The £50m Oak Cancer Centre at the Royal Marsden Hospital does pretty much everything that you could ask it to. Across six storeys, it plays host to a rapid diagnostic centre, with mammography and endoscopy suites, phlebotomy and haemotology units, an advanced treatment area including 63 chemotherapy bays, a pharmacy, consulting and training rooms, conference facilities, and – sandwiched in on the first floor – a pioneering centre for advanced research and clinical trials.
In an approach the Surrey NHS hospital describes as “bench to bedside”, the BREEAM Excellent centre provides a base for 400 scientists and 200 healthcare professionals. The challenge for architect BDP was to organise all this activity under one roof while conveying a sense of reassurance to the countless outpatients who pass through the Oak’s doors. It does this in a variety of ways: by integrating daylight and views to aid orientation and make the building feel less clinical; by using a warm palette of largely natural materials including oak panels, stone floors and exposed concrete columns; and by obsessing over small details. “Everything’s well put together,” says project architect Peter Ruffell. “It’s organised in a very rigorous way. Members of the public might not necessarily notice it, but they’ll feel it.”
This starts with the building exterior. A landscaped forecourt slopes up to the double-height main entrance, in the middle of a long crescent-shaped brick facade. Above this, the first-floor research centre is delineated as a glazed ribbon, above which the upper levels almost seem to float. These floors, which contain the day care unit, treatment bays, a staff restaurant and outdoor terraces, are also predominantly glazed behind deep brises-soleil. The gently curving frame is clad in GRC and incorporates a dramatic 2m cantilever at either end, which further emphasises the sense of lightness.
The facade design is all in the service of creating a legible building, with different zones clearly articulated amid the solidity of brick and GRC-clad concrete. Ruffell points out that the detailing of the GRC panels was also important: “We were meticulous with the setting out of the joints so they all align with the mullions. That sort of organisation makes a big difference. It sort of lets people know they’re in safe hands.”
Similar attention has been paid to the arrival experience. BDP has exploited the natural slope of the site to introduce a discrete entrance on the side elevation at lower ground level. This is for the diagnostic centre and allows for a subtle separation of patient flows. “If you've been referred by your GP because you might have cancer, you're going to be incredibly anxious. It can be very stressful to be around people visibly showing signs of illness or the side-effects of the treatment.”
The entrance to the treatment centre is on the main elevation. Here, a bright linear reception behind the facade has a series of welcome points and cafe areas, lending it the genial buzz of a public space. Beyond this lies a full-height atrium, bathed in light from above, and a shimmering metal staircase. “A lot of hospitals are like mazes, but here you can always see the stair or the outside, so you’re never lost,” explains Ruffell.
From this central space, patients can navigate their way past the activity of the research to the treatment areas, upper terraces and further spaces to the back of the site. The most impressive space is the second-floor chemotherapy infusion suite, which stretches the length of the building behind the glazed facade. “It's a great spot for watching the hospital estate in full activity, but you're also in the top of the trees, so it has the calmness of a garden,” he says. The treatment chairs are separated by 1m-high partitions, allowing privacy for those who want it, but also the possibility of social interaction between patients. “It’s very open plan and could have felt like an airport lounge, but because it's got that gentle curve, you don't feel as though it’s such a large room.”
The whole wide-ranging programme is underpinned by a reinforced-concrete frame, which is both very efficient and very hardworking. Slabs are 300mm deep and support a 7.5m x 7.5m grid. “We try to set up as regular a grid as possible to embed future flexibility,” says Ruffell. “You have to find a balance that works with the often conflicting needs of the programme on each floor.”
Although much of the structure is concealed by plasterboard, a high level of detailing was still necessary. Cast-in channels ensure that all drainage is concealed behind the cantilevered terraces, and the exposed columns that adorn the main entrance and atrium have a high-quality polished finish. As with the GRC cladding, the coffers in the chemotherapy suite align precisely with the pergola above – another subliminal gesture of rigour and care.
Structural engineer Campbell Reith has calculated that its lean design approach reduced the total amount of reinforcement by an estimated 66 tonnes, saving 55 tonnes CO2e. The embodied carbon footprint of the primary structural frame was 205kgCO2e/m2, while the superstructure’s footprint of 165 kgCO2e/m2 is not only 18% below the contemporary 2020 RIBA baseline, but also achieves 2025 baseline levels, aligning it with the RIBA 2030 Climate Challenge.