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New Hospital Proposal Birmingham

Birmingham

New hospital on the site of Birmingham's University Hospital to the south west of the city centre. Designed by BDP Architects.

We welcome the opportunity to comment again on the proposals for this significant new hospital development in Birmingham. We last reviewed this scheme a year ago when it was one of two bidders and our comments at the time were directed at the Trust. We are pleased that they have sought to share this information with the Consort team and that subsequently they have been given the opportunity to respond to our concerns as well as those of the local authority. We are encouraged by the continued interest at a high level within the Trust regarding issues of design quality.

A hospital of this size and prominence ought to be an exemplar of the public sector's commitment to high design standards through the Better Public Buildings programme. It should be a plausible candidate for the Prime Minister's Better Public Building Award. We are not yet convinced that it has reached this standard but we are optimistic that this could be achieved given enough time for the design detailing and the commitment to quality.

Masterplanning

We are pleased that the time and effort has been taken to revisit the siting of the initial proposal and that a masterplan and broader urban design analysis is informing the design thinking. In particular, the further exploration of the urban grain, reconciling the grids presented by the existing buildings and the archaeology, and developing the movement patterns beyond the site boundary are major steps towards improving the scheme. The result is a far more convincing project. The improvements seem to have come about as a result of a number of factors: the repositioning of the building, the need to reduce the affordability gap, the additional time allowed for considering the design, and further consideration of the masterplan layout.

The need to reduce the size of the hospital in response to affordability issues has, in our view, demonstrably led to a more comfortable and understandable building. This is still a vast building, but the necessity to reduce the amount of accommodation, which was previously causing difficulties in arriving at a design which worked well, has allowed the architects to make the function and design of the hospital work for them rather than against them. We are encouraged that, at this stage, it is the quantity of accommodation that has been reduced rather than the aspiration for high quality.

In our view, the organisational diagram and logic of the layout and adjacencies seems to be working well - this has not been achieved in some other large hospital schemes we have seen recently. The use of the topography to separate servicing, visitors and A&E is a welcome proposition and appears to assist the management of the clinical adjacencies.

Movement

The proposed movement patterns across and around the site are now far more convincing. The ability for car drivers to drop patients and visitors then re-circulate in a clear manner back to the car park will assist people with way finding. Returning to the main entrance at grade will lead to the feeling of familiarity and may help put anxious people at ease. We are concerned that the distances from the extremities of the car parking to the wards, via the canopy, the entrance and the hospital street are extremely long. We wonder whether there is the possibility of allowing access to the cores B and C of the hospital street or outpatients' corridor directly from the car park to the south. A possible, more ambitious, alternative may be to make more use of the roof space above outpatients to deliver people from the car parking to core B at the same level as A&E.

We welcome the further work carried out in identifying and enhancing the main pedestrian and cycle routes across the site. The model does not yet illustrate these as well as the drawings, and we reiterate our point made last year that these routes need to be direct; that the kerb-to-kerb distance of crossings of roads should be minimised; that where needed, pedestrians should be given priority over vehicle traffic; and that pedestrian routes should be well lit and well observed from adjacent buildings.

Landscape

A welcome consequence of the re-positioning of the building is that there appears to be a more open feel to the campus and the opportunity for a substantive landscaped area, rather than a number of incidental 'left-over' spaces. The ability to reorder and enhance the open space gives the proposal the potential to be something beyond one's normal expectations of a hospital campus. We welcome the further development of the landscape design for the area of the scheduled ancient monument, and note that this is to be a separate commission. We are also encouraged by the development of a formal hard landscape area at the entrance to the hospital, linking the new with the existing. We would wish to see the landscape strategy further developed to ensure that areas adjacent to Vincent Drive and between the plaza and the drop off zone are not simply leftover spaces amongst access roads, but are integral to the network of open spaces. If handled appropriately these spaces could become useful additions to the therapeutic environment of the hospital, allowing patients and visitors to feel that they are able to leave the confines of the hospital wards, without leaving the site.

Built form

1. Mental health

Most of our concern about the architecture is directed at the Mental Health buildings. We understand the constraints imposed on the positioning of these buildings on this sensitive part of the site and we welcome the way in which the topography of this site is being used as an asset rather than a constraint to be engineered away. We also appreciate that the buildings are designed to be familiar and have a smaller, human scale; the use of pitched roof to the wards for example.

However, the buildings have the appearance of having to respond in design terms to too many constraints, without any underlying ideas that would deal with these. We appreciate that the site, the schedule of accommodation and the clinical needs are difficult to reconcile successfully. Unfortunately, the result is a set of buildings lacking coherence or empathy with their surroundings - some built elements are curved, some buildings are 'kinked', staircases appear stuck on and other accommodation seems to 'pop out' - the entrance and reception to the Adult Acute, or the lecture theatre to the Older Adult Unit, for example. These buildings appear as if they could be part of the older estate, developed as an accretion of accommodation, rather than a new and rational set of propositions. In our opinion, there is a need for coherence and clarity in their design. For many people, these buildings will form their first impression of the hospital; their design needs to be improved to reflect this importance.

2. Acute buildings

We continue to find the shape of the ward blocks both intriguing and problematic. Our previous concerns about the nature of the courtyards, the actual level of daylight in some of the lightwells and courtyards and the potentially relentless internal curved corridors remain. We are pleased that the atria are now open to the sky rather than being enclosed with a lightweight PTFE roof.

This is a very large building with an extremely large and significant roofscape. The roofs of the wards and the lower blocks will form a prominent part of the long distance and close views, and so they need to be considered as a 'fifth elevation' in visual terms. We have some reservations about the dominant forms of the roofscape of the ward block. Such bold forms imply something rather grand, perhaps huge spaces underneath, whereas the actual accommodation is subdivided into quite small parts; and there is no reflection of the fact that there are large areas of plant at the upper levels, or of the circulation routes, which might be top lit at this level. If large parts of the plant housing require access to fresh air, freely available at this level but not shown in the scheme, perhaps it would be better to address this now rather than later and make it a part of the architecture, rather than something that compromises an architectural idea later. Any flues, telecommunications equipment etc need to be carefully designed and disposed under the control of the architect before planning permission is granted; and we recommend that planning conditions closely control such matters. We draw attention to the importance of illustrating the building's skyline in near and distant views. It will be important that the designers do further work at this stage on the detailed design of the ward blocks, and the materials to be used. At present it appears as though the facades of the wards are smooth and curved. In reality the windows are unlikely to be curved pieces of glass, so the building is unlikely to have the smooth, continuous surface as illustrated; there are likely to be reveals and different depths to the panels. We would wish to be consulted about these materials and details in due course, as they will have a dramatic effect on the appearance of the building.

Great care will need to be taken with the design of the corridor links across the courtyard; they need to be as light and transparent as possible from the point of view of maintaining the sense of a single external space in the courtyard, while providing a comfortable and dignified route for users of all kinds, who may not want to feel over-exposed to view. The final effect is almost certain to be less light and transparent than indicated now so it would be better to own up to this and explore the consequences.

Further thought should also be directed at the design of the link bridge to the existing hospital buildings. This will be an important and highly prominent element of the scheme and if not designed with care could undermine the quality of the project.

In conclusion, we are pleased that the larger part of this project appears to be developing in a promising way. For the promise to be realised in the face of all sorts of pressures that may stand in its way will require above all continuing commitment to quality on the part of the client. We would be happy to advise further on the development of the designs.