At home in the country

James Parker visited the rural children's hospice that aims to provide an informal and happy atmosphere of 'home away from home,' without forgetting relatives' needs, and which succeeds in both aims.

The Little Haven Children's Hospice is the first specialised children's hospice to be built in Essex. Largely operating outside the NHS, its funding mechanism is clearly very different, and arguably it has produced a building that far surpasses NHS standards, though the contract itself does not appear dramatically unusual. The bottom line is that L3.9m was found for this project, including the fund-raising necessary, though the unit will only provide a maximum of nine care beds for children with mainly muscular disorders of a "progressive" nature. It was funded solely through charitable donations, not having a grant even from the National Lottery, and the single largest donation being a paltry L98 000. While charity funding may be a necessary evil when such areas of healthcare do not fall within traditional funding structures, if it produces a building of this quality one can only applaud it.

PROCUREMENT & DESIGN

The Christian registered charity South East Essex Hospice established an adult hospice in Westcliffe-- On-Sea in 1983, and ten years later it began the appeal for a hospice on the site near the village of Thundersley to serve children from outer London Boroughs and Essex. Robin Fanshawe was appointed project director in 1993 and began research for the scheme, which opened to patients finally in March 1998. The multi-disciplinary project team visited other children's hospices (there are 12 in the UK) to discover best practice, and began the lengthy briefing process. As project architect for Essex firm David Ruffle Architects, Chris Matthews, says, "There was not much of a precedent at that point". Fanshawe had expertise at the Fair Havens hospice at Westcliffe to draw on however, and channelled the clinical input into the achievement of design solutions.

The 120-acre site, which includes beautifully landscaped grounds, was originally purchased from British Airways at a cost of L250 000, and the Essex Wildlife Trust now leases 100 acres for the nature reserve, which is a valuable aid to the revenue. Local people had previously "been used to walking their dogs," says the hospice's public relations manager Jenny Hubbard, so sensitivity to local residents' wishes was called for and obtained in a thorough consultation process. This extensive consultation was mirrored in the development team, which consisted of various palliative care professionals and the architect. Chris Matthews says the costs were "well determined before we started," and construction manager for contractor J Hodgson, Keith Burns, admits that because the such schemes are charity-driven, "contracting can be quite adversarial, because of increasing costs". However he adds that selecting "user-friendly" sub-contractors enabled "early recognition of problems through good teamwork". Many of the scheme's details required vigilance from the main contractor to ensure they were completed to the correct specification. Construction work was also sensitive to the requirements of the Essex Wildlife Trust eg by not dumping litter, and carrying out the earth moving necessary for the deep cut sensitively. The close relationship achieved between development team, contractor and sub-contractors, says Keith Burns, was akin to 'partnering', and ensured that the scheme was completed on time and on budget.

Children from birth to 16 years of age are accepted for care in the hospice. It is a very large building, considering there are only nine beds, and faces the daunting sum of an estimated lm annual running cost, with its many support areas and a high staff-patient ratio. The patients' conditions are life-threatening, and they are not expected to reach adulthood, though the hospice has been designed to be as life-affirming as possible. As project architect Chris Matthews says, "This is very different to an adult hospice - that is somewhere that people go to die, but this is somewhere where they make the most of what they've got. The focus is on the quality of life rather than managing death". The main treatments are physiotherapy and drug-based pain management, and eight of the nine beds are for respite care, with the one remaining being for emergency cases. In addition to the unassuming human scale of the two-storey form externally, many of the internal areas resemble domestic spaces, avoiding institutional connotations in a thoroughly convincing and natural way, as detailed below.

EXTERNAL ELEMENTS

The two-storey building is located on a gently sloping rural site near Southend in Essex, surrounded by a nature reserve, which is adjacent to the busy A127 arterial route to London. However it is virtually invisible from the 'B-road' that accesses the unit, due to trees and also to the low profile of the building, which required a deep cut in the land to maintain the views. The first feature noticed on approaching the unit is the impressive turret that houses the staircase. A novel `buy a brick' campaign, whereby each brick in the turret was signed by a sponsor from the community, raised L100 000. The unit's rustic grey brick and natural slate gives a the impression of a large farmhouse.

The natural Spanish slate was one of the unit's major enhancements, and probably not a cheap one. It was however required by the planners, and caps the 'authentic' feel fittingly. The sweep of the roof caused by the almost complete S-shape of the unit is very dramatic sight to behold at the south elevation, where on the north side it is broken by dormer windows to the first floor which give a suitably homely impression. The bricks are complemented by red-stained rafters which extend beyond the walls in many areas, the resultant lattice effect providing pleasant light into the south corridor (see pic, above).

INTERNAL AREAS

The building is split into three sections; communal activities, care spaces, and a teaching block, with the latter being firmly located as separate from the exterior, having its own entrance. This separation further increases the comforting and safe nature of the environment, with the main hospice areas are located together, thus allowing their spaces to flow into each other naturally. The building is sensibly organised, with the "service" rooms on the north side of the ground floor, facing both the access drive, and at a greater distance the busy A127, and the patients' bedrooms on the sheltered, private south side.

Entering the hospice, children can view the hydrotherapy pool, featuring mosaic murals, and adjoining spa pool, through a large window in the reception area. Architects Chris Matthews says the window was placed so that "frightened children could see that this was a fun place to be - looking more like a leisure centre than an institution," as indeed it does.

The external line of the building is attractively broken at this eastern end, with staff rooms jutting out, allowing for a supplementary corridor off the reception. To the left (east) of the recep tion is the teaching facility, with separate entrance and kitchen and substantial seminar room, to the right the staff areas and plant room, and ahead is the corridor that snakes along the south of the building. Here the curve of the building and the requirements it placed on materials construction is most apparent. The steel girders that support the roof are left exposed and painted and are very effective in showing the natural, gentle curve achieved in such a contrasting rigid material.

The corridor opens out into the spacious communal lounge to the west, with its wood burning stove in a brick fireplace, and various types of domestic chairs - to be arranged to achieve any desired layout by users. The adjoining central dining area similarly encourages a social atmosphere.

The emphasis on fun is then clearly demonstrated by the large 'wet' (involving water and sand) and 'dry' play areas (featuring a variety of distractions), located adjacent to each other at the end of the south facing corridor. Located near this however is the bereavement suite, which has been incorporated at the centre of the unit in a conscious attempt to avoid pushing parents to the end of the building when their child dies, and rather to give them the space and time to deal with it in their own way, as they would at home. Thus there is a quiet family room with comfortable chairs, special access for a hearse, and a private garden, unseen by others in the unit due to screening, but also located at the centre. The painful reality has been addressed with true sensitivity by the design team.

Three bathrooms - one non-- assisted and two assisted - have been provided. Lastly, past the patient bedrooms at the west extremity of the unit, one of which is designed for teenagers with a handset that operates TV/video, staff call and lights, is a games room with a pool table. This has been created in the knowledge that fathers often feel "like a fish out of water," according to Jenny Hubbard, and can share their experiences here. The chapel is a focal point, located in a wood-panelled turret, echoing the staircase enclosure, but with a wider diameter and an interesting sloped ceiling, providing an informal atmosphere for prayer.

The unit features total underfloor heating, due to the obvious risks of radiators to vulnerable patients. A fluid screed was laid enclosing the heating element loops, on top of a traditional screed. In the plant rooms to the west end of the first floor is located the extract plant that powers a central vacuum system, that allows care staff (who also undertake cleaning) to plug in hoses at any of the many portals located in walls, avoiding the obstructions caused by dragging vacuum cleaners around. Next to these plant spaces and storage cupboards are the family bedrooms, where relatives may stay overnight, and a domestic-feel family lounge/dining room. Offices are located at the western end of the first floor.

ARTWORK & LANDSCAPING

The land to the south of the unit has been attractively landscaped, though the trees and shrubs are yet to mature. The garden features sculptures and a pagoda, whose base cleverly incorporates the plant used to drive a waterfall which flows over rocks beneath. This raised area screens the rear of the patient bedrooms, and the beds may be wheeled through doors onto patios to enjoy the fresh air, without losing any privacy; wooden screens also contribute to this.

The visual impression of internal finishes is of solidity and quality - for example in the impressive yet domestic kitchen, whose appliances are only semi-industrial. Many items were donated by reputable stores, such as the curtains from John Lewis.

The garden sculptures are especially impressive, notably the two boxing hares donated to the hospice. For children able to appreciate it this must surely be an invaluable healing area. A series of interconnecting paths have been created which will allow relatives to walk a fair distance from the unit but still be able to see it. For the several wheelchair users, paths with square as opposed to bevelled edged paving slabs have been used for smoother travel. Wider turning areas have also been incorporated.

CONCLUSION

With such high building and running costs it is easy to see why the charity is making approaches to the health authority and social services for additional funding. One hopes that more input from the NHS would not change the 'family' nature of the organisation that has been echoed in the welcoming spaces of this fine building.

Copyright Wilmington Publishing Ltd. Nov 1998
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