Pile of hope - 20 years of Maggie's Centres

It’s been 20 years since Maggie Jencks dreamt of a single room where cancer patients, like herself, could go to escape. She didn’t live quite long enough to see the first Maggie’s Centre open, but this October marks the opening of the 18th centre in 18 years. Her modest vision has been transformed from her husband Charles Jencks’ ‘pile of hope’ — a stack of articles promising breakthroughs — to the ambitious charity of today...


Words Cate St Hill

Portraits Ivan Jones

Twenty years ago, as Maggie Keswick Jencks, the wife of architectural theorist and critic Charles Jencks, was dying from cancer, she had a modest vision to transform a room at the end of her hospital corridor in Edinburgh into one small haven for cancer patients. It was to provide a respite from the impersonal surroundings of NHS institutions, with their cold, windowless corridors, clinical decor, harsh lights and the noxious therapy.

Fast-forward to today and there are 22 Maggie's Centres built or planned across the UK and abroad, each located on the site of a large hospital, offering a domestic sanctuary that encourages self-help. Each 300 sq m centre is conceived by a different design legend, making use of Charles Jencks' overflowing address book of architect friends. From Richard Rogers to Zaha Hadid, and from Frank Gehry to Rem Koolhaas, they have produced a diverse family of architectural delights, the buildings becoming iconic as experiments in healthcare design.

Charles Jencks reflects underneath Wilkinson Eyre’s tree houselike Centre. Photo Credit: Ivan Jones
Charles Jencks reflects underneath Wilkinson Eyre's tree houselike Centre. Photo Credit: Ivan Jones

But they were, and continue to be, far more than architectural statements. As the NHS bursts at the seams -- 'a machine, a factory for making people healthy', Jencks calls it -- Maggie's Centres offer a humane, complementary environment for people with cancer.

With more than one in three people in the UK diagnosed with some form of cancer during their lifetime, and many living longer than earlier patients, thanks to improved treatment, Jencks believes these centres are needed now more than ever, and that's partly down to the positive role architecture can play.

Frank Gehry’s centre in Dundee (2003) was the first purpose-built centre by an international architect. Photo Credit: Raf Makda
Frank Gehry's centre in Dundee (2003) was the first purpose-built centre by an international architect. Photo Credit: Raf Makda

With 18 centres under his belt, Jencks -- now 75 -- is still very much involved in the development of each Maggie's centre. 'I'm an irritant,' he declares when he meets Blueprint at his postmodern home in Holland Park. 'I know I irritate people, but I'm a strong believer that the cancer thing is really important. I'm always pushing because, for Maggie and me, there was really only one thing: to live longer, and I really care about people getting an extension of life. I'm convinced that people who come to Maggie's live longer; we haven't yet been able to measure longevity because it's very complicated, but I want to do a proper scientific study.

The reason I care so much is that I don't want Maggie's to feel like it isn't a life and death thing -- it was for Maggie and it is for me.' Maggie Jencks was diagnosed with what she called 'the dreaded disease' in 1988. During the next few years Charles Jencks started 'a pile of hope', a stack of articles from popular and professional press, many promising an imminent breakthrough.

Piers Gough’s centre (2011) in Nottingham has interiors by Paul Smith. Photo Credit: Courtesy of maggie’s centre

'I read a lot, I did a lot of research because once every week something comes out about cancer,' he reveals. 'I know all the stuff, mastectomy versus lumpectomy, chemotherapy versus radiotherapy. Maggie found it exhausting.' In 1993 they were told she had just two months to live, but she went on to live for another 25 months, giving her time to create a blueprint for the cancer-care centres. 'To cut a long story short, Maggie and I decided to fight,' says Jencks. 'Empowering the patient became our strapline, although Maggie hated it because it's too American. From her experience came the idea of setting up one little room. It gave her a focus she never had in her life.'

Carmody Groarke’s centre on Merseyside also opened this Year Photo: Carmody Groarke
Carmody Groarke's centre on Merseyside also opened this Year Photo: Carmody Groarke

While she was undergoing chemotherapy, Maggie wrote a personal account of her experience, entitled A View from the Front Line, in which she bemoaned the windowless box she was forced to spend her weekly visits in. 'Waiting in itself is not so bad -- it's the circumstances in which you have to wait that count,' she wrote. 'Overhead (sometimes even neon) lighting, interior spaces with no views out and miserable seating against the walls all contribute to extreme mental and physical enervation. Patients who arrive relatively hopeful soon start to wilt.' At first she wrote about the simple need for a private area, 'an old-fashioned ladies' room -- not a partitioned toilet in a row,' which 'supplies privacy for crying, water for washing the face, and a mirror for getting ready to deal with the world outside again.'

The centre is temporary, grouping seven existing structures within an envelope of fiberglass. Photo: Carmody Groarke
The centre is temporary, grouping seven existing structures within an envelope of fiberglass. Photo: Carmody Groarke

In the end, the one room idea was turned down by the Western General Hospital, but after six months of bargaining, the first Maggie's Centre was born. Designed by Richard Murphy Architects and completed in 1996 -- just a year after Maggie died -- it is a modest, modern intervention into the fabric of an old stable block. Murphy, working on the plans while Maggie was still alive, brought the dour heavy greywacke stone building back to life with coloured steel and glass-brick additions. The building has a domestic scale, with a series of tightly layered spaces with low-hanging eaves, clerestory lighting and a light-filled communal kitchen at its heart. Various nooks provide randomly placed spaces for rest and reflection, so window seats are crammed into stair landings, and tight corners offer places for informal chats.

The centre is temporary, grouping seven existing structures within an envelope of fiberglass. Photo: Carmody Groarke
The centre is temporary, grouping seven existing structures within an envelope of fiberglass. Photo: Carmody Groarke

It became a powerful template for the other centres that followed: from Page/Park Architects' restored gatehouse in Glasgow (2002) and Frank Gehry's wavy silver-roofed cottage in Dundee (2003) to Zaha Hadid's angular black box in Fife (2006) -- her first permanent structure to be built in the UK -- and Richard Rogers' bright orange building in west London that went on to win him the Stirling Prize in 2009. This year, Carmody Groarke, Reiach and Hall and Wilkinson Eyre complete the line-up, while Steven Holl's controversial Maggie's at Bart's Hospital in London has planning permission, but is facing a legal challenge.

The opening of Gehry’s centre caused a media storm. Photo: 10 Charles Jencks
The opening of Gehry's centre caused a media storm. Photo: 10 Charles Jencks

The centres are a world away from the clinical surroundings Maggie herself encountered in Edinburgh. Patients are encouraged, but not forced to enter a programme of psychological and emotional support, including relaxation, support groups, one-to-one counselling, lectures and workshops. Yet Maggie's Centres don't give off a New Age vibe or make reference to Freud's consulting couch; they are informal, like a home away from home. Jencks coined the term 'kitchenism' to describe the communal ambience of the centres, which allows patients and carers to come and go when they wish and simply gather around the kitchen table for a cup of tea in a proper mug, not a hospital-issued plastic cup. Jencks says: 'We have a brief and that is really important. Of course each architect produces a different centre, one brief can produce 18 different solutions.

Maggie Keswick Jencks in her garden in Portrack, Scotland. Photo: courtesy of Maggie’s centre
Maggie Keswick Jencks in her garden in Portrack, Scotland. Photo: Courtesy of Maggie's centre

In that sense we're not a franchise. We have often said that we are a hybrid: a friendly building that is welcoming, down-to-earth, vernacular background, solid, comforting, because when you have cancer you don't want a big architectural statement. On the other hand, it has to be an institution, which is not institutional; it has the arts in it, so it's kind of an art gallery but not an art gallery; it's got a spiritual role so it's a non-denominational church.'

Reiach and Hall Architects’ centre in Lanarkshire (2014) is conceived as a walled garden. Photo: David Grandorge
Reiach and Hall Architects' centre in Lanarkshire (2014) is conceived as a walled garden. Photo: David Grandorge

Laura Lee, at one time Maggie's oncologist nurse in Edinburgh, and now the CEO of Maggie's agrees: 'People are coming in from what can be a very clinical, austere hospital world into an environment that communicates that "you're going to be cared for and that you matter". The environment has a remarkable capacity in all of our buildings, because of what the architects have done, to communicate that it is a safe place to talk about one's innermost fears and worries. I think the centres have brought a focus to how environments can influence how professionals behave and how people can best communicate.' For Lee, having a different building in each location has the added benefit of giving the community and each of the staff teams a sense of ownership -- it makes them feel like they have something no one else has.

While the reasons for the progress of Maggie's from a humble vision -- 'a wee Scottish institution', as Jencks describes it -- to the ambitious charity of today are myriad, one answer lies in the long list of architect names that reads somewhat like a who's-who in the architecture world. It may sound surprising but it wasn't always the charity's intention. Maggie's is completely reliant on fundraising and donations; it costs £590,000 a year to keep a Maggie's Centre open and £4-6m to create a new one. So the charity quickly became aware that money was considerably easier to raise if it involved top architects.

'It wasn't premeditated, it isn't as if we have a head-hunting policy,' says Jencks. 'It may look that way but we only became aware after Frank's [Gehry] building. Our chairman came up to me and said, "Look, we've got to make architecture a big thing," and I said, "Of course, I always believed that." In 1999 we showed designs in the Sir John Soane's Museum and Frank produced an absolutely mad scheme, but because Bilbao [Guggenheim] was the number one building in the world we had more column inches than you've ever seen. I had no idea that it was going to be an incredible media event. Frank got Bob Geldof to open it and we were on the 10 O'Clock News. How many buildings are on the 10 O'Clock News?'

Gehry's building, looking over the River Tay in Dundee, has a crinkly, silver roof and dumpy, white tower that makes it stand out against the mountainous landscape. It became the subject of a first-class postage stamp for Architecture Week 2006 and helped the charity transform Maggie's blueprint into the mini-icons of cancer care it is today.

Now Maggie's has architects queuing up to design a centre. Some are friends of Jencks and others approach the Maggie's charity themselves, while many design the centres pro bono. Richard Rogers, for example, gave the team a place in his office for five years, 'Zaha did the whole thing for nothing', and Ted Cullinan 'pushed' him 'against a wall' for Maggie's Newcastle (2013, see Blueprint 329). Norman Foster, meanwhile, was approached for the centre at The Christie, Manchester, due to complete in 2016. 'That was a very touching commission for me,' muses Jencks. 'I've known Norman for longer than 40 years, if not more, and he is a friend. He wanted to do one, his first wife Wendy died of cancer and he had cancer. We could have commissioned him before but I knew Manchester might come up, and it's ideal; he's the great hero of Manchester in a way.'

Architects are a competitive bunch and each centre has set the bar a little higher. ('Someone said it was like winning an Oscar,' concedes Jencks.) Perhaps it's because of the slew of publicity that now comes with a Maggie's Centre -- much like the annual Serpentine Pavilion -- or perhaps it's because the architects feel like they're giving something back. Jencks cites what Rem Koolhaas calls 'the age of shopping' as an answer. At a time when architects are designing generic shopping centres and glass towers, a cancer-care centre offers a deeply challenging commission that deals with the fundamental questions of life and death. 'It's a funny commission, because all these architects really love doing it; we haven't pulled out a bad one,' he says. 'We are a client with a need for a building type that architects respond to and I think architects really rise to the occasion and now, of course, they rise to each other.'

Jencks is still very much involved in the development of each Maggie’s Centre. Photo: Ivan Jones
Jencks is still very much involved in the development of each Maggie's Centre. Photo: Ivan Jones

Another factor for Maggie's success, Jencks believes, is the impact the centres have on the patients themselves -- both their personalised programme of events and their architecture, which Jencks is keen to differentiate between. When Maggie was diagnosed with cancer, they were initially inspired by Dr David Spiegel in California, who offered his breast-cancer patients sessions of informal group therapy on top of their normal treatment. He found that those who participated in the sessions reported reduced pain and improved psychological symptoms and, perhaps more surprisingly, ended up living 18 months longer than the average breast-cancer patient. 'I think that we do make a difference,' says Jencks. 'One of the things we give is information, and information is power. We don't try to force it on them, we don't put any psychological pressure on any patient. Everything is voluntary, but I'm sure that if they did all the things that Maggie did herself -- the exercise, the diet, incredible amounts of alternative, complementary and some crazy therapy -- you'd find a measurable difference.'

The arts -- interior design, landscape and art -- are also crucial in raising a patient's spirits, says Jencks: 'I was always aware, and Maggie was too, that health and the arts are interlinked and that's an extremely important part of my ideology or belief system.' The idea of a hybrid building -- of health, gardens, art and culture -- goes back to the sixth century BC, argues Jencks, when the small city of Epidaurus in Ancient Greece was the most celebrated healing centre in the classical world. There was a large sleeping hall, 160 guest rooms for the sick, a sanctuary, and mineral springs and fountains. 'We went to Epidaurus and it was apparent that great architecture and painting, sculpture, landscape, interiors are all wrapped up in health. We now have a Maggie's art group and we're raising our game with landscaping, but money is always a problem -- you can raise money for a building, but if you try to raise money for art or for landscape, you just can't do it,' continues Jencks.

Rewind to the Sixties, and many postmodern writers, including Jencks, criticised the fundamental role of modern architecture to change society for the better. Maggie even criticised 'the vacuum-cleaning period of architecture', when modernists fell in love with the white cube, during her time at the Architectural Association, when she met Jencks. A turnaround came when Charles Jencks took part in a BBC debate on health and architecture several years after Maggie died. Jencks argued that one should support good architecture for itself, not because it would change patient care or determine behaviour. To Jencks' surprise a doctor completely disagreed: 'He was saying there was absenteeism in the NHS caused by the architecture and he knew it because he wasn't showing up himself! It really turned me around, I have to say. As a postmodernist I fought the modernists who said architecture can lift society up.' Jencks is now inclined to agree with the doctor, and concedes that the effect of architecture on people could be measured. 'My view is that the higher the culture, the less architecture really deterministically matters, so if you're a prisoner it really matters, if you're deprived it really matters, if you're in hospital it matters... so the lower down the scale of how you feel, then the more the architecture matters. That's part of an answer, but it's complicated,' he reflects.

Maggie's original vision has now been realised over and over, and on a much larger scale that she had ever imagined. And ambitions still remain high: in the UK there are 58 NHS cancer centres and Maggie's has sites on 18 of those -- a further goal is to be at all of them. It is currently working on five more centres, in London, Falkirk, Manchester, Cardiff and Leeds, as well as ideas for some further afield in Oslo, Melbourne and Qatar. And while there is an inconclusive connection between architecture and wellbeing, there is an irrefutable relationship between body and mind. Cancer is a physical problem and a psychological one, too. Maggie's Centres have added to that ever-growing 'pile of hope' Jencks started. And, if Jencks has his way, it will just get bigger and bigger...

Maggie's Oxford by Wilkinson Eyre Architects
Opened this October, the 18th Maggie's centre in 18 years comes in the form of Wilkinson Eyre Architects' tree house at Churchill Hospital, Oxford. Raised on piloti, the skewed, wooden building floats amid a small copse on the edge of a protected Area of Natural Beauty. 'We wouldn't have normally been allowed to build here,' concedes founding director Chris Wilkinson, 'but because it was so much part of the design, they accepted that we were building in among the trees. There's a special relationship between Maggie's and the natural space.'

As visitors drive around the corner from the main road into the hospital grounds and its car park, the new building reveals itself, like a large three-pronged boomerang that has just landed in the overgrowth. Tightly slotted into a ditch, it is raised up 4m to connect to the adjacent hospital buildings. Terraces thrust right into the trees, and the hope is that the space below the building, its 'fifth elevation' as Wilkinson describes it, will be used by visitors for personal contemplation.

Light floods into the wooden-clad interior. Photo: wilkinson eyre architects
Light floods into the wooden-clad interior. Photo: Wilkinson Eyre Architects

The building itself is made entirely of timber from Finland, even down to the structural frame. To minimise damage to the site, prefabricated cross-ply, laminated, timber panels were erected on informal clusters of slender, tilted columns, fixed to concealed screw piles below ground. 'We almost didn't want to touch the site at all,' says Wilkinson. While the building's exterior is angular and slightly awkward-looking, inside the interior envelops you in a warm, softly scented cocoon of birch plywood. The tripartite plan, designed to fit the building in around the trees, stems from the central, homely kitchen (a prerequisite of every Maggie's brief). Says Wilkinson: 'People who come here are in quite a fragile, emotional state and the idea Maggie had was that architecture could help people feel better. I do totally agree that architecture has the ability to be uplifting and raise the spirit. You don't want it to look like you're walking into someone's living room; we wanted to find a special quality which you can only really describe as Maggie's.'

The building has a tripartite plan to fit around the existing copse of trees. Photo: Wilkinson Eyre Architects
The building has a tripartite plan to fit around the existing copse of trees. Photo: Wilkinson Eyre Architects

Three wings, housing separate but flexible areas for information, group consultations and relaxation, are connected by plywood partition walls and clerestory glazing. There's no reception area or lobby, making for a welcoming, democratic building. In the middle is a triangular table designed by Wilkinson Eyre for the space, which sits 12 people, but also provides intimate corners for two to three people. Openings in the roof allow in sunlight, while glazed floor lights provide glimpses down to the landscape below. 'You're in among the trees wherever you are, the windows have been lined up to give the best views,' says Wilkinson.

For the moment the timber trellising that zigzags around the building looks somewhat crude, but over time the building will gently fade to silver to match the natural surroundings. No doubt the strong connection between the inside and outside will provide a sense of calm to patients, an elaboration on Maggie's initial concept of one room looking out on to the landscape. After all, tree houses have always been a way to true escapism.

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