Penoyre & Prasad’s Holywood Arches primary health centre in Belfast has enough of the boutique hotel about it to cheer visitors and patients alike. But it’s the inspired mix of health and social services that is its real triumph

In working-class inner Belfast, the first of a new breed of people-friendly, multipurpose health centres has appeared. Visitors are given a warm welcome by a radiant and airy central atrium that would not look out of place in a boutique hotel. From 8.30am to 8.30pm, they are offered a novel one-stop shop combining primary healthcare treatment and social services advice. As well as many treatments available in conventional health centres, it brings together seven independent GPs’ surgeries, some 200 outreach care staff who visit patients in their homes, community spaces, and, most unusual of all, a fully fledged Citizens Advice Bureau.

The large, bright and airy atrium makes patients and staff feel at ease, and all departments can be pointed out from the reception desk
The large, bright and airy atrium makes patients and staff feel at ease, and all departments can be pointed out from the reception desk

This is the 6300 m2 £8.6m Holywood Arches Community Treatment and Care Centre. Its architecture has already won one of this year’s RIBA awards, and this, combined with its inspired mix of health and social services, makes it a model for NHS LIFT developments in England and Wales. Developed by Health Estates of Northern Ireland, it was designed by architect Penoyre & Prasad of London in partnership with local practice Todd Architects.

The building stands in an accessible location just off the main Westminster Avenue in east Belfast. Its crisp form of white-rendered walls, curved corners and large rectangular windows is plainly visible from the main road. This clean-cut shape betrays no signs of incorporating a lacklustre 1970s building that housed the old health centre. A glowing three-storey-high panel of abstract-patterned glass signals the main entrance, while a window wall wrapped around the ground floor invites glimpses inside. Sadly this civic presence is largely dissolved by a sea of surface car parking in which the four-storey pavilion is marooned.

It is only on entering the building that it really comes into its own. The central atrium that opens out a few steps from the main entrance gives the impression of being larger than the building exterior. It stretches right through from one end of the building to the other with views out at either end. It glows in the daylight that floods down through glazed roof and bounces off white-plastered walls. And at its midpoint, a tropical fig tree stands as a huge, living, evergreen centrepiece.

Next to the fig tree stretches the main reception desk. On either side of it, staircases zig-zag up three floors with lifts rising just beyond them. And projecting into the atrium on either side are large curved open balconies. All of which simplifies wayfinding in the building, as all the health and social facilities and their access routes can be clearly pointed out from the reception desk. And the first port of call for visitors are the prominent balconies, which serve as relaxed waiting rooms for the facilities alongside them.

The district treatment and care centre is clearly visible from a main road in east Belfast
The district treatment and care centre is clearly visible from a main road in east Belfast

The building is graced by a simple yet cheery palette of materials. Most of the walls are finished in white-painted plaster, with splashes of yellow and crimson at either end. But these plain surfaces are warmed up by plenty of natural timber trim in the shape of balcony sills, stair treads, banisters and internal window mullions. Even more cheery are internal doors and suspended ceiling panels to corridors and waiting areas, which are finished in a rich, chestnut-coloured beech. And instead of dreary institutional strip lights, circular downlighters set into the ceilings create bright pools of light.

As for the services on offer, social, community and healthcare facilities all share the ground floor. Ten multipurpose consulting rooms are served by a rota of visiting medical specialists a new breed of specialist trained nurses. At one end of the building a large conference room and two meeting rooms are available to local community groups. But pride of place next to the main entrance is the Citizens Advice Bureau.

“We brought in the Citizens Advice Bureau because a lot of people coming here for health treatment have problems with their social security benefits,” explains Jim Hibbert, who was client representative for the NHS trust occupying the building. Pointing to a large empty space between the CAB reception desk and the main entrance, he adds: “The next stage will be to develop a hands-on database with computers that will be available to visitors.”

The three upper floors are divided vertically between the seven GPs’ practices, which are stacked at the main entrance end, and all the other primary healthcare facilities, which take up the rest of the building. Bringing together such a range of operations has offered opportunities for sharing. Physiotherapy and footcare departments, for instance, share a fitness suite on the second floor.

Most of the third floor is devoted to outreach workers. They comprise some 200 health visitors, district nurses and social workers who visit their clients, many of them elderly and infirm, in their own homes. Previously scattered around dozens of small unsatisfactory premises, they have now been brought into the wider community healthcare fold, where they have access to files, post, meeting rooms, electronic equipment, and most vital of all, fellow colleagues for discussion and stimulation.

Another substantial stimulant to staff interaction is a staff club, which occupies the fifth floor at one end of the building. As well as providing meals and refreshments throughout the day, it is used for evening events, while the encircling window wall gives it an exhilarating penthouse ambience with a wide rooftop panorama of Belfast.

At the same time, the building incorporates a degree of flexibility that should allow the facilities within it to change and adapt over time. This includes a wireless IT network.

“Holywood Arches is a one-stop shop for health treatment and social advice,” sums up Jim Hibbert. He also notes the more sensitive social issue that it actually serves Northern Ireland’s two divided communities, as it located at the cusp between them in east Belfast. As for the synergy of integrating healthcare and social facilities in one building this, ironically enough, is partly the result of the prolonged bitter conflict between the two communities, as it brought in direct rule and led to the merger of health and social services within one government department. And the uplifting building that houses these facilities is largely thanks to another centralised government organisation, the Health Estates agency, which under the guidance of John Cole (see page 50), recognises the primacy of the end product, the building, over the means of delivery.

First outing for performance-related partnering

The Holywood Arches Community Treatment and Care Centre was
the first building to be procured under the performance-related partnering system favoured by Health Estates Northern Ireland.

The PRP system is based on John Egan’s Achieving Excellence principles of lean management, in which the design-and-build contractor is brought in early to work with the design team and is required to take on a guaranteed maximum price contract based on the client’s costings and agreed details. In return, the contractor is offered further contracts, though with cost savings of 3-5% built in.

The GMP contract for Holywood Arches was awarded to local firm, Farrans Construction, which set up a subsidiary company to target healthcare work and is about to sign up its third health centre contract in its PRP framework agreement with Health Estates. The outturn cost for Holywood Arches, including external works and fittings, was a keen £7.3m, or £1365/m².

In reference to the second contract in the PRP framework, Timothy Sheehan, Health Estate’s project manager, says: “It was a year behind Holywood Arches, but was built at roughly the same cost because the savings we negotiated were swallowed up by inflation. But Farrans’ experience on the first project made it quicker for them to build.”

Construction of Holywood Arches was complicated by the fact that the new building incorporates part of a former health centre on the site. The 1970s building was stripped down to its concrete frame and substantially remodelled to match the new building. As a result, construction work was carried out in two phases to allow the health centre to operate continually throughout the 28-month contract.

Project team

client South and East Belfast (Health & Social Services) Trust development
agency Health Estates Northern Ireland
architects Penoyre & Prasad, Todd Architects
health planning consultant Ann Noble Architects
structural engineer Price & Myers
services engineer Max Fordham LLP
landscape architect Gillespies
quantity surveyor White Young Green
main contractor Farrans Construction