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Healthy Circulation

Fluid spaces of the new Maggie’s Centre are a reaction to the institutional nature of hospitals, yet still lack a sense of human scale

As a building type, it’s difficult to categorise what a Maggie’s Centre actually is. Maggie Keswick Jencks started the respite centres for cancer sufferers, but she never lived to see the completion of the first one in Edinburgh in 1996 (which my practice designed), and the initiative has since been continued by her husband, Charles Jencks. 

All Maggie’s Centres are privately funded. Under his stewardship and led by the remarkable Laura Lee, formerly an oncology nurse and now head of a multimillion-pound charity, Maggie’s Glasgow Gartnavel opened this October, to become the eighth completed centre in 15 years. More centres are on site and in design, two of them outside the UK. Even Maggie, with her immense optimism and ambition, would have been amazed to see what has been achieved in such a short time.

Jencks, who is in perhaps the unique position of critic-turned-client, has pursued a policy of high-profile international architectural commissions. OMA follows Frank Gehry, Zaha Hadid and Kisho Kurokowa. To his credit, he has been catholic with his commissions, and the architectural disparity between the different centres is worth an article in itself. OMA was an obvious choice, given that Rem Koolhaas is a former student of Charles’s from his time when he was a teacher at the Architectural Association and a personal friend of Maggie.

Jencks has described the centres using terms such as house, gallery, spiritual retreat and refuge. Non-clinical in their function, at one level they aim to provide spaces for one-to-one counselling, group activities and information for those recently diagnosed with cancer. But at another level they provide intangible support, a sense of being in a welcoming place surrounded by people with whom you could share your experiences, or who are expert listeners. It’s a kind of home-from-home and a world away from the more clinical atmosphere of a hospital.

Almost universally, each of these little buildings (although they do seem to be getting progressively bigger) sits alongside a sprawling, major hospital complex.  Koolhaas has observed that you need only to look at a hospital such as Gartnavel to see how the concept of civic pride and care has declined through the generations. His new centre sits on the edge of a small wood which itself is completely surrounded by the rest of the hospital campus. To one side is the original 19th-century hospital building, a wonderful castellated stone celebration of Victorian confidence, now listed as a historic structure but partially derelict; to another, is a typical 1960s Modernist slab block.

Surrounding it all is the incoherent junk of the most recent building programme, a product of the widely discredited PFI procurement process, which puts building contractors in charge of design. Looming large among these latest additions is the Beatson Oncology Centre, the largest cancer centre in Scotland and the second largest in the UK. Some might say if hospitals were designed along humane principles there would be no need for Maggie’s Centres; others accept that factory-style healthcare is inevitable and concede that Maggie’s Centres fill a gap in the patient’s experience.

Koolhaas teases and stretches the accommodation into a continuous sequence around a small courtyard. The plan is conceived as a series of orthogonal spaces which collide into each other and are generally relieved by large areas of glazing looking both inward and out. Small ramps occur everywhere between spaces, presumably as a way of marking thresholds, but these are intensely irritating and wholly unnecessary as the whole building could so easily have been on a single level. Where walls do occur these are fashioned into L-shapes which define alcoves of activity: library, kitchen, dining space, office, meeting room and a large multipurpose space that can be separated off using giant sliding screens. 

Healthcare institutions tend to be characterised by oppressive corridors, so minimising dedicated circulation space might be seen as a priority in such a project. Yet here it is celebrated, rather like being in an art museum. Indeed, the building has the feel of a beautiful sculpture gallery still waiting for its exhibits to arrive, reinforced by the real thing outside, set in the landscape designed by Charles and Maggie’s daughter Lily.
The interior aesthetic is minimalist, with exposed concrete walls, large panes of glass and immense glazed sliding doors topped off
by a floating flat roof with a timber soffit, perhaps the only element that provides a sense of warmth.

Counterpointing the cool, open spaces, a small top-lit room lined in curving laminated timber forms an intimate enclave for confidential conversations. Curiously, as so much of the building is deliberately indeterminate, this space consists of two fixed seats projecting from the laminated wall but set just far apart from each other to make conversation stilted. The asceticism no doubt appeals to a certain set; let’s hope it doesn’t alienate others. Cancer is not just a middle-class disease.

Before seeing the centre, I had assumed that the courtyard form was a means of turning it in on itself, away from the detritus outside. Yet views out are as expansive as those in to the courtyard. This is clearly beneficial when focusing on the remaining fragment of woodland, but counter-productive elsewhere. Inexplicably, a huge bay window in the most popular space, the kitchen, faces the Beatson Oncology Centre, the place from which patients have come, and presumably, would like to forget about. Is this carelessness or is an unfathomable agenda at work?At five times the size of the first centre in Edinburgh, OMA’s Maggie’s Centre is generously proportioned, but perhaps too generous to cultivate a sense of inhabitation. Not only are there large areas of space where nothing particularly happens, there is also confusion as to which bits are for the public. 

It would be a fantastic venue for a party; how people find their way around seems less clear. The entrance has already been found to be confusing, and visitors have a habit of heading off in the wrong direction, always a potential problem with a race-track plan. Paradoxically, from the architect who brought us the classic analysis of scale with S,M,L,XL, there appears to be a scale problem. We are used to the accusation that the ‘human scale’ is absent from so much contemporary architecture. Here, starting with the front door, there are few familiar, humanly scaled elements.

As it develops, the Maggie’s programme of centres is starting to resemble a fascinating dispersed Wiessenhof of small health buildings. And, like Stuttgart, most designs are by international architects more familiar with the large scale. They also go to the heart of what architecture can do. Some time ago, I discussed with Charles Jencks what was the most significant book on architectural theory of the last 50 years.

Unsurprisingly, he cited Robert Venturi’s Complexity and Contradiction as the first serious critique of what Modernism had become, in particular, its lack of signs, symbols or rhetoric. My suggestion was Christopher Alexander’s A Pattern Language, a wonderful reassertion of what makes rooms, housing, spaces and cities either humane or inhumane. With OMA’s Maggie’s Centre, you sense that neither agenda is at work. 

Architect OMA
Executive architect Keppie
Structural engineer Sinclair Knight Merz
Services engineer KJ Tait Engineers
Landscape consultant Lily Jencks
Photographs Keith Hunter, Philippe Ruault

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