Past, present and future


Simon Baynham, property director of The Howard de Walden Estate, explains the unique challenges involved in deploying modern medicine in a heritage environment

The film The King’s Speech shone a spotlight on speech therapist Lionel Logue, who, at his Harley Street consulting rooms, helped George VI overcome his stammer. Dr Logue was also responsible for installing the first artificial voice box in the UK. His patient was John Baynham—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.

Today, some 5,000 medical professionals operate in the Harley Street Medical Area, covering just about every specialism. The area’s rich history is reflected in its buildings. Marylebone is a conservation area, home to 360 listed buildings. It is a place of curious opposites—modern medicine and centuries’ old architecture—and marrying the two remains a real challenge. As we’ve consistently proven, however, it is a challenge that can be readily met.

Let’s start by looking at one of our newest clinics: the RB&HH Specialist Care outpatients and diagnostics facility on Wimpole Street. As the private arm of the Royal Brompton and Harefield NHS Foundation Trust, known globally for its excellence in cardiovascular and respiratory care, the facility is home to some extremely specialist equipment. For example, it is one of only two centres in the UK that offers rubidium cardiac imaging, which dramatically reduces imaging time and patients’ exposure to radiation while increasing diagnostic accuracy. It’s an impressive bit of kit, but installing this machine and other vital equipment into a historic townhouse 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. The 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 is crucial that nothing disturbs or distorts that field, so all kinds of factors had to be taken into consideration, from underground lines to lifts in surrounding buildings, and even the passing traffic outside.

RB&HH Specialist Care in the Harley Street Medical Area

RB&HH Specialist Care

RB&HH Specialist Care in the Harley Street Medical Area

Noisy systems
Scanners also require substantial (and notoriously noisy) cooling systems, but these exceeded sound levels for roof installation, so were put in the basement instead. In fact, the basements in Harley Street and its surrounding areas are often a significant boon for medical practices. At The London Clinic, a 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 installed, another challenge became apparent: powering it. Harley Street’s grid network is, like much of London, working at full capacity, and the amount of 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 were built in a time before electricity was the norm, but we are able to power the cutting edge technology that now resides within them.

There are other logistical challenges, too. 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. 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. That is whywe focus on creating pleasant, welcoming atmospheres. Fortius, for example, converted 12,500 sq ft of space on 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—far removed from the traditional medical facility blueprint. 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 facade.

  • Fortius Clinic

Design innovation
There’s plenty of room for design innovation, too. Isokinetic opened its first clinic outside Italy here in September 2014 and has taken a particularly clever approach to its internal set-up. The clinic, which serves some 1,500 patients a year—many of them Olympic champions, prima ballerinas, and Premier League 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 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. 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. 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.

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 would rather a property remain vacant for an extended period than be taken by just any clinic—the Harley Street Medical Area is more than the sum of its parts, after all.

In 2017, we were given planning permission to begin work on a new hospital across two of the most historic buildings in the area: 73 and 75 Harley Street. This facility, run by HCA, will provide care and support to children and their families affected by cancer. There are concerns among some that the building work required 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 to the area.

Revolutionary cancer treatment
We’re also delighted that Advanced Oncotherapy and Circle Health’s proton beam therapy clinic is due to open its doors in 2019. This 12,000 sq ft laboratory, which is set to revolutionise UK cancer treatment, will be housed in a Grade II listed building. It 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. Piling and excavation of the basement where the proton accelerator will be installed is well underway.

When I first began working with The Howard de Walden Estate, some people expressed the view that Harley Street’s medical component would soon disappear, leaving behind only offices and residential premises. More than 22 years later, it is still here, and is thriving. 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 its already tremendous offering. With our cutting edge medical care and beautiful urban setting, there really is nowhere else like it in the world.