Barnet General Hospital: Phase 1A

The recently completed first phase of a Nucleus hospital in north London may revive old issues about design policy, but it has to be assessed without its companion phase, due for PFI. Peter Scher found it had some good qualities but may at present lack others.

* The redevelopment of Barnet General Hospital was designed as a Nucleus scheme, originally obtaining Planning Approval in 1991, and the first phase was occupied last March. During that period there has been so much change in the medical, social and political setting for health services that it is something of a surprise to encounter Nucleus again in a new hospital (see HD, Jan, Feb, '84). Of course the Nucleus programme was so ruthlessly implemented that too many schemes and too much capital was committed for it to be phased out quickly either by the progress of the previous Government's agenda of privatisation and PFI, or by any new wheeze the present government may want to try now.

During the gestation and birth of Phase 1A Barnet's plans were exposed to some high-profile political controversies, compounding the inevitable rethinking and adjustments of many departmental services and plans such as beset all hospital developments. However, having cleared the local authority's planning hurdles early on, changes to the overall form and elevations of the building were ruled out to avoid unacceptable delays and uncertainties, as well as design costs. In effect the 'nucleus', comprising a hospital street between two pairs of 'templates' on the site chosen, became the fixed envelope for whatever changes were required in the accommodation.

Many of the important advantages of Nucleus stem from adopting standard departmental template plans and where this has been done at Barnet, as in the adult acute wards, the result is no more or less remarkable than it is anywhere else. Where standard plans are not suited to the requirements arranging the accommodation within the unalterable plan form is not always a success.

SITING, LAYOUT AND ACCESS

Although the site of the existing hospital is a fine one on a steep southfacing slope bounded on the northwestern side by Wellhouse Lane and open fields beyond, the whole area is occupied by a dense mixture of separate hospital buildings of all ages and conditions The Phase lA is placed tight alongside Wellhouse Lane where the terminal end of the hospital street is celebrated by a fully glazed stairway between the flanks of the two template blocks. The second phase, subtly renamed Phase 1B, will complete the redevelopment southwards with a block plan almost identical with the first phase - two more pairs of templates along an extension of the hospital street to a new permanent main entrance. Both phases have some accommodation in blocks projecting out from the Nucleus grid on the southwestern side.

Phase lA is three storeys high except at the northeastern end where it has to cut into the ground at the highest part of the site and the two ground floor (level 1) templates are reduced. The new hospital is not physically linked to other buildings on the site and its main entrance is a temporary one at the end of the street where the next phase is to be joined on. It is approached from an existing site entrance off Wellhouse Lane where there is also a convenient bus stop, but at this stage of the development access and parking remain something of a nightmare.

LEVEL 1

The block of accommodation projecting from the southwestern end of the two templates at level 1 is called the 'Prow' on account of the pointed symmetrical outline of its plan. In three dimensions it bears not the faintest resemblance to the front of a ship. The Prow contains part of the diagnostic imaging department additional to one template, and the entrance and waiting area of the AED additional to the other template.

In this layout, although there are recognisable parts of the standard template, plans imposed by the old directorate both departments are considerably larger, hence the addition of the Prow. A 15-bed observation ward has been substituted for the standard nucleus fracture clinic in the segment of the AED template which is next to, and forms the circulation link with, the hospital street. The entrances to the AED are very conveniently related to Wellhouse Lane though ambulances need to reverse under the canopy which only projects a modest distance to obtain cover for unloading patients. The canopy is an elegant design of tensioned fabric hung from tubular steel columns.

The hospital street linking the two templates has a fully glazed wall on the southwestern side which projects as a curved bay into the courtyard. This space, which recurs on each level, is very bright and pleasant with well-controlled and clear signposting. A bank of lifts facing the curved bay projects its solid wails into the courtyard on the other side. On this side of the street the two templates, reduced in area by the rising ground, are joined to accommodate the day unit. The department's own entrance at the south 'transept' of the template leads to a generous reception and waiting area. Thereafter the accommodation is fitted into the space around the three sides of the courtyard. Most of the recovery area is windowless being placed alongside the retaining wall. The plan does not reflect a specific operational pattern as all the departmental circulation uses the central corridor.

WOMEN'S AND CHILDREN'S SERVICES

The first floor, level 2, is devoted to women's and children's services. On the southwestern side the paediatric template contains a 20-bed ward, an eight-bed adolescent unit, an outpatients, and the parents' rooms for overnight stay. The adjoining template has a 24-bed maternity ward and a 16-bed gynaecology ward with its own associated investigation suite. At the southwestern end the children's ward playroom and the bedrooms in the women's wards have doors to a paved roof terrace on the roof of the level 1 links to the Prow. If funding becomes available to make them safe and secure they would be very agreeable outdoor areas for all the users.

On the other side of the street the two templates accommodate the antenatal clinic, central delivery suite and neonatal unit.

Central delivery has two operating rooms and nine delivery rooms, including one with isolation facilities and one with a birthing pool. This is the conventional provision as compared with the system of LDRP rooms now being adopted with some success eg at Kingston (see HD, Feb '96, pp21-24) and at Dorchester (see HD, Nov '97, ppl9-22).

ADULT ACUTE WARDS, THEATRES AND ITU

Level 3 has four 24 bed standard adult acute surgical wards in the two southwestern templates while the operating department (five theatres) and ITU (five intensive care and seven high dependency beds) occupy the other two templates. These standard ward plans are well-known from countless other Nucleus hospitals and only difza i ferences of detail merit comment.

The 24 bed ward layout is an obvious improvement on the original 28-bed Nucleus plan, so very many of which have now been built, but the shared ward pantry and the limitations of storage space still generate dissatisfaction. On the plus side placing the staff base in front of the two six bed bays instead of facing them appears much more comfortable, enabling more desking to be fitted in and a degree of enclosure for staff working in the area. On the other hand each ward has an extended internal corridor from the ward entrance to the staff base which cannot be under adequate observation. The arrangement of the two separate entrances to the ITU and HDU bed areas, together with the placement of the clean utility room and the staff base facing away from the beds, appears awkward and requires excessive circulation space.

DESIGN QUALITY

The external treatment of the block is conservatively designed and very well made, with brickwork, fenestration, roofing and trim cleanly detailed in good quality materials. No attempt has been made to give the temporary main entrance any significant or agreeable design quality. One basic glazed double doorway leads to a bleak unfurnished stairway, the hard finishes to this lofty space lacking any enhancement. Areas immediately external to Phase lA have also been left raw for future completion so the first impression of the new hospital is sadly marred.

The internal courtyards are neatly laid out and the planting should develop to provide some visual richness, but there is no seating and access to them is restricted as yet. The value of access to, or a view of, the outdoors is immense, as is the provision of arts in healthcare settings which is so widely recognised now that virtually every major hospital has, or says it has, an arts project. Barnet Hospital too has started an interesting arts project but it has yet to make any impact, in contrast with many comparable hospitals in the UK whose arts projects are now proving wonderfully effective. This is no side issue. Professionally co-ordinated and sensitively implemented programmes can dramatically enhance environmental quality, especially where the architecture is heavily restricted as in a standard Nucleus design.

Nucleus was developed with substantial professional resources to meet the political imperatives of the 1970s. By the time the new Barnet Hospital opened in 1997 the professional support and technical development for Nucleus had long gone and the political requirements of today are, shall we say, obscure. Of course any brand new hospital buildings are welcome and a blessing at a site where obsolete, worn-out and inadequate accommodation has to be used. They would be appreciated still more if their designs were expressive of a more optimistic, forward looking and welcoming approach. in

Copyright Wilmington Publishing Ltd. Feb 1998
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