Velindre Cancer Centre
Cardiff, Wales

The new facility under construction in Cardiff designed by White Arkitekter will show it’s possible to achieve a significant NHS building using mass timber; in a project that aims to create the UK’s most sustainable hospital 

The new Velindre Cancer Cancer Centre currently under construction in the west of Cardiff is a low-rise, elegant building with lofty ambitions to be the UK’s most sustainable hospital yet. This hope rests on the design by White Arkitekter which presents a building fabric designed for health both environmental and for users, with a hybrid structure consisting of a CLT timber framed core and a mix of concrete and hempcrete wings.

The emphasis is on a “harmonious environment for patients, visitors and staff” which harnesses the benefits of timber for creating a warm, calm feel that’s something of a rarity for health buildings of this type in the NHS. The building also prioritises daylight, views and natural materials, all of which are enhanced by the extensive exposed timber surfaces in public areas. Its breathable structure will assist both the facility’s sustained efficiency and users and staff enjoyment of the spaces.

Key moves to further reduce the building’s carbon score include prioritising local sourcing, all-electric heating, and circular economy principles employing low-carbon materials and offsite methods. In addition, it is the project investors Kajima Partnerships’ goal to make “minimal impact on the surrounding countryside.” Kajima led the Acorn Consortium which was appointed to build the facility following a public procurement process run by Velindre University NHS Trust; consisting of several firms including White Arkitekter, main contractor Sacyr UK, Kier Facilities Services, and Camlins Landscape Architects. 

The project is based on a “mutual investment model” undertaken between the consortium and the Welsh Government, who were driving it centrally as a major infrastructure scheme for Wales. There has been controversy around escalating build costs, with the project reportedly due to cost significantly more than the £562m it was priced at when initially tendered in 2021. However despite this, the architects and project team have achieved a remarkable feat in not only securing the client’s sustained support and investment, but getting this pioneering design for an NHS building onto site. 

Healthcare planning context

Over recent years, cancer diagnosis has increased as the research has improved, also revealing new types of cancers. While treatments have improved greatly, it’s estimated the numbers of people living with cancer in the UK will pass 4 million by 2030. At the same time, life expectancy following a diagnosis is far better in 2024, thanks to the range of treatments available, but this all means that there is a need for more facilities.

While there is a view that cancer facilities should be specialist centres which house the expensive high-technology treatments, but patients remain in the community, The Velindre Cancer Centre is slightly different. It is a long-standing cancer treatment unit founded in 1947 at the birth of the NHS, but requiring a significant upgrade in provision to meet demand. The building contains several linear accelerators, and replacing this tech in a new facility was just part of the challenge facing the project team. 

Michael Woodford, project lead & director of the London Studio of White Arkiteker explains that the Strategic Outline Case for this project arrived at the conclusion that refurbishing and adding to the existing facility in a traditional piecemeal NHS fashion was not the preferred solution. Land adjacent to Whitchurch Hospital belonging to the Cardiff and Vale Community Health
Board and located half a mile away, was identified as the location for a new facility. “They used to keep horses there and grow food for this beautiful Victorian psychiatric hospital.” 

The tender process was fruitful for the architects, says Woodford, being a “competitive dialogue” between the design team and client, “a very lengthy and robust process responding to the brief.” He explains further: “You’re actually co-designing with the trust project team, and it must be incredibly intense for them, because they have to do it with multiple clinician teams, and keep walls between them, because they’re doing something completely different to us.”  

Design approach

Alongside the clinical requirements for the departments within the building, the sustainability drivers were fundamental to the brief given to White – Woodford says in fact that “the biggest the most important thing in the brief, aside from the schedule of accommodation, was the sustainability drivers.” They were contained in a 100-page document detailing the sustainability goals; “material use, particularly natural materials, health and wellbeing, within the building fabric, air quality, landscape, green infrastructure and sustainable drainage solutions, green roofs, everything you could imagine really.” Importantly and unusually, embodied carbon targets were also included as well as operational carbon, as part of the aim for a minimum of BREEAM Excellent. 

Woodford said that one of the beneficial outcomes of putting embodied carbon at the top of the agenda was the practice questioning itself and saying: “Why don’t we take that really seriously and have that as a key pillar of our design process anyway?” He describes the lean design approach taken by White, as part of meeting these goals: “Our approach to the design was driven completely by the carbon agenda, and the best thing you can do is build less stuff.”

As part of reducing the build in order to push carbon down, White “challenged the client on car parking requirements.” They collaborated on green travel plans but in the knowledge that users tended to drive to the facility because of several issues including a lack of good local public transport.  

In addition, the trust wanted to maximise the use of timber in the building, but Woodford summarises the challenge of realising this aim: “We have met the aim, but timber in healthcare is difficult, particularly with new post-Grenfell fire legislation and Part B in general.” 

However, he asserts the benefits: “There is a lot of evidence that the traditional white walls and vinyl floors are actually not great for people’s health and wellbeing, so we did a lot of work internally on using natural materials such as lino, and daylight.” The architects even looked at cleaning regimes and the wellness impacts of typical hospital cleaning products: “We went really deep into it, to try and look at the whole spectrum of people’s health,” says Woodford.

He says there is a lack of updated technical evidence for why wood should not be used in healthcare interiors on grounds of harbouring bacteria. There are contrasting arguments that such natural materials can offer benefits for cancer patients in particular, who can for example suffer from ‘neuropathy’ i.e. nerve damage during chemo and radiotherapy treatment, which makes touching colder materials very unpleasant.

He says that the practice’s argument was “there are some rooms where infection control is very important, such as an operating theatre, but there are a hell of a lot of rooms where it’s not.” He adds: “If you go to an outpatient clinic, why do you have to sit on a plastic chair, and why can’t you have a timber window?” Woodford also believes that the benefits for staff of natural materials cannot be underestimated, given that these are not only places for users and equipment, but are equally workspaces. In terms of daylighting, the architects did modelling to ensure the clerestory glazing that runs around the top of the facades was correctly sized for the benefit of all.

The client in this case was keen for this building to have some of the feel of a Maggie’s Centre (there is already one on the Velindre Cancer Centre site, designed with a timber interior by Dow Jones Architects). This was a component of the client’s drive for using timber as a fundamental part of this new building, but Woodford plays down any notion of this being an experimental building: “We did break the mould, but we weren’t being super-innovative, just pushing back against some of the norms we have in the NHS, and taking the client on the journey.”

Forms & levels

A set of sustainability factors were embedded throughout the design decision phase, and helped to shape the building itself. “We followed a sustainability process through, from the siting and the building’s footprint, all the way through to the paint. It was always in the decision matrix, and the client was on board.” 

White applied a lot of its extensive Scandinavian knowledge of not only building in timber, but also providing a different level of environmental quality in clinical spaces; “We have worked on a lot of projects in Sweden where daylight and windows are expected in operating theatres,” says Woodford. 

In terms of cost, Woodford asserts that the learner design approach integral to this project’s sustainability ethos, reducing elements where possible, meant that major savings were obtained. “The outline planning had a multi-storey car park and energy centre, which we removed,” he says, adding that it originally had a much larger footprint (the car park is now in the basement). “It has less impact on nature, and less infrastructure is required.” 

The planning conditions necessitated a low-rise volume for the 35,000 m² footprint required, but this also assisted the specification of timber in the current context. The internal arrangement is broken down by department, with outpatients, radiotherapy, imaging and diagnostics on the ground floor and inpatient rooms on the first. There are two circulation cores at the north and south ends of the building. 

There is also an education facility, as well as catering and FM, administration and pharmacy. In terms of how the clinical adjacencies were arrived at, Woodford says that there are always a wide variety of requirements, and resolving these “is kind of like a 3D puzzle.” He continues:  “The arrangement was about making it as efficient as possible; you also have to think about growth over time; and changes in medical pathways and treatment.” 

The architects developed a rational H-shaped diagram with a central atrium core of CLT called the ‘Lolfa’ (Welsh for living room), which patients enter into first. There are entrances at the west and east; “because it’s kind of a building in the round, and rather than enter via a roundabout we wanted to address the neighbourhood because it’s kind of in the middle of this landscape.”

The departments are all accessed from the atrium core on the ground level, with most patients going to the outpatients and radiotherapy facilities. There is also direct access for the Centre for Learning, which also includes an Innovation Lab offering research and training. Patients and visitors will experience a timber-clad entrance area with a cafe and restaurant, a patient-transport waiting area and a lounge for younger patients.

The first floor contains all the inpatient facilities, and the southern facade has a discreet balcony allowing patients at end of life to be outside. There are also internal courtyards, and on the lower ground floor of the sloping site is the chemotherapy suite, directly connected to the car park enabling discrete regular access. The pharmacy is also located here, connecting horizontally to chemotherapy but also vertically to the other areas.

The facade of the building was designed to allow internal spaces to be easily reconfigured without the need for structural alterations. This intends to make it easy to adapt the hospital to future innovations in treatment and equipment. What the practice asserts is an “extremely low carbon” solution was arrived at by an approach of “material mapping” done around Cardiff to help reflect the local vernacular, and the result is a mix of materials. They wanted to use stone where possible, so the base is gabion walling including offcuts from a nearby quarry, tying the volumes together. The southern wing will have a timber cladding, and the north face will be zinc; the education block is clad in brick.

The practice was determined to have as little impact on the existing site as possible. The aim is for landscaping to be kept as wild as possible, and a  community kitchen garden and orchard will hark back to the original site and how it was used to grow food for the Whitchurch Hospital. “It’s a beautiful location on all sides,” says Woodford, “patients basically overlook a forest.” Native and indigenous species have been brought in, and there is virtually no boundary between the hospital perimeter and local footpaths through the attractive nature surrounding the site.

Structurally, the challenge, says Woodford, was around minimising the amount of timber required, versus the performance required for a healthcare facility: “Timber is not ideal for things like vibration. We came up with a flexible structural grid with Arup: keeping the recycled concrete very thin in the floors meets all the vibration record requirements and helps keep the building low.” 

Sustainable by nature

The all-electric hospital has a million kilowatt hours of PV interwoven with green roofs, and air source heat pumps as well as mechanical heat recovery. In addition the preparation has been beneath the scheme and in the basement for the future possible addition of ground source heating. The nature-focused SuDS system installed include minimal below-ground pipes, a swale network and a retention pond.

Where timber is not possible to be used in the build due to clinical requirements, the studio plans to use concrete with recycled ground granulated blast furnace slag (GGBS). The nine concrete linear accelerators in the radiotherapy department contain “a lot less concrete,” than normal, says Woodford, due to the approach they have taken of using lead-lined blocks, which also provides flexibility for future changes of configuration.

Once the practice knew that the wings were going to be in concrete, they delved into the more sustainable alternatives that would be possible, as “alternatives to traditional plaster board and metsec,” as Woodford characterises it. Hempcrete uses natural hemp and lime to help create structures which balance moisture while donating other thermal benefits. “It sounds a bit like a wonder material, but it’s very low tech, you build a frame and you put blocks in with lime mortar and you build a wall.” Although not as much was used as White had hoped on this project, hempcrete still provides a good deal of the structure.

Conclusion 

Woodford says that over his several years working on this complex project, it became apparent that architectural success in a healthcare building might be about a different, and more
fundamental set of values from the aesthetics-based ones that designers are traditionally taught to prioritise. This could partly explain why in his view, designing for healthcare functions isn’t given the respect that it truly deserves, including in the mainstream architectural media.

“I think the trouble with architecture in general is that we’re very focused on the object and what it looks like,” he says. “And healthcare is not really about the object, it’s about the system, the technical arrangement and also the impact it has on people and outcomes.” He adds: “If you design something really well and efficiently, where people want to work and like to work and patients feel better, there are direct correlations with you staff retention, staff employment, and patient health and wellbeing.”

The hospital is scheduled to open in 2027, when it will show the NHS that it’s possible to realise a treatment facility using a large amount of mass timber, because it’s good for people, and it’s worth the extra investment required. In the end, just because health buildings and cancer facilities in particular will increasingly require a large amount of high-tech equipment to help treat people, those buildings do not simply have to be housings for that equipment. All of the investment is for people to get well, so the buildings need to be funded on that basis too, to bring the wellness benefits that can help. Putting timber to the fore shows it’s the ultimate feel-good material, and can house the most intensive healthcare facilities beautifully.

Project Factfile

Client: Velindre University NHS Trust/Sacyr UK

Consortium: Kajima Partnerships, Sacyr, Aberdeen, Andrew Scott, Kier Facilities Services, White Arkitekter, Ingho, Hydroc, BAC, MJ Medical, Turley, Studio Response, Camlins Landscape Architects, Osborne Clarke, Operis, Confab Lab

Floor area: 36,000 m²

Dates: Competition win July 2022, start on site 2024

Awards: European Healthcare Design Award 2022