Creating therapeutic environments is Medical Architecture’s specialty. Directors at the practice Lianne Knotts and Ruairi Reeves explain to ADF’s Laura Shadwell how they are continuing to push boundaries in healthcare architecture

Medical Architecture; it does what it says on the tin. However, the practice originated from academia – the Medical Architecture Research Unit at North London Polytechnic, in the early 1990s. The firm’s founders, together with a more ‘arts’ focused colleague (Graham Cooper) – initially emerged in private practice when the faculty closed its doors in 1991.

To this day, the practice maintains an academic level of rigour – the benefits of which are particularly clear when working on healthcare projects. Medical Architecture also continues to contribute to NHS national guidance on design, including Health Building Notes (HBNs) which cover a variety of different elements of healthcare buildings.

Built on a shared focus

At its inception, the practice had one London studio, and fewer than 10 employees. Over the years, the practice has grown, forming a second studio in Newcastle upon Tyne in 2006, and now employs 50 staff. The two studios are similarly sized and are closely integrated, with a strong culture of collaboration. Although workload is not necessarily split geographically, the national reach provided by the two locations works well for the practice. Lianne Knotts is director and co-leader of the Newcastle studio, alongside fellow director Paul Yeomans. She tells ADF that the studios are both currently at a “really good size; everyone knows what each other is doing. We may grow, but we don’t have plans to turn into a 100-strong practice.”

Focusing exclusively on healthcare gives Medical Architecture a point of difference against other practices working in the sector; “We’re not the only healthcare architects, but because we only do healthcare, everyone within the practice is focused, and comparatively experienced,” says Ruairi Reeves, director and leader of the London branch, with director Bob Wills.

Resisting opportunities to diversify away from the sector, they have continued to play to their strengths, including deploying their skills on overseas projects in Ireland, Australia and Canada, which has been useful during periods when UK’s capital investment in healthcare has been less.

Understanding healthcare design

Approximately 90% of the practice’s work is in the NHS, with particular focus on mental health, acute care, and community health facilities such as community hospitals, and what Reeves calls an “emerging type of building, more of a ‘mega health hub.’” These integrated care facilities combine many healthcare services on one site with the aim of reducing hospital admissions. The pioneering Jean Bishop Integrated Care Centre in Hull is a key example of success. A study led by the Wolfson Palliative Care Research Centre at the University of Hull, concluded that frail patients at the Hull facility would be 50% less likely to need emergency treatment.

As a result of the team’s combined experience, Medical Architecture is able to strategically look at healthcare needs, alongside a patient-focused design approach to both the building’s interior and exterior. “We are continually pushing to think about things from patients’ point of view, as well as staff,” asserts Reeves. “For example, we’ve worked with artists in the early stages of projects to integrate art into the emerging designs, rather than just bolting it on at the end, and that’s been really successful in maximising its value,” adds Knotts.

Medical Architecture approaches a project not just as a building design, but as a diagram, in order to optimise the flow in terms of ‘patient pathways’ through the building, including where they intersect with all the functions patients will need to access. Retrofitting is a particular challenge when a healthcare building is in occupation, so as Reeves says, they “are passionate about getting the building right, first time. We want to create a timeless facility that ages well, but that also offers flexibility.”

Medical Architecture says that challenges for designers working in healthcare revolve around issues of funding. The practice regularly works with NHS Trusts to develop their estates strategy, exploring ways to extract the greatest value from their estates from a clinical, operational and environmental perspective.

A new wing at Stoke Mandeville Hospital in Buckinghamshire is an example of a client brief that was initially unaffordable, but  by creating flexible multi-functional space the architects reduced the building’s overall size and cost. This design (which won an award for its use of materials) lent itself to volumetric modular construction. “We believe at the time of completion in 2009 it was the UK’s largest modular healthcare building,
says Reeves.

The other all too frequent challenge is the ‘stop/start’ nature of projects, says Reeves, as each individual business case stage has to be signed off. “It’s a challenge for any architect,” he adds.

Dispelling the stigma

Mental health accommodation was once poor, dark and claustrophobic. Knotts details how in the practice’s early days they had heated discussions with clients as it sought to improve designs: “We helped pioneer a new approach in design to invest in circulation space, creating single loaded corridors with daylight, views out, and direct access to outdoor space.”

Where in the past there has been a stigma around mental health buildings, resulting from the historic asylum model, mental health is becoming more normalised and the buildings located closer to communities. A project that exemplifies this is Blossom Court in Tottenham, London – a mental health inpatient unit in a tight, urban site completed in 2020. The architects’ two-storey form provides its “own secure boundary, removing the need for secure fencing around its perimeter.” Despite the sensitivity of the function, the building has become firmly cemented within the community and its urban fabric, and offers a positive therapeutic environment. The interior and exterior connect successfully, with residents and staff benefitting from natural daylight, views and easy access to a courtyard and terrace in each pair of wards.

Sustainability stance

While sustainability and BREEAM have become core parts of Medical Architecture’s work, they say working to the standard presents challenges, especially in the mental health sector. For example, promoting rainwater harvesting to attain credits could pose a risk to patients who might drink the water. “It’s about striving for those credits that you know will have a positive benefit on the project,” asserts Knotts.

They look to combine – where possible – therapeutic design benefits with achieving sustainability, “enhancing biodiversity in the grounds,” for example, says Reeves. Using higher quality or durable natural materials – that can be repaired, rather than replaced – helps improve quality as well as sustainability. He says that when they have achieved BREEAM “Excellent” in projects, it’s generally where the strategy “has been to really focus on health and wellbeing.”

A former RIBA Part 3 examiner at Newcastle University, Knotts is keen to make sure the practice maintains its links with academia so students are aware of what healthcare architecture could offer them, and to inform them of the firm’s past projects. “Healthcare isn’t necessarily seen as a ‘sexy’ sector,” she admits, accepting that students often end up working in the field as a “happy accident.” She adds however: “the environments we design make a real difference to people, and the work we do is incredibly rewarding.”

Successful strategy

Healthcare projects do get recognised in industry awards from time to time, such as the Friendship Hospital in Bangladesh, by Kasef Chowdhury/URBANA, winning the 2021 RIBA International Prize. Medical Architecture’s schemes are no exception. It has three RIBA awards for Hopewood Park Hospital, Roseberry Park, and Bamburgh Clinic, and recently Clock View Hospital in Liverpool won in the 2022 Architecture Today Awards for ‘buildings that have stood the test of time’. The judges said the 2015 project “set a new national benchmark in mental health facility design.”

Reeves says it’s hard to achieve such success without an “ambitious client,” explaining: “When they are open to setting a benchmark for what good looks like, and understand the value of what you bring to a project, the results are always more successful.”

The practice is now at a scale where it is “looking forward to designing and delivering larger projects of up to £150m,” says Knotts. With the UK facing a recession, the short-term prognosis for investment in healthcare projects isn’t clear. However, NHS trusts are acutely aware of the work needed to be done to improve their estates; “maintaining an ageing estate does not always provide long term value,” adds Reeves.

Healthcare architecture may not often see the glamour or budgets of other sectors, but the success of Medical Architecture’s focus is self-evident as it continues to grow as a practice, produce well-regarded buildings, and nurture its staff.