AfH Wales Trip 2012

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STUDY TOUR

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.

 

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