The £10.6 million, three-storey building in North London, which serves as a “one-stop shop” for a wide range of services, and includes rooms for general practice, dentistry, children’s services consulting, examinations, physiotherapy and audiology services, also houses an advanced breast cancer unit complete with digital screening – which Morgan Ashurst says has been shown to be more effective in detecting small abnormalities in breast tissue, improving the detection rates for small cancers. With breast cancer mortality rates in Camden Borough 23% higher than the national average, it is a vital facility for local residents. It is hoped the new facility will help substantially reduce deaths from breast cancer by encouraging a greater take-up of screening and the use of improved technology. Facilities for staff and the community, meanwhile, include conference rooms, a café, and a gym. This was the fourth NHS LIFT contract awarded to Morgan Ashurst by Camden and Islington Community Solutions (CICS) – a public / private partnership company. Morgan Ashurst has previously built health centres at Bingfield Street, Hanley Road, and a Partnerships Centre at Camden Road in London, with CICS, all for Islington PCT. The firm is construction partner on four other NHS LIFT frameworks across the UK.
Demanding timescales
This time the brief was particularly demanding, but Morgan Ashurst delivered the scheme on time and on budget. Project manager Keith Williams has been shortlisted as Project Manager of the Year in the Chartered Institute of Building Awards (CIOB); the project has been shortlisted for the Stirling Prize, and has already won an NHS Lift Award and an RIBA London Award for design. In November, the Centre also won the Award for Best Primary Care Design for projects with a value under £15 million at the 2009 Building Better Healthcare Awards. “Morgan Ashurst is used to delivering complex and challenging health projects,” says Keith Williams. “For example, we helped to build the £250 million University College Hospital in London, one of the biggest hospital projects in the Government’s PFI programme. “However, we learned a lot through Kentish Town because everything about the project was innovative and new. The design process was unique, the healthcare model is pioneering, and the building’s function extended far beyond simply treating sick people. This building was always intended to be an inspiring place, and we are extremely proud to have delivered that on a reasonable budget.”
Making one man’s dream a reality
Morgan Ashurst explains that the new facility “all started with one man” – Dr Roy Macgregor, “who dreamed of transforming the existing 1960s James Wigg Practice in Bartholomew Road into a health centre fit for the 21st Century”. The winner of the Award for Design Champion of the Year at the 2009 Building Better Healthcare Awards, he joined forces with the Royal Institute of British Architects (RIBA) to launch a competition to design the centre. (He remains a practising doctor at the James Wigg practice today). The Kentish Town Health Centre that opened in 1974 was, Morgan Ashurst says, “unsatisfactory in a myriad of ways”. The company explains: “There are reports visitors could see into the children’s toilets from the entrance pergola; the reception was too small, with patients spilling into adjacent areas, and the building had a clumsy layout. However the biggest problem was that the surrounding tree roots destabilised the shallow strip foundations and rendered one entire wing structurally unsound”. The competition winners for the new centre were Allford Hall Monaghan Morris, whose design was inspired by the children’s logic game jenga – where players remove and replace wooden pieces to change the shape of the structure.
Construction and design challenges
Morgan Ashurst says it realised that Kentish Town would be a challenging project “almost immediately”. An entire wing of the former James Wigg Practice was marred by cracking in the concrete and some floor levels had sunk. Investigations revealed that land at one end had been bombed during the Second World War. Demolition was the only viable option. Morgan Ashurst planned to install 20 metre piled foundations for the new building, but there were obvious health and safety concerns. The company thus worked with Zetica – a leading underground survey company – to investigate whether there were any further unexploded devices hidden deep below the site. Curiously, Zetica used a German tank to carry out the searches, as it was the only vehicle robust enough to withstand any explosions. Fortunately, no unexploded devices were found, so construction began in earnest.
Jenga design
Morgan Ashurst project manager Keith Williams worked with the architect, and structural engineers Elliott Wood, to find a solution to ensure that – unlike in the game of jenga – the building did not counter-balance. The winning formula was to use concrete up to the second floor and steel above. “The fact that the building is top-heavy made it vital we chose the right combination of materials,” explains Keith Williams. “We worked with Elliott Wood’s structural engineers to test different materials using the ‘Staad Pro’ computer package, and produced practical scale models. Our solution was robust enough to hold the structure but light enough to prevent it from counterbalancing.” The LIFT form of contract prohibits any changes to the agreed design, but the client had requested more than 30 changes. Keith Williams “went out of his way” to accommodate them – by working up Deeds of Variation.
‘Value-engineered’ approach
Through regular design meetings Morgan Ashurst established that the chosen combination of glazing and ventilation would overheat. To overcome this problem, the team fitted architectural grilles over the windows so they could be left open all night to circulate fresh air. The team also had to “value engineer” several aspects of the project to ensure they were completed on time and on budget. This involved assessing all subcontractors in terms of how they could add value to the project. For example they found alternative insulation and rendering solutions to reduce long-term maintenance costs, and incorporated permanent scaffolding tie-in points for future maintenance and to reduce whole-life costs. “We didn’t want to just give the client what they asked for; we wanted to exceed their expectations,” says Keith Williams. “That meant building a centre that would last for the long-term, where generations of people will receive healthcare.”
Logistical challenges
Protected trees lay just 30 cm away from the site, resulting in severely restricted access – with just one seven ft wide “one-way” access road into site. Morgan Ashurst designed bespoke scaffolding and foundations which “worked around” the trees without affecting their roots. The site is surrounded by houses on all four sides, so noise had to be kept to an absolute minimum. Residents had also expressed concern about potential traffic and dust problems. In response, Morgan Ashurst issued special residents’ etiquette packs, advising its staff to wash dust from people’s cars, clean their windows, and answer questions about the project. The firm also arranged for lifting of a Council-imposed blanket parking ban so residents could park out-of-hours.
Management challenges
“There were a high number of stakeholders involved with this project, and up to 75 site personnel plus visitors,” explains Keith Williams. “Due to the large number of people involved, it was vital to maintain excellent communication throughout the construction process – with everyone from the client to end users of the building, as well as staff and sub-contractors. “We issued weekly reports, staged monthly meetings, and held regular informal discussions to appraise everyone about progress, commercial issues, and general site matters. By nurturing a climate of open, honest communication, we were able to quickly identify and resolve potential problems.”
Sustainability
As an integrated health centre, “leading the way for the NHS”, care had to be sustainable. Kentish Town Health Centre’s “green” features include natural ventilation. “Wind catchers placed on the roof capture fresh air and channel it into the building – eliminating the need for mechanical ventilation,” says Keith Williams. “The temperature inside will be closely monitored by a building management system, which will automatically open and close windows whenever necessary. “The long-term benefits have to extend beyond the technological gadgets and gizmos,” he adds. “The building has been designed and built so that the space is flexible, the systems are efficient, the layout is well-organised, and it is easy to use.” The space has been designed so that patients can see other people walking around – in order to inspire and accelerate recovery. Bright and colourful artwork, based loosely on a medical theme, adorns the walls, while light features have been installed to stimulate the senses. Most importantly, Morgan Ashurst says, “the building makes sense for patients and staff”. There are simple directions and coloured zones around the building to eliminate the chance of getting lost. Many signs are magnetic, allowing staff to change room use, and accordingly signage, as and when they need to. Computer systems have been upgraded so that all referral forms, information leaflets, and guidelines, are readily available on-screen. All meeting rooms are booked online and hot-desking frees-up clinical rooms, to allow more face-to-face sessions and shorter waits for appointments.
Planning and scheduling challenges
Just six months before completion, the Camden Council advised that Morgan Ashurst would need to re-apply for planning permission for the electricity substation that would power the Centre. Residents voiced concerns, so the team liaised with local councillors, and then presented its case to the planning committee. The application was approved. “The key to any problem is to build good working relationships,” says Keith Williams. “By liaising closely with residents, we were able to build trust, which is essential on a community project. This helped us to avoid a potentially serious problem, which could have delayed the project by weeks.”