Tuesday22 August 2017

A garden for England

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A serene, green courtyard is the at the heart of Steffian Bradley’s Gravesham Community Hospital in Kent

A fter struggling with a Victorian hospital with 60 changes of level, it’s not surprising that the Dartford Gravesham & Swanley NHS Primary Care Trust was initially keen that its new Gravesham Community Hospital should be all on one floor. But Steffian Bradley Architects had other ideas. The result — a denser arrangement grouped around a substantial courtyard garden — is an example of the welcoming environment that can be achieved in smaller hospitals.

The £25 million, PFI-procured hospital combines a minor injuries unit, outpatient department and residential facility for long-stay patients — a mix of services that is set to become more common. Under a £750 million Department of Health initiative, the NHS is concentrating acute services in a small number of super-sized hospitals and shifting planned and non-invasive health services into a new generation of community hospitals, which will also deal with social care.

Gravesham, built by Grosvenor Project Development Ltd, opened last year. It is one of the first projects won by the newly established UK office of US healthcare design specialist Steffian Bradley Architects. The challenge for the practice was to come up with a design flexible enough to accommodate the frequent changes in service provision, as well as the tricky combination of highly accessible outpatient facilities and highly secluded long-term care accommodation on the same site.

With the benefit of its experience in the US, Steffian Bradley challenged the client’s stipulation that outpatient accommodation be located on one floor, convincing the PCT that way-finding and travel times could be just as effective over two floors. The resulting decision — to stack facilities around a central therapy courtyard — was the key to the whole scheme. “This freed up the footprint enormously,” says managing director Martin Gillatt, adding that the more compact arrangement eliminated many corridors.

The two-storey 6,000sq m outpatient department is positioned in two wings on either side of the main entrance, with a minor injuries unit on the ground floor and an out-of-hours GP service located just off the 24-hour-a-day reception. Clear signs help visitors find their destinations in minutes. The clinic waiting rooms are fairly open, and some overlook the double-height entrance lobby, while the consultation rooms are arranged off corridors and are more private.

At a late stage in the planning, the decision was taken to incorporate the trust’s own offices on the site, which was achieved by simply adding another floor to the steel-framed building above the outpatient departments.

The decision to stack, rather than sprawl, makes the whole complex compact in scale


The intermediate care accommodation, which has its own rear entrance, is arranged around the other two sides of the courtyard on three levels. The hospital provides a total of 80 single bedrooms, mostly for elderly, long-stay patients, with one wing providing shorter-term intermediate care for those recuperating after operations or accidents. Rooms are arranged in clusters of six, and blocks are clad in western red cedar, reading as domestic-scale terraces rather than as large institutional blocks.

The decision to stack, rather than sprawl, makes the whole complex compact in scale, with views to and from different parts of the building. If they wished, staff could carry on walking in one direction and arrive back where they started: “Just like Bluewater!” says the hospital’s general manager Karen Jefferies.
But there the comparison with the UK’s biggest shopping centre stops, for Steffian Bradley has created an unusually calm and quiet hospital environment. What outpatients and visitors usually comment on, says Jefferies, is not the building’s eye-catching entrance, but its hidden “therapy” courtyard, an unexpected oasis arranged on two levels to allow maximum access for long-stay patients, whose dining and day-care rooms face on to the space. The architect made the most of this opportunity, bringing in Fira Landscape Architecture & Design to design attractive planting, interspersed with seating and hard landscaping.

“It has the wow factor,” says Jefferies. “For the people who live here, it’s their back garden.”

After the hubbub of the noisy streets of Gravesend outside the hospital, it’s certainly a quiet and pleasant space to escape to. And by attracting outpatients and staff into the courtyard to enjoy it, the design helps counteract the isolation that long-stay rehabilitating patients could well feel.

Another challenge was context: to succeed as a community hospital, the design had to respond to its surroundings in the heart of Gravesend and be accepted by the community it serves. The architect positioned the main entrance by the natural route to the site from the station and taxi rank, and gave it a dynamic canopy to signal its presence on the street.

Even though the community hospital is relatively small, its mass is still substantial, so Steffian Bradley sought to break this down to a scale more appropriate for the surrounding streetscape by using a range of materials. These include the distinctive green, glazed tiles to highlight the entrances, chosen by the architect both as a contrast to the brick and render facade, and because they relate to similar tiles already used in the area’s vernacular.

The courtyard, an unexpected oasis, helps to counteract the isolation of long-stay patients


Where the hospital backs onto residential streets, cedar panelling was chosen to give a warmer, more domestic feel more appropriate to the setting. Inside, graphic artwork refers to local landmarks, in particular the nearby River Thames.

According to client surveys, users of the hospital are positive about the building. “It’s bright and light, and it’s gone down really well,” says Jefferies. As well as the small scale and simplicity of navigation, she says this feel-good factor stems from the choice of colours and materials, and the uncluttered and airy space.

Gillatt says the aim was for a “fairly neutral, calming space. The building is animated by the people, and colour is so subjective.” But the building doesn’t shy away from colour entirely. Strong highlight colours have been used — for example, in the phlebotomy department, one wall is painted a vibrant orange and the vinyl floor patterned with a circle of corresponding colour. “For PFI, we have to work with the materials framework we’re given, but we do get a choice with colour.”

It’s some consolation for some of the trickier specification compromises Steffian Bradley experienced. “We couldn’t put down terrazzo flooring, although it might be the best option in that it’ll last for 30 years. We had to specify vinyl, which will last for 15,” Gillatt says.

For all the complexity of the hospital planning and PFI processes, ironically one of the most problematic design challenges, says Gillatt, was satisfying all faiths in the design of the small, multifaith pavilion in the courtyard. But you’d never know from the resulting space — a calm, light room with several faiths discreetly represented, but neutral enough to be used as a quiet room for those of none.

Suppliers’ details

Yellow multifacing brickwork by Blockley Kensington;

Aluminium timber-clad composite windows by Sampson;

Glazing: Pilkington Therm float, clear float and antisun glass;

Sto render supplied by Stoneguard

Vinyl flooring by Polyflor;

Furniture by Countrywide Healthcare Supplies

Internal doors by TDSL Doors

Western red cedar external timber by Decks Direct


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