Maggie’s Centres: wellness through building design and the environment

In March 2017, the 20th Maggie’s Centre was opened in the grounds of Forth Valley Royal Hospital in Falkirk. Designed by architects Garbers & James, it is expected to receive 3000 visits in the first year.

Maggies Centre Forth Valley, Garbers and James

Maggie’s provides free practical, emotional and social support to people with cancer and their family and friends, following the ideas about cancer care originally laid out by Maggie Keswick Jencks and co-founded by her husband Charles, who is a landscape architect. Among Maggie’s beliefs about cancer treatment was the importance of environment to a person dealing with cancer.

She talked about the need for “thoughtful lighting, a view out to trees, birds and sky,” and the opportunity “to relax and talk away from home cares”. She talked about the need for a welcoming, reassuring space, as well as a place for privacy, where someone can take in information at their own pace. This is what Maggie’s centres today aspire to.

A number of high profile architects have designed Maggie’s Centres across the UK – from the late Zaha Hadid to Frank Gehry, Richard Rogers and Rem Koolhaas.

The Maggie’s Centre in Kirkcaldy, Zaha Hadid Architects

Promoting wellbeing through the natural environment and effective design

Drawing on research which considers the significant impact that environment can have on wellbeing, Maggie’s Centres are designed to be warm and communal, while at the same time being stimulating and inspiring. The interiors are comfortable and home-like. Landscape designers and architects are encouraged to work closely together from the beginning of a project as the interplay between outside and inside space, the built and the “natural” environment, is seen as an important one.

A building, while not wholly capable of curing illness, can act as “a secondary therapy”, encouraging wellness, rehabilitation and inspiring strength from those who move around it.”

Each of the centres incorporates an open kitchenette where patients can gather for a cup of tea, airy sitting rooms with access to gardens and other landscape features, and bountiful views. There are also private rooms for one-on-one consultations; here Maggie’s staff can advise patients on a range of issues relating to their condition, whether that is dietary planning, discussing treatment options (in a non-clinical setting) or delivering classes such as yoga.

Spaces to promote mental wellbeing as well as physical healing

Maggie’s Centres are also about offering spaces to people to help improve their mental wellbeing. As well as quiet tranquil spaces for reflection and meditation, there are also central areas, focused on encouraging the creation of a community between the people who use the centre. Wide-open spaces, high ceilings and large windows, with lots of opportunities to view the outside landscaping and allow natural light to enter are a key feature of many of the Maggie’s Centres.

The locations also try as far as possible to provide a space free from noise and air pollution, while remaining close enough to oncology treatment centres to provide a localised base for the entire treatment plan of patients.

Fresh air, low levels of noise and exposure to sunlight and the natural environment, as well as designs that provide spaces that promote communal interaction to reduce feelings of isolation and loneliness, have all been shown to improve mental as well as physical wellbeing. In this way, the physical attributes and design of the Maggie’s buildings are helping to promote mental as well as physical wellbeing of patients and supplement the care being given by the cancer treatment centres located nearby.

Interior of the Maggie’s Centre in Manchester, Foster and Partners

Award-winning architecture and design

In 2017 Maggie’s Manchester was shortlisted for the Architects’ Journal Building of the Year award. And many of the individual centres have won regional design awards for their innovative use of space and incorporation of the natural environment into their designs.

A Maggie’s garden was also featured at the 2017 Chelsea Flower show, highlighting the importance of environment, and the role of the natural environment in rehabilitation and promoting wellness among those who are ill.

Final thoughts

How design and landscape can aid and empower patients is central to Maggie’s Centres. They are a prime example of how people can be encouraged to live and feel well through the design of buildings and the integration of the surrounding natural environment. These environments are the result of a complex set of natural and manmade factors, which interact with one another to promote a sense of wellness, strength and rehabilitation.

They demonstrate how the built environment can contribute to a holistic package of care – care for the whole person, not just their medical condition. Other health and social care providers can learn from them in terms of supporting the wellbeing of patients, carers and their families.


You can find out more about Maggie’s Centres though their website.

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The Dickensian disease: TB in 21st century England

England has the second highest tuberculosis (TB) rate in Western Europe, and a rate that is more than four times as high as in the US. Why is this seemingly Dickensian disease making a comeback in England today? And what is being done to tackle it?

The TB capital of Western Europe

Figures show that TB cases are centred on large urban centres; Manchester, Birmingham and Coventry to name just three. However London accounts for almost 50% of all cases of TB reported in England. A third of London boroughs are classed as ‘high incidence’ by the World Health Organisation (WHO), placing them in the same band as countries like Iraq and Rwanda, with more than 40 confirmed cases per 100,000 people per day.

In 2013 there were 3,500 new cases of TB diagnosed in the capital. Healthcare professionals stress the importance of early diagnosis and treatment as being a key strategy to eradicating the disease.

Stigmatisation is a real issue

TB is strongly associated with poverty and research has suggested that many people do not seek treatment for the disease because they are embarrassed about the potential repercussions of having to tell family members, support workers or employers. This not only poses a risk to the infected person, but significantly increases the chances of passing the infection on to others.

Similarly, statistics show that cases of TB are particularly prevalent among homeless populations and other vulnerable minority groups. Delays in seeking treatment, already-reduced immunity, pre-existing strains of the disease which can reoccur, and overcrowded shelters can all contribute to spreading the disease, which is caught through prolonged contact with an infected person (the bacteria is spread through airborne droplets).

Another barrier to effective treatment is misdiagnosis by general practitioners.  As a result there has been a conscious effort in London in particular to educate general practitioners and other primary healthcare workers on possible symptoms in the hope that it will help increase rates of diagnosis and treatment, and reduce the number of new cases.

A public health emergency?

However, the rise of antibiotic and drug resistant strains of the disease is making treatment of TB even more difficult. A full course of treatment of non-drug resistant TB bacteria can take up to two years in some cases. If the strain is drug resistant, patients can be taking as many as 9 different drugs a day, many of which have severe side effects and can be life-limiting in themselves.

Doctors have suggested that the rise of these drug resistant strains is not being taken seriously by Public Health England, or other associated bodies and that drug resistant TB should be considered as a public health emergency. In 2014 the LGA produced guidance on the public health role which should be taken on by local authorities to tackle TB locally within communities.

Updated guidance and treatment programmes

In early 2016, the National Institute for Health and Care Excellence (NICE) published updated guidance on TB, with a particularly strong focus on: early treatment; targeting vulnerable groups; and improving education and awareness of the disease for patients and GPs on how to spot symptoms.

Prior to this, in 2015, Public Health England produced a collaborative strategy, in partnership with NHS England, to tackle TB in England. The strategy looks at how health boards, local authorities and national bodies can cooperate to achieve national outcomes on TB diagnosis, treatment and eventual eradication. The report considers the creation of nine regional TB control boards, who would work alongside national bodies to achieve these national objectives. London-specific objectives and strategies were published in October 2015.

Practical support for sufferers in communities

Find & Treat  provides screening, advice and practical assistance to TB services and allied health and social care services in London. In partnership with Groundswell (a charity supporting homeless people), the team behind Find & Treat also recruit, train and support former TB patients who have experienced homelessness to work as peer advocates in their TB awareness team.

The Mobile X-ray Unit (MXU) now screens almost 10,000 socially vulnerable people at high risk of TB annually. The screening service operates in every London borough, and is regularly called to support the control of TB outbreaks nationally. University College London Hospitals (UCLH) host the service on behalf of NHS London, and are close to rolling out the Find & Treat initiative nationally (as recommended by NICE). Additionally in London there are two designated ‘hub’ hospitals, in the north and the south of the city with designated teams of TB specialists.

To further increase the profile of TB, prevention and treatment, actress Emma Thompson has been appointed as the Mayor of London’s TB Ambassador. This follows her son’s diagnosis with TB in 2011. Since her appointment she has been a very public face of TB awareness, regularly attending clinics and health drives to encourage people to get tested for the disease.

As the statistics have shown, TB rates are frighteningly high in some areas of the UK, and particularly in London. It is hoped that increased guidance and public awareness will help stop the increase of cases and avoid the potential public health epidemic which could arise in London as the population grows and pressure on NHS services intensifies. There is added incentive to curb this spread as the rise of antibiotic resistant strains becomes more prevalent.

Vaccination programmes, effective treatment centres and early intervention community initiatives, as well as investment in research and development for new drugs to treat the disease effectively, will be key to ensuring positive outcomes for all those affected by, or at risk of, TB in the UK.


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Three options DWP should explore in supporting those with poor mental health into work


Traffic cone with the text "works in progress".

By Steven McGinty

Last week, the UK government announced a new pilot scheme to support those with mental illness back into work. While similar to other government initiatives, this scheme has the unique selling point of offering treatment at an earlier stage, alongside employment support.

Like many of the government’s return to work policies, this might prove to be controversial. Many have expressed concerns over a comment from the Department for Work and Pensions (DWP) that suggests that counselling could become mandatory for those claiming benefits.  One of the most notable individuals to question this policy is Tom Pollard, Campaign and Policy Manager at Mind. He suggests that,

“If people are not getting access to the support they need, the government should address levels of funding for mental health services rather than putting even more pressure on those supported by benefits and not currently well enough to work.”

Although this pilot scheme has caused some heated debate, this is just one of the many ideas available to the government. Others include:

Aim High Routeback (Easington Pilot), County Durham

This pilot scheme was launched in 2005, as part of the Northern Way pilots, and was said to take a ‘health-first’ approach. The scheme was based in an NHS Primary Care Trust building, with participants focusing on the practical management of their health conditions, and employment only being discussed once individuals had started to make progress with their health. The project reported an above average return to work rate, in comparison with the other pilots. Interestingly, one of the key findings of the study was that participants were more likely to return to work if they felt like their health was ‘good or improving’.

JOBS II Model

This model was developed in the US and involves the use of peer led groups. The idea is that these groups can be used to support those with mental health problems back into employment, as well as prevent the negative health impacts which can arise from unemployment. The programme works on improving the jobseekers’ ability to search for work, as well as to cope with the setbacks of finding employment. The model has been found to be successful and has recently been recommended by the Department for Work and Pensions.

Mini-ICF-APP

This is a measure for assessing patients that was piloted by a community mental health team in Oxfordshire. The pilot involved asking new patients to fill in a 10 minute survey. This survey allowed medical staff to better assess the support needs of patients, as well as to identify their strengths and weaknesses. The staff were then able to offer more targeted referrals and interventions. For example, the use of cognitive behavioural therapy (CBT) or the tailoring of a patient’s medication. The pilot reported that this approach led to an improvement in outcomes for patients.

This is just a small sample of the research on improving the employment prospects of those with mental illness.

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Further reading (you may need to be a member to view some of these articles):