new hospital art

by Ben Spencer, 9 Mar 2010

Health services in NHS Greater Glasgow and Clyde (NHSGGC) are undergoing a radical transformation to meet the changing needs of the population. £750million investment in acute hospital services means radical changes to Greater Glasgow and Clyde’s healthcare services. The NHS is building new hospitals and redesigning the way patient services are delivered to provide modern healthcare, in fit-for-purpose buildings.

NHSGGC understands good health and well-being involves a holistic approach which includes thinking about art and therapeutic design in the look and feel of a place – the emotional environment. Nutrition, exercise, access to faster diagnosis and medical treatment are all recognised as vital to people’s health. There is a growing body of evidence which suggests environments designed to support positive emotions contribute to good health and wellbeing too.

Two new hospitals, located at the Stobhill Hospital and Victoria Infirmary sites, opened in 2009 – purpose-designed to deliver outpatient, diagnosis, day surgery and minor injuries care. Both developments included significant allowances for the involvement of artists.

The story of NHSGGC arts projects is summarised by Jackie Sands, Health Improvement Senior: Arts and Health: “Imagining Art strategies into new Hospitals Health Centres involves a strategic approach where plans are implemented in phases in line with build schedules, timeline, local regeneration plans, affordability and aspirations.” Indeed, this process was initiated with the appointment of Jackie Sands to the post of NHS Strategic Arts and Health Co-ordinator in 2005. This post was assimilated into the Health Improvement structure within Acute Planning in October 2008, signalling a commitment from NHSGGC to integrating art and creativity into healthcare.

The direct and tangible outcomes of this commitment, in addition to the creation of permanent artworks at the new Stobhill and Victoria Hospitals, include increased confidence within the NHS to support art projects and the allocation of NHS staff time / investment to subsequent projects: New South Glasgow Hospitals project, Maternity Extension, Drumchapel Child Therapy Centre, Barrhead and Renfrew Health Centres. The continuation of the Strategic Arts Co-ordinator post has been instrumental in setting up structures and mechanisms for involving NHS staff, partner and community stake-holders in the development of art strategies; art sector capacity building, contracts and procurement; fundraising of approx. £1.4m; and contributing to the development of the NHSGGC Design Action Plan.

Whilst recognising the very considerable achievements of the Health Improvement team, this reflection however concentrates mainly on the investment in artworks at the Stobhill Hospital and Victoria Infirmary sites only. Both projects received a single research and development grant from the Scottish Arts Council’s Artists Work in Public Places scheme in 2006 and subsequent, separate grants for their implementation in 2008. The value of the New Stobhill and New Victoria hospitals art and architecture programme is estimated to be in the region of £600,000.

BACKGROUND

The proposals for the involvement of artists at the new hospitals were put together as two distinct packages – with very different approaches. The period, and method, of development was widely divergent, although the timescale for delivery on-site was largely contemporaneous and therefore the two projects were somewhat inevitably considered as a single programme. Indeed, a single Public Art Manager was appointed to oversee the production and implementation of the artists’ work at both sites.

One issue impinged significantly on both projects – the procurement of both hospitals through the private finance initiative / public private partnership (PFI / PPP). This probably had more impact at the New Victoria Hospital where the schedule saw the architectural design scheme signed off before the arts strategy was approved. The PFI / PPP framework raises difficulties because the design scheme and costs are fixed within the capital contract – everything has to be pre-planned, as measurable and quantifiable output specifications, otherwise the client is penalised through inflated costs for additional works.

The art and architecture proposals at both hospitals were developed in collaboration with the architects, artists, NHS Strategic Arts and Health Co-ordinator, NHS Art, Architecture and Environment Steering Group and relevant local reference groups. Both projects also benefited from the involvement of Juliet Dean of public art agency PACE through the research and development phase. Again however because the project at the New Victoria Hospital was less advanced, Dean was more involved in developing a vision for the project at the Victoria Infirmary site and for promoting the art and architecture dialogue.

At Stobhill Hospital Reiach and Hall were appointed as project architects, selecting Thomas A Clark as lead artist for the project based on previous experience of working with him. The architects began a conversation with Clark in 2001 about art – architecture – health and therefore the artwork is integral to the design scheme. Together a concept for the hospital was developed entitled ‘Grove: a grove of larch in a forest of birch’ which is realised by setting the hospital within a large planting of silver birch and planting larch within internal courtyards through the building. These courtyards are also surfaced with natural larch boarding. Clark produced a unifying text to elucidate the theme and this informed the development of additional proposals by visual artists Andreas Karl Schultz, Donald Urquhart, Kenneth Dingwall and Olwen Shone – selected and curated by Clark. Alec Finaly was appointed to undertake a related community engagement project in Springburn Park.

At the New Victoria Hospital, PACE developed the project during the initial research phase, working with HLM, the project architects, to appoint Ally Wallace as lead artist and to develop a vision for the project, namely: the hospital in the park. The idea was to work in place as sustainably as possible in an historical, cultural and locally connected way. Work to bring the ‘outside in’ in a literal, metaphorical, cultural and historical sense; take the ‘old to the new’. A team of visual artists was appointed through an open selection process, comprising: Ally Wallace (lead artist), Hanneline Visnes, Calum Stirling, Jacki Parry and Ronnie Heeps.

Chris Fremantle was appointed as Public Art Manager across both projects in April 2008.

THE ART PROJECTS

New Stobhill Hospital

Clinic Waiting Areas, Thomas A Clark, Andreas Karl Schulze, Olwen Stone
In 15 waiting rooms which look out onto courtyards, the Latin names of trees are sandblasted onto the windows. The walls are decorated by bands of colour installed by Schulze. Each waiting room also contains a video on a woodland theme by Stone (displayed on a monitor).

Six Rooms, Thomas A Clark
In six sub-waiting areas at the south elevation on the first and second floors, the name of a single bufferfly is placed centrally on a wall, painted in appropriate colours: ‘orange tip’ in white and orange, ‘speckled wood’ in green and yellow etc.

Selected Grasses, Thomas A Clark, Olwen Stone
In the Day Surgery waiting area, a poem of the names of selected common grasses scrolls across an LED sign. A related video is projected onto a frosted screen between the waiting area and central arcade.

Day Surgery sub-waiting Areas, Kenneth Dingwall
Groups of shallow relief constructions, in multiples of six or twelve, of primary or high-keyed colour relationships to create visual permutations of colour sequences and pattern of visual rhythms.

Imaging Waiting Area, Thomas A Clark, Kenneth Dingwall
Level one corridor with natural roof lighting, Clark places ‘blue sky’ texts on the wall accompanied by a series of low relief shaped works by Dingwall. The shapes in varied blue hues and placed on the ceiling or wall angles, optically change depending on position or approach.

Endoscopy sub-waiting Areas, Kenneth Dingwall
Groups of multi-angled, low reliefs in monochrome or two colour.

Six Landscapes, Thomas A Clark, Donald Urquhart
In five of the reception/waiting areas with no external view, Urquhart will install works collaboratively with, and in response to, texts by Clark. At each location Urquhart’s work, comprising a flat rectangle of colour with a painting ‘on top’, is sited on one wall with the text on another; e.g. “a deposit of mist moss”

An Alphabet, Donald Urquhart
On level three, at the top of the central staircase, 18 framed drawings will be hung around the landing which provides access to staff areas. Each drawing is in the form of a diptych: the left panel holds a single letter whilst the right hand panel comprises imagery of a species of indigenous tree. This work is based on the Gaelic alphabet which contains 18 letters – each traditionally associated with a tree name.

Glade, Thomas A Clark, Donald Urquhart
Design by Urquhart, in response to a text by Clark, of two adjacent rooms on the ground floor, accessed directly form the arcade, for use by the Spiritual Care Department.

External Benches, Thomas A Clark
To the right of the main entrance, three stone benches each bearing a one-line inscription: in good company | in your own company | in the company of trees.

New Victoria Hospital

Car Park, Ally Wallace
Entrances to the main building, from the lower level car park, are highlighted with large scale wall markings and supergraphic signage.

Coloured Glazing, Ally Wallace
Throughout the building, panels of colour glass are introduced into the curtain wall glazing along the circulation areas to diffuse coloured light into the interior.

Squaring of the Circle, Ronnie Heeps
Design by Heeps for a Spiritual Faith and Healing Room, to provide a sanctuary space for patients and staff, through the use of circular motif to subert the squareness of the room.

Waiting Areas, Jacki Parry
Two adjacent waiting areas in the Outpatients Dept. and the Endoscopy waiting area are the site for Parry’s work – a series of nine small 3D objects, three in each waiting area. Each object is cast in paper and sealed in a ‘display pod’ – a transparent vacuum-formed oval container.

Thresholds and Prospects, Calum Stirling
At the junction of footpaths outside the hospital, Stirling has created a sculpture garden of various natural and manufactured forms. The scheme comprises trees and other planting, boulders, architectural cast pieces, a screen and sculptural seating.

Waiting Areas, Hanneline Visnes
A series of murals drawing on imagery from nature, in waiting areas on each floor, painted over a fairly large area of the wall but with an emphasis on detail.

Programmable spaces

Both hospitals have provision for programmable spaces for ‘community arts projects’ and touring exhibitions. Public areas have been identified within each building and provided with the means to receive artwork on a changing basis. The intention is to implement a continuous exhibition and commissioning programme of therapeutic arts and health improvement work, led by artists working with staff and community groups. Work generated through these interventions will be displayed in the designated, programmable areas. This is a particular feature of the New Victoria Hospital where resources for a 2-3year development programme to animate these spaces is built into the art project budget.

EDUCATION and OUTREACH

A community engagement project, at Stobhill, was undertaken by Alec Finlay with the Friends of Springburn Park. ‘Home for a King’ or ‘waiting room in the park’ is the result: a new entrance to the park opened up and marked with a Moon Gate. Boulders engraved with poetry, a bird box walk and additional benches seek to draw people further into the natural environment.

An overarching outreach programme, Widening the Circle, was also implemented with the aim of extending the knowledge and experience of members of the Steering Groups to other members of staff in the hospitals. In addition, the Arts & Health team have guided tours of the artworks. Further Interpretation and publications are proposed for both hospitals.

Allowances for education programmes (talks and workshops) were included in the original project budgets. For example, it is understood an artwork facilitated by Art in Hospital Artists working with hospital patients and local school children went up on the site hoardings in autumn 2007.

REFLECTION

Both projects demonstrate how artists can help the NHS develop an overall design vision for a new building, in creative ways. The approach at each site however varied widely, the result of different circumstances and the divergence of approach in the procurement of each new hospital. The impact of the artists’ interventions similarly therefore differs considerably. It is incredibly illuminating however to list all the art works as a way of noting the considerable achievement of NHSGGC in investing in artists’ work, as part of the redevelopment of the hospital estate, particularly given the size of NHSGGC as an organisation and the potential for this work to be completely marginalised.

In discussion with NHS staff, a criticism of the more conceptual and cerebral approach to the artwork programme at Stobhill is that it doesn’t particularly relate to the community, although the question remains as to ‘what is the community’. The work may also be considered too small, in some cases, for the scale of the new hospital spaces. The programme at Stobhill does however have considerable rigour and coherence, with all the artists responding to a clear statement of intent. The works are composed together, in dialogue with one another, and not separately as stand alone works. The exception perhaps is Alec Finlay’s intervention which appears rather more independent. The work is however outwith the new hospital building and the result of a separate community engagement project developed with the Friends of Springburn Park.

The artwork programme at the New Victoria Hospital appears more populist, although the artworks in themselves are still quite challenging. Perhaps this is because the artists’ interventions are described more easily in terms of traditional practice: painting, sculpture etc. The works exist pretty much in their own right rather than as part of the over-arching vision. The works tend to sit well in the smaller spaces of the New Victoria Hospital. The really innovative part of the New Victoria project is the commitment to the ongoing art programme.

Whilst widely different, to a certain extent it is predictable the two projects were bundled together and this actually appears to be a strength and success of the project. In a sense, the two projects form a type of pilot initiative and the scale of the intervention helps to raise the visibility of the arts and health strategy. The two projects also demonstrate a multiplicity of approaches, a range of different programmes which is hugely appropriate and encouraging – NHSGGC has not adopted a ‘one size fits all’ solution to involving artists in its work. Indeed, the breadth of work has helped to change the language around the art commissioning process and the two projects have been instrumental in building capacity within the Health Improvement team to champion and develop further projects.

In particular, the Arts and Health Co-ordinator sees the artwork programme working strategically to influence the rest of the NHSGGC about:

• consideration of emotions and psychological effects of place and spaces in healing;
• what it means when artists and designers ‘work in context’;
• how NHS based artists and art programmes can be catalysts for facilitating health sector role in neighbourhood and city regeneration;
• how NHS can work to support Glasgow City Council’s agenda for widening access to art and cultural activity.

The projects at the Stobhill and Victoria sites have also been hugely important to NHSGGC in demystifying the process of arts commissioning and demonstrating the professionalism of the arts. For many staff it has been “an exciting journey and privilege to work with artists”. As more people get involved in the process, more learning happens and this is seen as being incredibly important. The artists leave and so more and more people need to be involved in the process to ensure it is embedded into NHSGGC’s learning culture – knowledge gained through new work is disseminated, discussed and modifications adapted as a direct result of new practice. For the arts programme this is happening within the NHSGGC Design Champions Group and therefore it can be argued the art interventions at the new hospitals has been instrumental in beginning to influence the whole organisation. A further key achievement is the development of the Glasgow Arts and Health Network where information and learning can be shared.

Having said that some people still have difficulty in understanding artists’ working practice. For example, the research and development phase was considered very expensive – the question of value for money constantly needs to be argued at this stage. Also the artist design sketches were seen as final proposals with little understanding these would need considerable further development to be realised. It was clear that two totally different cultures were crashing together.

NHS Estates has however produced a useful briefing, entlitled: ‘Improving the Patient Experience: The Art of Good Health – A Practical Handbook’ 2003. An extract is available at publicartonline

This paper argues the arts have a significant contribution to make in creating impact in healthcare design. In particular, the arts can be used to:

• create local distinctiveness;
• ensure that the built environment reflects individual human scale;
• meet the spiritual and emotional needs of patients and staff;
• support and improve wayfinding, for example by creating landmarks at entrances and in key public spaces;
• enhance landscaping and interior design through creative use of materials and finishes;
• enhance the prestige and reputation of the NHS trust during the redevelopment process.

The paper goes on to describe the PFI design process and advise on the commissioning of artworks, managing the transfer of existing works of are to a new building and setting service agreements in place for an ongoing arts programme. It is recommended NHS Trusts develop arts strategies and arts development plans as part of the PFI procurement process. Key factors for success are highlighted as:

• build consensus early in the process with all stakeholders;
• establish an art and design committee, with clear terms of reference;
• ensure arts programme is professionally managed;
• define scope and parameters of the arts project to quantify the work to minimise risk;
• bring specialist arts advisers on board early;
• budget for the arts strategy early in the process.

It is recognised the Health Improvement and Capital Planning teams have learnt a huge amount in delivering the projects, but it is not clear whether this learning has been formalised. And ‘how to measure the impact of the projects is crucial to closing the loop’. Significantly the process for the procurement of artwork within new capital developments is now far more sophisticated and artwork is built into the output specifications for any new PFI / PPP contracts / tender documents.

The two projects at Stobhill and the New Victoria Hospital have acted as a real lever to influence NHS staff throughout the organisation. Also the support of the Scottish Arts Council has been instrumental in influencing and supporting NHS policy.

It appears that within only four years, the arts have moved from being considered as a separate agenda into an integral part of the capital planning process through the sustained promotion by the Health Improvement team. This is a truly considerable achievement.