Read the introduction to this series
I’d been sick the day before Oliver’s birth and hadn’t eaten anything at all for 24 hours during the labour, during which time I’d been standing up in the overly warm Delivery Room 1, attending to Celia. As a result, I actually collapse and black out, twice, and am rushed to A&E for a rapid-fire battery of tests. Again, I’ll skip details, but after a anti-sickness jab I was able to eat some food, get an hour’s kip and rejoin the labour. Celia is simply amazing, heroic, all the way through this, just as she had been during pregnancy and just as she continues to be.
But such is the seriousness of the situation at the time, in order to get from Elizabeth Garrett Anderson to the A&E at the adjoining main UCLH building, I travel in an ambulance. Ludicrously, the one-way system around UCLH, and its dense traffic, means the hospital journey takes 10 minutes, even though it is 100 metres away. This is a condition often experienced in London traffic, a distortion of space and time that would be fascinating were it not so irritating. Most Londoners will have experienced the sheer helpless frustration of being stuck in a tunnel on the tube, unable to just get out and walk. Few ‘urban transport solutions’ place the passengers in such a futile position as London’s extremely deep tube. I didn’t think it at the time, but being strapped to a stretcher in the back of an ambulance was essentially the same condition as travelling underground. London’s transport can just enfeeble sometimes. Were Londoners a more sensible, calm people, these delays might induce a zen-like state throughout the city, as people enjoy the enforced meditation. Though if they were a more sensible, calm people, they wouldn’t have got things into this mess in the first place.
Wired to the wall in UCLH, with tubes emerging from my hand and tiny heart-trace monitors stuck all over my body, I realised we’d been in the new UCLH building before, for a scans 6 weeks and at 20 weeks. It’s a giant complex, replacing an entire series of hospital buildings in central London, including the old Middlesex Hospital at Mortimer Street (originally founded 1745; rebuilt 1928) that S used to work at, several floors underground.
The new UCLH rises at the top of Gower Street in green and white, as if dressed in surgical robes. I’m not a huge fan of the building. Strapped to its wall, I begin to feel at one with it, but that’s quite different.
What really lets the place down is the service design job, or rather, lack of it. It’s as if the contractors left the building once the basic structure had been done. After that, little care appears to have been given to use of space, signage, design of systems etc. The food in vending machines is uniformly terrible – how can a hospital be selling crisps, fizzy drinks, powdered soups and chocolate bars? There are fabulous views east from the floor-to-ceiling window by the lifts, but a bizarrely hidden door entry system to the Early Pregnancy Unit 10 paces in the other direction. The ‘Enter’ button is actually positioned around a wall, away from the door. Moreover, the receptionist on the other side has to leave her chair to press the ‘door open’ button. When you’re at the EPU reception, there is only room for 3 people to sit. On the mornings we’d there, months before, there were 10 or 12 waiting for an appointment, so we have to overflow into an unused seminar room opposite, arranging the chairs into an impromptu waiting room. Another morning, however, this seminar room is in use. For a seminar. So we stand, or sit in the ward itself, as bed-ridden patients have consultations around us. On one occasion, we have to sit in a storage cupboard to wait to receive some results. And this, in an area allegedly designed for pregnant women. There were several other system faults that are really too tiresome to explain.
Odd, as the architects are Llewellyn Davies Yeang, with the latter being the interesting Ken Yeang – he of ‘Ecodesign’ and a vertical theory of urban design etc. There’s little evidence of his work here, though.
While it’s clearly as state-of-the-art as a British PFI-built programme will allow, the building itself is nothing special. It doesn’t seem to aspire to do anything, or be particularly progressive at all, sadly. In that respect, the Cruciform Building is still more interesting.
For instance, the UCLH ‘skyscraper’ also makes a virtue of all floors gaining natural light. Yet Cruciform did that too. Technology has allowed it to be 16 storeys tall, but there’s no real conceptual advance. Similarly, each floor has a symbolic element – a polar bear on the childrens’ ward etc. – but as I noted, Waterhouse did that in his Manchester Town Hall too. Their colour-coding scheme, with each floor having a different colour, won’t be particularly relevant for patients, each of whom generally will only see one floor and the reception. As with website design and other spatial organisations with multiple non-linear access points, colour coding is not that relevant. Only the designers see all the floors, all the pages, all the colours, the overall scheme. I’ve no doubt many other improvements have been made, which my untrained eyes won’t perceive, but as a patient it didn’t feel like the great advance you’d expect from a new hospital in Central London.
There was a form of post-occupancy evaluation on the new UCLH in Building Design a couple of months ago. However, it was hardly objective, being conducted by a couple of the Llewellyn Davies Yeang team. Still, it’s an interesting read, having experienced the building myself as a patient. What’s particularly pertinent, other than the fact is was designed in 1995, is that the facilities management company, Interserve, get a gentle kicking in the article (lifts not working; floors not cleaned sufficiently etc.) from both architects and staff. This element of the living building is as fundamental as any other, and to see the architects and staff passing the buck indicates why it’s not working. Until these projects are run holistically and in multidisciplinary fashion, with the architects feeling more responsibility for this ongoing service design, these kind of holes will persist and patients, in this case, will suffer.
A while ago, IDEO did some interesting, progressive work on rapid-prototyping within a ‘patient-centred’ approach to redesigning hospitals in Indiana and St. Louis. (There’s an excellent Q&A with Peter Coughlan of IDEO, by Mark Hurst at Good Experience; Further, Metropolis magazine covered IDEO’s health care work – PDF here.) Importantly, these were fixes that were "more informational than architectural." (Wonder how the work was received – it’d be interesting to see the equivalent of a post-occupancy evaluation on that.)
I’m not sure it always needs the sheer heft of a in-depth IDEO consultancy, though it would probably benefit from that; most of this is common sense and attention to detail. As with other bits of the NHS experience we were immersed in, the staff in these buildings were generally fantastic: hard-working, capable, knowledgeable, skilful, available, caring and helpful. However, the softer infrastructure around them – signage, systems, IT, interiors – was not so good.
I don’t want to rattle on about this, as much of the UCLH built experience was fine, nor do I wish to use Ollie’s birth as a platform to stand on for a moan. Hospitals suffer the unfortunate condition that, save for a few curious psychological anomalies, everyone is glad to see the back of them as soon as possible, no matter how well the job was done. Perhaps only prisons share this condition with medical establishments. What is it like to design and build under these conditions? Hospitals witness the extremes of human conditions, from intense joy to crushing despair, and yet are designed as places to numb, anaesthetise in all senses. And then you try to get out as soon as possible, perhaps because of the possibility of those extremes.
I for one, was certainly glad to have the long tube removed from the back of my hand, the pulse check from my finger, the heart-trace monitors peeled of my body, and to be out of there. But thanks to the extremely calm and capable doctors and nurses who helped me, and to Lucia, the midwife who came to check and ferried messages back and forth between Celia and I. It was time for another trip up and down Gower Street and then back into Elizabeth Garrett Anderson Delivery Room 1.
Other pieces in this series:
A birth, in 13 places
1. Scan; Private clinic, Harley Street, Central London
2. Elizabeth Garrett Anderson Hospital, UCLH, Huntley Street, Central London
3. Active Birth Centre, Tufnell Park, North London
4. Antenatal classes; 1A Roseberry Avenue, Central London
5. Bloomsbury Birthing Centre, Elizabeth Garrett Anderson Hospital, UCLH, Huntley Street, Central London
6. Delivery Room 1, Labour Ward, Elizabeth Garrett Anderson Hospital, UCLH, Huntley Street, Central London
7. A&E, UCLH Main Building, Gower Street, Central London
8. Amenity Room 6, Nixon Suite, Elizabeth Garrett Anderson Hospital (part of UCH), Huntley Street, Central London
9. Café Deco, Store Street, Central London
10. Transitional Care Unit, Elizabeth Garrett Anderson Hospital (UCLH), Huntley Street, Central London
11. Home, Gower Mews, Central London
12. Bloomsbury, Central London
13. Registry Office, Camden Town Hall, Central London
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