Right to Daylight
Ever since abandoning the pavilion plan the infusion of natural light in health care design has diminished. As in workspace across the sectors occupants in the latest generation of hospitals spend their working life under florescent tubes. Not only are professional preferences for such fittings impacting on the spirits of users, they also drain away natural resources. The drive for centralised services promotes constant ambient and task lighting damaging the operators whilst polluting the earth’s atmosphere. Dire forecasts of catastrophic effects on climatepersuade designers to readdress the balance between demands for conventional hardware and the softer values of refining care. With their greedy reliance on artificial means of illumination recent medical stock without the advantages of daylight will before long, be consigned to the dark ages.
Highly valued for its symbolic and ritual association mankind has an ancient and rich affinity with the sun. Its stimulus is persistent and essential to the wellbeing of the human condition. As highly phototropic creatures fake lighting fails to satisfy psychological and physical requirements and for the human species natural is most beneficial. Rendering colour true, natural sunlight is both wondrous and innately beautiful. Artist like Monet painting humble haystacks in a Normandy field, have attempted to capture its ephemeral and seductive radiance. Witness the crowds of worshippers descending the ramps at the Tate Modern to be re-energised under “The Weather Project” Olafur Elliason’s rendition of the setting sun. Engaging its therapeutic powers nourishing visual and tactile sensibilities offer a way to create a more benign working and living space. Considering the valuable contribution natural light can bring, it is important to make use of this abundant resource in the design of health care buildings. Paying due respect to healing powers of sunlight will however have considerable effect on the plan and form of the building, its orientation and facades, size and type of fenestration, room heights, pathways etc. Responsible clients will need to consider employing a range of daylight linking systems, such as skylights, light shelves, solar lamps and an array of luminary devices.
According to a revealing report Learning from French Hospital Design by architects BDP *1*, there is a consensus that health care environments contribute to patient recovery and given the opportunity designers can make a difference. . The concise report claims the latest French single bed hospitals are achieving superior design quality and cost less than two thirds of comparative British hospitals. Health care it postulates is generally based on the convenience of medic and carers, but patients put recovery first. The core economy is to have good patient outcomes. In France day lit plans and good amenity also aid staff wellbeing, and the result is better architecture which fosters user morale and community pride.
What then is the context and how is this being achieved?. French medicine it is understood pays greater attention to the locality and constitution of the patients. Using less antibiotics and more complementary care, medical practice favours ways to stimulate the immune system. Less invasive and gentle treatment like recovering in spas, homeopathy and even immunotherapy for cancer treatment are preferred. To improve the situation on the home front designers have often sought inspiration abroad, but there are significant barriers to incorporating ideas across national boundaries. In the early nineteenth century hospitals in Bordeaux and Paris led the way but until recently the generic hospital plan was engineered in the UK.
In 1864 the construction commenced on pavilion plan hospital erected in the grounds of the Chorlton Union Workhouse. Designed by the celebrated Manchester architect Thomas Worthington it comprised of five well-spaced ward blocks, each accommodating 96 patients and linked by a covered way. The pavilion plan at the Withington Hospital was the first to be built in England, and it was closely appraised by the influential nurse and public health reformer Florence Nightingale: The lady with the lamp wrote enthusiastically of these new hygienic hospital plans, which became the predominant form throughout the nineteenth century: “Second only to fresh air” Nightingale wrote “I should be inclined to rank light in importance for the sick. Direct sunlight, not only daylight, is necessary for speedy recovery. I mention from experience, as quite perceptible in promoting recovery, the being able to see out of a window, instead of looking against a dead wall; the bright colours of flowers…. It is generally said the effect is upon the mind. Perhaps so, but it is not less so upon the body.”
Evolving science informs us daylight is a primary source of energy and a form of electromagnetic radiation to which receptors of the human eye are highly sensitive. The properties and wave characteristics of the light are regulated through the eye and distributed to the endocrine glands. The glands disseminate and nourish the mental and physical processes constantly effecting our perception and emotional behaviour. As with photosynthesis in plants we are profoundly biologically affected by the quality and amount of daylight. Our mood and thoughts often reflect the cyclic variations and interplay of sun light. The ability to see the sky and surrounding life through the window help alleviate sensory deprivation and keeps us connected with the oscillations of natural phenomena. Being withdrawn from the external environment induces the sensation of being trapped, a cause of increased distress. It is now appreciated such deprived amenity within inpatient accommodation is contributing to unnecessary levels of stress, and causing reduced immunity. Fear and anxiety generated in such circumstances trigger increase adrenalin, resulting in hormone secretion inhibiting the body’s own natural biological defence and recovery process. Harsh electrical lighting regimes within medical institutions will have a negative effect on patient’s wellness and staff morale. An unsatisfactory situation when according to Florence Nightingale the very first rule is not to cause the patient further harm *2*
With their simple cross ventilation and sanitary arrangements, the elegant Victorian engineering ward distribution is replaced by increasingly complex infrastructures. Extended structures with interstitial floors where mechanical and electrical appliances abound to service ever further centralised accommodation. Major gas guzzling polluters the pre-oil crisis conceived international style insensitive to the UK seasons burn more fuel on summer air conditioning than on heating during the winter months. Even on the brightest of days deep within windowless caverns florescent strips ablaze. We are becoming increasingly aware construction is responsible for half the worlds CO2 and that such industrial excess is unsustainable. Exhausting fossil fuels and with warnings of global warming health care like every other sector will have to dramatically reduce its carbon emissions. Computer projections at the Met.Office have concluded the rises in global temperatures are more serious than previously thought. Leading ecologists are increasingly fearful and desperate to find measures of stabilising climate to avoid disastrous consequences. Energy efficiency and new technology must all be quickly utilised otherwise the cost of climate change rise the longer action is delayed. A sober analysis by the international Energy Agency forecasts electricity demand in the next 25 years is likely to double. In the same period emissions of carbon dioxide from all sectors are likely to increase by an alarming sixty-two percent.
One practical step is for all work spaces to incorporate adequate windows to provide outlook and access to outdoor life. A window wall would also accommodate barrier free means of escape and access to open space will improve the ambience within. To install sufficient fenestration to look out of, that opens will provide natural ventilation whilst reducing unnecessary power consumption. Such a brief would provide a positive contribution to health and safety for the benefit of the whole workforce. This modest recommendation would improve the quality of life across the population. Although daylight is of course free and non-polluting it may seem unnecessary to have to impose the statutory regulations which are beginning to appear in Europe. For the first time according to a recent report natural lighting is to be introduced into the building regulations in 2006. Encouraging improvements to workplace Part L regulations are considering guidance to include compliance with annual carbon dioxide emissions of the whole building. Opinions at the ODPM are alert to the use and wastage of electric power is proportional to the extent of windows but suggest u-values for glazing maybe less than the building fabric. Whilst large windows produce higher daylight factors there is a trade off between heat loss and solar gain in the summer. Adjusting the ratio and the proportion of double glazing they propose a discretionary design charter agreement between the client and the designers.
Right to daylight in France
Whilst the ODPM response was cautious the French according to the BDP report are far more emphatic laws which require daylight in all rooms where people work. The regulations are strictly applied producing shallow planning with daylight to most rooms. Adherence to the rules has generated two principal types of volumes, the multi-floor ward and the flat diagnostic - treatment “plateau” technique. French design offers generous day lit circulation spines and expressive gestures concentrating on entry and orientation to form a sense of place. Planning for natural day lighting and ventilation results in a lean linear hospital structure.
The right to daylight regulations specifically require at least 25% of the window wall to be glazed. Staff and clinical spaces with at least views into courtyards of a seven metre minimum width, and wider if the courts are taller than two levels. The resultant effect on the plateau technique is a woven tapestry with a 15m wide grain. Spaces over 4.5m from the windows and overlaps are used for utilities where no one works continuously.
The single bed wards incorporate thirty units in a continuous strip of rooms with nursing stations at intervals. A pair of patient-rooms are 3.5m wide to the centre wall to form a 7m structure bay.
Distant views, movement of the sun, access to daylight and gardens offers a calm supportive environment. Daylight value from superior work rooms provides better staff morale, aid recruitment, retention and better patient care. With their generous circulation, high daylight and good amenity user and community are more respectful of facilities. Visiting patients and health professionals from the UK describe new French hospitals as palatial.
Eco-friendly in Japan
Whilst the right to daylight aids staff wellbeing and patient recovery thermal emissions and energy targets are not considered heath care specific. Learning about more ecologically sympathetic buildings will require monitoring progress outside healthcare within other progressive eco-sensitive projects. In Japan BDP’s counterparts are Nikken Sekkei Architect and Engineers, the largest practice in the world. As part of their sustainable green architecture programme they have published useful research as guidance *3* on the use of light as a building element. Considering attributes natural light brings Nikken Sekkei however believe it will be important to apply this element in the design of their health buildings. Given the inherent need to function in the presence of natural light, it is essential to re-access integration of this renewable resource in all types of building design.
Natural light varies constantly changing with the seasons, weather and hour of the day. Endowing space with expansion and openness it brings outdoor conditions into the interior rooms. Movement of natural light is also a very desirable stimulus which makes places more dramatic and attractive. Variations in ambient light environment are more beneficial to the human eye and user’s mood. It provides a natural sense of time supports productivity and is universally appealing. In contrast artificial illumination alters colour perception, effects sleep-waking patterns and is associated with a host of health problems.
The Tokyo Gas Earth Port building provides an informative case study. It states within modern commercial buildings light and air conditioning account for 80% of total energy consumption. Completed in 1996 the Earth Port itself achieved a 45% reduction in primary energy use and reduced by two thirds CO2 discharge. In a analysis it was found when daylight enters both sides of a building, natural light is more effective and the space is more evenly lit with less variation in luminance. Strategies depend on latitude and orientation. Eaves mounted on window frames block direct solar radiation and amount of time shades are drawn to lengthen the hours natural light is available.
Use of automatic louvre blinds, light dimming and other control technology promotes better balanced light conditions. Natural Light gathering strategies include maximising size of fenestration and restricting depth of the open plan space to 16metres achieves 300 lux at centre. To control glare,1.2m wide aluminium light shelf eaves are fitted above the middle windows. The ceiling slopes inwards from a perimeter height of 3.5m to 2,5m at midway. For natural ventilation the upper window opens whilst the aluminium eaves reflect light illuminating the ceiling spreading extra light across the room. A 65% reduction in daytime energy consumption for lighting in the office was achieved. Multi-layered low-e glass technology was found to have the same insulation capacity as concrete walls. Heat gain was resolved by the aluminum light shelves which block direct solar radiation and baffle the sun rays. It confirms building can be made more transparent or translucent without increasing interior temperatures. to combine with a feeling of openness providing staff with unobstructed views. With computer modeling it is possible to predict the strength of natural light penetrating enclosure with a high degree of precision. The quality of daylight or the impact of glare and degree of user comfort however remains a challenge.
Since the early days of the pavilion the primary relationship between nursing and designers appears to have been undermined in favour of third parties whose purpose is unrelated to the quality of patient care. Informed regulation for increased quality of day lighting in buildings will align patients care and users more closely with their natural surroundings. A credit process in which energy consumption charges are directly related to the number of building occupants will encourage Trusts to ensure the provision of patient space is located closer to the edge of the building. With the twin benefits of improving patient outcomes and a free non-polluting natural resource, the re-introduction of natural daylight priorities provide a classic win-win situation.
References
! Learning From French Hospitals a BDP Building Design Partnership Report May2004
2 Quotation “It may seem a strange principle to enunciate as the very first requirement in a Hospital that it should do the sick no harm. It is quite necessary nevertheless to lay down such a principle." Florence Nightingale (1820-1910)
2 Quantitative Evaluation Techniques in the analysis of natural Light Koichi Kaiho Snior Engineer Nikken Sekkei Architects and Engineers. From Book Sustainable Architecture in Japan The Green Buildings of Nikken Sekkei William McDonough Wiley-Academy