AR Healthcare 2016 commended: architecture is deployed with great sensitivity to lift the spirits and help provide therapy
The promise offered by an approach down a quiet shady avenue, residential to one side, well treed to the other, was decisive for the choice of site of the new Maggie’s Centre in Manchester. That short journey, hardly a hundred yards away from its parent NHS institution, sets the tone for what is to come.
The founding principles of the centres were Maggie Keswick Jencks’ insistence, as cancer closed in on her, that ‘What matters is not to lose that joy of living in the fear of dying.’ The provision of emotional and psychological support, practical information and an uplifting environment, complementing NHS provision but entirely independent of the institution in question, forms the backbone of the brief, as articulated by Keswick Jencks and her cancer nurse. Since the first Maggie’s, designed by Richard Murphy, opened in Edinburgh back in 1996, nothing has caused that to alter, says CEO Laura Lee. Lee’s own involvement in Maggie’s is exceptional in itself. She was that cancer nurse and has been central in the charity ever since.
‘Clinical practice and technology on such a scale breed their own atmospheres, however much is done to minimise the impact’
Essentially, every designer of the now 20 centres (19 in the UK, one in Hong Kong) is required to interpret the task in their own fashion. As Lee puts it, ‘In essence they must approach their commission as if it has never been done before.’ Client liaison is the responsibility of Marcia Blakenham, while Charles Jencks remains heavily involved, sitting on the board and advising which talented and active architects might be suitable for consideration next. It is down to the architects to challenge the client, says Lee, and from that ‘an uplifting and surprising building’ will unfailingly emerge.
These are not easy commissions, locating a piece of land on a congested site is only the first difficulty. In Manchester, Foster + Partners have gone a step further. The practice provided the hospital with a masterplan, gratis, to argue the case more effectively and help plan future development around the area. Foster’s addition to the Maggie’s portfolio is across the road from The Christie, the largest specialist cancer centre in Britain, an institution with the essential apparatus and structure of a huge working hospital and research centre. Clinical practice and technology on such a scale breed their own atmospheres, however much is done to minimise the impact.
Manchester’s Maggie’s is unashamedly personal. Norman Foster was born in the city and this project has been driven by, in his words, ‘first-hand experience of the distress of a cancer diagnosis’. Architecture, says Foster, has the capacity to lift spirits and help provide therapy. This newest centre, the first in the north-west (Oldham by dRMM is close behind) and the largest so far, has been a labour of great care and devotion (and a job carried out entirely pro bono which has been borne aloft by the enthusiasm of the office).
If ever architecture can be proven to be deterministic, it is so in health, and never more than in palliative, therapeutic and complementary care. Every Maggie’s Centre aims to be an oasis – providing calm and reassurance, a quasi-domestic atmosphere in which natural light, physical comfort and visual stimuli all play their part. Keswick Jencks was an illuminating writer on the gardens of the East, both China and Japan, hence the importance of planting and green spaces in the centres. Dan Pearson was responsible for the interior courtyards at RSHP’s Maggie’s Charing Cross Hospital (2008) – offering wonderful respite, I well remember, to the weary and footsore at the 3am stage of a Maggie’s all-night walk – and now he has designed the extensive gardens, and conservatory/greenhouse, in Manchester.
Foster’s Maggie’s is from the outset an exercise in elegant understatement. The first impression, coming towards it along the avenue, is of a long low single-storey pavilion, wrapped by canopied verandas, walls clad in oyster-coloured weatherboarding, interrupted at intervals by generous floor-to-ceiling fixed glazing. The shallow pitched roof is clad in a brownish bronze, and a succession of triangular rooflights crown the roofline.
The entrance is not immediately obvious, but a break in the low wall and hedge is indicative and guides you, off centre, towards a door set at right angles. Coming in, as visitors are encouraged to do on the off chance, is simple – no paraphernalia, buzzers or intercoms, just a glazed door which opens on a gentle push. Once inside, the atmosphere is, as Foster’s partner in charge Darron Haylock says, ‘homely and yet not like home’. The first stop is at an enormous kitchen table, where the volunteers gather, offering food and drink but also acting as the habitual eyes and ears of a Maggie’s. This is very far from the world of the reception desk, the appointment book or the long wait in the corridor.
‘The volunteers told me that people tend to choose a favourite room and return to it on each visit’
Throughout, surfaces, palette and materials are simple, quiet in tone. The flooring is of blue-black Staffordshire brick pavers and runs cleanly from the exterior inside. The columns to the canopy that wraps the entire circumference of the building are housed in ‘shoes’ of the same material. Overhead the structural mesh of trellised timber braces and elegant laminated veneer lumber (LVL) columns provides interest and a measure of aesthetic lightheartedness. The furniture is stylish and comfortable with vivid rugs adding sharp colour notes, along with prints on the walls. With a whiff of Scandinavian Modernism about them, the various rooms, with their different aspects and different atmospheres, all flow back to that focal central kitchen. Wood-burning stoves are at the centre of the two largest rooms, either end. The easy asymmetry of the plan and the loose interconnections between spaces, equally belie the tortuous, careful process of design revealed in the series of preparatory drawings and models.
The importance of this commission extends to encompass model makers and mathematicians, engineers and sustainability specialists, as well as the firm’s product designers. Visualisation started immediately with freehand drawings and moved on to aids such as a full-scale paper mock-up of the structural timber member. Coloured diagrams designating the different functions of the rooms morphed into coloured Perspex models. The lattice of the brace had been tested to be tough and lightweight but not fussy. Foster’s long-standing passion for the technology of aircraft manufacture was back in the frame. By the entrance, a framed assembly of reduced scale (1:20) models of these elements is on show.
Natural transparency was high on the desiderata, as was housing the administration discreetly, but not behind closed doors or out of sight. As a result there is an upper level mezzanine, running the length of the building and which offers up to 10 desk spaces. Built-in storage (Foster’s product designers’ work) minimises clutter and the look of an office. The building as a whole is sufficiently porous that a nurse or counsellor could quickly come downstairs to offer support, yet staff can work away overhead while the various ground-floor rooms are being used, as on my visit, by several couples – each room offering somewhere for a patient to doze, rest or just talk to their companion. The volunteers told me that people tend to choose a favourite room and return to it on each visit. Acoustic ceilings ensure quiet, but only a designated consultation room has a closed door, otherwise rooms are interchangeable although one larger one is readily available for yoga or other relaxation regimes.
At the hub of it all is the kitchen, warmly lit, the working elements and shelving to the rear. The centre offers advice on everything from financial problems to wig fitting, and one small room is a library, stacked with helpful books and magazines. Even more thoughtful, is the size and design of the lavatory – far from being just a functional cubicle, it is a comfortable small room, a place for a good cry out of sight. Nothing institutional has crept in, not even illuminated green running men signs to the exit. The chilly metal handrails to the upstairs mezzanine are being replaced with wooden alternatives, touch is as important as sight.
Much of the additional space at Maggie’s Manchester lies in the generous gardens around it as well as the internal greenhouse, a full-height conservatory with temperature-controlled glazed panels. If I have a single reservation about the aesthetics at Maggie’s Manchester it is about the quirky end elevation of that conservatory, a curiously overbearing, bull-nosed affair. However, the ambition is for a dense curtaining of climbers, running up the columns and along and I suspect that the snub-nosed glasshouse will disappear in something of a forest. Pearson’s planting scheme is still immature in these early months but offers the prospect of broad-brush perennial borders. Raised vegetable beds are particularly popular with visitors and where possible the cooks are using home-grown produce. Remembering that this is the north-west of England, with the rainfall that once attracted the cotton mills to these cities, Maggie’s users can draw upon the pleasures of outdoors, without physical discomfort. Either well protected by the canopied verandas or indoors in the comfort of a well-heated space, there is the therapeutic sight (and scent) of abundant seasonal planting. Inside the greenhouse, a Cumbrian green slate-topped table sits on runners. It can be a congenial seating area or, on occasion, slide out to become a handy workstation for someone potting up the plants around the area.
Now, as Maggie’s Manchester settles down into its day-to-day existence, the architects step back, leaving the users, as Darron Haylock puts it, ‘to follow their own life, not the architects’ scheme’. And that, tout court, is how the continued programme of Maggie’s Centres goes, one diamond standard brief but many resolutions.
Maggie’s Centre Manchester
Architect/structural engineer: Foster + Partners
Landscape architect: Dan Pearson Studio
Photographs: Luke Hayes