Creating an impression: Midlands’ massive hospital

Big hospitals might be the most difficult buildings to design. Circulation is a real head-scratcher, needing discrete routes for staff, visitors, ‘blue-light’ arrivals and bed-bound patients in constant motion between wards and clinical areas. Added to that are countless conduits for fluids, gasses and data to rival those of any science lab. There’s a panoply of spaces with unique and onerous requirements, from adjacency to infection control. So the question in my mind, en route to the new Midland Metropolitan University Hospital, is whether it’s been possible to do all that, on a tight budget, and still deliver a pleasant, even uplifting experience for patients.

First impressions are ambiguous, but hopeful. The 736-bed acute general hospital, which replaces two existing facilities, sits on a 6.5ha brownfield site in Smethwick, just west of Birmingham. Towering over terraced houses and tatty sheds, the 11-storey megastructure has a scale and functional clarity that might more readily suggest industrial than therapeutic use, but there’s evident refinement in neat steel and terracotta cladding, delicate cross-bracing and inset balconies. The impact is further softened by glimpses of greenery on high-level terraces and the building’s signature feature – a quilted ETFE enclosure wrapping over one end.

The imposing bulk arises from the architects’ early decision to reject the sprawling arrangement envisaged in the brief in favour of stacked accommodation. That has several advantages, says Laura Cagni of Cagni Williams, which worked as architectural design lead alongside HKS as architectural project lead and Sonnemann Toon as architectural clinical lead. 

One is efficient planning and reduced travel distances. A logical layer-cake has produced a form resembling a super-sized hovercraft. At the base is a two-storey carpark, partly hidden by cutting the building into sloping ground. It is topped by a three-storey rectangular podium with chamfered corners, containing all clinical departments, from A&E to operating theatres. Above this ‘hot block’, a boxy superstructure faced in orange terracotta contains the wards. At the southern end they meet an external winter garden, sheltered by that sloping plane of translucent ETFE like a six-storey windscreen.

Another benefit of a compact footprint is to free much of the site for landscape. ‘It’s important to have breathing space’, says Cagni. ‘Hospitals shouldn’t be fortresses; they need to extend open arms’. She was conscious that by providing public space MMUH could catalyse regeneration of the country’s second-poorest borough, and also – from personal experience – that patients can feel a shocking sense of disjuncture between isolated, antiseptic hospitals and the world beyond. ‘Healthcare is what the community does to help you out when you are ill,’ she says. ‘You are not left on your own, and the building should reflect that.'

Approaching MMUH across the new ‘village green’, through a ring of trees and swathes of shrubs and grasses, there are encouraging signs of welcome. Along the southern end, bench seating is integrated in a double-height concrete colonnade. In the middle an ETFE canopy fans out to mark the main entrance.

Inside, visitors pass through a broad, lofty passage lined with acid-green bathroom pods, and into a giant lightwell through which rises one of three brightly coloured Hi-Tech stair towers. It’s light, palpably spacious, and looking up towards the pillowy roof, the view is frankly awesome. From here, lifts shuttle swiftly to all departments and wards above. For the sick or anxious visitor, wayfinding has been made easeful and intuitive. ‘It’s designed with two things in mind,’ says HKS partner Francis Gallagher. ‘If you know where you’re going, you can get there quickly; if not, go to the welcome centre on Level 5.’

Emerging there, the heart lifts again. The reception desk marks the entrance to the voluminous winter garden – six storeys high, extending to about an acre, and with skyline views of the city on three sides. Its scale is dizzying; bridges run between four ward wings arranged in an E-shape, which frame distinct shop-lined piazzas where more lightwells plunge down to courtyard gardens below. Ringed by planted terraces, and with paving dotted by trees and lamp-posts, it feels like an extension of the park below. ‘It’s a non-briefed communal area,’ says Cagni. ‘You can have an art exhibition, a market, or kids running and playing.'

There’s a clear similarity to the glassy concourse of London’s mould-breaking Evelina Children’s Hospital, designed by Hopkins Architects – where both directors of Cagni Williams previously worked. Seeing the effect of corridor-free circulation, fresh air and abundant daylight made a powerful impression, says Cagni. 

At MMUH the winter garden was originally intended to be glazed, but that proved unaffordable; ETFE was substituted for a quarter of the price. A proposed glulam timber frame had to be swapped for steel trusses. To retain a vital sense of warmth, punchy shades of orange have been applied liberally across internal terracotta facades and the stair towers – ‘a “designer’s colour”, not a muted NHS colour’, says Cagni. 

These adjustments only hint at the obstacles encountered during the building’s decade-long gestation. Most significant was the collapse of contractor Carillion in 2018. Balfour Beatty stepped in to complete the job. ‘The amount of work that has gone into it is unbelievable,’ says Balfour Beatty  commercial director Steve Reeves. 
He estimates, for example, that there are more than 20,000 instances where services pass through fire walls. Ensuring compliance was greatly complicated by the minimal space allotted to services, arising from the original cheese-paring PFI contract.  

In that context, the generosity of the winter garden is particularly remarkable. ‘Everybody said it was impossible’, Cagni recalls. The key was the efficiency achieved throughout the building by a regular 7.8m column grid, avoiding expensive transfer structures. This useful dimension works for parking bays, just as it does for bulky equipment like MRI scanners, and also for multi-bed and single-bed wards, thanks to some deft tweaks to the geometry of partitions. ‘There was a lot of testing,’ says HKS partner Jane Ho, ‘working out where we could challenge NHS guidelines but still provide the necessary functionality’. 

Complex clinical planning was guided by the precepts of patient-centred design – the idea that an environment that promotes wellbeing can improve recovery. There is, sadly, limited evidence of that in the materials palette: wards are kitted out in functional but dull plasterboard, vinyl and ceiling tiles. This is not inevitable, as shown by the wooden floors and soffits at Herzog & de Meuron’s Kinderspital Zürich, which opened a week before MMUH. ‘I would love the freer rein that architects have on the Continent,’ says Gallagher, ‘but we have the constraints of public funding and different rules on maintenance’.

Instead, attention was directed towards ensuring good daylight, with big windows oriented towards interesting views, access to green space and other amenities that help relieve a hospital stay. In the paediatric department we stop in a play area with a zesty yellow floor and glass walls looking into a leafy lightwell. ‘We also challenged ourselves to pepper the building with small spaces where you can go for a bit of silence or to get your head together,’ says Gallagher. ‘That’s something you don’t often see in UK hospitals’.

Some hard-won successes are so subtle that the casual observer might miss them. Critical care departments are often windowless as patients are typically unconscious, but here the architects were determined to introduce natural light; at some level, says Jane Ho, they might still be aware of their surroundings. 

So will the design of this hospital produce real clinical benefits? ‘Absolutely’, says Dr Sarb Clare, deputy chief medical officer. ‘The things that are fundamentally important to patients – light, comfort, colour – have really come through, and I would expect most of our KPIs to come down, from length of stay to mortality.’ That’s quite the endorsement. If the delivery of MMUH confirms that big hospital design is unusually hard, it’s also clear that it can bring outsized rewards. 

In numbers

Gross internal and external floor area 166,600m²
Gross internal floor area 84,000m²
Operating theatres 13
Local users 500,000