June 1, 2020
Pandemics aren’t new, but they’re rare, and rarely have we had such insight into the workings of the NHS as we deal with the current coronavirus crisis. As a nation, we’ve watched medical staff at work in hospitals while responsive environments are rapidly built in challenging circumstances.
In local communities, we’ve witnessed the ‘social care challenge’ of managing frail elderly people in residential care, or those with learning difficulties requiring specialist support.
There have been many notable challenges, according to ADP’s health sector director Chris Thornton.
“Hospital trusts reacted to the pandemic in several ways,” he explains. “Many were able to refocus teams on strategic projects, ensuring long- term plans weren’t derailed, while areas flagged for refurbishment were released to create space for COVID-19 patients.
“Hospitals that had previously cut space standards found it harder to adjust. There simply wasn’t the room to add in critical dividers to minimise cross-contamination.
Meanwhile, those hospital trusts that had taken a more flexible approach to space found it easier to adapt, turning multi-bed wards into single-bed areas. Health Building Notes came into their own and it was an interesting realisation for teams planning on the ground.”
So, while construction stuttered in almost every other sector during lockdown, in healthcare it remained ‘healthy’.
For the ADP team, work on key projects for Guy’s and St Thomas’ NHS Foundation Trust in London has continued at pace. A contractor has now been appointed to deliver the first stages of a hybrid facility, co-locating departments from the Evelina London Children’s Hospital on the St Thomas’ Hospital campus (or site) and research teams from King’s College London in the heart of a health campus, enhancing services and facilitating larger, strategic projects.
The team was also involved in another specialist COVID-19 scheme, exploring the design of temporary step-down facilities for patients discharged from hospital and not yet ready to return home.
Chris explains: “As our understanding of the virus is evolving, demand for this new type of facility is emerging. “COVID-19 patients have uniquely challenging, complex issues, and a recovery period unlike any virus we’ve experienced before. Complete recovery is a long process, potentially six to 12 months for some patients, and requires specialist continuing care.”
Unlike the Nightingale Hospitals, such as those established in Sunderland and at the ExCeL in London, these patients are ambulatory and so the spaces need to allow for safe, independent movement and rehabilitation.
Other considerations include:
• The need for higher staff/patient ratios, and facilities such as bathrooms and showers, which are not needed in intensive care Nightingale units.
• Integrating continuing care services for planned onward recovery at home or in care.
• Complexities of patients with ongoing conditions and treatments such as renal, oncology and mental health issues.
Beyond the immediate crisis, what does this mean for our health sector? More funding, adjusted priorities and perhaps a change of thinking about what makes a good healthcare environment?
Looking through the lens of an architect, the ADP team has several recommendations.
Focus on flexibility: Hospitals with the ability to flex bed spaces – male-to-female or speciality-to- speciality – are inherently fitter for purpose when priorities change. Considering this within the whole- life value/cost of a project could lead to greater efficiency in the longer term.
Re-evaluate the scale and purpose of emergency departments: The recent drop in attendance raises concerns about patients ‘staying away’ when early diagnosis and treatment could save lives. Reduced participation in high-risk activities undoubtedly had an impact, but in the longer term, the pandemic could accelerate a rethink of emergency care design, and be supported by a reallocation of funding to provide focused, specialist and integrated community health solutions.
Integrate health and social care facilities within town-centre regeneration: Much of the groundwork here is already done – the gap in services was evident, but funding was challenging without a meeting of civic, NHS, community, and commercial minds.
For example, ADP is currently on site at Gloucester Quays, a local authority-funded mixed-use community health development. The three-storey building relocates two health centres that combines GP surgeries with a pharmacy, office space and ground-floor parking. The project is one of several regeneration schemes helping to transform Gloucester, and will support 18,000 patients in the city with a growing range of healthcare needs.
Bringing health to the high street through the delivery of linked services, such as orthodontics and health education, widens access to health services in local communities – particularly for patients below the poverty line.
Further opportunities include the integration of health and wellbeing facilities such as leisure and community centres, to enrich and complement the healthcare environment.
Amrit Naru, studio director at ADP Newcastle, reflects: “Over the last 20 years, the North East has seen the development of some of the best healthcare buildings in the country. Providing satellite facilities and services – physically and virtually – in the heart of our communities ensures every patient has access to the foremost healthcare and technologies.”
Raise the bar for elderly care: Care homes should be centres of excellence, and not just meet minimum standards. Repurposing buildings with strong links to the community and surrounding landscape can significantly improve resident wellbeing.
In Dundee, ADP is working with private developer Consensus Capital, converting a former hospital into a 70-bed residential facility catering for elderly, elderly care and specialist dementia patients. Particular care has been paid to the layout, providing protective spaces both internally and externally within a beautiful, mature setting.
Chris concludes: “ADP’s approach to healthcare has always been patient-focused with a holistic approach to wellbeing. In the rapid timeline of COVID-19, the need for capacity has trumped thoughts around patient and staff environments. With long-term recovery periods, the need for agility and flexibility in delivering diverse, complex clinical services comes to the fore. We must focus on building users now, more so than ever.”
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