BRIEF • ARCHITECT’S VIEW • CLIENT’S VIEW • ENGINEER’S VIEW • WORKING DETAIL • RELATED PROJECTS IN THE AJ BUILDINGS LIBRARY

At Liverpool’s Lime Street station travellers are greeted by a life-size statue of Ken Dodd, one of the city’s greatest comic thespians. Famed for his child-like humour, Dodd and his eponymous Diddymen were inextricably linked with Knotty Ash, a suburb on the eastern edge of Liverpool. This leafy bourne is home to the Alder Hey Children’s Hospital, currently in the process of reinventing itself from an outmoded Edwardian institution into a state-of-the-art technical facility and much-heralded showpiece for modern hospital procurement and design.

In their reliance on cheerfulness as a panacea to distract from darker maladies, comic thespians and children’s hospitals have much in common. Few things tug more intensely at the core of our humanity than a sick or suffering child, and children’s hospitals have their own special pathos. However, since Alder Hey was originally founded in 1914, advances in medical science, preventative care and social attitudes continue to radically improve prospects for child health and welfare. While this represents incontrovertible progress, the new Alder Hey has other ghosts to exorcise, notably the scandal of organ harvesting and retention that beset the hospital a decade ago. At the time, the affair’s ghoulish details amplified the perceived image of the hospital as an opaque and slightly sinister institution, despite its historically cherished place in the community. The new Alder Hey makes a cathartic break with the past and architecture has been a conspicuous agent of its reinvention.


Alder Hey Children’s Hospital by BDP Circulation corridor, Critical Care unit

BDP’s building is all about colour, transparency and Super Dutch contoured expressiveness: a vivacious Rita Ora, as opposed to the tottering and decrepit Miss Havisham next door. The latter is due to be euthanised and its site landscaped as part of a wider initiative between the city and the local NHS Health Trust to recast existing Springfield Park, currently little more than lawns, trees and an obligatory war memorial, as a lushly verdant children’s health park.

Hospital sites usually tend to come fettered with constraints, but here BDP was confronted with the rare luxury of a genuine tabula rasa in which to situate what is, by all measure, a whopper of a project: 60,000m2 of hospital (the equivalent of six secondary schools) and 32,000m2 of parking. Conceptually and topographically the park catalyses the scheme, orchestrating a porous and fertile reciprocity between landscape and building. ‘It’s about feeling grounded,’ says BDP design director Benedict Zucchi, ‘the architecture brings a sense of the park to you.’ It sounds obvious, but hospital environments with access to views, light and greenery can improve patient recovery and outcomes, acting as healing balms to the body and mind. In the old Alder Hey, however, with its 18-bed Nightingale wards and unrelenting corridors, often the only panoramas were of dispiriting brick courtyards.

Comic thespians such as Ken Dodd and children’s hospitals have much in common

Organised around a roughly hand-shaped structure (rather like the 1947 ‘finger’ plan of Copenhagen) three long wings extend deep into the park from the more solid ‘palm’ of a parking structure and outpatients department. Palm and fingers are unified by the canyon of an internal street that forms a new public route to the old hospital. Given the scale and sensitivity of the programme, a key aim was to make the building legible and navigable for both patients and staff, so acting to demystify its functions and workings. Resembling a more salubrious version of an airport concourse, the internal street is the entry point and social condenser, colonised with shops, café, specially designed furniture and a giant, conical structure containing a multi-faith space. Within the fingers, clinical adjacencies dictated the arrangement of so-called ‘hot’ spaces (A&E, critical care, theatres) on the lower levels, with wards stacked above to enjoy more privileged views and light.

Alder Hey Children’s Hospital by BDP Atrium view looking north, showing elevated cone at levels 2 and 3 housing Spiritual Care centre and Adolescent Suite

Swooping languidly into the park, the undulating trio of grass-roofed fingers give the building a powerful topographic quality, emphasised by its external carapace of dark pink concrete, scraped, buffed and scored to resemble local geological strata. Within this striation, jewel-like encrustations clad in anodised aluminium pop out intermittently, adding to the visual and textural richness of the composition. Unusually, in an era still in thrall to insubstantial, thin-skinned architecture, the external walls are load-bearing, formed from modular precast units. As well as saving construction time (a necessary exigency of the PFI process), this gives the building a pleasing sense of heft and rootedness in the landscape. Perhaps because Alder Hey’s constituency is children, its language appears to have consciously evolved away from the cliché of the clinical, as epitomised by London’s University College Hospital, a comparably major health project but whose mammoth millefeuille of white cladding and pistachio glazing is a study in architectural anomie.

Alder Hey Children’s Hospital by BDP Courtyard between north and middle fingers

At Alder Hey, the imperative for legibility is underscored by the need to humanise and civilise what is still a huge and potentially disorientating warren of spaces, dominated by the overpowering technicalities and kit involved with medical care. Subtle but highly considered details make a calculated difference, such as the strategic use of colour in the ward bays to code, guide and animate; corridors designed to meander; and large glazed sliding doors that create a fluid sense of openness and generous external decks for play and socialising. Resisting the lure of the twee, which often bedevils children’s hospitals, artist Lucy Casson was involved in creating a series of playful animal characters, who adorn the signage and populate a huge wooden mobile suspended in the concourse.


Alder Hey’s language appears to have consciously evolved away from the clinical

Essentially, Alder Hey is an exercise in deconstruction and reinvention. By dismantling the fixed and often challenging physical, operational and cultural apparatus of the conventional hospital typology, it can be reconceptualised and reassembled anew. Clearly, functional efficiency is still crucial, but this static armature is flexed and coloured to an unprecedented degree by the human factor. Purists may find some of the architectural language a bit overly gestural at times (rather like Ken Dodd, in fact) but, like all good comic thespians, it has a quieter, more thoughtful side that connects with and articulates the realities and complexities of the human condition.

Alder Hey Children’s Hospital by BDP Ground floor plan

Brief

If we’ve seen it before, it’s not for us,’ was the challenge set by the Alder Hey Trust’s design vision, which emphasised innovation, child-centred identity and clinical best practice.

The functional brief stipulated 270 bedrooms across six wards and a large critical care unit with 48 beds, together with 16 theatres and significant areas for imaging, A&E and outpatients. The project also caters for facilities management flows through the provision of automated guided vehicles, dedicated basement links and vertical cores. A 1,200-space multi-storey car park was also specified, which has been incorporated centrally within the plan without allowing its massing to dominate the hospital’s external appearance.

The Trust’s brief, which described its vision for the creation of a ‘Children’s Healthpark’, was ambitious and aspirational. It stipulated broad concepts such as ‘greenery’, ‘views’, ‘therapeutic’ and ‘innovative’, while at the same time recognising that the building needed to be fundamentally clinically functional.

Ged Couser, project architect, BDP

Alder Hey Children’s Hospital by BDP Critical Care ward

Engineer’s view

From the engineering perspective, a major challenge at Alder Hey has been meeting the Trust’s stringent sustainability targets in four key areas: energy, carbon, onsite renewables and on-site electricity generation. All are based on measuring utility supplies at the site boundary, a more onerous requirement than the standard HTM Encode 2 approach used for hospitals. The project also targeted – and has achieved – its design stage BREEAM Excellent rating. It’s the combination of targets that creates the challenge – how to achieve the right energy mix to meet all targets at the same time?

Take the combined heat and power system as an example. We needed the CHP to efficiently generate power to meet the on-site electricity generation target. As a bonus, it also provides an efficient source of recoverable heat. But the bigger the CHP, the greater the primary energy consumption and the harder it becomes to meet the energy target. Furthermore, the CHP’s fuel source and controls impact on the carbon target. After much analysis, we arrived at a balanced solution comprising a blend of both gas and biofuel engines. Other aspects include:

A large closed loop ground source heat pump installation under the landscaping, providing heating and cooling

Tri-generation (combined cooling, heat and power generation) via an absorption chiller to maximise CHP run times when use of heat elsewhere in the hospital is low.

Air source heat pumps to a number of air-handling units to contribute to carbon savings.

Roof-mounted photovoltaic panels to provide renewable electricity.

These aspects only touch the surface of what the entire engineering task involved. Meeting the Trust’s aspiration to be the most sustainable major acute hospital in the UK involved lots more measures, passive and active, big and small, requiring a collaborative effort from the whole project team. For Hoare Lea the excitement now is how this innovative and child-centred hospital will perform in practice and what we can do to further optimise performance.

David Armstrong, partner, Hoare Lea

Alder Hey Children’s Hospital by BDP

Working detail

Alder Hey Children’s Hospital by BDP Working detail

The concept of the building as a ‘hill in the park’ came to us very early on in the design process and as the design developed the construction methodology for the building reinforced that concept. The building had to be completed to a very tight timescale, so we worked very closely with Laing O’Rourke, our immediate client, to design the building utilising their load-bearing precast system.

The panels were carefully designed using a number of red sandstone coloured mixes with striations on the outer face to emulate Liverpool’s native geology, as exposed most notably in the deep cutting leading into Lime Street station. The material choice also recalls Liverpool’s great collection of red sandstone civic architecture, making the building ‘of its place’.

For the ward floors, a single panel supports the slabs at each level; whereas on the lower floors, which have a greater floor-to-floor height, a stitched two-panel approach was taken. The panels came to site in 10m x 3.75m modules weighing over 20 tonnes, with the windows already incorporated. This enabled a rapid construction programme.

The ‘jewels’ – large bay windows which contain spaces like the four-bed bays cantilevered from the main building line – continue the hill-in-the-park theme.

They are clad in differently coloured anodised rainscreen panels and are detailed as sharp crystalline shapes, contrasting with the massive and naturalistic main wall panelling. The cantilever is achieved using precast cross-shear walls, between which precast slabs span.

The flowing green roofs are also supported on precast units spanning between the load-bearing outer walls, upon which the growing medium for the wildflower meadow mat is supported using geotextile pockets in response to the 45° slope.

Running around the top of the building is a silver parapet coping, which unifies all of the elements of the building, including the atrium concourse, within a continuous playful ripple.

Ged Couser, project architect, BDP

Alder Hey Children’s Hospital by BDP

Architect’s view

The Trust’s brief called for a unique paediatric environment that, together with adjacent Springfield Park, would form an integrated ‘Children’s Health Park’. Its hilly, undulating profile makes the new building instantly recognisable, even from a distance: it manifests a striking identity that stands in deliberate contrast to the typical idea of a hospital.

The three-finger plan form gives almost all rooms a view of the park; and access to outdoor space at the end of each ward will connect children with the outdoors even if they have a long in-patient stay. Internally, the goal was to make wayfinding simple and stress-free and to get away from the long corridors characteristic of the hospital’s current buildings. This open feel begins with the atrium concourse, a five storey-high space that links the building’s two principal entrances and gives visitors an immediate appreciation of the hospital’s layout and a reassuring sense of its life and buzz. The sense of openness extends to the clinical areas, where sliding glass doors were used in all bedrooms to optimise observation and daylight. In the Critical Care Unit this approach has produced an innovative layout with patient bays curved around a central staff base and a rooflight that floods the eight-bed cluster with daylight.

The fingers vary in plan and section from floor to floor, adapting very successfully to the functional requirements of the different clinical areas: from deeper-plan diagnostic and treatment areas, like A&E, Imaging, Theatres and the 48-bed Critical Care Unit on lower floors, to shallower plan wards with 75 per cent single rooms on upper floors. This flexibility allowed the design team to take advantage of the extensive consultation process with staff, children’s and family groups, progressively adapting and refining layouts in response to comments without the constraints of a preconceived external form.

The design drew on BDP’s experience of schools and previous paediatric hospitals like the Royal Alexandra Children’s Hospital, completed in 2007. A collaboration between BDP’s London, Manchester and Sheffield studios, Alder Hey has been a major project for us as architects, landscape architects and lead consultants for over five years.

Benedict Zucchi, design director, BDP

Alder Hey Children’s Hospital by BDP

Client’s view

We first met BDP during a competitive tender process in 2010 when they were given a clear but pretty demanding brief. We were looking for a hospital that was unique in its design but also provided the very best working environment for our staff and the best experience possible for our patients and their families.

In 2009 nearly 1,000 children and young people took part in a consultation telling us what they wanted in their new hospital. They wanted a building that didn’t look like a hospital; a place where they could recover quickly, have fun and play; and where their parents and siblings could be looked after, too. They also wanted a hospital that was good for the environment and to be able to see green space from the windows.

Throughout the design process, BDP worked closely with our Children and Young People’s Design Group, spending a huge amount of time talking to patients about the building design, ensuring they created a hospital that was right for them. BDP has also spent time engaging with our staff to create a building befitting the high-quality care they provide.

This month we moved into our brand new, state-of-the-art hospital – ‘Alder Hey in the Park’ – and found it to be a world-class healing environment for children and young people. From the beginning, our vision has always been to create something really special and unique – a leading-edge centre for children’s healthcare and research. BDP’s willingness to listen to the views of our patients, families and our staff has been vital in turning this vision into a reality.

Dave Houghton, project manager, Alder Hey Children’s Hospital