Pan's Labyrinth

The famous children’s hospital has been growing since it began and it isn’t finished yet. But licking its squashed, higgeldy-piggeldy buildings into shape needs more than a sprinkling of pixie dust

Iain Kettles’ and Susie Hunter’s inflatable tree in the Botnar wing atrium.
Iain Kettles’ and Susie Hunter’s inflatable tree in the Botnar wing atrium.

If Great Ormond St hospital were a person, it would obviously be Peter Pan; like JM Barrie’s impish little miscreant, but one of various bits stitched together. A doctor seeing Great Ormond St wheeled on a stretcher into A&E might think: ’What on earth am I going to do with this mess?’ But he’d know there could be no possibility of it ever slipping away; he’d do anything to ensure that it was not only saved, but made better than before. 

The mythology of Great Ormond St, its genius loci, is everything – a talisman, one feels, that will protect this 160-year-old institution in perpetuity. By the time the Hospital for Sick Children was built in 1852, its location had fallen badly out of fashion, but the idea of a hospital serving the poor and ill children of a fetid industrial city took a romantic hold with the public: its proximity to Thomas Coram’s 1769 Foundling Hospital and the burgeoning slums on the edge of Saffron Hill giving it further prescience. The hospital became permanently embedded in the public consciousness in 1908 with Barrie’s bequest of the posthumous royalties from his famous fairytale – creating not only a funding stream, but a brand with worldwide charm and appeal forever linked to the notion of play and fantasy. 

That’s quite some legacy, even for Stirling-Prize winner Stanton Williams, which was last month announced as architect for part of the third phase of GOSH’s four phase redevelopment – its Centre for Rare Diseases further along Guilford St.  The 5,500m2 centre will contain laboratories, ‘manufacturing facilities’ and offices as well as much-needed outpatient clinical space. Stanton Williams’ expertise in state-of-the-art research facilities is unquestioned, but the official press release says it was its design proposal that ‘responded best to the constraints of the site’.

Studio Weave’s ‘Lullaby Factory’ addresses the yet-to-be-revealed facade of what will be the Mittal Children’s Medical Centre.
Studio Weave’s ‘Lullaby Factory’ addresses the yet-to-be-revealed facade of what will be the Mittal Children’s Medical Centre.

When talking of GOSH, ‘constraints’ is something of an understatement. Its island site, heaped with odd shaped structures of different provenance all stitched to a central spine, has been in almost a constant state of expansion and renewal since its founding. The townhouse at 49 Great Ormond St was replaced by a 100-bed neo-gothic pile by Edward Barry in 1875, to which was added the south wing in 1893 and the 1908 Astor outpatients building, which was demolished in 1938. When the opportunity to buy the nearby Coram’s Fields was scuppered in 1929, GOSH was left with no choice but to keep developing its 2ha block. So followed Southwood Building, completed 1948, the Barrie Wing in 1963, and the mid-rise brutalist cardiac wing, which after many delays opened in 1987. The 1994 Variety Club Building, by Powell and Moya, replaced Barry’s building, and while providing modern clinical facilities, also brought the realisation that further development of the now-congested block was either going to involve some delicate poche of any remaining free areas on the site, or an altogether bolder approach.

Hence the creation of the Development Control Plan in 1998, which by the time Phase 2B completes will have delivered a hospital with over 100,000m2 of clinical provision. Natalie Robinson, deputy director of redevelopment, explains that the concept of selling up this piece of prime central London real estate to build a bespoke, state-of-the-art facility on the edge of the city was never a consideration. Her view is that the hospital was is far too enmeshed with the nearby Institute of Child Health and Neurology, University College Hospital’s National Hospital for Neurology and Neurosurgery, and the Royal London Hospital for Integrated Medicine. Adjacencies aside, she confirms that there’s an enormous attachment to the site and its position in the centre of the capital ensures it attracts the best consultants from across the world. Just as importantly, its fund-raising arm links it to Great Ormond Street so strongly that there are genuine fears that a move away could discourage the charitable funds needed to see the hospital’s reinvention through. 

The six storey Botnar Wing sits easily within the surrounding Georgian streetscape of Lamb’s Conduit St.
The six storey Botnar Wing sits easily within the surrounding Georgian streetscape of Lamb’s Conduit St.

Robinson has just seen the opening of Phase 2A of the Development Control Plan (DCP). The six storey Morgan Stanley Clinical Building – by Llewelyn Davies Yeang, now in liquidation – provides 93 in-patient beds and additional space at the theatres floor on Level 3. Phase 2B, she explains, will involve corrective surgery: after level three floors on the cardiac wing don’t coincide with the rest of the hospital. So LDY is dismantling the wing down to level three, and rebuilding it to connect with Phase 2A to form the £321m new Mittal Children’s Medical Centre. It will also align with the Variety Club Building and the 2006 private Octav Botnar wing on the site’s south east edge, by Anshen+Allen (now Stantec). Although this might seem bizarre, Robinson says the aim is to create east-west connectivity across the site along a ‘Hospital Street’, linking the distinct buildings that pepper the site.

Bang in the middle of the GOSH site, the Mittal Children’s Centre is proving a logistical challenge. LDY Associate architect Mark Gage points out that constructing 2m away from any building would be problematic, but doing so from a fully functioning wing of a hospital requires serious forethought. Hence the Mittal Centre’s emphasis on pre-fabrication. Gage says that anything that could be manufactured off-site and craned in, was; post-tensioned slabs, cladding panels, toilet pods – anything that would minimize the inevitable noise, dust and disruption. That challenge will be re-doubled when the cardiac wing is dismantled. 

The north face of the Morgan Stanley Clinical Wing is the only part of the Phase 2 building that can be perceived by the public.
The north face of the Morgan Stanley Clinical Wing is the only part of the Phase 2 building that can be perceived by the public.

‘Gage makes a key point – you are not treating sick children but sick families, so layouts are designed to facilitate communication and care while maintaining privacy’

Gage says that the DCP is retested with each phase to ensure the aims still tally with modern clinical practice and to draw on lessons from the last phase. In this way, room layouts for the Mittal Centre drew from those developed in the Phase 1 private Botnar wing; slimmed down, but adopting the same clear glass walls to the corridors for clinical observation, outboard private bathrooms, parent/carer sleeping zones that can be curtained off, and nurses’ corridor workstations to allow monitoring without constant intrusion into ‘private’ space. Gage makes a key point here – that you are not treating sick children but sick families, and that carers probably know as much about their child’s condition as the consultants treating them. Layouts are thus designed to facilitate communication and care while maintaining privacy. With optimised accommodation and theatres, Gage refers to it as a clinical ‘black box’.

The role of art has also been implicit in GOSH’s development strategy, with no doubt in the Trust’s mind that it increases patient wellbeing. The result is works like the huge inflatable sculpture in the Botnar wing atrium by Iain Kettles and Susie Hunter, and Jason Bruges Studio’s interactive ‘Nature Trail’ on the theatre floor. Dealing with the sliver of hidden space between the Mittal Children’s Centre and the yet-to-be-demolished Southwood building, architect Studio Weave installed its ‘Lullaby Factory’, an installation that drew on the visual pandemonium of Southwood’s service elevation. Unable to remove any of the pipes, the firm merely added to them, creating a ‘Chitty Chitty Bang Bang’ world of pipes, tubes and horns, together with an enchanting piece of specially composed music by composer Jessica Curry, which every child can listen to from their bedside headsets.

With the demolition of the Southwood building, it’s anticipated that the butterfly will emerge from its enclosing chrysalis. LDY might have produced a clinical ‘black box’, with nothing but its thin north elevation visible to the street, but the intention has always been the full revelation of the west facade when Southwood comes down – hence the facade’s Portland stone cladding. Areas of glazing standing proud from this elevation, Gage explains, articulate the public areas within the cores, while ward rooms express themselves with more conventional fenestration. This elevation will overlook what is deemed virtually impossible on this site – an external courtyard. Perhaps for this reason Robinson, who is used to challenges, seems most animated when talking about this phase of the project. Only accessible via the narrow Powis Place, which links Great Ormond and Guilford streets, Robinson envisions it as a semi-private square, creating a grand entrance for a hospital currently served only by a very underwhelming blue-painted steel and plexiglass canopy. The start/endpoint of Hospital St, the block will achieve three main objectives: to make sense of the internal circulation by declaring it via a large public orientation zone, to make all clinical services available both cross-departmentally and public/private, and to finally give external expression to a world-famous hospital that has been reinventing itself slowly from the inside out and – until that point – virtually hidden from public view.

Architect to the £34.5m Botnar wing, Stantec’s Catherine Zeliotis describes the DCP as a ‘constantly moving target…something with a life of its own’, and believes that this proposal, like all the others, will be open to reappraisal and change. For her, the piecemeal development had led to some interesting eventualities – most obviously the fact that the Variety Club Building sits just where hospital’s courtyard should be. Zeliotis is acutely aware of the currency of a street name- Stantec has been working with private hospital The London Clinic, which has spent millions on a reorganisation that turns its main entrance 180° from Devonshire Place onto Harley St. The two streets might be physically parallel, but are poles apart in branding. She says private trusts pay good money to ensure their doors face the right street.

Robinson meanwhile seems less concerned with this than a bigger idea. The sense of semi-privacy afforded by a courtyard would give it the sense of a communal garden rather than a public square, she says, and more than compensate for the kudos of the street name. And who’s to say she’s wrong? Beneath the landscape of the square she talks of a ‘Discovery Centre’ or a ‘Play Zone’. ‘Like the Tellytubbies House?’ I ask jokingly. ‘Perhaps,’ she answers, seemingly considering the clinical justification of just such a proposal. It won’t be that; but whatever it is, sequestered away from the bustle of London’s streets, you hope it’ll be the hospital’s own take on Neverland.