Light touch: a new addition to St Thomas's Hospital, the Evelina Children's Hospital exploits space, light and colour.

Megastructure or campus? This is a key question for architects engaged in hospital design in the UK, where a combination of technophilia and response to short-term clinical fashion has for decades resulted in too many hospitals resembling rambling horizontal oilrigs rather than places of peace and healing. Budget and programme requirements have too often led to confusing environments, where patient care and visitor comfort come a poor second to an obsession with initial capital cost.

It is a relief, therefore, to visit the Evelina Children's Hospital in London, designed by Hopkins Architects. Here, primacy has been given to the experience of the patients during their sometimes long-term stay; this is an environment flooded with natural light, and in which colour and materials play an important role. It is a large (16 000sqm), exuberant building, whose confident structural design is worthy of the Victorians who created the St Thomas' Hospital complex in which the Hopkins building now sits.

The story of the hospital is complicated; founded in the twelfth century on a different site several miles to the east, it moved to its Thames-side location opposite the Houses of Parliament in 1871. The design by Henry Currey was of heroic proportions: a long series of linked courtyard blocks addressed the Thames at the rear, while a series of separate entrances fronted Lambeth Palace Road (the nearby palace is the home of the Archbishop of Canterbury). Currey created a hospital which managed to be both megastructure in terms of its physical impact and range of activities accommodated, yet at the same time a campus by dint of the way that different medical activities were separated within a series of hospital buildings.

Florence Nightingale founded her pioneering school of nursing in the hospital, with its then novel attitude to neatness and cleanliness, attitudes now having to be relearned in the wake of MRSA and other cross-infections (additional hand-washing facilities are being installed). A medical school opened at the hospital in 1871, and its role as a teaching hospital has continued to this day. Most significantly, the design of the hospital acknowledged the civic and symbolic function of such a group of buildings, whose grandeur responded to their cross-river parliamentary neighbour; the hospital was very obviously a part of the city in which it stood, and part of an urban grain capable of absorbing this monument to Victorian reforming zeal. Moreover, the courtyard arrangements facing the river gave dormitories air, light, and views, attributes which the Hopkins building emulates.

[ILLUSTRATION OMITTED]

[ILLUSTRATION OMITTED]

Sadly, much of the Victorian design proposition has been lost or diluted, particularly in the decades since the Second World War, when extensive bombing destroyed large chunks of the complex. The impressive additions by YRM, completed in the early 1970s, have themselves been modified, with a resulting loss of circulation clarity. Accretional construction, no doubt for good purposes, has left the public realm of the campus in a sorry state, littered with obscure entrances, and with exteriors which Nurse Nightingale would have condemned as unacceptably dirty. The old road onto which the Victorian buildings faced, is long gone, the new route a busy urban road with a bus lane rather than hospital drop-offs. Inside St Thomas's, the forest of signage is a sure sign of circulation confusion. You have to work there to know how to get around.

Equally historically chequered is the story of the Evelina Children's Hospital itself. It was founded in 1869 by Ferdinand de Rothschild as an independent institution, located in Bermondsey, south-east London, close to the old St Thomas's Hospital site. On the formation of the National Health Service, the institution was incorporated within the trust responsible for St Thomas's and Guy's Hospitals, and Evelina was eventually located within the Guy's Hospital tower next to London Bridge railway station. It will relocate to the Hopkins building later this year, its name and history having been part of the fund-raising campaign to make the Hopkins Evelina possible.

The complex histories of the institutions involved in providing healthcare in this part of London have been incidental to the architectural effort in creating the new building. In place of complexity they have provided clarity; in place of that signage forest, they have given a clear sense of direction; in place of darkened back-of-house circulation routes they have provided light and views. The Guy's and St Thomas's hospital trust project manager. Alastair Gourlay, recalls the programme requirement for a 'real children's hospital, not an adult hospital with cartoons on the walls'. It should be noted that 'children' includes anyone up to the age of 18. The client brief, in part derived from long discussion with children and parents, was for a hospital that doesn't feel like a hospital', devoid of 'long scary corridors', and reflecting high aspirations both for an architectural 'wow' factor, and for evidently high levels of construction quality.

[ILLUSTRATION OMITTED]

[ILLUSTRATION OMITTED]

[ILLUSTRATION OMITTED]

[ILLUSTRATION OMITTED]

[ILLUSTRATION OMITTED]

[ILLUSTRATION OMITTED]

[ILLUSTRATION OMITTED]

[ILLUSTRATION OMITTED]

[ILLUSTRATION OMITTED]

[ILLUSTRATION OMITTED]

[ILLUSTRATION OMITTED]

For Gourlay, the architect had to act as 'a sort of sponge', absorbing client and user ideas, but then translating them into a building based on fresh design thinking. The result is impressive. From either of two ground-floor entrances, one to Lambeth Palace Road, the other to an internal street, you enter a huge volume, with ground-to-floor 'rocket lifts', encased in steel and painted bright red. This is an unusual colour for a Hopkins building, but here it feels right, cheery without being gaudy. No seriously ill or bedridden child will use these lifts; there are alternatives as well as bridge links to other parts of the hospital. Look upwards from the central ground floor space, and you can see the sky--courtesy of a four-storey, glazed conservatory which provides (along with the lifts) the requisite wow factor. This roofing element has been a recent feature of the practice's work, from the central space in the riverside building for British MPs, Portcullis House (AR February 2001), to the new headquarters for the Wellcome Trust, the medical charity (AR February 2005). The contents within Evelina, however, are much more complex, incorporating, for example, school facilities--for the children, not the medical students.

Cafes and waiting areas fill the central ground-floor space, complete with yet-to-be-installed artwork, with perimeter rooms providing outpatient, therapy and pharmacy facilities. The disposition of other facilities/departments is clearly but unobtrusively signed, with each floor given a name, icon and colour deriving from the natural world--Ocean, Arctic, Forest, Beach, Savannah, Mountain, Sky. In-patient accommodation starts on the third floor (Forest), which also provides the atrium floor. Highly sophisticated intensive care (20-bed) and theatre facilities are provided on the second floor, but even here the design manages to incorporate natural light to a significant degree.

Floors above the atrium contain wards, with the top floor currently given over to administration, but capable of future conversion once the second phase of the project takes place next door. The wards themselves, with 120 beds in total, have 'snake' routes avoiding long dark corridors, and attention to the patient experience is very clear: plaster ceilings to look at rather than the ubiquitous suspended ceiling tile; a parent fold-out bed next to every child's; personalised tv control and so on. Six- and four-bed wards are twinned, with one nursing station covering the pair.

The way in which artworks have been used within the rubber flooring material, playful without being infantile, is a sign of the seriousness with which ideas about colour, identity, way-finding and architecture have been skilfully combined, along with a desire to use natural materials wherever possible. All this is brought into clear view by the natural light that pervades the whole building, not just the atrium. Vertical cuts bring light into the floors below, while high ceilings and large windows give most spaces a real feeling of engagement with the outside world. The natural/assisted ventilation system, including opening louvres that bring in outside air (and some noise) add to that feeling.

As built, the Hopkins Architects contribution to the history of the Evelina Hospital is significant and impressive. This is a building which is generous in its volumes, and the long life, loose-fit, low-energy approach to the design is already paying dividends in terms of additional requirements now being absorbed without difficulty. It is an example of the way in which a design-and-build contract, where the architect is novated to the contractor (in this case Gleeson), can work extremely well. This is largely because the client knew what it wanted; the architect produced detailed designs before the contractor became involved; and the contractor was able to contribute positively to reducing cost and increasing specification quality through its purchasing power, an acknowledgement partner-in-charge Andy Barnett and co-director Pam Bate are happy to make.

Most British hospital projects these days are procured using the so-called Private Finance Initiative, criticised by many architects because designers are responsible to contractors from day one, and not necessarily given the opportunity to interact with the client in any deep way. Since PFI contracts for architects are essentially design-and-build, the question arises as to what Evelina might have lost had it been procured under a PFI contract. The answer is that if the client and the aspiration for the project were the same, it is conceivable (though not likely) that similar quality might have been achieved. However, hospital trusts without any independent funding can find themselves ground down by process and constraint to the point where they are grateful for whatever comes their way. Evelina should show them what is possible if they have the will to insist on quality.

For the Hopkins project to be successful in the fullest sense, it will be necessary to carry out additional work beyond the boundary of the building itself. Already, the hospital trust has asked the architect to improve the rear entrance, and clean up the buildings opposite as part of the process, creating a civilised alternative entrance route to the alternatives on the main road, or through the main hospital. In the longer term, the ambition is to recreate the old route the Victorian buildings opened on to, this time not as a public road, but as a hospital street, bringing back into play the idea of St Thomas's as a piece of urban design, as well as a hospital rooted in the history of its city. Campus not megastructure.

[ILLUSTRATION OMITTED]

[ILLUSTRATION OMITTED]

[ILLUSTRATION OMITTED]