TRANSFORMING CABLES WYND HOUSE
Scott Doherty Stage 6 Arc8060 Thesis Portfolio
CONTENTS
.01
.03
.02
.04
.06
.05
Thesis introduction
P.1
Archiving Cables Wynd House
P.16
Local Issues of Health and Social Care
P.38
De-industrialisation of Hospitals
P.60
Design Development
P.70
The Transformation of Cables Wynd House
P96
- Deprivation In Leith - Social housing Megastructures
P.2 P.6
- Background - Problems
P.18 P.30
- Restructuring Healthcare In Leith - Covid-19 Pandemic - The Brief
P.40 P54 P.58
- Transformation of Cables Wynd House - Residential Healthcare
P.62 P.66
- Precedent Analysis - Schematic Layout
P.72 P.84
- Phase 1
P.98
- Introduction - Surgery and Entrance - Accommodation
P.100 P.108 P.120
- Phase 2
P.144
- Introduction - Accommodation - Physical Rehabilitation - Rooftop Intervention - Phase 3
P.146 P.162 P.172 P.180 P.188
.01 Thesis Introduction Leith Social Housing Megastructures
Drawing by Basel Spence of Hutchensontown C, Gorbals, Glasgow
1
Deprivation Post-War Construction in Edinburgh
Data from the Scottish Index of Multiple Deprivation and the Scottish 2016 Census ranks levels of education, housing, crime, income, health, employment and geographic access across Scotland. While these statistics don’t show exact problems, they do indicate where possible issues may lay. After Analysing this data across the whole of Edinburgh, Leith was particularly interesting because of the large fluctuations in the deprivation levels, both the highest and lowest levels are present (left.) When analysing the architectural differences between the lower and higher deprived areas, many of the areas classified as having ‘lower’ deprivation in Leith were distinguished by post-war developments (To the right, red shows constructions between the end of WW11 and 1980. Numbers show census and deprivation data on a scale of 1- 10, 1 is low.)
Deprivation Levels across Edinburgh
3
Post-war construction across Leith Social Housing Megastructures While some of the constructions in the large post-war development process were retail or leisure facilities, like the large kirgate shopping centre (Images to left.), the majority of the postwar constructions in Leith were large social housing megastructures which aimed at providing better accommodation compared with the Victorian slums known for overcrowding, poor sanitisation, disease and crime. While these were generally successful in the postwar period, there have been many problems with postwar social housing megastructures since.
1960’s photographs of Kirkgate shopping centre and Kirkgate house
5
Post-war Social Housing Megastructures Current methods of dealing with them in Leith The majority of the post-war social housing megastructures in Leith lasted into the 21st century, However recently in leith these constructions have been dealt with in a few ways. The original method was to use “value-engineered sticking plasters” (Citadel court, right) to disguise the concrete structure. However, these only covered up any of the problems. Implementing strict rules in citadel court such as minimum resident ages, didn’t help the social, economical or stigmatisation issues that postwar social housing tower-blocks were having either. Consequently the recent method of dealing with them (Lieth fort, left) has been to demolish them and build new housing. Erasing part of Leith’s history, this method has negative economical, social and environmental affects.
Leith fort development finished construction in 1963 (above) Citadel Court in the 1960’s and a photograph taken in 2019 showing the “valued engineered sticking plasters” that were put over it (right)
7
CABLES WYND HOUSE
LINKSVIEW HOUSE
KIRKGATE HOUSE
Post-War Social Housing Megastructures Specific Site Development A small section of Leith, however, still has all of the large social housing megastructures that were built in the post-war period remaining. The small ‘heart shaped’ area is located next to the river and close to the city centre in Leith (image of this to the right, red represents all the post-war construction that still remain.) The three large and most iconic of these constructions (all images to the left) are Cables Wynd House, Linksview house and Kirkgate House These buildings are undeniably under threat to eventually have the same treatment of demolition if real change is not taken to ensure there survival for years to come. To go about change, firstly, the real issues and positive benefits of post-war megastructures in Scotland must be understood.
Photo’s taken of Cables Wynd House, Linksview House and Kirkgate house, all in a small area of Leith
9
Post-War Social Housing Megastructures History - Origins Following the Second World War, the trend of constructing large social housing megastructures was particularly influential in the development of Scottish cities like Glasgow and Edinburgh. Inspired by Le Corbusier’s utopian dream and ‘unite d’habitation’,1 these built cityscapes attempted to rehouse large numbers of people displaced from Victorian slums. Their aims to mitigate the troublesome living conditions of poor sanitation, disease, crime and overcrowding were generally successful.2
1 2
Image Above of the Red Road Flats after there construction in Glasgow, to the right one of the original elevation drawings by Basil Spence of Hutchinsontown C, Gorbals in Glasgow
Marmot, A.F. (1981), The Legacy of Le Corbusier and High-Rise Housing, Built Environment Vol 7 No.2, p.82-95 Boughton, J. (2018), Municipal Dreams; The rise and fall of council Housing, Verso Publications, p.108-139
11
Problems in the UK Post-war Social Housing Megastructures However, the idealisation of these structures did not last long. Through poor construction and a changing political and social landscape, the general public fell out of love with these buildings. With large disasters like the Ronan Point disaster (image to the left) at the end of the 60’s, to the recent Grenfell tower fire (image to the right) happening elsewhere in the UK, they have been very negatively thought of in the British consciousness as a whole. Consequently, there has often been a lack of maintenance that led to their degradation. During the 80s and 90s the negative portrayal of these buildings increased, due to speculation that they fuelled the large growth of drug use in Scotland. Despite the trend of “value-engineered sticking plasters” attempting to disguise the concrete structure, the unfair stigma that these social housing blocks generated troublesome behaviour persisted and they remain “convenient scapegoats” for various failures of society.3 3
Image above of Grenfell Tower after the tragic fire in 2017, to the right a picture of the Ronan point disaster in 1968
Hanley, L. (2007), Estates an Intimate History, London, Granta Publications
13
Post-war Social Housing Megastructures Benefits Consequently Demolitions of iconic structures like the Red Road Flats (left image) or Hutchinsontown C, Gorbals in Glasgow (right image) embody how these buildings have been dealt with across Scotland in the last two decades. Nonetheless, in an ever changing political and social landscape, this approach may be on the verge of being reshaped. In Leith, Cables Wynd House and Linksview House recently received the highest historic listing available, urging their protection for years to come. Following on, eight high rise blocks built in the 1960s in Aberdeen were just nominated to get a similar listing, with supporting reasons being their historic, social and architectural importance to Scotland. While these are significant gestures, this support has yet to materialise in physical improvements or maintenance changes, and as a result Cables Wynd House is still slowly degrading. Putting aside the environmental and heritage benefits of protecting megastructures, the ‘vertical cities’ of post-war megastructures have unique architectural possibilities in scale and densification that could not be achieved in any other form of construction. Whether “the benefits of the landscape, the views they offer…. [or] the absence of noise,”4 it’s necessary to see the unique potential values in these properties and put them to good use. To truly change the attitudes on these buildings that lead to their demolition, developments must be made which understand the benefits these buildings possess. With Cables Wynd House being such an infamous structure, it’s listing provides an opportunity to investigate alternate possibilities to demolition postwar tower-blocks, that may be more economically, environmentally, politically and socially sustainable for Scotland. This this thesis then looks at the transformation of Cables Wynd House in order to show the architectural potential of Scottish post-war megastructures once you get past their stigmatisation. Before moving any further forward, a more detailed history of Cables Wynd House should be done.
4
Image Above of the Red Road Flats being demolished and Hutchinsontown C, Gorbals in Glasgow
Druot, F. Lacaton, A. Vassal, J.P. (2007), Plus: Large-scale Housing Development, Editorial Gustavo Gili - p.65-71
15
.02 Cables Wynd House Archiving the building History and Problems
Photograph taken in the 1960’s of the newly finished Cables Wynd House
17
Cables Wynd House A Brief History
Locally influential architects Alison, Hutchinson & Partners designed Cables Wynd House as part of a major post-war development along with the neighbouring Linksview House. The social housing tower block was constructed between 1963 and 1965 (right), to contain 212 social housing apartments on nine floors. Of these over 200 have remained socially rented. The design of the building displays many of the characteristics of brutalist architecture in the postwar period in the UK; large, monolithic, rigid geometry and mass concrete construction.
Image above is an ariel photograph of Cables Wynd House under construction during 1965, image to the left is a photograph of a resident recently moved into the new apartments in the 1960’s
19
Cables Wynd House Structure Red Dotted Lines - Structural Walls and Floors
The buildings design has remain pretty much the same, with little intervention into it since Alison, Hutchinson & Partners design. A brief overview of the buildings structure will follow.
Roof Floor 9 Floor 8 Floor 7 Floor 6 Floor 5 Floor 4 Floor 3 Floor 2 Floor 1
Rear Elevation Drawing by Author
21
Cables Wynd House Floor 2, 5, 8 Red - Structural Walls and Floors Black - Removable walls
Apart from eight ground floor apartments access to all apartments will be done via three sets of stair and lift towers. One in the centre and one at either end of the building. This will lead onto three floors (2,5 and 8), with individual stair cases to a apartments on the floor above and below. The image to left shows the original construction drawings of Alison, Hutchenson and partners for these floors. The right hand side image shows the layout of each standardised apartment repeated on this floor.
Alison Hutchenson and Partners original construction drawings included the extension at the North East End - Complete floor plan above, apartment floor plan to the right, Section to bottom right
23
Cables Wynd House Floor 1, 3, 4, 6, 7, 9 Red - Structural Walls and Floors Black - Removable walls
The stairs on floor 2, 5 and 8 lead up or down to a repeated standardised apartment layout on floors 1, 3, 4, 6, 7 and 9,The image to the left shows the original construction drawings of Alison, Hutchenson and partners for the entire floor. The right hand side image shows the layout of each standardised apartment.
Alison Hutchenson and Partners original construction drawings included the extension at the North East End - Complete floor plan above, apartment floor plan to the right, Section to bottom right
25
Cables Wynd House North East End Although still designed by Alson Hutchenson and Partners, there was one part of the building that was built slightly after the rest and acts structurally independents. To the left is an Image of Cables Wynd House immediately after its construction in 1965, shortly after the building was extended to the north east end. Shown to the left, the structure and design layout of the standardised apartments repeated in this end of the building.
Photograph of Cables Wynd House after the completion of the construction on the majority of Cables Wynd House and before the extension to the north east end (the end closet in this photograph)
27
Cables Wynd House Current Situation
While not structurally changing, over the past sixty years, Cables Wynd House (left), often known as the Banana Flats, grew a reputation as a drug estate, something emphasised in Irvine Welsh’s Trainspotting novel and associated film. It became neglected and has gathered many further issues which will be discussed. Despite this, due to the unique architectural form in its curved shape and its strong social connections for some local people in the area, in early 2017 the building recently received one of the highest listing statuses in Britain. Yet, there has been very little intervention into Cables Wynd House since its original construction. As was seen in other Megastructures in Leith and Scotland, many of these same issues lead to demolition, consequently the building requires modernisation. It’s listing was based on it’s social, historic and architectural importance. Attention of physical features throughout the listing reports/ comments from residents were based on: - The visual aspect of its unique shape and rear elevation - Imposing nature of the large concrete form - The “streets in the sky” and back elevation balconies design. What can be demolished? The possible removal of GF brick walls and gardens/entrances, the car park block, the GF fences, the energy/ storage buildings, all interior apartment walls and floors. When Cables Wynd House was listed this North East end of the building was left out of the historic listing status. As such when looking at intervening in Cables Wynd House, this section of the building is of far less importance to preserving as is.
Above are several of the headlines used in Scottish Newspapers when Cables Wynd House received it’s historic listing. Many concentrated on it’s reputation as a drug estate or use in Trainspotting
29
Cables Wynd House Problems
As mentioned, despite it’s current historic listing, Cables Wynd House has many growing problems which mirror the issues seen throughout most Scottish megastructures that have ended up being demolished: - Designed by Alison, Hutchinson & Partners to be an open structure at ground level, most of the public spaces which allowed access through the building are now blocked off. (highlighted in red in left image) - The underground car park and community balconies have also been shut. - In contrast to the original aim of the architects for “streets in the sky,� corridor spaces, except to be passed through, are barely used. - There are serious issues with maintenance of lifts. Often breaking down this leaves it hard for many inhabitants to access their apartments. - Elsewhere pressing maintenance issues throughout the building like heating, electricity and internal/external renovations all remain hard to fix. - CCTV has removed many of the issues of troublesome behaviour in/ around the building, yet there remains a large stigmatisation. - In the private spaces, housing typologies remain the same two-bed apartments as in the 1960s (highlighted in red in the right image), yet the majority of inhabitants that use the building have changed (refugees, elderly, individuals living by themselves, etc.) - The narrow entrance corridors, stairs to access apartments (highlighted in red in the right image) and lack of storage mean it is difficult for some people (like people using bikes) to use many of the apartments - With an ageing population and only eight of the apartments are prioritised for the elderly and with lack of maintenance, access to upper floors is hard.
Original drawings by Alison, Hutchinson and Partners of Cables Wynd House, Red Sections show the areas which have since been blocked off
31
Site visit andMedia Presentation Cables Wynd House Representation Some of these problems were seen through visiting the site. As well as looking around the interior and exterior, I also talked with the security and managers of the building, as well as a few residents. While discussing positive steps that have been taken in the social aspects in the building (CCTV has drastically reduced crime and drug use) and the improvements in the local area. I was told where the building was seriously struggling to remain full functional and inhabitable because of the previously mentioned issues got from a severe lack of financing. Because of it’s iconic status, Cables Wynd also has a strong media presence, which represents how it is seen in the general publics eye. The media representations include the film The Banana Republic, Photographer Derek Anderson’s Into The Wynd (All images to the left from https://www.derekanderson.co.uk/leith), the film Trainspotting by Danny Boyle and book by Irvine Welsh. The stigmatisation of Cables Wynd House being a “drug estate” is defiantly further fuelled by much of the representation, but also it is clear many of its residents feel unfairly treated within their current living conditions.
All photographs above taken by Derek Anderson and his photography project Into the Wynd
33
1940s
1970s
Throughout the 1970s and 80s many of the political, social and economical issues that Scotland faced during this period meant that there was very little physical development that took place, as a consequence the majority of constructions began to become neglected and run down. The area had a strong presence of Drugs and crime
Following the post-war clearance of the slums, Edinburgh City Council rehoused many residents in Leith in new large scale social housing megastructures. This took place in a period of political change in Scotland, which included a raise in Scottish Nationalism and support for the SNP. Alison Hutchinson & Partners designed many of these constructions including Leith Fort Housing, Cables Wynd House and Linksview House.
In the 1940’s and 50’s Leith struggled with Industrial decline and de-industrialisation. many of the residents were living in poor living conditions of Victorians slums which included high crime levels, poor sanitation, overcrowding and high levels of disease.
1920 Victorian Slum
1960s
1950s
1950’s Old Kirgate Shopping Centre
Cables Wynd Construction
1966 Cables Wynd House
1967 Newkirkgate shopping centre
Guru Nanak Gurdwara Singh Sabha Sikh Temple 1976
Trainspotting Setting
1980s
Cables Wynd House Context To understand further the issues Cables Wynd House has, it is important to contextualise it within it’s location. Situated by the sea, Leith was historically Scotland’s premier port, officially becoming part of the City of Edinburgh in 1920. The existing architectural landscape was primarily formed by a strong industrial existence and large post-war developments. Due to industrial decline, Leith became known as a deprived area with a strong reputation for drugs. However, following the 90s, Leith has dramatically developed. An urban renewal process has focused on further improving the infrastructure and programmes across Leith. The area is becoming a vibrant mixed community by appealing to not only growing youth culture, but also Leith’s ageing population, remaining “Leithers” and immigrants. In this modern environment, with the structure and function of Cables Wynd House remaining the same as the post-war period, it has become outdated and needs to reintegrate into the urban environment and with the communities that surround it.
Future
1990s
Existing There continues to be large amounts of planned redevelopment in the area, which includes many residential units
Links House Exterior planning proposal submitted
Since industrial decline and a rise in crime and drugs during up until the 90s, Leith has rapidly developed as an area. There have been large master plans, as can be seen in the dock area which began the process of urban renewal throughout the whole of Leith. This has meant an influx of youths into the area. Combined with remaining “Leithers”, an influx in Immigration and an ageing population across Leith this has meant a vibrant mixed community is beginning to populate Leith. This has meant the need for housing in the area and a large amount of modern residential developments have occurred in the area. Along with this is a growing food and drink sector. High class restaurants and bars can be seen attracted even more youths into the area. This has occurred along side the existing functional programmes relating to mechanics that have remained from Leith’s History.
Large amounts of Residential redevelopment New Kirkgate redevelopment 2002
Remaining Mechanics
Academy of Sound and Music 1994
Hospital Shut Down 1987
The Whiskey Society 1983
35
Cables Wynd House Neighbouring buildings A closer look at the site immediately surrounding Cables Wynd House, represents this shift in population and building change. The majority of the immediately neighbouring buildings are residential developments that have been worked on in some way (new or refurbishments the last twenty years), most of these are higher rented housing. Residential (Grey)
Other (red & Green) Whiskey Society
Bars/ Restaurants
Mechanics
Parks
37
.03 Health and Social Care in Leith New “Homely� Hospital Settings Covid-19 Pandemic
Photograph of the Paimio Santorium designed for Tuberculosis patients by Alvar Aalto.in Finland
39
Leith A change in Health and Social Care Region During the research into the site surrounding Cables Wynd House, the discovery of the closing down of Leith General Hospital (directly opposite Cables Wynd House) and due to the clinical understanding of postwar architecture and their similarities to traditional hospitals, a second parallel thesis investigation took place, looking into the change of healthcare in Scotland and current problems that are present because of this in Leith. Leith is part of the most populous social and health care region (North East region as part of the city of Edinburgh) that makes up NHS Lothian, the provider of nearly all healthcare facilities in the area (image below shows the extent of NHS Lothians area). Over the last few decades there has been a large change in how healthcare is being delivered across the NHS Leith is an excellent example of this change. The area has gone from a reasonably large general hospital (Leith Hospital to the right) serving its patients, to a version of healthcare where traditional hospital stays are reduced for more homely environments. The following research investigates how NHS Scotland, NHS Lothian and healthcare improvement Scotland plan to move healthcare forward, specifically focussing on issues in Leith.
Historic photographs of Leith hospital in occupation above
41
Restructuring of Health Facilities in Leith
New aim for Scottish Health and Social Care
Leith Hospital was a general hospital in Leith that provided a large facility including adult medical and surgical wards, paediatric medical and surgical wards, a casualty department and a wide range of out-patient services for the surrounding community. Due to financial implications and a restructuring process, the hospital was closed in 1987 and facilities moved elsewhere in Edinburgh.
After demonstration, the Leith community treatment centre (the first of its kind in Scotland) was introduced to reduce the urgency for facilities in Leith. It provided a wide range of outpatient and day services for adults and children. It highlighted the need for growing care in a community setting, away from hospital based care.
Leith Hospital shut
Health and Social Care Extra Care in Leith
Porthaven Care Home shut
This kind of health and social care approach is specifically hard for elderly and extra care individuals. To cope with the growing need of home care, charities like Minority Ethnic Carers of People Project are aiming to provide relief to the large amounts of people who struggle to get assistance at home in Leith.
Leith Community Treatment Centre opened
Ferrylee Care Home know longer fit for purpose
Care Charities recently opened
Scottish problems in complex clinical care (HBCCC) and extra care
Integrating Health and Social Care with Social Housing for the Elderly
Further struggles for the care of elderly can be seen in the two extra care facilities within Leith: Ferrylee and Porthaven. These were both Identified as no longer “fit for purpose” in the late 2010s. Consequently, the historic Porthaven building was demolished and replaced by social housing, its inhabitants were moved to outer Edinburgh. Following complaints in Ferrylee and other similar services in Edinburgh, in 2015-2016, NHS Lothian investigated the delivery of hospital-based clinical care in Edinburgh. Further to this Health and Care Improvement Scotland reviewed strategies going forward, stating “this shocking report underlines the need to invest in staff and facilities that can cope with Scotland’s changing health and social care needs.”
Reports by NHS Lothian and Health and Care improvement Scotland and the shift in the type of health and social care in Leith suggested new aims which align with the need to provide more social housing. We need to ensure that we benefit from integrations of health and social care development to provide flexible alternatives to hospital admission of suitable accommodation where appropriate care and support can be provided. - Move hospital-based clinical care and other care programs to a more “homely setting.” - Move to a community service approach. Offer significant opportunities to support people in homely settings, using integrated and co-ordinated services.
- More intermediate care services to support them to live independently in the community. - Develop a flexible range of solutions to meet a wider range of people’s needs. - Prevent health services being used as the “default” when social support might be more appropriate.
43
NHS Lothian Specific Goals Facility Development Till 2024 This change in healthcare and the need for more facilities in Leith discussed by NHS Lothian and Healthcare improvement Scotland can be narrowed down to a few key points to take forward:
MOVE TO “HOMELY COMMUNITY SETTING”
INTEGRATED CARE APPROACH
One of the major movements in healthcare and aims in Leith is to provide more “homely” care. If possible this should be done at home, but it is becoming increasingly evident that this is not the best for people who live alone or struggle in a more independent setting. More homely community hospital type settings are needed.
The majority of patients in Leith are above the age of 65 and social care is becoming an increasingly important function to integrate with healthcare to truly take care of peoples health and mental well being. In the new approach to healthcare in Scotland, it is important that social and health care are combined together.
Some of the papers and website used: OUR HEALTH, OUR CARE, OUR FUTURE Your chance to help shape healthcare in Lothian., NHS LOTHIAN’S DRAFT STRATEGIC PLAN FOR 2014-2024 (2014). NHS Lothian Review of hospital-based complex clinical care. (2016) NHS Lothian, Healthcare Improvement Scotland Hospital Based Complex Clinical Care (2015). The Scottish Government, Directorate for Health and Social Care Integration NHS Lothian. (2020). NHS Lothian, https://www.nhslothian.scot/Pages/default.aspx A National Clinical Strategy for Scotland. (2016) The Scottish Government
INNOVATION TO RAISE QUALITY FOR THE GREATEST BENEFIT TO PATIENTS
CONTINUOUS CARE AND SUPPORT ALLOWING MORE SELFMANAGEMENT
Any new facility should not be based on maintaining existing healthcare systems, but should aim to find new innovative ways to improve health or social care for all patients
One of the problems with the current healthcare facilities in Leith, is that many patients who live alone, has mobility issues or struggles with mental well-being need more and a different type of care that the current system does not account for, more intermediate facilities between home and the hospital should be provided
CARERS AS FULL PARTNERS As well as patients, it is important to consider the health, mental wellbeing and safety of staff members. This will mean that facilities should be designed around any of their needs, not just work needs but be able to provide them with a setting in which they can live their best lives from. In the new version of a more homely health care setting this may be that more living quarters for staff should be designed around their possible needs.
IMPROVED APPROACH DESIGNED AROUND SPECIFIC CONDITIONS It is essential that new approaches are based on a specific disease or condition. A less generic concentration on a specific disease will mean that social and health care support and treatment will be more effective for patients.
45
Rehabilitation and Prehabilitation Cancer Care in Leith
INCREASE IN CANCER REGISTRATIONS
DECREASE IN CANCER MORTALITY
RED - PERCENT OF CANCERS DEALT WITH SURGERIES Red - Percent of Cancers that had surgical
Mortality Rate
Cancer Registrations
treatment in 2008 Scottish Cancer Care Plan
Year YEAR
Since the basis of moving Leith healthcare to a more “homely setting” is then basing the care of patients around a specific disease, further research into specific problems in the management of certain diseases in Scotland and Leith needs to be done. One of the largest problems that needs to be dealt with in Leith is that of Cancer Care. The number of Cancer registrations in Scotland is increasing, while the mortality rate for Cancer has decreased substantially in Scotland, with the majority of treatments for Cancer diagnosis’s being dealt with through surgery (All the graphs to the left have been received from data from Cancer Research UK). However Cancer Research in Scotland has stated that the mortality rate could dramatically decreased even further to just 25%, as well as the mental well being of patients being dramatically improved. In the changing healthcare landscape in Leith, there is serious questions of how this can be achieved. The following Thesis project will investigate various ways that recent medical expertise, information, research and reports have suggested and show can dramatically improve patients lives and chance of survival. The successfulness of cancer surgery is reliant on the condition of patients before and after surgery. The many recent publications have stated the importance of mental and physical health in the weeks and months before and after Surgeries as one of the biggest factors in how successful the actual surgeries are. Due to the debilitating nature of the disease, many patients alone or with families find it very hard. to deal with Whether for an elderly person who lives alone and feels trapped by the disease or somebody who is finding the disease overwhelming so has difficulties living a beneficial lifestyle prior to surgery, better care should be provided to improve the overall lives of patients. The prehabilitation and rehabilitation of cancer patients before and after surgery is essential to decreasing the mortality of cancer surgeries and improving the health and well-being of patients. This design will specifically look at creating a prehabilitation and rehabilitation cancer surgery facility that can physically, mentally, and socially improve patients lives.
47
Rehabilitation and Prehabilitation Problems and Issues Summary The basics of all this research means that a proposed new prehabilitation and rehabilitation facility for patients undergoing cancer surgery will help patients with certain Cancers or certain mental, social and physical issues greatly:
Invasive Elective Surgeries
Issues in Leith Healthcare
Solutions in Leith Healthcare
Benefits to Prehabilitation and Rehabilitation
Problems of Surgical Procedures
Prehabilitation and Rehabilitation
Invasive Elective Surgeries
Hospital stays are often kept to a minimum due to pressure on the NHS, this can lead to several problems, especially when dealing with cancer:
The proposal will be a “homely� prehabilitation and rehabilitation centre that will aim to reduce hospital stays, pressure on the NHS and help patients get back to their normal sooner, but equally as importantly the proposal will:
A few specific Cancer surgeries have proven to have a potentially long lay off that are not accommodated in Leith’s new health care system and the patients will be helped significantly by their health and mental well being before and after surgery. There has also been a large increase in demand in various of these surgeries in Scotland: - Colorectal excision - Thoracoscopic lobectomy - Radical prostatectomy - Gastrointestinal surgeries - Endometrial surgeries - Prostate surgeries
- Patients are often not physically and mentally prepared for operations - Patients can often find it physically and mentally hard to get back to normal life - Isolation & feeling of Alone - People consequently can feel overwhelmed
- Provide community for people who would otherwise feel isolated and overwhelmed - Allow people who would have found it difficult to undergo normal life for a while, a brief time to life independently - Increase the health well being of patients in the short and long term
49
A change in European Healthcare
A change in European Healthcare
Moving to residential healthcare
Moving to Rehabilitation & Prehabilitation Healthcare
Some parts of Europe have already seen this new version of more “homely” hospital care be successfully implemented. The Patient Hotel In Denmark was based around the idea of residential living, it was designed to be “an attractive alternative for self-sufficient patients who live far away and who need accommodation in connection to examination and treatment. The patient hotel offers tranquillity, the opportunity to organize the day as you wish and to have some privacy or use public areas. For patients undergoing long-term treatment, the hotel can be a welcome break outside the clinical hospital environment.”1 While not being based around a specific condition, the basis of how the design incorporates residential architecture into hospital care, will be used as a resource for how Cables Wynd House could become more residential healthcare than a traditional hospital
Some parts of Europe have already seen this new version of prehabilitation or rehabilitation hospital care be successfully implemented. The rehabilitation centre in the Netherlands by Koen Van Velsen designed more of a community facility than a hospital. The concept for design was based on the idea that “a positive and stimulating environment increases the well-being of patients and has a beneficial effect on their revalidation process. The design ambition was not to create a centre with the appearance of a health building but a building as a part of its surroundings and the community.”2 This building wasn’t based specifically around a condition but the basis of how the design was laid out and incorporated as more of a community centred building will be used as inspiration in the approach to transforming Cables Wynd House.
1 Patient Hotel / 3XN, https://www.archdaily.com/777710/patient-hotel-3xn 2 Rehabilitation Centre Groot Klimmendaal / Koen van Velsen, https://www.archdaily.com/126290/rehabilitation-centre-groot-klimmendaal-koen-van-velsen
PATIENT HOTEL IN DENMARK - 3XN
REHABILITATION CENTRE GROOT KLIMMENDAAL - KOEN VAN VELSEN
51
Covid-19 Pandemic A change in immediate Healthcare requirements
Of course, in recent months the healthcare industry of the entire world has changed dramatically and no healthcare project can be done in isolation away from the impact of the Covid-19 Pandemic. The Covid-19 pandemic has not just affected healthcare over the last and next few months, but will create a lasting problem for years to come in the health and social care industry. For any facility to be designed or thought about, the current pandemic and possible future waves or other pandemics must be a vital consideration.
Map above, in red, the areas in Scotland most affected by the pandemic, data provided from the Scottish Government
53
Covid-19 Pandemic in Scotland
General Statistics in Scotland
General Statistics by Area
General Statistics by Issue
Scotland is no different to the majority of the rest of the world or UK, in being effected by the Covid-19 Pandemic. The graphs below shows the tragic number of deaths across Scotland. As with the rest of the UK, there was a dramatic escalation of the virus through March and April, and there has been a decreasing number over May and June. However the government has stated the risk of a repeat in the escalation of Virus case over the coming months and year if not careful.
Throughout Scotland, the worst hit places have been large Urban Areas. Glasgow has by far been the worst hit region and the Lothian region, under the healthcare administration of NHS Lothian has been the second worst effect region in Scotland, with the majority of cases and deaths being in the Edinburgh and Leith region.
While the number of cases and who catches Covid-19 has been indiscriminate and everyone has been effected, the scale of the impact that catching the virus has had, differs depending on where you are. In the more deprived areas in Scotland you are far more likely to get serious ill with Covid-19 (it should also be noted that you are also far more likely to have multiple other illness like cancer as well). In deprived areas where people are close together, like Leith, Covid0-19 has had very serious consequences.
Deaths Deaths Date (up until Mid May) Date (Up until Mid-May)
Region (Lothian in Red)
Red - Lothian
% of population living in most deprived areas
Covid-19 Pandemic in Scotland
Deaths Deaths
Covid-19 Pandemic in Scotland
Fatalities per 100,000 population
All data and graphs has been provided from the Scottish Government or NHS Scotland
55
Immediate Impact On Healthcare in Leith Postponed and Cancelled treatment across Leith
The immediate issues of the Covid-19 Pandemic is creating a equally troublesome situation for healthcare in the future, especially in these deprived areas. on the 17th March the government and NHS Scotland put the healthcare system on an Emergency footing where all elective surgeries in Edinburgh were cancelled for at least three months, meaning there is now a serious backlog of surgeries which hospitals will not be able to catch up with for some time. Additionally urgently suspected Cancer referrals by GPS’s in Scotland have declined by 72% (Dr Gregor Smith at one of the Scottish daily Covid-19 briefings, urgent people to go see their GP’s), which will create a serious and immediate problem with higher numbers of more serious cases being reported in the coming few months. All of these will leave a significant stain on facilities, where more were needed already NHS Scotland placed on emergency footing. (2020). Scottish Government, retrieved from https:// www.gov.scot/news/nhs-scotland-placed-on-emergency-footing/
Above are several of the headlines used in Scottish Newspapers during the Covid-19 Pandemic after elective cancer surgeries had been cancelled and a couple of months after the begging when cancer referrals were noticeably down
57
Brief Transforming Cables Wynd House
THESIS THE SUMMARY OF THE BRIEF FOR THIS THESIS IS, THE TRANSFORMATION OF CABLES WYND HOUSE INTO A NEW HEALTHCARE FACILITY IN LEITH IN ORDER TO SOLVE TWO SPECIFIC PROBLEMS IN LEITH’S HEALTHCARE SYSTEM AND EXPRESS THE POTENTIAL OF SCOTTISH POSTWAR SOCIAL HOUSING MEGASTRUCTURES
PHASE 1 A TEMPORARY FACILITY WHICH CAN COPE WITH THE IMMEDIATE PRESSURES ON HEALTHCARE FACILITIES IN LEITH CAUSED BY THE COVID-19 PANDEMIC. THE INTERVENTION SHOULD SPECIFICALLY FOCUS ON ISSUES DUE TO SURGERY CANCELLATIONS AND A REDUCTION IN CANCER REFERRALS.
PHASE 2 A PERMANENT FACILITY TO COPE WITH THE GROWING NEED FOR MORE “HOMELY CARE” HEALTHCARE FACILITIES IN LEITH. THE INTERVENTION SHOULD FOCUS ON THE PREHABILITATION AND REHABILITATION OF PATIENTS UNDERGOING CANCER SURGERY.
59
.04 De-industrialisation of Hospitals Transformation of Cables Wynd House Residential Healthcare
61
A clinical understanding of Megastructures Applying healthcare regulations and standards. On first glance post-war megastructures resemble and have many similarities with hospitals around the UK. However this does not mean they can simply used as healthcare facilities. Before moving forward with the proposals for transforming Cables Wynd House an understanding of the healthcare guidance in Scotland needs to be understood to know how these buildings can be used as healthcare facilities.
63
Adapting Cables Wynd House For Healthcare The Application of Scottish healthcare guidance There are too many guidances, specification, rules and regulations for healthcare and hospital facilities in hospitals to discuss them all properly here, instead a brief over view of some of the most important one will be summed up here to explain how they effected the design considerations for the transformation of Cables Wynd House. This begins with the general principles of the more public spaces from entrances, circulation spaces and waiting rooms to the functional spaces which will consist of many specific clinical facilities which are necessary. 1 Corridors are needed for apartments for access, privacy and safety. They must be simple and safe to negotiate. Currently Cables Wynd House only has narrow corridors on three floors, not up-to most guidance requirements, which means healthcare access for patients with various disabilities will find access difficult.
2 Specific clinical facilities need rooms of various sizes. Open, unobstructed space is needed for many healthcare facilities. The Health Building Note 26 (Facilities for surgical procedures)and the health building note 02-01: Cancer treatment facilities state the necessity of open space and light which could not be directly accommodated for in Cables Wynd Houses current Layout.
2 Lifts should be versatile accommodating as many types of load as possible, stairs should be determined by potential use. Evident in the ‘Core elements Health Building Note 00-04: Circulation and communication spaces’ document which guidance is used in Scottish Healthcare facilities, there are lots of specifics for lifts and stairs in healthcare facilities, of which, Cables Wynd House circulation routes need to be improved.
1 Patients and the Public should not share the same entrance. Staff can share the same entrance as patients. There is currently no specific entrance, lobby, waiting area, this will need to be incorporated into the design
FLOOR 2, 5, 8
FLOOR 1, 3, 4, 6, 7, 9
NORTHEAST END
Adapting accommodation For Healthcare The Application of Scottish healthcare guidance
As the design for the rehabilitation and prehabilitation surgical cancer centre in Cables Wynd House will be mainly a residential “homely� form of living, there also strict guidance and rules for accommodation in healthcare facilities for patients with various cancers that should be followed. Outlines here are just a few of the most key considerations and the application to Cables Wynd House.
2
3 6
5 1
1 - Avoiding the necessity of using stairs for patients is key. Many people using the building will either be elderly or have some form of illness or disability. As two thirds of the floors currently are only accessed by stairs, this needs to be changed during the transformation of Cables Wynd House. The other numbers are detailed for what needs to be adapted on the next page.
4
All Data has been taken from the Building Notes which are published by the UK, The more generic design guidance and cancer specific design guidance building notes have been paid attention to more.
67
Adapting accommodation For Healthcare The Application of Scottish healthcare guidance 2
3
4
5
6
STORAGE
CORRIDORS
BEDROOMS
EXTERIOR
BATHROOMS
Large Store rooms are costly, shallow spaces opening directly from circulation areas, with no outward opening doors is more convenient. The current Storage rooms in Cables Wynd House are on floors 2, 5, 8 and are large and not easily accessible from the corridors.
There must be space in corridors for either beds/ wheelchairs to pass each other or turn around. On some floors which require patients with disabilities that limit their movement and floors which will require patients being moved on beds will to and from apartments.
Clear bed space (not including storage, doors, worktop space etc.) of at least 3600mm (width) x 3700 (depth). Some of the non structural walls should be removed to create large, lighter and more open space for patients.
Thresholds should be designed to facilitate access to courtyards, receive natural daylight/ ventilation and positioned for views of the outside world. The original design for Cables Wynd House means that natural light and links to the outside can easily be achieved through the building with a few changes.
All single/multi bed rooms should have en-suite sanitary facilities. These should be easily accessible by all patients no matter what Disability of Illness. Current layouts of rooms mean that no bedroom currently has an en-suite.
69
.05 Design Development Transforming Cables Wynd House De-industralising Health Care
Photograph of a conceptual model made in the development stage of this project
71
Druot, Lacaton & Vassal Architects Transforming Postwar Social Housing Megastructures Across France
To begin the development process to transform Cables Wynd House into a healthcare facility, I started by looking into Druot, Lacaton & Vassal’s work.
“Never demolish, never remove or replace, always add, transform and reuse!” F.Druot, A.Lacaton, J.P. Vassal, 2007
“Fundamentally, the idea of architecture’s political culpability is not only absurd (because a building is not a political subject) but it is also inimical to culture. After all, ultimately, we owe our architectural and urban culture to a large extent to the fact that buildings often survived the ideological dogmas of those who built them………. A number of the most important buildings in our cultural history have survived only because they have been reprogrammed ideologically (and generally also functionally), time and time again.”
Lacaton & Vassal Architects are a French architectural studio founded in the late 1980s by Anne Lacaton and Philippe Vassal. They have a large range of projects across France, specifically in the residential sector. But it was their ideology on post-war tower-blocks with Frederic Druot, that expanded their architectural reputation to become an internationally renowned firm. Reacting to the political initiative ‘Programme National de Renovation Urbaine’ by the French government, their original outline for this ideology was set forward in 2007 in the publication PLUS+ (Image to right). Rejecting the nationalised premise of demolishing megastructures in France., they helped to introduce a successful model of retrofitting tower-blocks in deprived areas, which in turn solved multiple housing and economic issues. One of the many precedents of this methodology is Tour Bois-le-Pretre (left), a social housing tower-block in the 17th district of Paris. The original building, constructed in the North of Paris mainly from concrete, was built in the 1960s and contained 96 rented apartments. The radical transformation in line with their PLUS+ ideology, consisted of multiple interventions moving from inside the residential apartment to the exterior, without displacing existing occupants.
F.Druot, A.Lacaton, J.P. Vassal, 2007
73
Druot, Lacaton & Vassal Applying their methodology
While Druot, Lacaton and Vassal’s building portfolio of transforming post-war megastructures in France shows how they can be successfully added to and intervened in, due to their work being solely in the residential sector, it was actually their PLUS+ methodology that offered the largest inspiration for my thesis project. The general understanding of the methodology, as the title described, was to add a “plus”1 to the structure. There plus+ methodology discuss many reasons why and how this could be done. To the left are multiple images from the methodology publication. They looked at the structures of post-war megastructures as having unlimited amount of possibilities, whether incorporating swimming pools, restaurants or day care centres. While this methodology was generally considered and applied for the residential sector, it can easily be adapted for a heathcare facility, especially one that is investigating a new “homely” version of healthcare. Moving forward with this project, the development process essentially will follow a similar process of looking what can I add to Cables Wynd House to transform it into a healthcare facility? Through out the development process I have referred back and used Druot, Lacaton & Vassals examples, especially in the accommodation of my proposal (like how they added light/ space.) 1
Druot, F. Lacaton, A. Vassal, J.P. (2007), Plus: Large-scale Housing Development, Editorial Gustavo Gili
All pictures are renders of proposals by Druot, Lacaton & Vassal in their PLUS+ methodology
75
Speculate “what can you add” Precedent study
Taking this idea from Druot, Lacaton and Vassal’s PLUS+ Methodology, of speculating what can you add to the structure to make it a healthcare facility. Beginning with the exterior and what you can add to the outside of Cables Wynd House. Similair to the Paimio Tuberculosis Sanatorium designed by Alvar Aalto, (left) any addition to the structure should be based on the specific disease that the healthcare facility is trying to help.( balcony space to give patients outside time) Similar to large WoZoCo Amsterdam residential development in Holland designed by MVRDV, (below) these additions will not simply look at being restricted by the structural grid of Cables Wynd House but use modern construction techniques to interrupt the structure and add to it.
Photograph of the Paimio Santorium designed for Tuberculosis patients by Alvar Aalto.in Finland
77
Speculate “what can you add” Exterior additions
The application of this work, left a series of speculations, on what I could add to the structure to transform it into a healthcare facility: Green Spaces (bottom two images) - Activity space: suitable plants/ raised planting beds for therapeutic gardening - Boundaries: residents feel less enclosed if the building is surrounded by greenery - Circulation Space: gardens with places to sit and footpath circuits connected to a central space for the safety and tranquillity of residents within the building.
A series of interventions will aim at providing a greater number of functional spaces. Responding to Currently in Cables Wynd House navigations for
issues within the site, building and potential
visitors, postmen, etc. is particularly difficult. For a
protagonists, they will facilitate more of the
concentration on the elderly and people with
rehabilitation and care programme. The strict
disabilities as the protaganist, this is an essential
structural grid will specifically not be a limiting factor
feature to change. A new clearer entrance and easier
to confirm to and hence will be broken deliberately.
circulation throughout the entire building requires an additional intervention to improve this
Circulation Spaces (top left image) - Entrance Space: for easier navigation, include a comfy lounge area - Lifts: New and greater number of modern lifts for easier access - Circulation: easier circulation around the building and access into apartments Facade & Finishing (all images) - Increased lighting and colour: for safety and mental health improvements - Easier Circulation: clearer navigation (signs, etc.) so less confusion Additional Facilities (top right images) - Staff Space: Offices, stores, record keeping, meeting spaces, training session spaces, relax spaces, extra accomodation, quite rooms for consultations/ visits - Common Facilities: Kitchens, Cafe’s, Excersize spaces, etc for community and interactions between residents, something shown as very positive for health
(Top left) looking at improve circulation through an extension to one facade, (top right) adding extension for larger clinical facilities, (bottom left) a walking and green space intervention to the roof, (bottom right) Balcony space for additionall lighter and green space to patients accomodation For physical and mental rehabilitation;
79
Speculate “what can you add” Precedent study
In a further process development, the speculation of what can you add, should not be simply defined to the exterior of the structure. The “double house” concept in the unite d’ Habitation, marseille le corbusier, one of the first post-war megastructures (to the left) has been developed in recent years, the double house concept in utrecht, designed by MVDRV (bottom left) has shown how residential apartments in modern society should not be the standard two beds apartments laid ontop of each other. The Gifu Kitagata Apartments designed by Kazuyo Sejima (bottom right), show how this application can be brought into a large megatructure, with sections taken out, and different scaled spaces throughout the building. A speculation as well as what can you add (by taking away parts of the structure) formed the next stage of development.
Images above of unite d’ Habitation, marseille, design by Le Corbusier
81
Speculate “What can you add?� Internal re-organisation
This is a look at one of the initial sectional developments after taking the concept of what can you add (by taking away) to the interior of the structure. A series of functional spaces, looking at adding social, mental and physical rehabilitation space and green spaces were designed into the structure.
The metal and social Rehabilitation of patients is becoming known as equally important for patients
The Physical Rehabilitation of patients is key to their recovery
Section through Cables Wynd House looking at manipulation the structure to create larger spaces for various functions
Green Space for the mental and physical benefits it can have for patients
Programme
Rehabilitation
Prehabilitation
Post Residential Surgery (1-8 weeks) Apartments
Pre Residential Surgery (1-8 weeks) Apartments
Patients
Communal
Living
Reprogramming
Aerobic Excersize & Resistance training
Staff
Anxiety Reduction
Nutrition
Excersize
Standing
Chair
Food Preperation
Bed
Living Spaces
Nutritionist (1hr per week)
Offices, etc. (easy access to residential apartments Kinesioligist (1hr meeting per day)
En-suite
Basic Programme
Bed
Extra Space
Social/ Mental Rehabilitation Reduce Isolation & Loneliness
Urban GF Plan
Kitchen & Gym For pateints further along in the recovery period
Weights
Swimming
The diagram to the right (on the next two pages of well) looks at data from rehabilitation centres around Scotland, publications on the prehabilitation and rehabilitation of cancer patients around the world, information on cancer charity website, NHS website information on Cancer care, the rehabilitation centre Groot Klimmendall and the patient hotel in Denmark to building up a comprehensive list of the exact needs of patients in a prehabiltation and rehabilitation facility for cancer surgery patients. The first step here looks at splitting the building into the needs of patients going through prehabilitation and the needs of patients going through rehabilitation.
Walking (30 mins x3 per day)
Light/ Greenery
Access to Roof, Swimming, Table Tennis, Urban Spces, NHS Staff
Kitchen Specific Diet Plan
Taking these speculations of what you can add internally and externally to the structure for the social, physical and mental benefit for cancer patients requires a more careful consideration to exactly what spaces are needed, who will use them and how long for.
Callisthenics
Psychologist (90 mins per week)
Roof Intervention vegitation, Library, Cafe, Etc.
Elastic band movement
85
Spatial Connotations
Reprogramming
Rehabilitation
Patients
Prehabilitation
Communal
Staff
Individual
Specialised Apartments
Functional
Gym
Roof Intervention
Offices
Cooking
Psychologist Office
Relaxing
Developments
Rehabilitation
Prehabilitation
Developing the Section
(1-8 weeks)
(1-8 weeks)
The comprehensive list of needs to be included in the design on page 84, has then been converted into architectural spaces which will be needed. The conceptual section achieved through speculating what you could add to the structure, has begun to be developed further below to co-ordinate with this new more developed series of spaces.
- Following surgery residents will be given apartments until they are fully recovered and able to go back to normal life. If daily care is needed these specialised apartments will be connected to staff offices/ kitchens and living spaces for more round the clock care.
- Residents will come to Cables Wynd House for a small time. They will have daily/ weekly meetings with a physcologist, kinastegiologist and Nutritionst combined with a programme of exercise and a strict diet, in order to be in the best possible place for a successful procedure without complications
Collective
Residential Apartments
Apartments
Kitchen
Further Programme
Kinesioligist Office
Nutrionist Office
Urban Spaces Excersize
Pools
Gym
Muti-use Rooms
Therapy Rooms
Social
Kitchen
Spiritual Care
Roof Intervention
Urban Spaces
87
Spatial Connections
Private
Intermediate Spaces
Reprogramming
Public
Final Programme Social Spaces
Staff
Specialised
Mental Spaces
Finally due to the nature of the building/ programme it is important to introduce life, community and a public nature into the structure.
Work
Living
Family
Physical Spaces
Multi-purpose rooms
Patient
Roof Intervention
Large MultiPurpose Space
- Children/ family: Introduce enjoyment for people going through a difficult time and connect the building more with the city - Community spaces: Access for everybody in Leith, making the building public
Consultation rooms
Relax Spaces
Spiritual Care
Offices
Gymnasium
Kitchens/ Dining
Laundry/ W.C’S
Veiwing Platforms
Green Space
Cafe’s, etc. for Leithers
Entrance Space
Activity Areas
Pools
Therapy
Library/ Computers
- Entrance: Easier navigation for everyone around the building
Multi-purpose rooms
Gathering Spaces
Seating/ Circulation
89
Rear Elevation
Front Elevation
The development of the internal re-organisation of the building due to it’s prehabilitation and rehabilitation function, meant some additional space was needed. Two external extensions (one either side) to the building for the these functions have been designed around the site constraints.
Further exterior developments on the roofscape to add an extra external and green space for patients, and to the front to provide an extension for better circulation and clear entrance into the building have also been designed. These external interventions and previous schematic section, make up the general building layout to take forward into the detailed design.
Conceptual Images of the more detailed design responses to prehabilitation and rehabilitation which will be converted into the final designs
91
Cite Du Grand Parc, Bordeaux, France Druot, Lacaton & Vassal
Dresden Museum of Military History Daniel Libeskind
Documentation Centre, Nuremberg GĂźnther Domenig
Material Approach to Preservation
Due to the historic listing status of the building and the importance of the structure to the local community and Scotland as a whole, when adding to the structure a clear stance on Preservation needs to be done. As was the case with many of the iconic examples to the left, this will follow the Ruskinian concept of preservation commonly used in conservation in strongly contrasting the original structure through materiality and form. “Do not let us talk then of restoration. The thing is a Lie from beginning to end.....It is a necessity for destruction. Accept it as such, pull the building down, throw its stones into neglected corners, make a ballast of them, or mortar, if you will; but do it honestly, and do not set up a Lie in their place. And look that necessity in the face before it comes, and you may prevent it.... take proper care of your monuments, and you will not need to restore them.... Count its stones as you would jewels of a crown; set watches about it as if at the gates of a besieged city; bind it together with iron where it loosens; stay it with timber where it declines; do not care about the unsightliness of the aid; better a crutch than a lost limb; and do this tenderly, and reverently, and continually, and many a generation will still be born and pass away beneath its shadow. Its evil day must come at last; but let it come declared openly, and let no dishonouring and false substitute deprive it of the funeral office of memory� J.Ruskin, Lamp of Memory
As can be seen in the conceptual design before, the form has been done to clearly contrast Cables Wynd Houses rigid grid.
93
Material Approach to Preservation
Corten Steel Cladding The key material approach for interventions will be looking into something which greatly contrasts the concrete form of the existing Cables Wynd House structure. Therefore the focus of all interventions will be on Corten steel. Leith has a strong history with industrialisation, along with the material properties corten steel seems like the perfect material to explore further in this specific project. It’s rusting colour allows the additions to clearly act as “honest” interventions and not as part of the original structure. (One precedent which incorporated a Corten steel cladded roof extension is: Bennetts Shaftesbury Theatre in London - image to the right)
Conceptual Image of using corten steel as a material to explore possible intervention to Cables Wynd House with
95
.06 The Transformation of Cables Wynd House Phase 1 - Temporary Facility Phase 2 - Permanent Facility
97
PHASE 1 A TEMPORARY SURGERY FACILITY TO COMBAT THE CURRENT HEALTHCARE CRISIS CAUSED BY THE COVID-19 PANDEMIC
99
Access Zoning Location Plan
The first phase of the design looks at creating a temporary facility which can cope with the immediate pressures on healthcare facilities in Leith caused by the Covid-19 pandemic. The intervention should specifically focus on issues due to surgery cancellations and a reduction in cancer referrals. The basic design of phase 1, will be done in co-ordination with the phase 2 schematic design already discussed, in order to avoid unnecessary damage to Cables Wynd House
Emergency Services Access Cables Wynd House Residents Access
Staff, Patients and Family Access
101
Basic Layout and Circulation Schematic Floor Plans
As this is an immediate and more temporary functional design, only a small section (shown to left) of Cables Wynd House will be transformed. This will be split into a few sections, a main entrance space which will restrict access of the rest of the intervention, clinical spaces, staff spaces and patient accommodation. Access to the rest of Cables Wynd House for existing residents will be done separately through two entrances. As this phase will be adapted into a second phase there will several measures that will only need to be in place for a shorter period of time and not adapted further, these will be built in a less permanent way
KEY ENTRANCE SPACE
RESIDENCES AND STAFF SPACE
TEMPORARY FACILITIES
CABLES WYND HOUSE RESIDENT ENTRANCE CABLES WYND HOUSE RESIDENT CIRCULATION
103
Users Circulation Construction area
12
Construction area to remain on site for later phases of the work to continue
1
Ground Floor Plan
The circulation is key in phase 1, to limit the possibility of patients getting Covid-19, this is a closer look at the distinct separate circulation and separation between patients, staff and existing Cables Wynd House Residents during phase 1
Surgical Facilities
Patients Circulation
Facilities in order to provide space for 1000’s of extra surgeries in Leith/Edinburgh
5
Tem
pora
ry sp aces Durin g pha spac se 1, e t incre s are nee emporar y ded t ase in o hou visito se rs.
7
11
16
1 2 3 4 5 6 7 8 9 10 11
- Main Entrance Space - Reception Area - Waiting Area before testing - Temporary Testing Zone for Covid-19 - Waiting Area (No entry unless covid-19 free) - Changing Area - Pre-op and X-ray room - Surgery Operating rooms - Post-op Rooms - Patient Circulation Spaces - Emergency Entrance (Ambulance arrivals)
Cables Wynd House Residents Circulation 12 13
14
- Cables Wynd House residents Entrances - Main entrance (post boxes, etc.)
Staff Circulation 14 15 16
- Private/ Separate Staff Entrance - Circulation for staff rooms and Lab - Sterilisation/ Medical Supply Room KEY
Entrance Space To test and check all patients for Covid-19 before entrance, separate residential access
Red - Existing Walls Grey - Proposed Walls
105
Rear Elevation
ENTRANCE AND SURGERY
Areas of Development
ACCOMMODATION TEMPORARY FACILITIES
Rear Elevation Areas of Development - Entrance and Surgical Facility
The first area of the proposal which will be discussed in more detail will be the entrance, all clinical and surgeries facilities and the related staff spaces
Surgical Facilities Research Strategy
As patients who have recently gone or are currently going through surgeries are often the more vulnerable patients to being seriously affected by covid-19, it is very necessary that they take all potential measures to protect themselves from virus transmission. The majority of data that I have used for these precautions was received from The Royal College Of Surgeons and there guidance on the “recovery of surgical services during and after COVID-19”, where they recommend that “Covid-19 free sites might be created at independent hospitals, within designated areas” to become Covid-19 negative surgical facilities. Data Also Received from current procedures of private hospitals (acting as covid-19 free surgery hubs), NHS Guidance for Surgeries taking place during the pandemic and successful trails in Singapore hospitals.
End Of Stay
Post-Op
Surgery
Pre-Op
Wait
Test
Start
- The path of the patient to/ from the operating theatre should be kept clear. No foot traffic except for essential staff in these areas. As well as the design layout, this can be minimised be using either a security or a surgical team member travelling in advance of the patient to clear the way.
- The patient should be left to recover in or as close to the operating theatre as possible, minimal dedicated staff should be the only point of contact until they can be safely transferred to another room on the ward
- Limit operating theatre staff, all foot traffic around the operating theatre should be minimised, no unnecessary items should be brought into the operating theatre.
- Where appropriate, the majority of pre-surgery reviews and consultations should be done via virtual clinics.
- After throat and nose swabs and the small initial interview, patients will wait for 48 hours at home to make sure they are not coronavirus positive, if they are, then they must follow recommended NHS guidelines and the surgery will be temporarily put on hold. If all tests are negative, then the patient may return to the surgery facility where after a quick temperature check they may proceed.
- Patients are swabbed in the throat and through the nose prior to surgery to make sure they are not coronavirus positive.
- Capacity for dealing with a backlog of surgeries must be increased and organised.
- rules and regulations for the individual rooms will be discussed later.
- All rooms should be cleaned thoroughly after use, full necessary PPE is donned by staff after complex surgeries.
- Considerations should be given to minimise time in surgical facility - full necessary PPE is donned by staff during complex surgeries.
- For immediate checks before the surgery takes place, standard guidelines throughout hospitals should be followed: - Staff members should be minimised where possible. - full necessary PPE is donned by staff before complex surgeries. - All rooms should be cleaned thoroughly before use.
- There should be an interview with attention to sick contacts and extent of social isolation performed. - Temperatures are taken before access into the surgery waiting room.
- Backlog of local elective surgeries will be identified and ordered by prioritisation, then systematically followed through - Diagnostic capacity and suspicions must remain in place until a vaccine for covid-19 is found. 111
Surgical Facilities Spatial Strategy
End Of Stay
Post-Op
Surgery
Pre-Op
Wait
Test
Start
7
6
5
4
3
2
1
Staff Spaces
Post-Operation Beds and Storage
Operation Rooms and Sterilisation
Pre-operation room and Xray Room
Waiting Area’s
Temporary Testing Centre
Entrance & Reception
113
Surgical Facilities Design
Following research into the strict measurements for surgical facilities in the Covid-19 era, the layout of the design in Cables Wynd House has been designed sequentially, to create to most simple and easy to use building, follow all the rules previously laid out . Red - Existing Walls Grey - Proposed Walls
7
5
6
5
4
3
2
3
1
Staff Spaces
Operation Rooms and Sterilisation
Post-Operation Beds and Storage
Operation Rooms
Pre-operation room and Xray Room
Waiting Area
Temporary Testing Centre
Waiting Area
Entrance & Reception
115
2 1 3
Entrance Space Construction
4
Red - Existing Structure In order to provide the larger entrance space needed and preserve the iconic rear facade relatively intact, there needs to be a large structure imposed, to achieve this and clearly contrast the existing concrete frame a steel frame will be used.
1) Structural Steel Beams
5
6
ENTRANCE SPACE
2) Existing Concrete Structure 3) Metal Sheeting 4) Exposed Steel Portal Frame 5) Large Glazing Panels 6) Existing Concrete Facade
117
Rear Elevation
ENTRANCE AND SURGERY
Areas of Development
ACCOMMODATION TEMPORARY FACILITIES
Rear Elevation Areas of Development - Patient Accommodation
The second area of the proposal which will be discussed in more detail will be the patients accommodation, these will be adapted from the existing residential apartments of Cables Wynd House.
Transforming Cables Wynd House Apartments
Transforming Cables Wynd House Apartments
Transforming Cables Wynd House Apartments
Existing Apartments
Transformed Apartments
Covid-19 Precautions
The first step to transforming apartments to accommodate patients after surgery will be removing unnecessary, easy to move walls, the design should then be based around typical patient needs.
Because of the Covid-19 pandemic, extra precautions will be needed in order to offer vital protection for all patients using the facilities. Strict guidelines will effect the design of accommodation layouts
All current spaces inside an apartment of Cables Wynd House are below the lowest recommended surface area required for a patients room in a healthcare facility.
123
Designing for Covid-19 Measurements 1
The first measurements to consider in the designs of apartments are those that are used throughout all healthcare facilities as a driving force of design. However, they are no more important than ever to consider in order to reduce the possible transmission of Covid-19. 1 - Hand Hygiene
2 - Waste Management
3 - Cleaning
4 - Differentiating Care
Guidelines
Guidelines
Guidelines
Guidelines
NHS Guidance suggests:
NHS Guidance suggests:
NHS Guidance suggests:
NHS Guidance suggests:
There are strict guidelines for hand washing in patient rooms and public areas of a hospital. Shown below are the key areas which the provision of sanitisation equipment must allow for, facilities must be co-ordinated accordingly.
- Large Volumes of waste may be generated by more frequent use of PPE needed in a pandemic era, the constant influx of hospital patients and “catch it, bin it, kill it� method, means that waste management rules should be followed
There must be the correct equipment provided and associated spaces designed for to allow for the daily cleaning of all pubic and patient areas to happen easily. Thorough cleaning after a patient has left is particularity important.
- Creating cohort areas which differentiate the level of care that is required. Ideally single rooms are ideal, if this is not possible privacy curtains and screens should be used to minimise opportunities for close contact.
Short Term Care
Long Term Constant Care 125
Designing for Covid-19 Measurements 1
1 - HAND HYGIENE
2 - WASTE MANAGEMENT
3 - CLEANING
4 - DIFFERENTIATING OF CARE
127
Medium Term Care Patients who may require a few weeks of varying degree of care. Space for family members included
Long Term Care Apartments to accommodate patients & Family with minimal mobility for an extended duration
Apartments The effects of guidelines 1 KEY Red - Proposed Walls Grey - Existing Walls Protective measures - Red
1) Hand Hygiene - Hand Washing & Sanitisation
2) Waste Management - Disposal Bins
Short Term Care Apartments to accommodate patients who only need up-to a week recovery, with less supervision needed
3) Designated Cleaning areas - Cleaning Supply Rooms
129
Social Distancing Precautions Guidelines 1m
1m
One of the biggest changes to the design of healthcare facilities during and following this Pandemic, is social distancing. The importance of keeping away from close contact from as many people as possible is essential in healthcare scenario’s to avoid high transmission rates. It is essential then, that architects adapt this into the design process. NHS Guidances Suggests 1) Social distancing In every situation possible, a 2m distance between all patients, staff and visitors will be adhered to. 2) Visitation Visitors will be limited, for patients who need family around permanently (elderly couples, parents with children, etc.) space for visitors to permanently stay with their loved one may be provided. 3) Material contamination 2m
2m
- Seating should be provided, as it’s best not to sit on the patient’s bed or in their immediate surrounding. - Screens (similar to those used in nightingale hospitals) can be used to separate patients. In some situations curtains may also be used.
131
Social Distancing Precautions Plan
Social Distancing Tape
Screens Folding screens which can be put away to the side will be provided encase there is either a hign risk case, multiple visitors or their is a rapid increase in he transmission of the disease in Scotland or Leith.
Social Distancing Tape
Red Circles - Advised 2m Distancing Grey Circles - Future 1m Distancing
1750mm
1300mm
Separation Screen
Various forms of seating will be provided, mainly for the benefit of the family members staying with/ or visiting the patient. This will help provide extra preventative measures of virus and infections being passed on.
2000mm
Seating Visitation
Separation Screen
The aim is to reduce the amount of outside visitation as much as possible, meaning a reduction in the chance of passing on infections. Stay in family space hence have been designed into some patients apartments
133
Material Strategies
Material Strategies
Public Spaces
Individual Spaces
For the health & safety of patients and staff, there are various regulations and recently implemented guidelines that are recommended to be in place in hospitals surrounded material use of individual apartments in order to reduce risk of transmitting viruses.
Due to the size of and foot-traffic in public spaces (like corridors), there is a large increase in contamination, missing sections while cleaning and time to clean it is preferable for a material strategy where viruses will last time on. The persistence of viruses, specifically Covid-19 on aluminium is one of the lowest, with it being between 2-8 hours.
Cleaning Process - As has been discussed, the NHS have strict protocols on the cleaning of healthcare facilities. As such, the materials used in the re-purposing of Cables Wynd House should be chosen on their ability to be easily cleaned. - Items such as door handles are the most likely to pass on viruses between people. Contact with these should be limited. They should be cleaned as frequently as possible. Access - Keep the door closed with windows open to improve airflow and ventilation when possible, especially whilst using detergent and disinfection products. - Because Items such as door handles are the most likely to pass on viruses between people, the number of doors should be limited if unnecessary. To Avoid - Ideally there should be minimal carpet use in all hospital settings. - Use of fabric material for screens and curtains. - Small enclosed spaces with poor ventilation. - Use of materials with high virus persistence. Data from NHS Scotland and Health Improvement Scotland
Data from The New England Journal of Medicine and The Healthcare Infection Society
135
Material Strategies
Interior Aluminium Cladding No Carpet
Viruses will only stay on Aluminium for a few hours
Luxury Vinyl Tiling - easier to clean than timber flooring
Isometric Drawing Door Removal Doors removed, sliding doors used, Door hooks to prevent constant opening.
Each room should be carefully designed to consider various steps which would reduce the likely hood of passing on Covid-19, as well as provide confidence for patients, family and staff. These considerations include: Material choices, cleaning and reduced contact time with furniture, etc.:
Aluminium Cladding
Access
1000mm
To Avoid
Cleaning Surfaces
Material Guidelines Health Building Note 00-10 Part B – Walls and ceilings - guidance
137
1 Corridor Space
2
3
Construction
CORRIDOR SPACE
A closer look at the public corridor outside a medium care patients room 4 1) Existing Concrete Structure 2) Void for mechanics and electrics, etc. 3) Timber stud wall 4) Lights and ceiling
6 5
5) Temporary Screen 9
7
6) Aluminium Cladding 7) Sanitisation and hand washing station 8) Tape on floor signifying social distancing 9) Large glazing panel
8
Red - Existing Structure
139
Rear Elevation
ENTRANCE AND SURGERY
Areas of Development
ACCOMMODATION TEMPORARY FACILITIES
Final Image Phase 1 Rear Elevation
(To the left) A final Image at the back of Cables Wynd House looking at the phase 1 transformation in use.
143
PHASE 2 A PERMANENT PREHABILITATION AND REHABILITATION CANCER SURGERY CENTRE
Access Zoning Location Plan
The Second phase of the design looks at creating a permanent facilities to cope with the growing need for health care facilities in leith, learning from the change to more “homely care� in Leith, which will provide Prehabilitation and rehabilitation surgical facilities to cope with growing healthcare issues in leith. The basic circulation in and around the building will follow the phase 1 design.
Patient Access Points Public Access Points
Staff Access Points
147
Basic Design Layout Exploded Isometric Drawing
The basis of this design follows on from the basic layout of Phase one. The large entrance space will be expanded throughout the entirety of Cables Wynd House, creating a more public centre to the building, which everyone can access. The actual entrance will remain the same, an additional structure will be added onto the phase 1 entrance intervention (this should be considered during the phase 1 design phase)
CENTRAL CORE (EXTENDED ENTRANCE)
149
STORAGE/GENERATORS AND SHORT TERM CARE
LONG AND SHORT TERM CARE AND REHABILITATION/ PREHABILITATION FACILITIES
Basic Design Layout Exploded Isometric Drawing
LONG AND MEDIUM TERM CARE AND REHABILITATION/ PREHABILITATION FACILITIES SHORT AND MEDIUM TERM CARE AND REHABILITATION/ PREHABILITATION FACILITIES COMMUNAL FACILITIES AND REHABILITATION/ PREHABILITATION FACILITIES
MEDIUM AND SHORT TERM CARE AND REHABILITATION/ PREHABILITATION FACILITIES
POST-SURGERY AND STAFF ACCOMMODATION AND REHABILITATION/ PREHABILITATION FACILITIES
POST-SURGERY AND SHORT TERM CARE
The rest of the building will have various levels of restricted access. Patients wings and physical rehabilitation spaces will only be able to be accessed by patients and staff members of Cables Wynd House. The series of residences and physical rehabilitation spaces will be discussed in more detail over the coming pages.
ACCOMMODATION AND STAFF SPACES
PHYSICAL REHABILITATION
PUBLIC, STAFF AND PATIENT CIRCULATION
CLINICAL FACILITIES AND PHYSICAL REHABILITATION
STAFF AND PATIENT CIRCULATION CLINICAL FACILITIES AND PHYSICAL REHABILITATION
STAFF CIRCULATION
151
ROOF INTERVENTION
PHYSICAL REHABILITATION ACCOMMODATION
Rear Elevation Areas of Development
Healthcare and Public Interactions Urban Areas of Development
1
Phase 2 development will consist of various transformations and additions, specifically focusing on creating a greater connection with the city around it and increase it’s capacity and function within. The building will become a public monument in this phase, with the urban plan, GF development, but also the roof intervention which will be discussed and the viewing platforms within the building. One of the most important ways to achieve integrating the building successfully into community will be through its urban ground floors strategy. The development in phase 2 in this section will be done through two sections: 1 - Therapeutic Horticulture, Patients Activities and Community Green Space 2 - NHS Staff and Local Business Connections
2
155
Urban Development 1 Therapeutic Horticulture, Patients Activities and Community Green Space
The first urban development looks at transforming an almost empty park and areas outside Cables Wynd House into large green areas. The area immediately outside of Cables Wynd House will be transformed with therapeutic horticulture to give patients an easily accessible outside space that will greatly benefits them. The park will then further this with a green urban area, filled with water features, a large seating area, a place for a temporary stage/ activity area and grass/ horticulture/ trees.
1
1 - Urban development for hospital
2 - Therapeutic Horticulture & Gardening
Green space for residential developments
Mental well�being of patients
2
2
157
Urban Development 2 NHS Staff and Local Business Connections
The second development will look at the park at the other side of Cables Wynd House, where there is currently a park which is used very minimally and a caged of concrete for sport. The urban design will look at creating a series of outside and covered spaces which will provide staff (who’s space are designed next to it) to go for breaks. The space will also provide a small cafe area. Due to the lack of outside space for the whiskey society and bars restaurants neighbouring the park, this will provide a space for events and seating.
3 - Staff members
4 - Local Businesses
Cafe, Seating and Garden Areas for staff members
The Whiskey Society & neighbouring bars/ Restaurants
3
3&4
4
4
159
ROOF INTERVENTION
PHYSICAL REHABILITATION ACCOMMODATION
Rear Elevation Areas of Development
Rear Elevation Areas of Development - Patient Accommodation
The first area of the proposal that will be investigated in more detail in phase 2 will be a closer look at the residential accommodations for patients.
Residential Apartments Cross Sections
These cross-section look at how Cables Wynd House might be transformed for both the Prehabilitation and Rehabilitation accommodation functions. While the outside facade will be ‘preserved’, the strict interior grid system in Cables Wynd House will be open to manipulation depending on the functional needs. At various points structural reinforcements will consequentially be needed. A look at patients and various support mechanisms like family or staff depending on their current situation and a look at how various post cancer surgery apartments may be arranged. These basic iterations include long term care primarily used by the elderly and most sick to short term care for quicker surgeries of more healthy, younger people. A closer look at different examples of these will be done next week.
SHORT TERM CARE
MEDIUM TERM CARE
POST SURGERY ROOMS
LONG TERM CARE
165
Residential apartments Cross Sections
There is not enough time to discuss and investigate every room and floor in detail in this thesis, instead just two specific floors and one specific room within these floors will be investigated in more detail. To the left is a look at some of the medium and long term cancer care units for prehabilitation and rehabilitation patient residences. The apartments will be standardised, with changes made depending on the patients illness, needs, living and care requirements. At the end of the accommodation will be spaces trailered to the needs of patients on that floors, for example, the bottom row on this page will have medium care patients who may have some difficulty moving, therefore the facilities on the will have a kinastegiologist and spaces to do some exercises.
Red Section Cut - Proposed Walls
167
PUBLIC CORRIDOR CLINICAL TREATMENT RE-USE RAILINGS/ OBJECTS USED FOR COVID-19 MEASURES REUSED FOR OTHER PURPOSES
SPECIFIC MACHINERY AND SPACIAL NEEDS FOR PATIENTS DISEASE
TRANSFORMATION TO SOCIAL SPACE PERMANENT SANITISATION A NURSE SINK AND SANITISATION IN PLACE FOR A SUSTAINABLE APPROACH TO SANITISATION
Residential apartment Isometric Room
Again there is only enough time to discuss one room within these rows to express the changes made from phase 1 to phase 2. The changes are centred around a few key themes throughout all the residential units, making them more “homely” and specific to a disease. Like to the right this may consist of a few things, specialised equipment for certain cancers may be needed in certain rooms, furnishings should be changed to suit lifestyles that are typically found at home, this may mean more storage to the use of TV’s, The balcony can be made into a more pubic space again. While doing all these change it is important that they are related and easily adaptable to and from the phase one designs. FURNISHINGS MORE PERMANENT AND HOMELY DESIGN TO RESIDENCE S
Red Section Cut - Proposed New Walls 169
ROOF INTERVENTION
PHYSICAL REHABILITATION ACCOMMODATION
Rear Elevation Areas of Development
Rear Elevation Areas of Development - Physical Rehabilitation
The second area of the proposal that will be investigated in more detail in phase 2 will be a closer look at space for the physical rehabilitation of patients.
Physical Prehabilitation Hydrotherapy an d Gymnasium
The unused underground car park and existing structure which formed a temporary space during phase 1 will be transformed into a swimming and hydrotherapy section of the building, which may also have a partial public nature, with the use by local schools for teaching and social purposes. There will be no alterations to Cables Wynd Houses structure, which will be left exposed. A small extension in place of the unused car park will be done in simple fashion using a similar method to the rest of the building work: steel frame, glazing and corten steel cladding as the primary materials. Above the hydrotherapy pools on the 9 floors above Cables Wynd House are various physical rehabilitation facilities. Directly above it, in this image is the largest space for physical rehabilitation in the gymnasium. The facility has been design as a more generic space to the one above it to house all forms of rehabilitation excersizes. As was seen in the kinastegiologist spaces, the further up spaces will be designed around specific rehabilitation facilities for specific diseases.
175
GYMNASIUM SWIMMING POOL
Physical Prehabilitation
HYDROTHERAPY POOLS Strategies
As with much of the design, when making the more significant changes to Cables Wynd House, Environmental factors have always been part of the design process, Windows have therefore been placed in order to ensure the most efficient natural ventilation possible. Solar panels have been placed on the extension roof, due to the direction of the roof this will help reduce the energy use from other sources in the large physical rehabilitation spaces. The generator room for the swimming pool has been put underneath the ground floor to the east end where the underground car park was to start.
Red - Existing Concrete Structure
GENERATOR IN NORTH EAST END
THERAPEUTIC HORTICULTURE
177
ROOF INTERVENTION
PHYSICAL REHABILITATION ACCOMMODATION
Rear Elevation Areas of Development
Rear Elevation Areas of Development - Rooftop Intervention
The last area of the proposal that will be investigated in more detail in phase 2 will be a closer look at the roof top intervention
Roof Top Intervention
Therapeutic Horticulture
Floor Plan
Areas should be accessible for patients to participate in gardening activities
Outside exercise and greenery space has been proven to have great social, physical and mental benefits to patients before and after surgery. Often patients find it hard in a hospital scenario to get these benefits. It is important in a prehabilitation and Rehabilitaiton facility, that this is therefore provided for. The unused rooftop provides an opportunity to do this. The rooftop has been designed around a walking circuit providing greatest benefits social, physically and mentally for patients. The design has also been done to allow the general public of Leith access and enjoyment of a green space in their city with views of the whole of Edinburgh
Cafe The cafe will be constructed for social benefits for the public and patients (+economical)
5 3
9 1
Roofscape Walking Circuit Key
Entrance The roof is a public space accessed separately by the general community and patients
1 2 3 4 5 6 7 8 9
- Public Viewing Area - Lobby Space - Large outdoor seating area - Therapeutic Horticulture - Water feature - Entrance Space - Larger Tree and Garden Zone - Fruit/ Vegetable Growing Area - Cafe & Indoor seating 183
2 - PLANTING INTERVENTION
3 - LARGER TREE INTERVENTION
6 - SMALLER TREE INTERVENTION
FRUIT/VEGETABLE GROWING AREA
THERAPEUTIC HORTICULTURE
THERAPEUTIC HORTICULTURE
Roof Top Intervention
B
Constructional details of horticulture
Key
A) Soil ranging between 500-1000mm B) Maximum bush height (2000-6000mm)
Due to the excessive weight that green roofs can have, especially after it has rained, it is important to look into how the existing concrete structure can be adapted to do this. The first step (image 2 & 6) is interventions directly within Cables Wynd House existing building footprint. This will be unable to take an exceptional amount of weight, thus the maximum height of the vegetation that is planted in these sections will be beneath 2000mm. This will consequently mean that the soil depth will be around 500mm, the concrete structural floor will be reinforced by steel connections below to make sure it can withstand any extra weight. In order to have some larger horticulture on the roof scape of Cables Wynd House, the extension to the entrance of Cables Wynd House (Image 3) will be designed with a large structural roof with multiple supports.
C) New Structural Floor (300-500mm)
3
D) Corten steel facade cladding panels B
6 E) External timber floor decking panels
B
E
2
E Red - Existing Concrete Structure
A
A A
C
Grey - Proposed New Structure
C
D C
185
ROOF INTERVENTION
PHYSICAL REHABILITATION ACCOMMODATION
Rear Elevation Areas of Development
PHASE 3 PREVENTATIVE HEALTHCARE DESIGN MEASURES ENCASE OF A FUTURE PANDEMIC
189
A Future Pandemic
CENTRAL CORE (EXTENDED ENTRANCE)
Precausionary Measures
There is now the understanding that a new virus and pandemic could come at anytime. Any healthcare developments will have to consider how they can design to cope for this. In this design, the phase two changes from phase 1 will be done in a way that they can easily be changed back to a virus free hub at anytime. This means several measures in public and private spaces have been taken.
ACCOMMODATION AND STAFF SPACES
Accommodation being converted between phase 1 and 2 will be discussed further on the next page. Staff accommodation will be dealt with in a very similar way to patients accommodation. In-terms of the staff and clinical spaces. All of the surgery facilities have been designed in the same way as phase 1, so can easily act as virus free surgery hubs if necessary.
The central core has been left with the same entrance as phase 1. In the case of another pandemic, temporary testing centres should again be placed within the entrance to restrict access into the building. The other entrances should also be closed off, so that their can be great control over who can enter into the building. The communal space have been designed with easy to clean surfaces and with plenty of access to natural ventilation to in order to mitigate possible transmission in those areas.
PHYSICAL REHABILITATION
If a future pandemic does happen, and there are some registered cases of a virus in Cables Wynd House, the wing that contains physical rehabilitation spaces may be closed off completely. If the virus is successfully kept out of the facility through carefully control of who remains and is omitted into the facility, then these facilities could remain open to patients within the hospital so they can get the best exercise without leaving the building.
191
PHASE 1 & 3
PHASE 2
Residential Apartments Future Pandemic
The design of all accommodation for patients in phase 2 has been done from the template of Phase 1 plans. Any measures that have been change have been done so for the greater functionality of objectives in the phase 2 design, once the current Covid-19 pandemic precautions are no longer necessary. Since the threat of a future pandemic is a real concern, these can be changed back at any time. Corridors have been left empty (no permanent walls or objects) and the same size so that screens, tape and sanitisation stations can easily be put back in. The Material strategies have remained relatively the same as well. Some sanitisation and washing station have also remained in place, meaning in a future pandemic only a few additional ones will be needed. The railings that were put in for screens will be reused for curtains, electronics and medical equipment meaning they can also be easily implemented back if ever necessary. While the image to the left only shows one room, all corridors and other accommodation will follow a very similar premise. 193
Final Image Phase 2/3 Rear Elevation
(To the left) A final Image looking at the rear of Cables Wynd House in use in either phase 2 or 3
195
STAGE 2 2020
STAGE 1 2020
STAGE 4 2035
STAGE 3 2025
IMMEDIATE COVI-19 FREE SURGERY HUB
THE DE-INDUSTRIALISATION OF HEALTHCARE
PREVENTATIVE MEASURES FOR FUTURE PANDEMICS
REHABILITATION AND PREHABILITATION SURGERY FACILITY
TRANSFORMING CABLES WYND HOUSE
Scott Doherty Stage 6 Arc8060 Thesis Portfolio