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The Peckham Health Centre, the Finsbury Health Centre, the Lambeth Community Care Centre and the Heart of Hounslow Health Centre How do we position these buildings in terms of their respective healthcare and architectural cultures?

AR597: Dissertation Ruaraidh Peck 7963 28 February 2014 Kent School of Architecture University of Kent Supervisor: Gerry Adler th


AR597: Dissertation Ruaraidh Peck

I would like to thank my supervisor, Professor Gerry Adler, for all the help and guidance he has given me throughout the last year in writing this Dissertation. Through his knowledge of 20th Century Architecture he helped me identify buildings and possible themes I could mention throughout this dissertation. I would also like to thank my sister, Francesca, my mother, Claire and grandfather, George Thomas who have kindly given me advice and pointers on how to improve certain aspects of my writing style.

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AR597: Dissertation Ruaraidh Peck

“The architect should strive continually to simplify; the ensemble of the rooms should then be carefully considered that comfort and utility may go hand in hand with beauty.� Frank Lloyd Wright

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AR597: Dissertation Ruaraidh Peck This dissertation sets out to examine the evolution of healthcare during the 20 th Century and early 21st Century and how new architectural styles and technologies helped achieve this. It will begin by examining the state of healthcare and health centres at the beginning of the 20 th century. Subsequently we will look at some of the pioneers in the medical profession who envisioned new healthcare praxis should be provided in the 1930s and how this resulted in two iconic but very different buildings the Peckham Health Centre, by Sir Owen Williams, and the Finsbury Health Centre, by Berthold Lubetkin. These two centres were both champions of the Modernist movement which was beginning to establish itself in the UK at this time and helped promote a new way of thinking in how health centres could be designed, and helping to influence the design of many future projects. This dissertation will also examine how these ideas, both in healthcare and architecture, influenced architects in the 1980s and 2000s. We shall investigate the Lambeth Community Care Centre, designed by Edward Cullinan, and the Heart of Hounslow by Cullinan alumni Penoyre & Prasad. Both of these architects wanted to revolutionise the design of health centres and bring them back in tone with the ideals and principles set down in the 1930s but also to update them to suit more contemporary health centre needs. It will examine the ways in which these buildings were influenced by elements of the 1930s, but also how these architects laid the foundations for the new path they believed design should begin to follow. Finally I will analyse these factors to see how successful each building truly was in this regard and then why they were or were not successful in these areas. Furthermore I will study the style of these buildings and whether they corresponded to the styles of the time. I will also then examine what can be learnt from these buildings and what we can gauge about the future direction of health centre architecture.

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AR597: Dissertation Ruaraidh Peck

Contents Introduction

5

The Peckham Health Centre, 1935

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& the Finsbury Health Centre, 1938 Lambeth Community Care College, 1985

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& the Heart of Hounslow Health Centre, 2007 Conclusion

29

Bibliography

32

List of Illustrations

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AR597: Dissertation Ruaraidh Peck

Introduction Before the 20th century healthcare in the UK, in both architectural terms as well as in the ways in which medical treatment was carried out, had progressed very little; however, in the early 20 th century, changes in attitude towards healthcare, architectural styles and technology caused rapid changes in this sector. The introduction of the modernist movements and its ideals were key features in this regard bringing revolutionary and inspirational design to a sector that had, generally been ignored by architects in the past. This combined with new emerging architectural technologies in this period, helped lead to a change from the often dark, compact and generally not very pleasant health facilities into bright, open, airy spaces. Furthermore, the cultural resonance of both Florence Nightingale during the Crimea War, and the atrocities of the First World War, had led to the burgeoning societal sense of the importance of human dignity within the healthcare experience, that was now becoming independent of the class constraints of the 19th century These changes in attitude helped lead the UK towards better healthcare with pioneering buildings such as the Peckham Health Centre and the Finsbury Health Centre in the 1930s, helping to set a precedent of how future health facilities should be. Unfortunately despite these early 20 th century healthcare revolutions, generally, the health system had remained static. The formation of the NHS in 1948 resulted in many new health centres following a strict set of guidelines which architecturally constricted and therefore produced fairly standard designs from architects. Despite this there have been attempts to further evolve the way health is treated in the UK with designs such as the Lambeth Community Care Centre in the 1980s, which attempted to modernise the regulations the NHS had for health centres. Lambeth contained many ideas from Finsbury and Peckham but also served as a precedent for future designs inspiring many of the most stunning health centres of recent times. The firm of Penoyre & Prasad, formed from architects who had worked on Lambeth at Edward Cullinan Architects, have built some of these stunning centres, winning critical acclaim and awards in the process such as the BD Health Architects of the Year Award 2007, partly due to their design for the Heart of Hounslow Health Centre in 2007. Many of these contemporary centres have built upon the ideas set forward by Peckham, Finsbury and Lambeth to create ideal centres that can be enjoyed by everyone during their stay at them.

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AR597: Dissertation Ruaraidh Peck The aim, therefore of this dissertation, is to see how health care evolved throughout the 20 th and early 21st century by studying these examples from this period and examining the extent to which they tried to change the cultures of both Healthcare treatment and Healthcare architecture. By studying examples from throughout this period it will also study how successful these designs were in changing these attitudes of health and healthcare architecture in the UK during this period.

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AR597: Dissertation Ruaraidh Peck

The Peckham Health Centre, 1935 Sir Owen Williams & the Finsbury Health Centre, 1938 Berthold Lubetkin In the 1930s there was no formal national health system in the United Kingdom, the majority of all health centres and hospitals were run by charities, benefactors and rich industrialists. This led to a great variation in the standards of health care across the country, with the best care being available in economically rich areas, such as London, whereas the poorer parts of the country had the worst healthcare. It was still very common in the 1920s and 30s, in addition to health centres and hospitals, for doctors to perform house-calls. In 1926, one such doctor, a Dr George Scott Williamson, ran a pilot experiment in his own house in an attempt to revolutionise healthcare. Dr Scott Williamson conducted this experiment, together with his wife Dr Innes Pearse, in their small house in Peckham, between 1926 and 1929, to assess the effect of early treatment on diseases. They invited local families to pay a small subscription fee, which enabled them to attend various activities, and use the facilities in Dr Scott Williamson’s house during their free time where they could be observed by Williamson or his wife. If during their observations they spotted anything suspicious they would then refer the family member to a specialist colleague of theirs, giving them the opportunity to have their diseases treated in their infancy. By 1929 Williamson’s trial had proved successful showing ‘that disease and disorder, however early diagnosed, however successfully treated, tended simply to recur as long as the individual suffering them returned to the same environment and the same way of life’ 1 therefore he ended the trial and began looking into ways to progress further with the experiment, this led to construction of the Peckham Health Centre in 1935.

1

Pearse, I. H., & Crocker, L. H. (1985). The Peckham Experiment. Edinburgh: Scottish Academic Press. p. viii

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AR597: Dissertation Ruaraidh Peck Williamson commissioned Sir Owen Williams, a successful Engineer and Architect who had been knighted for his work in 1924, to design the new health centre that was officially called “The Pioneer Health Centre” but was also referred to as “The Peckham Health Centre” then simply as “The Centre”. Prior to 1935 Sir Owen Williams was best known for his recently completed Boots Factory (D10 Building), Nottingham (1932) and the Daily Express Building, Manchester (1931) as well as his collaboration with architect Maxwell Aryton on the original Wembley Stadium (1924). Unlike most health centres at the time which were simply designed to treat illnesses, Peckham required a design that was able to ‘research, observe, assess and record the quality of life of its subject’ 2 while also being able to enhance the environment of the building to help facilitate these factors.

Figure - View of the front of the Peckham Health Centre

The site chosen for the centre was set back from a quiet street that ran perpendicular to one of the busiest roads in Peckham and was designed to accommodate 2,000 families, or 6,000 people, from the local area at any one time. The idea was to replicate the original experiment in the Williamson house where the families would sleep in their own home and go to work as normal, however they would spend their free time in the Centre where they would be observed by Williamson and Pearse and their assistants for a small weekly fee. The entire centre was open to all of the families and had a very modern open plan design. This allowed for easy movement throughout the building to the various spaces inside, with the exception of the Medical Department, where the actual diagnosing and basic treatment of family members occurred, which was kept private.

2 Pearse, I. H., & Crocker, L. H. (1985). The Peckham Experiment. Edinburgh: Scottish Academic Press. p. ix

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AR597: Dissertation Ruaraidh Peck

Figure - Floor Plans of Peckham Health Centre with labels describing all the spaces

The Centre itself consists of a concrete frame building enclosing an indoor swimming pool, which is located in the heart of the Centre, and comprising a structural form of pillars on a grid system throughout the building. This allowed it to have a large open plan, and a mainly glass façade. The internal partition walls were primarily made of lightweight glass which provided a large degree of light, airflow and a feeling of openness throughout the centre. The only place without glass internal walls, due to the need for privacy, was the consultation block which was located along the eastern side of the top floor. This consultation block incorporated reception rooms, changing rooms, consultation rooms and a bio-chemical laboratory and appeared much more like a typical health centre or hospital compared to the rest of the centre. The remainder of the building contained areas for relaxation and study, most of which overlooked the central swimming pool, helping to create a sense of community. The design of the central pool was considered architecturally the jewel in the crown, which Paul Overy, writing in Light, Air and Openness, described as ‘a spectacular top-lit

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AR597: Dissertation Ruaraidh Peck indoor swimming pool’3 On the top floor there were various rooms for quiet contemplation or relaxation as well as games rooms, work-shops and a library; while on the first floor there was a large cafeteria and a mixed-use hall that overlooked the central swimming pool via a continuous lightweight glass wall. On the ground floor though, there was a larger variation of room types with a gymnasium, theatre, nurseries, cloakrooms, changing rooms, spray chambers and another swimming pool for infants and learners. By setting back the building, the Centre overlooked a courtyard which initially was just an area of concrete used for cycling, roller skating and other outdoor activities. In later years, however, as the experiment progressed, new useful activities evolved, transforming the site by adding such things as a tennis court to provide a greater range of activities. The outdoor space, as well as the swimming pool and gymnasium, was where the visiting families were expected to spend much of their free time exercising and were, therefore, important areas of observation for Williamson and his colleagues. The design was very revolutionary at the time as unlike similar buildings it invited social contact and therefore made it very easy for simple meetings as well as formal and informal group meetings or celebratory occasions. All of these factors were put into place so that Williamson could continue the Peckham experiment and therefore he bore this in mind during the design stages to make sure that every space allowed for this.

Figure - Photos of the Various Activities that took place in Peckham

3

Overy, P. (2007). Light, Air and Openess. London: Thames & Hudson. p.63

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AR597: Dissertation Ruaraidh Peck However in the 1930s due to the general state of poor medical care in the country, there were many other attempts and views about how national healthcare could and should be improved. One such attempt was at the Finsbury Health Centre designed by Berthold Lubetkin and completed in 1938. In the early 1930s the Finsbury area of London lacked any real health centres and was ‘a maze of dispensaries, voluntary hospitals, private contracts, clubs and clinics’ 4. This led to an early attempt in 1931 to create a new health centre in Finsbury on the site of Vineyard Gardens; however, this fell through in 1933 due to problems acquiring the site. Despite this there was still a need for the centre, so in the autumn of 1935 Dr Chuni Lal Katial, who had practices in Canning Town and Harley Street, asked for Lubetkin to visit him in at Finsbury Town Hall to discuss plans for the health centre. Dr Katial had been impressed with the TB Clinic in East Ham, designed by Lubetkin’s firm Tecton, when he met them in 1932 and believed Tecton were the best choice to design this new health centre for Finsbury. By 1935 Dr Katial had become the Chairman of the Public Health Committee and, after the Public Health (London) Act of 1936 passed, he commissioned Tecton to design the centre and it opened in October 1938.

Figure - Diagram showing the spaces in the Finsbury Health Centre

The project brief was ‘to amalgamate and standardize the various services and facilities that had accumulated piecemeal in different parts of the borough’ 5 and Dr Katial believed this goal would create an interesting problem of ‘a building for which there was really no modern precedent or

4 Allan, J. (2012). Berthold Lubetkin. London: Artifice books on architecture. p.333

5

Fine, S. V. (2000). Healthcare Architecture in an Era of Radical Trasnformation. London: Yale University Press. p.282

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AR597: Dissertation Ruaraidh Peck pattern’6. The building required a far more diverse range of rooms and spaces compared to that required of Peckham. This was due to the different uses for the building requiring many various doctors’ suites, clinics, laboratories and a mortuary. Lubetkin overcame this challenge by creating a building with an H-shaped axial plan consisting of a central zone containing the rooms with a greater sense of permanence such as the lecture hall, arrival spaces and waiting rooms. Meanwhile it had all the other spaces located within the two wings of the building with the intention that these spaces would have more design freedom in aid of any future changes that might be required.

Figure - Plans of the Finsbury Health Centre

Figure - Section through the centre of Finsbury

Like Peckham, Finsbury was a statement of the new technologies emerging in Architecture, with its concrete form which created a juxtaposition with the neo-vernacular brick buildings located in the Finsbury area at the time. The centre was also constructed in the heart of a residential area to help create a community feel for the local residents. This feeling was aided by the creation of a ramp which led to the main foyer which had decorative and colourful murals on the walls of the arrival area created by Gordon Cullen. The rest of the interior walls were also adorned and the waiting areas and circulation were designed to facilitate the finding of locations in the building. Peter Coe and Malcolm Reading described the centre as being a ‘megaphone for health’7

6 Fine, S. V. (2000). Healthcare Architecture in an Era of Radical Trasnformation. London: Yale University Press. p.282 7 Fine, S. V. (2000). Healthcare Architecture in an Era of Radical Trasnformation. London: Yale University Press. p.283

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Figure - The Murals that adorned the walls of Finsbury

Unlike Peckham which was designed around a concrete column grid structure, Finsbury had no internal load bearing columns creating a truly flexible and adaptable space within the centre. Despite the different approaches taken to structurally support these buildings they were both very radical at the time in what they were doing and created greater flexibility that had not been possible prior to the 20th Century. These factors also later aided in renovation works on the buildings when converting Peckham into flats and the various renovations and modernisations Finsbury has undertaken since its opening. The concrete walls of Finsbury supported the horizontal floor slabs and roof while the end walls were monolithic which helped in wind deflection as well as providing structural bracing.

Figure - Left is the structural grid of Peckham while right is the relatively open foyer of Finsbury

Figure - Image of Finsbury showing the monolithic nature of the end walls

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AR597: Dissertation Ruaraidh Peck The Finsbury Health Centre is not one of the most famous or significant architectural works of Tecton but it does however stand ‘the test of time as an expression of the belief that architecture can be an agent for human betterment.’ 8 The project attracted large amounts of attention from the general public and both architectural and medical critics. The centre’s design was seen as a beacon of light both in healthcare and architectural terms in a rather dull borough; furthermore, it was seen as a good fit between the practical uses of the building and the contextual buildings, which was a result of clear diagrams and drawings between all the people involved in the process.

Figure - The Diagrams used during the design phase by Tecton

8 Fine, S. V. (2000). Healthcare Architecture in an Era of Radical Trasnformation. London: Yale University Press. p.285

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AR597: Dissertation Ruaraidh Peck Despite both being classed as health centres, built at approximately the same time and within a few miles of each other they were both very different in terms of how healthcare should be provided. Peckham was aimed more at the prevention of illness whereas Finsbury was very much about the treatment of it. This point was raised by the Spectator shortly after the completion of Finsbury when it said ‘Finsbury is not really a health centre in the same sense that Peckham is. It is a polyclinic, organised for disease. Peckham is organised by health’ 9. The different philosophies of the buildings are very striking because Peckham required the local families to spend a great amount of their time actually at the centre with the doctors, who could observe them for any sign of illness and provide early treatment when it did appear. Finsbury however, was very much what we would consider a traditional health centre where once you began to show signs of illness you could then visit the centre for the doctors to try and to heal you. Despite their very different ideas of how health care should evolve both buildings were a clear example of how new ideas in architecture were revolutionising building design at this time, irrespective of the type of building. By the mid/late 1930s Modernism was finally beginning to establish itself with architects in London, due partly to the works of Sir Owen Williams and Berthold Lubetkin as well as others such as Ernő Goldfinger in the early 1930s; still however mainly in industrial and residential buildings. Even though many of these of these new buildings were modernist in idea, a substantial number of them others, such as 1-3 Willow Road by Goldfinger built in 1939, still held onto elements of the local vernacular. At the time to have two important new health centres built in the modernism style was a major milestone in cementing its place in the conservative view of the British Public. The introduction of modernism brought with it the ability to produce the light and open spaces found in both of these health centres. Despite all of these positive factors, and the fact that the local residents loved using the facilities at the Peckham Health Centre, plus the indications that the research was working through the prevention of illness, the Peckham Health Centre failed to survive the turbulence of the mid-20 th century. The centre suspended operations at the outbreak of World War II in 1939 and despite reopening in 1946 it struggled with the political changes that were occurring in the country at the time. In the post-war period the new Labour government was campaigning for a new welfare state based on the model being championed by the Finsbury Health Centre, this led to the formation of the National Health Service (NHS) in 1948. This resulted in the final closure of the Peckham Health Centre in 1950 and the end of the original experiment. However, it was not the end of the building 9 Allan, J. (2012). Berthold Lubetkin. London: Artifice books on architecture. p.333

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AR597: Dissertation Ruaraidh Peck itself or of the ideals behind it as the centre was the inspiration for the UK’s Healthy Living Centres such as the Bromley by Bow Centre and the Pioneer Health Foundation. There were formed in the wake of the centre’s closure in an attempt to carry on the work of Drs Williamsons and Pearse and aimed for a time when ‘centres inspired by the Peckham Experiment would unleash the power of the individual. They would nurture people within their own families and communities and would be places where people are empowered to maintain themselves in their social and family environment and take real responsibility for their own lives.’ 10

Figure - Front Page of 'The Times' newspaper on the day of the opening of Finsbury

The building itself due to the versatility of its design meant that after the centre’s closure it could easily be adapted to other uses. In 1950 it was handed over to London County Council when it performed various roles, including being used as an adult educational college. By the 1990s however, it had been converted into luxury apartments. Generally the exterior of the building was preserved during this conversion process, however some of the interior spaces were altered such as the gymnasium, theatre and open plan spaces being divided up to form apartments. Meanwhile the swimming pool was reduced in depth with its diving boards taken out of commission, albeit kept in place. In contrast the Finsbury Health Centre which helped provide a model example for future NHS buildings is still in use to this day and was in fact restored in the mid-1990s reverting it to its 1930s appearance as well as modernising it for contemporary healthcare requirements.

10

Foundation, T. P. (2013, 12 02). Relevance Today. Retrieved from The Pioneer Health Foundation Web site: http://www.thephf.org/index.php/relevance-today

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AR597: Dissertation Ruaraidh Peck Regardless of the fact that the Finsbury Health Centre is still in use today and the Peckham Health Centre has now been closed for 60 years, in some respects Peckham is still the ideal we, as a society, are looking for at a time when we are doing our uttermost to ensure we lead healthy lives, and therefore reduce the chance of becoming ill. This can be proved by the fact that in 1994 Lord Donaldson of Kingsbridge in a statement to the government, after a debate on the subject of family healthcare and whether the findings of Peckham had been studied further, ‘My Lords, during the debate on the family on 23rd February, your Lordships discussed with insight and sympathy the increasing disintegration of the family, its effect on the health and happiness of its members and its dire consequences for the surrounding community and for the country. No fewer than 28 noble Lords took part in that debate, and I was astonished, […] not one of the speakers mentioned the work of the Peckham experiment’11. Finsbury though is a good example of progress from healthcare in the late 19th and early 20th century, and can be viewed as a less extreme example of a method of dealing with the prevention and cure of diseases. This is why the model set up by Finsbury was later adopted when the government commisioned the NHS.

Figure - Early Sketch of Finsbury and its proposed surroundings

11Lords Sitting Minutes. (1994, April 11). Peckham Health Centre. Retrieved from HANSARD 1803-2005: http://goo.gl/qDgesP Accessed (2014, 17 02)

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Lambeth Community Care Centre, 1985 Edward Cullinan Architects & the Heart of Hounslow Health Centre, 2007 Penoyre & Prasad By the 1980s healthcare had vastly improved in the United Kingdom compared to the conditions prevailing in the early 20th century when the Peckham and Finsbury Health Centres had been attempting to improve. Furthermore by this time the NHS was well established after its formation in 1948 with hospitals and health centres part of the scheme throughout the country. However, this did not stop some people believing healthcare still needed to be improved. In November 1980 two doctors on behalf of Sue Thorne, chairwomen of the Community Health Council and Roger Higgs approached the architectural firm of Edward Cullinan with a ‘vision of a new kind of health facility’ 12. The architects took up the contract almost immediately as they were ‘thrilled at the prospect of designing a new, socially useful ‘missionary’ project’ 13. Two weeks later the government approved funding and work began on designing the new Lambeth Community Care Centre. However there were several factors that allowed and led to the construction of the Lambeth Community Care Centre in the first place. These began in the early 1960s when part of St Thomas’s Hospital in London was torn down in favour of a new modern block known as the North Wing which left the older part known as “The Lambeth” redundant. In 1976 this led to an attempt by the Health Authority to tear it down and replace it with accommodation for 1000 nurses, this was opposed by the Community Health Council, a watchdog for the NHS set up by the government. After a four year consultation period an agreement was reached allowing The Lambeth to be torn down under the condition that new ‘sheltered housing for the elderly and disabled and a new community hospital’ 14 was constructed. At the time there was an increased emphasis on how to improve conditions for people who frequently required medical attention by supporting care and services in the urban 12 13

Marberry, S. O. (1995). Innovations in Healthcare Design. New York: Van Nostrand Reinhold. p. 241 Marberry, S. O. (1995). Innovations in Healthcare Design. New York: Van Nostrand Reinhold. p. 241

14 Marberry, S. O. (1995). Innovations in Healthcare Design. New York: Van Nostrand Reinhold. p. 243

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AR597: Dissertation Ruaraidh Peck environments. The proposed Lambeth Community Care Centre was designed to cater for these needs.

Figure - Early sketch section of Lambeth

To help facilitate this mind-set of improvement in the state of hospital and health centre design, the project team chose Edward Cullinan Architects to design the Lambeth Community Care Centre for, among many reasons, their lack of any experience in healthcare architecture. This meant they were not just giving a fresh point of view for the direction of architecture in this space but due to their inexperience they had ‘no option but to question everybody on the team and many others who were not about their present accommodation and its shortcomings, in order to learn the functions’ .15 Not only did this leave them with creative freedom, as they were not constrained by previous ideas, it also meant that due to their lack of knowledge of some NHS procedures, some of which were ‘long outdated and still strangling the procurement of good health facilities’ 16 they had a greater chance of revolutionising healthcare architecture. The prime objective for the centre was, however, that it was supposed to provide a viable alternative to the ‘high tech’ district hospital of St Thomas’s while at the same time feel domesticated, so as to provide that much sought after improvement in long term or recurring care. To create this they were told to virtually design a domestic building which made Cullinan think at first, of small traditional English houses; however, they later took it to mean more of a large country style manor that was simply set in an urban environment, an idea which Ted Cullinan referred to as ‘we want to throw a country house party for sick people’ 17.

15 Marberry, S. O. (1995). Innovations in Healthcare Design. New York: Van Nostrand Reinhold. p. 245 16 Marberry, S. O. (1995). Innovations in Healthcare Design. New York: Van Nostrand Reinhold. p. 245 17 James, P., & Noakes, T. (1994). Hospital Architecture. Harlow, Essex: Longman Group. p.158

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Figure - Plans of Lambeth Community Care Centre. Left is the Ground Floor and Right is the First Floor

The concept of creating this building to make you feel as if it was in the countryside meant it felt like ‘a gateway to a secret garden rather than a neighbourhood hospital’ 18 because the interesting plan of the building had created an entirely enclosed and private garden for the visitors to the centre. In maintaining this idea of giving a domestic feel to a health centre Cullinan proposed a series of homelike spaces starting from the very entry point of the building. Visitors would enter into the centre from an enclosed entrance way, created by the roof extending out to the street, into a reception room from where they would be led into the sitting (waiting) room. On the ground floor there was also a series of smaller consultation rooms and day rooms for patients, all of which would be used for treatments such as physiotherapy, occupational therapy, speech therapy, chiropody and dentistry. From the sitting room you would be led upstairs into the magnificent rooftop conservatory where you would find the nurse’s station, and a series of 4 single rooms, then bedrooms, which each accommodated 4 long term patients, and allowed for treatments by the medical and nursing staff.

Figure - Section of Lambeth

18 Hale, J. A. (2005). Ends, Middles, Beginnings Edward Cullinan Architects. London: Black Dog Publishing p.106

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Figure - View of Lambeth from the private garden

In fact the top floor of the Community Care centre was much more of a conservatory type building with its glass and steel structure compared to the more traditional brick structure found on the ground floor. This was also an attempt to create a more domestic feel. This conservatory structure allowed more light to enter the top floor of the centre providing an opportunity to house plant life within the centre. This helped in giving a domestic feel to the wards on the top floor, as well as, bridging the gap between the private garden outside and the internal spaces. This feature also helped by allowing cross-ventilation to occur across the space and enabling the enjoyment of bright colours from the evening sun thanks to the windows and skylights. One of the skylights in the nurses’ offices was in fact said to be a distraction due the view of the full moon: ‘So successful was this focus that staff were drawn to it at all times.’ 19 These features along with the abundant daylight through the whole building, courtyards, the domestic feel and even features such as the avoidance of fluorescent lighting meant the building ‘symbolized a through rejection of the total institutionality of its nearby acute-care hospital, St Thomas’s.’ 20 In the 1930s when the Peckham Health Centre was built it was all about the centre being part of the community and therefore an integral part of life for the families living in that area. Lambeth built upon this idea but with some slight differences. Whereas Peckham was very much about being part of their daily routine, Lambeth wanted people to see it as an extension of their homes. This was done by creating a local community care centre where the patients could on the whole remain living at home and only visit the centre for scheduled check-ups and treatments, but at the same time still make people feel at home if they did have to stay at the centre for a prolonged period of time. One way in which they achieved this was by avoiding traditional, and more formal, doctor’s consultation rooms. However, this proved difficult because during the planning phase the Community Health 19 Marberry, S. O. (1995). Innovations in Healthcare Design. New York: Van Nostrand Reinhold. p. 248 20 Fine, S. V. (2000). Healthcare Architecture in an Era of Radical Transformation. London: Yale University Press. p.250

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AR597: Dissertation Ruaraidh Peck Council requested 2 independent consultation rooms on the top floor which Cullinan opposed and argued in favour of creating a series of private window seats where the consultations could happen instead. Cullinan argued these window seats, which consisted of seats in a window box facing each other, allowed for ‘the most intimate conversations and consultations to take place in public as well as allowing the patients, therapeutically, to spy on the activities in the street below’ 21.

Figure - The window seats used as consultation areas in Lambeth

Lambeth did prove to be an evolution of the concept of a community hospital that had been founded in the Oxford area in the 1960s. Most of those early community hospitals failed to compete with the growth of District General Hospitals and were forced to close by the 1980s. Lambeth set out to prove that these smaller scale centres could survive alongside the larger hospitals. Rather than try to compete with them, as the earlier community hospitals had, Lambeth aimed to complement its local District General Hospital, in this case St Thomas’s, by offering alternative uses. It allowed for operations and obstetrics to continue being performed at St Thomas’s and instead offered a service for basic medical care and treatment, post-operation rehabilitation and care for the elderly and disabled in the local community surrounding the centre. The care for the elderly and disabled also meant Lambeth acted in a similar way to a hospice but for a smaller region helping promote the community feel. These features led to the centre being classed as community architecture, a term that many architects at the time tried to shun when it was associated to with their buildings including Edward 21 Marberry, S. O. (1995). Innovations in Healthcare Design. New York: Van Nostrand Reinhold. p.248

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AR597: Dissertation Ruaraidh Peck Cullinan; however, due to its success and plaudits the practice found it hard to not to be proud of the building. The term community architecture was simply a term that was applied to buildings that architecturally ‘responded to the needs of under-privileged people, helping and enabling them to improve their own living conditions’ 22; however, most of the buildings that had previously been regarded as community architecture had often been described as aesthetically pleasing, something Lambeth was determined to change. In 1990, shortly after the fifth anniversary of the centre’s opening the Lambeth Community Care Centre was still treating patients and the local community, and had made such a big impression that it helped lead to the publishing of the Tomlinson Report. This report was an investigation into the state of London Healthcare Services which recommended the closure of several District General Hospitals in favour of more Lambeth-inspired local community hospitals. Just as almost 50 years previously the government had taken the example of centres such as the Finsbury Health Centre to form a precedent for the NHS, it was now suggesting a move to a newer form of health system based on precedents such as Lambeth that would improve ‘primary and community health care premises and services’23 Lambeth was such a major advancement in health care architecture that it helped inspire many future health centre projects, in fact architects Allford Hall Monaghan Morris said they took inspiration from Lambeth in the design of the their Kentish Town Health Centre in 2009; however, some of the best health centres of note in recent years have come out of Penoyre & Prasad. Penoyre & Prasad formed out of Edward Cullinan Architects in 1988 have since designed several health centres all based on similar principles to Lambeth, one of which was the NHS Heart of Hounslow Health Centre in 2007. During the commission of Hounslow the centre was tasked to be seen as a new ambition in primary care in the NHS where a large range of services could be located within one building. The aim of this was to create a new and better experience for visiting patients where these combined services would create a chance to develop staff capabilities and therefore the architecture of this building would need to facilitate this new ambition. Penoyre & Prasad had been formed shortly after the completion of the Lambeth Community Care Centre by two architects, Sunand Prasad and Greg Penoyre, who had both worked on the project during their time at Edward Cullinan Architects in 1988. By 2003 they had gained considerable experience in health centre design having worked on them throughout the late 1980s and 1990s 22 James, P., & Noakes, T. (1994). Hospital Architecture. Harlow, Essex: Longman Group. p.157

23

Valins, M. S. (1993). Primary Health Care Centres. Harlow, Essex: Longman Group. p.175

24 | The Peckham Health Centre, the Finsbury Health Centre, the Lambeth Community Care Centre and the Heart of Hounslow Health Centre


AR597: Dissertation Ruaraidh Peck building on and developing on the ideals of Lambeth. So when they were tasked with this interesting challenge they relished it. Sunand Prasad and Greg Penoyre had been involved with health care prior to the Lambeth project, with Prasad having worked shifts in an elderly care ward while Penoyre had worked with people suffering from learning difficulties. These experiences had helped them develop an understanding of the needs of these people and therefore what they should design to better fit around these needs.

Figure - Early Sketch of Hounslow

In a similar fashion to Lambeth, Penoyre & Prasad who wanted to set up a new vision of health care architecture that also met these new ambitions of the NHS, Mark Rowe, an architect at the firm, stated in an interview with Building Design online that they memorised the Department of Health guidelines to better know how to develop them: ‘It’s written as guidance, but in the PPP/PFI world, those contracts turn the guidance into pseudo-regulations’ 24. One of the key design ideas Penoyre & Prasad had was that each space, depending on its use, had its own identity but this raised the problem of ‘how do you give each component of the centre the right identity while also expressing the unity of the whole?’ 25. To help solve this problem they initially put together several concepts based on three themes; cloister, cluster and unitary. Of these 3 schemes the clients chose the unitary option because they wanted to show the transformation ‘from an atomised, “silo mentality” set of services to a coherent and “joined up” service’ 26.

24 Hunter, W. (2008, March). Penoyre & Prasad’s stylish building syndrome. Retrieved from Building Design Online: http://goo.gl/oxheJh (Accessed on 22nd February 2014)

25 Penoyre & Prasad. (2007). Transformations: The Architecture of Penoyre & Prasad. London: Black Dog Publishing. p. 154 26 Penoyre & Prasad. (2007). Transformations: The Architecture of Penoyre & Prasad. London: Black Dog Publishing. p. 155

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Figure - The three schemes: cloister, cluster and unitary

So for the final plan they designed a building in the shape of ‘a pair of hands cradling a space between them’27 with this space acting like a street between two rows of building giving the internal layout of the building a sense of community. This street widens out in the centre to create the heart of the building. As this space contains lifts and circulation bridges across it you can obtain a sense of the movement and energy of the building and the roof lights help to create a pleasant space to be in. However due to the fact this space was funded through a Public Private Partnership, Penoyre & Prasad had to bear in mind that the building may be adapted in the future for alternative uses as well as the fact that the sheer nature of constantly changing health services meant the building would have to have an adaptable design. This adaptability was achieved by creating a simple modular element that was repeated and which could be altered between open plan offices or cellular clinical rooms by having no internal structural partitions.

Figure - The pair of hands that formed inspiration for Hounslow's floor plan

27 Penoyre & Prasad. (2007). Transformations: The Architecture of Penoyre & Prasad. London: Black Dog Publishing. p. 155

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Figure - Hounslow Floor Plans. Left is the Ground Floor, while right is the First Floor

Figure - Section through Hounslow showing the central atrium

Much like Lambeth, Hounslow was trying to create a sense of community in this case with its street design but it was also using colour to achieve this. The street was a 5 storey atrium which was enclosed at either end by a large glass façade, which contained alternating glass and coloured aluminium panels vertically offset slightly to avoid forming a grid pattern, and therefore office- like feel, on the windows. As the atrium was also painted white this helped to cast ‘ever- changing patterns on its internal surfaces’28 but colour of course was not a new idea. This can be seen at Finsbury in the 1930s which had contained colourful murals in an attempt to give it a community feel and Lambeth also used colour to create a more relaxing feel for the patients. In Hounslow though these colourful windows also extended to the exterior street facade of the building where each panel could be individually replaced to better suit the internal spaces if they were reorganised. Furthermore, the building was also trying to create a better environment for the staff of the health 28 Penoyre & Prasad. (2007). Transformations: The Architecture of Penoyre & Prasad. London: Black Dog Publishing. p. 156

27 | The Peckham Health Centre, the Finsbury Health Centre, the Lambeth Community Care Centre and the Heart of Hounslow Health Centre


AR597: Dissertation Ruaraidh Peck centre and therefore, had the centre staff room on the top floor of the centre where they were treated to a panoramic view of London.

Figure - The colour window panels

Hounslow was seen as a great success of the NHS’s vision for the scheme containing spaces for four GP practices, several clinics, physiotherapy spaces, podiatry areas, space for a social care outreach program, a special area for speech and language problems and children with learning disabilities, dentistry and a café where you could also receive general health information. All of these services were also, due to the design, easily visible from the reception desk in the atrium and therefore visitors would easily be able to find their way to whichever service they required. Since its opening, the centre has won several awards such as the ‘Hounslow Rewarding Design Award‘ and was commended for ‘Best Primary or Community Care Design’ at the Building Better Health Awards. It also helped Penoyre & Prasad win the ‘Health Building Architect of the Year 2007’ at the ‘BD Architect of the Year Awards’ in the year of its completion.

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Figure - Series of perspectives of Hounslow. Top Left is a view of the atrium, Top Right is the rear facade, Bottom Left is the main entrance and the Bottom Right is the street facade

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Conclusion These four key influential 20th century health centres illuminate and detail the progression, in architectural terms, of health centre design in the UK during this time. We can also observe how health centre designs have not only had to evolve due to changes in the system of the NHS that have occurred, but had to look into the future to make sure they were prepared for any changes they may later face. In the early 20th century architects tended not to design health centres and therefore, prior to the 1930s the UK had only seen standard brick designed Victorian Health Centres and Hospitals. These new buildings meant that Berthold Lubetkin and Sir Owen Williams both helped introduce the UK Health sector to the Modernist movement sweeping across Europe at this time. Modernism had been having a difficult time establishing itself in conservative Britain before the 1930s but due to several notable buildings in the early part of the decade it was starting to gain popularity and Finsbury and Peckham both helped to further this acceptance. As a consequence of healthcare in the 1930s still being quite rudimentary, several doctors were aiming to revolutionise treatments and had new theories of how this should happen. Even though Dr Pearse and Dr Williamson did take a very different direction to that of Dr Katial, in how healthcare could be improved, they did share the similar idea, that the space where treatments or preventative medicine were performed could have a direct impact on the efficacy of the treatment. Hence they both commissioned architects who took advantage of the light, air and openness of Modernism to create health centres that gave them their ideal environment for the treatment and prevention of illnesses. While the ideals of Peckham worked in theory they were based on the prevention of illness which required a strict change in lifestyle. This meant that after the Second World War the centre failed to re-establish itself properly and by 1950 had run out of funding and was forced to shut; however, from a design perspective it cannot be seen as a failure. The centre had a focus on providing an open plan with plenty of light allowing the space to be easily adapted which has benefited the centre considerably since its closure. These design factors allowed the centre to be easily converted into residential flats in the 1990s without having to remove any of the character of the building and maintaining many of the original facilities such as the pool and other communal areas. The experiment that took place, is still seen as a potential answer to our health care needs with Lord Donaldson of Kingsbridge proposing it as a solution to better family health in 1994 and the experiment itself is still ongoing due to the efforts of the Pioneer Foundation. 30 | The Peckham Health Centre, the Finsbury Health Centre, the Lambeth Community Care Centre and the Heart of Hounslow Health Centre


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In contrast, Finsbury focused on the treatment of illness and therefore became a more successful centre and was an inspiration for the early guidelines of the NHS. Finsbury can be seen as a successful example due partly to the fact that it was used as a precedent in the late 1940s when the government established the National Health Service, but also because it is still in use as a health centre to this day almost 80 years since it opened. This shows how Lubetkin’s adaptive design has allowed the centre to evolve to suit modern needs and methods in health care without any need for major changes. The idea of the centre being at the heart of the community was a key factor of both Peckham and Finsbury and it was this idea that was taken forward especially with Lambeth and Hounslow. Lambeth was built as a centre that would focus on the local community where patients who required recurring visits could be made to feel at home and therefore not feel reluctant to visit it. Hounslow was also at the heart of the community which Penoyre & Prasad wanted to emphasise and therefore they created a sense of a street going through the middle of the building from which everything led off. Both of these centres adhered to the early ideals of modernism, as both Finsbury and Peckham had, by providing a great deal of light and openness. Lambeth had similarities to Peckham as well, in the sense that both created a sense of home for their visitors. Lambeth had areas which gave the impression of rooms in a the house such as the waiting room which felt like a living room or the reception which was like stepping into the hall of the house. Lambeth also had a private garden for visitors to enjoy during their stay which the treatments rooms overlooked and could be seen from the stairwells. However, it did not have the open plan design of Peckham and Finsbury and instead had clearly defined spaces for each purpose of the centre. However, this did not restrict the centre too much, as in the 2010s the centre was able to be modernised and converted into an amputee rehabilitation centre. Partly due to the experience Penoyre & Prasad had from working on Lambeth, Hounslow also took elements from Lambeth and Finsbury when it was being designed. It kept the community feel the others centres had as well as the use of colour and light to make it an enjoyable pleasant space. It also had a similar open plan design to Finsbury, with the intention that it could be adapted for other uses in the future. Hounslow can be seen as a natural evolution of the principles set out in Lambeth due in part to the fact that Penoyre & Prasad worked on both, and built upon Edward Cullinan’s ideas during their work on all their centres including Hounslow. Therefore Lambeth can be seen as a 31 | The Peckham Health Centre, the Finsbury Health Centre, the Lambeth Community Care Centre and the Heart of Hounslow Health Centre


AR597: Dissertation Ruaraidh Peck success in that like Finsbury it is still operating currently as a health centre, and has been able to be successfully modernised and adapted to future needs in healthcare. Hounslow, at the time of its opening, was seen as a success and with their previous knowledge Penoyre & Prasad established a design that should be able to adapt to any future needs; however, it is impossible to know for certain what changes may occur in healthcare in the future. However the architecture of health centres will always be linked to the latest ideas in and visions of healthcare and will always remain in a state of flux. New visions and ideals will emerge such as in the 1930s and 1980s which will require new and interesting designs to work and new attempts will be made to revolutionise the way in which healthcare is administered. There is also a shift occurring towards palliative healthcare with buildings such as the Maggie Centres which focus on the long term care of patients. These centres are often small scale centres and are made to feel like a home, building upon the ideas of Peckham and Lambeth. We can perhaps conclude then, that because of the extent to which healthcare architecture is influenced by new ideals and technologies it is particularly difficult to predict the future course of design in this area. What we can say though is that these designs and their architects will most likely continue to draw inspiration from the past and the foundations laid out by the architects we have discussed.

32 | The Peckham Health Centre, the Finsbury Health Centre, the Lambeth Community Care Centre and the Heart of Hounslow Health Centre


AR597: Dissertation Ruaraidh Peck Bibliography Allan, J. (2012). Berthold Lubetkin. London: Artifice books on architecture. Allinson, K. (2006). London's Contemporary Architects. Oxford: Taylor & Francis. Charlton, S., & Powers, A. (2006). British Modern. London: Twentieth Century Society. Cox, A., & Groves, P. (1990). Hospitals and Health-Care Facilities. London: Butterworth & Co. Fine, S. V. (2000). Healthcare Architecture in an Era of Radical Trasnformation. London: Yale University Press. Franck, K. A., & Howard, T. v. (2010). Design Through Dialogue. Chichester: John Wiley & Sons. Hale, J. A. (2005). Ends, Middles, Beginnings Edward Cullinan Architects. London: Black Dog Publishing. Hannay, P. (1985, July). ‘A Patient Pioneer’. Architect's Journal, Vol. 182, pp. 12-15. Hunter, W. (2008, March). ‘Penoyre & Prasad’s stylish building syndrome’. Building Design Online (Accessed on 22nd February 2014)http://goo.gl/oxheJh James, P., & Noakes, T. (1994). Hospital Architecture. Harlow, Essex: Longman Group. Jencks, C., & Heathcote, E. (2010). The Architecture of Hope. London: Frances Lincoln. Linn, C. (2010, May). ‘Here's Hope’. Architectural Record, Vol. 198, pp. 72-78. Lubbock, J., Buchanan, P., & Ashton, J. (1985, October). ‘Lambeth Community Care Centre’. Architect's Journal, Vol. 182, pp. 60-103. Marberry, S. O. (1995). Innovations in Healthcare Design. New York: Van Nostrand Reinhold. Overy, P. (2007). Light, Air and Openess. London: Thames & Hudson. Pearse, I. H., & Crocker, L. H. (1985). The Peckham Experiment. Edinburgh: Scottish Academic Press. Penoyre & Prasad. (2007). Transformations: The Architecture of Penoyre & Prasad. London: Black Dog Publishing. (Essays by Sunand Prasad) Powell, K. (1995). Edward Cullinan Architects. London: Academy Editions. Powell, K. (2006). Richard Rogers. London: Phaidon Press. Valins, M. S. (1993). Primary Health Care Centres. Harlow, Essex: Longman Group. Wagenaar, C. (2006). The Architecture of Hospitals. Rotterdam: NAi Publishers. http://www.thephf.org/index.php/relevance-today (Accessed on 2nd December 2013) An information page describing what the Pioneer Health Foundation has done since the centre’s closure and its goals for the future. http://goo.gl/qDgesP (Accessed on 17th February 2014) Minutes of a Lords Sitting about the Peckham Health Centre on 11 th April 1994

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List of Illustrations Figure 1: View of the front of the Peckham Health Centre Overy, P. (2007). Light, Air and Openess. London: Thames & Hudson. p.64 Figure 2: Floor Plans of Peckham Health Centre with labels describing all the spaces Pearse, I. H., & Crocker, L. H. (1985). The Peckham Experiment. Edinburgh: Scottish Academic Press. p. 300 Figure 3: Photos of the Various Activities that took place in Peckham Overy, P. (2007). Light, Air and Openess. London: Thames & Hudson. p.65 Figure 4: Diagram showing the spaces in the Finsbury Health Centre Allan, J. (2012). Berthold Lubetkin. London: Artifice books on architecture. p. 338 Figure 5: Plans of the Finsbury Health Centre Allan, J. (2012). Berthold Lubetkin. London: Artifice books on architecture. p. 338 & 339 Figure 6: Section through the centre of Finsbury Allan, J. (2012). Berthold Lubetkin. London: Artifice books on architecture. p. 339 Figure 7: The Murals that adorned the walls of Finsbury Fine, S. V. (2000). Healthcare Architecture in an Era of Radical Trasnformation. London: Yale University Press. p. 285 Figure 8: Left is the structural grid of Peckham while right is the relatively open foyer of Finsbury Left: Valins, M. S. (1993). Primary Health Care Centres. Harlow, Essex: Longman Group. p. 4 Right: Allan, J. (2012). Berthold Lubetkin. London: Artifice books on architecture. p. 335 Figure 9: Image of Finsbury showing the monolithic nature of the end walls Fine, S. V. (2000). Healthcare Architecture in an Era of Radical Trasnformation. London: Yale University Press. p. 281 Figure 10: The Diagrams used during the design phase by Tecton Fine, S. V. (2000). Healthcare Architecture in an Era of Radical Trasnformation. London: Yale University Press. p. 284 Figure 11: Front Page of 'The Times' newspaper on the day of the opening of Finsbury Allan, J. (2012). Berthold Lubetkin. London: Artifice books on architecture. p. 332 Figure 12: Early Sketch of Finsbury and its proposed surroundings Allan, J. (2012). Berthold Lubetkin. London: Artifice books on architecture. p. 348 Figure 13: Early sketch section of Lambeth

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AR597: Dissertation Ruaraidh Peck Franck, K. A., & Howard, T. v. (2010). Design Through Dialogue. Chichester: John Wiley & Sons. p. 39 Figure 14: Plans of Lambeth Care Centre. Left is the Ground Floor and Right is the First Floor Hannay, P. (1985, July). ‘A Patient Pioneer’. Architect's Journal, Vol. 182, pp.15. Figure 15: Section of Lambeth Hannay, P. (1985, July). ‘A Patient Pioneer’. Architect's Journal, Vol. 182, pp.15. Figure 16: View of Lambeth from the private garden Franck, K. A., & Howard, T. v. (2010). Design Through Dialogue. Chichester: John Wiley & Sons. p. 39 Figure 17: The window seats used as consultation areas in Lambeth Franck, K. A., & Howard, T. v. (2010). Design Through Dialogue. Chichester: John Wiley & Sons. p. 153 Figure 18: Early Sketch of Hounslow Penoyre & Prasad. (2007). Transformations: The Architecture of Penoyre & Prasad. London: Black Dog Publishing. (Essays by Sunand Prasad) p. 156 Figure 19: The three schemes: cloister, cluster and unitary Penoyre & Prasad. (2007). Transformations: The Architecture of Penoyre & Prasad. London: Black Dog Publishing. (Essays by Sunand Prasad) p. 154 Figure 20: The pair of hands that formed inspiration for Hounslow's floor plan Penoyre & Prasad. (2007). Transformations: The Architecture of Penoyre & Prasad. London: Black Dog Publishing. (Essays by Sunand Prasad) p. 159 Figure 21: Hounslow Floor Plans. Left is the Ground Floor, while right is the First Floor Penoyre & Prasad. (2007). Transformations: The Architecture of Penoyre & Prasad. London: Black Dog Publishing. (Essays by Sunand Prasad) p. 158 Figure 22: Section through Hounslow showing the central atrium Penoyre & Prasad. (2007). Transformations: The Architecture of Penoyre & Prasad. London: Black Dog Publishing. (Essays by Sunand Prasad) p. 161 Figure 23: The colour window panels Penoyre & Prasad. (2007). Transformations: The Architecture of Penoyre & Prasad. London: Black Dog Publishing. (Essays by Sunand Prasad) p. 156 Figure 24: Series of perspectives of Hounslow. Top Left is a view of the atrium, Top Right is the rear facade, Bottom Left is the main entrance and the Bottom Right is the street facade Penoyre & Prasad. (2007). Transformations: The Architecture of Penoyre & Prasad. London: Black Dog Publishing. (Essays by Sunand Prasad) pp. 157, 159, 160 & 161 35 | The Peckham Health Centre, the Finsbury Health Centre, the Lambeth Community Care Centre and the Heart of Hounslow Health Centre


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