A modern classic

Peter Scher reports on an exemplary project to house the Birmingham Children's Hospital in a much-loved refurbished building, retaining and enhancing many of its original features.

The Birmingham Children's Hospital opened its doors in Steelhouse Lane near the city centre in 1861. Soon after, in 1870, the hospital was moved across Birmingham to occupy the old Lying-in Hospital. In 1914 this was replaced by a new children's hospital. Following the 'reform' of the NHS the West Midlands Regional Health Authority carried out a strategic review of hospital services in 1992 which confirmed the need for the reprovision of the children's hospital. In the spring of 1998 it reopened in Steelhouse Lane, celebrating not only a new beginning for the children's hospital but a happy ending as well for the building it now occupies.

The RHA's strategic review in 1992/93 also recommended the closure of the Birmingham General Hospital in Steelhouse Lane. This was a famous, highly admired building of great architectural significance and value which had already survived previous attempts to close it, thanks to widespread public resistance.

To cut a long story short, the reprovision of the children's hospital services at the 'General' site became the preferred option for meeting the Region's strategic design. In a remarkably quick programme procurement was set in train and work started on site in May 1996. The L30m facility is a combination of new-build and refurbishment, restoring to new and active life a much-loved citycentre institution.

HEALTHCARE IN THE CITY CENTRE

In this short article it is not possible to give a detailed account of so large a tertiary care hospital (of 280 beds) with a complete range of departments, using state-of-the-art equipment to carry out leadingedge clinical and research work with high-quality patient care. This unusual project is most instructive in the way it illuminates a number of today's key issues for us.

The first and simplest of these issues is the importance of having healthcare facilities in the heart of a city. While the NHS still owns many important sites in city centres throughout the UK they should be maintained tenaciously (as here at Birmingham) for vital healthcare facilities. To dispose of them in order to 'rationalise' services or to obtain better `value-for-money', or simply to realise the capital is short-sighted and inconsiderate of the interests of future generations. Such sites will never be reacquired for the NHS. The children who are treated so well and expertly at Birmingham Children's Hospital should grow up to defend its continued existence at this site long into the future.

LESSON FROM HISTORY

The next point to consider is a lesson from history. The architect William Hensman won the competition for the new Birmingham General Hospital in 1892 and its rich redbrick and terracotta design was highly praised; it was also a very well-planned layout. Like all historic hospitals it was subjected to dramatic growth and change, most spectacularly since the 1950s. In response to ever-changing medical, social and financial pressures the building design was assaulted and insulted in a succession of inappropriate and downright unpleasant alterations, additions and demolitions.

The ornate entrance front was destroyed and replaced by a characterless addition while an administrative block was build on the frontage effectively smothering the appearance and amenity of the original design. On the other three sides of the complex many ad hoc additions have been built from the fifties onward none respectful of, or in sympathy with, the Victorian original, nor having notable design qualities of their own. It was being neglected to death and its closure seemed imminent. But the happy ending was the reprovision of the Birmingham Children's Hospital on the site, saving a distinguished building from a final act of vandalism.

The lesson from history is to resist the quick-fix building solutions that seem to meet urgent needs but are so insensitive to architectural values that they debase and destroy works of quality and high civic amenity. The redevelopment by Powell Moya Partnership has sensibly and sensitively restored the appearance and quality of the original building, where feasible, both inside and outside. The additions in new fabric, while being confidently modern, respect their Victorian setting without intruding.

The architects had already demonstrated great skill in adding the new Variety Club Building at the Hospital for Sick Children at Great Ormond Street, London (see HD Mar '94, pp 19-25). There they solved the immense problems of phased decanting, construction and renewal on a densely packed and intensively used hospital site, and did so very successfully. At Birmingham it was easier because the existing building was spacious and no longer in use. Nevertheless, when English Heritage refused a modest application for funds to reproduce some of the former architectural quality there was never to be enough for an ideal restoration.

HI-TECH ADDITIONS

Although the pavilion wards were readily converted for today's nursing needs and the simpler requirements of many departments could be catered for in the upgrade, the historic fabric was nowhere appropriate for the new hi-tech facilities required for today's operating theatres, intensive care units, radiography and imaging centres etc.

Powell Moya Partnership has placed the largest element of new fabric which accommodates these departments in the area between two pavilion ward blocks on the northern side of the building. The new block is 'T'-shaped on plan and links neatly to each floor of the original building. Where the stern of the 'T' joins the existing hospital street it incorporates new bed lifts and at each end of the crossbar of the 'T' new escape stairs articulate the links near the ends of the pavilion wards.

Placing the hi-tech facilities in appropriately designed new buildings related to existing historic wards makes great sense providing the design is well-handled - a comparable example, albeit on a more spacious site, can be seen in the Crosslink Block designed by GTD Partnership at the eighteenth century Royal Naval Hospital Haslar, Gosport in the 1970s.

Powell Moya Partnership's new block is faced with large perfectly smooth white and grey panels contrasting with the decorative redbrick and terracotta of Henman's design, and the new mix is richly enjoyable to the eye. Similarly, at the new main entrance a broad all-glazed corridor leads from the glass-canopied front to the existing building.

The misbegotten administration block that closed off the front court has now gone and the open forecourt restored to something more like the original in function and design. But unhappily the lost original frontage centrepiece could not be reconstructed and the numb extension that took its place now overlooks the glass roof of the entrance way.

A QUALITY INTERIOR FOR CHILD-CENTRED CARE

The richness of the Victorian exterior was matched by the interior, where structural arches and piers, ornamental glazed tiling, wrought-iron stair balustrades and oak doors were used. Much of this was removed or badly neglected over recent decades but some of the remains have been carefully and sensitively restored to enhance the bright refurbishment and to maintain the link with the building's origins and history. The predominantly white walls and ceilings in both new and refurbished interiors with occasional panels in bold bright singing colours are vintage Powell Moya. The scheme ideally supports the unmistakable atmosphere of cheerfulness encountered throughout the Birmingham Children's Hospital.

Most departments are well furnished with pictures and decorative items specifically chosen to appeal to children. This is typical of children's hospitals and paediatric departments in even the bleakest general hospitals. Without a properly resourced and staffed arts project these pieces get chosen by staff and parents raising funds or receiving donations and there seems no shortage. They need be none the worse for that. The trust is actively considering the appointment of an arts co-ordinator who, will be faced with a happy if challenging task in this wonderfully child-centred place. A charming example is the use of child's voice for the recorded floor announcements in the lift. In addition to the abundance of visual art, much entertainment is provided for the child patients with live music, storytelling, etc and the excellent facilities of the new Play Centre. This is in a new single-storey block placed in the courtyard beside the original Victorian conservatory; its flat roof provides an attractive open-air platform for a variety of gatherings.

A third issue brought to the fore by this project provides much food for thought to those concerned with the design and architecture of healthcare buildings today. Having won the architectural competition for the 346-bed Birmingham General Hospital Henman was instructed by the Building Committee to introduce a full system of mechanical ventilation to the naturally ventilated design. At that date (1892) this innovation was to be seen in use at the Victoria Infirmary in Glasgow and the engineer, WIlliam Key, who devised it collaborated with Henman on the redesign. The controversy over natural versus mechanical ventilation brought Henman to the fore and as it developed profoundly influenced subsequent designs for major hospitals. Hospital design became a matter of intense professional interest among doctors and architects and was the subject of important meetings at the RIBA and the Architectural Association in London and at key institutions in other major cities. The professional journals also give the issues full and informed coverage. Outside the pages of HD our subject is virtually ignored today.

The mechanical ventilation at Birmingham did not continue in use for very many years but the underground shafts and plenum chambers, the built-in distribution ducts and the decorative pinnacle and rooftop vents had their impact on the design. Jeremy Taylor in his valuable book. "The Architect and the Pavilion Hospital" (Health Service Journal 22 January 1998, pp 40-41) gives an excellent account of the design in its historical and professional context and the passionate discussion of hospital design generated at the time.

So in addition to the architectural quality and the community associations that make the Birmingham General Hospital so treasurable it is also an historic structure and we must hope its survival will not be threatened again. The new/old Birmingham Children's Hospital has clear messages for us about valuing and respecting and enjoying what we have inherited that is good, while at the same time demonstrating that we can, and must, create the new facilities of equal quality that we need for today's healthcare. CEI

Copyright Wilmington Publishing Ltd. Jan 1999
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