Village concept at heart of cancer centre

Jess Unwin reports on the new £160 million state-of-the-art facility emerging at St Guy’s Hospital in London

A place less like a hospital and on a human scale – but a place that still reassures patients they’ll get the treatment they need and which, because of a lack of space, is 14 storeys high. That is the balance to be struck and the challenge of the new cancer centre at Guy’s Hospital, London.

Building is now well under way on Guy’s and St Thomas’ NHS Foundation Trust’s £160 million state-of-the-art cancer centre for adults on a triangular site on the corner of Great Maze Pond and Snowsfield. The centre will be a health hub for south-east London, hosting specialist cancer services, training, development and research. It’s expected the building will provide for 700 outpatients at peak times.

One of the big drivers for the development is to bring cancer services together on one spot instead of patients having to find their way to several different locations within Guy’s and St Thomas’ hospitals for diagnosis and ongoing cancer treatment.

Since 2011, a project team that has included patients as well as staff have been working with main contractor Laing O’Rourke, plus two firms of architects – Rogers Stirk Harbour and Partners (RSH), and Stantec Anshen and Allen – to create the design details for the new cancer centre. Contribution at all stages from people like Diana Crawshaw, chair of the patient reference group, and herself a breast cancer survivor, is helping to make sure the building works for both patients and staff. Further feedback was gathered from public exhibitions and community meetings and has been instrumental in the design developments – from treatment facilities to public spaces.

Ivan Harbour, RSH’s partner in charge of project for the centre, reveals:

“The brief from the trust was that they were looking for new and radical thinking on how you might make a cancer treatment centre – how you might make that place less like a hospital and more personal for people.”

Although one goal was to create a landmark building to mark the southern entrance to Guy’s Hospital, the heart of the design concept for the centre is based around the idea of breaking the building down into ‘villages’ and zones to humanise the scale of the building.

Ivan remembers:

“Early on we had a meeting at the top of Guy’s Tower and I was standing at the bottom outside the lift. There was a whole host of signage and I was thinking, my goodness, what on earth do you do here if you’re a patient – how do you find your way around this place?”

He continues:

“Like a lot of hospitals, cancer services are spread around – it’s been a developing area so spaces have been adopted as and when available. The trust wanted ideas about how to provide treatment and diagnostics around this one place. Because the site is not large we knew we’d have to build something of 14 storeys simply to get the area they needed.

“We thought, what if visitors or patients, rather than being faced with a long list of floors and activities and trying to work out where to go, what if they had fewer options? What if we divided a 14-storey building into one that feels effectively like it has fewer levels. So, the plan of the building was broken down into just four components: ground floor plus three above – something much more human and therefore easier to use. And that drove this concept of the villages. When you arrive at the building, instead of 20 options of where you want to go, you’ve got three options. We’re thinking of the building not as a telephone directory of floors but as a series of spaces that serve particular aspects of the facility.”

Each so-called village comprises two to three floors and will offer a range of clinical and complementary care spaces with most of the related treatment facilities grouped together in one place. The villages will have balconies to allow light into the building and provide outdoor space, but privacy is maintained by a series of dividing screens, as many consultation/examination rooms overlook balconies.

The ground floor and first floor are the welcome village. This will form the heart of the building, a part of which is home to the Dimbleby Cancer Centre – a comprehensive information and counselling facility for patients and carers. There is also a rehabilitation gym and other drop-in facilities, plus space to relax and a café and shops.

In a break with the norm, the radiotherapy village locates the radiotherapy suites above ground. Typically these facilities have been placed in basements, or ‘bunkers’ as some patients described them, with no natural light. In the new Guy’s cancer centre they will be on the second floor, where they will be properly integrated into the other functions of the building.

The one-stop village will bring together the majority of services that outpatients might need, including minor pro-cedures and imaging. In the chemotherapy village, different-sized treatment areas will be created to allow patients to choose from either a large communal area or a more intimate and private space. Research facilities within the chemotherapy village will be run by King’s College London. This will contain tissue banking and an experimental oncology facility with supporting laboratories. Finally, at the top of the building is the private patients unit.

The other key design concept is how each floor has been laid out to accommodate what’s been dubbed the ‘science of treatment’ and the ‘art of care’. Says Ivan:

“Essentially, the building is a triangle and it’s split into two parts for the science of treatment and the art of care. The latter is the part of the building closest to the street corner and the former is the back of the building and is a very simple, repetitive, adaptable and flexible space that can evolve over time to provide all the technical back-up to the people side of building.”

The divide is flexible – some floors feature clearly separated zones, some have care and treatment adjacent to each other with connections and some are suited to interwoven zones – but organising spaces along the lines of need, or not, for a divide has really helped. Ivan explains:

“We’ve been able to say, well, these parts aren’t going to be clinical so they don’t need to look like a hospital. That also means we can be less stringent with controls but of course without compromising the operation of clinical areas.

“In a more traditional hospital layout, you throw everything together as a sort of porridge and the whole thing is clinical, whereas if you can be clear about which parts are used in which way you can go a different way with design.”

Crucial to the more welcoming ambience of the centre is that it is so visually permeable – both from inside and the street – with glass comprising close to 50 per cent of the panelised system that clads the concrete frame. Says Ivan:

“We were very interested in getting as much daylight as possible in there, albeit controlled and understanding that there are certain parts of the building that shouldn’t be all exposed. Each of the villages has this large balcony outside of it arrival floor and is designed to feel like it’s got a bit of outdoors as part of it. There’s a great relationship between you and the sky.”

Research suggests art can help people recover faster because we all feel better in a beautiful space. But art within the new cancer centre will also be employed to help people find their way around the building, using themes to intuitively identify the different villages. Three artists have now been selected: Angela Bulloch works across a variety of media such as light, sound and video installations; Gitta Gschwendtner is to focus on developing a key identity for each village through a practical design response to furniture, floors and perhaps a wayfinding artistic solution; and Mariele Neudecker will take on the balcony gardens and outdoor spaces.

With piling and basement work complete, above-ground floors are emerging in a project that is targeting a BREEAM Excellent rating. After installation of medical equipment next year, then commissioning and staff orientation during spring and summer 2016, the new cancer centre at Guy’s opens to patients in the autumn that year.

Client: Guy’s and St Thomas’ NHS Foundation Trust

Architect: Rogers Stirk Harbour and Partners

Co-architect: Stantec Anshen & Allen

Main contractor: Laing O’Rourke

Structural engineering: Arup

Services engineering: Arup