BACKGROUND RESEARCH ON BENENDEN HOSPITAL

BACKGROUND RESEARCH ON BENENDEN HOSPITAL

Benenden Hospital was founded in 1907 and became the centre for hospital treatment for members of Trade Unions and Friendly Societies and subsequently large numbers of public sector employees who joined what is now the Benenden Healthcare Society. The Society has a membership of over 940,000.

Benenden Hospital is an independent trust hospital with charitable status, situated in Kent within its own private grounds. The hospital was originally built for the National Association for the Establishment and Maintenance of Sanatoria for workers suffering from Tuberculosis. This was a consortium founded by the Holiday Saturday Fund movement of trade unions and friendly societies which
The Society joined.

By 1945, as the only member of The National Association, The Society became the sanatorium's governing body. In April 1951 the National Association disbanded and The Society acquired the hospital.

With the decline in the incidence of TB the Society agreed to treat a growing number of members with chest complaints and cancer. The building of an operating theatre, surgical wards, an x-ray department, staff accommodation and facilities took place and new services such as physiotherapy and occupational therapy were introduced.

During the 1980's and 1990's the Hospital continued its expansion and developed on the range of surgical procedures that were already taking place. The Hospital now provides treatment for a wide range of specialties.

The Hospital has survived and grown over nearly a hundred years through war damage and the inception and development of the National Health Service, by its ability to adapt to the changing circumstances and the needs of members who support it. The close relationship it has with its Board of Governors, the Committee of Management and Society Branches hold it in good stead and will ensure it continues to adapt to the changing needs of the members of the Benenden Healthcare Society Ltd in the future.

The Society's philosophy states: 'The Benenden Healthcare Society Limited, in the spirit of mutual aid and support, exists to meet the needs of its members and their families who are suffering anxiety or distress in seeking medical advice or treatment. It aims to do so at a cost affordable by all and with equal opportunity'.

The Society is a non-profit making friendly society funded by contributions from members (the level of which is determined by the membership itself). Its independent low-cost scheme is available to all Royal Mail, British Telecom, Civil Service and Local Authority employees, and those employed in related bodies and agencies. Today, approximately 960,000 members are covered by the scheme, which works alongside, not in competition, with the NHS. It is not a private medical insurance scheme. Members claim on each occasion they may need medical benefits, but members accept a collective responsibility for using the Society's facilities when they face difficulty inobtaining medical advice and care in the NHS. The Society, is therefore, able to offer a back-up to the NHS at minimal cost.

Today, the Hospital, as well as being available to the Society's membership,is a provider of services to both privately insured patients and the National Health Services. It is an approved primary provider under the NHS Patient Choice Scheme and provides diagnostic services directly for general practitioners. It is also accredited by the major health insurance organisations.

In recent years the hospital has increasingly been able to provide services for patients who are not members of the Benenden Healthcare Society. Local National Health Services are increasing their use of the Hospital's facilities as are patients who wish to use private medical insurance or who wish to pay directly for their own hospital care.

The hospital places great emphasis on quality providing comfortable, clean and infection free accommodation and a range of clinical services which are tailored to meet the needs of individual patients. The hospital has a Matron - a senior and experienced professional - who has the authority to resolve problems and to make sure the 'patient pathway' is both effective and patient friendly. The Hospital recently scooped five out of 12 of the Healthcare 100 Awards for best employer accolades.

The hospital enjoys a beautiful location in the heart of rural Kent and yet is accessible by road or by rail from many parts of south and south east England.

  • During the period 2006-2008, Benenden Hospital had no cases of MRSA infections compared to 10,000+ in NHS hospitals*.
  • During the same period, Benenden Hospital also had no cases of C Diff infections compared to 150,000+ in NHS hospitals**.

It provides a wide range of outpatient and inpatient services to:

Members of the Benenden Healthcare Society

NHS patients referred by their local GP under the Choose and Book scheme

Private patients.

What is particularly inspiring in this building is the new Lister wing (Picture 1) which was added in 1937 to designs by Burnet, Tait and Lorne. It is a dynamic and elegant modernist structure, probably influenced By Erich Mendelson and Serge Chermayeff's De La Warr Pavilion. This the main focus of our study and major source for our upcoming designs and approaches. This is a rigorously detailed pavilion in steel and glass, with ample sun shading to ensure internal comfort.

LISTER WING CASE STUDY:

John McAslan's new wing for Benenden Hospital in Kent and the conservation of the matching listed wing from the 1930s are successfully completing a scheme that failed in earlier attempts

Thomas Smith Tait, the most influential Scottish architect of the inter-war period, died in 1954 at the age of 72. John McAslan, born in Glasgow in the same year, greatly admires Tait's work and was thrilled when his practice was commissioned to partially restore one of the latter's works and to design a new building in close proximity to it.

John McAslan and Partners (JMP) had no past experience in the design of hospital buildings, so the new clinic at Benenden Hospital in Kent was a challenge. Where the practice scored was with its proven expertise in restoring and extending iconic modern buildings, ranging from a Frank Lloyd Wright campus in Florida to the Peter Jones department store in London and the De La Warr Pavilion at Bexhill-on-Sea.

It was the last of these, in which JMP has been involved for nearly a decade, that attracted the attention of local planners when the hospital proposed a possible new building adjacent to Tait's Lister Wing (completed in 1937 and now a listed building) and led to a detailed masterplan report in 1999. Planning permission and listed building consent were obtained in 2000, with the support of English Heritage, and the new building was completed late in 2002.

At Benenden, Tait turned to a more lightweight aesthetic, perhaps inspired by Duiker & Bijvoet's renowned Zonnestraal Sanatorium at Hilversum. The designs also reflect more than a sidelong glance at the Bexhill Pavilion (Tait chaired the jury that selected Mendelsohn & Chermayeff 's scheme).

The two-storey wing contained wards along the southern edge, opening to a terrace and first floor balcony - the walls are meant to dematerialise in pursuit of fresh air - with a spine of service spaces to the north. Fully glazed to the south, the building's north-facing facade is of load-bearing brick. Benenden Hospital had been founded in 1906 'to accommodate the lower-salaried tubercular cases', with special provision for civil servants and Post Office employees.

The site was, and is, superb, with views south across the Weald. Today, the 145-bed hospital, run by the Benenden Healthcare Society and still independent of the NHS, offers a wide range of treatment, with specialities in endoscopy and gynaecology. Its buildings reflect a process of somewhat random development over the past century. In the early 1950s, Oswald Pearce was commissioned to design the Williams Wing as a close copy of Tait's building. The two blocks were connected by a clumsy three-storey link - the western 'bullnose' end of the Lister Wing was demolished as part of that project.

Within 40 years, Pearce's building had become a serious problem, with spalling concrete and water penetration leading to its closure. The potential for repairing and converting it was explored but this course was judged impractical. The proposal to demolish it was uncontroversial, given the undertaking to restore the lost integrity of its listed neighbour.

Few original drawings of the Lister Wing could be found, so JMP's reconstruction of the lost end relied on a close survey, with specialist fabricators manufacturing steel windows to match the originals and the (remarkably thin) concrete roof extended with the advice of Arup. Tait's building is in good condition throughout, though it would benefit from a general overhaul (now under way). JMP project architect Richard Ellis says English Heritage was concerned principally with the facade and the retention of the plan, so there was no funding for a strict restoration.

The new clinic occupies the same site and orientation as the Williams Wing - a conscious decision on the part of JMP. With the former link block removed, a connection had to be made with the Lister Wing and other hospital buildings (very ordinary masonry clad structures of the 1980s and '90s) to the north. This has been elegantly achieved as a deliberately neutral connection, well set back and externally rendered.

The plan places consulting rooms along the southern edge at first floor level. A central corridor separates these rooms from WCs and other facilities. The procedure rooms are accessed via a corridor along the northern edge of the building. Cantilevered at first floor level, it is connected directly to the blocks to the north. About 50 per cent of ground floor space is dedicated to sterile areas for the storage and preparation of surgical instruments and other material; the remainder has yet to be fitted out but is unlikely to remain vacant for long. Access stairs to the exterior are provided at each end of the building in fully glazed 'bookend' enclosures, recalling the glazed bullnose ends of Tait's original Lister Wing.

Constructed on a steel frame with floors formed on precast concrete planks, the new clinic is a straightforward and economical structure. Servicing requirements are moderate - consulting rooms and communal spaces are naturally ventilated - so connections can be discreetly accommodated within ceiling voids. The preference of the planners (and the architects) was for an undemonstrative new building that made no attempt to ape the style of the 1930s, nor vie for attention.

Before the Second World War, with the battle against tuberculosis the main concern, Tait opened his southern facade to the sun. In fine weather, the windows of the wards would be wide open with some patients lying in the open air. Consulting rooms need to be private places and those in the new clinic have both opening windows and blinds. Solar gain is controlled by the wall of fixed louvres standing forward of the facade. The landscape can still be glimpsed from inside the building; externally the effect of the solar screen is to provide the southern facade with a layered, essentially neutral, look. In visual terms this is a deliberate move: Tait's building can again be read as an elegant, virtually freestanding, glazed pavilion in the landscape. To the rear, where it closely abuts other buildings, the clinic is simply rendered, a cheaper alternative to the brick used in the '30s.

As a sensitive but far from timid response to historical context, JMP's building is everything one would expect from its architects.

For patients and staff, the facilities it offers are a huge improvement on those previously available. Internally, and this doubtless reflects a tight budget, spaces are less than generous. The building is one element in a large medical complex and extensive communal spaces were not required, but the reception would have benefited from being less cramped - its floor area is only a little larger than that of the escape stairs. Internal finishes are certainly economical, though an element of strong colour is used in communal areas to good effect.

Structural strategy

The project comprises four different elements:

  • The new two-storey building, known as the Jubilee Wing, contains consulting rooms, sterilisation areas and procedure rooms plus plant rooms;
  • A new three-storey block, south of the existing Queen's Ward, known as the link building. It connects the ward with the Jubilee Wing and the 1930s Lister Wing.
  • The building contains a lift, stairs and a plant room at level three;
  • Two discrete two-storey corridor structures which provide access from the link to the Jubilee Wing and the Lister Wing. The bridges allow differential movement of the three main building zones by the provision of movement joints; and reinstatement of the western bullnose of the Lister Wing building.
  • The new buildings are braced steel frames at a grid spacing of maximum 6m.

Ties are provided perpendicular to the primary spans. The beams at each floor are typically positioned within the depth of the floor slab using a 'slimfloor' style arrangement. This system was chosen to match the existing floor-to-ceiling heights and to minimise the structure, to leave maximum space for services. The floor-to ceiling height was so critical that welded plates on the underside of the I-beams could not be used to support the precast concrete floor panels as they do in actual slimfloor construction. Instead, the bottom flange of the UC sections used as primary beams support the precast panels. The top flange of the UC had to be cut away over a length sufficient to allow each panel to be inserted into the zone between the UC flanges, before being slid along the span into position.

The floor slabs are formed using precast concrete panels with an in-situ concrete topping joining the panels together into a stiff diaphragm. At ground level, the precast panels bear directly onto the foundations, which consist of mass concrete trench-filled strips and are founded on the Tunbridge Wells Sand Formation.

The western bullnose of the Lister Wing was reinstated. It has an in-situ slab at level one, supported on masonry stub walls down to the pad foundations. The 190mmthick slab at level two is supported on masonry walls within the building and at its two ends by arcade beams. These beams are curved and located at an inner and outer perimeter, supported on a series of steel CHS posts. The 170mm roof slab cantilevers out over either the main masonry cross walls or the inner arcade beam, supported by CHS posts. The reconstruction of the building reinstated the original structural configuration.

Services

The new wing has a hierarchy of services. The consulting rooms on the south facade are naturally ventilated. However, there was a concern that full-height glazing of rooms on the southern facade would lead to excessive solar heat gain, which was confirmed by analysis predicting internal temperatures in summer. A bank of external louver blades was incorporated to provide shade to the glazing in summer when the sun angle is high, but to allow daylight through in winter when the sun angle is low.

The ancillary rooms are treated with mechanical supply and extract systems, controlled by a centralised building management system.

Specialist areas within the new wing were discussed in detail with the hospital. The gynaecology and endoscopy procedure rooms have a dedicated mechanical air supply and are maintained at a negative pressure to avoid the spread of contaminants. In contrast, the clean production area, where the sterilised surgical equipment is packed and stored, is kept under positive pressure via another dedicated mechanical supply to prevent contaminants entering the space. Night-time set-back and a standby motor ensures this area is pressurised 24 hours a day.

The electrical and public health services design were discussed in depth with the hospital to ensure all the relevant hospital standards were adhered to. The project was successfully carried out without major disturbance to the existing hospital's activities.

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