Environmental Health

At Alder Hey Children’s Hospital BDP bucks the trend in healthcare design by showing as much care for humanity as efficiency, finds Richard Murphy


At the opening of his Glasgow Gartnavel Maggie’s Centre in 2011, Rem Koolhaas showed an aerial photograph of the four main phases of the development of the surrounding hospital, spanning just over 100 years. Sequentially we saw a nineteenth-century gothic building bursting with civic pride, which then moved to a 1930s stripped aesthetic, followed by a 1960s concrete slab block, and concluded at the turn of this century with what can only be described as ‘PFI style’. The implication was that slowly but surely our expectations of hospital design have slipped. The last couple of decades has seen a huge expansion in the quantity of hospital construction, but our grandchildren (who’ll still be paying off the credit card bill) won’t look back with pride at its quality. Hospitals procured through the most costly and convoluted system devised by man rarely lift the spirits, even if they do meet efficiency targets. Indeed, like the oxpecker bird cleaning the teeth of the crocodile, Maggie’s Centres paradoxically thrive as gatehouses of humanity against the dreary backdrop of these human meat-processing factories.

There are, of course, exceptions and the new Alder Hey children’s hospital in a Liverpool suburb is certainly one of them. Maybe the very pathos of a hospital specialising in children demands that the human spirit once again reasserts itself at the centre of the hospital design agenda. Architect BDP was also lucky to be able to take advantage of a land swap with the local council. What had been an adjacent park became the greenfield site for the hospital and where the existing hospital stands will shortly become a park. BDP was also able to masterplan the site, so that effectively Alder Hey will become a campus of excellence in both paediatric practice and research. Hopefully this plan will be followed to avoid the familiar ad hoc chaos of most of our hospital campuses – as indeed it has been in its first manifestation, a research building by Hopkins Architects.

‘Spiritual care’ is accomodated in a timber-clad pod within the atrium

Since the hospital serves a wide area, the reality of car use is acknowledged with a square-planned multi-storey carpark placed on the site, but cleverly disguised by the hospital building spreading around three of its sides, which also works to deliver car-based visitors direct to the pièce de résistance of the entire project, a tall daylit atrium. This ‘street’ also collects pedestrians from the main road, and at the other end connects the hospital to the medical research park. Everyone arrives immediately at the heart of the hospital and can move onwards directly to one of five hospital ‘fingers’: three main clinical wards to the west, and the outpatient and pathology wings wrapping the car-park. At one stroke, gone are the usual wandering corridors, which are such a disorientating and depressing feature of our large hospitals.

Over the last few years there seems to have been a strong Ralph Erskine gene at work within BDP, and it is evident here in the language of the atrium, with its asymmetric bent glulam structure, pedestrian bridges and spiritual centre as a free-standing tree. This space is a triumph, with its cafes, seating areas, information screens, reception desk and delightful animal-inspired signage by the primary artist, Lucy Casson. It is a lively high street with so many distractions that it is easy to forget that one is in a hospital at all. BDP and its artist have also avoided the all-too-easy patronising funny shapes and garish colours that seem to be the default in buildings designed for children.

Critical care bays open to circulation route

The three main clinical wings are highly complex plans packed with state-of-the-art equipment and mostly single bedrooms. First impression is of the generosity of space and although internal corridor planning is essential at this scale, it has been ameliorated by either generous filtered top-lights or significant social spaces created around nurses’ stations, which make journeys enjoyable and measurable. Indeed, I imagine it is a pleasure to work in this hospital, unlike so many others where the efficient location of a nursing station seems to be the only consideration given to the quality of the working environment. Is it any surprise that the NHS has a massive staff drop-out rate?


Shared ward room

The central wing has intensive care bays, arranged as six gently curving bulges which spread beyond the perimeter, allowing the staff a panoramic view of six bays each. This planning device also allows natural light to penetrate through a rooflight between the bays and the floor above, itself entirely occupied by plant. The move is both obvious and at the same time brilliant, since it transforms what would otherwise be an extremely deep-plan space into a truly delightful place in which to do this delicate and demanding work.

Top-lit circulation space

Innovation abounds throughout the hospital, not least in the robot delivery and waste disposal trolleys that occupy the basement. Interestingly, Alder Hey is also becoming a centre of innovative ideas in information technology, communicating with children and families even before they arrive.

Externally, between the three clinical wings there are fingers of intensely landscaped space, addressed by all the wards. One wishes there had been some elbow room in the site planning for the angle between the wards to be a little more generous, both to make more meaningful external space and give genuine sideways views to the adjacent park. The building here is constructed of gigantic loadbearing precast panels, which speeded up the building programme and which BDP says are sculpted to remind visitors of the deep sandstone railway cuttings experienced on the approach to Lime Street Station.

Single ward room

At the end of each wing the inevitable grass roof curves down to meet the park in ski jump fashion, with recreational terraces for the children incised into them. Externally, these are the most distinctive elements of the building, but to me appear something of a gimmick, and the terraces might have been better planned if they had not had to co-exist with an undulating green roof.

If I have a major criticism, however, it is of the fourth wing, the outpatients’ department, on the south side of the carpark. This is organised over three floors around lightwells which struggle to be gardens, but the internal planning has slipped into wandering corridor mode, which is unfortunate in the most frequently visited part of the hospital. I became completely disorientated there.

We are told that good school building design improves children’s education. We do not know for sure if good design saves people’s lives, or aids recovery, though that claim is made by the Maggie’s Centre movement and others. I suspect more research is needed. But Alder Hey is about more than clinical outcomes for its young patients. It must equally be about the morale of parents dealing with the agony of an ill child, and of course that of the staff. Here, this hospital represents a huge leap forward. Somehow, through the bureaucratic jungle that governments have created for procuring hospitals, BDP has won through and created an inspiring centre which, according to the hospital’s own management, must now rank as one of the best in the world.

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