'Cutting edge' medicine in heritage buildings


The Harley Street Medical Area in London is home to some of the world’s most ‘cutting edge’ medical facilities, yet it is a place restricted by, but blessed with, historical architecture and listed buildings. Simon Baynham, property director at The Howard de Walden Estate, which looks after the area, explains the unique challenges involved in deploying modern medicine in a heritage environment.

Harley Street has been synonymous with private medicine since the mid-19th century. In 1860, just 20 doctor operated in the area, a number that has grown considerably over the decades, and which includes many notable medical professionals. Florence Nightingale worked here, as did pioneering ophthalmologist, Sir Harold Ridley, and world-renowned obstetrician Sir Grantly Dick-Read, while the contemporary movie, The King’s Speech, shone a spotlight on doctor and speech therapist, Lionel Logue, who helped King George VI overcome his stammer with lessons held here. Dr Logue was also responsible for installing the first artificial voice box in the UK in a patient. That patient was John Baynham – who was my grandfather. From a young age, I was aware of the incredible work that can be done when medics are given the opportunity to innovate and strive for the very best.

Simon Baynham, Property Director, The Howard de Walden Estate

Today, some 5,000 medical professionals operate in the Harley Street Medical Area, covering just about every possible specialism. The area’s rich history is well reflected in its buildings and architecture. This whole region of London’s bustling Marylebone is a conservation area, home to 360 listed buildings – ranging from grand Georgian townhouses to smaller Victorian properties. People visit us from across the world, not just for pioneering medical treatment, but also to admire our beautiful facades, ornate windows, and sculpted stonework. It’s an area of curious opposites – modern medicine and centuries old architecture – and marrying the two remains a real challenge: its historic external appearance doesn’t always reflect the cutting edge work that’s being done. As we’ve consistently proven, however, it can be done.

Logistical challenges
Let’s start by looking at one of our newest clinics – the Royal Brompton and Harefield NHS Foundation Trust’s (RB&HH) outpatients and diagnostics facility on Wimpole Street, which opened in July. The Trust is known globally for its excellence in cardiovascular and respiratory care, and therefore needs a lot of extremely specialist medical equipment to uphold that reputation. For example, it’s one of only two centres in the UK that offers Rubidium Cardiac Imaging, a technology that reduces the traditional imaging process from more than four hours to less than 60 minutes. Patients’ exposure to radiation is dramatically reduced, and diagnostic accuracy is considerably increased. It’s a vital bit of kit, and sets the Trust apart from all other imaging clinics in the country, but installing the machine and other necessary equipment into its historic Wimpole Street premises took serious planning. Larger pieces of equipment, such as the MRI machine and PET CT scanner, had to be craned over the front of the building and lowered six storeys, while adjacent roads were closed off. These are hugely expensive machines, so the process required expert handling, and the architectural challenges didn’t stop once they were on the premises either. Installing the MRI scanner involved a number of complex requirements because of the magnetic field it generates. It’s crucial that nothing that disturbs or distorts that field, so all kinds of factors had to be taken into consideration – such as the nearest underground line, lifts in surrounding buildings, and even the passing traffic outside.

Substantial cooling systems
MRI machines and PET scanners also require substantial cooling systems, but these are notoriously noisy, and exceeded sound levels for roof installation, so they were put in the basement instead, proving that architectural limitations associated with these kinds of buildings aren’t completely insurmountable. In fact, the basements in Harley Street and its surrounding areas are usually a significant boon for medical practices. At The London Clinic, for example, a brand new pathology facility was installed in the basement thanks to an amazing network of drains that make it possible and safe to get rid of medical waste. Once RB&HH’s equipment was inside the building, another challenge became apparent – powering it. Harley Street’s grid network is, like many parts of London, working at full capacity, and there is little available additional power – conservation or otherwise – but the amount of high-quality power required by these machines is substantial. The answer? Build an electrical substation. It seems like a dramatic solution, but it’s the most practical, and a number of properties in the area have done the same. Many of these buildings existed in a time before electricity was the norm, but there’s no issue in running the cutting edge technology that now resides within them.

Style and substance
There are other logistical challenges, too, of course. Wooden floor joists need to be strengthened, you can’t just install a lift anywhere in a listed building, and size restrictions are a factor. If a medical practice wants to expand, it’s not easy to get planning permission – and impossible in some cases. Clinics can take up residence in buildings next to one another, but they can’t always open up party walls, which makes it difficult to develop a fully integrated facility, so a lot of imagination is required in getting around these issues. Nevertheless, these issues primarily stem from the very thing that draws practices here in the first place. As RB&HH’s project leader, Lindsey Condron, explains: “We were determined to create an environment that would have a calming effect on patients and their families. That’s partly why the more historic parts of the building were so attractive to us.”

That is what medicine is all about, after all – the patients, which is why, once our buildings are kitted out with top-of-the range equipment, we focus on creating pleasant, welcoming atmospheres. Fortius (HEJ – October 2017), for example, converted 12,500 ft2 of space in picturesque Bentinck Street into a world class orthopaedic surgical facility, keeping a focus squarely on the patient experience. This FIFA Medical Centre of Excellence offers a soft and relaxing environment full of organic forms, warm colours, and ambient lighting design – as far removed from the traditional medical facility blueprint as you could imagine. However, style is matched by substance, as beyond the fresh and contemporary patient waiting areas are state-of-the-art operating theatres and ‘high-spec’ private rooms, all designed and constructed sympathetically to the building’s elegant Edwardian façade.

Design innovation
There’s plenty of room for design innovation, too. Isokinetic opened its first clinic outside Italy here in September 2014 (the area attracts talent from across the world – Germany’s famed spinal and orthopaedics Schoen Clinic will open its doors here in 2018), and has taken a particularly clever approach to its internal set-up. The Isokinetic London clinic, which serves some 1,500 patients a year – many of them Olympic champions, prima ballerinas, and Premiership footballers – operates a five-stage recovery programme, and the building’s interior reflects this. The setting of the initial recovery stage – water rehabilitation, is located on the bottom floor of the building, while final fitness sessions take place on the top floor. Every area of the building represents a step forward in a patient’s recovery, and they are all working towards the summit of health.

The development of the clinic didn’t come without its issues, though. The properties earmarked for conversion were situated back-to-back instead of the much more straightforward side-to-side, and initial plans were turned down by the planning authority, requiring a radical re-think of the original design. In the event, the project saw the demolition of a mews house and some ancillary buildings, plus a substantial excavation. Now the clinic boasts the largest hydrotherapy pool in London, and a unique, high-tech ‘green room’, where neuroscience meets biomechanics to help prevent injury and reduce injury reoccurrence. The space is equipped with three high-speed cameras, a force platform, and a 3.0 m by 2.5 m video feedback wall. It’s no surprise that the clinic won the Public Service Architecture category in the UK Property Awards 2015, and was highly commended in the Health category at the AJ Retrofit Awards 2015.

Special surroundings
It’s this kind of excellence and innovative thinking that we look for when considering new tenants for our buildings. We have an exacting long-term vision, and proactively work with a group of advisors to identify missing specialisms and then fill that gap with the very best medical professionals. We’d rather a property remain vacant during an extended period than be taken by just any clinic – Harley Street Medical Area is more than the sum of its parts, after all. Of course, once we find the right tenants, we’re prepared to invest heavily in its facilities, and indeed, in the surrounding area. Many of Harley Street’s clinics are attracted to the area because of its accessible location and ‘village’ atmosphere. Surrounding the medical buildings are restaurants, cafés, shops, and cultural institutions, plus hotels (many of which have formed close ties with the hospitals), leafy parks, and attractive sitting areas, designed for moments of peace and quiet reflection. For patients undergoing treatment and their families, the area is comfortable, and offers many welcome distractions. But we want to make worlds on either side of hospital doors more cohesive still, so we’re now exploring options for a concierge service, which would help patients with travel, accommodation, and post-treatment services (private medicine should be a five-star experience, after all). We’re also looking at the feasibility of creating a special hotel for patients who have been discharged, but do not yet feel comfortable making an onward journey, or who require outpatient treatment.

Looking ahead
Offering additional services like these adds premium value to our patient offering, and contributes to our main objective of remaining a serious contender in an increasingly competitive market. When doctors arrived in the area in the late 19th century, they for a long time enjoyed the reputation of the most well-known and in-demand medical region in the world. But it’s not enough to simply maintain our current status (although we carry out comprehensive building maintenance every seven years). We need to be constantly pushing forward to remain at the forefront of technology. Of course, given the nature of our buildings, this can sometimes prove controversial – another unique challenge faced by the Harley Street Medical Area.

Children’s cancer hospital
Earlier this year, we were given planning permission to begin work on a children’s cancer hospital across two of the most historic buildings in the area. Number 73 was once the home of former Prime Minister, William Gladstone, while number 75 was the home of Charles Lyell, a close contemporary of Charles Darwin. This ‘one-stop’ facility, run by HCA for diagnosis and treatment, will provide the very best in care and support to children and their families affected by cancer. We believe this facility will add greatly to our offering, and it is right that we are at the forefront of work to combat some of our most pressing and serious illnesses. There are concerns among some that the building work intervention required for this pioneering clinic will change the face of Harley Street, but the premises will – like every other in the area – be designed and refurbished sympathetically in keeping with its surrounding aesthetic. We’re very happy to welcome this extremely important and deserving facility on board.

Proton beam therapy
We’re also delighted to welcome Advanced Oncotherapy and Circle Health’s proton beam therapy clinic, which is due to open its doors in 2019, and was pioneered by the physicist behind the Large Hadron Collider, Professor Steve Myers. The £26 million laboratory is set to revolutionise UK cancer treatment. Up until now, proton beam therapy has been costly to install, and costly to offer to patients, but the ground-breaking LIGHT technology makes this incredible treatment accessible for all. The Harley Street Proton Therapy Centre, approximately 12,000 ft2 in size, will consist of rooms for patient imaging, treatment, consultation, patients, administration, the proton accelerator, and ancillary systems such as power supply. This will all be housed in a Grade II listed building, and will use a world-first modular system that’s less expensive and significantly smaller than machines currently on the market, so the equipment can simply be taken through the front door in parts before being constructed on site – similar technology at The Christie Hospital in Manchester weighs 250 tonnes and had to be craned in. No other proton beam system could be installed in Harley Street. Piling and excavation of the basement where the proton accelerator will be installed is well underway.

Councillor’s backing
Residents have expressed concerns about radiation dangers, but they can be assured that the facility carries no noise, radiation exposure, or vibration risk. As deputy Conservative council leader, Robert Davis, said when the plans were given the go-ahead: “I can think of few better reasons to approve a development than creating a centre of excellence where people receive high quality medical care and attention, particularly for the treatment of an illness that affects so many of us.”

When I first began working with The Howard de Walden Estate, people firmly believed that Harley Street’s medical component would disappear after five years, leaving behind only offices and residential premises. More than 22 years later, it’s still here, and is thriving, and it is heartening to see how far we’ve come. The sheer level of medical excellence found behind these elegant period facades has turned Harley Street into a powerhouse of modern medicine. But there’s still much to be done, both in breaking down stereotypes and generalisations associated with the area, and in maximising it’s already tremendous offering, which will also provide skilled employment and significantly contribute to improving the UK’s alarming balance of trade deficit. The UK’s private healthcare sector accounts for less than 1% of the global medical tourism market, for example. We’re extremely well-positioned to help grow that figure, because with our cutting edge medical care and beautiful urban setting, there really is nowhere else like it in the world.