Wednesday23 August 2017

Lift and celebrate

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In a south-west London suburb, Penoyre & Prasad has negotiated its way through a complex contract and NHS regulations to deliver a striking uplift in design standards

A pproaching the curved red brick wall of Penoyre & Prasad’s imposing Green Wrythe Lane Health Centre in the south London suburb of Carshalton, a repeated window detail immediately catches the eye. Aluminium frames project proud of the brick facade, with part of their width taken up by a panel of mesh-covered slats. Cantilevering purposefully from this panel are five horizontal solar-shading timber louvres. In the bland normality of the street-scape around, it’s a bold detail but also a mildly disconcerting one.

The window detail turns out to be the result of statutory requirements to provide acoustic protection for consulting rooms while ensuring a supply of fresh air (see box overleaf). But just as project architect Adam Cole is explaining this, a patient at the centre interrupts to say that her mother, who lives across the road, thinks the louvres and mesh remind her of the bars on a prison window. Mother has put her finger on it.

Penoyre & Prasad has wrested design innovation from the jaws of regulation and produced an NHS healthcare centre with the scale and presence of a true public building — it’s just unfortunate that the two achievements have worked against each other.

This health and social services centre is one of two new-build health centres delivered by Building Better Health, the private sector partner in the South West London Health Partnership, a joint public-private venture to deliver improvements under the NHS Local Improvement Finance Trust programme. The Lift

initiative aims to bring design vigour to what historically has been the contractor-led process of PFI healthcare procurement. Under Lift, design control would be put into the hands of small and medium-sized practices with a fresh outlook and imagination, but a wider consortium would ensure the project’s delivery.

Building Better Health includes Penoyre & Prasad, Buschow Henley, Davis Langdon, and Rock Consulting, plus contractor Willmott Dixon and facilities manager Kier. The local primary care trust is the overall client, leasing the space to GP surgeries and to dental, chiropody and social services. But Penoyre & Prasad also had to design to accommodate the needs of end users and Kier, which had an obvious interest in the build quality of the centre and its life cycle costs.

Cole says that the difference between Lift and conventional PFI is that the architect was appointed by the consortium rather than by the contractor, and so was less in the latter’s sway during the design development stages.

“The point was that it would not be contractor-led. For this job, we were all equal partners,” he says. A bold claim, considering that Penoyre & Prasad ended up being novated to Willmott Dixon anyway. But as the contractor had to work to the architect’s outline elemental specification on areas of the design that were not developed fully prior to financial close, and this arrangement led to upgraded specifications that would normally have been unheard of under PFI, it seems a justified one.

The point was that it would not be contractor-led. For this job, we were all equal partners


The centre addresses a roundabout, opposite a low parade of shops, a Blockbuster video store and a patch of empty land, and it certainly makes its presence felt. A large glazed area, denoting the reception, faces south. Ground level is highlighted by a bright wall of coloured ceramic tiles, set back from the building line. The overhang covers a ramped main entrance to the centre. In front, fair-faced elliptical concrete columns take the loads at the building’s edge to ground. A side access road leads to the rear of the building and a car park.

The red brick skin on the curving south- and east-facing facades matches the brick buildings nearby, but it’s doing more than lend a contextual element. The brick is a fundamental part of the thermal mass strategy, facilitating passive heating and cooling for the naturally ventilated structure. The same approach is carried through internally, with the use of exposed concrete slab soffits wherever possible.

Glazing on this facade deals with solar gain by using horizontal cedar louvres. But for larger expanses such as the main reception area, the budget was directed towards high-performance glass. This glass, being impregnated rather than coated, benefits from low reflectivity and high translucency. It may seem a small point in the specification, but it’s one that serves to make the relationship between the centre and the street beyond a clear and direct one.

Internally, the ceramic-tiled reception area makes the biggest statement, rising a full four storeys to the roof’s apex. From the ground-floor waiting area, patients access GP surgery rooms located in the east block, or take the stainless steel and glass staircase to the first floor to dental, podiatry and childcare consulting rooms. Above these are the non-public areas for social services staff: open-plan offices, meeting rooms, break-out areas in the large roof dormer spaces, and a grand, double-height staff room.

The elliptical concrete columns that run through the building have been painted rather than left fair-faced. “We weren’t sure if, in this location, the design restraint of modernism would be associated with a low budget,” says Cole.

The south-facing consulting rooms are warm, bright and spacious, even if — having been designed to accommodate minor surgical procedures — the rubber flooring and white-painted Thermacell walls leave them feeling a little hard. But all rooms have timber doors and frames, and GP consulting rooms and corridors are given a softer touch with carpeting.

These seem like natural considerations, but these surfaces were not achieved without a fight — because of the need for strict infection control, including the spectre of MRSA. As Penoyre & Prasad associate Mark Rowe points out: “In the acute sector, there is real concern and a tendency to impose strict guidelines prohibiting such things as carpets, fabric and timber. That said, there’s no specific guidance with regard to the provision of primary healthcare. We had to achieve sign-off from the PCT’s infection control officer and identify our argument for non-compliance with the onerous Health Facilities Note 30 guidance.”

Cole says that Willmott Dixon took a proactive attitude throughout, motivated by the desire to keep its place in the Building Better Health consortium. A good example of the quality achieved is found on the north and west elevations, where the English oak weatherscreen cladding has impeccably placed timbers and perfectly counter-sunk screw housings.

Willmott Dixon upgraded emergency staircases from mild steel to stainless steel and glass, and produced a slick hidden gutter detail at the roof-wall interface


The contractor’s conscientiousness is also evident in the window package, where subcontractors were appointed on a budget that was based solely on design intent drawings and an outline specification.

“This came in over budget once costed against the working drawings,” says Cole.

“But with the specification being precise about glazing performance, it was an overspend they took on the nose.” In other words, the outline elemental specification included in the contract allowed the architect the leeway to define the window spec in full once novated.

Willmott Dixon also upgraded emergency staircases from mild steel to stainless steel and glass, and produced a truly slick hidden gutter detail at the roof-wall interface.

At £2,300sq m, the project had a reasonable budget that has been well spent to provide a warm, light and airy health facility. Penoyre & Prasad has had to jump through hoops to meet regulations, a symptom of which is that overwrought window detail. Nevertheless, it has made real efforts to bring quality and softness to what could easily have become an institutionalised building.

And even if the facade evoked a completely different kind of institution for one local resident, others have taken it to their hearts.

At a focus group meeting during the design stage, the local police advised Penoyre & Prasad that the centre would have to be protected with a wire fence, a notion the architect politely but firmly rejected. After six months, the centre is unmarked by graffiti or vandalism, and local taggers have shown their respect for the building by restricting themselves to the unseen rear wall of the car park substation.

Shading for sight and sound

Penoyre & Prasad associate Mark Rowe explains the thinking behind the consulting room windows

A lot of factors affected the development of this detail. First, we needed to bring light in and allow for natural ventilation as part of our passive ventilation strategy. Second, the Department of Health’s Health Technical Memorandum 2045 requirements meant that a maximum sound limit of 23 decibels was permitted in the consulting rooms. And having a southern elevation, we also had to deal with solar gain.

We iterated between a lot of possible designs for the acoustic louvres, liaising with window supplier Architectural Aluminium. But because we were already working within the costed contract, we had to consider the most cost-effective solutions. To achieve the attenuation we needed, we required sectional depth to the louvres, which resulted in the 300mm-deep window box.

The windows were originally to be steel, but became so heavy that we ended up specifying them in aluminium so that the weight of the whole unit did not end up levering bricks out of the wall.

There’s mesh on both sides of the louvre detail. The external mesh is there to prevent birds nesting in the damper.

We always conceived this part of the window as reading more as a surface, rather than as a succession of louvres.
We were always concerned about them looking rough-and-ready, and wanted to mitigate that by masking them.
Had this detail been procured traditionally, I imagine
it would have been more refined, with a finer mesh that would have given that surface reading.

But we were working politically within tight regulatory and contractual constraints.

Suppliers’ details

Windows Architectural Aluminium
Curtain walling Stoakes Systems
Oak cladding Vincent Timber
Reception desk Wallis Joinery
Ceramic tiles Architectural Ceramics
Roof Rosemary Clay tiles by Lafarge
Balustrading Metamont
Ceilings SAS International supplied by BD Contracts


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