A 'Care Hotel' for the city.

A ‘CARE HOTEL’ FOR THE CITY Exploration of a residential ‘culture of care’ and its future promises.

MURIEL MULIER POSTGRAD HOUSING & URBANISM PROMOTORS: LAWRENCE BARTH AND DOMINIC PAPA YEAR 2019-2020

FOREWORD

This thesis would not have been possible without the careful support of the following people: Thanks to Larry and Dominic, for your boundless commitment and passion during design workshops, while staying critical and thoughtful.

Thanks to Anna, Elena, Irénée and Jorge for your dedication in the program and the instructive courses. You all opened my eyes to ‘talking through drawing’ and infected us with the microbe for good urban practices.

Thanks to my family; Mama, Papa, Harold and Edward, for this opportunity in London and the continuous love and support overseas but also at home during this exceptional lockdown. To my uncle ‘London’ for your hospitality and making me feel like a local.

Thanks to my dearest friends of H&U, even though the goodbye was very abrupt, I’m thankful for the unforgettable experience and to have been able to learn from and with you. Hope to meet you all again in the future!

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TABLE OF CONTENTS

Page

Research questions

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CHAPTER 1: A ‘Care hotel’ framework within the future knowledge neighbourhood.

A. Plurality in the future knowledge neighbourhood.

1.

The neighbourhood, a city building problem.

2.

Drivers of change 2.1.

Role of bio politics towards a plural urbanism.

2.2. The pandemic triggers change in the care landscape.

2.3. ‘Care Hotel’ as a framework.

B. Learning from other genres.

1.

Multiplicity in the genre of hotels.

2.

Empowerment of a community centre. The case of the soviet’s ‘social condenser’.

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CHAPTER 2: Scenario’s of a ‘Care hotel’.

A. Three possible scenarios and their challenges.

1.

Scenario 1: Community 2.

Scenario 2: Research 3.

Scenario 3: Housing

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CHAPTER 3: Designing typologies that can generate new business models.

A. Home as a spatial paradox.

Intermezzo: the genre of care homes.

B. Associative practices. Tension between the individual and the collective.

C. Cooperatives as enablers of a ‘Care Hotel’.

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CHAPTER 4: Design values for a ‘Care hotel’.

A. Adaptive infrastructure.

B. Accelerator of knowledge clusters.

C. Multiplicity in time.

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X. APPENDIX A. Primary care and the significance of community oriented care.

B. Case studies: London vs Antwerp, additional information.

C. Drawings case study scenarios chapter 2.

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Conclusion

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Bibliography

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Introduction

A ‘CARE HOTEL’ FOR THE CITY INTRODUCTION

Neighbourhoods in central city environments are collectors of the rich variety in people’s everyday lives. There is a bio-politics that is driving our understanding of the urban area, health and wellbeing and we should acknowledge it is becoming more powerful.

The integration of health & well-being is closely brought into our everyday life by society and politics. Healthcare is increasingly moving away from ‘cure’ in the direction of ‘prevention’ or ‘care’ and from the hospital setting to a more domestic environment. In 6

our common understanding of providing care, medical services are either clustered around institutions or distributed first line care drop-ins. This separation is outdated.

But today, there already is a spark of proliferation of healthcare services that go beyond the mere provision of healthcare. Business models that exist today are getting close to enabling real change in first line care for the city.

Our organisation of neighbourhoods is easily generated by exclusion, but “It is the difficult unity through inclusion rather than the easy unity through exclusion”, as Venturi argues, that changes everyday life activities by building a more complementary, richer and a more integrated neighbourhood. Inclusion means that within a collection of differences, the plurality is driving spatial organisations and materiality.

We propose there should be a new category that we could

A ‘Care hotel’ as a framework is driven by a local

define as a ‘Care Hotel’. This ambiguous concept could be close

institution that is agile to respond to challenges, values

to our everyday neighbourhood life, driven by the the growth

the provision of research and has a built-in leadership

and proliferation of life science industries with their innovative

and responsibility from within the home that drives a

research, a sense of duty of care and it could be based on different

stronger localism. Through this conceivable genre of

modes of inhabitation that can be short to medium-term.

project, a ‘Care hotel’ as a framework has an effect on

We will argue that a ‘Care hotel’ is not just a new sort of hotel

the concept of the knowledge neighbourhood to provide

neither is it a community centre, these are related genres of

diversity within and a distribution of services outwards.

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architecture.

The ‘future of hospitals’ is much more complex and contradictory This thesis investigates the wider debate of the future of healthcare where urban neighbourhoods are not simply culturally or

through research of thinkers in urbanism and architecture (such

economically driven, but a ‘Collage’ of both, as Colin Rowe argued. as Richard Sennett, Robin Evans and Colin Rowe) and uses We will demonstrate that the ambiguity of the concept of a ‘Care

precedents as part of the research methodology.

Hotel’ is a starting point to rethink dense urbanity with the future challenges healthcare provision will have.

The aim of this thesis is to build up the framework of a ‘Care

Today living and working have been brought closer to each

hotel’ for central city environments, what are their drivers of

other, and as a consequence, this also led to juxtaposing housing

change and which values matter? It would be relevant to test

and health, certainly with the impact of COVID19 healthcare

and develop these concepts further in practicing architecture.

becomes even more centre of our lives and thus in dense cities.

A second trend being observed is the multiplication of actors, where in the UK, for instance, the NHS together with the city councils form crossovers. For individuals and families, how you are balancing between your own surveillance and being part of a shared collective, depends on how networks are built up and how participation is perceived. The care landscape needs both institutional top-down and local associated practices bottom-up.

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Why do we need to update today our notion of a neighbourhood model? Why is the future knowledge neighbourhood driven by bio-politics in need of plurality? Why is the proliferation in provision of care opening the opportunity to be a participant in our everyday neighbourhood?

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Since there is a paradox between the home vs hospital, why is healthcare architecture in need of new business models? Is there a relation between the design question and new business models? Who should take the responsibility in dealing with this ‘bio-power’?

01 A.

A ‘CARE HOTEL’ FRAMEWORK WITHIN THE FUTURE KNOWLEDGE NEIGHBOURHOOD.

PLURALITY IN THE FUTURE KNOWLEDGE NEIGHBOURHOOD.

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1. THE NEIGHBOURHOOD, A CITY BUILDING PROBLEM.

Understanding how cities work and perform, can be explored from the neighbourhood. It allows to explore how an urban area works through its formal consistency and its performance and, more importantly, how future change might take place. The concept of the neighbourhood relies on our immediate community and our access to services. In 1943 drew Patrick Abercrombie drew London’s community map, often referred to as the ‘Patato plan’. Through his social and functional analysis, he defines London as a collection of self-sufficient entities, some act as ‘villages’. He was convinced that the spirit of the depicted communities would be blurred around their boundaries and definitely get lost in the growing sprawl in the 20th century.

So which model should we use today when we describe a neighbourhood and what size and scale are we envisioning them? Let us compare two central city neighbourhoods, as an example, London, Pentonville and Antwerp (Belgium), ‘het Eilandje’.

London’s fabric is neither a complete street-based or deep block fabric; the fabric has perturbations where corridors, high streets and urban roads shift the traditional terraced housing or the deeper modernist blocks. In this synchronic evolution London consist of many differences sometimes very close to each other. Whereas London, with its rapid expansion since the Industrial Revolution, is a polycentric model, comparing this to the city of Antwerp, as a traditional European city there is still a clear historic centre, Antwerp is mono-centric. Both harbour cities have one side of the river that is only later on developed and tied together with the central city centre (Southbank in the case of London and Left bank in the case of Antwerp).

Pentonville lies squeezed east-west between two transport hubs, King’s Cross and Angel and is today at the border of Islington (with a density of 69 dwellings/hectare1) with Camden. It used to be dominated by wharves, warehouses and railways, that’s why Pentonville is left out in-between Abercrombie’s ‘villages’. Similarly in Antwerp, the harbour used to be really close to the historical city centre with a docks system, ‘het Eilandje’ today is a gentrification area with a slow conversion of the warehouses to cultural institutions, housing and workspaces.

Within a walkable distance, Pentonville is accessed through its transport 1 ‘Number and Density of Dwellings by Borough – London Datastore’. [n.d.]. <https:// data.london.gov.uk/dataset/number-and-density-of-dwellings-by-borough>[accessed15September 2020].

hubs and has a proliferation of health technology firms around the transport hubs and the east-west corridor Euston road. Beyond the corridor, on a second row linear slabs of modernist housing estates dominate the fabric. Along the Regent’s canal we can find already a lot of converted former warehouses into offices or housing. On ‘het Eilandje’ in Antwerp, the size of a building block is much deeper (100x100m) since they follow the dimensions of the former warehouses in the dock area. Conceptually these two neighbourhoods are both well accessible areas and potentially interesting for thriving mixed-use future central city environments. The presence of major universities and research institutions in the area adds to this potential.

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Figure 1 // Forshawâ&#x20AC;&#x2122;s London community map, Patrick Abercrombie 1943. The mentioned Pentonville area is indicated.

There is also an argument for shifting the focal point of knowledge clusters back to the core of the city.

Central city fabrics can benefit from the potential of logistics and services that already exist, while it is much harder for satellite campuses to reach that same diverse network. Moreover, central city areas can more easily accommodate small and medium enterprises, certainly an advantage for start-ups and entrepreneurial business.

So a knowledge neighbourhood takes advantage of the proximity of knowledge based activities but also pays off for the community where it is inserted. “This growing emphasis upon knowledge has been influential in shaping new conceptions of urban and regional development policy and strong claims have been made as to the potential of such developments for urban and regional regeneration.”4 Hence, civic life needs to support these knowledge networks and in itself rests upon the inclusion of residential life.

2 Hudson, Ray. 2011. ‘From Knowledge-Based Economy to … Knowledge-Based Economy?

Reflections on Changes in the Economy and Development Policies in the North East of England’, Regional Studies, 45.7: 997–1012 https://doi.org/10.1080/00343400802662633, p.998.

3 New London Architecture (Organization). 2018. Knowledge Capital: Making Places for Education, Innovation and Health.

4 Ibidem.

Figure 3 // John Roque map 1740 of London.

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Figure 2 // Antwerp and its fortification 1850.

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As a concept in these central city environments, neighbourhoods have the tendency to attract knowledge. From big anchor institutions to spin-off start-ups, from reliance on big arteries to reliance on finer grain fabrics that are much less prominently visible. Translating their variety of sizes provides opportunities for a diverse, collaborative and competitive knowledge neighbourhood. So the model of our future neighbourhoods needs adjustments, we place a greater emphasis on resources for learning for example. School networks today also go beyond the classroom and involve different partnerships such as foundations, sportive extracurricular organisations, research centres and libraries.

The knowledge neighbourhood is driven by a knowledge economy; defined as an economy of intensive knowledge based activities that through ‘cross-fertilisation’ are boosting the advances in research and development based on intellectual capacities instead of natural resources.2 Proximity to certain anchors (such as hospitals, research institutes and universities) can create clusters, as we can see around King’s Cross in London, with institutions such as the Francis Crick institute, Wellcome collections, British Library and the UCL. ‘A ‘cluster effect’ is set in motion as a range of knowledge economy businesses who related to be close to the anchor.’ 3 King’s Cross is very different from the typical example of a knowledge cluster such as Kendall Square in Cambridge, Massachusetts planned around the campus of MIT. If Kendall Square has been a planned innovation district, then King’s Cross has mostly grown unplanned as a redevelopment of former industrial sites around transport hubs.

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Figure 4 // Academic clusters in relation to Community services of Care Company Antwerp.

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Figure 5 // Research and Academic clusters in relation to their satellite campuses London.

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Figure 6 // Clusters in Antwerp, ‘Het Eilandje’; 74 hectares, 13 inh/hect (and rising since 2017).

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Figure 7 // Clusters in London, Pentonville (Islington); 62 hectares, 138 inh/hect (2019).

2. DRIVERS OF CHANGE

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2.1 Role of bio-politics towards a plural urbanism.

In recent years we have seen significant shifts in the understanding of the relationship between health, well-being and urban area. The integration of health & well-being is closely brought into our everyday life by society and politics, healthcare is increasingly moving away from ‘cure’ in the direction to ‘prevention’ or ‘care’. This means a shift from the hospital setting to a more domestic environment. This process has been facilitated by the rapid development and innovation in the life sciences sector in production, research, systems of care and education. For example, remote monitoring through tele-medicine. The life science industry is, in the case of the UK , one of the most rapidly growing sectors of both the nation and the metropolitan economy, mainly driven by the ‘Golden Triangle region’ (London, Oxford, Cambridge) it contributes to an annual £74 bn in output.5 Reinier De Graaf from OMA, points out that in a society where the elderly are likely to become the many and the care givers the fewer, patients become clients and doctors enterprisers. Healthcare institutions are subject to the laws of the market economy. At the same time beingwell is much more a personal responsibility and the shorter the stay in the hospital is for the better.6 There is a fundamental rethinking of healthcare provision needed in order to be agile for the next great challenge. For our concept of the neighbourhoods this means that our networks, especially in the case of health and well-being, need to be agile and based on trust in order to collaborate.

The use of the term bio politics in this context has a historically loaded meaning, some poststructuralists use it with the meaning assigned by Michel Foucault at first in his book ‘History of Sexuality’ in 1976, in the meaning to ‘ensure, sustain and multiply life, to put this life in order’7 .

Others denote the term to studies relating to biology and political science.

In relation to healthcare specifically, Foucault argues it is illusory to think about healthcare as something that would cover all the needs of every individual in terms of health. In this modern era, there is not a clear difference between the healthy and the un-healthy anymore, but rather there is a developed ‘bio politics’ that makes every individual aware of her/his own health. There is an awareness of an impossibility of a perfect health and this also implies that there is a norm that has to be considered of what can be covered and what not.

This norm, Foucault argues, is not implemented by a power of law but 5 ‘Knowledge Networks: London and the Ox-Cam Arc’. [n.d.]. New London Architecture<https://nla.london/insights/knowledge-networks-london-and-the-ox-cam-arc> [accessed 9 August 2020],p.5.

6 ‘Reinier de Graaf : « L’hôpital du futur devra être plus qu’un hôpital »’. 2019. Le Monde.fr<https://www.lemonde.fr/idees/article/2019/11/15/reinier-de-graaf-l-hopital-du-futur-devra-etre-plus-qu-un-hopital_6019345_3232.html> [accessed 15 September 2020].

7 Foucault, Michel, and Robert Hurley. 1998. The Will to Knowledge, The History of Sexuality, v. 1, Amended reprint (London: Penguin Books), p. 139.

driven by what politics and economy construct as the norm. This ‘biopower’, as he names it, is the mechanism behind ‘bio-politics’ that places basic biological features of human species as object of a political or general strategy of power.8 Specific political transformations, depending on capitalism, sovereignty and neoliberalism each regulate a population to regulate a series of biological processes, such as birth rates, mortality, life expectancy. And regulating these would result in having a stronger influence and control over a population.

So we have a health obsessed society, and this was already the case before COVID-19 hit our lives and economies in early 2020. In this society the idea of being ‘healthy’ goes further than only an absence of ‘illness’. It has expanded to a general well-being concerning all types of functioning.

Today, individual initiatives and voluntary biomedical technology support a new environmental urban planning policy. The challenge in these debates, however, is that often “Health is a desired state, but also a prescribed state and ideological position.”9 Contemporary architecture and urban planning can address very obvious concepts as ‘community’, ‘green’, ‘city’ and ‘body’. As Tafuri or Sennett have written about the ‘City as a body’, we do not speak about tissue regeneration anymore, but about a ‘surgery’ technique. Specialised care environments use an emphasis on green inner-outside relationships (think of the courtyards in Maggie’s centres or Herzog and the Meuron’s REHAB centre), they are a contradiction to the supposedly harmful urban lifestyle. In this way Roger Ulrich’s research, from 1984, on the positive effect of the view from the patient’s room on the healing process is still regarded as breakthrough.10 But we can also be sceptical about the much used techniques in healthcare architecture.

Think of that bright colour of a patient’s room or the green in the patio or the domesticized sofa in the waiting room. Can these be exactly measured and earn the title of an effectively ‘healing or therapeutic’ environment?

If, eventually, bio-politics has the power to transform urban areas, how should we organise our future neighbourhoods in contrast to previous concepts? Today, common understandings of medical services are seen as either clustered around institutions or distributed first line care dropins. The separation of concentration and distribution resonates with earlier Modernist ‘zoning’ principles, where health care community centres were 8 ‘Foucault and Healthcare: A Biopolitical Problem’. 2013. THE FUNAMBULIST MAGAZINE<https://thefunambulist.net/history/foucault-foucault-and-healthcare-a-biopolitical-problem> [accessed 15 September 2020].

9 Zardini, Mirko, Giovanna Borasi, Margaret Campbell, and Centre canadien d’architecture (eds.). 2012. Imperfect Health: The Medicalization of Architecture, 1st ed (Montréal: Canadian Centre for Architecture : Lars Müller Publishers), p.16.

10 Ulrich, R. 1984. ‘View through a Window May Influence Recovery from Surgery’, Science, 224.4647: 420–21 https://doi.org/10.1126/science.6143402.

placed as separate elements, often central in deep residential blocks. They worked as ‘stamps’, as new elements in the neighbourhood. This is exactly what we have seen in old models of the ideal neighbourhood, like Clarence Parry’s model with community centres and neighbourhood institutions inserted right in the middle of the neighbourhood. We can imagine that general practitioners and doctors in old neighbourhood models would be fairly centralised and visible in a dominant residential community.

an initiator for an alternative culture of care for the sake of the community around it, very different from the growing and clustered ‘big machine’ institutions of the National Health Service (NHS).

Robert Venturi in ‘Complexity and Contradiction in Architecture’, sees the city not as an obligation to a perfect unity. The organisation of neighbourhoods is easily generated by exclusion if it is only residential, cultural or economic. But Venturi argues that

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Figure 8 // Ideal Neighbourhood model for metropolitan areas of a 160 acres for 5000 people, half- mile radius, on a 5 minutes walking distance, designated ‘zoning’ of programs. Model by Clarence Perry 1929.

Problematic about this model is the separate zoning of cultural or economic life as something mono functional, that would dominate the nature of the 160 acres with the exception of some central placed community institutions. Richard Sennett argues that it is precisely the difference between and even inside neighbourhoods that is the instrument that can be used to bring elements closer. In practice, in my opinion, cities are complex, full of layering and planning should address neighbourhoods as the sum of its differences driven by its culture, geography and history.

Modernist thinking started a chain of thoughts where bio-politics’ influence on a neighbourhood was explored. In the modernist tradition, a health care centre, for example Peckham centre in London, placed the individual focus on a ‘healthy lifestyle’. Moreover, these health centres were

that changes everyday life activities. As a result, this leads to a more complementary, richer and a more integrated neighbourhood.

Changing the healthcare culture of a neighbourhood will take time and there should be a respect for difference and also an overlay of a new hierarchy. “This difficult whole can include a diversity of directions, … there can be an extreme multiplicity that still reads like a unity through a tendency of the parts to change scale, and to be perceived as an overall pattern or texture.” 12 When we want to accommodate difference, this asks for a sense of plurality. Our fundamental concept of the basics of a city needs to change through a pluralist design. Ryan Brent in ‘The Largest Art’ argues that plurality is already embedded in cities and sometimes beyond the control of the designer, those city’s plural elements – imagined for more than a single design solution - become more powerful. “By incorporating the city’s plural elements.. urban design becomes more democratic, participatory, open-ended and infinite.” 13 The inclusion we anticipate, as Venturi had argued, means that as a collection of differences, it is plurality that is driving spatial organisations and materiality.

Take the contrast between inside and outside, it might be seen as a major manifestation of contradiction in architecture, but a continuity inside-out is nothing new, from the Renaissance church exterior to the‘flowing space’ in the modernist Barcelona pavilion. This promotes a unity of inside and out, without a separateness of horizontal and vertical planes. Architecture can mediate between leaving space that is static and non-static, specific and general. This links back to Colin Rowe and Fred Koetter’s critique on the utopian ideal city, that in reality the ‘collage’ technique as a planning tool serves an ambiguity14 , just like the nature of the city, both distinct and plural.

11 Venturi, Robert. 1977. Complexity and Contradiction in Architecture, The Museum of Modern Art Papers on Architecture, 2d ed (New York : Boston: Museum of Modern Art ; distributed by New York Graphic Society), p. 88.

12 Ibidem.

13 Ryan, Brent D. 2017. The Largest Art: A Measured Manifesto for a Plural Urbanism(Cambridge, Massachusetts ; London, England: The MIT Press),Chapter 1, p. 2.

14 Colin Rowe and Fred Koetter, Collage City, (London: The MIT Press, 1978) p. 117.

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“It is the difficult unity through inclusion rather than the easy unity through exclusion” ,11

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2.2. The pandemic triggers change in the care landscape.

We stated before that the notion of health and well-being comes at the centre of a concept of a knowledge neighbourhood, associated with global bio-political trends. Let’s look at these trends in the healthcare sector, especially triggered by the COVID19 pandemic.

The extraordinary event of the pandemic had shown the collapse of infrastructural systems, economic breakdowns and the failure of a government to act quickly to protect public health. If we take the longterm perspective on fundamental change in our cities, it will for sure leave emotional and financial scars and mark our relationships based on distancing in new patterns of association and neighbourliness. We can ask ourselves, wasn’t the geometry of proximity in neighbourhoods already changing before March 2020? An increase in local awareness, production, consumption and action from associative collectives was already moving.

The pandemic made it clear that localism is growing in importance and that our close networks need to be strengthened. These are a promise for mutualism in the future.

The COVID19 pandemic highlights the challenges in the healthcare sector, think of care homes at the front line (certainly in combination with the current demographic shift in an ageing society), the inequality in access to care and the access to resources when boundaries are in place. Physicality has been replaced by horizontal processes that are dispersed and can include physical, affective and virtual networks of care. The latter, the increase in technology tools, has boosted since the pandemic. Pekka Kahri, technological head officer of Helsinki University hospital stated: “Covid19 has accelerated the adaption into digital healthcare and telemedicine solutions”. 15 Specific digital online consultant one-on-one will take place rather than GP visits, new AI triages approaches reduce costs for care paths for both first care and urgency assessments. These developments have the potential to make the notion of ‘caring for’ more and more disembodied.

Therefore, it is important that

only be digitally networked, but also be embedded in well-connected, adaptable and responsive approaches to the neighbourhood it is located in. Literature in health geography has taken a hold of the term ‘landscapes of care’. Such landscapes are an analytical framework where diverse care and care relationships are located, shaped in and stretched in socio-spatial dimensions beyond the health domain, political institutional arrangements, culture, home and the family.

The trend of a search for alternative spaces of care, such as halfway housing, supported accommodation, care homes, assistance living... was already there before the pandemic and rethinks the boundaries of public-private, institution-domestic.The relocation of care is often deinstitutionalised and brought into the home, where ‘care in place’ is invisible. “‘Invisible care’ is given by default and embedded into our daily lifestyle that comes naturally.”17 For example, support from friends, family or the close community takes up a significant part of the support system.

The home can be seen as a spatial paradox both considered as a good and bad place, dependent and autonomous. On the downside, this distribution of the care landscape can cause a significant loneliness, disruption of interactive communities and insecurity regarding access to personal data when using digital technologies as alternative check-ups. That’s why concepts as density and richness especially in central city environments still matter. So in my opinion it is wrong to simply think of density as the worst ‘enemy’ during the pandemic. Density brings mutualism and a common attitude.

“Caring about should be understood as an embodied phenomenon rather than a disembodied experience, even where care is physically distant. It can occur across space and time zones and manifest though a variety of forms of contact.” 16 As a consequence, clusters of concentrated medical expertise should not

15 Finnish start-ups in digital healthcare, HCH Health TV. 2020. How to Combat Covid-19 with Digital Care Pathways Webinar Key Points<https://vimeo.com/434981971> [accessed 15 September 2020].

16 Landscapes of care from a health geography perspective.

Milligan, Christine, and Janine Wiles. 2010. ‘Landscapes of Care’:, Progress in Human Geography<https://doi.org/10.1177/0309132510364556>.

17 Vlaams Bouwmeester. [n.d.]. ‘Pilootprojecten Onzichtbare Zorg’ <https://www. vlaamsbouwmeester.be/nl/publicaties/pilootprojecten-onzichtbare-zorg>[accessed 15 July 2020], p.6.

18 Harari, Yuval Noah. 2020. ‘Yuval Noah Harari: The World after Coronavirus’, Financial Timeshttps://www.ft.com/ content/19d90308-6858-11ea-a3c9-1fe6fedcca75.

19 Damluji, Hassan. 2019. The Responsible Globalist: What Citizens of the World Can Learn from Nationalism(London: Allen Lane, an imprint of Penguin Books), p.9.

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The global impact of COVID19 is out of the ordinary, only partially comparable to the historic 14th century Black death or the early 20th century Spanish flu. This global problem asks for a global response, where globalism doesn’t always seem to live op to its reputation and provide true solutions. Moreover, the crisis is responsible for a certain disunity and a rise of individualism. But, as Yuval Noah Harari argues in the second part of his article “the world after coronavirus”, every crisis creates an opportunity, the world is in need of global solidarity and co-operation to solve things effectively. “We need to trust scientific data and healthcare experts over unfounded conspiracy theories and self-serving politicians.” 18 During the pandemic, neighbourhoods with strong mutual aid and a collective consciousness thrive in their localism. So what if the distinction between globalism and nationalism is not so far apart, as Hassan Damluji argues in his book ‘The Responsible Globalist’? Somewhere where the powerful sense of belonging, that nationalism has created (and now is even stronger than ever) informs the global level, witch the aim of building together an inclusive global nation. 19 This is precisely how the knowledge neighbourhood works, with both international research collaboration ànd local exposure, possible interactive by its adjacency to other collaborators and overlapping between neighbourhoods.

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2.3. A ‘Care hotel’ as a framework.

Let’s suggest there is a new category as part of the ‘care landscape’ that we could define as a ‘Care Hotel’. This ambiguous concept would be firstly close to our everyday neighbourhood life secondly take advantage of the culture of a research community and support affiliations and networks of the bio-economy. Thirdly, the closeness to residential life, creates a possibility for short to medium term stay. A ‘Care Hotel’ takes on the duty and responsibility of care in society. In itself it is a reflection or ‘Collage’, like Colin Rowe’s technique, of all the possibilities of the complex care system, but taking therapeutic lifestyles and new bio-economy services as a starting point. The ambiguity of the concept of a ‘Care Hotel’ is a possible medium to rethink urbanity in relation to the future challenges in healthcare provision. A ‘Care Hotel’ is not precisely a hotel and it doesn’t repeat the notion of a community centre. If we want to think about how to reach out to our homes and think of making healthcare closest to us, how does this framework become more ‘visible’ instead of ‘invisible’ partnerships distributed within the knowledge neighbourhood?

This care network wants to be located in places that are well connected and in close proximity to local and more sustainable fine grain as supply chain, local talent resources, civic amenities and other work related activities.

As a second consequence, employment opportunities and a shifting of social responsibilities occur within this network with a proliferation of alternative places of care. The demand for a greater range of educational and professional skills comes together with the social responsibility and involvement of the local community.

If innovation in life sciences becomes more urbanised, away from the notion of a typical ‘60s separate science park or creative village, then housing becomes a necessary part of the mix. Healthcare gets closer than ever inside our homes and innovation such as tele-medicines, ‘care in place’ changes our domesticity from within. Innovation means always that there are certain risks, economical but also reflected on how robust and dynamic urban life around it can be. Current changes in work-based networks and the emergence of life-long learning changes how we design Since inclusivity is a unity of differences, a ‘Care Hotel’ is not one single neighbourhoods as a key piece of the city. typology or a single handed solution. It is a framework used to rethink urban and spatial design. It envisions certain opportunities. As a first consequence, healthcare becomes connected to an economic expansion that demands new partnerships and a different kind of knowledge and expertise. In this business model both interdisciplinary and specialised knowledge become part of a true care network. Networks in economic terms are defined as

“a set of reciprocal, reputational or customary trust and cooperation-based linkages among actors that coalesces to enable its members to pursue common interests”.20

► Figure 9// Possible spatial adjacencies and relations for a ‘Care Hotel’.

20 Cooke, P. 2001.‘Regional Innovation Systems, Clusters, and the Knowledge Economy’, Industrial and Corporate Change, 10.4: 945–74 https://doi.org/10.1093/icc/10.4.945, p.953.

write-up

nurse station Patient records blood test Reception waiting room

consultation

lecture

yoga cafĂŠ - restaurant

gymnastics

lab space

test patients

collaboration

interview

robotics

library

digital library

shared living

therapy space

health check-up single care room

guest room

shared dining

shared kitchen

shared terrace

exposition

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conference publication results

B.

LEARNING FROM OTHER GENRES.

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1. MULTIPLICITY IN THE GENRE OF HOTELS.

A‘Care Hotel’, hints at the multiplicity of shared space that is already present in the genre of hotels. The Chelsea hotel in New York, for example, was conceived around a shared attitude of a collective creative culture. As an early cooperative, the Chelsea hotel was one of the “Hubert Home Clubs” models located in the centre of New York’s the early 20th century theatre district. The Chelsea is a combination of both individual developments in different types of apartments (see figure 12), often named as Aparthotels21 today, and driven by the purpose of a creative collective life. Many famous artists have stayed at the Chelsea hotel for example. The individual cell is shaped differently according to the needs, which resulted in a variety of types. On the other hand, collectively this scheme shows a joint stock of collective spaces; some units were built without a kitchen and offered flexible spatial solutions, allowing inhabitants to combine or split spaces.

In this age of sharing economy and a growing importance to local areas, we see in the hotel genre that consumer demands have been broadening the spectrum and diversity of accommodation, think of Airbnb and WeWork that are blurring the boundaries between life, work and play.

‘As hotels have become more visible and accessible within the urban landscape, people feel more welcome to use their spaces in ways they may not have in the past. Successfully turning outwards, hotels are opening up their social spaces for visitors, workers and the local community.’ 22 As the hotel business has significant challenges during the COVID-19 crisis, they are looking for new ways to do business, and integrating closer with their community may offer opportunities.

Another way to refer to hotels, connects to the trend of single-person rooms in hospitals specifically. Hospitals as long skinny blocks, pulled out into loops and chains often appear to result in hotel-like strings of double-banked perimeter rooms. This lay-out refers back to concepts from the 19th century, where Nurse Florence Nightingale drew out slender connected blocks ensuring segregation of infectious patients, goodcross ventilation, supervision and specific ward systems (see figure 10)23.

Healthcare architecture today isn’t very different from the pavilion model with separate wards (see figure 11). Moreover, the pavilion plan had – 21 Aparthotels serve a market for people who are looking for comfortable, often longer-term accommodation, providing a similar lifestyle and facilities of a home, whilst on a more affordable basis compared to a traditional hotel, usually in central hub locations.

22 ‘London’s Hotels: Expanding Social Spaces’. [n.d.]. New London Architecture <https://nla.london/insights/londons-hotels-expanding-social-spaces> [accessed 15 September 2020].

23 Wilson, Rob. [n.d.]. ‘How Hospital Design Is Being Shaped by the Trend for Single-Person Rooms’, Architects Journal<https://www.architectsjournal.co.uk/buildings/how-hospital-design-is-being-shaped-by-the-trend-for-single-person-rooms/10019396.article> [accessed 3 August 2020].

besides its faults – retained an architecture that is closer to the ‘human scale’. Victoria Bates highlights in her article, ‘Humanizing healthcare environments’, that in this way the Pavilion plan replicated the wider aims of humanistic treatment: building a community, while acknowledging the individuality of patients within it.24 The renewed emphasis on the importance of architectural layout of new hospitals with anonymous single-person rooms is viewed by some as a ‘me’ oriented consumer/service culture. The design is often a reflection of the number of beds, as a calculable unity for the healthcare sector driving the form. But what might seem a luxury for a day, can rapidly become lonely for many.

“To create the truly ‘long life, loose fit’ city that will meet the changing demands of the health and education sectors, we will need different building typologies and approaches to planning.” 25 ‘The care hotel’ takes healthcare as a driver of urban forces, with the aim to relieve pressure of the institutional primary hospital care. Domènech and Tirado refer to this replacement of traditional arrangements as‘extitutional arrangements’. “The excitation represents a deterritorializarion of the institution and its remanifestation though new spaces and times which potentially end the interior/exterior distinction of the institution.”26 New building types that start to appear are, for example, labelled as patient hotels, step up/step down services, halfway homes, medi-hotels or ‘Care hotel’. All of these provide alternatives to hospitalization through short or long term residential services for patients, and often their families, with a combination of psychosocial and clinical support.

From an urbanistic point of view, similar to hotel chains or models, a ‘Care Hotel’ is not one focal point of a city or neighbourhood that comprehensively incorporates a set of functions, but a concept that could be largely distributed. Especially in the post-war era, transatlantic chains, for example Conrad Hilton’s chain, have epitomised the concept of a modernist, universal and predictable accommodation, lobbies, bars and restaurants are designed to be identical around the world.27 The trend of distribution of services can also be found in therapy and care in the framework of a care landscape, not as generalised as in the genre of hotels, but serving a purpose by connecting to the specific neighbourhood and forming networks around an existing and new shared care knowledge.

24 Bates, Victoria. 2018. ‘“Humanizing” Healthcare Environments: Architecture, Art and Design in Modern Hospitals’, Design for Health, 2.1: 5–19 https://doi.org/10.1080/24735132.2018.1 436304,P.13.

25 New London Architecture (Organization). 2018. Knowledge Capital: Making Places for Education, Innovation and Health, p.42.

26 Milligan, Christine, and Janine Wiles. 2010. ‘Landscapes of Care’:, Progress in Human Geographyhttps://doi.org/10.1177/0309132510364556, p. 756.

27 Avermaete, Tom, and Anne Massey (eds.). 2012. Hotel Lobbies and Lounges: The Architecture of Professional Hospitality, Interior Architecture (London ; New York: Routledge), p.8.

►

Figure 11 // IGLO care home on the left bank of Antwerp as an infill strategy

►

Figure 10 // ‘The Pavilion model’ for the St. Thomas Hospital, published by

Nurse Florence Nightingale after her return from the Crimean war (1854-1856).

in a deep modernist ‘super block’ by De Smet Vermeulen architects, 2014.

23

► Figure 12// Ground plan of the Chelsea hotel with a variety of types and a broad corridor to gather. ►

Figure 13// Functional diagram of free open plan of hotels today.

24

2. EMPOWERMENT OF A COMMUNITY CENTRE. THE CASE OF THE SOVIET’S ‘SOCIAL CONDENSER’.

The importance of a local network of care often linked to a ‘community of care’ is placed in these new spaces of care outside traditional institutional environments. Community centres symbolise not ‘the big things’ but the ordinary, everyday and mundane architecture in which they are often located in repurposed buildings. A new construction of a community centre though, can be seen as a symbol of both a local community and its local policy at a specific moment in time. Through entrepreneurialism a community can be empowered and have spin-off benefits. 28 Let’s look into the genre of community centres, arguably the Social Condenser, promoted by Soviet Constructivist architects during the late 1920s. It was a powerful architectural-ideological concept. The Social Condenser, with the archi-type of the Narkomfin Communal House in Moscow, was an attempt by the early Soviet state to reconfigure daily life, form a new social life and it enables the transition of a Soviet society into the new level of social evolution. Often Social Condesers have a negative connotation linked to a repressive communist way of shaping people. In the OMA book Content a social condenser is described as: “Like electrical condensers that transform the nature of current, the architects’ proposed ‘Social Condensers’ were to turn the self-centered individual of capitalist society into a whole man, the informed militant of socialist society in which the interests of each merged with the interests of all.” 29 None of its 54 units had a dedicated kitchen. Instead, the building was built with a communal kitchen, laundry, crèche facilities, a library and gymnasium (see figure 15), with the aim to stimulate an ethos of self-improvement and a more socially engaged lifestyle. As such was the Narkomfin as ‘social condenser’ used as a blueprint for all housing for the Soviet Union on the basis of these orthogonal forms and later inspired post-war housing all over Europe with Le Corbusier’s Unité D’Habitation for example. Problematic is that the social condenser was an exact copy-paste in different neighbourhoods and not highly programmed, which resulted in a lack of purpose.

class health provision was quite different at that time from the state health provision elsewhere in the UK.30 The literal transparency of the Peckham health centre was a dominant feature that allowed visual contact between activities. The Health centre was progressive for its time, notably ”in its radical and preventative approach to public health provision in which the emphasis truly was on encouraging healthy lifestyles and forms of recreation, rather than on treating ill-health.”31 This was already following the shift from ‘cure to care’, as mentioned before.

Historically, healthcare centres, often embedded in a housing estate, like the Finsbury or Peckham health centre, served an accessible, affordable service of primary care and had an accountability towards the community around it. The Peckham Health centre, opened in 1935, was run as a membership organisation with members active in the management of the centre. The philosophy of an ‘individual free development’ for a working28 Thornham, Helen, and Katy Parry. 2015. ‘Constructing Communities: The Community Centre as Contested Site’, Community Development Journal, 50.1: 24–39 https://doi.org/10.1093/ cdj/bst088,p.25.

29 ‘Revolution and the Social Condenser: How Soviet Architects Sought a Radical New Society’. [n.d.]. Strelka Mag <https://strelkamag.com/en/article/architecture-revolution-social-condenser> [accessed 10 August 2020].

30 Worpole, Ken. 2000. Here Comes the Sun: Architecture and Public Space in Twentieth-Century European Culture(London: Reaktion Books), p.59.

31 Vronskaya, Alla. 2017. ‘Making Sense of Narkomfin’, Architectural Review<https:// www.architectural-review.com/essays/making-sense-of-narkomfin> [accessed 10 August 2020].

► Figure 14/ Socialized or sociable? The inside of a social condenser in operation.

Zuyev club oscow, by Golosov 1928.

25

►

Figure 15 // Narkomfin’s individual and collective space .

► Figure 16/ Open air exercises at the Peckham centre, South London, 1935. Designed by Sir Owen Williams.

Genre

Community centre

Hotels

‘Care hotel’

Organisational

It used to be a social condenser, a multifunctional space.

Are a multiple of collective spaces, diversity from individual to collective space.

A multiple of collective space around the notion of health and well-being.

Morphological

Since they are too generic, they are lacking purpose.

Since they are too generic, they are lacking purpose.

Not a ready-made unique solution, different scenarios possible with different purposes.

Urbanistic

In the old neighbourhood model, placed on one focal point in the neighbourhood.

In the case of a chain, part of a distributed system.

Embedded in a distributed system in the neighbourhood.

Figure 17 // Summary of similarities and differences of the Care hotel and the genres of the Community Centre and Hotels.

►

26

CONCLUSION CHAPTER 1

In this way healthcare centres resemble community centres, by providing a service to the community around it, with the difference that the whole program focuses on a healthcare and well-being lifestyle (see figure 17). So we can argue that these genres are not as differentiated today anymore.

Driven by trends in bio-politics, there is a need to look for a new type of framework of spatial organisation that can provide a collage of a differences, a plurality in the ‘care landscape’. Major trends we discussed are the shift from ‘cure’ to ‘care’, care in place, deinstitutionalisation, telemedicine and a growing third generation. The fundamental concept of the knowledge neighbourhoods is not realising one growing cluster topdown and continuously adding new elements to a ‘big machine’ like a hospital. It has been argued that there is an opportunity to link everyday neighbourhood life together with care proliferation instead. Away from the Clarence Perry’s model of the neighbourhood that uses a‘zoning’ principle of simply colouring a zone A ‘or’ B towards a possibility of overlaying A ‘and’ B. Is our own well-being most importantly in alignment with good community practices? Or is it today only research-driven under the ‘bio power’ pressure? Or is well-being in the future only a characteristic of our residential environment? A ‘Care Hotel’ is in this way not one of these 3 scenarios, but a diagnostic tool to think about our neighbourhood. It is an in impulse to proliferate knowledge and associated practices that can immerse in the neighbourhood. These scenarios’ will be further explored in chapter 2. The research outcome of this thesis doesn’t need to portray one specific space or city. Rather a ‘Care Hotel’ is a way to update principles by which we can define our understanding of the neighbourhood in a plural way, acknowledging its differences depending on various conditions.

02

SCENARIO’S OF A ‘CARE HOTEL’.

Let’s look into 3 possible scenarios, the Community, Research and Housing centre. These 3 are explorations towards forming an argument of an integrated ‘Care Hotel’.

Each scenario is based on existing exemplars; one exemplar being linked to healthcare, but for comparison purposes, we also refer to exemplars unrelated to healthcare. Each scenario looks for the challenges in each specific case and concludes with a larger aim of that scenario.

27

Urban challenges differ according to their context, the dominant morphology in our 3 dominant scenarios can be described as: Regeneration transport hub (1.East village Olympic Park, London), dense institutional cluster (2.Hampstead, London), traditional campus model (3.Rigshospitalet, Copenhagen).

East Village

Hampstead

► Figure 18/ The three examplary projects for three scenario’s.

Copenhagen

28

1. SCENARIO : COMMUNITY

Today we can advocate for a more pluralistic and participatory approach to community centres, where the state is not functioning on its own but in partnership with NGOs, community organisations and entrepreneurial collectives.32 Let’s imagine a first possible scenario that starts from bringing a wellness and therapeutic environment as a service within a community centre. Since there is a general trend in health and wellbeing towards a holistic treatment, what is referred to as stimulating a healthy lifestyle, healthcare facilities as preventive places should not be hidden but integrated with the public space or the city. Community centres today are mostly driven by a quite specific program, such as a sport complex for example. This rigid program, as we can see in the case study of the Xaverianen centre for example (see figure 19) works as a large shed structure with the indoor sport fields as mayor part. The community can however use the same space for events, lectures, expositions. The former friars of the monastery built the community centre on their property and took into account that the newly built university across the street could also use these same services.

The accumulation of shared experiences in our everyday life and our culture is what makes our neighbourhoods connected despite their differences.

By bringing health and social care services in the same physical space, users and their caregivers can easily access support services and build up informal linkages among different service providers. In the domain of mental health, we can see that community hubs become of growing importance as an accessible component for the whole neighbourhood.

They are not only based on a sensible economic decision or a need to leave pressure of hospital-based care. Community hubs for mental health go beyond the stigma, that they are uniquely a place for ‘complex cases’.33

So what could a community centre charged with a healthcare focus offer?

As we have discussed earlier, it is an illustration how a community centre today can be expected to be a place where there is equal provision to all.

Compared to the early model of the Soviet social condenser, it also balances between over-programming that becomes purposeless and underprogramming where citizens do not feel the initiative to start grassroots.

An interesting exemplar case in these healthcare community centres is the Sir Ludwig Guttmann Health and Wellbeing centre in the former Athletes’ Village on the 2012 Olympics site for the borough of Newham. In its reconfiguration after the Games to a non-hospital NHS building for primary care along with a 1500m2 for the East Village Community Development Trust. The internal ‘streetscape’ wraps the community in a ‘shell and core’ concept. The four story high atrium brings disparate activities together in the centre of the building. The building proved to facilitate the fit-out and use in 2012 as Medical and Doping Control facilities for the Olympic Games, but it offers today a bigger service for a growing residential mass, after the singular event. Stratford is a growing residential neighbourhood, there is a major regeneration after the Games happening, by 2030 more than 10,000 new homes will have been built in the Olympic park.

32 Batterbury, Simon. 1998.‘Campfens, Hubert (Ed.),“Community Development Around the World: Practice, Theory, Research, Training” (Book Review)’, Third World Planning Review, 20.1: 119 https://doi.org/10.3828/twpr.20.1.143p3471532t2363.

33 Chrysikou, Evangelia & Savvopoulou, Eleftheria & Mclennan, Peter & Higgs, Paul.

2019. ‘Implementing Research and Best Practice for the Development of Mental Health Hubs in the Community.’, Bartlett Real Estate Institute, p. 9.

29

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Figure 19 // Embedded in local neighbourhood, shed typology for various civic functions. Xaverianen community centre in Bruges.

Figure 21 // Exterior ‘shoe box’ shed typology.

►

►

Figure 20 // ‘Rue Intérieure’ in between sport field and offices.

30

Challenges encountered by the case of the Guttmann Health and Wellbeing centre: -Residential superblocks of (94 by 75m) provide a critical mass, but since their rigid dimensions, blocks could be opened and think beyond the ‘superlobbies’ as only collective.

-Community services are clustered and easy accessible to the neighbourhood, except for a connection east, because of the hard barrier that railway infrastructure provides and the contrast with the existing finer grain fabric of the residential suburbs.

-Stratford can still grow and has a high potential for further densification since its well connected DLR connection, however it should open up for diverse partners, a true knowledge neighbourhood is not working as an isolated ‘island’.

-The aim of the Community Health Centres would be to hybridise healthcare services and make health much more a day to day, preventive and visible place in the city, stimulating a ‘care culture’.

31

In a medical research scenario, if instead of a community centre that is solely run by the NHS, partnerships in medical research and tech are formed, this would be a positive asset as an exploration towards different approaches of therapy and life style. 35

Figure 22 // Cutting through slabs creates informal gatering space.

►

Around university campuses there is usually a research community, orginically located as a spin-off knowledge cluster. There is a growing importance of forming networks with public aspects to generate crossovers between the research community and the final users of the respectable research. The Wellcome collection, the Crick institute in London or the Smithsonian museums in Washington gather communities of learning, educating and researching as scientific ‘hothouses’ that support collaboration and makes research visible both internally and externally.The structure of research buildings is usually stacked or nested in organisation.

Within there is place for civic elements that can work as event spaces such as lecture halls, exhibition space or auditoriums, that bring transparency externally to research. The proliferation of these can be seen as ‘Research Hotels’, where similar to ‘artists in residence’, ‘research in residence’ can be provided.

The evolution in open source data, interdisciplinary research and the growing public interest and awareness of research contribute unsurprisingly an evolution of coworking spaces for science, healthcare and tech start-ups. They are looking for flexible access to labs and offices, often as incubators or accelerators co-located on a campus with a major institution or research body.34 For example, in the case of the De Krook, by RCR arquitectos in Ghent, the end-user and researcher are under the same roof. The established Imec research company gives innovative start-ups a workspace above the public city library of Ghent that is also a place of study and collaboration for the University of the City of Ghent. The layering of the steel façade of De Krook tries to be transparent as it is portraying itself as an ‘interactive future lab’.

Focusing now on a case study related to research in healthcare, let’s take for example the Immunity and transplantation Pears building in Hampstead,

by Hopkins architects. The Pears building starts from a partnership between the Royal Free Charity, University College London and the Royal Free London NHS Foundation Trust. Being located next to the hospital this enables researchers to understand more about diseases and treatments by having a greater access to patient samples. The other way around, having a quick follow up between research results and the practice improves the provision of care and will bring for example new treatments for conditions such as cancer and diabetes sooner to patients. Interestingly the building will not only incorporate laboratory research and write-up space but also a new patient hotel.

34 New London Architecture (Organization). 2018. Knowledge Capital: Making Places for Education, Innovation and Health, p.23.

Figure 23 // Stacking of library and research space.

►

32

2. SCENARIO : RESEARCH

35 appendix.

See more background about a possible business model with the NHS in the

33

►

Figure 24 // Diagram interactive future lab, changing public realm in the curve of the river, de Leie, de Krook city library in Ghent.

►

Figure 25 // IGLO care home on the left bank of Antwerp as an infill strategy

in a deep modernist ‘super block’ by De Smet Vermeulen architects, 2014.

34

Challenges encountered by the case of The Pears building in Hampstead: -The clustering of the Royal Free Hospital is reaching its limits, the Pears building is placed as visible presence on the High Street, Haverstock Hill. In this way the accessibility of the hospital complex becomes multiple and can leave the pressure from the main entrance. The cluster contains educational, first aid GP collective and alternative spaces for care, the Maggie’s centre, these are taking the advantage of belonging to the same site.

These are also the elements that could be distributed in the wider fabric, where for example deeper blocks on the other side of the High Street of 131 m on 58 m provide an opportunity. The residential linear slabs or terraced housing in Belsize of Hampstead are much likely to be adaptable for this. Interestingly we see that the Royal Free hospital has a foundation trust located in the residential fabric. We could argue that this is an emergence of new clusters of research, as counterpart to the single dense cluster. (see proliferation of care services expected in the next 10 years).

-The biggest challenge is the strict zoning of healthcare buildings vs residential neighbourhoods, we could think of a more balanced network of both distribution and concentration in the neighbourhood. The Royal Free hospital is a unitary site, owned by a single entity. It seems that a unitary sites provides total design freedom, but this control is not infinite. If these dense clusters are a big single zone, unitary sites are not thriving because of their bigness, but built upon their differences. This is in a way a critique on Koolhaas’s argument that states to abandon plurality towards ‘bigness’. 1 -The aim of the Research Centres is to make the science and tech of ‘closed’ institutions more open and accessible to a wider community in a reverse interactive way.

1 Koolhaas, Rem, and Bruce Mau. 1995. ‘Bigness: of the problem of Large’.

Small, Medium, Large, Extra-Large: Office for Metropolitan Arcitecture(Rotterdam: 010), p. 495-516.

35

Quite literally in the medical context, housing that is probably the closest to the healthcare institutions are aptly named ‘Patients hotels’, ‘Medihotels’ or ‘Clinical crisis’ houses. Patients undergoing long-term treatments, who life far-away and need accommodation in connection to examination and treatment but can take care of themselves are preferable not given a room in the hospital itself. ‘Patient hotels’, are rather popular in Nordic countries and are built adjacent to hospitals campuses. They are not only for patients but also for family, friends and other guests. The Rigshospitalet in Denmark’s leading hospital in Copenhagen is such example (see figure 26). The unknown length of stay on the road to recovery asks for flexibility in long and short stay accommodation; and as is the case in hotels there is a need for an exchange of experience or gathering spaces, one more public than the other.

This provision of care and option for temporality of residents that we see in these patient hotels is something that should translated towards regular housing development. Care could be a more obvious asset to housing projects, depending on the extent to which residents need specific care provisions. Think of the proliferation of therapies that are based on our everyday life, ex. the nutritionist, the yoga studio, the gym, etc. Like an ‘option space’ in the Spreefeld project in Berlin (see figure 29 and 30).

Bringing housing initiatives to new coalitions and linking inhabitants to entrepreneurial and market thinking, can be witnessed in the cooperatives of Kraftwerk. The mixtures of life styles offered within an affordable cluster living are assets of the cooperative model. The initial manifesto of Kraftwerk, in 1993, stated that participation should go further than only ‘members’ of the cooperation. “...working in participation with

public institutions, companies, private organisations and foundations have an aim for opening up the cooperative towards the city and enrich the diversity of life.”36 As a result a variety of provisions is ensured (see figure 27).

36 Poullain, Adrien. 2018. Choisir l’habitat Partagé: L’aventure de Kraftwerk(Marseille: Parenthèses), p.75.

Figure 26 // Diagram of short-stay accommodation wrapped around a collective atrium, place for family and friends on the campus, Patient hotel Copenhagen.

►

36

3. SCENARIO : HOUSING

Figure 30 // Spreefeld, Mitte Berlin (2013) an open plot along the Spree with a publicly accesible ground floor outside and inside, both flexible in size.

►

►

Figure 29 // Option space for example can be an atelier, common workshop space or gathering space. Spreefeld Cohousing (2013) by Carpaneto, Fatkoehl and BAR Architekten.

Boat shed

►

Figure 28 // A variety of provisions. Kraftwerk (2024), 350 dwellings on Baufeld C, Koch Areal in the centre of Zürich, by Studio Trachsler Hoffmann architects.

‘option’ space

►

37

Figure 27 // Coalitions in the DNA of the future project.

38

Challenges encountered by the case of The Patient hotel Righospitalet Copenhagen: -As an addition to the Hospital and University campus, there are possibilities in close collaboration with these actors. However, housing is not presented on the campus. We can see that the typical perimeter housing blocks could be easily accomodated within the grid of the campus (100 by 80 m approx.). This gives the opportunity to provide a much more ambiguous form of both housing and healthcare.

-The campus model needs to deal with a coherent landscape in between the institutions. The campus borders big parks and green space, however these could be brought more inside the campus redevelopment.

-The aim of the Housing Centres is to include healthcare in an inclusive housing scheme, not to ‘be cured’ but to ‘be cared’. Depending on the residents’ lifestyles various care/therapy focused activities can be included, that could potentially open up for the neighbourhood.

39

40

CONCLUSION CHAPTER 2

We can conclude that the framework of a ‘Care Hotel’ needs to strike a balance between the generic and the specific, between concentration and distribution.The 3 scenarios describe different diagrammatic scenarios to a possible ‘Care Hotel’ framework in a knowledge neighbourhood.

Something that is hard to achieve in a cluster model that limits itself to open up to the wider neighbourhood (like in Hampstead). Certain constraints in the exemplars have been identified. The campus model, for example, could take the advantage of a flexible‘chess-like’ grid system that can contain both housing and healthcare facilities (like in Copenhagen).

Finally, as we have seen in the East Village, the urban regeneration with a concentration of community centres asks for various scales of negotiation with the community.

95 m

75 m Church

Chobham Academy

Nursery school

Sports centre

Stratford International

Ludwig Guttmann Health & Well being Centre

Royal Free hospital Foundation Trust

Pears building

School of medicine

Maggieâ&#x20AC;&#x2122;s centre

Hill stock Haver

EM entrance

GP collective

Hampstead 280 m Royal Free hospital

188 m

58 m 131 m

Belsize Belsize Underground

41

14 m

270 m

University library

Patient hotel

University of Copenhagen

Community assembly space University of Copenhagen

Righospitalet 550 m

Learning centre

Rehab housing

83 m 103 m

Housing mix with central service Care assistance living 70 m

126 m

03

HOME AS A SPATIAL PARADOX.

the revenues for retrofitting processes of the existing built heritage and the desire for long-term care provisions opens possibilities for affordable health reliance systems. Housing as infrastructure of care is much more plausible. This provision of care and option for temporality of residents that we see in these patient hotels or care homes is something that should be part of regular housing development. Care could be a more obvious asset to housing projects, depending on the extend to which residents need specific care provisions.38 We should also not forget that with the shift of ‘care in place’, there is an increasing emphasis on the home as key site of care-giving with informal (or familial) carers. In literature, some describe this shift as a synonym to an institutionalisation of the home space.

►

The paradigm between the home and the hospital is much more complex than choosing one or the other. It results in interesting questions, including how hospital functions will relate to the phenomenon of the residential care zone, which eventually lead to a wider ‘health care landscape’.

Extramural small scale institutions with day functions are replacing large and vast traditional care institutions. Psychiatric, acute somatic nursing, dementia and to a certain extent care homes have reduced the internal organisation of care and living separation to a minimum.37 The meaning of ‘the home’ and belonging somewhere has a subjective meaning today (see figure 33 how people with dementia would map mentally where they belong). In psychiatry and above all in care for the elderly we see similar frameworks of the attempt to create a less institutional impression.

As an extreme example, the floating Adamant psychiatric hospital on the Seine, is far from the usual soothing and protected care place. (see figure 31) By humanizing the healthcare buildings, the human takes the centre stage again, which is a direct critique on the large institutions that are too ‘generic’.

Figure 32 // Huis Perrekes, garden pavilion as an ‘open’ place for various

activities. NU architectuuratelier.

Figure 31 // Therapy workshops (pottery, music, reading, drawing etc.) in a domestic

►

42

A.

DESIGNING TYPOLOGIES THAT CAN GENERATE NEW BUSINESS MODELS.

setting focusing on the stay and return of patients. Adamant psychiatric hospital, Paris

An exemplar of an atypical care home where the care and living units are blurred is the small scale is ‘Huis Perrekes’, located in Geel in Flanders, a home for people with dementia, that makes living ‘as normal as possible’ through 4 elements: an existing house, low rise extension, pavilion and garden. The garden is a public place for the neighbourhood where music, art, nature is intertwined between the inhabitants of ‘Huis Perrekes’ and cyclists, neighbours and passers- by.

Given the attention to long term use of residential complexes but also 37 Mens, Noor, and Cor Wagenaar. 2010. Health Care Architecture in the Netherlands(Rotterdam: NAI Publishers),p.331.

Furthermore, a ‘surveillance under the skin’ through technology can contribute to either a better well-being and or an unease while monitoring personal data.

“As care provided at home is less public ‘visible’ the shift from care in institutional settings to more fragmented, private, often less visible community-based settings both enables and is shaped by the stealthy informalization and privatisation of care as the costs of care are shifted away from collective society to individuals and families.” 39 38 See intermezzo about the genre of care homes.

39 Landscapes of care from a health geography perspective. Milligan, Christine, and Janine Wiles. 2010. ‘Landscapes of Care’:, Progress in Human Geography<https://doi. org/10.1177/0309132510364556>; p. 747.

43

Belonging. A mental map of interlocking small worlds for a project for young dementia.

Approach needed with recognisable space, care in detail. Drawing by Studio Jan Vermeulen/Tom Thys Architecten/Sergison Bates Architects.

â&#x2013;ş

Figure 33 //

►

Figure 34 // Huis Perrekes, composition of garden pavilion, orginial house, low rise extension and the garden.

INTERMEZZO: THE GENRE OF CARE HOMES

If we look into the genre of care homes, we can conclude that the intertwining of the home and care has been tried in various ways. We predomeninately find the following typologies: linearity, wings, courtyards and open block types predominately. These typologies can drive new mixed forms and a range of derivatives. As we have seen that new business models arise, we can ask ourselves how typologies can influence these new models. Care homes show an attention to various scales of delivery of care services resulting in (hopefully) a quality of life for the residents.

In the genre of care homes for ageing people this crossover between care - often assistance or care built-in the centre - and housing is clearly there.

Designing for the elderly is the most obvious exemplar of Healthcare Care homes and mostly reflect an institutional feeling of long corridors with double banked perimeter rooms. The case study by Dominique Coulon and accociés however shows how a variety of shared central spaces leads a trend of domestication of these institutions. Collective spaces around the atrium can be the space for encounter or seclusion outside the typical ‘care room’ (see figure 35).

We could argue that care homes are maybe too specific for our third scenario of chapter 2, since the ageing society is not only made up by the elderly but by a web of ages, different cultural backgrounds, urban scape and time. Moreover, health concerns everyone. To reflect society in a housing project there is this mix of all ages for example needed.

40 Neely, A. & Lopez, P. (2020) Care in the Time of COVID-19, Antipode online blog, retrieved at:https://antipodeoneline.org/2020/03/10/care-in-time-of-covid-19/.

Figure 35 // Care home Dominique Coulon & Associées Hunique, groundfloor.

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44

But what if solidarity and trust is reciprocal between people living in communities and the concept of a collective society has something positive to offer? The universal mantra ‘Stay at home’ during the pandemic reveals the inequality and vulnerability for a majority of urban inhabitants.

The practice of living is fundamentally decisive for a population’s health and care. Domestic spaces are filled with more bodies not at all as adaptable to peaceful coexistence and many kitchen tables are converted in working desks. Today, the call for adequate housing is even more pressing.

“We can think housing as ‘infrastructure of care’ inasmuch as the networks of solidarity in the proximity or from afar contained in the practices and tactics to sustain wellbeing. Here the infrastructures of care is what allows to weave “the individual body, the social body, and the body politic”40 We can state that COVID-19 presents us the urge to rethink our housing future, since there is an opportunity to transform the collective and the city through housing.

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Figure 36 // Set of typologies derived from examplars of healtcare infrastructure.

B.

ASSOCIATIVE PRACTICES. TENSION BETWEEN THE INDIVIDUAL AND THE COLLECTIVE.

Care is a critical concept that shows that a reorientation in the disciplines of architecture and urban planning is reflected in power. In ‘a caring architecture’, Joan C. Tronto argues that it does not start from the object, the building, the park, the city zone but, rather, it starts from the responsibility to care- i.e. ‘who is in power’?41 ‘Care is always political since the relation between the care

46

giver and the care receiver is a power relation.’ 42

As Yuval Harari argued, local institutionalised respect and a strong local pattern matter in a world after the coronavirus. But where does the field of action lie? As we have seen in the idea of ‘a soviet social condenser’, the idea that every citizen in various neighbourhoods needs the same provision of services, reduces the citizen to a pure service consumer.

In order to provide a space of freedom for individuals, where their actions matter within a local network or neighbourhood leadership and responsibility are needed. Here the tension between the individual and the collective manifests itself. In the case of provision of care, who should take up responsibility? The power of ‘caring’, creates a tension between dependency and autonomy. Comparable to the third generation that struggles with a move from autonomy of their own home to a dependency in a care home. This is one of the problems with the ethics of care, finding a balance between privacy and the collective. The communitarian belonging can add upon the general wellbeing and happiness of tenants.

Density is a valuable tool, but we should be aware how much, depending on our personal differences, one wants to share of its intimacy. Successful schemes have shown how to free up space and generate additional values, while maintaining high quality units within those (see part C of this chapter on cooperatives as enablers).

Paul Hirst touches deeper on the ambiguity of the individual or the community in his associative understanding. He said that “the individual and the state can only exist because of society.” 43 An association is based on a voluntary basis between human actors instead of giving society matters to centralised states or isolated activities of individuals. The advantage of the association is that it can quickly monitor local challenges, because here a lot of knowledge is based. Reciprocity within a care community should not be underestimated, caring is an activity in both ways.

41 Joan Tronto, ‘Caring Architecture’ in Critical Care. Architecture and Urbanism for A Broken Planet, edited by Angelika Fitz and Elke Krasny (Boston: Mit Press, 2019), p 26–32.

42 Ibidem.

43 Associationalism, Hirst, Paul. 1996. Associative Democracy: New Forms of Economic and Social Governance, repr (Cambridge: Polity Press)

But what makes a community? Richard Sennett asks this question in ‘Flesh and Stones’ in 1996, apart from the ordinary usage of a place where people care about people they know well or immediate live next to, a community is a collection of like-minded people. Sennett distinguishes society from community as an amalgation of differences. In finding a relationship between business model and the design question that looks for civic action is not situated in a compulsory ‘one size fits all’ solution, as Sennett writes. “Civic compassion issues from chat physical awareness of lack in ourselves, not from sheer goodwill or political rectitude.”44 For example, the Maggie’s Centres as business model, charity dropin cancer care centres, does not impose one typology. Their exuberant architecture, with a certain‘icon’ gestalt, results in a variation of typologies, but all with the same ambition of giving this specific program of care for staff and patients. We can find some comparable spatial qualities for this specific business model throughout all the drop-in centres: a central space around a kitchen table, the blurring between the inside and outside (often connected to nature), lowering thresholds, the balance between open plan & containment and finally an easy routing.

Every country has of course its own specific health care system, which enhances or limits the possibility to create new initiatives in the ‘care landscape’. Based on ideological background, the health care system in the UK, the so-called Beveridge system, differs significantly from the Bismarck system, used in countries such as Belgium, the Netherlands, France. The Bismarck system uses a social insurance system, financed by employers and employees through payroll deduction. Job activity in healthcare is based on individual care givers. Hence, doctors and hospitals tend to be private in Bismarck countrie and free lancers are mostly paid according to performance. Whereas in the UK healthcare is mostly organised by the government and they act as a single-payer in a national health service system (NHS). By use of income taxes as main funding, everyone who is a citizen is given coverage and given access to health care.

Comparing these models, we can argue that the private and public sectors do not need to act separately in the ‘care landscape’, when they partner-up or use each others networks spill-overs can create new models such as an informal care network in the Netherlands, like Buurtzorg, or an extension of primary care as part of everyday civic life. Since they both influence the ‘diagram’ of the neighbourhood, by partnering up their responsibility brings a shared civic expectation.

44 Sennett, Richard. 1996. Flesh and Stone: The Body and the City in Western Civilization(New York: Norton), p.370.

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47

Figure 37 // Morphology of various Maggie’s centres.

Figure 38 // Maggie’s centre and Health foundry, importance of inside-outside relationships.

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Figure 39 // Case studies that are new business models in the healthcare and well being sector.

Change will only happen slowly but we should acknowledge that the growth of a strong localism has the potential to prove that a bottomup leadership and responsibility can be an alternative for the way we understand caring for each other, in all its layers and facets. Since the reproductive number of the COVID19 virus, for example, differs locally and heterogeneity in communities have been highlighted, resilience in healthcare systems relies on local responsibility.

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Figure 40 // New initiatives in the care landscape, bottom-up and grassroots as carrier for social assets. Opportunity to scale-up these initiatives by collaboration.

50

C.

COOPERATIVES AS ENABLERS OF A ‘CARE HOTEL’.

The importance of new players in the care landscape are in line with the growing localism. Housing cooperatives can be a promising partner amongst new initiatives. Collective space might not guarantee a direct gain but in between the possible financials gains it can provide a margin for purposeful social significance. Looking at this trend around the world, in Zurich, where housing co-operatives date back to the 19th century, the city has a strong tradition of self-help and supported its citizens with protection from the markets. The land is leased by the Zurich city council.

Here small to medium sized co-ops become the driver for its typological transformation. In this way affordability for residents is secured, by adding commercial space and public courtyards, this make co-ops viable by adapting to the 21th century needs. In Zürich 20% of the housing offer are ‘Genossenshaften’ (co-ops). 45

initiative where through mutualism a ‘Care Hotel’ framework is applicable.

The cooperative La Borda in Barcelona for example, stretches the living spaces from private to public by enhancing community life. A health and care space for massages, injections, quick check-ups or even guest rooms that could be used for quarantine.

Kalkbreite in Zürich, with 91 residential units, forms a building block with a heterogeneous floor plan for a range of layouts from one- to eightroom apartments, all linked by a ‘rue intérieur’e. There are 3 types of cluster apartment, through which different lifestyles are accommodated.

Satellite flex apartments can be connected to other kitchens and units and guest houses are available. The range of offerings needs a high degree of neighbourhood integration, this includes services. On the publicly accessible ground floor a health centre adds value to the residential property, the tram stop underneath the building provides If a future living model proposes a way of belonging by subscription in easy accessibility and commercial space including a movie theatre make order to access an aspirational lifestyle, we have the choice to subscribe a complex mixed program.47 “Building for health is not just ourselves into an optimised individual dwelling or into an optimised about the healthcare system but the entire city and the collective, the cooperative. On the one hand, the concept of a hyper built environment, the access to resources, and the type of individualised pod aims to shape the self, by creating a maximum quality 48 living condition within an individual dwelling. The sharing cooperative, livelihood made possible based on [such] access.” on the other hand, prioritises the responsibility as a community and aims Kalkbreite or Star Apartments show that because of a cooperative a certain to maximise integration of an assembly. The latter requires participation type lifestyle with access to health resources creates assets. and a certain degree of responsibility by the individual to the chosen Star Apartments in Los Angeles, provides supportive housing to 100 community. As Emile Durkheim (1893) and Paul Hirst (1994) have argued formerly homeless individual using modular prefabricated units. On an associative democracy creates an open cooperative on a voluntary the plinth a Health and Wellness centre for the residents is located and basis, in between the dichotomy of individual or collective. Cooperatives underneath the county department of health services primarily focuses resources towards the most critical determent for health: are based on participation, where the members are also shareholders, so on funnelling 49 there is no landlord in the game. The members are both owners, users and housing. supervisors of the cooperative in order to sustain the collective needs as a goal rather than operating profit maximization.46 Today, some cooperatives have already embedded the notion of ‘long living’ in their housing offer, if the cooperative provides flexibility and interchangeability of people’s needs, the cooperative can provide support if personal needs change and members can move to other apartments within the same neighbourhood.

That’s why the model of the cooperative is a good example as a bottom-up 45 Poullain, Adrien. 2018. Choisir l’habitat Partagé: L’aventure de Kraftwerk(Marseille: Parenthèses), p.75.

46 Lieve Jacobs (Cera), Peggy Totté (Architectuurwijzer), Jan Denoo & Tim Devos (endeavour), Michiel Van Balen (Miss Miyagi). ‘Coöperatief wonen in Vlaanderen’. Cera CV. August 2020. Accessed from: https://www.cera.coop/nl/cooperaties/info-en-onderzoek/documentatie-links-onderzoek/2020/20200807_n_cooperatief-wonen-in-vlaanderen.

47 Susanne Schmid, Dietmar Eberle, Margrit Hugentobler. 2019. The Story of Communal Living: Models of Urban Coexistence(Boston, MA: Birkhauser Verlag), p. 255-256.

48 ‘A Radical Transformation in Building and Designing for Health Is Underway—but Not Everyone Will Benefit Equally’. 2020. Har- vard Graduate School of Design<https://www.gsd. harvard.edu/2020/04/the-pandemic-may-instigate-a-radical-transformation-in-buil- ding-and-designing-for-health-but-not-everyone-will-benefit-equally/> [accessed 22 May 2020].

49 ‘Star Apartments’. [n.d.]. Skid Row Housing Trust<https://skidrow.org/buildings/ star-apartments/> [accessed 15 September 2020].

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Figure 41 // The cooperative as initiator pre and post construction.

La Borda, Barcelona, LaCol cooperativa

52

Kalkbreite, Zürich, Müller Sigrist Architekten

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Star Apartments, Los Angeles, Michael Maltzan Architecture

Figure 42 // Housing cooperatives with access to ranges of healthcare.

53

CONCLUSION CHAPTER 3

54

We can conclude that good care, in our everyday domesticity, needs good housing. For the knowledge neighbourhood, the cooperative as a business model is a plausible model that, as an associative practise with built-in leadership and responsibility, drives a stronger localism. Cooperatives have a dialectic relationship between collective and individual space.

â&#x20AC;&#x153; [a cooperative] alternates phases of organization and of spontaneity by letting the collective subject implicitly cooperate with architecture and foster explicit co-operation among its individuals.â&#x20AC;?50

50 The Rosa Luxemburg Reader, ed. Peter Hudis and Kevin B. Anderson (New York: Monthly Review Press, 2004), accessed through: http://thecityasaproject.org/2013/05/hannes-meyer-co-op-architecture/.

04

DESIGN VALUES FOR A ‘CARE HOTEL’.

Having deepend our understanding of possible scenarios, and further discussed the importance of housing, what are the implications then for our notion of a ‘Care Hotel’ embedded in a knowledge cluster? Which design values do we need to take into account?

We can speculate how a ‘Care Hotel’, that in itself provides the flexibility to shift and change over time, transforms in a robust, expanding network that is maybe not that temporary anymore? Ideally, when a cluster is set in place co-location becomes almost an obvious part between two parties, just like the link between universities and research today. On the other hand, partnerships bring frictions and these frictions can be vary in time.

55

A.

ADAPTIVE STRUCTURES.

Requirements for privacy and retreat in our homes can be translated into spatial organisations that work as separations. As Robin Evens argues in his essay ‘Figures, Doors and Passages’, architecture has been instrumental in formation of everyday events and the shift to the corridor in the plan acts as a regulator of thresholds and separations based on access and movement.51 So if we start from the sequence of shared space, we can think about designing principles of intimacy through subdivision. The particular room of one’s own is an element of privacy, retreat, contemplation. Communal areas can, however, be these places where through a spatial composition of transitional elements (cores, elevators, stairs) and separation elements (corridors, windows, walls, doors, furniture) they can give way to a variety of events from both common leisure, therapy, co-creation to retreat, individual therapy and personal space.

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One thing is certain that either concentration or distribution of knowledge dependingon institutionsornot,relies onhousingas needed‘infrastructure’, especially when providing care. To foster care, as an asymmetrical need that entails a range of types of care on various scales, we need to look for an easy ‘expand or shrink’, a static and non-static spatial organisation or adaptive structure.

Figure 43 // Possible stacking in an adaptive structure.

Losone care home and Mehr als Wohnen, located in Zürich.

Imagine the care hotel is an object that consist of regular and irregular space, the regular here is the servicing, storage, that what the building ‘controls’, the irregular the research space, civic community centre and residential communal space.The architecture of a care hotel is not about the form but about creating a ‘condition’ of overlays with the ambition to intensify a system of care in a knowledge neighbourhood. As approaches to research and tech The role of the core as separation element depicts the flow of individual evolve very quickly, base build area of these elements needs to be units (in the case of housing) in relation to their shared space. Figure generic, as a shed typology, to provide various short-term interiors 43 shows a 6 units 20 x 10 meter deep block, with their variations in in order to create long-term value. common and private. We can conclude that a fragmented sequence of shared space provides more plurality. This is visible in the examplars of the 51 Evans, Robin. 1997. Translations from Drawing to Building and Other Essays, Chapter ‘Figures, Doors and Passages’, AA Documents, 2 (London: Architectural Association).

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56 Figure 44 // 1/500 typologies, Separation and privacy spatial organisations, from single corridors, pavilion to courtyards and compact blocks.

57

ACCELERATOR OF KNOWLEDGE CLUSTERS.

Collaboration, innovation and excellence are at the heart of these educational-research networks today. For example, the MedCity network, which partners academic, business and health services in life science together, has recently set up the London COVID-19 Alliance. This Alliance between central city universities, institutions and partners, including King’s College London, Imperial College London, UCL, Queen Mary University of London has worked closely with Government and agencies across London, offering expertise and innovation to tackle the pandemic.52 Coming back to the case of Antwerp, their will be a new hospital (ZNA) campus on ‘Het Eilandje’. The old hospital in the inner city is being transferred to this new site along the docks. Clustering several public amenities, close to new educational institutions across the street and a residential growing fabric at a 5-minute walking distance. In this case the clustering of one care hub, named by the architects Robbrecht & Daem a ‘care boulevard’, is concentrated. Within the central city fabric of Camden and Islington, the Ormond hospital for example is part of a much more distributed cluster with partnerships with the Crick institute, Zayed centre, Wellcome collection, start-up health technology firms. The co-location of knowledge based activities brings intensity, for a compelling framework a multiplicity of forms can be part of a distributed system. More information on both the projects in Antwerp and London, see the Appendix.

1.

In the scenario’s of chapter 2 different diagrams of neighbourhoods were presented. A neighbourhood of cells (Hampstead) and clusters (East Village and Copenhagen). The model of cells is still car-based, with local facilities at each heart and seperation with for example green zones or industrial zones around it. Secondly, a cluster takes higher densities of overlapping groups with local facilities that also serve a wider district. As a result, even though integration in the cluster might bring some friction, overall there is more inclusivity.

We state that ‘Care hotels’ can be new accelerators in residential neighbourhoods that open opportunities for both residents and visitors.

Moreover, the focus on healthcare does not only help one specific layer of society (as in care homes), but serves an open community and in the end contributes to a healthy, diverse, inclusive and innovative city. Just like in the case of London, Ormond’s hospitals and UCL research institutes were already present in fabric, as a result the recently added Wellcome collection, Crick institute and Zayed centre wanted to be related to these anchors.

52 ‘Accelerating Cutting-Edge Innovation in London and the Greater South East of England’. [n.d.]. MedCity <https://www.medcityhq.com/> [accessed 18 September 2020]

2.

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58

B.

Figure 45 // Evolution of diagrams of neighbourhoods; 1.cells, 2.cluster

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Figure 46 // Concentration and distribution of clusters in Antwerp (above) and London (under).

C.

MULTIPLICITY IN TIME.

Taking a different attitude to how things interrelate, friction can be beneficial, maybe surprising and stimulating.

“space is a frame that needs to be used in various ways and also in ways that are not predicted.”54

The perception of the city is not one of incremental design but constructed over time, here we can use the term ‘event’ as Bernard Tschumi argues that architecture and not its program is in itself already an event. His cinematic theoretical explorations of events, movements and spaces that can be compressed, inserted and transference create complexity and intensity.55 I would argue that event spaces are determined by their causality and temporality. As a third design value for the framework of our ‘Care hotel’, we should use architecture as an event space. Since we can conclude that healthcare infrastructure has over time also become a research centre, residential comes more and more into relation to these infrastructures and residential care environments flourish by having different ways of participatory living and community’s civic action.

The adjacency of difference (health infrastructure, research, housing) should be over time co-presence and not serial. The idea of a infill, peacefull adjustment is, in my opinion, not durable. There is a risk in having the event all at once, but the intertwining on both the level of architecture, no form that is restricted to a function, and urbanism, no zoning of functions.

53 Evans, Robin. 1997. Translations from Drawing to Building and Other Essays, Chapter ‘Figures, Doors and Passages’, AA Documents, 2 (London: Architectural Association).

54 Alexandre Theriot public lecture of the Berlage institute, ‘Breaches / Autumn 2019 / The Berlage’. [n.d.]. <http://www.theberlage.nl/events/details/2020_01_16_breaches> [accessed 1 June 2020].

55 Tschumi, Bernard. 1996. Architecture and Disjunction, Disjunction (Essays Written between 1984 and 1991) (London: The MIT Press), p. 254.

Figure 47 // Diagram of the functional house for frictionless living by Alexander Klein.

Separation elements bring hierarchy in sequencing through space.

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60

Where Alexander Klein wanted frictionless living53 in his schemes, in reality, activities in cities are never one or the other, the city is full of contradictions and complexities that are full of friction. We know that the current relationship between health infrastructure and housing gives a certain tension between the individual and the collective (see chapter 3), certainly since programs of care are very delicate and personal. However, this doesn’t signify that friction should be avoided. Addressing friction over time, it opens the community space of a care home for example also for the local school, new therapy workshops or educational lectures. Of course time is key here, since not everything happens at once.

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Figure 48 // Multiplicity in time and overlapping of uses. This scheme shows what could be possibile, not a single handed solution.

X

PRIMARY CARE AND THE SIGNIFICANCE OF COMMUNITY ORIENTED CARE.

Figure 49 // Community-based service types in acutue hospital care are rare.

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We have often mentioned a primary care with a community-based service.

This Community oriented primary care (COPC) is the primary care that is provision of a day-to-day healthcare. Typically, this is the first connection and starting point of continuing care for patients within a healthcare system. This first step also entails the coordination to other specialists if the patient may need this. Involvement of the community means that services are not only for the patients but also for their significant others and informal carers.

As seen in figure 50, is the COPC approach and effective way to detect similar problems and come up with treatment plans following up the trends in a wider community.

Thus the involvement of the community in primary care requires hierarchical, dispersed and participatory models.

Instead of standard acute hospital care, these community-based service types are alternative forms of care, that are not that widely spread1 (see Figure 49, in the case of In-patient and residential alternatives to standard acute psychiatric wards in England ). They for sure take some pressure off the hospitals, but can also allow trained nurses for example to take on some of the duties of GP’s, allowing GP’s to develop new skills and innovate. Community care fosters belonging and a sense of citizenship, it encourages also to bring other community facilities into the mix.

1 Johnson, Sonia, Helen Gilburt, Brynmor Lloyd-Evans, David P. J. Osborn, Jed Boardman, and others. 2009. ‘In-Patient and Residential Alternatives to Standard Acute Psychiatric Wards in England’, British Journal of Psychiatry, 194.5: 456–63 <https://doi.org/10.1192/bjp. bp.108.051698>.

Figure 50 // Community Oriented Primary Care (COPD), a people centred approach, acknowledging influence from housing, education, labour, environment etc.

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62

A.

APPENDIX

B.

CASE STUDIES: LONDON VS ANTWERP,

ADDITIONAL INFORMATION.

63

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Figure 51 // Atrium space in the Zayed Research Centre.

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Figure 52 // Groundplan of the Zayed Research Centre.

Figure 53 // Great Ormand Street Hospital.

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1.

Development models in London mostly use place-based strategies, where the concentration of research also draws commercial partners in the investment besides world leading specialists and researchers. The challenge is to retain these skills and talent since medical practice has increasingly been globalised and hugely specialised over the past 30 years. Developments of knowledge neighbourhoods need to be considered within wider policy frameworks, in the case of London, the boroughs have leeway to diversify according to the local strengths. Where technology, remote distance learning and working from home during COVID has shown how it can replace physical space, the importance of high-quality, affordable, adaptable and attractive space in order to retain these highly skilled researchers in the centre of the city, matters to both the GLA to have high quality urban areas and most possibly to the employer, the NHS. Hospital institutions can bring specialised research, as is the case of the Ormond Street Institute of Child Health located in central London; this is the largest paediatric centre in Europe dedicated to both clinical and basic science research. Their specialised research forms a geographical cluster to the UCL institute, Day-care accommodation for children taking part in clinical research studies providing Research and Development guidance in partnership with the Great Ormond Street Hospital. The recently added Zayed Centre for research into Rare diseases, by Stanton Williams, which has been added to these existing partnerships, has a structure that potentially could contribute not only to the laboratories and the outpatients together, but also to a wider research community. The structure of the Zayed Centre, however, has unfortunately a single transparent orientation, an infill strategy with a dominant street based orientation. The bigger hospitals in central London were all opened by colleges of the University of London (University College, King’s College and Imperial College). Medical students needed patients to treat and train.

The colleges and hospitals and NHS trusts are still as strongly linked in a powerful mix of training, treatment and research.

The Area of NHS Estates is larger than the combined area of the UK’s largest cities.2 Today the land that the NHS owns is land-locked, the capacity is at its limits, their boundaries with businesses, research and education become more fluid and they have recently become a private developer on the property market themselves. Their assets and estates are outdated. So, there is a need for expertise and co-creation. One model we see today are joint-ventures between architects, the NHS and education in search for a vision. On the other hand, a speculative offer that has both a generic and specific component is a model that tries to provide space for a wide range of companies that come and go. The concept of a ‘Care Hotel’ can work as a framework to provide both generic and specific needs.

The highly discussed Naylor Review of 2017 stated that, with the NHS being a significant land owner, in the case of London, there is an opportunity of 170.3 Ha, worth for £ 1 billion.3 The Naylor Review proposes to sell up 5.7 billion-worth of NHS land and buildings.

There is a movement against this privatisation of the National Health Service.

Figure 54 // Proliferation of wider services beyond the NHS services.

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The model of a free universal health benefit like the NHS is bound to have a lot of hospitals, some of them very big and in wrong locations today. Inner London, for example has too many, while on the suburbs hospitals are hard to reach from residential areas. 4 Victorian-built wards are outdated and hospitals tend to become smaller, more specialised and flexible.5 Not everything should necessarily be done in the same place. As an example, treating patients who have suffered from major physical trauma such as a stabbing or a serious car accident is not treated in every hospital anymore, but only in four centralised hospitals, based on their geography. The model of the NHS from the early 1950s was based upon provision for a population of around 250,000 people. Each District General Hospital provided for a broad range of emergency and planned medical and surgical treatments. Today, this model is shifting to at least 500,000 people for an emergency department.

Let’s think even further, there is also an alternative where the NHS could create its own bespoke housing association, given the significant housing shortage in the UK. Building more homes on unused, or underutilised NHS ‘surplus’ land and sites provides a financial opportunity but also an opportunity for better healthy quality housing in general and residential homes for NHS staff in specific. The opportunity in London is 13 % by size and 57 % by value, reflecting a very high amount of valuable sites.

Research by the London Land Commission on these ‘surplus sites’ showed that overall, 130,000 houses could be developed. These sites are currently home to schools, hospitals and some are lying dormant.

Figure 55 // London’s Sustainability and transformation plans, measured in area and value .

In the case of London, Sustainability and Transformation plans, are 5year plans that will show how local services will evolve, become sustainable and ultimately improve patient care and NHSs efficiency.

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2 The Naylor Review 3 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/604913/Naylor_review_data_analysis.pdf.

4 https://www.londoncommunications.co.uk/insights/blog/why-londons-nhsis-where-it-is/.

5 https://play.curio.io/track/6Pd63cC66bTMUUDhYlMbBE

Figure 56 // Dispersion of hospitals and Trusts owned by the NHS, as of November 2015.

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64

OPPORTUNITIES IN COLLABORATION WITH THE NHS

65 Figure 57 // The new planned care campus, designed by Robbrecht & Daem, uses the conjunction of different armatures as an intensified public plinth, making care accessible with a low threshold.

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2.

The planned ‘care boulevard’ ZNA at the hinge point of the historic city centre of Antwerp and the orthogonal pattern of the harbour, forms a permeable public plinth with care related functions or community supportive functions and hospital functions on top (see figure 28). The development strategy aims to mix urban liveable places with the hospital to support this place. The challenge here is to establish a network with care provision as a public asset. Bringing urban collective amenities, socio-cultural, small retail and workspace.

Besides, when the city or new care institutions thinks about possible partnerships in knowledge environments, housing comes into the equation. The city wishes to transform ‘het Eilandje’ and the docks area into a dynamic area by the water, driven by a big residential offer that is already partly realised. Every quarter, like the Cadix and Montevideo quarter, has its own identity (see masterplan figure 30). ‘Het Eilandje’ houses 2 776 people (in 2017), but the Cadix area will grow from 1500 to 4000 inhabitants in the next couple of years. East-west the quarters will be form a part of a green city boulevard. North-south ‘het Eilandje’ is connected with the river Scheldt Quays and a cultural north-south axis via the Sailor’s Quarter (with the Museum aan de Stroom, MAS by Neutelings Riedijk). 6 The new planned ZNA site lies at the hinge point between the Cadix area on ‘het Eilandje’ and the Nord of ‘Park Spoor Noord’, a former railway yard, and will be home to a new university campus, public amenities, offices and care provision.

As a hinge point, this is reflected in its confronting scales, from the organically grown historic city centre towards an orthogonal pattern where each former industrial yard generates difference in open space and offer of housing. This clashing of urban fabrics offers possibilities, just like the perturbations we have seen in the London fabric. The amalgam of buildings as blocks, older traditional row housing, and big chunks of an industrial past, makes ‘het Eilandje’ an interesting test site for a pluralist approach.

Specifically, to deal with with the ageing of the city of Antwerp’s population in an integrated manner, ‘Zorgbedrijf Antwerpen’ (‘Care Company’), part of the public centre for social welfare (ocmw), drew up a strategic plan to better align the care homes and life in the neighbourhood. Care masterplans were written out through‘Open Call’ competitions, initiated by the ‘Antwerpse Stadsbouwmeester’, whose core task is to control the spatial quality from an independent position, both for public and private commissions.

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Figure 58 // Masterplan ‘Het Eilandje’.

6 https://www.antwerpen.be/docs/Stad/Stadsvernieuwing/9746949_urbandevelopment_English.pdf

66

C.

DRAWINGS CASE STUDY SCENARIOS CHAPTER 2.

95 m

75 m

67

Church

Chobham Academy

Nursery school

Sports centre

Ludwig Guttmann Health & Well being Centre

Stratford International

East Village, London

Royal Free hospital Foundation Trust

Pears building

School of medicine

Maggieâ&#x20AC;&#x2122;s centre

Hill

68

k rstoc

Have EM entrance

GP collective

Hampstead 280 m Royal Free hospital

188 m

58 m 131 m

Belsize Belsize Underground

14 m

Hampstead, London

270 m

University library

Patient hotel

University of Copenhagen

69

Community assembly space University of Copenhagen

Righospitalet 550 m

Learning centre

Rehab housing

83 m 103 m

Housing mix with central service Care assistance living 70 m

126 m

Rigshospitalet, Copenhagen

CONCLUSION

The ‘Care Hotel’ is a way to update principles by which we can define our understanding of the neighbourhood in a plural way, acknowledging its differences depending on various conditions.

It’s precisely in densities that mutualism can flourish, look at how this triggered a common attitude during lockdown. We should not be indifferent for stark contrasts.

The ‘Care Hotel’ as a framework could be an impulse to proliferate knowledge that is immersing in the neighbourhood. We looked into 3 possible scenarios; concerning community, research and housing. There is a need for a ‘collage’ through inclusion rather 70

than a zoning of functions. Care is an asymmetrical need that entails a range of types on various scales, combined with housing this asks for an adaptive infrastructure. This thesis argued that a low threshold for a first line healthcare provision can spark real change upon the surrounding neighbourhood. As a bottom-line it is not about ‘curing yourself’, but an overarching concept of ‘caring for’. This starts from the argument that ‘good care’ comes with ‘good housing’. To rethink a framework of responsibility for the knowledge neighbourhood, signifies that we are looking for associative practices, built-in leadership and a responsibility from within the homes that drives a stronger localism. We can speculate how the ‘Care hotel’, that in itself provides the flexibility to shift and change over time, transforms in a robust, expanding network that is transcending temporality. Ideally, when a cluster is set in place co-location becomes almost an obvious part between two parties, just like the link between universities and research in spin-offs today. On the other hand, partnerships bring frictions and these frictions can bring exciting variations providing resilient future outcomes.

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