The Health Dilemma: achieving quality, scale and efficiency

Venue:, 2 Hans Street, London SW1X 0NJ
Date and Time:  Wednesday 24 April 17:00-20:00 (arrival 16:45)

Background:
There have been new and radical recent policy decisions in UK and Danish healthcare as different approaches to the common challenges both health systems face – how to square the circle of rising demand, rising cost and diminishing funding.

In Denmark hard won productivity gains have been achieved and it is now hoped that it will be possible to scale this up in a substantial hospital building programme — the largest construction project since church construction in the Middle Ages. http://www.danishhospitalconstruction.com/

In the UK, the hospitals have been built and it is now suggested this will be scaled back as a consequence of giving financial control to the newly formed clinical commissioning groups in the hope that more ‘hospital’ services can be provided at a local (cheaper) level and further efficiencies can be achieved from being able to source from private and well as public providers.

Given that both countries have common challenges but taken different approaches what can we learn from each other and how can this knowledge be translated into opportunities globally?

Chair:    Sunand Prasad, Past President of Royal Institute of British Architects

Programme:

16:45     Arrival

17.00     Welcome by Ambassador Anne Hedensted Steffensen

17.05     Minister for Trade and Investment, Pia Olsen-Dyhr
Based on the Danish healthcare model, how can significant spending on public sector healthcare translate into global opportunities?

17.15   Point of view from panellist:

• Sir Muir Gray, Chief Knowledge Officer, NHS

The New Paradigm: Population health care

• Marlene Willemann Würgler, Senior adviser, Centre for Health Technology, Business and Regional Development, Danish Regions
  Achieving efficiency through hospital building programme and working with industry

Paul Westbury, CBE, Chief Executive Officer, Buro Happold

Do we want good health or free health?

Teva Hesse, Head of London Office, CF Møller Architects

Design by Evidence – Case: Treating Mental Illness in Therapeutic Environments

17.45     Q & A/chaired discussion between panellists, open for participation of other attendees

19.00     Networking and Reception

20.00     End of event

Following the Ambassador’s welcome address -making reference to Denmark’s long history of and commitment to healthcare and caring environments- John Cooper, AfH chair, cited the Paralympics as the catalyst for this year’s AfH focus on “designing for impairment”.

The evenings’ presentations were initiated by the first of our five speakers, Dr Jan Gawronski, clinical lead for the London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital. Jan shared his clinical view on the pace of progress for spinal cord injury patients with the culture of rehabilitation being about far more than survival and existence.  These were Inspirational stories of patients with catastrophic spinal injuries becoming medal winning Paralympian’s, within the space of a few short years. Jan promoted a change in mindset, from thinking of “disability” as what can’t be done, to a universal experience approach of “there should be no category of things people can’t do.”

Stephanie Williamson, Deputy Project Director at the Royal National Orthopaedic Hospital, provided an invaluable insight into the RNOH journey and change of focus from pure surgery to promoting holistic independence. This is being achieved through the PFI process of translating their patient needs into a design brief and the 3 R’s; Restoration (surgery), Rehabilitation and Re-integration. Their ‘psycho-social cradle of care’ requires a dynamic environment and a ‘wheel-based’ approach to movement.

Tom Hagedorn Danielsen, architect and senior partner at C F Moller, treated us to a visual feast from their portfolio of schemes. Taking us from Vetruvian man, evidence-based design and knowledge based design through some inspirational schemes applying their ‘off-stage’ – ‘on-stage’ approach to healthcare projects including the Acute Infection Hospital at Malmo with it’s circular wards and open air circulation. His presentation concluded with a touching presentation on their Hospice success stories, which are actively prolonging life.

With all the presentations we were reminded that, although we are dealing with life-changing serious events, a common theme of care, humanity and humour prevail. Tom’s cartoon of a poorly patient in a Hospital bed, with a perplexed doctor at their side saying “you’re looking really bad, better call for an architect!”, had us laughing and questioning what we do at the same time.

Dr Sue Hignett, Reader in Healthcare Ergonomics and Patient Safety at Loughborough University, presented research on ‘ergonomics versus the human factor’. She championed ‘universal design’ whilst discouraging un-conscious actions for tasks that require vigilance: a real challenge in the face of conflicting evidence, for us all to respond to. With reference to her ‘Dial F’ model, where the building is identified as the one stable element within healthcare, Sue challenged the audience to ‘embrace inclusive design, promoting it, not as the gold standard, but as the minimum standard’.

Allan Vinther from Guldmann Technical, enlightened the audience on how interesting ceiling mounted hoists could be, as equipment to enable and promote rehabilitation within a safe, and literally supportive, environment. Allan highlighted areas where hoists could be used to “release time to care”, whilst explaining the science behind not only manual handling and lifting, but also the shear forces which cause bed sores.

A lively discussion followed covering a broad range of topics, from the exceptions to 100% single rooms being best, to the cost effectiveness of ceiling hoists. The discussion culminated in two fantastic comments in relation to designing for impairment: Firstly, from Stephanie Williamson, “within our village square, we are trying to promote the sense that the Paralympics happens every day at RNOH.”;  and finally an observation that in designing for impairment, “we should concentrate on maximising the gain rather than mitigating the loss”.

Our thanks go to the Danish Embassy, the Danish Ambassador, the speakers and Guldmann, for making the evening a resounding success.

CONSULTATION – OUT NOW – CLOSES 31 MAY 2013

The consultation on the Sustainable Development Strategy for the Health, Public Health and Social Care System 2014 – 2020 is now open and throughout February we have been raising awareness across the system – so apologies if you have already received information similar to this.

We are seeking input from across the whole healthcare system including NHS, Public Health, Social Care, CCG’s, Health and Wellbeing Boards, membership organisations and Local Authorities.
This is your opportunity to help shape the future of a truly sustainable health and care system we can all be proud of.
How to respond to the consultation
The consultation document, survey response form and background information can be found at www.sdu.nhs.uk/sds <http://www.sdu.nhs.uk/sds>
Alternatively you can

• Submit your comments by e-mail to info@sdu.nhs.uk <mailto:info@sdu.nhs.uk>
• Write to us at Sustainable Development Unit, Victoria House,      Capital Park, Fulbourn, Cambridge, CB21 5XB
• Send us examples of best practice / case studies you feel should be      included in future thinking

Engaging your teams
We would like to encourage you to use this consultation as an opportunity to engage with your teams and networks.  We have developed some materials <http://www.sdu.nhs.uk/sustainable-health/engagement-resources/engagement-resources.aspx>  for you to use including:

• A introduction to the consultation video by       Sonia Roschnik
• A PowerPoint slide set
• A number of workshop exercises

If you require any additional support please do let us know.
Spread the word
We would appreciate any help you can provide in cascading this information throughout your organisation and networks.  Actions such as:

• Passing this e-mail to you communications teams       for inclusion in newsletters,       e-bulletins, websites etc
• Ensuring your sustainability champion is aware
• Forwarding this e-mail to your contacts

Thank you for your help.  Some background information is included below should you need it.
Regards
Charles Kitchin
On behalf of the Sustainable Development Unit

Background information

The sustainable development strategy will be the sustainable development plan for the health, public health and social care sector from 2014 – 2020. It will build on the NHS Carbon Reduction Strategy (2009), outlining practical steps that need to be taken to move the health system further on the journey towards sustainable healthcare delivery.

The purpose of this consultation and engagement process is to seek the views of the entire health and care system to help determine the future scope and approach of a sustainable development strategy that allows us to understand how and where to focus health and care sector efforts to deliver more financially, socially and environmentally sustainable care.

We refer to the whole system as  ‘health and care system’ which  includes all NHS services, services delivered on behalf of the NHS, social care, public health and health protection services,  and the interests covered by Health and Wellbeing Boards and their interface with the health and social care sector.

Key questions
The NHS Carbon Reduction Strategy (2009) focussed, as the title suggests, on the NHS and on carbon reduction.  Key questions for the new strategy are:
·         Should we widen the scope beyond the NHS to the wider social care and public health system
·         Should we widen the approach beyond carbon reduction to include other areas of sustainable development?
·         How ambitious should the strategy be?
In addition to these fundamental principles the consultation asks for views on:
·         What are the main priorities?
·         How should we measure progress?
·         What further areas of research are needed?

They’ve held two Design Forums on the subject, bringing together some of the leading experts in the field to discuss the latest thinking on the built environment and products and services.

The audio recordings of the talks are on their website :

The Built Environment

Hear how our homes and public spaces can be improved.

http://www.designcouncil.org.uk/our-work/Insight/ageing-better-by-design/

Products & Services

Find how products and services can meet the needs of an ageing population.

<http://www.designcouncil.org.uk/our-work/Insight/ageing-better-by-design/products-and-services/>  of the five presentations are now available on their website.

Entitled Designs on Health, AfH ran 4 sessions as part of the main conference programme. Three showcased good practice examples encompassing international, UK and interdisciplinary perspectives. A panel of experts from trusts and design practice further discussed how to encourage and achieve good design in the future.

Tye Farrow from Canada invited us to think about changing the conversation from driving principles for design that are pathogenic  to salutogenic ; that is moving from identifying detiorating disease patterns to looking at how to enhance health.

He set out 5 vital signs for this fresh approach to design :

• Nature- connected to and viewing nature around
• Authenticity- draws on meaningful local influences
• Variety- sense of discovery
• Vitality- place to energise
• Legacy- promoting healthy lifestyles

And invited us to consider the question- Where will we set the bar?

Johannes Eggen set out the principles driving his work in Norway where it is the accepted norm to provide views, light and airy spaces in hospitals and simply not sufficient to make places that are only safe and clean. But he urged us to think how to make them of human scale and described his design as being about the poetry of small differences. Having an informed client is essential to sustain the continuity of the vision into operation. Making designs adaptable to the future is essential.

Will Wimshurst from Rogers Stirk Harbour eloquently walked us through the design for the Maggie’s Centre at Hammersmith describing the places made for quiet contemplation and social engagement in and around the centre. In the proposals for the Guys Cancer Centre he talked about  ‘the art of care and the science of treatment’ and described the way in which they were achieving human scale and identity in a 15 storey building adjacent to the Shard and Guys Tower- the tallest hospital in Europe.

Gareth Hoskins, Richard Murphy and Benedict Zucchi illustrated designs for buildings in the UK. Gareth’s design approach champions a clear diagram, being specific to the site and responding to user experience. Richard presented his ‘crusade against the corridor’ and the process of immersion in the brief to understand the needs of front line staff. Benedict  described a ‘hospital without precedent’ with the tensions of achieving long-life loose fit at the same time as developing a sense of place.

Design is an interdisciplinary activity and how these different approaches come together is both fascinating and essential to achieving good design.  Addressed by a doctor, architect, artist, graphic and product designers through various designs we understood how to make clinical processes more effective; use colour and graphics to assist wayfinding; make products that reduce medical errors; achieve scale and light in buildings; and bring joy and narrative to the work.

The debate focused on the future of healthcare design and we were invited by Rory Coonan in a provocative address to question current design policy to reduce the needs to ‘safe, clean and suitable’ with the tendency to retrench to standard template design for speed; to think about the notion of making SLOW SPACE- that which responds to people’s senses. All the panellists responded with reasons for making health buildings places for healing, finding clarity out of complexity, getting people engaged in the process. The knowledge gaps in the current system were acknowledged as an inhibiter to achieving these goals. We were presented with the sobering fact that 25% of patients in hospitals have cognitive problems such as dementia.

The success of our ‘conference within the conference’ was demonstrated by the high number of delegates attending each session. We certainly caused a stir in the discussions and we had fun doing it!

With thanks to our presenters

Will Wilmshurst, Tye Farrow, Johannes Eggen, Gareth Hoskins, Richard Murphy, Benedict Zucchi, Dr Ganeth Suntharalingam, Claudia Bloom, Kate Blee, Morag Myerscough and Mike Smart

And panelists

Rory Coonan , John Cole, Alastair Gorlay, Sarah Waller

And chairs

John Cooper, Chris Shaw and Susan Francis

Presentations available in PDF format.

Gareth Hoskins presentation

Tye Farrow presentation

William Wimshurst presentation_Part1
William Wimshurst presentation_Part2
William Wimshurst presentation_Part3
William Wimshurst presentation_Part4
Kate Blee & Claudia Bloom presentation_Part1
Kate Blee & Claudia Bloom presentation_Part2
Kate Blee & Claudia Bloom presentation_Part3
Kate Blee & Claudia Bloom presentation_Part4
Kate Blee & Claudia Bloom presentation_Part5

Johannes Eggen presentation_Part1
Johannes Eggen presentation_Part2
Johannes Eggen presentation_Part3
Johannes Eggen presentation_Part4
Johannes Eggen presentation_Part5
Johannes Eggen presentation_Part6
Johannes Eggen presentation_Part7
Johannes Eggen presentation_Part8

The new format succeeded in showcasing members work, with informative and entertaining panels highlighting the aims and aspirations of Practices, Health Clients and of course,  Architects for Health. We were pleased to host many members on the stand and will be responding to all new membership and sponsorship enquiries received.

With our focus for the coming year covering topics including, designing for physical disability, bariatric design, neuro-rehab support, dementia and sensory impairment. We succeeded in tickling all the senses, visually the stand looked fantastic, the fox’s glacier fruits tasted great, our silent corner provided respite from the hubbub,  whilst offering the most comfortable seats in the house, courtesy of Hitch Mylius.  The sixth sense is in tune and say’s “submit next year to avoid disappointment” and avoid Clients asking you the question …”Where’s my scheme and why haven’t you submitted?”

Members who submitted entries for this year’s exhibition were not disappointed, together with having the opportunity of an award they all received the added bonus of their images being presented to the European Health Property Network (EuHPN) event in Copenhagen.

And so to the results of our “internationally judged competition” with. Gold, silver and bronze awards being presented in our Olympic year to:-

AfH Gold award 2012, BDP’s Alderhey Children’s Hospital AfH Silver award 2012, HLM’s Cynon Valley Community Hospital AfH bronze award 2012, P H + S’s Houghton-le-Spring Primary Care Centre

Our thanks go to Tye Farrow and John Cole for undertaking the judging, in what proved to be a broad range of entries.

A very successful event for all those involved, will you join in the fun next year?”

For this year exhibition of members projects see the gallery: http://www.architectsforhealth.com/iheem-2012/

Rosemary Jenssen, AfH Executive member

It is a great sadness to announce the sudden death of Peter Scher.

Born in the Jewish East End, Peter was the only son of Isaac, an artist and Elizabeth, a seamstress. His grandparents, Israel and Leah had arrived in Britain in 1900 from Lithuania to build a better and safer life. Evacuated from London to a ‘safer` Sheffield (which was blitzed heavily on the night of their arrival!), Peter was awarded a scholarship to Christ Hospital Public School in 1943 where he excelled, and which nurtured and developed his lifelong interest in everything. At the age of seventeen he started his studies for an architecture degree at the Bartlett School of Architecture in the University of London. This was interrupted by his call-up to undertake National Service, which he refused as a conscientious objector. This resulted in him being posted as a hospital porter for two years, the loss of his right to vote for five years, and in  his never being able to serve on a jury.

Peter’s professional career began as an Assistant Architect at J M Austin Smith and Partners and A M Gear, in 1954. His involvement in healthcare architecture began in 1958, when he became involved with the redevelopment of St Thomas’ Hospital in London. He went on from there to George Trew and Dunn where he became an Associate (1965-1975), working on South Teesside General Hospital and various major healthcare feasibility studies alongside community developments such as Winstanley and Livingstone Neighbourhood developments, incorporating over five hundred dwellings, residential homes for children and the elderly, shops, and churches. He became a partner in the firm in 1975, taking responsibility for central services, research, quality assurance and coordination of all major projects. He also took a lead role in North Tyneside General Hospital, The London Clinic, feasibility studies for Basildon and Orsett Hospitals, and the development of a Psychiatric Unit at North Tyneside.

In the early 1980s he retired from a daily routine and turned his attention to arts for health, and journalism, and was a regular contributor to the International Union of Architects Public Health Group (UIAPHG). He remained a consultant to his practice and was involved in a wide range of activities which included his role as a CABE enabler, membership of the Department of Health Design Review Panel, teaching at Hertfordshire University and conducting research. In pursuing his journalistic interests he made a great contribution as advisory editor to the magazine Hospital Design, raising the overall quality of the criticism and review of health buildings and making the journal a household name in this specialist field. He promoted a serious interest in the building response to health service change.

In addition to this he made an invaluable contribution to the Nuffield Trust book ‘Fifty Years of Ideas in Health Care Buildings (1999) to celebrate the first fifty years of the NHS.

But maybe Peter’s most passionate interest in the recent past was his work on art in healthcare buildings, notably with Peter Senior at Manchester Metropolitan University, where he was appointed as a Visiting Research Fellow (1987-2010). His prolific output and enthusiasm can best be summarised by a comment from Peter Senior who wrote:

‘Peter Scher’s interest and understanding of the power of the arts to affect people’s sensibilities together with his experience of the architecture and design of health buildings were of enormous value to the work of Arts for Health. The studies and research undertaken were invaluable in gaining trust and raising credibility in this work as it was accepted throughout the UK and abroad. `

Amongst the many projects and research works that were published, were two that particularly stand out- ‘Patient-focused Architecture for Health Care` (1996), a major study, and ‘The Exeter Evaluation` (1999), the first independent professional evaluation of a major hospital arts project (published in the Journal of Medical Ethics of the BMJ).

Peter was a remarkable man of considerable modesty with a mind that saw possibilities and alternative approaches to design often missed by his colleagues. He was passionate about the architecture of health buildings and wrote beautifully about, it and was always willing to join in debate. His ability to deliver gentle, constructive criticism of real insight was much admired.  In 2010 he was nominated for and received a Lifetime Achievement Award for his contribution to healthcare design through a long and distinguished career, and in his contribution to the promotion of the study of patient focused environments and the healing power of art. In his private life Peter ploughed his own artistic furrow, being a keen violinist, an interest he pursued to the end. He is sadly missed.

Peter is survived by his wife Anne and two daughters Lucy and Susan and sons Steven and Michael.

Peter Scher: born 30^th October 1932, died 17^th October 2012

AN

November 2012

YSBYTY YSTRAD FAWR

10 July 2012

Leaving Cardiff by coach, the Architects for Health study group wound their way through the spectacular Welsh countryside to the new local general hospital, Ysbyty Ystrad Fawr, located in the former mining town of Ystrad Mynach, five miles north of Caerphilly.

Officially opened in November 2011, the new hospital provides replacement services for three former hospitals in the borough of Caerphilly, co-locating all services under one roof.  In addition the hospital provides a range of services previously only available from the major acute centres.

The hospital provides 226 beds (26 of which are located in the elderly mental health unit), being one of the first to provide 100% single en-suite bedrooms (more of that to follow).  Services available at the hospital include a 24 hour local emergency centre (together with GP out of hours services), integrated mental health unit, day surgery, diagnostic, outpatient, therapies and a midwife led birthing unit.

The hospital was designed by Nightingale Associates and built by BAM under the ‘Designed for Life’ framework which was set up by the Welsh Assembly in 2006 to provide strategic partnering to support the aspiration to provide world class healthcare services in Wales by 2015.

Arranged over three principal levels, the main entrance is located at one end of the hospital street announced by an elegant glazed prow featuring coloureds glazed panels atop a terracotta entrance vestibule at the northern end of the site, creating a four storey galleried void within.  The main clinical accommodation is raised up one level to acknowledge the hospital’s location within a flood plain adjacent to the River Rhymney, allowing some 600 car parking spaces to be provided beneath the building ( very popular with the staff ) .  Visitors drop off and emergency accesses are both provided at the upper level.

Moving from the main entrance, the clinical accommodation is arranged on either side of the hospital street, a long naturally lit artery with wards formed in V-shaped blocks creating triangular courtyards one side and trapezoidal blocks on the other.  Landscaped courtyards help to articulate the journey along the street and also provide welcome visual interest.  The courtyard elevations are clad with silver grey composite metal cladding (possibly the result of value engineering?) which is relieved by large glazed screens to the street articulated with multi-coloured aluminium fins attached to the curtain wall. Internally, the circulation spaces adopt a simple muted palette of white walls, grey floors and full height oak doors set in glazed screens collectively providing a blank canvass for future artwork.

An unfortunate consequence of the move to raise the building up one level is the visual dominance of the car parking at the lower level and the physical disconnect of the courtyards from the clinical accommodation which seemed to be a missed opportunity given the hospital’s dramatic location.

Public spaces within the building, however, are particularly well handled with the use of the building section to create a selection of double height spaces in the restaurant and other waiting areas, naturally lit from a variety of sources, although the selection of standard furniture disappointingly did not match the aspirations of the architecture.

Each 30 bedded V-shaped ward is accessed from a single shared reception at the junction of the street and the V form, from where the single bedrooms are simply arranged either side of the corridor, with the en-suite bathrooms placed back to back between bedrooms.  Full height glazed screens to each bedroom allow natural light to filter into the corridor and allow patients to control privacy through the use of integral blinds.

Each bedroom is identical in layout, with vertical bedhead trunking always located to the left of the bed and in between the bed and en-suite bathroom.  The plan form allows each room to benefit from a large window divided into three horizontal panels, providing a choice of ventilation at low or high level, although the height of the cill in the typical bedroom visited was a little high to benefit views of the landscaping at the lower levels from the bed.  Anecdotal patient feedback was generally good, although some had felt ‘a little isolated’ despite day rooms being provided within each ward.

The long tapered shape of the site clearly informed the overall parti, and whilst there remained nagging doubts about the resolution of the flood plain, parking and entrance arrangements, the success of the project must be judged on the key ambitions of the scheme- namely, the bringing together of disparate clinical services under one roof combined with the decision to provide 100% single rooms.

YSBYTY ANEURIN BEVAN

10 July 2012

Following lunch at Ystrad Fawr, the AfH contingent travelled to Ebbw Vale, to visit Ysbyty Aneurin Bevan, the new local general hospital for Blaenau Gwent, some 35 miles north of Caerphilly which opened in October 2010.

Located on the site of the former Ebbw Vale steelworks which closed in 2004, the hospital was one of the first projects on the site intended to regenerate the area.  Other developments on site recently completed or under construction include some pilot eco-homes, a post 16 college and a new primary school.

Delivered under the same ‘Designed for Life’ procurement as Ystrad Fawr, the hospital forms part of the wider national strategy to reconfigure and improve the provision of healthcare services throughout Wales.  Services previously provided at two hospitals are now brought together in one facility to serve the whole catchment area of Blaenau Gwent.

These include 96 in-patient bedrooms – the first to provide 100% single en-suite accommodation incorporating an adult mental health unit with out-patient, day care and an 11 bedded in-patient facility.  Other services include an out-patients department, an urgent care centre, a birthing unit, diagnostic support and a large therapies unit.

Unlike Ystrad Fawr, the site for the hospital was not affected by flood plain issues and here all accommodation is readily accessed from ground level, with the entrance located more centrally within the plan, minimising travel distances to the main wards which are all located at first floor level.  Visitors are greeted with a pleasant entrance and cafe area with views out to a landscaped courtyard.

In plan, the building features similar V-shaped ward design to the Ystrad Fawr creating triangular shaped courtyards, with the therapies and mental health unit forming extended legs at ground level.  Here the courtyards are far more successful by virtue of their location at ground level, with access afforded from the perimeter and the bright, white  render treatment to the internal courtyard elevations creates a cheerier finish than the silver grey cladding panels at Ystrad Fawr.

The therapies unit makes particularly good use of the site by using the external spaces as part of the rehabilitation ‘garden’, where patients are able to use pathways etc. to aid movement and recovery.

Establishing a similar colour and finishes palette of white walls, grey floors and oak doors, the interiors are complimented by well-designed joinery details to the main stair and principal reception desks.  Externally the elevations are comprised of a collage of materials including stone faced block, fibre cement panels and splashes of copper cladding, referencing the former industrial nature of the site. The indented entrance façade creates a vehicular drop off point, and all car parking is located a short distance from the main entrance.

The design of the single bedrooms is identical to the Ystrad Fawr, but here grouped into 32 bed wards, accessed at the centre of the ward on  the point of the ‘V’, thereby creating an ‘L’ shaped ward.  Each ward benefits from a day room (some complete with a terrace), to provide social space for in-patients, however these were not being used as intended apparently due to the short stay of patients and their preference to remain in their rooms – perhaps a reflection to their success.  As an unintended consequence, staff have apparently ‘adopted’ these unofficially!!

Whilst a year separated the opening of the two hospitals visited, it is evident they were born from the same design approach, evolving from the detail resolution of the single bedroom, the design of the V-shaped wards enclosing landscaped courtyards through to the adoption of similar interior detailing and colour palette.

This design approach represents a move to a more patient focussed healthcare system, reinforced by the co-location of a range of sub-acute clinical services under one roof and taken together, the hospitals can be seen as physical evidence of a step change in the provision of healthcare in Wales in the twenty first century.

Teenage Cancer Trust at University Hospital for Wales

Opened in July 2009, the ‘Skypod’ at University Hospital of Wales follows the same guiding principles promoted by the Teenage Cancer Trust in all their centres nationwide. Essentially the charity’s mission is to provide inpatient and day care services to cancer patients between 13 to 24 years in age appropriate settings. Applauded for the charity’s trademark for design inspired interiors, this unit shown to us by nurse consultant Laura Clark and lead nurse Jenny Labaton was no exception. Whilst making a bold design statement the ‘Skypod’ was sensitively articulated to communicate to a very specialist patient user.

On a difficult infill site, the unit is appropriately located between the paediatric and adult oncology departments. ORMS designed the first and second floor extension on stilts to sit over existing ground level accommodation. Architecturally the extension is a gallant eye catching insertion into a nondescript backdrop of concrete and pebble dash.

Arrival to the unit via a dedicated lift delivered us to the first floor of the extension, where the bedrooms, 2 singles and 2 three-bed bays are located around a central nurse station/ reception area. For patients requiring a higher level of care such as post surgical and transplant, one of the single bedrooms has an accessible en-suite bathroom fitted with ceiling hoist and is HEPA filtered. This single bedroom is otherwise identical to the adjacent one, fully presented as a teenage friendly space with desk/ dressing table, computer games console and feature lighting.

In the three-bed bays specifically, visual privacy is afforded by the design of the cubicle curtains which were formed by multiple layers of textiles, each giving differing degrees of transparency. As well as providing full visual privacy as and when needs dictate, the layers also offer a subtle and useful communication tool for the patients to indicate their reservation/ desire for social engagement at the bed side. Should some social interaction be sought beyond the bed space, a sliding screen at the end of the room reveals a discrete den shared between the 2 no. three-bed bays. The living area located on the second floor, occupies the majority of the floor plate and has open views over the hospital site offered by the full height glazed balcony doors. The space is open plan and multi-functional other than for a curved timber cladded structure which encapsulates the ‘chill-out zone’. Darkly lit and softly furnished, this space provides a cocoon-like hideaway for those wishing to retreat. The attention paid to privacy, dignity and social issues shown in the living areas and the bed bays is a key demonstration of the response to patient-focussed needs.

Significantly, around the time this project was launched, a study was commissioned by the charity and undertaken by The Futures Company. With the aim to address the real needs of patients, their friends, families and staff, ‘control, comfort, stimulation, personalisation and connectivity’ were reported as “benefit platforms”. It was clear from our visit that the design of this unit works hand in hand with the model of care to deliver on these “benefit platforms” in responding sensitively to the physical and emotional needs of young people whilst also championing the relationship between the built environment and health outcomes.

Cynon Valley Hospital

The final visit on the AfH tour took us to the Cynon Valley, where the new £60m Ysbyty Cwm Cynon sits in the centre of the flood plain. Designed by HLM Architects and completed in Spring 2012, the hospital is based on an unusual radial design and spread, over 2 storeys. Patients and visitors arrive at the centre of the circle, giving the impression that the building is welcoming the community as its wings embrace the main entrance approach.

With a floor area of 18,500sqm, the building provides primary care support for the neighbourhood including outpatient care, minor injuries, therapies suite, diagnostic facilities on the ground level. On the first floor, we find four flexible 25 bed medical wards as well as ancillary administration and plant rooms. A midwife led birthing unit was also planned for this area but it was not completed

The accommodation is arranged in two concentric curved wings punctuated by a string of planted courtyards around which the departments wrap. The hospital street between the two forms follows a gentle arc that reduces it’s perceived length and links to the entrance atrium part way along in the form of a wedge providing views through to the hills beyond.

Although this building was completed after the Aneurin bevan and Ystrad Fawr hospitals, the design work started as far back as 2001 before the advent of Designed for Life Procurement Frameworks and the 100% single bed ward agenda. Arguably the flexible wards are more appropriate to accommodate rehab inpatients in any case. The fact that the project was procured traditionally is reflected in the quality of internal finishes. For example, the solid surface acrylic forming the booths in the dental suite were particularly well detailed – subtle in design and finely finished.

Flexibility were built into the wards by a common template, but what distinguishes them from standard ward designs is the generous floor to ceiling height of 3.3m which in combination with exposed concrete soffits offer a sense of spaciousness, comfort and a clutter-free aesthetic.

The art strategy themed around nature followed consultations with staff and art consultants. These were presented as sculpture, murals, photography and paintings. One memorable installation assembled from large carved stone panels draws the eye along the atrium on entry to the building.

Whilst this hospital is less striking in it’s architectural execution than Ystrad Fawr and Aneurin Bevan in terms of material palette and form, it’s real success lies in the attention given to the design of the interior and it’s attempt to enhance the user experience by features such as the colour-themed canopies to each department threshold, generous restaurant terrace overlooking the hills and the well presented courtyards.

Global architecture competition for students – Better cities, better lives

Open to: All architecture students (undergraduates/architects in training)

The brief: The UIA theme for World Architecture Day 2012: London is Architects are city changers. As global populations rise, architects will be responsible for shaping the urban fabric and developing the necessary tools to accommodate the citizens of the 21st century. This theme embraces the United Nations’ Human World Urban Campaign initiative established to promote business practices, models and technologies that provide viable solutions to the challenges of urbanisation.

You are invited to submit your ideas/concepts of how you could forward the aim of Better cities, better lives. The jury will be looking for ideas/innovation/notated sketches rather than detailed drawings. You may select a specific city/challenge or a generic solution.

Format: 1 A2 PDF (portrait)

Deadline: Friday 07 September 2012

Cost: Entry is free

Judging: A panel of WAN AWARD judges will assess the submissions and draw up six shortlisted entries. The winner will be announced at World Architecture Day 2012: London on Monday 01 October.

The winner will receive an iPad and their submission will be published in WAN’s News Review to our 230,000 global readership.

Send entries to caroline.stephens@wantoday.com

http://www.worldarchitecturenews.com/index.php?fuseaction=wanappln.showbriefdetail&newsid=1651

A new study will explore effective practices for selecting either a standardised or innovative approach to flexible design

What do you have to do?

You will simply agree to take part in an detailed discussion that will help to identify components or building systems/processes

Why participate?

·       This would be a great opportunity for a robust discussion about their project and learn things out of it.

·       This would also be a great opportunity explore possible flexibility solutions.

·       Contributions will be used to improve current flexibility strategies.

More information

See PDF Participant information sheet 1

What next?

Simply email researcher

Ahmad Mohammad Ahmad

(A.M.Ahmad@lboro.ac.uk)

School of Civil and Building Engineering, Loughborough University