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The Art of Healing

Next year marks the 20th birthday for Maggie’s Centres, drop-in centres for cancer patients, created by some of the world’s leading architects to engender a healthy environment. What is the legacy of this most design-led of charities and how much of an impact can quality design make on recovery? Abi Millar talks to architectural critic Charles Jencks (co-founder of the charity with his late wife Maggie), charity CEO Laura Lee, and Norman Foster, who is designing a new centre due to open next year.

When Maggie Keswick Jencks died in July 1995, she left behind a tantalising glimpse of what her legacy would be. She had spent the last year of her life drafting plans for a Cancer Caring Centre, and her vision was now starting to take shape. Right until the end, she was buzzing with ideas, raising £70,000 for the fledgling charity in her final month.

Maggie had been diagnosed with advanced cancer two years previously, and had been given just two to three months to live. Treating this less as a grim inevitability and more as a rule to be broken, she adopted what she called ‘guerrilla tactics’: changing her diet, taking up tai chi, and powering through reams of cancer care literature. This battle mentality bought her extra time, and with it, a newfound sense of purpose.

What if there were a designated place, she wondered, to deal with everything cancer entailed? When she received her prognosis, she had been forced to process the news in a windowless hospital corridor; just one in a production line of patients, in an environment of utilitarian gloom. What if there were somewhere they could drop in for support, beyond the hospital itself?

Working together with her oncology nurse, Laura Lee, and her husband, the architectural theorist Charles Jencks, she created a blueprint for the first Maggie’s Centre. This would aid patients practically, emotionally and socially, with a view to extending their life and improving its quality. In contrast to the bleak clinical settings of a consulting room, or the neon lights of a waiting area, the building would offer comfortable surroundings and a view onto nature. It would be part of the NHS hospital, but separate in an important way.

Building hope

With her goal clarified and focus sharpened, Maggie would go on to describe her final year as the best of her life. And while she did not live to see the centre, which opened in November 1996, it clearly fulfilled the hopes she had laid out.

“The first centre was designed by Richard Murphy, an unknown architect who Maggie herself had found through a friend,” recalls Charles Jencks. “We’d interviewed four big architects, but Maggie and I chose Richard because he was committed. Although the big offices were more competent in delivery, they wouldn’t give us the personal service we needed, and with a good architect passion is nine tenths of what you want.”

A converted stable block, in the grounds of the Western General Hospital in Edinburgh, the building was determinedly anti-institutional. With a domestic, kitchen-table feel and a hybrid purpose, it was intended to convey what Jencks calls ‘an architecture of hope’.

Although not intended as an archetype, it would go on to deeply influence the network of Maggie’s Centres that followed. Today there are 18 centres up and running, plus two temporary structures, with four new buildings scheduled to open in 2016. Running alongside some of the UK’s most prominent cancer hospitals, each building provides a different take on Maggie’s original blueprint.

“It’s far more creative than a franchise,” says Jencks. “We have maybe 10 or 20 big functions that have to be incorporated, but the architects have the freedom to customise their design to the site, to the budget, to whatever concept they have. In a way this is a really interesting kind of postmodern paradigm, because there is not one best optimum solution – all the cancer caring centres are different, and they’re all equally good.”

Despite the precedent set by Richard Murphy, most of the architects that followed have been far from unknown. Richard Rogers designed a Maggie’s Centre in West London; Zaha Hadid created the sharply geometric Maggie’s Fife. Frank Gehry completed Maggie’s Dundee in 2003, followed by a Hong Kong building (the first outside the UK) in 2013. Norman Foster is currently working on the largest centre to date, Maggie’s at the Christie, which is due to open in Manchester early next year.

“I have followed the development of the Maggie’s Centres since the first one was built in Edinburgh,” explains Lord Foster. “I believe passionately in the values behind the project – the idea that architecture has the power to lift the spirits and help in the process of therapy. The timing, and the opportunity to design a new centre in the city of my youth, were both right for us.”

The language of health

While this runaway success goes beyond anything Maggie envisaged, it has occurred organically, without any pushiness on the part of the charity. These days, it’s the hospitals that approach Maggie’s about opening a centre, rather than the other way round. And while some of the architects were headhunted (Jencks says he looks for people who are young, local, and on the ascendant), others came to him in the hopes of getting involved.

“Ted Cullinan came up to me at a party, pushed me against the wall, looked me straight in the eye, and said ‘I want to do a Maggie’s Centre’,” he laughs. “At that point we’d already given Newcastle to Foreign Office Architects, but for many reasons the site changed. Laura called me and said help, we need someone to do a new Maggie’s Centre design for Newcastle, and I said – aha, I know just the person.”

Laura Lee, formerly Maggie’s nurse, is now the charity’s CEO, and the client to whom all the architects report.

“We continually come back to, how does it feel to arrive at this building, what does the front door feel like, how does it feel to move into that space?” she explains. “We have a fundamental belief that Maggie’s is about trying to solve a social problem, and the architects need to be given the opportunity to investigate that social problem and come up with the solutions. So although each building might look different, it communicates the same emotional language.”

While today’s hospitals, based on modernist principles, are typically mechanistic and technocratic by design, Maggie’s Centres owe more to an earlier ‘lost’ tradition of healthcare architecture, which can be traced back at least as far as Ancient Greece. According to this model, the mind is as important as the body, meaning a functional, hyper-sterile environment can only take you so far.

Maggie’s Centres, then, provide a haven, but also a view out to nature and the cosmos. They provide spiritual succor (albeit of a non-religious variety), but also a place to receive practical advice. They are pluralist and postmodernist, an antidote to the specialisation that typifies the hospitals next door.

Maggie’s West London, for instance, provides a defensive, domestic refuge within a busy urban site. Maggie’s Dundee, on top of a hill, is designed ‘to engender life and optimism’. And the new Maggie’s at The Christie makes plentiful use of outdoor spaces, as though disappearing into nature.

“Our aim is to create a building that is welcoming, friendly, and without any of the institutional references of a hospital or health centre – a light-filled, homely space where people can gather, talk or simply reflect,” says Lord Foster. “That is why throughout the building there is a focus on natural light, greenery and views. The timber frame helps to connect the building with the surrounding greenery – externally, this structure will be partially planted with vines, making the architecture appear to dissolve into the gardens.”

Coming with age

As the charity moves into its 20th year, Jencks feels there is a growing need for centres of this kind. Like the rest of the developed world, the UK has an ageing population, who are liable to suffer from more chronic disease and spend longer in healthcare settings. Hospitals will need to evolve to accommodate these new demands, which may mean displacing some of their original functions onto centres like Maggie’s.

“I think all the five big chronic diseases should have Maggie’s Centre style self-help organisations because the hospitals need backup,” he explains. “My hope is that hospitals will evolve into a direction that incorporates these kinds of centres, but doesn’t swallow them – they should be administratively and culturally separate. We hope to have a Maggie’s Centre at every single big cancer hospital, developing them one by one. We are complementary to them, yin and yang.”

Towards the end of her life, Maggie Keswick Jencks wrote one should not ‘lose the joy of living in the fear of dying’, which would become a fitting strapline for the centres that bear her name. In the 20 years since she died, the charity has provided thousands of people with a safe space in trying circumstances. At the crux of this mission is good design.

“Each of our architects still gets the same architectural brief that Richard Murphy got 20 years ago, and that is very much about how we want the building to make people feel,” says Lee. “Yes, there are some functions that it needs to deliver on, but our primary objective is helping them feel more in control when they’re anxious and overwhelmed.”

“It sounds corny, but I don’t have a favourite centre,” adds Jencks. “All the buildings are incredibly interesting and moving in provocative in their own way.”

This is the cover story for the Summer 2015 edition of LEAF Review and also appears in Practical Patient Care UK

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