Interview Interview transcribed as ‘intelligent verbatim’. Names of third-party individuals have been removed from this transcript. A redaction is marked by ‘…’. BDP provided the images discussed during this interview. Participant prefix key: IV: Interviewer IE: Interviewee Transcript begins 00:03 IV: Okay. Thank you very much. This is Victoria Bates and it is 2:30 on the 20th of January 2023. Can you introduce yourself? IE: Yep. Hi, I’m Victoria Casey or Vicky Casey. I’m a director in architecture with the firm Building Design Partnerships. IV: Great. Thanks Vicky. So, we’re just going to have an hour or so conversation about your practice and your work with BDP and any work you do outside or before. I don’t know anything about your career actually so we can talk a bit about that. So, just to start off then can you just tell me a bit about yourself, your professional practice as an architect – how you got into this – what your career has involved to date? IE: Yeah, sure. So, I’ve been working with BDP since 2004. So, not quite sure – quite a number of years. It’s 2023. So, however many years that is. I took some time off in the middle to have kids so it’s not been a continuous time but mostly it has been. And prior to working with BDP I was studying architecture – did my part one placement in America. Went back and did my part two. Started with BDP as I say in 2004 as – and then became a qualified architect with BDP. And throughout my time I’ve been almost solely focused on healthcare architecture. Although within that come other disciplines. There’s quite a lot of interface with master planning – when we’re working on really big healthcare projects – and how hospital estates sort of land themselves within the wider city. Sometimes it can be looking at if they’re going to sell off some of the land for housing or different things. Or interior design and art strategies and landscape and sustainability. So, whilst it has been within the healthcare sector there’s been quite a lot of multidisciplinary work and that’s probably due to the fact that the healthcare estates are quite large. But also due to the fact that BDP is a multidisciplinary practice so we have in-house engineering, acoustics, lighting, landscape, sustainability. So, within the company it’s a multidisciplinary approach to design anyway which is one of the things that I quite enjoy about working with them and probably part of the reason I’ve stayed for so long. IV: Great. So, BDP was your first architecture job? IE: It was my – well, I guess I – technically I had a job with a couple of architecture firms before BDP but not as a qualified architect if that makes sense. So, during my training and then leading up to becoming qualified. But I have been with BDP for a long time. IV: And have you always had an interest in healthcare architecture or what drew you in to that particular part of the work? IE: I’d say I had a resistance to it before I joined in that I had worked for smaller firms before joining BDP. And on joining the studio that I joined with Sheffield and they had at that time recently won the commission to do the Queen Elizabeth Hospital in Birmingham. Which was a massive project for BDP and is one of the biggest healthcare projects nationally – or certainly was at the time. So, it was quite daunting and actually I guess I saw my – I didn’t see myself as going into that field. It wasn’t something I had a particular interest in. It was quite – like I say, daunting – to think that this was potentially a seven year project and when you’re quite young that seems like quite a long time, especially when you’re trying to qualify. You’re more interested in projects that are going to turn over quicker than that. So, I was slightly resistant if anything to join the team but then as soon as I had I realised that the complexity involved in healthcare architecture is really interesting. The fact that you’re dealing with such a cross-section of society – people with all sorts of vulnerabilities. Technically they’re far more complex than almost any other building. You’ve got strategies in there to separate certain key flows from other flows which I feel is only maybe comparable to an airport or something like that in terms of the way that you go about design. Yeah. Certainly, a lot more complex than almost any other building typology. And with that comes an awful lot of interest and trying to make them good. Yeah. By working in this sector it feels like I can take transferable skills to quite a lot of other project types which are less complex and apply some really logical thinking that’s been - So, yeah so I haven’t – once I was in, I don’t want to leave the sector, if that makes sense. IV: So, you see the complexity as an advantage? IE: Definitely, yeah. From a problem-solving perspective. And just knowing that what you’re doing is worthy. That if you can design a space that is pleasant and better for people to recuperate in, that you’re – yeah. It’s not like designing a high-end office for a corporate client that’s got loads of money that just wants it to be how they want it to be on a whim. There are really critical fundamental things to try to get right technically and then if you can add joy to that on top, then that’s – Yeah, I get a lot of job satisfaction from being in the sector for that reason. IV: I’m interested in how things have changed, I suppose in a number of ways. Because you’re talking about – I presume – almost 20 years ago. I was doing my maths there. Coming in as someone presumably with little to no experience in the healthcare sector and now as someone with a lot of experience. But also of course a very different – well, not of course – presumably – I assume – a healthcare sector that looked different 20 years ago. So, I guess there’s two parallel questions there. One is like, how have things changed for you? What have you learnt? What do you do differently now? And one is how do you think it is different – like, practically different – to be doing the job? IE: I think – how is it practically different? One of the biggest influencing factors that I’ve felt potentially has been the – because it’s funded work it goes hand-in-hand with government motivation. So, when I did the Queen Elizabeth Hospital, that was part of the PFI process and that one was coming along at a time when I think there was – from my perspective – there was an improvement in the quality of building that you could produce. And some of the negative connotations with PFIs – particularly to do with the schools, I think – I feel like the bigger complexity of the healthcare project and certainly the Queen Elizabeth, well, we won a RIBA award for design quality for that hospital. And the one that I went onto after that, which was Southmead Brunel Building in Bristol, again won a RIBA award for its design quality. So, we were able in that – the political situation influences the number of healthcare buildings that are going on more than anything else almost. And if that funding dries up then the large healthcare projects go on hold. So, that’s definitely had a bearing on how work has come through in the sector. And yeah, the ability to do architecture of a higher quality – or a quality that we’re proud of – wasn’t necessarily easy under those circumstances but it potentially wasn’t as hard as you might think. I do feel that we’ve been able to produce good buildings within those constraints of the NHS funding and PFI contracts., ad potentially to produce buildings of a higher quality than some that have had other funding mechanisms that you might think would be easier. In terms of what’s changed over that timeframe, I guess you’re always designing flexibly because healthcare technology always moves on quite quickly. So, the brief that you get at the beginning of the project – certainly, the larger projects take a long time to come forward. So, it can take seven years – 10 years – from start to finish. By which time technology has changed so you have to design flexibly, and I think getting trusts to get into that mindset at the beginning is quite challenging because they start writing their briefs and they want – they have a very specific way of running their department. It’s very difficult for them to see – to future gaze. Sometimes they future gaze to things that may or may not come into – you know, they may see – some of them are very forward looking and see real change coming into the clinical model. And some of them want to have their department as it is as their sort of realm. And we often have to bring in a flexible approach which designs for a kind of five to 10 year – You want to get the bits that are going to be up for 50 years as right as possible with very minimal change. And then bits that may change over the course of a five year, 10 year period, you want to design in that flexibility such that that change isn’t really disruptive. And sometimes that’s about getting the skeleton of the hospital really logical so that entrances, departments and lift cause and things like that are really easy and intuitive to find. Because those are the sorts of things that aren’t going – you know, you’re not going to change the whole skeleton of circulation within the lifespan of a building. Or you certainly don’t want to. So, if you can put a lot of thought into that at the beginning, that can often be – give the building more longevity. And so things like that we thought about a lot for the Queen Elizabeth and then also the same for Southmead. It’s one of the first things we try to do. Things that have changed from doing the two projects. So, Queen Elizabeth was – well, for me we started in 2004. For the practice I think started about 2002. Ran through until about 2009-ish. I’m not quite sure. Southmead started around 2007. 2006, 2007 and ran through to 2014, ’16. Across that timeframe I think - I don’t know whether it was more to do with the trust motivation but sort of biophilic design and the quality of landscape space was more at the forefront on Southmead. And the QE was more clinically minded. But that could have been a trust view as opposed to a change through history view. Although I think there is something in that that it has become more prominent. You know, certainly there’s a lot more people talking about wellbeing and the holistic benefits of having access to outdoor space and landscape space. Has been an ongoing trend I guess even beyond the healthcare sector. So, potentially – maybe that’s both. Maybe it’s both a trend and kind of client motivation. IV: Great, thank you. And how about you as an architect? Do you feel as though you approach things differently in healthcare now? IE: I think [pause] I don’t think I approach things differently based on change. Maybe there’s - It’s an interesting question. I’m more mindful from my experience of when things – when you lose things. So at what point to hold on to certain things that you want to keep. To be particularly cognisant of an opportunity for a really exciting space or part of the brief. And potentially if you think about things too late then maybe the funding isn’t there at that point or other things. Or trying to get the client excited about certain things. If I see that there’s an opportunity for something to be really good, to try and make sure that I’m bringing it up at a relevant point so that it can gain momentum from the trust board or from anybody within the client side, to say, ‘Oh, you do realise that you could do this?’ And I think maybe that comes from experience of working through projects and seeing slightly missed opportunities along the way, more than anything. Is that –? Or were you meaning something else? IV: Yeah, yeah. I was interested just in how your experience had shaped you and your work. So, yeah. That’s a good example. I’m also interested in your process as an architect. So, it follows on really but I wonder if you could talk me through – ? I know it’s a seven year job or whatever but I mean how does a hospital come to be? Where do you start? Maybe just talk me through how you get to your ideas and how do you get from brief to building? IE: Okay. So, I think the majority start with a masterplan. So, if you’re talking about a significant investment in building a new hospital, it will either be on a completely green field site where there isn’t a hospital already. At which point it’s quite a lot simpler. Most of the time you’ll be working beside an existing hospital and parts of that hospital will be – they’ll have been vacated or there is a bit of land available such that you can – there’s an obvious place to start building. But that might be not the best from an adjacency perspective of core clinical services. So, it can be quite a – the initial stages of looking at how you can completely transform a healthcare estate with a large project, a lot of the early work is around trying to unlock the potential for a long-term vision and looking at the critical clinical adjacencies along the way. You know, you’ve got core clinical activity like theatres and critical care and A&E that are kind of like a lynchpin of – centre of gravity – for critical clinical cases – that might be tied to a helipad if it’s a trauma centre. So, trying to work out where they sit to make sure that that can function and have continuous care. So, if you’ve got that facility existing, you obviously have to build a new set of that and open it before you close the old one. So, there’s always a complicated phasing strategy involved in that. And sometimes that can – if you don’t think big enough sometimes that is what leads to kind of piecemeal development. Because if you’re not going to unlock any of that then ultimately everything has to add on in and around those core services because they’re 24/7, 365 days a year. Which is why you see a lot of piecemeal development and in-filling of existing hospital estates. So, to get a long-term vision it can be quite painful for trusts to go through and quite expensive. But as soon as you’ve unlocked that bit then it’s about at what point can you then vacate parts of the site to then rebuild the other bits and to place it in such a way that you can create a really beautiful and considered new building. I make it sound like it’s completely impossible. Saying it out loud I’m thinking, “God!” IV: You’re talking about quite specific projects are you where you’ve got an existing hospital? A new building that’s going where there’s an existing hospital? IE: Well, all of them really. I guess the Queen Elizabeth, Southmead, Alder Hey, Great Ormond Street. They all append – More commonly than not that will be the piece of land that the trust own so the land adjacent to the existing is more often than not – It might be – sometimes there’s nurses’ accommodation that’s fallen into disrepair that’s no longer fit for purpose that gets demolished. But it’s land that is adjacent to the hospital that the hospital own that you then – that can be the start of the project. Or just other buildings that have – that are no longer fit for purpose that are up for demolition. Where there’s a small amount of decant of – okay, there’s a few services in there but not very much. And then that creates a plot of land that’s within their ownership. And then you try to attach as much logic as possible. Like I was saying before about getting the key circulation. Because from day one, if that’s wrong, then you’re committing that hospital forever more to have people in beds passing people in public spaces, passing people with FM trollies. If that circulation’s wrong then the kind of patient dignity for the next 50 years is – it’s not something that you can unpick later and change. If those corridor routes are convoluted and difficult to navigate then that’s just there forever. And actually the in-filling approach that I was talking about is another reason why something might start out quite simple and quite logical and then end up in kind of rabbit warren. I guess another reason for that is the fire strategy that’s involved in UK hospitals which is you’re normally in a fire situation everybody wants to get out of the hospital. Sorry, everybody wants to get out of the building as quickly as possible and it relies on people going down stair cores and having a distance to a stair core to escape. If you’ve got everybody in beds then they can’t go down a stair. So you link them horizontally so that you can wheel those people in a fire situation out of that compartment – deal with the fire – and if you keep them horizontally then you can keep them attached to oxygen and attached to the things, ‘cause actually if you took them away from that they would die by being disconnected from things. So, the fire strategy is very horizontally based as opposed to very vertical and out based. And that creates loops so that’s why you often get looped accommodation within a hospital plan, which can lead to non-intuitive wayfinding because people feel like they’re going round and round in circles ‘cause in fact they are going round and round in circles. So, trying to create a circulation strategy that doesn’t have that feel to it, that allows you to very clearly and simply just go up and into a department without that feeling of the loops. That’s quite – that’s something that we take quite seriously really early on. And actually it is one of the major bits it’s easy to get wrong if you don’t consider that from day one. IV: Great. So, that’s – so you start with I guess, the flows and the structure. IE: Yeah. And that can even be actually things as simple as separating out level access. So you want your ground floor. You want to be able to walk into the hospital on a level that feels like part of the public ground so that you go out – you are arriving in a public space so like an outside – maybe a square or maybe there’s some parkland or green space landscape as you go into the hospital. You want to be able to walk in and feel like you’re in a public space that’s pleasant. That’s if you’re going to outpatients or as a visitor, potentially a member of staff as well. But if you’ve got an A&E department, that also wants to be at the ground floor. But that wants to very much not be part of that space. So, either you have a very large ground floor that has two ends that are – one dedicated for trauma, one dedicated for public – or you separate it. If you’ve got a gradient across the site you can sometimes gain a ground floor level access at the higher point for one of those users and a ground floor level access underneath. And that way you’ve separated those two key flows from a site wide perspective by using the level of the land to help you in separating that out. And that can also be a separation of service routes and things. So, FM facilities and management, deliveries of – there’s a lot of logistical – there’s lots of waste in and out. There’s lots of deliveries of drugs and deliveries of goods in and out and trying to not make that part of the user experience. If you’re arriving as a stressed visitor or a stressed person who’s about to go in and have an operation you want them to just really easily find their parking, have a really pleasant walk in to the front door. A really logical easy route in the lift up wherever it is they’re going, instantly be able to see the front of that department, instantly be able to connect on to where they’re going and not to interact with, you know, a delivery of some linen or somebody arriving at A&E by helicopter or – So, this is what I was saying about the airport analogy is that there’s lots of different flows all going around and you just want everybody who’s arriving for a different purpose – the delivery person wants to just arrive at the service yard without interacting with the others. Likewise the A&E person. Likewise the visitor. Likewise the member of staff. You’ve got all these different people that want to have a really pleasant journey arrival sequence and they all want to be separated out. So, yeah. That’s the sort of thing if you’re doing a really big hospital project you can sort out more of that stuff. The smaller the project gets, the more it gets towards the land of being an extension on an existing, the less you can unlock some of those things to make them better. IV: So you’re talking quite a lot about thinking about different people’s journey through the hospital and different people’s experiences and what people want or need. In some ways, going back to basics I mean how do you know that? Like, where are you getting your knowledge from of what people want? Do you ask people? Is this from literature? Is this building guidance? IE: I think there’s a lot in guidance that says what good is and that you should aim to separate these flows. We do a lot of stakeholder engagement with trust user groups and then people that come and use the hospital. Some of it I think is common sense for what would be better. I think we’ve all experienced hospitals where all these things clash. So, there’s a common understanding that people don’t want that. Trying to make it a reality is the hard bit ‘cause as I’ve just described you can sort of intuit why these things might all end up clashing because if you do ad hoc additions and things like that then obviously it gets harder to keep a hold of that separation of flow. Is there any other method by which we get that? I think it’s more that through the consultation process with staff you uncover more of the clinical flows that go on and things. The people that are really useful to talk to is the head of nursing and an anaesthetists. Anaesthetists will – there’s quite a lot of staff that work in silos of their specialism. Quite rightly because that’s what they do. And the anaesthetist is somebody who will actually go round quite a large majority of the hospital. So, they’re quite a useful person to engage with ‘cause they’ve got quite a holistic view of the whole building from – yeah – so we try and sort of find key people who have – Each trust will have a different clinical model potentially so that can affect which – the way adjacencies work between different departments and things. And they all have different specialisms so sometimes there’s certain – Yeah, we’re always learning new things about certain departments needing certain things based on technological advancement or different ways of doing things. Or just a particular set of relationships. If there’s a hospital that really specialises in a particular type of disease. Although, having said that, pretty much A&E, critical care theatres they’re always kind of pivotal within any hospital. So, they need to be sort of right within the skeleton quite early. Landing those and then where the public zone is, is probably the first bit. IV: That’s really interesting. I always think about porters as people who – IE: Yeah, porters are really useful as well. Yeah, no that is true. IV: Do you speak mainly to staff or do you do consultation with potential patients? IE: Yeah we do. We go to patient panel groups and patients with different sort of physical disabilities. There’s access groups, patient panel groups, families. So, relatives of – you know – people that are assisting patients in the hospital environment. Yeah, there’s sort of wider stakeholder engagement that’s – that’s a part of pulling out the information that’s required. I guess there’s a slightly longer stakeholder engagement with staff for clinical sign-off of their departments ‘cause they’ll be looking in more detail at the absolute layout of their department where they go to get – Yeah, where they go to replenish stock or where their storeroom needs to be or how far it is to their staff base. How far they walk between patients and how central their staff base is to monitor whether patients are in private rooms or whether they’re in multi-bed bays or how open that is and how the sort of observation lies and that kind of thing – back to their group. And that’s changed over time as well. And obviously the pandemic as well. So, there’s been a kind of shift from multi-bed bays into single room accommodation has been a trend and that comes with slightly longer corridors because you can pack more people in in multi-bed bays into a shorter run of corridor length. And that’s a culture that certainly in the NHS, with funding challenges, if you’ve got not quite as many staff as you want and you want them to look after people in single rooms, and those single rooms are further away, yeah, that can be hard to advocate for what best practice is. Because best practice from a building perspective dictates that actually single rooms, infection control, post-pandemic, keeping people in private spaces, giving them the ability to have a kind of hotel room feel, is very much the direction of travel of what ‘good’ looks like. But obviously then you go into some buildings with existing set-ups where everybody’s – you know, maybe it’s a hospital that hasn’t seen much investment over the last 30 years and they’re on a quite old model of lots of people in multi-bed bays. Actually, those staff - if they haven’t got quite enough staff – they’re walking a very short distance to see an awful lot of patients and you can understand why they would be hesitant for why 100% single bedrooms is good – because they potentially can’t see how that would work for them with the current set-up. So, there’s a kind of journey of – if you’re building a new hospital and if it’s got a completely different style of ward – you have to take along with that from the trust side – they have to have an investment in staffing levels and recruitment and making sure that they can actually make it work. And I think there’s sometimes some tension there with the politics and investment and how long – It can be a bit – IV: Yeah, that’s interesting. That is something I’ve noticed at Southmead the single rooms, that stand out from a lot of hospitals I’ve visited. IE: Yeah, so Southmead’s 75% single to four-bed bays. They’ve got two four-bed bays on each ward and then the rest is single. And yeah. And then there’s discussions – I think it’s – speaking completely personally as opposed to as a professional – just a personal opinion – I think when you go to 100% single rooms you lose – there might be some people who want to be in a four-bed bay who have a preference for having company. And who maybe feel isolated in a room on their own. So, I can see why there would be a benefit to retain that as an option to give. Whether it’s even possible to give patients that choice or whether actually you get given the bed that’s available and you’re grateful that there’s a bed available. In an ideal world, if a patient had a choice that would be lovely to be able to put them in a room that suited their psychological needs from how they feel they would benefit from care. That would be good. I think some of the research into multi-bed bays I believe comes out of America where a multi-bed bay can be just two people. And that’s very different. I think as a female – I mean, I guess they’re single gender wards but maybe it doesn’t matter if you’re male or female or – but having just one person in a room – if you don’t get on with them – that can be quite aggressive. Whereas I think if the research was done on a four-bed bay where then there’s safety in numbers and actually if you can’t move or get to your call button that somebody in your bay can do that then there’s a – it’s just a very different dynamic. So, I don’t know that the research necessarily reflects – Sometimes I feel like it’s a bit harsh on the multi-bay – Yeah, the arguments against multi-bed bays. There’s certainly an infection control thing where obviously single rooms is going to be better from an infection control perspective. But some of the arguments that say people don’t like being in a multi-bed bay – I believe – comes from some prominent studies to do with two-bed multi-bed bays. Which may or may not be as relevant for four beds which was more common in the UK. IV: Oh, that’s interesting. That might explain why we tend to have four or six but rarely two. IE: Yeah, I think it’s an American thing the two bed bay. Six beds was the old school UK model and then it went to four beds and yeah so older hospitals will have six-bed bays and the structure will be set out to the standard for the six-bed bay. So, sometimes you’ll see four beds retrofitted into a six bed based on a building that was built in maybe the 1960s through ‘80s maybe. It’s before my time but I believe that sort of timeframe had six-bed bays and they were very specific dimensions. So, you’ll find a six-point-nine grid or a – the column spacing will be really specific to that guidance of that time that said, ‘This is the size that a six-bed bay should be. This is the distance between the beds.’ And you’ll find it repeated over multiple hospitals up and down the country. And then as you go into getting when the guidance changed to four beds you’ll find the grid between the columns changing to fit that guidance. So, yeah. IV: I feel like I could talk to you about beds for a long time. I’ll do that off camera. IE: Yeah we could talk about inboard ensuites and outboard ensuites and nested ensuites. There’s a whole thing about that too. IV: I know. It’s a really interesting topic. I have lots more questions. If we have time I’ll come back to that. I mean it does move on a bit to my question about interiors. When you move on from the structure how much role do you have in interiors? Do you have in-house interior designers? To what extent do you work with them? What’s the next step? IE: Yeah. So we do have in-house interior design and they were more involved with the Brunel building than some of our other buildings that I’ve worked on. They’re certainly specialists in that field and we’ve done a number of projects – large hospital projects – with our interior team and they do – they really add value to the look and feel of the hospital and making it feel less clinical and a much more pleasant environment. Yeah, we try to integrate with them quite early on. So, even at the strategic level where I was saying – those early concepts where we’re setting out the skeleton of the hospital and those separation of flow. At that point it’s really great if we can be thinking about the art strategy and intuitive way finding. So, generating a public space where there’s an obvious place to put a really large piece of art so that people instead of relying on signage that says, ‘You need to go to this lift and this floor and this department,’ and you have to find a blue sign with white text on that gives you all of those things – if we can actually design a really vibrant public space and place a big piece of art either at an entrance point or whatever else – then people intuitively say, ‘Oh, I’ll meet you by the three monkeys,’ or, ‘I’ll meet you by the lion,’ or, ‘I’ll meet you by the hoops or whatever else.’ And people adopt – they kind of get memory markers of how to navigate that building based on actually finding their way back as well. So, you go into a space and you can find your way back and I think that’s one of the beautiful things about Southmead hospital is that it’s got these three very large atria through the centre of it and you can – because the spaces all link off that space – so you’ve got core clinical activity on one side with A&E and theatres and critical care and you’ve got ward spaces on the other side and everything – every departmental entrance is off one of those three atria spaces which is a really big public space – people intuitively find their way back to being along the side of that atrium space. So you don’t have this feeling of being – the very centre of the hospital is completely filled with daylight and a big public space so you don’t feel like you’re in a public space and then all of a sudden you’re in this thing that loops back and forth and you don’t know where you are and then you need to find your way back. It’s very much the heart of the hospital. And that was something that came out of the really early briefing from the trust. So, the trust had visited about five different best practice hospitals in Europe – while they are at a competitor stage of choosing architects – and when they wrote their brief they said, ‘This is what we like about these hospitals and this is what we don’t like. We like this about this one. We like this about this one.’ And one of the ones they really liked was Riks hospital in Norway and that one had a central atrium design with facilities off each side. And they said, ‘We just never felt lost in that hospital. It had daylight at the centre of it and it was lovely to never feel lost.’ So they didn’t know that what they were saying to us was really prescriptive in what they wanted but we were able to say, ‘Ah, okay we have to find a way of making this building work.’ Which actually really prescribed the amount of site grab that you took. So, sometimes you can make hospitals quite vertical and you can stack everything up and then you get a shorter horizontal adjacency and you kind of go up in a lift so things are stacked really tightly. So, you could have a really short vertical adjacency as opposed to a really long horizontal adjacency. In order to do the bit with the atrium all the way down the middle you take a bit more land and you have everything coming off side by side. So we needed to then find a way of fitting that on the site. Which was fine actually. We were able to do that But it was a really – I don’t think they realised how useful that was as a piece of feedback. In some ways it was really prescriptive then what we knew that they wanted. IV: Yeah, that’s interesting how much of it is driven by, I guess, their inspiration or the brief in the first place as well. IE: It was really, really brilliant. And actually it made them a really informed client, the fact that they had gone – I mean, in the grand scheme of things it really didn’t cost very much for them to go on that tour and see those buildings but from our perspective, them saying, ‘we liked this, we didn’t like this,’ was such a useful thing for us. For them to be able to communicate in a language of architecture just from likes and dislikes they were able to communicate some really complex things that they definitely wouldn’t have been able to – we wouldn’t have been able to get out of them as easily otherwise. IV: As we’re on Southmead and the atrium – Actually, before I ask you to talk me through it in a bit more detail – Well, no, actually you can. Sorry. I was going to ask as well about the other sensory qualities of the space. So, beyond the structure and the light whether you – or how you factor in other sensory issues. Like whether it’s sound control or smell or anything like that. And so I don’t know if you want to talk about that when you talk through the Southmead example or whether you want to answer that now. IE: I think maybe I’ll do both. We certainly did think about the experience of the space from a sensory perspective and trying to make it a really pleasant environment for as many people as possible and – I guess – less clinical in nature. Having an awareness that by taking this approach there would be a big public space through the heart of the hospital. With the Riks example it’s – the clinical corridor – the key circulation route goes down the side of the atrium – but it’s closed. So it’s sealed which is the normal way of doing things from a fire perspective. It’s – we felt like what we wanted to explore with Southmead was whether we could do that – find a way of dealing with the fire issue by having something that created a fire seal but that was – we actually did it through a roller shutter that comes – shutter that comes up and down. And that way we could have openings from that public space. And that was something from the very beginning we could see would be an opportunity to really link the clinical space with the vibrancy of the public space below. So, I can talk you through that ‘cause there are other bits to do with acoustics and things that we considered. Which if I just take a second to get to the – I gave a talk on it at the European Health Conference and I’ve got a presentation on it from that, that maybe explains it. Let me – IV: That’s great. Thank you. IE: I’ll share my screen. Has that worked? IV: Yes. IE: I think if I just flick through it as opposed to giving it as a presentation. So, we wanted to create a space that had a sense of calm and a sense of vibrancy. And actually the key to that success came from just as I was talking about an informed client – an experienced team – so the fact that we’d designed large hospital buildings before – and being able to lock in quality early on in the competitive process. So, this is Riks hospital where they went on their study tour before. And you can see the dark grey is the – Can you see the thumbnails of you and me in the corner or can you see the? Can you just see my screen? IV: I can see you as well, yes. IE: Do I need to move this box out of the way? Is that better? IV: That’s fine. Yeah, I can just see the PowerPoint and then I can see you on Zoom. IE: Can you see my cursor? IV: Yes. IE: Okay, so there’s a dark – the dark grey is the central public space that goes all the way through the hospital. And then you can see the ward space is going off like fingers. They have a slightly different fire strategy in Norway so they’re allowed to do fingers a bit more than we can that go off into the distance. But here you can see the loop space of all the clinical departments. And this is this central – dark grey area – central light-filled atrium down the middle. So, they had said that they had really liked – on their study tour – they really liked the fact that they kept coming back to this – you know, you go out of a department and then there’s a corridor that lines the side with this atrium space. So there’s a key sort of circulation route and I think it runs down that side. So, you’re walking through upper levels of the hospital and you can still see and navigate back to this key space which is why they didn’t feel lost. And then – IV: What’s that..? Sorry, I’m interrupting you as we’re going through the slides. The colour at the end, was that referenced or was it just the structure that they were interested..? IE: They did reference that in terms of wanting to have key pieces of art in that space as an art strategy. So, they did mention having big pieces of art as being an important factor. But it was more the fact that it was a day-lit space that was something that they could remember. So that they could see where – every time they went into a department and out again they could see where they were based on reorientating themselves intuitively by just seeing this space. Which I guess is quite sort of large in scale and recognisable. ‘Oh, we’re back beside the atrium again and we’re going back in this direction.’ The experience team is the fact that BDP, the team and the client team had done different buildings – large hospital buildings – before and within our group of specialists we worked with … an acoustician. He’s not a BDP acoustician, they had independent acousticians. And he had been – at the same time as doing Southmead was writing the guidance document on acoustics and going through a whole load of stakeholder engagement sessions with all different people with hearing requirements to rewrite that guidance at the time that we were doing the hospital, for Southmead. So, he was able to give some really detailed feedback on – from an acoustic perspective – of what was becoming best in practice approaches. And some of the stakeholder consultations – some of the nuance into what got written into the guidance – he was able to give us the background to the nuance for why certain things were written in the guidance, which was really helpful to have that experience within the team. So, from a building hospitals before perspective and having really good people in the team to help develop the design. That was about the fact that we made the brief for the atrium space – I think was probably written before they went to the study tour and was much smaller and we were able to actually deliver a much bigger main entrance space than was in the original brief. Which was kind of added value that I believe helped secure us the winning architect in the competition because – and that was one of the things that we were then trying to hold onto and deliver throughout the project. It's quite grand in scale so the atria space is kind of in scale comparable to the naves of some quite impressive cathedrals in terms of their height and length. And then the art strategy. Just creating memory markers as I was talking about. Trying to put key pieces of art into different zones. I suppose the art that went in in the end within the atria isn’t as memorable as it could have been in terms of giving those key wayfinding markers. Although certainly within the landscape it is outside. These were the early visuals of this idea that we wanted clinicians and patients and staff and porters to be walking along this upper route and to have this connectivity to a public space below – both acoustically and visually. So in Riks in Norway there’s a visual connection to the public space below. So this is this feeling of you’re walking along – this is basically a route from theatres back to ward – that you can see this public space below. And actually in Southmead you can see and hear and smell the public space below. So this space is naturally ventilated so you can – there’s kind of a feeling of fresh air and kind of movement of air that’s really quite lovely that makes it all feel a bit more vibrant I guess. Rather than these particular corridors that quite often feel very sterile and closed off from the public space of the hospital. And then a sense of calm. Having really clear wayfinding. So, because every single department entrance comes off the three key – there’s three big lifts and stair cores. The trust wanted the stair to be as prominent as the lift so that if people did feel able to use the stairs that that would be something that was inviting. So, the stair actually – that one’s coming from the other direction. I wonder if I have a – do I have one that goes..? I don’t know if I’ve got that one in here. There you can see it there. You can see that the stair’s specifically orientated so that you see the reception desk and then the stair is right in front of you. So, the lift is immediately behind but the stair is just ever so slightly more inviting than the lift core. Such that if you did feel that you could climb the stairs it’s kind of inviting you to do that. And that’s something that the trust were really keen – for their own staff as much as for patients – because I guess patients are often not in a state – You know a lot of people have got a physical reason to be in hospital that might mean that taking the stairs isn’t appropriate for them. But from a staffing perspective they wanted it to be inviting to go up and down the central stair cores if possible. If I go back – Yeah, so visually calm. So, trying to remove the clutter of signage. So it uses an airport gate system. So in terms of communicating with patients they’ll get a letter that says you go to gate 27 or stair core F or lift F, gate 27. And then that’s all the information you need to know. And one month that could be a dermatology clinic and another month that could be a completely different clinic and actually they don’t need to change any signage or any words. And nobody has to read any long words on signs, they just get a letter that’s about them, that says, ‘You’re going to this point.’ And if you think about an airport the gate changes every half hour. So at nine o’clock in the morning it’s going to Lisbon and at eleven o’clock in the morning it’s going to New York. And from a user perspective you don’t need to know that it’s got all these different things happening behind the scenes. You just need to know that you’re going to gate – terminal to gate 27. So, as a way of really distilling to simplicity to what is a really complex set of things, it means that the signage doesn’t need to be updated constantly. So staff don’t need to be – well, more patients don’t need to be reading boards full of masses of information – and they just get pointed to that. So, it makes the signage a lot simpler visually. I’m sure there’s people that will argue this is a really bad system for all sorts of other reasons but yeah from our perspective we felt that it would remove a lot of visual clutter from the space. So, you’ve got these super graphics – these really large – A, B and C to tell you which stair core or lift core you’re headed to. You have got whole department big signs with the A. A, B, C, D, E, F that show you as you’re going through. And then as soon as you go up that lift core – I don’t think I’ve got the picture in here but it just immediately peels off to a right or a left. So, there’s always two departments from each stair core and each level – you’ve only ever got two options. Go right or go left. So, you’ll have two gates if you like – two gate numbers – at each level – so that you make your way to the lift core and then you peel off right or left. And you don’t have to go through lots and lots of different twists and turns. And then the sense of calm visually also comes from – the trust had a real integration with their arts group – Fresh Arts – who – they wanted to maintain gallery spaces. So, we go through a process that’s called a C-Sheet process where we load up every single switch and socket and piece of equipment into every single room and from the sort of day dot, what was really unique on the Brunel building at Southmead was that we designated whole areas of wall for art galleries from the very beginning. So that nothing else in terms of visual clutter could go onto those spaces. So, you can see I think there’s one plug socket there. But in terms of doorways or noticeboards or locations for – I don’t know – a couple of bins or anything really. These spaces were kind of – even though there is space there for other bits it’s really minimal and actually a lot of space has been kept clear for art such that you’ve then just got a very simple signage that tells you where the rooms are. And because there’s not clutter everywhere else, that becomes much more prominent. Whereas as soon as you’ve got – I mean, I’ll need to go back again and see if posters and different things have crept in everywhere but – IV: Yeah. I’ll try and find that exact photo. See if I can take it. IE: Yeah. See if it has changed. But yeah the idea was that if you can keep the visual – So, even coordinating these windows to be high-level windows to get a little bit of daylight into these rooms behind – they wanted to have this approach that was called, ‘Follow The Light,’ so that if you are walking towards your final destination you’re walking beside the side of a landscaped corridor and daylight so that you can see where you’re going. And remember. Very similar idea to this bit where you kind of remember where you are because you’ve gone past this space. For patients walking to their outpatient clinics they wanted them to be walking down the side of a day-lit corridor. They’ve then got borrowed light from high-level windows. I mean, these windows could have been lower but then you’d have private conversations going on behind and you’d have lost the ability to have those – that kind of run of sort of artwork. Which – I mean, everything’s a compromise. It means these rooms have slightly less daylight than they might have otherwise had. But they advantage is that you’ve got a really intuitive corridor route to get to all of those exam rooms and you’ve got the opportunity to have this clear bit of wall to have that artwork. There you can see – And then – so that was all about visually having a sense of calm. We then had a sense of calm through having a connection to natural light and fresh air and nature. So, we put winter gardens into the space inside in order to – Actually these spaces here are ward bedrooms. So, they need to have privacy for people in the bedroom. Need to not be connected to that public space as it goes by. So in most of the ground level it’s all outpatients and public space. And there’s one atrium at the end whereby the ward space – we had to have a few more wards and not quite as much ground floor space as public. So, there’s a ward that goes past and in order to give privacy to those bedrooms, we’ve put a winter garden in to separate that space. So, the trees kind of give a view out onto nature from the ward spaces. They give a view into nature from the public space and they separate those views. And again – IV: It’s quite unusual to have trees in hospitals. Did you have any challenges in getting that approved? Any kind of infection control. IE: I guess this is what I was talking about before about locking things in at the right time and having an awareness that there’s an opportunity. We suggested this at the competitive stage and then we signed our contracts with an agreement that we would deliver this. And because we’d got it in at that point it was much able to retain it and keep it. ‘Cause the trust really wanted it. IV: That’s great. IE: They felt like that was one of the things that – why they’d chosen our design. So, it became harder for that to be eroded over time ‘cause everybody had bought into it as being a concept. And actually they had mentioned in Riks that they really liked the fact that they had trees in and so we took the trees and we made them winter gardens. ‘We’ll take that and we’ll try and deliver something like that but more,’ because it was one of the things that they liked. You can see that there’s – There wasn’t really an infection control risk because these are public spaces that don’t – whilst there is clinical space behind, it’s completely sealed. So, it’s kept completely within the public zone off the – you can see the early visual there with the green space in it. We were concerned that they might not grow very well so we put these lights in that were supposed to simulate daylight to make sure that they got enough daylight. But actually they’ve grown too well. The feedback we’ve had is that they haven’t had to turn the lights on. This one was quite an early one but they’ve been trimmed back and they’re growing even with the lights not on. Which is great. Which I think is probably due to the landscape designer choosing very specific specimens that were going to be happy in that environment. So, that’s a good news story. Yeah, so the winter garden that’s in the centre connects to the multifaith room. So, we’ve got that space here that’s kind of in the centre – in the heart of the hospital – to make it really prominent and accessible so that people can find it easily. And then there’s a – Below there’s the mortuary and the FM area and the – that’s another one of the key flows sadly within any hospital is obviously not everybody makes it and you do need to have a kind of mortuary space and then a private viewing room and that wants to be very discrete kind of dignity to grieving relatives. And then the ability to get the functional aspects of that space out in a way that doesn’t interface with the other public flows. So, this is the kind of private garden space below with a kind of viewing room that’s directly below the multifaith space so that if you do have to go through that side of the hospital facilities, it’s intuitively really close together. So, you’ve got visitor lifts. A separate set of lifts that are just for that purpose and you can go up and use the multifaith space above and then that space below. And I don’t think anybody really knows that that’s happening. You know if you’re not using that service it’s really central but it’s also quite private within that. Well, that was our aim anyway was that it would feel quite private within that space. IV: Yeah, I’ve been there a number of times and I didn’t know that was there. IE: Yeah. IV: Which means it’s successful. IE: That’s good. I guess. Yeah and that was something that again we locked in right at the beginning. So, even in the very earliest drawings when we’re like – I don’t know – one month into the project maybe – two months into the project – and we’re starting to draw really early sections – that idea was in there as that’s why that winter garden’s in that place. That’s what it’s purpose is. We talked about the idea of separating the flow of mortuary arrival, you know, hearses and the public coming in from the level above and going down through that space and having the multifaith space linked there in the centre of the hospital. I guess that was one of the things that maybe on other projects we haven’t been able to – You know, that’s one of the things that it’s not a really prominent adjacency that needs to be resolved. You wouldn’t think of it as a driving force behind a whole hospital design but it was something that we were aware that, ‘Okay, if we want that to be good, what does good look like? How do we make that flow work and how do we consider that from day one so that we can make that a really sensitive thing?’ If that makes sense. So, that’s the multifaith space above. And again that was part of this sense of calm that if you can get that flow right so that those people can access that in a really intuitive way then this will add to this sense of calm. That you’re not going off through some rabbit warren into the basement to find some bits that’s completely separate from – I don’t know – it would be very easy for the body viewing room in the mortuary to be on a really convoluted route from the main entrance of most hospitals. ‘Cause those two bits just aren’t intrinsically linked in any way. There’s no reason – other than considering the user and their experience of going to that space – there’s no reason to be – the main entrance to be linked to that bit. Does that make sense? IV: Yeah. Where did this..? I don’t know if this was you or someone else but the colour palette. I notice it’s the same in the space – the blue green and I’m not sure what I would call that colour. And then that’s also used as part of the wayfinding isn’t it. Do you know why those particular colours were..? IE: We went through that process. They – I guess on previous hospitals sometimes there was a real resistance – There’s a kind of acceptance that blue is a good colour to use and green from appealing to lots of people. There was a hesitancy on previous projects to use a bright red or a bright yellow because people talked about connotations with blood and with urine and again with brown and with poo. So, sometimes within healthcare projects those views can be linked through. But then you find that so many hospitals are just – You end up with a kind of – almost the blue colour becomes really clinical because so many hospitals see it as a safe colour to use. So, we wanted to – actually originally this red – reddish one was the hardest one to deliver ‘cause red’s not a particularly stable colour in terms of its ability to cope with sunlight and things. But we were quite excited to – We went through a process basically with the trust of choosing that. We just wanted to make sure that each one – we did theme it so that each atrium did have a different colour. I wonder whether that’s – I don’t think I have a drawing of that. But yeah, each of the three atria are different in scale and different in colour so that there’s like – Oh, you can see it on that one. Kind of greenish and a blueish and a pinkish. So, I think one of them was yellow for a while and then this one became more red. Yeah, we went through it with the trust for their preferences and we just – we were – from our perspective – from a design perspective – we just wanted the colour to give a little bit of an indication for which zone you were in. So, it is zoned by colour in the atria spaces. It flows through a little bit into the wider hospital in that the colour used in that zone does go into being a little bit behind waiting areas. Reception desks as you go a little bit further in. So you’ve got a feel of which zone of the hospital you’re in. Yeah. Does that answer your question? IV: Yeah. Yeah. I was interested exactly in what you were saying about the fact that there’s some red and brighter pinks in there and where that came from. IE: Yeah. This is just trying to be multidenominational to give a kind of – I guess a stained glass aesthetic but without any kind of specific – probably just cultural references. And then a sense of vibrancy was to do with the life of the hospital. So, like I was saying, we wanted to connect the life of the hospital happening down here with the clinical routes above. So, this is what I was saying. That circulation route that runs the whole way along the edge of the hospital – you’ve then got department entrances feeding off that and ward entrances feeding off that. So that if you’re travelling from any ward to any kind of core clinical area – be it theatres or imaging or critical care – everybody’s going to travel along that one corridor and that one corridor is on every level. At ground floor it’s public but every level above it’s clinical, so that you can connect back to this central space and have a bit of connection to the life of the hospital. So that you might be on a route from ward back to theatre or to theatre or to whatever and you kind of – rather than it feeling really closed off and clinical you’re reminded of the life of things happening around you. ‘Cause there’ll be choirs singing in this space or pianos playing. And that kind of music will filter through and you’ll have an awareness of it. So, our hope is that if you’re a surgeon or a porter or a relative walking back from theatres that you would be kind of interrupted with the sound of a choir singing or something else to give a kind of bit of positive vibrancy to that journey. Which in any other hospital would just be a kind of closed white corridor with no acoustic connectivity to anything happening that’s public. So, that’s something that we were really selling from the beginning as an idea that the trust really liked and wanted us to try and – We said, ‘Look we don’t know if we can make these open. There’s all sorts of technical reasons why that’s quite challenging but we really want to try.’ And we did. We managed to do that. And like I say there is a clever concealed piece of wall that comes down to make that fire safe. Which is one of the main challenges to why it’s not done everywhere. And then that corridor also – as you go behind those coloured glazed panels that we were talking about – gives a kind of different colourwash as you go through that corridor space. Which probably adds to a visual vibrancy to that kind of space, hopefully. And then at night time it has also a sense of vibrancy of the artwork. The kind of binary clock piece that’s in the entrance. All of these lights turn on and off and give it a sense of vibrancy at night time. And then audibly – this is where I was telling you about the acoustician that was involved. Having a sense of calm and vibrancy. There’s an awful lot of acoustic absorption that’s all of these lift towers are perforated. I don’t know if you can see – maybe you can see there there’s kind of a different texture. So, at ground floor they’re not perforated because people might put chewing gum in the hole but above ground – IV: You’ve really thought of everything. IE: Well, yeah. You can’t really. Once you look at it you see it but when you’re not looking for it I don’t think you do see it. But yeah the ground floor is solid and then everything above is perforated. And acoustically absorbing. And then the soffits of all of these pieces have got acoustic absorption in all the soffits here. So, the orange and the pink is all acoustic absorption and then the blue is daylight from above. That means that in – we kind of position pieces for intimate conversation underneath the soffits. So, you can see the acoustic absorption in the ceiling there. So, if you’re having a conversation at the pharmacy or at the reception desk behind here – So, the darker pink bits are where there’s the most absorption. So, the pharmacy’s there and that bit’s got a lot of absorption. And then when you head out into the main space it’s got less absorption. So the reverberation time in the centre of the space is quite different to the reverberation time underneath those more private areas so that you can actually navigate through sound. So, if you’re – if you are using – if you’re blind and you’re using or you’ve got a visual impairment – you can actually navigate back towards the main thoroughfare of the public space by that change in sound level, potentially. And there was some stakeholder feedback on – when we designed the update to Glasgow Queen Street Station last – a couple of years ago. One of their access panels – they had some visually impaired people who talked about using sound to navigate. And they had said that you don’t want to completely kill the sound from the street. As soon as you go into the train station there’s quite a lot of acoustic stuff there to do with being able to hear announcements of trains that are on time or late. And so the acoustic environment in a train station is very important to make those announcements legible. But this person was saying you don’t want to just instantly kill the street noise because they use that as a wayfinding tool to know if they can hear just a little bit of that noise and they can hear it getting louder then if they’re on their way out of the station they know they’re walking in the right direction and they don’t need to ask for help because they can hear the street sounds getting louder. Like, ‘Oh, okay. I’m definitely walking towards an exit.’ Whereas if you kill it completely as much as possible then that space when you’re inside it is very hard to navigate. You know the sound isn’t helping you. Does that make sense? IV: Yes. Yes it does. IE: So, within that – I mean that was quite specific feedback that we got later. But actually our acoustician was telling us something similar, saying that a vibrancy of differences in sound and reverberation time can be quite helpful to give spaces a different character. So, actually if you’re having a private conversation you do want a tiny bit of background noise because if it’s completely silent then everybody can overhear what you’re saying and it doesn’t feel very confidential. And this was the kind of subtlety and the nuance that he was talking about within writing the guidance. So, maybe – So, he was saying – I think there is maybe a paragraph in the guidance that talks about this to say, ‘You want to maintain a small amount of noise to allow for private conversation.’ But it’s that thinking that you want it to be – you want it to be suppressed such that you can have a quiet conversation and be heard but just a little tiny bit of background noise so that you feel that it’s private. So that’s what we were trying to achieve in these spaces under here where you’re going up to a reception desk and saying, ‘Okay, I’ve arrived and where do I go next?’ kind of thing. And then you’ve got a midway waiting area that’s in between and then you’ve got the area out in the centre where you might have choirs or different things going on where there’s a higher reverberation time so it’s got more vibrancy so that maybe you can navigate the space in terms of an acoustic map of going from calmer spaces acoustically to more vibrant spaces. Which hopefully correspond with the public – the more public areas and then through to the more private areas of that atrium space. And then you peel off that bit into a department as you head backwards. Yeah so the choirs and the pianos and everything are out in the central part of the space and they’re providing volume and interest and vibrancy up to these openings up above to the people walking back and forth from clinical departments. And the fact that these atria are really big gave all these extra opportunities to have – for the hospital to have choirs and orchestras and dancing and life and for that to be viewed kind of from above. So, you can see when they’ve got – when they’ve had performances on you can see people looking on from above and looking down into that space so maybe you can’t get off your ward completely but you can come and see that vibrancy of life happening. Again, these are people looking out from those openings and down into the choirs happening below. So, there’s a real kind of connection across the whole hospital of sort of positive noise and music that’s generated and that kind of filling the whole hospital with life. Which hopefully is a really positive outcome of the design. And then I had a little – I’ll come back to you. IV: Can I ask you about..? I’m aware of time so I don’t want to take up your time for much longer but that’s really interesting. One thing I’m really struck by is the goals I suppose – the atmospheric goals of calm and vibrancy which seem on paper to be the opposite. So, I wondered how you see those kind of fitting together in design and architecture terms. How can somewhere be calm and vibrant at the same time? IE: Well, I think that’s the role of good acoustics. So, having a space that as long as you have localised absorption of acoustics such that you can create – and I guess beyond that quieter areas such as quiet rooms and really quiet spaces. I guess it was something we were aware of that maybe we didn’t refer to it as calm and vibrancy. We probably referred to it as a connection to the life of the hospital, was probably what we were originally thinking of. Which I’ve probably then post-rationalised into, ‘Yes, we thought about areas that had to be calmer because there’s some quite confidential conversations happening and you want to then filter into a private space.’ You know once you’ve gone past that atrium space you’re going to go into a process of having a clinical consultation so there is this peeling off from a very public area into something that’s very personal and very private. But I guess it was also taking some learning from retail environments and airport environments and other public buildings that are of this scale. Hospitals don’t often have that feeling of vibrancy of – quite often it is just so clinical and yeah, I guess the trust’s comment about liking Riks and the fact that that central space gave them a connectivity to the life of the hospital and that being a public space. Having the winter gardens in there maybe makes it feel that calmness but knowing that we wanted to have choirs in there and that feels more vibrant – I don’t know. It’s just that mix of life. Yeah, the life of the hospital. Feeling that it can’t just all be about ward bedrooms and operating theatres because actually there’s people – staff live their whole life – they spend a vast majority of their life in that building and it wants to feel like a vibrant place to be – would be a positive thing. Yeah but accepting – Well, I haven’t talked about that I think there’s about seven different garden spaces that all link off as well. I could have talked about. Which again are maybe spaces to find more of that calmness. Again, there’s a staff roof terrace with a roof garden that’s just for them to escape to. So, I guess it was about trying to meet the human needs of the people using the hospital and appreciating that they will fundamentally sometimes need a calm quiet space to be in and sometimes they will need a vibrant space. And to be fair, if I had to define the atrium as a calm or vibrant space it is one of the more vibrant spaces and I guess acoustically I was just trying to show that there’s a bleeding into a calmness that happens at the edges of that space. An appreciation that you then want to go into a more private realm of clinical consultation. IV: Yeah so actually I mean as we talked about it has a lot of private rooms so you can have – the idea is then that you can have calm – you can have calm but you’re not cut off. IE: Yeah. And I suppose the multifaith space as well is a calm space off it with rooms associated. Yeah. IV: It’s just interesting to hear you talk about it and to hear I suppose a philosophy of calm that’s not about things having to be, you know, completely silent and pastel coloured to achieve that. IE: Yeah. And I guess that might not be everybody’s description – some people for it to be calm would need it to be completely silent. Then you’re getting into the nuance of sensory design and the fact that you can’t say that something is good because it might not be good – Yeah, I appreciate that from a neurodiverse point of view it might still be too vibrant as a space and you might need to take yourself off to somewhere that is completely calm. But yeah. Again, I didn’t talk about the floor finish but from a floor finish perspective that’s not got patterning in it so that that’s got a kind of calmness to that so that it’s easier to make it more legible and easier to read and so that you’ve got big objects like the stair core that come down into it as a very obvious change. But that you haven’t got crazy patterning going on that can be misread about stepped or different things. Which again there’s no one size fits all we just try to do what we believe will work for the majority of people as best we can and be cognisant that, yeah, certainly through access meetings with user groups with visual impairments, there is a lot about trying to make spaces clean and legible. That dictates why you wouldn’t put for example a really vibrantly patterned floor would be a bad idea for a lot of that – those needs. IV: Thank you. And I suppose that brings me back to my question about change over time. I wonder do you feel there’s more awareness now? More consultation or more kind of attention to inclusive design or is that something you think has been there throughout? IE: I think within – interestingly I think it’s been there within healthcare for longer than anywhere else because – So, throughout my whole career I’ve been involved in stakeholder engagements specifically with people with all sorts of different additional needs. Because they are the users of the hospital. So, even back doing the Queen Elizabeth there was a lot of access group meetings – meetings with people with all sorts of different requirements – because they are fundamentally the building users of the hospital. So, within the healthcare sector I think that awareness of inclusive design has been there far longer just because it’s such a prominent user group that everybody who’s coming there who isn’t a staff member is coming there because they’ve got some physical or mental ailment that they are needing help with and they’re more vulnerable. And it could be people that aren’t used to having a disability that are vulnerable for that period of time that they’re using the hospital. And so they’re not capable disabled people. This is probably completely the wrong terminology but people who aren’t used to being in a wheelchair who are all of a sudden in a wheelchair and very much not used to having all of those dependent needs on a learning curve of how – and who are not coping with whatever period of – that’s brought them into hospital. We have consulted with a wide range of user groups ever since I’ve been involved which I think I’ve then seen come through in everything. So, changing spaces. You know the bigger toilet facilities to allow adults to change with dignity. They’ve been in 10 years in hospital buildings before they’ve come in through Part M – sorry, Part M is the accessible design standards within all sectors. So, I’ve certainly seen more awareness for inclusive design. Yeah. Come in much more into healthcare and then feed through into housing and schools and other building typologies. IV: It’s interesting. I suppose to your point at the very beginning about how – I mean I see – from you talking through Southmead I see very much your point about complexity but also the – yeah, like what you can learn from healthcare and take into other design and how it’s leading in many ways. That’s really interesting. IE: Yeah. That’s certainly – I think a lot of people are scared of going into healthcare architecture but I – yeah. I don’t want to leave it having been in it. IV: Hopefully, you won’t – I mean I’m sure we’ll always need hospitals. I’m aware that we’re over the hour so I want to let you go. I suppose just before I finish is there anything you wanted to say or anything you wanted to communicate that I haven’t asked or given you a chance to say? IE: No, I guess for the record I’ve got – you know you shouldn’t have favourites but Southmead is a bit of a favourite and it’s to the credit of the clients, the trust side ambition really helped a lot because they – and they had really high quality standards. So the fact there’s an awful lot of natural timber – natural wood finish – which is hard to get in terms of infection control and different things – and we were really prescriptive about putting those into the areas where we could put them into where it was safe to do so. But their aspiration from an interior quality finish and tying that in early to make it a commitment that we had to deliver from a – yeah. Was really helpful. So, I’m really grateful for the – it was a really good team and the contractor as well was really brilliant. And the fact that it was a PFI and yeah. I mean there are problems with the funding of that and the ongoing costs and things like that but there’s an awful lot of people who will slam the design quality of the PFI process and the fact that we were able to deliver that hospital in a PFI environment in an NHS with the restrictions that healthcare buildings and infection control and everything else. Yeah, I’m really proud that collectively as a team – from all parties within that team – were able to deliver it. So, be really interesting if you were able to talk to some of the other people involved to see their story of it. To see if they feel the same way. But from our perspective it’s one that we really yeah, proud of. There’ll be problems with it. There’ll be bits that don’t work that we think work. But hopefully it’s – it’ll stand the test of time and be considered a good hospital from a design perspective going forward. I hope it does. Be interesting to see. IV: That’s great. It’s nice to end on a positive note. I mean it was all very positive this conversation but yeah to hear about a really positive relationship between the architect and the client that’s not – IE: Yeah I’m sure that had a really massive part as to how we were all able to hold onto certain things and to actually – ‘cause a lot of the things that we wanted to do in the very beginning, we really did manage to hold onto and deliver. Things that might have been – You know, really difficult decisions about whether you can justify the cost of a winter garden and trees or whether you end up with just gravel or something. So, the fact that we were able to collectively keep things was really a testament to the whole team approach buying into the quality of the design. And the ideas and what we were trying to deliver. IV: Great. Well, thank you so much Vicky. I’m just going to stop recording now but thank you very much for your time. Transcript ends 92:12 202 Page 2 of 2