The hospitable: Foster + Partners’ Circle Bath hospital

A nondescript industrial estate on the fringes of Bath seems an unlikely location for Foster + Partners’ first hospital. The closest the area comes to architectural highlights are the identikit car showrooms that interrupt the lines of anonymous brick sheds.

But then, this was always going to be an unlikely hospital. “We wanted a building that looked more like a five-star hotel than a hospital,” says Ali Parsa, the managing partner of health provider Circle, the scheme’s client. “We’ve forgotten what the word ‘hospital’ means. It comes from ‘hospitality’ and visiting a hospital is a very important time in your life. To make it drab is really wrong.”

If you think this is the glossy prelude to a megabudget luxury spa-type experience for the super-rich, think again. Circle is hoping to capitalise on the government’s promise to allow NHS patients to choose where they go for non-emergency specialist treatment, as long as the provider meets NHS standards, and, crucially, costs (see box).

So does the building live up to its boutique hotel billing? With just 28 beds, it is certainly boutique in scale, and it cuts a strikingly cosmopolitan figure in the mundane surroundings. Long and low, the upper half is clad in sleek, stainless steel shingles punctuated with a long rectangular slot for the windows, which are set well back from the facade. This silvery box overhangs the base and contrasts with the black cladding and glazing at ground level. The overall effect is sophisticated and businesslike.

And the inauspicious surroundings are forgotten as soon as you enter. Opposite the reception is a large window with stunning views over the rolling Somerset countryside, without a shed in sight. The reception opens onto a central atrium, where wooden acoustic panelling is interspersed with red painted areas and works of art on the walls. The effect is of a traditional drawing room. “It’s the first space you come into and the way you are handled as you arrive is very important to your experience of the hospital,” says Spencer de Grey, Foster’s senior executive and head of design. “The idea was to create a central space that was friendly and welcoming. Everything relates to this space so you always know where you are in the building, which gets away from the long corridors typical of most hospitals.”

The three-storey structure is arranged as three distinct zones: the basement, where the clinical action takes place; the consulting rooms on the ground floor; and the bedrooms on the first floor.

The basement is predictably business-like. Areas such as imaging services are like any other hospital, with white walls and vinyl flooring. But it’s the operating theatres that contain the big surprise. These have windows – a first according to de Grey. “Why shouldn’t a surgeon rest their eyes on natural light when doing an operation?” asks de Grey. “If it only makes 1% or 2% difference it’s worth it.” It fits in with the whole people-first emphasis, but it’s not clear how much use will be made of them – there are blinds that can be closed at the push of a button.

The consulting rooms open off the atrium on the ground floor and are arranged along the south side so both patients and consultants can enjoy the views. The rooms are simple, but a fabric privacy screen around the bed adds a touch of quality. The boutique hotel feel is provided by large ceramic tiles that do a decent job of imitating travertine.

A complete lack of signage also helps with the hotel theme. Bizarrely, this is supposed to help make the building function more efficiently. According to Parsa, inefficiency in conventional hospitals stems from the fact that staff and spaces have designated functions. The theory is that patients pass through these spaces as the day progresses, which means that staff further downstream can find themselves doing nothing for the first two hours of the day, while later on this is true of the people who deal with patients at the beginning of the day.

At Circle, the lack of designation means rooms can be used all day long with nurses and support staff taking on a variety of roles. The equipment needed for each speciality is kept on trolleys and wheeled into consulting rooms as needed. The small scale of the hospital means staff know each patient and, helped by sophisticated record-keeping systems, can direct each individual to the appropriate room.

Not surprisingly, it is upstairs on the bedroom floor where the hotel theme really takes off. The whole storey has real timber flooring – unheard of in a modern hospital. “Floors are critical to how you perceive a space and this helps get away from an overbearing, institutional feel,” says de Grey. He says a lot of research was needed to ensure the floors would meet healthcare standards of hygiene. The floors are made by Kahrs and are an engineered, prefinished wooden block system directly bonded to the screed. The blocks are given a post-installation coat of lacquer, the matting agent of which makes the floors non-slip. Steam cleaning is out because it would damage the finish; instead an antibacterial agent is mixed into water for cleaning.

The bedrooms have a quietly sophisticated air. Cool umber panels define the ensuite bathroom; the panels are set against off-white walls. Each room has a window seat with a bed underneath, should a relative or friend want to stay overnight. Again, there are fine views over the surrounding countryside although other parts of the industrial park blot the landscape on the north side. All the windows are openable and each room has a mini herb garden in the space between the window and the front of the facade. “We all felt a bedroom with herbs growing outside your window had strong medical connotations,” says de Grey. “Herbs are medicinal and give a sense of wellbeing.”

So does it all work? Yes, it does – if you have the choice of where to undergo surgery, this is far more appealing than your average PFI super-hospital. Whether it will be on a scale large enough to revolutionise healthcare is another matter; Parsa certainly think it might: “The Body Shop may only have a small percentage of the cosmetics market but hardly anyone does animal testing any more. They changed the way people think and we will change patients’ views of what a hospital should be. Others will follow.”

Making it stack up financially is going to be the biggest challenge – last June, Circle had problems getting funding because of the credit crunch, and whether it can deliver a Rolls-Royce service for Mondeo money remains to be seen. But if it does, healthcare in the UK may never be quite the same again.

How did Foster tackle its first hospital?

Foster + Partners broke into the education market in 2003 with its Bexley academy and has gone on to make schools an important part of its portfolio. Now the firm is doing the same with hospitals.

How does an architect enter such a complex and highly technical sector? Circle was more interested in an architect that could bring fresh ideas to healthcare design rather than preconceived ideas formed from years of designing hospitals. It liked Foster’s approach which initially was very conceptual. “We did quite a lot of research knowing what the general aims were and we were able to respond with some quite strong ideas and strategies, without getting too technical, that met their requirements,” says Spencer de Grey, Foster’s senior executive and head of design.

This meeting of ideas included keeping the hospital small and including a central space – an idea taken from the firm’s experience designing academies. De Grey says this area minimises the need for long corridors and means much of the building is visible from one place, features that are as useful in a hospital as they are in a school.

Having secured the commission, Foster carried out extensive research. This included visiting other hospitals, including one in the US, and getting input from clinicians. This research is evident in the final design – for example, the bathroom is only a short distance from the patient’s bed and handrails have been strategically placed to help them get to the toilet. Full-scale mock-ups of rooms were built and shown to clinicians for feedback.

De Grey says his experience of working on Circle Bath was very positive and he is keen to design more hospitals, adding that Foster is talking to Circle about doing another five or six projects.

De Grey won’t say if the practice would like to take on a big hospital but his reply doesn’t rule it out. “There is a lot to learn from the small-scale approach but I don’t think it is the only one,” he says. “There is still a need for large teaching hospitals. This doesn’t cut that out but it does alter the balance.”

Who’s in the Circle?

Circle is a bit like the John Lewis of healthcare, in that it is owned and run as a partnership by some 2,000 clinicians. It has ambitions to open 25 hospitals over the next four to five years which will be delivered by Health Properties Management, Circle’s development arm, and designed by architects including Rogers Stirk Harbour + Partners, Hopkins Architects, Foster + Partners and Building Design Partnership.

All of these hospitals will be relatively small as the partnership believes large institutions are inherently difficult to manage efficiently. As Ali Parsa, Circle’s managing partner, says: “There’s a very good reason why the army has units of 100 people, as any more than this becomes very difficult to manage.”

The hospitals will carry out a range of procedures including general surgery and orthopaedics but will not offer highly intensive procedures, such as neurosurgery, which are associated with large hospitals. The company has about 1,300 practising consultants on its books.

Circle Bath is the organisation’s first new-build project to follow the hospital-as-boutique-hotel model. The hospital cost £21.8m to build, a figure Parsa says is equivalent per square metre to a PFI hospital. However, sources close to the project claimed it cost 25% more than an equivalent conventional hospital, which isn’t surprising given the high levels of specification. According to Parsa, patients will also enjoy much higher standards than in an NHS hospital. For example, the food budget is £15 per day per person, compared with £2.50 for a private hospital and just 75p for the NHS – and the meals are all organic.

How will Circle manage to offer this service for the rates it gets from the NHS? Parsa says it’s all down to efficiency, quoting Office of National Statistics figures that show NHS efficiency has decreased by 6.4% over the last 10 years. “The truth is we can’t afford to pay for the growth in the healthcare budget. So we either cut services or deliver these more efficiently,” he says. The hospital at Bath has been configured so staff and space utilisation is high; it also has features such as linen rooms outside the bedrooms, which save staff spending much of their day treading up and down corridors.

Circle has a target to cut costs by 30% and reduce its build programme by 50% during its roll out of 25 planned hospitals. This will be done, it claims, by extensive use of prefabrication for elements such as the bathrooms. But it will be interesting to see if the health provider manages to maintain the quality of its developments.

Does Circle have ambitions beyond the initial 25 hospitals it is planning? Parsa says not, but he thinks offering patient choice and allowing private companies to provide it could revolutionise healthcare. He likens the potential impact to the liberalisation of the skies which allowed low-cost carriers like Ryanair and Easyjet to shake up the airline market.

Original print headline - The hospitable