Special report: Designing a new model for children's hospitals

23-Jul-2022

BBH speaks to the team behind the design of the new Cambridge Children's Hospital, a project which is setting a benchmark for the future of paediatric care

The new hospital has been designed to treat the 'whole child' and will bring together physical and mental health services under one roof

The new hospital has been designed to treat the 'whole child' and will bring together physical and mental health services under one roof

The UK is poised to change the way healthcare is delivered to children and young people with the announcement that plans for a new type of paediatric hospital have been given the green light by planners.

Planning permission was recently granted for the early designs of the flagship 35,000sq m Cambridge Children’s Hospital, which will set a new model for healthcare delivery both nationally and internationally.

Designed as a ‘hospital without walls’, it will be innovative in the way that it fully integrates mental and physical health provision for children and young people, bringing together the offerings of its three partners: Cambridge University Hospitals NHS Foundation Trust, Cambridgeshire and Peterborough NHS Foundation Trust, and the University of Cambridge.

A new model

This new model will be underpinned by world-class research in child health and genomics, focused on early detection and prevention to improve outcomes and exploring new treatments for rare and common disorders.

The project is being delivered by an international design team led by Turner & Townsend, as project manager and cost manager, and comprises an architectural collaboration between HawkinsBrown and White Arkitekter, with Ramboll providing engineering services, MJ Medical providing healthcare planning, and planning consultancy by Bidwells.

Treating the whole child

Graham Dodd, associate director of Turner & Townsend, said: “The key driver from the very beginning of this project was to combine all services in a single building in order to treat the ‘whole child’, so we have physical and mental health services located alongside research activity. This is something unique.”

Negar Mihanyar, associate director and architectural project lead at HawkinsBrown, added: “This is the first time this approach has been taken.

The key driver from the very beginning of this project was to combine all services in a single building in order to treat the ‘whole child’

“The really visionary part of the brief for this project is to bring all this together – a long overdue breakdown of the traditional silos to provide inclusive and holistic care.”

Situated alongside Addenbrooke’s Hospital and the Rosie Maternity Hospital on the Cambridge Biomedical Campus, the proposed development will care for children and young people from across the east of England, as well as nationally and internationally.

Turning healthcare on its head

Dr Rob Heuschkel, clinical director for the project at Cambridge University Hospitals NHS Foundation Trust (CUH), said: “Tradition has always kept mental and physical care separate – siloed off by specialisms, disconnected across wards, and split between hospitals miles apart. And yet, for us, the two couldn’t be more connected.

“There is an urgent need for a new type of care; care which researches the links between the mind and the body, which removes silos, and which pioneers integration across mental and physical health.”

As part of the project, staff will be dual trained in mental and physical healthcare and experts in all disciplines will be brought together under one roof.

Dr Heuschkel said: “We’re going to turn healthcare as we know it on its head.

“Rather than moving the child to get the help they require, we’re going to bring the support they need to them. This will make their experience smoother and ensure they can access both mental and physical support from one place, without travelling between buildings and, quite often, hospitals.”

And this joined-up plan for care delivery has also underpinned the design approach to the project.

A connection to nature

Fresh air, natural daylight, and a connection to the outdoors are key design elements, with outdoor courtyards at all levels giving children opportunities to interact, learn, and empathise.

Clinical accommodation is organised in three efficient flexible blocks, arranged around a central integration hub that forms the heart of the hospital.

Tradition has always kept mental and physical care separate and yet, for us, the two couldn’t be more connected

Critical care, operating theatres, day surgery accommodation, and in-patient mental and physical health wards will sit alongside space for imaging and radiology, staff and dedicated family areas, biomedical research, a public reception, and cafe space.

And the wards, where patients spend the longest periods of time, will be located at the top of the building to maximise natural daylight; while operating theatres, intensive care facilities, and other high-tech spaces will be on the lower floors, with connections to the existing Rosie Hospital and the wider Addenbrooke’s estate.

In the centre of the site is a playground designed to offer a sense of relief and surprise from the typical day-to-day hospital environment.

While for younger age groups this space, and other pockets of landscaping will largely be playgrounds and sensory gardens; there will also be dedicated spaces for teenagers and young people to relax.

And the hospital itself will be set within a landscape, creating the feeling of a summer meadow.

Patients and their families were integral to the design process, with a number of stakeholder sessions held to help inform the project

Patients and their families were integral to the design process, with a number of stakeholder sessions held to help inform the project

Child’s play

“When you come into the hospital, the first space you see is the outdoor playground,” explains Mihanyar.

“Then all the primary circulation space is organised around a loop looking down onto this area.

“In the middle are integral public places of respite, enclosed rooms or interior garden spaces where people can take phone calls; or more-informal spaces that help to normalise the hospital experience, which is another unique element of this design.

The really visionary part of the brief for this project is to bring all this together – a long overdue breakdown of the traditional silos to provide inclusive and holistic care

“We have also made sure that wayfinding is intuitive and have looked at ways of getting daylight into even the deepest parts of the plan, with gardens, lightwells, and courtyards, helping to bring the outside in.”

Play will also be integral to the way care is delivered in the new hospital, with spaces for creative therapies such as music and art included in the design.

“It’s not just younger children, either, with age-appropriate spaces specially targeted at teenagers, too,” said Mihanyar.

These spaces are being informed by experts, including the University of Cambridge’s Lego Professor of Play, Paul Ramchandani.

He said: “Play is the language of childhood and it’s essential that children have opportunities to play in hospital, so they can maintain fun and friendships and explore and express feelings and difficulties even in tough times – perhaps especially in tough times.”

There will also be educational provision, which can be shared across both physical and mental health services and a plethora of multi-faith respite and meditation spaces.

Stakeholder engagement

Speaking to BBH following the news that Cambridge City Council had approved the initial designs, Dodd said many of the design ideas came from stakeholder feedback sessions with staff, patients, and their families.

He added: “As well as the unique approach to delivering care to young people, this project also put children and their carers in the driving seat in terms of the design.

As well as the unique approach to delivering care to young people, this project also put children and their carers in the driving seat in terms of the design

“We held extensive engagement sessions and the ideas and comments from these have helped to shape the project.”

Mihanyar explains: “Instrumental to the success of the design was getting young people involved.

“One of the interview panels when we were bidding for the project was entirely made up of children and teenagers, who came up with activities for us to do and a list of questions. They even asked us to design a hospital in three minutes while they shouted out words that were important to them.

“The children have been so critical in this design and have helped us to think about what hospitals feel like, smell like, and look like and we have learned an awful lot from that.

“We can only change the future of healthcare by listening carefully to people who use the services.”

From these feedback sessions, the importance of nature and artwork was deemed key, but more surprisingly, young people also wanted to ensure parents and other family members were considered in the final design.

Mihanyar said: “They said they could see their parents were worried and they wanted them to have somewhere comfortable while they were in the hospital. This led to us including more space for families, both private and public.”

And, due to the length of time patients may stay at the hospital, particularly for psychiatric conditions, the facility has been designed to feel homely, using domestic materials and incorporating spaces that reflect everyday domestic life.

Jens Axelsson, senior healthcare architect at White Arkitekter, adds: “It really struck me during the stakeholder sessions that children said they were stressed if their parents were worried or uncomfortable, which meant we really had to consider everyone in the design.

We can only change the future of healthcare by listening carefully to people who use the services

“Because we were considering both physical and mental health conditions, it was quite a challenging brief for the design and clinical teams.”

With the project currently at RIBA stage 2 in terms of delivery, the team is now beginning to explore the interior design approach.

Mihanyar said: “We have taken the landscape of East Anglia as our inspiration, using the tones and hues of nature as a reference. “Our aim is that the building should be playful and have character – child friendly, not childish.”

Fit for the future

As well as considering the needs of current patients, the design team also considered the ever-changing nature of healthcare buildings, which need to be flexible to meet future demands.

Iain Mitchell-Jones, director at Ramboll, explains: “The building, when you break it down, is very simple.

“The COVID-19 Pandemic showed us how quickly things can change so we have provided extra levels of resilience.

“Throughout the design process we were thinking about how the hospital will operate when it opens, but also in 30 years time, and we tried to do some forward thinking, looking at ways in which care delivery might change or what new technologies might come in.

“It was not just about looking at each room, but also the technology demands of each department or area and building in appropriate levels of flexibility so the hospital can adapt and change over time – a long life, loose fit approach.”

Many of the rooms have been designed so they can be easily repurposed, switching function depending on the current pressures.

These include a series of unique ‘universal’ rooms which sit between the physical and mental health wards and can be used by all patients.

“It’s about introducing futureproofing without being overly specific,” said Dodd.

“These universal rooms can swing between physical and mental health and this is quite a unique approach and further helps to break down barriers.”

It’s very rare you have the chance to build something with the potential to impact the whole world. But, with Cambridge Children’s Hospital, we have just that

Axelsson adds: “When we spoke to the stakeholders, service users talked about how traditionally they had to travel long distances from physical health wards to mental health facilities, so having these rooms which can easily flex is really important.

“There was not really any precedent to this, so we had to think about how we could incorporate all the necessary medical equipment, but at the same time address issues such as ligature risk.”

The journey to net-zero carbon

With all NHS organisations now charged with achieving net-zero carbon emissions by 2040, energy efficiency was also top of the agenda for the design team, with the hospital earmarked as an exemplar in sustainability.

Mitchell-Jones said “The client is very forward thinking in terms of the hospital’s impact on the environment and we have considered the impact of the development throughout the design phase.

“We have looked at shading and increasing natural daylight into the building, while balancing this with the risk of overheating.

“We have designed the building and its position to do much of this important work for us, with high levels of façade performance and airtightness, so we are keeping energy inside.

“We are also looking at various engineering solutions for energy efficiency, including PV solar arrays on the roof and air and ground source heat pumps.

“The aim is that we are on a pathway to the development being carbon net zero.”

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Dr Rob Heuschkel concludes: “It’s very rare you have the chance to build something with the potential to impact the whole world. But, with Cambridge Children’s Hospital, we have just that.”

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