Faith, hope and charity

Faith, hope and charity

Scher, Peter

Frank Gehry’s design, given for free to this new centre, obliges us to question all our tenets of belief about architecture and the design of buildings for healthcare. Peter Scher is not wholly converted.

The new centre is a small building that should prove very easy to assess in terms of function and design, something I have been doing to the best of my ability for years. Its floor area is 255 m^sup 2^ and it has only eight functional areas indoors, plus WCs and stores, so the plan could hardly fail to ‘work’ and its interior is certainly pleasant. Frank Gehry designed it to be “a friendly little clubhouse.” Its provenance and purposes are well known and have been summarised in previous issues of HD (February 2001 and June 2003).

A very short recap of the background will suffice. Maggie’s Cancer Care Centres are intended to provide the non-clinical support and advice for cancer patients, their families and carers which is not generally available in existing NHS cancer units. This they do wonderfully and from here on in this assessment the excellent, wholly compassionate and very skilled service of Maggies’s Centres will go without saying.

Maggie Keswick was a student at the Architectural Association when she met and later married Charles Jencks who is very well-known to architects for his critical and historical writings and for his advocacy of “post-modernism”. Maggie Jencks developed cancer and while enduring many different treatments she discovered the need for places where compassionate support was freely available. She determined to work to start fulfilling that need and following her death in July 1995 it has been Charles Jencks’ great achievement to develop and realise her vision.

Maggie and Charles had the knowledge, contacts and enthusiasm to envision these cancer care centres being designed by the world’s best creative designers. One such was their friend Frank Gehry, an international celebrity architect based in California, with an impressive list of major designs, his best known in Europe being the spectacular Guggenheim Museum in Bilbao, Spain. The Dundee Maggies’s Centre is his first building in the UK carried out with the Scottish architect Fred Stephen as executive architect. Others, not for healthcare, are in the pipeline.


In the rarefied cultural discussion of architecture arguments are polarised between no-nonsense social utilitarianism and the architecture of extreme egotism or extreme expressionism. Most architects with long experience designing for the NHS are, or become, no-nonsense social utilitarians and Gehry, at the opposite pole, directly confronts and challenges that ethos.

The accompanying illustrations are clear and easily read however the inside was not finished. The site is beautiful, as are the views from it in all directions and Gehry has placed there one of his trademark built forms. Almost all the walls are curved on plan with those of the two-storey ovoid tower curving in section, too. Around the tower the single-storey accommodation is covered by what its admirers describe as a “geometrically complex” or “stunningly concertinaed” roof, a “frozen kilt”, or a “shawl in a Vermeer painting”.

I cannot share in the admiration for this fashion designer’s approach to architecture, the “frozen kilt” beinq neither more nor less interesting than would be a catwalk creation inspired by, say, a composite roof decking system. The building is a bout the size of one of the larger stands at the Interbuild exhibition and seems to demonstrate that exhibitionist approach – a ‘wow’ factor that says “me, me, me” (to quote Sunand Prasad, HD, May 2003).

“I don’t know where you cross the line between architecture and sculpture. For me it is the same,” says Gehry. “What is architecture? It is a three-dimensional object, right? So why can’t buildings be anything?” Charles Jencks clearly admires this “powerful sculptural creativity” which, he said, Gehry combines with “cheap functional architecture”. Not guite in this case. Before construction began HD guoted Jencks as saying “he was confident Gehry would produce a fine building within the budget of L350,000 for 250 m^sup 2^. ‘He is really good at low budget jobs. This is the water he swims in.'” (HD, February 2001, p25)

Its cost is now given as L1.3m, the 255m^sup 2^ of accommodation having taken nearly 18 months to build. This appears to be over L5000 per m^sup 2^ and I believe sets a record for any building featured in HD. Notwithstanding Gehry and his British associates James F Stephen and Ove Arup waiving their fees for the work and HBG project managing the construction at cost it would probably fail any NHS value-for-money test. However the money is all raised for charity and it is not for me to criticise how it is spent and how long it took to complete this facility for such a noble cause.


Nevertheless we can raise a few questions about detail. The outward opening doors of both WCs will cause some obstruction. The high-powered spotlights in the roof of the common room will be intolerable to users lying on the floor during relaxation sessions. No user who has difficulty climbing the spiral stair will have access to the upstairs seating area. Fixed seating (specifically condemned by Maggie Jencks in “A View From the Front Line”) along the window wall deprives those seated of the splendid view over the estuary while glare from the window wall may prove very uncomfortable for others in conversation with them. There appears only limited freedom for users to arrange freestanding seating informally; curved walls are likely to present difficulties for arranging fixed items and for placing furniture in the therapy room and the library. In the common room some effort was required to customise mountings for the long straight tubular fluorescent light fitting to the curved wall, and lastly, clean white walls meet the flooring without any skirtings.

Those are the sort of nits picked routinely in the utilitarian NHS culture and perhaps have no relevance in Gehry’s sculptures or, more importantly, in the caring culture at these centres where no effort or expense will be spared to alleviate any and every unsatisfactory experience of the users. After all, remember how these care centres have come about:

“Maggie Keswick Jencks went to see her oncologist…the consultant told her she had three or four months to live and then politely asked her to move into the hospital corridor – ‘we have so many patients waiting’. A consultant from Ninewells Hospital advised that with current workload the time available for a consultant to advise an individual that they have cancer and offer initial advice is 15 minutes. Following this the patient is left to deal with the matter.”


In Maggie’s Centres, and other voluntary charities that offer support, patient-focused care is guaranteed, as, sadly, it is not in the NHS. And those bodies usually recognise that patient-focused architecture is a positive enhancement of that care.

For comparison with Dundee there is an outstanding example of a high quality refurbishment of a redundant chapel for L630,000, featured in HD fairly recently. The London Haven which is a breast cancer support centre with excellent facilities. It was the first developed by the Haven Trust which came into being after an almost identical experience of inconsiderateness in announcing a diagnosis and dismissing the patient for whom, in Maggie’s words, “A diagnosis hits you like a punch in the stomach.” The London Haven is a gem and, at about L1000 per m^sup 2^, very good value for money (HD, May 2000, pp17-20).

So much for the accommodation which, it must be stressed, is deliberately very “open”, in perfect keeping with the ethos that Maggie’s Centres embrace. Caring attention and support for the users precedes privacy which may only be obtained here in the therapy room or in the small retreat room.


The centre is placed within the site of the famous Ninewells Teaching Hospital, opened in 1974. The location is a richly landscaped bluff overlooking Invergowrie Bay and the wide tidal estuary of the River Tay. The views are stunning and the building is nicely positioned to enjoy the very best of them. Each Maggie’s Centre is located close to a hospital’s cancer unit but remaining financially and physically separate. At Dundee it is in sight of the hospital’s oncology department so that patients and staff can go from one to the other. This entails a walk along an undulating footpath, passing through a copse – a very pleasant experience, when the weather is clement, for someone who is not feeling weak or has no difficulty walking or is not pushing a wheelchair. Exposed up there in a storm or in the dark and cold of a Scottish winter the experience will be challenging even for the fit. The centre does of course have its own vehicular access road and parking area. The A&E department is at this end of the hospital megastructure and between it and the centre is the emergency helipad so some noisy episodes will occasionally disturb the planned calm and peace there. But there I go nitpicking again.


We are commanded to marvel at the roof by every participant in the project and by every commentator. It is of course “innovative,” the fruit of Gehry’s method of designing over there and Fred Stephen’s skill and knowledge in finding specialist fabricators over here. Gehry the sculptor designs by physical modelling, using curved surface CAD software to develop the geometry (inaccessible before computer graphics technology). Three-dimensional digitisers and deposition printers are employed to define the forms and control the fabricating equipment – in this case cutting machines for the Finnish laminated plywood beams which curve in both plan and section. The complex, clear-finished timberwork is exposed indoors and under the extensive eaves but there is also an expedient steel beam – well concealed within one wall. The roof finish is of stainless steel interlocking roof tiles laid broken-bonded in many different curving planes with all welting carried out in situ. There are no gutters at all but in the ground vertically beneath each of the numerous roof valleys there is a rainwater gulley covered discreetly by a layer of large pebbles. During severely adverse weather in this high exposed position falling rain is said to be driven horizontally but this of course is a problem even with the best designed guttering.

From many surrounding viewpoints the new centre is seen prominently and it is certainly an unmistakable silhouette, a landmark. Readers may judge from the illustrations whether this roof design is comprehensible and appropriate as a form, and not simply a conspicuous one. My misgivings about its cost and a number of functional details might weigh less than the gain to the head and the heart that great design delivers. To me it is neither comprehensible nor appropriate and it has no evident relation to the plan of the accommodation it covers. I am not impressed by this as a work of architecture notwithstanding all the resources, effort, dedication and indeed love that goes into every initiative for the Maggie’s Cancer Care Centres. If Gehry is right – architecture and sculpture are the same, architecture is a three-dimensional object, buildings can be anything – then I have truly been barking up the wrong tree.

In reviewing the London Haven I observed the contrast between the quality of support obtained from such charities and what is offered in much of the NHS, which is scandalously inadequate. The development of Maggie’s Centres reinforces that observation. But in the end it must be said again that much, much good to many desperately ill patients, their families, friends and carers will flow from the operation and use of these centres. How welcome and appreciated they are!

Client: Maggie’s Centre, Dundee

Floor area: 255 m^sup 2^

Cost: L1.3m

Architect: Frank Gehry/James Stephen Architects

Contractor: HBG Construction

Structural engineer: April Scotland

Start on site: April 2002

Open to patients: September 2003

Photography: Raf Makda

Copyright Wilmington Publishing Ltd. Oct 2003

Provided by ProQuest Information and Learning Company. All rights Reserved