Nucleus-powered stations

An early model Nucleus hospital has produced a second phase. Peter Scher assesses the success of its mutant "alternative Nucleus templates" that attempt to improve nurse observation and patient privacy, and also reviews the attractive addition of a new patient hotel.

Phase 1 of this hospital was part of the first wave of Nucleus hospitals that opened their doors in the early eighties. It was placed on a greenfield site to the north of Bridgend in Mid-Glamorgan and the original design (architects Alex Gordon Partnership) comprised seven two storey templates and a service centre initially, to be continued with a future phase of seven more templates.

The first phase opened in October 1985; in June 1987 an evaluation of Nucleus for the DHSS by the Medical Architecture Research Unit (MARU) demonstrated many of the defects of the system (see HD Jan/Feb '89) but by then some of the damaging financial pressures were being relaxed by the Treasury allowing a little improvement. By the time Phase 2 was being planned the NHS 'reforms' were imposed and the architects of the WHCSA had developed 'Echelon' ward layouts for some much-admired Community Hospitals (by then, too, the designers had become 'Estatecare'; now they are `Capita EC'). An exercise was mounted to apply the Echelon layouts within a nucleus template (see HD Mar, '97, pp 18-19) and the result has now been realised in Phase 2, completed in 1997.

A THEORETICAL EXERCISE

The WHCSA's 1993 drawing-board exercise produced the alternative template plan shape. In place of the well-known truncated cross the WHCSA adopted a pierced square set diagonally to the grid but having rectangular arms attached to each corner and thus corresponding with the grid and plan form of the standard template at the junctions with adjacent templates and the hospital street. A template pattern is established clearly different from the familiar one on plan which also generates some differences in three dimensions.

The analysis makes a number of claims for this generic alternative when compared with both the 1980s standard nucleus and the 1990s' enlarged and improved version. For example - for a pair of 28-bed adult acute wards it is less in total area than both (by approximately 26m^sup 2^ and 112m^sup 2^ respectively); it has improved bed observation (above 50% normally required); it has fewer internal (windowless) rooms; it has improved daylight penetration and window views; and it is more energy efficient, with revenue savings of about 600 pa per ward in air-handling and lighting costs, as well as the savings in capital cost. It is to be hoped that when these departments as built have been in use for a period their actual performance is independently tested to see whether the claims were justified.

AREAS AND ECHELONS

Since the space inadequacies of 1980s standard nucleus wards was always well-known, and acknowledged officially when the Department's architects released the later and enlarged version, it is hard to assess the WHCSA's claimed enhancements without very detailed area analyses to see what are the losses which must support the gains and savings. At Bridgend there are only three standard wards and they are each of 24 beds for elderly patients. Unlike the alternative generic plans for adult acute wards these have five- and four-bed rooms instead of the usual six-bed rooms. The 'echelon' arrangement which advantageously breaks up the rows of beds in eight-bed rooms at the Mold, Chirk and Deesside models hardly seems worthwhile at Bridgend where there is only one patient (in the five-bed rooms only) who does not have his/her own 'corner'. Nor is the other advantage of the Echelon layout realised in this plan, ie improved observation. At Mold the Echelon ward provides observation from the staff base of 80% of beds (see the MARU Evaluation, ref 3/88). For the alternative nucleus adult acute ward template "above 50%" was claimed; by my reckoning just eight of the 24 bedheads here can be observed directly from the staff base (and vice versa, for patients in bed derive important benefit from being able to see the staff base). The plan's prime location, opposite to the staff base, is given to the two assisted bathrooms (see floor plan, p20).

Some of the other advantages are evident however notably at the staff base and the day/dining room. The former has a greater useful working area, enclosed from the corridor, than standard nucleus and it is placed so as to have its own window onto the internal courtyard. It is glazed to the corridor however which again, in comparison with most other ward plans, restricts observation and communication.

The dayrooms of the standard nucleus template were wholly unsatisfactory and this alternative is altogether better. It is placed at the far end of the template from the street so for the pair of wards they are together, with the shared pantry in between them. Each may have windows on two sides for agreeable daylighting as well as a small bay window, so daylight and views are excellent and the irregular plan shape is no disadvantage here.

The 'Welsh Nucleus', as this alternative template has been called, illustrates the unnecessary restraints that the 'system' imposes on the design process. The first is the requirement to fit a variety of hospital departments into a predetermined plan shape, whether truncated cross, pierced square or any other outline. The second is to strive mindlessly to fit the hospital's functions into ever smaller spaces. Neither of these objectives make sense in design terms, but presumably the first appeals to rulers and regulators and the second to the Treasury and its agents.

COURTYARDS

The introduction of the square courtyard in the middle of the block yields very little advantage in quality as it is so small - 9 m by 9 m - and although only two storeys high light penetration and view is further restricted by the wide overhang of the pitched roofs around it. Exceptional efforts will be needed to enhance and enliven these small overshadowed and closely overlooked yards. The courtyards beside the hospital street serving the new Phase 2 templates have more quirky shapes (all three are different) than the rectangles of standard nucleus, but again the wide overhang at the eaves diminishes their quality as open spaces to see and to use. Although the area of the enclosed courtyards within the template grid is slightly greater than for 1980s standard nucleus it does not seem so because in effect it is shared by three instead of two.

AN UNSATISFACTORY MUTATION

In sum I do not consider this version of Nucleus to be an overall improvement on the standard. On the ground floor of the three templates a variety of hospital departments have been fitted as best they could be into the fixed shape (plan, right). In the case of template one, nearest the main entrance, the small square inner courtyard has been lost on both floors, presumably because the area was needed by the departments put there. Some very welcome design relief is obtained with a pleasant glazed corridor link on the hospital frontage between this template and the main entrance template of Phase 1. Architectural design has been reduced to solving geometrical jigsaw puzzles, made all the more difficult by the diagonal setting of the pierced square. This difficulty is all too frequently manifest in awkward, sometimes bizarre, room shapes, even in the wards for which the geometry was invented. The clean and dirty utility rooms and the various offices and stores are notably 'funny' pieces of the jigsaw though arranging furniture and fittings in them is no joke.

As stated earlier the 'Welsh Nucleus' should be independently evaluated to obtain a fair judgement but in my estimation it will not live up to all that its promoters claim for it. Hopefully the epidemic of standard Nucleus hospitals has died down now but this new strain of the virus may prove even more disagreeable.

A CIVILISED CONTRAST

It was with considerable pleasure and not a little relief therefore that I went back through Phase 1 to the other end of the hospital street to visit Phase 2's patient hotel and postgraduate medical centre. This part has nothing to do with Nucleus, standard or otherwise, but is a simple well-designed and civilised work of architecture. It has an H-shaped plan form - two long wings joined off-centre by the cross block on the axis of the hospital street. This free standing block is linked to the street on both floors but has its own entrance and parking area. It has three functional elements; in the wing nearest the hospital there are two floors of hotel-standard rooms for patients who have to attend the hospital with overnight stay but do not need admission to a hospital ward. There are nine rooms on each side of a central corridor on each floor, 36 rooms in all. Their finishes and furnishings are simple but of high quality and they have very pleasant views to quiet, accessible gardens outside. They were not yet in use when I saw them.

In the other wing the Postgraduate Medical centre comprises library, conference suite and associated areas on the ground floor, linked to a 120 seat lecture theatre and two seminar rooms on part of the upper floor. The third element, occupying the rest of the upper floor here is called the consultants' suite which has ten single bedrooms with ensuite toilet facilities, treatment and utility rooms and a consulting clinic.

The form of this building is tailored to the rooms and their uses without striving for originality, dramatic expression or aesthetic effect but the result is pleasing to experience inside and externally and is well-suited to its purpose and location. No 'system' is apparent in its design, which is the fruit of employing decent architectural skill. This is the alternative to Nucleus that the NHS needs in plenty.

Client: Bridgend and District NHS Trust

Floor area: Approx 3500 ml

Total cost: L7.7m

Start on site: Nov '95

Completion: Nov '97

Architect/quantity surveyor/M&E engineer/landscaping: Capita EC

Main contractor: Amec

Project manager: Babtie Management

Structural engineer: Clarke Bond Partnership

M&E subcontractor: Matthew Hall

Copyright Wilmington Publishing Ltd. May 1998
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