The “tree of life” at Maggie’s Oldham
The look and feel of where a patient receives care at the end of life has a huge impact on their wellbeing. This Hospice Care Week we shine the spotlight on two healthcare centres that put the care for the patients at the forefront of their designs.
Maggie’s cancer centres, founded in 1995, are renowned for their innovative design. When they opened their Oldham facility at the Royal Oldham Hospital in 2017, it became the first building of its kind in the UK to be constructed from timber, challenging the conventions of healthcare architecture.
“It has many practical, psychological and aesthetic benefits” says Professor Alex de Rijke, founding director of dRMM, the firm commissioned to design the building. “In wood there is hope, scale, warmth, and nature’s clever plan to absorb carbon. There is also the fact that it is a non-toxic, versatile material and very much a symbol of health.”
It is also wholly sustainable, yet despite all these benefits steel and concrete are still default materials in the construction industry. De Rijke is highly critical of this, and of a lot of healthcare design. “Hospitals routinely provide a rather dispiriting and institutionalised environment” he says, “which not only feels depressing but absolutely disempowers users with design tropes.” He blames this on a procurement process that prioritises cost-cutting, and takes the control of the design away from designers and gives it to companies with no training in the field who favour cheap materials.
“It is not good enough to just be critical” he adds, “so we have made a building that is a critique of hospital architecture, but is also a very positive manifesto for another way of doing it. We took a great deal of advice from both Maggie’s and from people dealing and living with cancer, and that enabled us to think about the general as well as the particular design, everything from the psychological aspect to specific spaces and views, the effect of light levels and colour, even details such as the role of wood in a tactile sense, for example avoiding metal because of the problem of peripheral neuropathy, fingers made painful by chemo. The whole project was treated as an holistic approach to design.”
A tree has been positioned in the middle of the building because “it represents life and growth and also the cycle of life, and the tree continues to make positive contributions to the world even when it is dead. It enriches the soil, it still provides a habitat for other creatures, it can be used as fuel or as building material, so even when it is dead a tree is in a way offering hope for the future.” As a result the patients refer to it as the “tree of life.”
The building has gone on to win over a dozen awards, including Building of the Year and Sustainability Award at RIBA’s 2018 North West Awards.
The Prince and Princess of Wales Hospice in Glasgow has also broken with tradition in their new site in Bellahouston Park, which opens next month. CEO Rhona Baillie is confident there is nowhere else like it. “People have been absolutely astounded by what this building looks and feels like, because it is just not like a healthcare unit, it almost looks like a boutique hotel.”
The aim was to create an environment that was non-clinical in appearance, and so they deliberately chose an architect with no previous healthcare experience. As well as researching healthcare centres in the UK they looked at large houses surrounded by parkland in the US and hotels with internal courtyards in Morocco, before finding St Olav’s Hospital in Trondheim, Norway, which provided much of the inspiration for the new hospice.
A quirk of St Olav’s is a feature called the “string of pearls”, because the bedrooms are dotted in a circle around an external courtyard in the centre. “We reversed that with the bedrooms looking onto a central communal area where people can gather to read, watch television and listen to music” Baillie says. The walls in each room can slide back, remote controlled by the patients, so they decide when they want privacy and when they want to see what is happening in the communal area.
“There is fantastic visibility from the patients out to either the relatives or the nurses, because there are no nursing stations, there is nothing to create a barrier” Baillie explains. This is something patients said they wanted from the new site, as being closer to the clinical staff can help reduce anxiety. Instead of traditional nursing stations there are laptops in each room, so the nurses can make notes while they sit with them.
On the other side the bedrooms face an external courtyard, where water, light and greenery create a calming environment. Baillie explains these are aspects that are very highly recognised in healthcare design, but what sets this site apart is that there is no evidence of clinical equipment anywhere. The communal area has console tables with oxygen points so patients do not need to use heavy oxygen cylinders, and in the rooms medical equipment is stashed inside cupboards until needed, when it can be brought out via a hoist.
“It is all 21st century equipment but we do not see why that should have to be obvious to a patient who is dying. Why can’t we care for them in a different way, somewhere that looks like home?”
To this end there are fireplaces throughout the building with real fires to evoke homeliness (risk assessed of course, Baillie hastens to add), artworks, curtains, and even the entrance is a domestic-sized Georgian door.
Many elements of their design meant challenging thoughts on infection control, such as the use of carpeting, and permitting animals to stay. “If patient care is going to be truly focused then some of those rules are not right for them. We want to meet the patient and family brief before the infection control brief. We are not an operating theatre, we are a place for terminally ill people.”
Both Maggie’s and the Bellahouston centre have been designed with the wellbeing of the patients as their chief concern. “There is significant research to say if you make patients feel more relaxed then that in turn affects their emotional pain and that can potentially reduce the physical pain and symptoms” Baillie says.
This also has an impact on the staff who care for them. Prince and Princess of Wales Education facilitator Liz Smith says she was blown away when she visited the new building. “I have worked in palliative care for over 20 years and to think that patients, families and carers are going to be cared for in such a beautiful environment was very emotional for me. There has been so much thought put into what really matters to people as they live with a life-limiting illness or support their loved ones, that I have no doubt their experience can only be enhanced. For me working in such an environment is an exciting prospect, and I cannot wait to get there.”
Hospice Care Week runs till October 14.
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