Case study 4 Maggie Centre Edinburgh cancer support centre

Architect: Richard Murphy Architects.

The following is Richard Murphy's account (18 June 2001).

Maggie Keswick Jenks founded the cancer care centre after her own diagnosis with cancer and her experience of how the National Health Service dealt with that period in her life. She became very interested in the idea of a place which was not run by the hospital, but had patients on the board and could get information on lifestyle issues such as diet, yoga, beautician, massage, and many other nonmainstream responses to the disease. She persuaded the Western General Hospital in Edinburgh to donate a disused stable and eventually we were appointed as the architects. The briefing of the building was complex as Maggie had many ideas as to what might happen there although the building itself was extremely small to accommodate everything. Essentially though shining through the whole experience was the idea that it should be as non-institutional as possible (no corridors) and the domestic model of a house was quickly arrived at. It should also be as open and as flexible as possible and hence our idea of single space with rooms that can be added or subtracted by the device of folding sliding doors. On entering the building, there is a big space which contains information, staircase/library, and lots of light and then views into smaller spaces of the familiar domestic nature of a kitchen and a living room and upstairs are two counselling rooms.

The building opened in 1996 and became an immediate success and quite quickly it was realized that an extension to double its size was needed. The cancer care centre movement has now grown with Edinburgh remaining as its central administrative base so there was need for more offices, a second counselling room, and a large activities room which is capable of subdivison. The extension completed this year has seen the building grow in two opposite directions, a two-storey development to the west and a new single-storey activity room to the northeast. In this way, the central space remains central to the building and although doubled in size, we hope the final complex remains non-institutional.

Architecturally, from the outside, extending one of our own buildings has been relatively easy as the original conversion envisaged the stable building as a shell into which an inner building was placed and this can be read clearly by the non-alignment of walls and glass block panels, etc. with the original openings. This inner building has then been extracted to the exterior in both directions so that the extensions are, we hope, relatively seamless affairs in both directions.

Figure 11.27 Maggie Centre, Edinburgh: external view. Architect: Richard Murphy Architects. Photographed by Alan Forbes (also in colour section)

The following article about the Maggie Centre, written by Catherine Croft appeared in Building Health a supplement of Building Design February 2001.

'Somewhere to come home to.

As a result of Maggie Jenck's experiences of cancer care, she set up the first Maggie's Centre cancer caring centre -using domestic scale and open layout to give patients "a home they wouldn't have quite dared build themselves". Now, with new schemes from, among others, Frank Gehry and Daniel Libeskind in the pipeline, there are plans for six centres.

For June Langstaff, a patient at Edinburgh's Western General Hospital undergoing five weeks of radiotherapy for breast cancer, the first Maggie's Centre was a real refuge. She describes the hospital's oncology department as being like "an enormous castle fortress", but says that walking through the door of Richard Murphy's nearby tiny table conversion made her "feel cuddled": cared-for from the very start. Given their objectives, this has to be the best tribute both architect and client could have ever hoped to receive.

The Maggie's Centres - and there are soon to be six of them, in Edinburgh, Glasgow, Dundee, Sheffield, Cambridge and London - have a very special brief. When Maggie Keswick Jencks was told that her own cancer had recurred and she had only three to four months to live her overworked consultant had no time to talk to her and her husband (critic Charles Jencks). Minutes after breaking the news to them, he was saying: "And I'm so sorry, dear, but could we move you to the corridor, we have so many patients waiting ...".

Maggie was determined that she would do all she could to ensure that the same didn't happen to anyone else, and that there was somewhere both cancer patient and their friends and relatives could go for information, support and to have time to adjust and think.

The Maggie's Centre cancer caring centres (the first of which she was able to be closely involved in as a new treatment gave her 18 months' remission), are not hospices, but places providing information for those faced with a bewildering range of complementary therapies and advice about diet, exercise, and relaxation, as well as complex decisions to make about conventional treatment. As programme director Andrew Anderson summarises, the Maggie's Centres "are both a bolt hole, somewhere it's okay to cry, and they are about making patients better, more demanding 'clients', who don't just feel pushed around by a system they can't control".

The brief for the new projects combines what has been learnt from Edinburgh with Maggie's original ideas. Each centre will be built in the grounds of a hospital with a specialist oncology department, but it is the anonymous, frighteningly institutional atmosphere of a large hospital that is to be avoided at all costs.

Corridors are eliminated, and it is important that on entering each building there are no dark corners and it is easy to see and understand the whole layout. As well as a small seating area with a fire, there is a prominent kitchen table, and plenty of spaces where it is possible to sit on the periphery but not feel excluded, so that patients can take their time deciding what activities or conversations they wish to participate in.

The relationship with the exterior is also important, and views of trees and nature are especially valued by both staff and patients. The site for the Dundee centre has to be the

Figure 11.28 Maggie Centre, Edinburgh: section. Architect: Richard Murphy Architects

best yet in this respect: it looks down onto the river Dee and a separate fundraising project is seeking money to construct a lake in front of it, with a island for contemplation reached by a narrow bridge.

The brief states: "we need to think of all the aspects of hospital layouts which reinforce 'institution' - and then unpick them", and concludes by hoping that patients will experience each centre as feeling 'like a home they wouldn't have quite dared build themselves, and which makes them feel that there is at least one positive aspect about their visit to the hospital which they may look forward to".

In Edinburgh, Murphy's original 1996 project has been extended, adding a larger multi-purpose meeting room, another consulting room and more offices from which to oversee all the new centres. It is still very small, and the domestic scale that is the key to its success is skilfully maintained.

A second centre is underway, with a £360,000 lottery grant as part of the funding package. Like Edinburgh it is

Maggie Edinburgh Plan
Figure 11.29 Maggie Centre, Edinburgh: ground floor plan. Architect: Richard Murphy Architects
Figure 11.30 Maggie Centre, Edinburgh: first floor plan. Architect: Richard Murphy Architects

a conversion, this time of a small Victorian gatehouse at Glasgow's Western Infirmary Hospital. It too is designed by a local Scottish architect (Page & Park, best known for the Glasgow Lighthouse building). Again the kitchen is at the heart of the building. The library is at the base of the castellated turret and will be lit from above, and there will be a relaxation room in a lead-clad extension raised a half level to increase privacy.

The next two centres, however, are causing much more excitement: Frank Gehry is designing the Dundee Maggie's Centre, while Daniel Libeskind is working on a scheme for Cambridge. both Gehry and Libeskind were friends of Maggie's and have donated their time for free. Centres for Sheffield and the Charing Cross Hospital in London are also planned, but as yet no architects have been selected.

Rather than resorting to a committee, this very personal approach to developing each project will be enormously aided by having Marsha Blakenham acting as client. Blak-enham, whose own home epitomises the relaxed open-pan ethos sought for the cancer care centres, was a close friend of Maggie's and will liaise closely with oncology nurse Laura Lee who treated her and now heads the Edinburgh Centre. "We are absolutely not rolling out a franchise", she says. "We want every Maggie's Centre to have its own distinctive identity".

The importance of good design and aesthetics is as important to her as to all the other key players (she is a painter and potter when not fundraising and inspiring others). She is aware that using "star architects" will generate extra interest and facilitate fundraising, but she is adamant that neither she nor Charles Jencks is putting an intellectualised architectural agenda at the top of their list of priorities.

Indeed, although Jencks sees the way in which Murphy weaves together the old and the new as post-modern, he also emphasises that the centres are "not pushing a most-modernist line". He sees Gehry's experience of the vernacular as particularly relevant and hopes that each project will combine modesty with "great inspirational architecture".

Frank Gehry remembers Maggie as "a very special lady: close to sainthood". His office has been working full time on the Dundee Centre as "a labour of love" for four months and has designed everything including the furniture and the light fittings. Stirling-based James Stephens Architects is now producing working drawings and will supervise the project on site. The initial models were rejected for being "too Ronchamp-like". Gehry admits that they were "excessive: a tour de force - nice sculpture but irrelevant". He is very aware that some people have seen the anonymity and low-key exterior of the Edinburgh centre as key to its success and that the last thing the organisation wants is to be accused of commissioning fancy architecture for the sake of it. He has sleepless nights over this very point and says that Maggie finally came to him in a dream and told him to "calm it down".

The latest version is more modest: in his words "more subtle and laid-back". His initial image of a tower as a "beacon of hope" is retained, but a flamboyant mini-Bilbao roofspace has been replaced by a folded stainless steel sheet (titanium would have been too expensive), across which he hopes that soft cloud shadows will ripple. This corrugated roof form was inspired by the folds in the sleeve of a blouse worn by a woman in a Vermeer painting in the Metropolitan, a postcard of which is pinned over Gehry's desk and reminds him of Maggie.

Daniel Libeskind has yet to commit himself on paper. Blakenham describes his scheme as "just a twinkle in his eye", but he has been talking about producing a "tree house" for the very tight site at Addenbrookes Hospital in Cambridge.

He is extremely excited by the ethical content of the project and is aiming to produce "not just a shallow image, but a place that is interesting to be in and dignified". In many ways the project is the exact opposite of his Jewish Museum, which overawes and disorientates the visitor. Libeskind is also highly unusual in that he has gone straight to building large, public buildings, rather than starting with small domestic projects - although he is now also working on a villa in Majorca which is about the same size as the Maggie Centre. He will be presenting initial concepts at the Soane Museum at the end of February.

As for the future, there is no doubt that the Maggie's Centres are fulfilling a very real need and the concept could spread further. New advances in genetic testing for cancer-causing genes will create additional demand for counselling, information and support.

However, as yet the organisation feels that six centres is enough, and that they will want time to learn from the first generation of buildings, and consider how the charity's structure could grow before commissioning any more. Although cancer affects men and women more or less equally, 70% of the visitors to the Maggie's Centre are women. Staff are convinced that this is just symptomatic of the British male's reluctance to discuss feelings, but it might be worth considering whether the kitchen-table domestic ethos is less appealing to men. There has also been some criticism of the House & Garden, comfortable middle-classness of the atmosphere.

Gehry believes that "we underestimate what architecture can do: we don't play enough", and the Maggie's Centres have certainly encouraged inventive play focused on very serious ethical issues. But for architects, perhaps the most heartening aspect of this very worthwhile project is the recognition by both client and building users that buildings can empower people and make them feel good about themselves, and that this is worth paying a bit extra for.'

The final test will be the post-occupancy evaluation of this series of buildings. Will they achieve the objective of providing an environment for the caring interaction of human emotions or will the aspirations of architect 'prima donnas' submerge the objectives of the brief with an over concern for form? This approach stands at the opposite end of the spectrum to design by management, cost planning and space planning allocations.

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