a g e , b u t I a m s u r e if there was a cheap material whic h l a s t e d f o r e v e r h o s p i t a l s w o u l d u s e i t . T h e r e i s a l w a y s a n increased uncertainty within non-p l a c e s t h a t a p p e a r s t o r y l e s s o r w i t h o u t c h a r a c t e r ; w i t h o u t memory. “Homes are also, of cours e , m a d e o f m e m o r i e s . T h e i r r e a l i t y l i e s n o t s o m u c h i n t h e i r physicality but in the images we h a v e o f p r e c i o u s o r p a i n f u l m o m e n t s w i t h i n t h e i r w a l l s . O u r childhood homes colour our percep t i o n s o f e v e r y s u b s e q u e n t s p a c e w e i n h a b i t a n d t h e y c o n d i t i o n our responses, either encouraging u s t o r e c r e a t e t h e r o o m s o f o u r p a s t o r t o r e a c t a g a i n s t t h e m . But it turns out that our memories a r e m o r e c l o s e l y t i e d w i t h o u r m i n d s t h a n m e r e n o s t a l g i a . ” 7 Additionally Alison Blunt and Ann Va r l e y d e s c r i b e h o m e a s a p l a c e o f b e l o n g i n g r i c h i n e m o t i o n s , meanings and experiences at the h e a r t o f h u m a n l i f e . 8 W i t h i n t h e s e c l i n i c a l e n v i r o n m e n t s t h e r e i s almost nothing to react to. The wh o l e t h i n g i s a l i e n a t i n g t o a n y o n e e v e n i f w e a v o i d t h e t o p i c o f our own mortality, which many do a i m t o a v o i d . M u c h l i k e m y Q M C c a s e s t u d y t h e m a t e r i a l s a r e hard and homogenous allowing for a s l i t t l e w e a r a n d d i r t t o a c c u m u l a t e a s p o s s i b l e . T h e l i g h t i n g is equally as homogenous creating a v e s s e l r e m i n i s c e n t o f a l a b y r i n t h i n w h i c h w e a r e s u p p o s e d to recover. There are good reasons f o r t h e s e t y p e s o f m a t e r i a l s a d m i t t e d l y h o w e v e r t h e r e i s m u c h opportunity to thoughtfully soften a n d h u m a n i s e t h e m a t e r i a l p a l e t t e o f h o s p i t a l s i n t h e s a m e way the home is carefully choreog r a p h e d . T h e u s e o f t i m b e r a n d b r i c k s e e m o b v i o u s c h o i c e s ,

E d w i n H e a t h cote, The Meaning of Home. Ibid 11 G a s t o n B a c helard, Poetics of Space, trans. M J o l a s ( B o s ton: Becon press, 1969). 12 E l l e a n o r J o lliffe, “Concious Walls” (The U n i v e r s i t y o f Nottingham, 2014). 13 E d w i n H e a t hcote, The Meaning of Home. 14 Ibid 9

F i g u r e 7 6 L e f t: Scara Brae settlement, O r k n e y s h o w ing the primative hut formation, 5 t h c e n t u r y AD. F i g u r e 7 7 R i g ht: The house at 51 W i n d m i l l r o a d demostraiting the facade a n t h r o p o m o r phic qualities of the facade articulation.

but it is their connection to human s t h a t g i v e s t h e m t h e i r q u a l i t y. L i k e t h e d i m e n s i o n s o f a b r i c k fitting to a hand and the story of e a c h b r i c k b e i n g l a i d o r t h e c a r v e d w a r m t h o f t i m b e r. The influence of our childhood hom e s i s p r o f o u n d a n d i m b e d d e d w i t h i n u s . A s s t a t e d b e f o r e t h e home has remained relatively unch a n g e d w i t h t h e v e r n a c u l a r e n d u r i n g l o n g e r t h a n a n y o t h e r. Once man created fire the next co n s t r u c t w a s t h e r o o f , m o r e t o p r o t e c t t h e f i r e t h a n m a n h i m s e l f . Built of necessity it was a pitched r o o f . A s k a l m o s t a n y c h i l d t o d r a w a h o u s e a n d i t w i l l h a v e a pitched roof and more than likely b e m a d e o f b r i c k . 9 F r o m m y t y p o l o g i c a l s t u d y o f h o u s i n g w i t h i n the Typologies and Change docume n t t h e p i t c h e d r o o f i s c o n s i s t e n t t h r o u g h o u t h i s t o r y e s p e c i a l l y when defining a dwelling. Only du r i n g t h e m o d e r n m o v e m e n t w a s t h e p i t c h e d r o o f w h i p p e d o f f leaving flat pure volumes. I am sur e w e a r e a l l w e l l a w a r e o f t h e m a n y r e a s o n s f o r t h e f a i l i n g s o f many modernist estates constructe d i n t h e m i d 2 0 t h c e n t u r y, b u t i t a l m o s t s e e m s l i k e a r e a c t i o n against the new style with everyo n e p r i o r t o t h i s t i m e s e e k i n g f a m i l i a r i t y w i t h i n t h e c o n f i n e s o f a pitched roof of which all of their h o m e s w o u l d h a v e c o n s i s t e d . P i t c h e d r o o f s a l s o d e f i n e a m o r e human scale of building with large i n s t i t u t i o n s u n a b l e t o b e c o m p o s e d i n t h e s a m e w a y. E n d u r i n g for thousands of years out of a pri m i t i v e n e c e s s i t y, t h e f o r m o f a d w e l l i n g a n d i t s p i t c h e d r o o f i s a strong symbol embedded within m a n y, e v e n f r o m a v e r y e a r l y a g e . The House So far Homes appear to made prim a r i l y o f m e m o r i e s i n s c r i b e d t h r o u g h o u r p r o c e s s o f d w e l l i n g captured in objects or the building i t s e l f . T h e f a m i l i a r i t y i n f o r m , a n d t h e c o m f o r t a n d c o n t r o l in tectonics and material evoke a u n i q u e a t m o s p h e r e c r e a t i n g a p l a c e w e f e e l s a f e s t , “ t h e m o s t familiar of places” 10 or as Gaston B a c h e l a r d p u t s i t “ o u r c o r n e r o f t h e w o r l d ” 1 1 . I h a v e f o u n d t w o aspects of the house that are mos t i m p o r t a n t i n t h i s i n s t a n c e : T h e r o o t e d n e s s a n d s e c u r i t y o f t h e core which is fundamentally the h o m e , a n d t h a t o f p l a c e s t o d r e a m , e v o k i n g t h e i d e a o f f u r t h e r escapism. In setting out with two p a r t s , u n a v o i d a b l y d r a w i n g o n s o m e o f m y o w n e x p e r i e n c e s of home, I will look at the home as a t w o l a y e r e d e n t i t y f i r s t l y s t u d y i n g t h e s e p a r a t e p a r t s o f a home, in the form of thresholds an d r o o m s , f o r m i n g t h e o u t e r s h e l l . I w i l l t h e n l o o k a t t h e p l a c e s to daydream as entities withdrawi n g f u r t h e r i n t o t h e r e a l m o f t h e d o m e s t i c . T h i s w i l l f i n a l l y b e concluded exploring how the home b e c o m e s g r e a t e r t h a n t h e s u m o f i t s i n d i v i d u a l p a r t s . Homes are usually very modest bui l d i n g s b u i l t o f n e c e s s i t y r a t h e r t h a n d e l i g h t . 1 2 I t s c o n s t r u c t i o n and proportions therefore derive fr o m t h e h u m a n s c a l e m o s t a p p r o p r i a t e f o r d w e l l i n g . T h e h u m b l e brick speaks of the proportions of a h a n d a n d t h e l a b o u r p l a c e d i n l a y i n g e a c h b r i c k . L a r g e blank facades of brick are punctur e d b y w i n d o w s a n d d o o r s , a r e a s a l l o w e d f o r e m b e l l i s h m e n t and articulation on a truly human s c a l e . “ G e t a s m a l l c h i l d t o d r a w a h o u s e a n d y o u w i l l a l m o s t certainly see the face emerge.” 13 F a c a d e n a t u r a l l y d e r i v e s f r o m t h e L a t i n f a c i e s , ‘ f a c e ’ . 1 4 Heathcote speaks of the facade in t h i s p e r s o n i f i e d w a y e s p e c i a l l y w h e n r e f e r r i n g t o c h i l d r e n a n d their views of the home, windows a s e y e s , t h e d o o r s a s t h e m o u t h a n d r o o f f o r h a i r. T h e f a c t t h e

Ibid Ibid 17 Ibid 18 B e a t r i z C o l omina, “Collaborations- The P r i v a t e L i f e of Modern Architecture,” J o u r n a l o f t h e Society of Architectural H i s t o r i a n s , 2 000, 462–71. 19 Ibid 20 E d w i n H e a t hcote, The Meaning of Home. 15 16

F i g u r e 7 8 R i g ht Top: Door handle to C a b a n e P r o f f eseur G. Rossier, Valais Alps Switzerland. F i g u r e 7 9 R i g ht Bottom: Raised door step d e n o t i n g t h e first crossing of threshold.

house can be seen in this anthropo m o r p h i c w a y s p e a k s o f i d e n t i t y o r p u t t i n g a f a c e t o t h e ( n a m e ) place, familiarity and a welcoming n a t u r e i n m o s t c a s e s i n c o n t r a s t t o t h e b l a n k a n o n y m o u s n e s s of institutions. Interestingly facad e c a n a l s o b e u s e d i n t h e s e n s e o f ‘ p u t t i n g o n a f a c a d e ’ o r a n external appearance or in this cas e t h e f a c e o f t h e b u i l d i n g . T h o u g h t o f i n t h i s w a y t h e f a c a d e is a critical element when talking a b o u t t h e d o m e s t i c . T h e l e v e l o f p r i v a c y a n d i n t i m a c y d o e s not allow itself to appear transpar e n t w i t h n o t h i n g t o h i d e . I t a c t s a l m o s t i n t h e s e n s e o f , a s Sigmund Freud put it, going back t o t h e f a c e a n a l o g y, a h e a d f i l t e r i n g w h a t i t s h o w s t o t h e p u b l i c whilst harbouring the thoughts be h i n d i n t h e m i n d . 1 5 D o m e s t i c f a c a d e s t h e n s p e a k o f a w e l c o m i n g and familiar face defined both ant h r o p o m o r p h i c a l l y a n d c o m p o s i t i o n w i s e b y t h e h u m a n s c a l e , despite the clear definition of bou n d a r y b e t w e e n p u b l i c a n d p r i v a t e c o n t r o l l e d b y t h e f a c a d e w e want people to see. Front Doors “The door is a crossing, a junction m a r k i n g t h e d i v i d e b e t w e e n t h e r e l a t i o n o f t h e p u b l i c a n d t h e private, between chaos of the unfo r m e d w o r l d o u t s i d e a n d t h e s a c r o s a n c t o r d e r w i t h i n , a n d s u c h it represents a profoundly symboli c m o m e n t t h a t n e e d s t o b e m a r k e d . ” 1 6 Over time our mediation and cross i n g o f t h i s b o u n d a r y o f t h e f a c a d e o r p u b l i c a n d p r i v a t e h a s become increasingly more complex . W i t h p u b l i c , s e m i p u b l i c a n d p r i v a t e s p a c e s l e a d i n g u s o n a journey to the core of the domes t i c r e a l m . B u t o u r f i r s t p h y s i c a l i n t e r a c t i o n w i t h t h e b u i l d i n g comes at the front door. This initia l t h r e s h o l d d e n o t e s t h e f i r s t c r o s s i n g b e y o n d t h e f a c a d e articulated by shelter and the door s t e p w h e r e y o u w a i t t o b e r e c e i v e d . T h e e l e v a t e d p l a n e o f the doorstep creates a subtle disti n c t i o n o f a n i n b e t w e e n z o n e o f s e m i - p u b l i c a n d s e m i - p r i v a t e interaction almost as a bridge into t h e d o m e s t i c r e a l m . 1 7 I t b e g i n s t h e f o r m a t i o n o f a p r i m i t i v e space in the form of a domestic em b r a c e p r o v i d i n g s h e l t e r a n d a v e r y h u m a n s c a l e o f e n t r a n c e within an otherwise relatively blan k f a c a d e . S i m i l a r l y B e a t r i z C o l o m i n a s t a t e s “ A t t h e t h r e s h o l d a line has been drawn” 18 reinforcin g t h e s a f e t y o f t h e h o m e u s i n g m i l i t a r y m e t a p h o r w h e r e o n passing this threshold we “leave t h e h o m e l a n d t o d o b a t t l e o u t s i d e . ” 1 9 M u c h l i k e d e f e n s i v e h o m e s of old this threshold, whilst infinit e l y m o r e s u b t l e , i s s t i l l i n s o m e w a y s a d e f e n s i v e s t r a t e g y t o make us feel safe from the chaos o f t h e o u t s i d e w o r l d . Heathcote uses the front door of n u m b e r 1 0 d o w n i n g s t r e e t t o e x p l a i n t h e v a r i o u s a r t i c u l a t i o n s of this key threshold. Similarly to t h e f a c a d e t h e d o o r e m p l o y s a n a n t h r o p o m o r p h i s m a n d a n opportunity of embellishment to re f l e c t t h e r e s i d e n t . 2 0 I t h a s a t r i p a r t i t e p a n e l l i n g w i t h i n t h e door denoting the head, torso and l e g s w i t h t h e d o o r k n o b a s t h e n a v a l . E v e n w i t h i n t h e m o s t humble of houses these articulatio n s s t i l l e n d u r e i n o n e w a y o r a n o t h e r c o n t r a s t i n g t h e r e l a t i v e l y simple door texture with the meta l h a n d l e s t h a t w e t o u c h , p o l i s h e d b y t h e m a n y h a n d s w h i c h have used them. This is quite disti n c t l y d i f f e r e n t t o t h a t o f t h e i n s t i t u t i o n w h e r e w e a r e g r e e t e d a homogenous level access, somet i m e a c a n o p y, a n d a s i n g l e p a n e o f g l a s s a u t o m a t i c a l l y o p e n i n g

A k i k o B u s c h, Geography of Home (London: P r i n c e t o n A r chitectural Press, 1999). 22 E d w i n H e a t hcote, The Meaning of Home. 23 Ibid 21

F i g u r e 8 0 R i g ht: The use of earthy natural m a t e r i a l w i t hin the hall space emphasising i t s m e d i a t i o n between inside and ou t.

before us in a fairly cold and func t i o n a l w a y. The domestic threshold of the fron t d o o r h a s a l w a y s h a d r i t u a l i s t i c a n d c e r e m o n i a l c o n n o t a t i o n s 2 1 even dating back to the design of t e m p l e s o r g r a n d h o u s e s w h i c h u s e d t o a c k n o w l e d g e t h e r i s i n g sun of a new day. 22 As said stated b e f o r e m u c h o f o u r d o m e s t i c r e a l m h a s r e m a i n e d r e l a t i v e l y unchanged but this notion of light s e e m s t o h a v e e n d u r e d a l o t l o n g e r t h a n m o s t . E v e n t o d a y this threshold is lit, which could a g a i n b e s e e n a s a n o t h e r p r o t e c t i v e s t r a t e g y b e t w e e n t h e inside and out. Whether this is ph y s i c a l p r o t e c t i o n a l l o w i n g p e o p l e t o b e s e e n w h o w o u l d otherwise be hidden or the more m e t a p h o r i c a l p r o t e c t i o n f r o m d a r k n e s s a n d e v i l s p i r i t s . E v e n certain elements date back to the o r n a m e n t a t i o n o f t e m p l e s w h i c h u s e d b r o n z e t o c a p t u r e t h e sunâ&#x20AC;&#x2122;s rays emphasising that which w e t o u c h . To d a y w e u s e t h e l e s s l a v i s h m a t e r i a l o f b r a s s to denote this interaction but the w a r m t h a n d p r e m i s e r e m a i n s t h e s a m e e s p e c i a l l y i n d o o r handles. Interestingly to touch the d o o r h a n d l e r e i n f o r c e s a n e l e m e n t o f o w n e r s h i p . A v i s i t o r s first physical interaction with the h o u s e m i g h t n o t b e u n t i l t h e h a n d r a i l o f t h e h a l l a f t e r b e i n g admitted past this first threshold. O n l y t h e o w n e r ( s ) h a s t h e k e y a n d r i g h t s t o t o u c h t h e d o o r handle and admit themselves and a n y o n e e l s e d o i n g s o w i t h o u t p e r m i s s i o n i s s e e n a s a p e r s o n a l attack. Halls â&#x20AC;&#x153;It is in essence a social space, th e i n t e r n a l , t h e d o m e s t i c e q u i v a l e n t o f t h e t o w n s q u a r e . T h e coats, boots and umbrellas, and th e s t o n e m a r b l e f l o o r s , w e r e a r e m i n d e r o f i t s n a t u r e a s a n interface between interior and ext e r i o r. O n l y a g e n e r a t i o n a g o , a h a l l t a b l e w o u l d h a v e b e e n crowned with a telephone, more ev i d e n c e o f i t s b o a r d e r c o n d i t i o n b e t w e e n t h e w o r l d s o f p u b l i c and private.â&#x20AC;? 23 Whilst the hall has become more o f a f u n c t i o n a l s p a c e i n m o d e r n s o c i e t y, a n d h a s l o s t s o m e o f its importance in articulating the g r a n d e u r o f t h e s p a c e , i t i s a t t h e c o r e o f t h e h o m e m e d i a t i n g between this inside and outside re a l m . I m p o r t a n t l y t h e c o u n t e r p o i n t o f t h e d o o r s t e p i s r e f l e c t e d in the door with the door mat cont i n u i n g t h i s l a n g u a g e b e y o n d t h e d o o r t o t h e s e c o n d l a n d i n g within the hall. All spaces work ar o u n d t h e h a l l w h i c h e x t e n d s h o r i z o n t a l l y t h r o u g h o u t t h e h o m e but also vertically and must be, in m o s t c a s e s , r e - e n t e r e d t o a c c e s s o t h e r s p a c e s . T h e m a t e r i a l i t y as stated by Heathcote acknowled g e s t h i s i n s i d e o u t c o n d i t i o n u s i n g p r i m a r i l y h a r d w e a r i n g natural materials sometimes givin g u s k e y s a s t o t h e m o r e a c c e s s i b l e s p a c e s w h e r e t h e m a t e r i a l language is continued. This also re i n f o r c e s t h e d i s t i n c t s e p a r a t i o n f r o m m o r e p r i v a t e r o o m s which opt for softer, more intimate f u r n i s h i n g s i n w h i c h r e s i d e n t s c a n i n h a b i t . T h e h a l l i s o n l y one of the only double height spac e s w i t h i n t h e h o u s e a g a i n e m p h a s i s i n g p r i v a c y, h a b i t a t i o n a n d circulation. The hall is distinctly a n o n - i n h a b i t e d s p a c e w h e r e i f y o u a r e w a i t i n g f o r s o m e o n e y o u might sit upon the stairs.

Ibid Ibid 26 Ibid 27 Ibid 28 Ibid 29 Ibid 24 25

F i g u r e 8 1 R i g ht: Maggie’s centre by OMA s h o w i n g t h e complete avoidance of long corridors.

Apartment buildings are interestin g i n t h a t t h e y h a v e t o a d d i n a n o t h e r l a y e r. A p a r t m e n t s c o n t a i n a more complex layering of bounda r i e s b e t w e e n p u b l i c s p a c e a n d r e s i d e n t s o n l y s p a c e . 2 4 I n essence an additional hall/ corrido r i s p u t i n p l a c e b e f o r e y o u a c c e s s y o u r o w n h a l l g o i n g f r o m canopy to lobby to private hall spa c e . T h i s i s a l s o r e f l e c t e d i n t h e l e v e l o f i n h a b i t a t i o n . P r i v a t e spaces can be fully inhabited but t h e c o m m u n a l a r e a s w i t h l i t t l e d e f i n i t i o n o v e r o w n e r s h i p become much more like public spa c e s i n b e t w e e n t h e i n s i d e a n d o u t s i d e . I h a v e a d d e d t h i s i d e a in as it demonstrates a more comp l e x d o m e s t i c l a y e r i n g s y s t e m w h i c h c o u l d b e m o r e a p p r o p r i a t e to hospital application. However l o n g c o r r i d o r s a r e s e l d o m f o u n d w i t h i n t h e d o m e s t i c r e a l m a s they create an ambiguous non-plac e . T h e l o n g c o r r i d o r h a s b e e n a d o p t e d b y i n s t i t u t i o n , h o s p i t a l s , hotels etc which have hopelessly t a i n t e d t h e i m a g e c r e a t i n g s o m e t h i n g u n s e t t l i n g a b o u t t h e m . 2 5 In many ways I would say this mak e s h i g h d e n s i t y a p a r t m e n t s s o m e w h a t l e s s o f a h o m e , b u t t h i s will undoubtedly be down to my ow n v e r y d i f f e r e n t p e r c e p t i o n s o f h o m e . O n e t h i n g i s c e r t a i n though, long vast circulation space s s h o u l d b e a v o i d e d m u c h l i k e i n a n u m b e r o f t h e M a g g i e ’s centres where rooms are created i n s t e a d , a n d t h e a v o i d a n c e o f t h e ‘ l o n g s c a r y c o r r i d o r ’ i s a primary aim. Fireplaces “Its appeal is obvious. As German o b s e r v e r H e r m a n n M u t h e s i u s w r o t e i n T h e E n g l i s h H o u s e , ‘ To an Englishman the idea of a room w i t h o u t a f i r e p l a c e i s q u i t e s i m p l y u n t h i n k a b l e . . . t h e f i r e p l a c e is the domestic altar before which d a i l y a n d h o u r l y h e s a c r i f i c e s t o t h e h o u s e h o l d g o d s . ’ ” 2 6 Whilst physically halls maybe the c e n t r e o f t h e p l a n a n d o r i g i n a l l y t h e p r i m a r y / o n l y r o o m 2 7 t h e central focus or ‘heart of the home ’ h a s s h i f t e d . F i r e p l a c e s a r e a k e y f o c u s w i t h i n t h e d o m e s t i c interior and are to rephrase Muthe s i u s , d i s t i n c t l y B r i t i s h . I t s t i l l r e m a i n s a t t h e c e n t r e o f t h e room piercing up and out, express e d e x t e r n a l l y. To d a y i t c o m p e t e s w i t h t e l e v i s i o n s n o w s i t t i n g in an awkward competition with ea c h o t h e r n o t q u i t e f u l l y r e s o l v e d . C h i m n e y s p r o v i d e t h e n o t i o n of heat and a remembrance of how h o u s e s u s e d t o b e h e a t e d , a l t h o u g h t o d a y c o m p r i s e m o r e of a notion than being intrinsic to e v e r y d a y l i f e . T h e f i r e p l a c e s t i l l p l a y s i t s p a r t , e s p e c i a l l y a t Christmas (one of the most domest i c o f h o l i d a y s ) w i t h S a n t a v i s i t i n g d o w n t h e c h i m n e y t o p u t presents in stockings hung on the m a n t e l p i e c e . C h r i s t m a s r e i n f o r c e s t h e d o m e s t i c r e a l m . Whilst more decorative than anyth i n g t o d a y f i r e p l a c e s a s a p a r t o f t h e d o m e s t i c i n t e r i o r s h o u l d not be underestimate. Heathcote a r g u e s t h a t t h e h o u s e a r o s e a s a s h e l t e r f o r t h e f i r e m o r e so than man and it was the fire th a t w a s c r u c i a l t o l i f e a s o p p o s e d t o t h e r o o f . 2 8 T h i s i s s t i l l celebrated and stepped in traditio n e s p e c i a l l y w i t h i n B r i t i s h c u l t u r e . T h e f i r e d p l a c e p r o v i d e d a counterpoint to the window with a d i f f e r e n t v i e w t o t h e e t h e r e a l w o r l d o f l i g h t a n d h e a t . 2 9

Ibid Ibid 32 R o b y n L o n g hurst, “(Dis)embodies G e o g r a p h i e s , ” in Progress in Human G e o g r a p h y, 1 997, 486–501. 33 B u s c h , G e o graphy of Home. 34 P h i l i p p a Tr istram, Living Spaces in Fact a n d F i c t i o n ( London: Routledge, 1989). 30

Kitchen

F i g u r e 8 2 R i g ht: Continuation of the hall m a t e r i a l c r e ating a connection to the k i t c h e n a s a more public space and the i m p o r t a n t c o nnection to the garden beyond.

“The modern Kitchen is very much t h e h e a r t o f t h e h o m e . I t h a s b e c o m e t h e d e f a u l t c o n t e m p o r a r y social space, a place of both intim a t e f a m i l y m e a l s a n d o f i n f o r m a l s o c i a l i n t e r c o u r s e ” 3 0 The kitchen as a space is the true h e a r t o f e v e r y h o m e . I t i n t e r e s t i n g l y s p a n s b e t w e e n t h e h a l l and more intimate spaces both bei n g u s e d f o r e v e r y d a y c o n v e r s a t i o n s a n d e n t e r t a i n i n g b u t a l s o for more intimate family affairs. It i s o n e o f t h e m o s t c o m f o r t i n g p l a c e s r e l a t i n g t o t h e m a g i c of transformation and alchemy of c o o k i n g p r o v i n g s u s t e n a n c e , b u t a l s o o f t h e m o t h e r, o f w a r m refuge and the security of the wom b . 3 1 T h i s h a s b e e n a k e y i d e a c a r r i e d f o r w a r d i n t o t h e M a g g i e ’s centres, specifically that of Roger S t i r k H a r b o u r + P a r t n e r s w h e r e t h e i d e a o f t h e k i t c h e n provided the important heart of th e d e s i g n . I t i s n o w o b v i o u s t o s e e w h y t h i s w a s d o n e , a n d w h y it is successful when dealing with c a n c e r s u f f e r e r s . P e o p l e d e a l w i t h t h i n g s i n v e r y d i f f e r e n t ways so need that control of eithe r o p e n i n g u p t o s h o w t h e i r e m o t i o n s o r w i t h d r a w t o s e c u r e privacy. This complex yet subtle ch a n g e d e r i v e s f r o m t h e d o m e s t i c r e a l m a n d i s n o t f o u n d i n a n y other building. Despite this the kitchen is one of t h e f e w p l a c e s t h a t r e q u i r e s a l e v e l o f f u n c t i o n a l i t y. L o n g h u r s t suggests that inhabitants project t h e m s e l v e s o n t o t h e i r s u r r o u n d i n g s a n d t h i s i n t u r n r e f l e c t s themselves. 32 This might be said o f a l l s p a c e s w i t h i n a h o m e w h e n t h i n k i n g a b o u t d e s i g n a n d decoration, but it is most particula r w i t h i n t h e k i t c h e n w h e r e r e g u l a r r i t u a l s o f c o o k i n g a n d cleaning take place. These regular p r o c e s s e s a r e u n i q u e t o t h e r e s i d e n t a n d b e c o m e c a p t u r e d in the organisation and wear of th e s u r r o u n d i n g s . T h i s a g a i n d e n o t e s t h i s c o n t r o l o v e r t h e environment with everything in its r i g h t f u l p l a c e . I a m s u r e e v e r y o n e h a s b e e n i n a n o t h e r k i t c h e n gone to find the spoons and autom a t i c a l l y o p e n e d t h e w r o n g d r a w d u e t o d e f a u l t i n g t o t h e remembered ritualistic memory rep e a t e d n u m e r o u s t i m e s w i t h i n t h e i r o w n h o m e . To c a r r y o u t these rituals gives a sense of norm a l i t y a n d a d i s t i n c t f e e l i n g o f h o m e . Homes often have their own logic. B u s c h a r g u e s t h a t h o m e s a r e n e v e r l a n d s c a p e s o f l o g i c e v e n if the design does follow a type of l o g i c , a n d p r e c i s i o n a n d t h e w a y i n w h i c h w e i n h a b i t m e a n s a home of logic is somewhat less o f a h o m e . 3 3 I w o u l d h a v e t o a g r e e a n d d i s a g r e e w i t h B u s c h on this point. Homes are never rat i o n a l o r c o m p l y t o s t r i c t l o g i c b u t I t h i n k h o m e s h a v e a v e r y esoteric logic defined by the inhab i t a n t . P r e v i o u s l y i t w a s s t a t e d t h a t t h e h o m e p r o t e c t s t h e inhabitants from the chaos of the o u t s i d e w o r l d , a l o g i c o r o r d e r w e d o n o t u n d e r s t a n d . F r o m an outsiders perspective a home c o u l d s e e m v e r y c h a o t i c b u t i t i s m e r e l y a n l o g i c t h e y d o n o t understand. Every object has a spe c i f i c p l a c e r o u t e d f r o m y e a r s o f d w e l l i n g r e l a t i n g t o t h e previous point of remembered ritua l . T h i s i s u n d e r s t o o d b y t h e i n h a b i t a n t a l l o w i n g t h e m t o d e f i n e their own logic inhabiting the spa c e f u l l y f e e l i n g i n c o n t r o l a n d c o m f o r t a b l e . T h i s i s r e i n f o r c e d b y Thomas Hardy who says “The wors t t h i n g o f t a k i n g a f u r n i s h e d h o u s e , i s t h a t t h e a r t i c l e s i n t h e rooms are saturated with the thou g h t s a n d g l a n c e s o f o t h e r s ” . 3 4

E d w i n H e a t hcote, The Meaning of Home. Ibid 37 B a c h e l a r d , Poetics of Space. 38 E d w i n H e a t hcote, The Meaning of Home. 39 B a c h e l a r d , Poetics of Space. 35

Bedrooms

F i g u r e 8 3 R i g ht: Peter Zumthor’s home s t u d i o d e m o straiting careful consideration f o r s o f t f u r n i shing and arrangement to c r e a t a d o m e stic environment connected to t h e l a n d s c a p e despite the use of modern m a t e r i a l s a n d high ceilings.

“It all begins on the bed. Perhaps o u r t e n d e r e s t a n d p e r h a p s o u r m o s t e c s t a t i c m o m e n t s o c c u r there and, if we are lucky, perhaps i t a l l e n d s t h e r e t o o . We m a y n o l o n g e r b e b o r n o r d i e i n our own bedrooms, instead emergi n g o r e x p i r i n g u n d e r t h e s i c k l y f l i c k e r i n g f l u o r e s c e n t s o f t h e hospital, but we are probably still c o n c e i v e d i n t h e b e d r o o m a n d , o f a l l t h e r o o m s i n o u r h o u s e , i t remains the most intimate, the mo s t p r i v a t e a n d t h e m o s t p r e c i o u s . ” 3 5 Further still into the domestic laye r s w e c o m e t o t h e b e d r o o m o f t e n e l e v a t e d b y t h e s t a i r s o f the hall to security, one of the mo s t p r i v a t e o f r o o m s . T h e h i e r a r c h y o f t h e h o u s e b e c o m e s m o s t evident at this point. A usual fami l y u n i t w i l l c o m p r i s e p a r e n t / p a r e n t s a n d c h i l d / c h i l d r e n . T h e parent(s) have control over the hou s e , i t s o r g a n i s a t i o n a n d d e c o r a t i o n e t c . W i t h i n t h e b e d r o o m , especially for children, it is the op p o r t u n i t y o f t h e i r o w n p r i v a t e s p a c e t o i n h a b i t a s t h e y s e e f i t and escape the enforced regime of t h e p a r e n t s ( a l t h o u g h t h e y w i l l i n v a d e f r o m t i m e t o t i m e ) . T h e scale of space also reduces with s u b t l e r e d u c t i o n s i n c e i l i n g a n d r o o m d i m e n s i o n s a n d t h e m o s t freestanding furniture. At this inn e r m o s t l a y e r w e a r e a t o u r m o s t v u l n e r a b l e w h e n s l e e p i n g a n d any invasion of this space is intru s i v e a t a v e r y h i g h l e v e l . H e a t h c o t e l i k e n s t h e b e d r o o m t o t h e idea of an inner sanctum. 36 Places to Dream Within the fixed solidarity of the h o u s e w e h a v e s e e n t h e c o m p l e x l a y e r i n g o f t h e d o m e s t i c r e a l m through careful use of thresholds a n d t e x t u r e s d e n o t i n g b o u n d a r i e s a n d a h i e r a r c h y o f l e v e l o f inhabitance. The house remembers t h e i n h a b i t a n c e b u t a l s o t h e d r i v e r s o f c o n c e p t i o n w i t h i n w h a t is now primarily ornamentation su c h a s t h e f i r e p l a c e . Ye t i n h a b i t a n t s c r e a t e t h e i r l o g i c w i t h i n the home, appearing chaotic from a n o u t s i d e r s p o i n t o f v i e w. T h i s l o g i c i s a l s o f o u n d w i t h i n the formal arrangement and tecton i c s o f t h e h o m e w h e r e p h y s i c a l l y t h e h a l l i s t h e m o s t c e n t r a l space yet is arguably functional a n d t h e l e a s t i m p o r t a n t . W h i l s t t h e k i t c h e n i s t h e t r u e h e a r t o f the home evoking strong private an d c o l l e c t i v e f e e l i n g s a n d r i t u a l i s t i c a c t s c a r r i e d o u t o n a d a i l y basis. Very briefly touched upon in t h e p r e v i o u s c h a p t e r i s t h e f u r t h e r w i t h d r a w a l e v e n f r o m t h e domestic realm both for adults and c h i l d r e n a l i k e , a s a t y p e o f e s c a p i s m t o p l a c e s i n w h i c h t h e y can dream leaving the troubles of t h e w o r l d b e h i n d . B a c h e l a r d r e m i n d s u s o f t h e i m p o r t a n c e of the home we grow up in and ho w i t s h a p e s o u r p e r c e i v e d h i e r a r c h y o f i n h a b i t a t i o n a n d t h a t homes embody both home but also d r e a m s . 3 7 “The child’s den and the garden sh e d a r e a t t e m p t s t o c r e a t e a s e p a r a t e w o r l d w i t h i n a w o r l d , a world over which we have control a n d t h e m e a n s n o t o n l y t o i m a g i n e b u t t o s h a p e ” 3 8 The house is solid and rootes us to ‘ o u r p l a c e i n t h e w o r l d ’ 3 9 p r e s e n t i n g a f a c e , h o u s i n g functional elements and in some c a s e s s h o w i n g o f f . T h e s h e d , d e n , s h e d w h a t e v e r y o u w a n t t o

E d w i n H e a t hcote, The Meaning of Home. B a c h e l a r d , Poetics of Space. 42 E d w i n H e a t hcote, The Meaning of Home. 43 M i c h a e l d e -Certeau, Luce Girad, and P i e r r e M a y o l , The Practice of Everyd ay Life. ( L o n d o n : U n i versity of Minnesota Press, 1998). 40 41

call it in humble and very simple i n i t s c o n s t r u c t i o n . I t i s s o f t m a d e o f t i m b e r o r b e d s h e e t , b u t importantly is made or able to be m a d e b y t h e i n h a b i t a n t g i v i n g a g r e a t c o n n e c t i o n . M u c h l i k e i n The Lion, The Witch and The Ward r o b e t h e w a r d r o b e r e p r e s e n t s t h e d r e a m s p a c e o f t h e b e d r o o m . Heathcote describes the need for d r e a m s p a c e s s p e c i f i c a l l y f o r c h i l d r e n , “ C h i l d r e n n e e d t o create worlds to escape the adult o n e w i t h i n w h i c h t h e i r l i v e s a r e s o p r e s c r i b e d . W h e t h e r i t i s a shop- bought garden house, a shod d i l y c o n s t r u c t e d s h a c k , a n a p p r o p r i a t e d t o o l s h e d o r a s u s p e c t construction of blankets, sheets an d c l o t h e s p e g s , t h i s i s t h e p r i m a r y a c t o f m a k i n g a h o m e a n d is a critical step in the establishin g o f t h e n e s t i n g i n s t i n c t . I t i s t h e w a y i n w h i c h c h i l d r e n b e g i n to understand the world of habitat i o n a n d d w e l l i n g i n s p a c e . ” 4 0 B a c h e l a r d c o n f i r m s t h i s i d e a saying the spaces we build for our s e l v e s a t c h i l d h o o d a r e e c h o e s o f t h e p r i m i t i v e h u t i n w h i c h to dream. 41 Whilst adults also like t o e s c a p e , t o t h e g a r a g e , s h e d o r s t u d y, i t s a f e t o s a y t h e house is the realm of the parents/ a d u l t s . T h e i r c o n t r o l r e s i d e s i n t h e i r o r d e r a n d c o n t r o l o f t h e environment. Children do not have t h i s c o n t r o l s o e s c a p e t h e a d u l t r e a l m t o a p l a c e i n w h i c h t h e y can have full control without cons e q u e n c e s . Children create their own worlds i n w h i c h t o p l a y. W h e n c h i l d r e n p l a y w i t h “ d o l l s h o u s e s o r model railways, toy soldiers or tan k s , w o r l d i n w h i c h t h e r e a r e n o c o n s e q u e n c e s f o r a c t i o n s , and over which (unlike the real wo r l d ) c h i l d r e n c a n e x e r t c o n t r o l ” . 4 2 B o t h h o m e a n d p l a y a r e exceptionally important for childre n t o l e a r n a n d d e v e l o p . T h e h o m e c r e a t e s t h o u s a n d s o f memories which define how the ch i l d w i l l e v e n t u a l l y b e h a v e . 4 3 P l a y n o t o n l y a l l o w s a l e v e l of escapism it creates this control t e a c h i n g c h i l d r e n h o w t o d w e l l . O n e c a n n o t e x i s t w i t h o u t the other. This is why it is hard to i m a g i n e w h a t i t m u s t b e l i k e b e i n g y o u n g a n d i n a h o s p i t a l environment for a long period of ti m e e s p e c i a l l y w h e n i t i s a n a d u l t w a r d p a i n t e d i n b r i g h t colours like in QMC. Control mean s v e r y d i f f e r e n t t h i n g s t o d i f f e r e n t p e o p l e b u t w i t h i n t h e r e a l m of domesticity these differences d e f i n e d i f f e r e n t w a y s i n w h i c h t o d w e l l , f e e l c o m f o r t a b l e , s a f e and in control of our space and ult i m a t e l y o u r l i v e s .

E d w i n H e a t hcote, The Meaning of Home.

Conclusion With more and more â&#x20AC;&#x2DC;rites of pass a g e â&#x20AC;&#x2122; 4 4 b e i n g m e d i c a l i s e d , m o v e d a w a y f r o m t h e r e a l m o f t h e domestic to the institution, the ho s p i t a l e n v i r o n m e n t i s a n i n c r e a s i n g l y m o r e i m p o r t a n t p l a c e i n our lives. The home and hospital a p p e a r t o b e f a r m o r e l i n k e d t h a n I i n i t i a l l y t h o u g h t a n d w o u l d have believed to begin with but la c k a n y c o n n e c t i o n . T h e d o m e s t i c r e a l m m e a n s d i f f e r e n t t h i n g s to different people but there are f u n d a m e n t a l f e a t u r e s w h i c h d e r i v e f r o m d w e l l i n g . T h e h o m e is primarily constructed of memori e s w h i c h a r e a l l o w e d t o i n s c r i b e t h e m s e l v e s t h r o u g h o b j e c t s or within the building fabric itself d e v e l o p i n g a h i s t o r y a n d c h a r a c t e r i n w h i c h w e d w e l l . We find familiarity in strong vernacula r f o r m s e v e n w h e n t h e i r f u n c t i o n h a s c e a s e d t o b e i m p o r t a n t leaving them as ornamentation and t r a c e s o f t h e o r i g i n s o f d w e l l i n g . F a m i l i a r i t y i s a l s o d e r i v e d from material articulations such as b r i c k , t i m b e r, c a r p e t , t i l e s a n d p l a s t e r b o a r d a l l o f w h i c h h a v e a relation to the human scale and c r a f t . The home works in a twofold way, t h e h o m e i t s e l f a n d t h e p l a c e s i n w h i c h t o d r e a m . T h e h o m e provides the solidity and fixed nod e i n w h i c h l i f e r e v o l v e s d e n o t i n g l e v e l s o f p r i v a c y a n d inhabitation through material, atm o s p h e r e a n d t h r e s h o l d s a l l a d h e r i n g t o t h e e s o t e r i c l o g i c o f t h e inhabitant. This revolves further a r o u n d a s t r o n g h e a r t o f t h e k i t c h e n w h i c h s p e a k s o f i n t i m a c y, entertaining, sustenance but also w a r m t h a n d t h a t o f t h e m o t h e r. We f e e l s a f e w i t h i n t h e h o m e i n which we have total control and o w n e r s h i p o f o u r e n v i r o n m e n t , i t s o r g a n i s a t i o n , d e c o r a t i o n a n d logic. Whilst adults also like to es c a p e a n d d r e a m t h e h o m e i s p r i m a r i l y t h e r e a l m o f t h e a d u l t . Places to dream are humble and us u a l l y c r a f t e d b y t h e m a k e r, p r i m a r i l y i n w h i c h c h i l d r e n c a n p l a y and dream. This is the realm in wh i c h c h i l d r e n c a n f e e l c o m f o r t a b l e , s a f e a n d e x e r t c o n t r o l o v e r their surroundings and actions. It i s a t y p e o f e s c a p i s m f r o m t h e p r e s c r i p t i o n o f t h e a d u l t w o r l d and the inner most place in which t o w i t h d r a w l e a v i n g t h e c h a o s o f t h e o u t s i d e w o r l d b e h i n d .

Place Deficit Disorder

4 .1 Pla ce Disorder

Deficit

M a r k H a c k e tt and Declan Hill, “Forum for A l t e r n a t i v e Belfast,” Forum for Alternative B e l f a s t , 2 0 0 9, http://www.forumbelfast. org/. 2 C r a i g , D . H . “A History of Belfast City H o s p i t a l . ” U l ster Medical Journal, no. 43 (1974): 1–14. 3 N a n E l l i n , “Your City Yourself,” in I m p e r f e c t H e alth: The Medicalization of A r c h i t e c t u r e , ed. Giovanna Borasi and Mirko Z a r d i n i ( C a n adian centre for architecture: l a r s m u l l e r p ublishers, 2012). 4 G i o v a n n a a nd Zardini, Imperfect Health, T h e M e d i c a l i zation of Architecture. 1

F i g u r e 8 4 O p posite: Life expectancy of N o r t h e r n I r e l and and Belfast F i g u r e 8 5 & 86 Overleaf: Degeneration of B e l f a s t ( 1 9 6 0s - Present).

A n

I l l

C i t y

B e l f a s t

In the past Belfast was an industri a l c e n t r e h o l d i n g a l a r g e s t a k e p r i m a r i l y i n t h e s h i p b u i l d i n g business. Today it is a very differe n t p l a c e . T h e m e m o r i e s o f t h e s h i p b u i l d i n g i n d u s t r y s t i l l remain in the Titanic quarter wher e S a m s o n a n d G o l i a t h s t i l l s t a n d a s a b a c k d r o p t o t h e q u a i n t brick housing estates. It is a place c l e a r l y s t i l l s t r u g g l i n g f r o m p o l i t i c a l u n r e s t e v e n a f t e r ‘ T h e Troubles’ concluded almost 20 yea r s a g o , w h i c h i s e v i d e n t i n t h e u r b a n c o m p o s i t i o n . F r o m t h e 1960’s Belfast has seemingly unbu i l t a w e l l f u n c t i o n i n g c i t y c a r v i n g i t u p t o m a k e c a r s t h e m a i n source of transport. In this time th e C i t i e s p o p u l a t i o n d r o p p e d b y 3 5 % c h o o s i n g t o m o v e t o t h e suburbs and public spaces became s p a r s e m a k i n g w a y f o r c a r p a r k s a n d a b a n d o n e d b u i l d i n g s . 1 As a city Belfast and its surroundi n g a r e a s a r e s u p p o r t e d b y s o m e o f t h e b e s t h e a l t h c a r e facilities in Ireland specifically sp e c i a l i s i n g i n c a n c e r c a r e . 2 H o w e v e r a n i n t e r e s t i n g c o n d i t i o n arises where Belfast has a signific a n t l y l o w e r l i f e e x p e c t a n c y t h a n a n y w h e r e i n t h e w h o l e o f Northern Ireland. From experiencin g t h e c i t y, t h e 1 9 6 0 s r e c o n f i g u r a t i o n l e a v e v e r y l i t t l e p u b l i c space resulting in a disconnected c i t y f a b r i c , c a r v e d u p b y r o a d s g i v i n g p r i o r i t y t o c a r s , p r i m a r i l y used for leisure and shopping with v e r y f e w r e s i d e n t s . “ W h i l e g r e a t p l a c e s n o u r i s h b o d y a n d soul, poor environmental and urba n q u a l i t y c h a l l e n g e s u s p h y s i c a l l y a s w e l l a s e m o t i o n a l l y. ” 3 Lifestyle is a key contributor to he a l t h a n d i s h e a v i l y i n f l u e n c e d b y o u r u r b a n e n v i r o n m e n t . T h e r e is no doubt that the drastic histori c a l c h a n g e s i n B e l f a s t h a v e h a d a s i g n i f i c a n t l y n e g a t i v e e f f e c t . Belfast is in need of urgent regene r a t i o n . T h e h e a l i n g o f o u r s e l v e s a n d p l a c e s g o h a n d i n h a n d . 4

4 .5 Pla ce Disorder

Deficit

A l a n J o n e s , “Belfast - Sixth Year Thesis M i c h a e l S t a c ey’s MARS Unit,” December 2 3 , 2 0 1 4 , h t t ps://pod51031.outlook.com/ o w a / # p a t h = / mail. 6 R u t h M o r r o w, “Belfast - Sixth Year Thesis M i c h a e l S t a cey’s MARS Unit,” December 2 3 , 2 0 1 4 , h t t ps://pod51031.outlook.com/ o w a / # p a t h = / mail. 7 A l i s t a i r H a l l , “Belfast - Sixth Year Thesis M i c h a e l S t a cey’s MARS Unit,” December 2 3 , 2 0 1 4 , h t t ps://pod51031.outlook.com/ o w a / # p a t h = / mail. 5

R u t h M o r r o w, “Belfast - Sixth Year Thesis M i c h a e l S t a c ey’s MARS Unit.” 8

F i g u r e 8 7 & 88 Previous Spread: Existing h o s p i t a l s w i thin Belfast and Void sites w i t h i n B e l f a st. F i g u r e 8 9 O p posite: Potential sites within Belfast.

I n t e r v e n t i o n

S i t e

After Mapping and researching the e x i s t i n g c o n d i t i o n w i t h i n B e l f a s t I s p o k e t o a n u m b e r o f l o c a l practicing architects and tutors ba s e d a t Q u e e n s U n i v e r s i t y B e l f a s t t o t r y a n d h e l p m e p i n p o i n t a site within Belfast. A number of p o t e n t i a l s i t e s w e r e s u g g e s t e d b y A l a n J o n e s o f A l a n J o n e s Architects, Ruth Morrow of The Ta c t i l i t y F a c t o r y a n d A l i s t a i r H a l l f r o m H a l l M c k n i g h t A r c h i t e c t s finally coming to the four sites ma p p e d i n f i g u r e 7 8 . E a c h s i t e h a s i t s o w n d i s t i n c t o p p o r t u n i t i e s and challenges I will discuss bello w. F r o m m y r e s e a r c h I w o u l d l i k e t o f i n d a n u r b a n s i t e w i t h good architectural buildings to int e g r a t e w i t h i n p r e f e r a b l y o f m i x e d u s e t o e n c o u r a g e d i v e r s i t y. Because of its disconnected natur e i t w o u l d a l s o b e i m p o r t a n t t o b e i n a k e y p o s i t i o n w i t h i n t h e city to encourage this connectivity. Site A: Site A is the largest of the s i t e s s i t t i n g a t 5 . 1 6 h e c t a r e s . I t i s m o r e o f a n i n d u s t r i a l s i t e with warehouses and offices block s a s w e l l a s s h o p f r o n t a g e s . T h e n e o c l a s s i c a l B e l f a s t L i b r a r y sits on the East of the site as wel l a s t h e B e l f a s t Te l e g r a p h . I t h a s a l a r g e r n u m b e r o f o p p o r t u n i t y sites in the form of car parks and d e r e l i c t b u i l d i n g a n d w o u l d b e f o r m e d a s m o r e o f a c a m p u s type development much light city U n i v e r s i t i e s . 5 Site B: Bank Square has a significa n t o p p o r t u n i t y t o f u n c t i o n a s a p r o m i n e n t p u b l i c s q u a r e which it currently does not at the m o m e n t . I t i s o n e o f t h e l a r g e r s i t e s s e l e c t e d w i t h a r o u n d 2 . 2 hectares of space and a few build i n g s o f m e r i t t o i n t e g r a t e m y s c h e m e w i t h i n . I t h o u s e s a t w o church buildings and a very popula r f i s h r e s t a u r a n t b u t i s c u r r e n t l y d y s f u n c t i o n a l d u e t o a d e a l e r s yard at castle court being unwillin g t o g i v e B e r r y S t r e e t b a c k t o t h e c i t y p l a n . T h i s a r e a i s a significant axis from East to West a c r o s s B e l f a s t ( t w o c u l t u r a l h u b s i f y o u p l o t o u t w h e r e a r t i s t s sit in the city) currently cut off by t h e l a c k o f u s e o f a p o t e n t i a l p u b l i c s q u a r e ( c u r r e n t l y a c a r park) and the obstruction on Berry S t r e e t . 6 Site C: Site C is one of the smalle r s i t e s w i t h o n l y 0 . 7 8 H e c t a r e s o f s i t e b u t w i t h p o t e n t i a l i n the surrounding areas for addition a l d e v e l o p m e n t s a s t h e r e a r e a n u m b e r o f b u i l d i n g s d u e f o r demolition. The site sits around an e x i s t i n g s q u a r e c a l l e d B l a c k s t a f f s q u a r e a n d i s i n t h e m o r e southern part of the city centre. W h i l s t n o t a s p r o m i n e n t a s i t e a s B a n k S q u a r e i t h a s a n u m b e r o f opportunities being an old stone w a r e h o u s e b u i l d i n g w h i c h i s c u r r e n t l y n o t b e i n g u s e d a s w e l l a s an important tower building (Wind s o r H o u s e ) w h i c h i s a w a i t i n g a n e w l e a s e o f l i f e . T h e r e i s a l s o an existing car park which can be u s e d f o r d e v e l o p m e n t . 7 Site D: Site D is situated outside o f t h e c i t y c e n t r e a r e a i n w e s t B e l f a s t w i t h s t r o n g a r c h i t e c t u r a l character. The site is situated aro u n d t e m p l e m o r e a v e n u e w h i c h h a s o l d Vi c t o r i a n b a t h s a n d a newly built primary school trying t o e s t a b l i s h i t s e l f a s a n u r b a n v i l l a g e . D e s p i t e i t s s t r o n g architectural character it is primar i l y m o n o - c u l t u r e d b e i n g p r i m a r i l y p r o t e s t a n t , l o y a l i s t a n d working class. Whilst not in a prim e l o c a t i o n i t c r e a t e s a n i n t e r e s t i n g c h a l l e n g e o f h o w t o a t t r a c t neighbouring catholic community a n d i n d e e d t h e g r o w i n g i m m i g r a n t a n d m i g r a n t c o m m u n i t i e s t o come to East-side as it will be bra n d e d . 8

Typologies and Change

5 .0 Typ ologies Change

and

u . t v, “ N e w Children’s Hospital for B elfast,” U . t v, O c t o b e r 21, 2013, http://www.u.tv/ n e w s / N e w - c hildrens-hospital-for-Belfast/ d d d c b 2 e c - 0 c 8a-4a50-9bd0-ec905985fa3a. 2 H C M c G i l l , CA McMahan, and SS Gi dding, “ P r e v e n t i n g Heart Disease in the 21st C e n t u r y : I m p lications of the Pathobiological D e t e r m i n a n t s of Atherosclerosis in Youth ( P D AY ) S t u d y,” Circulation 117, no. 9 ( M a r c h 2 0 0 8 ): 1216–27, doi:10.1161/ C I R C U L AT I O NAHA.107.717033. 3 B V H o w a r d and CA McMahan, “Sugar a n d C a r d i o v a scular Disease: A State ment f o r H e a l t h c a r e Professionals from the C o m m i t t e e o n Nutrition of the Council o n N u t r i t i o n , Physical Activity, and M e t a b o l i s m of the American Heart A s s o c i a t i o n , ” Circulation 106, no. 4 ( J u l y 2 3 , 2 0 0 2): 523–27., doi:10.1161/ C I R C U L AT I O NAHA.107.717033. 1

F i g u r e 9 0 O p posite: My fifth year 480 unit m i x e d u s e h ousing project utilising the i d e a o f a s h ared basement to connect the d i f f e r e n t b l o cks and to hide parking, refuse c o l l e c t i o n a n d plant rooms.

B e l f a s t

C h i l d r e n ’s

H o s p i t a l

The idea of designing an entire dis a g g r e g a t e d h o s p i t a l w o u l d b e n o t h i n g s h o r t o f i m p o s s i b l e i n the given time frame. Based at the m o m e n t i n m y o w n t h e o r y, t h e i d e a o f a n e w d i a g g r e g a t e d hospital typology is not only neces s a r y b u t a l s o h a s a l o t o f p o t e n t i a l t o s o l v e a l a r g e n u m b e r of issues surrounding institutional i s e d h o s p i t a l s t o d a y. A t t h e m o m e n t f o r t h i s p r o j e c t I f e e l specificity will be key to developin g a n d t e s t i n g t h e i d e a s d i s c u s s e d w i t h i n m y t h e s i s . A f t e r visiting Hopkins Architects at the e n d o f J a n u a r y t o t a l k t o a s p e c i a l i s t h e a l t h c a r e d e s i g n e r I will be able to better gauge the ex t e n t t o w h i c h I w i l l n e e d t o s p e c i f y m y p r o g r a m m e . After researching the current state o f B e l f a s t t h e i n i t i a l t h o u g h t w a s t o d e s i g n a c h i l d r e n ’s hospital based on the fact the old i n s t i t u t i o n , w h i l s t r e c e i v i n g a n e w e x t e n s i o n i n 2 0 0 0 , w a s nearly 100 years old with conditio n s n o t f i t f o r p u r p o s e . H e a l t h M i n i s t e r E d w i n P o o t s v i s i t e d t h e hospital and said “I was shocked b y w h a t I s a w : d e d i c a t e d h e a l t h p r o f e s s i o n a l s g o i n g b e y o n d t h e call of duty to treat some extreme l y i l l c h i l d r e n b u t d o i n g s o i n s u r r o u n d i n g s t h a t , I a m a s h a m e d to say, are far from fit for purpose . ” 1 T h i s p r o m p t e d t h e s c h e m e t o r e p l a c e t h e e x i s t i n g h o s p i t a l starting in 2015 due for completio n o n 2 0 2 0 / 2 0 2 1 . W h i l s t s t i l l a h u g e u n d e r t a k i n g a c h i l d r e n ’s hospital narrows it down to a sma l l e r s c a l e a n d s t i l l g i v e s m e o p p o r t u n i t y t o t e s t t h e t h e o r y. I t also is important because of the u n i q u e c h a l l e n g e o f c r e a t i n g a f a m i l i a r e n v i r o n m e n t f o r p e o p l e more sensitive to scale and chang e o f t h e i r e n v i r o n m e n t . Alternatively but in a similar threa d t h e c h i l d r e n ’s c a r d i o l o g y s p e c i a l i s t u n i t , c u r r e n t l y a t T h e Royal Belfast Hospital, is being pr o p o s e d t o b e m o v e d t o D u b l i n a s i t i s s a i d t o b e u n e c o n o m i c in its current state. So to specify f u r t h e r I c o u l d p r o p o s e a c h i l d r e n ’s c a r d i o l o g y s p e c i a l i s t unit within the city of Belfast. Hea r t d i s e a s e i s t h e b i g g e s t k i l l e r i n t h e U K w i t h c a n c e r b e i n g third highest. Although cardiovasc u l a r d i s e a s e u s u a l l y a f f e c t s o l d e r a d u l t s , t h e a n t e c e d e n t s o f cardiovascular disease, notably at h e r o s c l e r o s i s , b e g i n i n e a r l y l i f e , m a k i n g p r i m a r y p r e v e n t i o n efforts necessary from childhood. 2 T h e k e y c o n t r i b u t i n g f a c t o r s t o h e a r t d i s e a s e a r e p r i m a r i l y life style which is a current eviden t i s s u e i n t h e c i t y o f B e l f a s t . T h e p r i m a r y c o n t r i b u t o r s t o cardiovascular diseases are: age, g e n d e r, t o b a c c o u s e , p h y s i c a l i n a c t i v i t y, e x c e s s i v e a l c o h o l consumption, unhealthy diet, obes i t y, f a m i l y h i s t o r y o f c a r d i o v a s c u l a r d i s e a s e , r a i s e d b l o o d pressure (hypertension), raised blo o d s u g a r ( d i a b e t e s m e l l i t u s ) , r a i s e d b l o o d c h o l e s t e r o l (hyperlipidemia), psychosocial fact o r s , p o v e r t y a n d l o w e d u c a t i o n a l s t a t u s , a n d a i r p o l l u t i o n . 3 I think Both of these potential opt i o n s g i v e m e e n o u g h s c o p e t o a p p l y m y t h e o r y t o a b u i l d i n g design with scale being the poten t i a l i s s u e . I t c o u l d b e a c a s e o f m a s t e r p l a n n i n g a n d t h e n specifically designing a unit of the b u i l d i n g . N o n e t h e l e s s i t w i l l a l l o w m e t o t e s t t h e i d e a s o f physical and visual connectivity, c r e a t i n g s p e c i f i c i t y i n e a c h d e p a r t m e n t , c r e a t i n g a n a p p r o p r i a t e scale, urban integration, building u p o n t h e i n h e r e n t q u a l i t i e s o f p l a c e , c r e a t i n g a p p r o p r i a t e balance between privacy and obse r v a t i o n , a d a p t a b i l i t y o f s p a c e s a n d t h e u l t i m a t e l e g i b i l i t y o f the building.

100

5 .1 Typ ologies Change

and

F i g u r e 9 1 O p posite: Paper model of Temple B a r - M e e t i n g House Square. F i g u r e 9 2 To p: Public space between the 3 i n s t i t u t e s l inking them together through r e l a t e d e v e n ts such as film screenings. F i g u r e 9 3 R i ght: Photograph of the stage o n t h e c o m m unal square attached to the c h i l d r e n ’s c e ntre.

Te m p l e

B a r,

M e e t i n g

H o u s e

S q u a r e

G r o u p

9 1

Temple Bar was one of the three s p a c e s f o r u r b a n r e g e n e r a t i o n w h e n G r o u p 9 1 w o n t h e Te m p l e Bar framework plan competition in 1 9 9 2 . G r o u p 9 1 C o m p r i s e d – G r a f t o n A r c h i t e c t s , O ’ D o n n e l l and Tuomey, Shay Cleary Architect s , D e r e k Ty n a n A r c h i t e c t s , P a u l K e o g h A r c h i t e c t s , M c C u l l o u g h Mulvin Architects, Shane O’Toole w i t h M i c h a e l K e l l y, a n d M c G a r r y N í E a n a i g h . T h e a i m w a s to form buildings around the publi c s p a c e i n a n a t t e m p t t o l i n k M e e t i n g H o u s e S q u a r e , C u r v e d Street and Temple Bar Square. Formerly used as a surface car par k M e e t i n g H o u s e S q u a r e i s n o w a c h a n g e a b l e p u b l i c s p a c e catering for markets, film nights a n d p e r f o r m a n c e s . T h e f o u r w a l l s o f t h e s q u a r e a r e m a d e u p of four institutions all related and c o n n e c t e d a r o u n d t h e s q u a r e : T h e A r k ( C h i l d r e n ’s c e n t r e ) , The Gallery of Photography, the Iri s h F i l m C e n t r e ( P r e - U r b a n r e g e n e r a t i o n ) a n d T h e N a t i o n a l Photography Centre. The arrangement of building metic u l o u s l y i n t e r w e a v e w i t h i n t h e e x i s t i n g f a b r i c m a i n t a i n i n g t h e public square space in which they c a n a l l i n t e r a c t a n d c o n n e c t w h i l s t n o t b e c o m i n g o n e l a r g e building giving nothing back to the u r b a n r e a l m . T h e s q u a r e s e e m e d l i k e a p l e a s a n t p l a c e t o b e but fairly quite which could have b e e n d o w n t o a n u m b e r o f r e a s o n s s u c h a s t h e s e a s o n o r t i m e o f day. However Cassidy writes that i t h a s a n u m b e r o f i s s u e s o n e b e i n g t h e f a c t t h a t i t i s a g a t e d square and not fully public. Secon d l y t h e i n t e n t i o n w a s f o r t h e s q u a r e t o b e p a r t o f t h e l i n k a n d bridge over the Liffey, however th e a c t u a l b r i d g e w a s p l a c e d a l o n g E u s t a n c e s t r e e t m e a n i n g t h a t is where most of the footfall happ e n s . To c o m b a t t h i s a n u m b e r o f e v e n t s a r e h e l d w i t h i n t h e square but the combination of man a g e r i a l a n d u r b a n p o s i t i o n i n g i s s u e s m e a n s i t s i n i t i a l p r e m i s e is somewhat lost. 101

F i g u r e 9 4 O p posite: View across the square t o t h e I r i s h F ilm Centre and National P h o t o g r a p h y Centre. F i g u r e 9 5 To p: View of the square showing s t a g e o f T h e Ark and the outside cin ema. F i g u r e 9 6 C e ntre: Plan of the square s h o w i n g a l l four buildings interweaving w i t h t h e e x i s ting fabric and connecting a r o u n d t h e s quare. F i g u r e 9 7 R i ght: View to the square from the P h o t o g r a p h i c archive.

103

5 .1

K i n g s

C r o s s

A r g e n t

F i g u r e 9 8 O p posite: Kingâ&#x20AC;&#x2122;s Cross d e v e l o p m e n t master plan highlighting the S t . P a n c r a s s quare office development. F i g u r e 9 9 To p: Central lorry delivery and c o l l e c t i o n r o ute at basement level. F i g u r e 1 0 0 O verleaf: Lower ground basement plan. F i g u r e 1 0 1 O verleaf: Upper basement plan. F i g u r e 1 0 2 O verleaf: Site section 01. F i g u r e 1 0 3 O verleaf: Site Section 02.

The kingâ&#x20AC;&#x2122;s Cross development look s t o c r e a t e a d i v e r s e m i x o f b u i l d i n g t y p o l o g i e s a n d u s e s whilst connecting into the wider fa b r i c o f a d i f f i c u l t s i t e s u r r o u n d e d b y i n f r a s t r u c t u r e . T h e i s s u e with temple bar in terms of a prec e d e n t i s t h a t a h o s p i t a l c a n n o t b e c o m p r i s e d o f s e p a r a t e buildings with no form of connecti o n . I n c o n t r a s t S t . P a n c r a s s q u a r e i s a t o t a l l y n e w d e v e l o p m e n t of separate blocks around a public s q u a r e . W h a t i s m o s t i m p o r t a n t a n d d i f f e r e n t a b o u t t h i s precedent is that the all of the blo c k s a r e c o n n e c t e d v i a a s h a r e d b a s e m e n t l e v e l b e l o w t h e square. Aside from providing a pot e n t i a l i d e a o f c o n n e c t i o n w i t h i n m y p r o j e c t t h e b a s e m e n t also allows for concealment of pa r k i n g , c y c l e s t o r e s a n d s h o w e r s , s t o r a g e o f s t o c k a n d r e f u s e , delivery bays, stair/ lift cores and p l a n t r o o m s . T h i s i s a n i n t e r e s t i n g a l t e r n a t i v e o f s i n k i n g t h e s e functions below ground solve a nu m b e r o f p r o b l e m s h o s p i t a l s , s u c h a s t h e Q u e e n â&#x20AC;&#x2122;s M e d i c a l c e n t r e suffer from, opening up the main s p a c e s f o r p e d e s t r i a n u s e . Unlike the temple bar approach th e s c h e m e i n t h i s a r e i s a t o t a l n e w b u i l d u p o n t h e e x i s t i n g industrial site. Whilst in other are a s o f t h e s c h e m e , s u c h a s t h e C e n t r a l S t . M a r t i n b u i l d i n g , utilise and build upon the existing c h a r a c t e r o f t h e a r e a i n t h i s a r e a o f t h e s c h e m e t h i s w a s n o t appropriate. Based upon the sites I h a v e c h o s e i n B e l f a s t I f e e l a c o m b i n a t i o n o f i d e a s f r o m t h e precedents will be appropriate but I t h i n k b u i l d i n g u p o n t h e e x i s t i n g c o n d i t i o n w i l l b e k e y.

105

106

107

108

109

5 .1

U p p e r

A l i s o n M a r garet Smithson, The Charged Vo i d : U r b a n i sm (New York: Monacell i Press, 2004). 2 P e t e r S m i t h son, Peter Smithson: C o n v e r s a t i o n s with Students: A Space for O u r G e n e r a t i on, 1st ed (New York: Princeton A r c h i t e c t u r a l Press, 2005). 3 Ibid 4 Ib i d

Within the Fonthill Abbey estate s a t 1 8 t h c e n t u r y, a n d e a r l i e r, f a r m s t e a d c o t t a g e s ; i t i s w i t h i n and around one of these cottages t h a t t h e U p p e r L a w n P a v i l i o n w a s c o n s t r u c t e d 1 . A l i s o n a n d Peter Smithson criticised Jean Pro u v é f o r d e s i g n i n g b u i l d i n g s t h a t a r e “ u n g e n e r o u s , s e e m t o isolate themselves from their surro u n d i n g s , s i t u n c o m f o r t a b l y, b e n o t c a p a b l e o f j o i n i n g ” 2 .

F i g u r e 1 0 4 O pposite: Internal model p e r s p e c t i v e of the Upper Lawn Pavilion at f ir s t f l o o r l e vel (refer to Making Without R h e t o r i c : C o nstructing Simplicity). F i g u r e 1 0 5 Top: External view of the p a v i l i o n a n d its integration with the as f o u n d c o n d i t ion on site. F i g u r e 1 0 6 R ight: Construction interface d e t a i l b r i n g i ng together precise and rough c o n s t r u c t i o n methods (refer to Making W i t h o u t R h e t oric: Constructing Simplicity).

L a w n

P a v i l io n

T h e

S m i t h s o n s

At the Upper Lawn Pavilion one of t h e k e y a s p e c t s o f t h e d e s i g n w a s r e s p o n d i n g t o t h e a s found conditions where the pavilio n t r i e s t o u n c o v e r s t h e q u a l i t i e s , a n d b u i l d u p o n , t h e e x i s t i n g place in its selective response to w h a t w a s f o u n d . T h e p a v i l i o n s t r a d d l e s o n e g a b l e w a l l o f the previous cottage, with the oth e r t e r m i n a t i n g t h e ‘ o u t s i d e r o o m ’ , p a v e d w i t h t h e e x i s t i n g cottage floor stones 1 . The two win d o w s e a t s , b o t h i n t e r n a l a n d e x t e r n a l , w e r e w i n d o w s i n t h e original cottage. The pavilion also r e s p o n d s t o t h e s u r r o u n d i n g c o n d i t i o n a s w e l l c o n t r i b u t i n g to the estates existing selection o f p a v i l i o n s w i t h i n t h e p i c t u r e s q u e l a n d s c a p e . P e t e r S m i t h s o n described the pavilion as “a true B r u t a l i s t w o r k ” 3 w h e r e “ B r u t a l i s m b e g i n s w h e n y o u a r e t r y i n g t o uncover the brickness of brick” 4 . From studying and making the pavi l i o n w i t h i n o u r r o o m s a n d c h a i r p r o j e c t I g a i n e d a g o o d understanding of how the pavilion f u l l y i n t e g r a t e s w i t h t h e r o u g h a n d a l m o s t o r g a n i c n a t u r e o f the as found elements. In relation t o i n t e g r a t i n g a h o s p i t a l i n t o t h e u r b a n e n v i r o n m e n t t h i s w i l l be a key driver of the scheme mak i n g s u r e t o b u i l d u p o n , a n d i m p r o v e t h e e x i s t i n g q u a l i t i e s o f place. But at the same time being s e l e c t i v e a n d k n o w i n g w h a t e l e m e n t s t o r e m o v e .

111

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and

J o h n

P e r r y

N u r s e r y

C h i l d r e n ’s

C e n t r e

D S D H A

H é l è n e B i n e t, “John Perry Nursery & C h i l d r e n ’s C entre,” DSDSA, 2014, http:// w w w. d s d h a . co.uk/projects/52419625b67 e 0 c 0 0 0 2 0 0 0 0 96/John-Perry-Nursery-andC h i l d r e n - s - C entre. 2 Ibid

The John Perry Nursery and Childre n ’s C e n t r e d e s i g n e d b y D S D H A w a s a n a w a r d w i n n i n g s c h e m e credited for how it dealt with bein g i n a s o c i a l l y c h a l l e n g e d a r e a . T h e s c h e m e w a s d e v e l o p e d through in depth discussions with r e s i d e n t s t o f u l l y d i s c o v e r t h e i r n e e d s a n d a s p i r a t i o n s i n parallel with that of the architects . R a t h e r t h a n r e i n f o r c i n g t h e d o m e s t i c r e a l m t h e r e s i d e n t s and architects felt it important to s p e c i f i c a l l y c o n n e c t t h e c h i l d r e n w i t h n a t u r e a n d t h e w o r l d around. 1

F i g u r e 1 0 7 O pposite: Internal play space v i e w w i t h l o wer window detail to enable v i e w s o u t f o r the children. F i g u r e 1 0 8 Top: External view of the nursery a n d c h i l d r e n ’s centre. F i g u r e 1 0 9 R ight: Nursery space in u se.

The scheme uses both indoor and o u t d o o r t e a c h i n g s p a c e s w h i c h i s r e f l e c t e d w i t h i n t h e f l e x i b l e indoor plan. Whilst shared, both b u i l d i n g s h a v e t h e i r o w n d i s t i n c t i d e n t i t i e s u s i n g a v a r i e t y o f economic and industrial materials u s e d i n c l e v e r w a y s t o a v o i d t h e d o m e s t i c r e a l m a s w e l l a s create some interesting scales. 2 M y p e r s o n a l f a v o u r i t e b e i n g t h e a p p r o p r i a t e l y s c a l e d w i n d o w s not only views out for the children b u t a l s o a s e n s e o f c o n t r o l a n d o w n e r s h i p w i t h i n t h e s p a c e where adults now feel less well pl a c e d . I a l s o l i k e t h e a r t i c u l a t i o n o f s p a c e t h r o u g h s c a l e a s w e l l as material to create distinction b e t w e e n t h e d i f f e r e n t f u n c t i o n s w i t h o u t b r e a k i n g t h e b a n k u s i n g high end finishes.

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5 .2

E v e l i n a

A r c h i t e c t s J ournal, “EVELINA CHILDREN’S H O S P I TA L , S OUTH LONDON,” Architects J o u r n a l , O c t ober 12, 2006, http://www. a r c h i t e c t s j o u rnal.co.uk/home/evelinac h i l d r e n s - h o spital-south-london/130250. article. 2 Ibid 3 H o p k i n s A r chitects, “Evelina Childr en’s H o s p i t a l , ” H opkins, 2005, http://www. h o p k i n s . c o . u k/projects/6/9/. 4 A r c h i t e c t s J ournal, “EVELINA CHILDREN’S H O S P I TA L , S OUTH LONDON.”

The initial driver for the hospital s e t o u t b y t h e c l i e n t w a s “ a r e a l C h i l d r e n ’s h o s p i t a l , n o t a n adult hospital with cartoons on the w a l l . ” 1 T h e s c h e m e u s e s a n u m b e r o f i n n o v a t i v e m o v e s t o avoid the typical institutionalised h o s p i t a l . U p o n e n t e r i n g y o u a r e g r e e t e d b y a l a r g e b r i g h t atrium space with views to the sur r o u n d i n g g a r d e n s a n d i n t e r n a l v i e w s t o s h a r e d p l a y s p a c e s . The is organised with two strips a r o u n d a c e n t r a l c o n c o u r s e r a i s i n g u p t h e f u l l h e i g h t o f t h e building adjoining the main atrium . I t c o m p r i s e s 1 2 0 b e d s j o i n e d b y w i n d i n g p a t h s t r y i n g t o a v o i d long scary corridors. The whole bu i l d i n g i s h e a v i l y d a y l i t e s p e c i a l l y w i t h i n t h e w a r d s w h e r e parents have pull down beds next t o t h e i r c h i l d r e n . T h r o u g h t h e c o n s i d e r e d d e s i g n a n d s e l e c t i o n of colours the hospital does not su f f e r s p a t i a l a n o n y m i n i t y a n y w h e r e . 2

F i g u r e 1 1 0 O pposite: Internal view o f main atrium space. F i g u r e 1 1 1 Top: Private children’s side room. F i g u r e 1 1 2 R i ght: Children’s shared Play S p a c e w i t h i n the central concourse.

C h i l d r e n ’s

H o s p i t a l

H o p k i n s

Whilst the hospital goes a long wa y t o b r e a k i n g d o w n t h e h o s p i t a l a s a n i n s t i t u t i o n , g e t t i n g the balance between privacy and s u r v e i l l a n c e r i g h t , b u t i t s u f f e r s f r o m b e i n g a l i t t l e s a f e . “ L i k e offices hospitals require flexible l a y o u t s a n d s o c i a l i n t e r a c t i o n s p a c e s . ” 3 I n t h i s s t a t e m e n t f r o m the Hopkins website lies some of t h e f a i l u r e s a n d s u c c e s s e s o f t h e h o s p i t a l . T h e s p a c e s o f s o c i a l interaction are key for making the h o s p i t a l w o r k a n d t o m a k e t h e c h i l d r e n f e e l c o m f o r t a b l e i n a foreign environment. One critic s a y s t h a t t h e d e t a i l i n g c o u l d h a v e b e e n t a k e n f u r t h e r a n d referred to the office typology in r e s p o n s e t o i t n o t b e i n g p l a y f u l e n o u g h . I t w a s a l s o c r i t i c i s e d for not integrating the outside wit h i n t h e s p a c e s s u f f e r i n g f r o m b e i n g i n a b u b b l e s p e c i f i c a l l y t h e atrium. 4 115

116

6 .1

Conclusion

R e f l e c t i o n In conclusion, the research into de s i g n a n d i m p o r t a n c e o f t h e h e a l i n g e n v i r o n m e n t i s r e l a t i v e l y new, with the full effects only just b e i n g t e s t e d , b u t i s n o n e t h e l e s s w i d e l y a c k n o w l e d g e d t o b e beneficial to both patients and sta f f i n m e d i c a l i n s t i t u t i o n s . I h a v e a l s o e s t a b l i s h e d t h a t w h e n i n hospital patients are at their most v a u n r a b l e b e c o m i n g m o r e s u s c e p t i b l e t o t h e e f f e c t s o f t h e i r environment and this topic as high l i g h t e d b y a n u m b e r o f s o u r c e s , m o s t n o t a b l y t h e m e d i a , s h o w s that the design of large institution a l i s e d h o s p i t a l s h a s n e v e r b e e n m o r e i m p o r t a n t o r c u r r e n t . Public hospitals suffer from functi o n a l m e d i c a l i s e d d e s i g n w i t h p i o n e e r i n g i n s t i t u t i o n s i n t h e design of the healing environment b e i n g p r i m a r i l y p r i v a t e v e n t u r e s . T h e a c k n o w l e d g e m e n t o f t h e patients is a rarity when consideri n g t h e d e s i g n o f h o s p i t a l s b u t w h e r e i t i s c o n s i d e r e d a s o n e o f the primary drivers it shows that g e n e r a l a r c h i t e c t u r a l p l a c e m a k i n g p r e s e n t s t h e l a r g e s t p o s i t i v e results in the composition of hosp i t a l , n o t m e d i c a l . W h e n c o n s i d e r i n g t h e p a t i e n t s b e i n g t r e a t e d the specificity of units is also imp o r t a n t , n o t o n l y t o f u l f i l t h e f u n c t i o n a l r e q u i r e m e n t s o f p a t i e n t s to a better extent avoiding the one s i z e f i t s a l l m o d e l b u t a l s o , t o c r e a t e u n i q u e c h a r a c t e r s w i t h i n each unit and the specialism that t h e y t r e a t . This lead me to the idea of disagg r e g a t i n g a h o s p i t a l i n t o s p e c i f i c s e l e c t e d u n i t s . H o s p i t a l s cannot be full disaggregated and i t i s e s s e n t i a l t o h a v e a j o i n i n g e l e m e n t c o n t a i n i n g m o r e general services used by all units w h i c h c a n r e a c h e a c h u n i t q u i c k l y s u c h a s a c r a s h t e a m s , A&E, pharmacy, etc. Critically a ho s p i t a l i s a m u c h t o o l a r g e u n d e r t a k i n g f o r a d e s i g n p r o j e c t s o I need to be more specific. I have f u r t h e r s p e c i f i e d m y t y p o l o g y t o b e a c h i l d r e n ’s h o s p i t a l , o n e because of the need in Belfast for a n e w c h i l d r e n ’s h o s p i t a l a n d t w o b e c a u s e c r e a t i n g a f a m i l i a r comfortable environment is far mo r e i m p o r t a n t f o r c h i l d r e n w h i c h w i l l h a v e g r e a t e r i n f l u e n c e s upon the actual design and detaili n g o f t h e h o s p i t a l . A f t e r v i s i t i n g H o p k i n s a r c h i t e c t s a t t h e e n d of January I will have a better und e r s t a n d i n g o f t h e a p p r o p r i a t e s c a l e t h e h o s p i t a l w i l l n e e d t o be and whether I will need to be m o r e s p e c i f i c . I w i l l a l s o g e t a b e t t e r i d e a o f t h e i n v o l v e m e n t i n designing a children’s hospital alo n g w i t h m o r e t e c h n i c a l a s p e c t s a n d r e q u i r e m e n t s . I a l s o t h i n k possibly looking at ways in which d e t a i l i n g c a n i n f o r m t h e f e e l i n g o f s p a c e w i l l b e i m p o r t a n t , primarily to avoid the office like fe e l i n g f o u n d i n t h e E v e l i n a h o s p i t a l f o r e x a m p l e . W i t h t h i s being said, moving forwards, Eveli n a C h i l d r e n ’s H o s p i t a l w i l l b e a k e y f o c u s o f m y p r e c e n d e n t study to aid me on both the techni c a l a n d f u c n t i o n a l r e q u i r e m e n t s n e e d e d w i t h i n a h o s p i t a l . Fundamentally the theories and de s i g n t o o l s I h a v e a c q u i r e d w i t h i n t h i s t h e s i s w i l l b e t e s t e d once I start designing, making sure t o m a i n t a i n a n e m p h a s i s o n t h e f e e l i n g , d e t a i l a n d atmosphere of places as opposed t o g e t t i n g c a r r i e d a w a y w i t h t h e t e c h n i c a l a s p e c t s o f d e s i g n i n g purely functional spaces.

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Conclusion

P o s i t i o n From my in depth typological analy s i s o f t h e h e a l i n g e n v i r o n m e n t a c r o s s m a n y t h e m e s a n d ideas, I believe that the creation o f b e t t e r p l a c e s t o r e c o v e r w h e n a t o u r m o s t v u l n e r a b l e i s o f the up most importance and has ne v e r b e e n m o r e c u r r e n t . T h e p a t i e n t s s h o u l d b e t h e k e y d r i v e r of the design process with their ne e d s c o m i n g f i r s t w h e t h e r t h i s b e m e d i c a l l y, p h y s i c a l l y o r psychologically. Rather than centr a l i s a t i o n , c l o s u r e s o f l o c a l b r a n c h e s a n d c u t w e s h o u l d b e investing in what is undoubtedly o n e o f t h e m o s t i m p o r t a n t p l a c e s w e w i l l e n c o u n t e r. W h e t h e r i t be feelings of great joy or sadness t h e s e s h o u l d n o t b e a s s o c i a t e d w i t h r e s e n t e d n o n - p l a c e s b u t the familiarity of place. Whilst careful consideration and r i g o u r n e e d t o b e e m p l o y e d w h e n d e f i n i n g a r e a s f o r t h e architecture to flourish the change s n e e d e d r e q u i r e c o u r a g e a n d r a d i c a l t h i n k i n g t o a f f e c t a typology so strongly medicalised t o p r o p o s e a f u t u r e a r c h i t e c t u r e o f t h e h o s p i t a l e n v i r o n m e n t . I propose an architecture that: 1. Responds to the future scenario i n B e l f a s t w h e r e t h e d e g e n e r a t e d c i t y i s r e g e n e r a t e d increasing in population with the n e w p r o p o s e d c h i l d r e n â&#x20AC;&#x2122;s r e l i e v i n g p r e s s u r e f r o m t h e e x i s t i n g NHS services. 2. A disaggregation of the current l y a g g r e g a t e d h o s p i t a l t y p o l o g y a l l o w i n g c i t y i n t e g r a t i o n , b e t t e r legibility and reduction in scale. 3. An architecture which reference s t h e f a m i l i a r e n v i r o n m e n t o f t h e d o m e s t i c r e a l m r e d u c i n g alienation and fear commonly felt w i t h i n h o s p i t a l t y p o l o g i e s . 4. Careful separation and stratific a t i o n o f p u b l i c t o p r i v a t e s p a c e s p r e s e r v i n g t h e d i g n i t y o f patients with an emphasis of mini m a l i n t r u s i o n f r o m s t a f f . 5. The creation of communal place s a r t i c u l a t e d w i t h i n t h e a r c h i t e c t u r e w h e r e p e o p l e c a n i n t e r a c t . 6. An architecture which integrate s t h e u s e o f a p u b l i c g r o u n d c o m p r i s e d o f t h e r a p e u t i c g a r d e n spaces which can be enjoyed by th e c i t y a s w e l l a s t h e p a t i e n t s a i d i n g t h e r e c o v e r y p r o c e s s . 7. An integrated urban strategy wh i c h e n c o u r a g e s t h e r e g e n e r a t i o n o f B e l f a s t t h r o u g h o p e n i n g u p historic routes, increasing permea b i l i t y a n d p r o v i s i o n o f m u c h n e e d e d g r e e n p u b l i c s p a c e .

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Conclusion

T h e s i s

P r o g r e s s i o n

I believe Bank Square is an approp r i a t e p l a c e t o t e s t m y a r c h i t e c t u r a l t h e o r i e s a s i t a l r e a d y h a s the makings of a core public space w i t h i n t h e c i t y, i t i s l o c a t e d w i t h i n t h e m o s t h i s t o r i c a r e a which is a key pivot point to the c i t i e s r e g e n e r a t i o n , a n d i t i s i m p o r t a n t l y l o c a t e d w i t h i n t h e neutral area of the city centre whi c h i s n o t t o r n b y t h e r e l g i o u s a n d p o l i t i c a l d i v i d e i n N o r t h e r n ireland. The challenge of rethinking the ho s p i t a l e n v i r o n m e n t l i e s i n i n t e g r a t i n g t h e h u m a n s c a l e o f t h e patient with the larger scale of fu n c t i o n a l i s m , h y g i e n e a n d t e c h n o l o g y w h i c h h a v e b e e n t h e drivers of such an important typolo g y s o f a r. 1. In-depth analysis, involving a re v i s i t , o f B a n k S q u a r e r a n g i n g f r o m h i s t o r i c t o i n f r a s t r u c t u r e a s well as the opportunities it presen t s i n t e r m s o f u r b a n s t r a t e g y a n d i n t e g r a t i o n w i t h t h e p u b l i c realm. 2. Critical and rigorous research in t o h o s p i t a l t y p o l o g i e s l o o k i n g a t f u n c t i o n a l r e q u i r e m e n t s a n d relationships as well as technical a s p e c t s , s p e c i f i c a l l y v i s i t i n g H o p k i n s A r c h i t e c t s t o d i s c u s s Evelina Childrenâ&#x20AC;&#x2122;s hospital as a pr i m a r y t y p o l o g i c a l s t u d y. 3. Careful analysis of how to disag g r e g a t e t h e h o s p i t a l t y p o l o g y u s i n g m e t h o d s t o a g g r e g a t e dependant services whilst maintai n g s u b t l e c o n n e c t i o n r o u t e s t h r o u g h o u t a b o v e a n d b u t p r i m a r i l y below ground. 3. Continued typological studies p r i m a r i l y f o c u s e d o n a n i n t e g r a t e d u r b a n s t r a t e g y a n d articulation of an architectural tec t o n i c w h i c h r e f e r e n c e s t h e d o m e s t i c r e a l m a n d r e l a t e s t h e t h e patients at all scales. 4. Exploration of materials in crea t i n g t h e s p a t i a l q u a l i t y o f d o m e s t i c i t y w h i c h s t i l l f u n c t i o n within a hospital as well as resear c h i n t o t e c h n o l o g i e s t o a t t e m p t t o o f f s e t t h e e n e r g y l o a d s experienced in the hospital typolo g y. 6. Explore the hospital typology w i t h i m a g i n a t i o n a n d r i g o u r.

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