NOVEMBER 2023 | £8 Infection control Designing out infection Offsite construction Rental facilities reduce pressure Lighting The importance of testing Inside this issue: Private hospital tackles NHS backlog
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Editor’s Letter APRIL 2023 Letter header goes here Letter header goes here After years of lobbying by mental health providers and charities, the Government has finally unveiled plans to inject more than £150m into mental health services, including improvements to the buildings from which care is delivered and creating new facilities across the country. The investment, up to April 2025, includes £143m of capital funding for 150 projects. It will be invested in providing and improving a range of spaces, including new mental health urgent assessment and care centres and the redesign and refurbishment of existing mental health suites and facilities including in emergency departments, creating spaces outside of A&E, and the expansion of crisis lines. Programmes will also focus on preventative measures, including improvement of sanctuary spaces and community mental health facilities. This focus on improving the estate offers a range of opportunities for contractors, architects and product manufacturers working within the sector. In this edition of mhdf you can read about some of the latest capital projects, including a new inpatient facility in Liverpool and a crisis café in Ealing (p5). Features include a focus on dementia-friendly lighting solutions (p8) and the impact of sensory rooms on people with mental health conditions (p13). In the next edition of mhdf we will focus on interior design and outdoor spaces. If you can help contact [email protected] Editor Jo Makosinski Sales director Julian Walter Production Nicola Cann Design Mary McCarthy Managing Director Toby Filby In this issue: 5 PROJECTS The latest mental health and dementia projects 15 DESIGN Exploring the benefit of sensory rooms in mental health settings 16 LIGHTING How smart lighting solutions are helping to support people living with dementia Cover image: Description and credit Best Wishes Jo Makosinski EDITOR [email protected] healthcaredm.co.uk 3 Editor’s Letter NOVEMBER 2023 Moving on Sadly, this will be my last edition as editor of healthcare design & management. For the past 12 years, I have been reporting on the very latest developments in the healthcare sector, focusing on design and construction and the delivery of estates and facilities services. And, during this time, I have been in awe of the innovation happening within the marketplace, with manufacturers and service providers taking on the challenges of supporting the NHS in the delivery of quality health services, and of those people on the frontline managing those estates. I have also grown to recognise the importance of the built environment on everyone who uses health and care services. And this influence cannot be underestimated, as it is widely proven to impact positively on the experience of patients, staff, and visitors, as well as on healthcare outcomes. In this edition, you can read more about these incredible interventions, including a focus on the benefits of modern methods of construction on creating the additional capacity needed to address the COVID-19 backlog (p8). Our feature sections include Infection Control (p21), where we look at how building design can help to reduce the transmission of potentially-deadly infections; and Lighting (p25), which focuses on the role of testing and regulation on medical lighting systems. And we explore the benefits of 5G connectivity in Utilities (p29). Moving forward, the new editor of hdm will be Dan Colombini. Features in the next edition will include a focus on surfaces, building products, and hand hygiene. If you can help contact Dan Colombini via [email protected] Editor Jo Makosinski Sales director Julian Walter Production Nicola Cann Design Mary McCarthy Managing Director Toby Filby Jo Makosinski EDITOR [email protected] Harborne Hospital, HCA Healthcare/Prime Plc The publishers do not necessarily agree with views expressed by contributors and cannot accept responsibility for claims made by manufacturers and authors, nor do they accept any responsibility for any errors in the subject matter of this publication. Publishers Stable Publishing Limited, SBC House, Restmor Way, Wallington, Surrey SM6 7AH, England. t. 020 8288 1080 f. 020 8288 1099 e. [email protected]
In this issue.... NOVEMBER 6 NEWS NHS England launches an urgent review of hospitals across the country as part of its response to the dangers of reinforced aerated autoclaved concrete (RAAC) on its building stock 8 OFFSITE CONSTRUCTION Looking at the role of modern methods of construction on the delivery of additional and upgraded healthcare buildings, including the need for greater understanding of project cost and the increased interest in temporary rental solutions 15 PROJECTS The latest health sector construction projects, including the completion of a new day treatment centre at Evelina London Children’s Hospital, a new short-stay ward at Northwick Park Hospital, and completion of construction work on an independent hospital in the Midlands
21 INFECTION CONTROL Shraddha Badoni of Pick Everard explores the techniques to improve infection control through better building design; plus why hand dryers are more efficient than paper towels for hand hygiene practices 25 LIGHTING We explore why testing and regulation are critical for medical lighting systems; plus how circadian lighting solutions are helping to reduce falls in care homes 29 UTILITIES How 5G technology adoption will revolutionise health services and what it means for the estate; plus new framework agreement supports NHS procurement
RAAC crisis leads to hospital evacuation fears Over recent weeks the Government announced the closure of more than 100 education facilities that were built using reinforced aerated autoclaved concrete (RAAC), which is known to be prone to collapse. And the move has heightened public interest in the presence of RAAC in the NHS estate, leading to the announcement of an urgent review of dozens of hospitals across the country. This will mean trusts will have to identify any RAAC within their estates and plan for any structural failure, including proposals to decant patients or services. The cheaper, lightweight concrete was commonly used in UK construction from the mid-1960s to the late 1990s, but has been found to lose structural integrity after around 30 years. There are 19 hospitals in England that are known to have been either partly, or completely, constructed using RAAC, seven of which were ‘made nearly exclusively’ of RAAC. Two of the seven have already been replaced and the other five are being reconstructed as part of the Government’s New Hospital Programme. But the timeline for these improvements has not been announced, with NHS England chief finance officer and deputy chief executive, Julian Kelly, unable to provide a specific deadline for the works. When asked by the parliamentary Public Accounts committee, he said: “There has been a commitment to eradicate them all by 2035”. But he added: “We have not done those full structural surveys to properly identify the total scale and level of the issue.” These full surveys are expected to be completed in the coming weeks, but it is unclear when RAAC will be removed from all hospitals and how much the procedure will cost the taxpayer, though the Government has set aside £700m to support the NHS to deal with the issues. In early September, NHS England chief commercial officer, Jacqui Rock, and national director for emergency planning and incident response, Dr Mike Prentice, said in a joint letter to NHS trusts: “Effective management of RAAC significantly reduces associated risks; but does not completely eliminate them. “Planning for RAAC failure, including the decant of patients and services where RAAC panels are present in clinical areas, is, therefore, part of business continuity planning for trusts where RAAC is known to be present, or is potentially present.” Earlier this year a regional evacuation plan was created and tested in the East of England NHS region, with lessons shared across the country. “We would recommend that all boards ensure that they are familiar with the learning from this exercise and that they are being incorporated into standard business continuity planning as a matter of good practice,” the NHS England letter said. “This exercise is, however, essential for those organisations with known RAAC, and should be done as a matter of priority if it has not already been completed.” Doncaster & Bassetlaw Teaching Hospitals NHS FT is the first acute NHS provider in the country to successfully eradicate RAAC from its sites, working with IHP to install replacement roofs at Bassetlaw Hospital 6 healthcaredm.co.uk NEWS
Greater education ‘key’ to unlocking potential Scott Tacchi, head of MMC at Sir Robert McAlpine, reveals why he believes we urgently need greater education on project costs at the heart of the political agenda 8 healthcaredm.co.uk OFFSITE CONSTRUCTION It has been a difficult time for the UK healthcare environment, first rocked by the National Audit Office report on the New Hospital Programme, and soon followed by the robustness of the Public Accounts Committee (PAC) interview. Then add in the national RAAC scandal impacting hospitals and all public buildings and the new Building Safety Bill, which fundamentally changes the way the industry designs, the competency of designers, and the early involvement of main contractors at RIBA stage 2. To the layperson, it might appear that UK healthcare programmes are not on the ropes, but facedown on the canvas. But, in the face of great challenges there are also significant opportunities – but only if the industry is brave and willing to put aside our historic preconceptions. MMC IN HEALTHCARE Much has been published exploring the benefits of MMC in healthcare and the wider construction environment. On numerous occasions the PAC referred to the benefits of the forthcoming new Hospital 2.0 (H2.0) design standards: it makes processes faster, improves quality, reduces defects, and is cheaper. It was also suggested in the PAC by those leading the programme that MMC would save 25% of the cost of a new hospital – assuming this was meant to be the ‘capital cost’ and not ‘total cost’. These benefits are true, in part, in certain circumstances. But many times, the desired outcome has led to the opposite of the intended outcome. So what will the H2.0 design standards comprise of? Currently, we believe standardised schedule of accommodation, room adjacencies, room templates, and standardised horizontal and vertical grid. In the future, façade detailing and other primary elements, such as MEP, will also be addressed. But with 40 hospitals to be opened by 2030, the industry cannot wait to be brave and grasp the MMC opportunity. Investment decisions require confidence in opportunity, a pipeline of work, and return on investment. But we must act now, otherwise the challenges around labour supply, inflation, and contractor capacity could derail this game-changing programme for good. Some may argue that Healthcare Technical Memorandums (HTMs) and Healthcare Building Notes (HBNs) have been about for years, and therefore there is no need for the H2.0. Unfortunately, this is not the case: nearly every hospital has different grid spacing and floor-to-floor heights. There has, up until now, been no benchmark for standardisation. However, the benefits of standardisation are apparent: with standardisation comes repetition, and with repetition comes the ability to bulk purchase, which in turn comes with reduced cost. So, what can be done now? Integrated Health Projects (IHP), a collaboration between Sir Robert McAlpine and Vinci, has embraced the NHP approach to standardisation, platform, and industrialisation for healthcare, with tangible benefits that will have positive outcomes on the bottom line. Take the ProCure 23 (P23) ‘MMC tool’, for example. With a minimum target of 70% ‘Combined MMC Value’, this challenges design teams and contractors to look at all aspects of the build to optimise project delivery. The tool has been adopted by National Health Projects (NHP) and the National Health Service England (NHSE) and is pass or fail at final business case stage.
healthcaredm.co.uk 9 OFFSITE CONSTRUCTION The National Rehabilitation Centre (NRC) was the first project to be assessed under the P23MMC tool and pass The bigger-picture benefits of this new approach include the following categories of standardisation: MMC category 0 and MMC category 7. Supplementing the seven recognised MMC categories, the focus of ‘Category 0’ is the early design phase, addressing factors such as robust and optimised area scheduling, grid spacing, approaches to a unified digital model, digital project management, and design through pre-construction innovation. ‘On-site’ methodology under ‘Category 7’ has existed since the seven MMC categories were coined. In the past, this meant simply ensuring that the trades were optimised in terms of sequencing, but now there is a new approach to productivity gains led by digital and robotic innovation. CHALLENGES AND RISKS Of course, it’s not just all ‘upside’. Continued innovation can also bring new challenges. CLASP, RAAC, SCOLA, SEAC, MACE and ONWARD are some of the systems developed and executed at speed in the 50s, 60s and 70s and rolled out en masse unaware of the challenges that would await only 20-plus years into their expected 60-year life cycle. RAAC is the most-recent example of innovation without development regimes – due to inaction it has closed 150-plus public buildings this summer. The construction industry has an obligation to learn from the many mistakes of the past and ensure they are not repeated. If a product or process is too good to be true, it’s normally because it isn’t. However, overlooking contemporary innovation because of failings in the past can be equally foolhardy. Gruelling and punishing testing regimes should come hand in hand with product innovation. We also need to recognise that the value of MMC is more than products and manufacturing techniques. So much of MMC’s opportunity can be determined at the onset of a project: the grid spacings; the approach to offsite benefits; the adoption of full digitisation that goes beyond BIM2; health and safety benefits through reduced working at height; carbon reduction through reduced vehicle movements combined with fewer site activities and the possibly of electrification of vehicles on site; speed of onsite works; and yes, ultimately reduction in cost. www.srm.com The NRC blends with the Stanford Hall Rehabilitation Estate’s natural surroundings and exemplifies top-tier sustainability The P23MMC tool challenges design teams and contractors to look at all aspects of the build to optimise project delivery
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healthcaredm.co.uk 11 OFFSITE CONSTRUCTION Keeping up with evolving demands The COVID-19 pandemic has left the NHS with a massive backlog of patients waiting for treatment. To address this, the Government has committed £8billion over three years to provide new beds, equipment, and technology. But, with almost every NHS trust across the country needing to increase capacity, the race is on to find the most-efficient ways of doing so – for the best price. And this is where modern methods of construction (MMC) continue to have an impact. Modular and mobile healthcare solutions have been growing in popularity, due mainly to the speed of delivery. But, much more recently, there has been a trend in favour of temporary units, which provide health trusts with additional flexibility for changes in future demand. They also keep costs to a minimum as they can be rented for only the period of time they are needed. LIGHTENING THE LOAD Mark Rooney of Premier Modular said: “Winter pressures, the COVID-19 backlog, staff shortages, a lack of facilities, social care crossovers, increasing patient numbers, and the need to increase patient throughput all serve to exacerbate and compound one another, causing the NHS to be continuously stretched, potentially to breaking point. “And, as healthcare service requirements are constantly changing, many NHS trusts are unsure of what they might need, even in the near future. “Plans to lighten the load are often last minute and precariously balanced between competing demands/stakeholders with fixed income targets, so trusts need their building projects to be delivered and installed quickly. “Built in half the time it would take by traditional bricks and mortar, a modular building operates just as efficiently and can accommodate large patient numbers within a few weeks, rather than months.” ADAPTING TO CHANGE While a large number of modular healthcare solutions delivered in the past few years have been permanent buildings designed to replace outdated facilities or create additional capacity, manufacturers are reporting increasing interest in temporary solutions. Rooney said: “Once installed, a modular solution can be reconfigured – enlarged, widened, and stacked – to adapt to changes of use or volumes of patients. “For example, due to the NHS’s maintenance backlog, trusts may need to start using decant facilities and modular units are reconfigurable, allowing personnel to decant different departments in and out and minimising the pressures faced through different services at different times.” To further relieve service pressure and capacity, health trusts can also now rent modular buildings for as long, or as little, as needed, altering and expanding them to meet current demands and facility needs. And framework agreements, such as NHS Shared Business Services and NHS Commercial Solutions, significantly reduce procurement time and costs. “It’s all about making the whole specification and buying process simple and seamless for trusts who are already stretched,” said Rooney. McAvoy delivered two 48-bed wards for Good Hope and Heartlands hospitals under a lease agreement We explore how temporary modular facilities are increasingly being specified to help reduce the NHS backlog at a time when capital funding is scarce
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healthcaredm.co.uk 13 OFFSITE CONSTRUCTION “If trusts don’t have the capital funds for a new facility, they finance the space they need by renting or leasing, with all the flexibility that affords. “This funding can also be spread over a number of years to prevent delays, or if hiring a temporary facility it will be included within opex budgets, rather than capex budgets, enabling trusts to stretch their funding resources further. COUNTING THE COST “By actively working alongside knowledgeable modular providers to predict where bottlenecks may occur, a pro-active approach can be taken for emergency response – meeting budgets and capacity needs and, most importantly, caring for patients effectively.” University Hospitals Birmingham NHS Foundation Trust recently chose a rental option to provide two 48-bed wards at Good Hope and Heartlands hospitals. Built by McAvoy, each two-storey modular building houses wards, ancillary areas, clean and dirty utilities, staff rooms, nursing stations, reception areas, and toilets. And, procured through the NHS Shared Business Services Framework, they were delivered in less than 18 weeks, with the trust opting to rent the units for an initial 10-year period. A spokesman for McAvoy said: “Rental is often the preferred choice in cases where there may be issues raising the necessary levels of capital required for a permanent build. PLANNING AHEAD “In this instance the trust was able to avail of a financial solution that avoided significant capital expenditure and an accommodation model that allowed for relocation/repurposing, either within the current location or at another trust site, if necessary, at a later stage. “Choosing a SmartCare rental option also provided the trust with increased flexibility in terms of business planning, with the option to extend the rental period.” John Cunningham, principal category manager at NHS Shared Business Services, added: “The NHS Shared Business Services Modular Buildings Framework was created to provide NHS trusts with the options they need to offer effective patient care and the delivery of these two 48-bed wards is an example of that being put into practice. “The SmartCare rental service that McAvoy has provided to the trust allows for both stability over a 10-year period, as well as the flexibility to relocate or repurpose the accommodation over that timeframe.” Offsite solutions provider, ModuleCo Healthcare (MCH) also recently handed over a new ophthalmic theatre at St Mary’s Hospital on the Isle of Wight, which will also be rented, in this case for a five-year period. Delivered in 20 weeks from order to handover, the high- specification theatre will enable the hospital to treat up to 18 more patients a day – a 40% increase in its current surgical capacity. And this will also reduce the number of patient referrals to NHS trusts off the island. UNLOCKING VALUE Alan Wilson, managing director at MCH, said: “This was a great example of the value NHS trusts can unlock by choosing true offsite construction, together with the flexible rental agreements manufacturers offer, allowing solutions that are financially viable and delivered quickly without any compromise on quality and patient care.” MTX Contracts has also seen increased uptake of its Full-Service Lease Extensions (FLEX) option. Launched in 2021 in direct response to the increased pressures and demands facing the healthcare sector as a result of the COVID-19 pandemic, FLEX acts as a rapid solution to increase clinical capacity which is both flexible and accessible. Delivering fast, full-service lease extensions, via a simple pay-asyou-grow, fixed-term monthly fee, the solution also supports the Government’s drive to embrace modern methods of construction for public sector projects. Managing director, David Hartley, said: “With such high pressure on the NHS following the Coronavirus pandemic, we need to be thinking differently about how we meet patient demand. “Seeking capital funding for expansions can be a timely process, but single-source funding provides another way, allowing the costs to sit off balance sheet, while at the same time enhancing a trust’s ability to serve patients, stakeholders, and the general community. “FLEX is a great option for a number of healthcare estates that are searching for a fast-track solution to expand their clinical capacity.” www.modulecohealthcare.co.uk www.mtxcontracts.co.uk www.premiermodular.co.uk www.mcavoygroup.com Lease agreements enable upfront capital costs to be avoided. IMAGE, PREMIER MODULAR Premier Modular has seen increased interest in temporary modular solutions
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Work has been completed on a new independent hospital in the Midlands which will provide services for both NHS and paying patients. The £100m Harborne Hospital has been developed by HCA Healthcare UK, which will be providing private health services, including in specialties such as cancer, cardiac, and orthopedics and across inpatient, outpatient, and diagnostic care. In partnership, University Hospitals Birmingham NHS Foundation Trust will manage two dedicated floors providing 72 inpatient beds for the care of NHS patients. Opening its doors to patients in early January, the hospital will provide a depth and breadth of independent healthcare not currently available in the region. A MILESTONE MOMENT The building will house four theatres, including a hybrid catheterisation laboratory; two minor operating/endoscopy suites; six ITU beds; 44 inpatient beds; and 16 daycase beds. Specialist health and care property developer, Prime plc, played a pivotal role in developing the hospital, knitting together the skills and aspirations of all the teams involved, including HCA UK; M&G Investments, which funded construction of the 14,728sq m hospital; and contractor, VINCI Building. Claire Smith, chief executive of The Harborne Hospital and vice president of HCA Healthcare UK NHS Joint Ventures, said: “It has been a huge collaborative effort to get to this milestone moment. “For HCA Healthcare UK work only continues now, and at pace, to ensure that come January this impressive building is an even-more-impressive hospital, equipped with the state-of-theart facilities, with teams of skilled medical professionals and the leading consultants that will make The Harborne Hospital the destination for high-quality private care in the region.” IMPROVING OUTCOMES Julian Miller, chief financial officer at University Hospitals Birmingham NHS Foundation Trust, added: “The Harborne Hospital provides the people of Birmingham and Solihull further capacity and greater access to outstanding NHS care in world-class facilities, delivered by leading NHS specialists. “This is a partnership of which we are proud; 72 additional NHS beds will support the exceptional demand we are seeing to treat more local people, support our mission to widen access to healthcare, and help cut waiting lists. And Peter Manners-Smith, fund manager at M&G Real Estate, said the collaboration between the private and public sectors set out a blueprint for how operators can work together to reduce pressure on the NHS. “This project is an excellent example of how private sector capital can be used to build exemplar facilities which support the NHS and improve health outcomes – and we are delighted to have reached this milestone,” he added. “By financing the construction through long-term leases, we have also been able to generate sustainable long-term returns for our investors and benefit retirement savers.” www.primeplc.com www.vinci-building.co.uk www.mandg.com www.hcahealthcare.co.uk healthcaredm.co.uk 15 PROJECTS NHS patients benefit from new private hospital Harborne Hospital will treat both private and NHS patients
16 healthcaredm.co.uk PROJECTS A&E EXPANSION DRIVES EFFICIENCIES The emergency department and theatre suite at Aintree University Hospital have been extended to improve the patient experience and drive clinical efficiency. Tilbury Douglas has completed a £20.5m expansion for Liverpool University Hospitals NHS Foundation Trust, creating a new two-storey extension with hybrid operating theatres, improved assessment areas, an enhanced radiology department, and improvements to ambulance drop-off bays on the ground floor. And a new Stroke Emergency Assessment Unit ensures patients are swiftly assessed using the CT scanner, so treatments are administered as soon as possible to ensure the optimum recovery outcome. Phil Shaw, divisional director for the North West at Tilbury Douglas, said: “These new facilities will enable health professionals to deliver the care that patients deserve in a space fit for purpose with an enhanced layout. “This will allow them to manoeuvre more quickly, driving clinical efficiencies and enhanced patient care for the local community.” www.tilburydouglas.co.uk A 32-bed short-stay ward is being created above the existing Northwick Park Hospital A&E department in one of the most-complex build programmes ever undertaken by modern methods of construction (MMC) specialist contractor, MTX. More than 50 structural steel modules manufactured offsite will be used to construct the new ward on a steel deck installed on existing concrete stub columns that were part of the original A&E department build. The challenging location in the middle of the busy hospital site requires the use of the UK’s largest crane to lift the modules into place and MTX is currently constructing additional site infrastructure including high-strength concrete foundations and piling to support the massive piece of equipment. A pedestrian bridge is also being built over a busy road to enable access to the build location for construction workers. In addition, the project also includes designing and installing mechanical modules pre-manufactured offsite to control the ventilation and the environment of the wards, with a dedicated integrated plant facility provided within the new building as part of the M&E specification. And the first floor will link to the existing hospital buildings via a 20m-long suspended connecting corridor. This will also link to two existing stairwells to provide access for staff and visitors. The £20m development is designed to enhance the quality of care provided to patients and is part of an NHS England initiative to meet the growing demand for general and acute beds across the country. www.mtxcontracts.co.uk Challenging project will address growing demand
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18 healthcaredm.co.uk PROJECTS Day unit transforms paediatric services As the new Evelina London Children’s Hospital day treatment centre opens its doors to patients, we look at the key drivers behind its design The building is clad with a panellised rainscreen system. IMAGE, EDWARD BISHOP The completion of the new six-storey day treatment centre at the Evelina London Children’s Hospital marks a step change in the way paediatric care is delivered. Designed by ADP Architecture and built by Morgan Sindall Construction, the new centre, situated on the St Thomas’ Hospital site in Lambeth Palace Road, increases the number of children the hospital can treat each year by more than 2,300. And waiting times will be reduced thanks to a seamless same-day patient journey - with everything from pre-surgery checks to post-op recovery co-located in one purpose-built space. Located on the ground and first floors is the new day surgery unit which has been designed to enhance the patient experience for young people and their families. It provides two new operating theatres and specialist clinic facilities, including the latest child-focused technology and equipment. It also houses an admissions area, first- and second-stage recovery unit, and discharge facilities, along with clinical support spaces. And patient flow was a primary design driver for the surgical unit, with the interior mapped out as a one-way system, whereby patients being prepared for, and entering, theatre do not cross over with patients post-op or as they move into recovery and same-day discharge. CHILD’S PLAY In the admission area, a contemporary play area is designed to entertain young patients and reduce anxiety, and the centre includes well-observed second-stage recovery rooms for young patients - ranging from early years to teenage - as well as supportive spaces for accompanying family members. On the second floor there are designated spaces for staff rest and relaxation away from the clinical setting - as well as changing rooms and flexible spaces for meetings and training. Overcoming the restrictions of inserting a new build within a constrained site, the design solution utilised modern methods of construction (MMC) techniques. The building’s steel frame is clad with a single-aesthetic panellised baguette rainscreen system, providing both solar shading and privacy from neighbouring buildings. Sitting between the original red-brick Victorian St Thomas’ Hospital South Wing and the contemporary Evelina London Children’s Hospital East Wing, the new building mediates between the two with a modern terracotta façade. THE ART OF DESIGN Hannah Brewster, regional healthcare director at ADP Architecture, explains: “Working with young people, NHS staff, and other building users, we designed the new building to reflect both its heritage context and the adjacent highly-functional and child-friendly Evelina London. “The simple building form and coherent elevation design sit comfortably next to its contemporary neighbour, while providing a clean backdrop for the more-decorative South Wing.” The interiors of the centre, including colour, graphics, and wayfinding, were consciously designed in collaboration with art consultant, Art in Site, and the Guy’s and St Thomas’ arts team, to create an inclusive and engaging environment for children, and a calm and reassuring space for families. An outer-space theme was chosen by staff and patients to continue the narrative of the natural world theme of the Evelina London. And Japanese manga artist, Kiriko Kubo – who has previously designed award- The hospital can treat an extra 2,300 children a year. IMAGE, GARETH WALKER Colours were chosen in conjunction with children and their families
healthcaredm.co.uk 19 PROJECTS The artwork and colour schemes complement the natural world theme of the main hospital winning artwork for Evelina London – reimagined original designs by children to create 82 space-themed pieces, featured throughout the building. The building was also designed to be fully accessible, with level thresholds at all external entrance doors, accessible WCs on all floors, door widths which allow for wheelchair users, and visual and colour contrasts designed for those with sensory impairments. In addition, the building was designed to be easily adaptable and fully versatile to respond to future NHS need, which is set to change and evolve over the coming decades. PART OF THE FAMILY Brewster said: “A key part of the brief was for the building to be separate from the main Evelina London’s Children’s Hospital – to both improve the overall experience of patients and protect the use of the unit as a daycare centre. “Our design ensures the building has its own identity with its own front door, appearing standalone, but with the added support and reassurance of being physically connected to the main hospital. “It is visually coherent through the sensitive use of the terracotta façade and integration of the interior design and artwork to feel very much part of the Evelina family.” James O’Brien, director of operations and improvement at Evelina London and project sponsor, added: “Opening the Children’s Day Treatment Centre is a significant milestone for us in continuing to provide outstanding healthcare for even more children and young people, meeting their needs now, and in the future. “The look on the children’s faces when they enter the building makes it clear how special the facility is and how different from what many people would expect when entering a ‘hospital’.” www.adp-architecture.com www.morgansindallconstruction.com ...An outer-space theme was chosen by staff and patients Space-themed artwork was designed by Art in Site and the trust’s arts in health team Icons courtesy of thenounproject.com
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healthcaredm.co.uk 21 INFECTION CONTROL DESIGNING OUT INFECTION Materials used in healthcare facilities must comply with the appropriate hygiene performance rating and include easy-to-clean surfaces Shraddha Badoni, Senior project co-ordinator and architectural technologist Pick Everard Shraddha Badoni, senior project co-ordinator and architectural technologist at Pick Everard, explores the techniques to improve infection control through better building design Since the pandemic, it would be impossible to deny the existence of a new approach to infection control. The NHS’s healthcare estates were challenged to the ultimate test, leaving the lessons learnt and newfound priorities to continue influencing decision makers today and into the future. Some of those decision makers include those you will find within a multi- disciplinary consultancy, including architects, health and safety designers, and mechanical and electrical engineering specialists, for example. And spatial planning and material specification have come to the fore, while ventilation is now unquestionably higher on the agenda to prevent airborne infection spread. The physical design of a hospital continues to evolve in response to the demands of the medical world. This is being seen in both new hospitals that are exceeding current healthcare standards, and older hospitals that are being retrofitted, refurbished, or renovated. While some of the design choices are clear to the naked eye and can be easily retrospectively added, there are others that are less obvious and require careful consideration if they are to be implemented. However, they all play a role in minimising the risk of infection transmission and maintaining more-efficient healthcare estates. PATIENT FLOW Understanding the way people interact with their environment is a critical design consideration in each and every project we undertake, which impacts spatial planning to a huge extent. In the healthcare sector, each building, its patients, visitors, and staff, have a tailored journey from entry to exit and spatial standards can be improved through creative modelling. Our work with hospitals, home to some of the busiest emergency departments in the country, could not be complete without thorough consultation and engagement sessions, which help us understand exactly how different facilities are used and the architectural limitations to consider. Ways to control patient flow, with infection control in mind, include limiting the number of entrances and providing adequate social distancing space in waiting areas, corridors, hallways, and stairs. The ultimate goal is to maintain a predictable flow, in order to make other
22 healthcaredm.co.uk The design of healthcare buildings can be optimised to encourage better infection control procedures. IMAGE, PETER H FROM PIXABAY Ventilation specification plays an important role in infection prevention INFECTION CONTROL design decisions, such as the location of hand sanitisers and associated facilities, more effective. VENTILATION Enhanced ventilation, whether natural or mechanical, can effectively decrease cross contamination risk of airborne infections. Variance in air pressure and distribution is critical and it is essential to consult the ventilation engineers early in the design process to determine the air flow pattern required, without causing discomfort to occupants or affecting the function of the department the system is serving. Different hospital departments have different ventilation requirements and it is important that initial stakeholder engagement sessions identify what the application is. For example, an infectious disease isolation room requires an air pressure of minus five pascals, whereas a critical care area requires an air pressure of 10 pascals. Ventilation designs must always be co-ordinated with the designs of other disciplines, notably architects and structural engineers. For positive air pressure regimes, advising the architect of maximum air leakage rates from an operating theatre will inform their design of wall linings, lobby locations, pressure stabilisers, and air transfer passages. Advising a structural engineer early of plant loadings and locations will also inform their design. And this is especially important on refurbishments, where the location of proposed plant may have constraints due to the existing strength and structure of the building. Ventilation designs are rigorously reviewed by teams of experts prior to issue and construction. Then, at the construction stage, the installation and system performances are validated with numerous tests and exercises to demonstrate the required design intent has been achieved. Once in operation, the ventilation considerations do not stop, and it is important to monitor the resilience of systems so that any faults with equipment can be prevented. ALL SHAPES AND SIZES All spaces and rooms in a healthcare facility are carefully considered to minimise the risk of infection to staff and patients. Minimal inside corners, with rounded solid surfaces, ensure cleaning can be completed more thoroughly. Horizontal surfaces, such as ledges and shelves, are also being reduced as part of Enhanced ventilation, whether natural or mechanical, can effectively decrease cross infection risk of airborne infections
healthcaredm.co.uk 23 INFECTION CONTROL new design practices, to help prevent the build-up of bacteria and the number of surfaces at different heights. MATERIALS Materials used in healthcare facilities must comply with the appropriate hygiene performance rating and include easy-toclean surfaces. This covers everything found inside a space, from handrails to furniture, and is reinforced by technical standards and guidance found in the NHS’s Health Building Notes. Antimicrobial materials are particularly ideal for healthcare environments as they prevent micro-organisms from growing on surfaces. There is value in material flexibility, too. Look at removable privacy curtains, for example, as these can be replaced more easily and cleaned off site if required. Though some materials are better than others, the key is to ensure that spaces are managed through a thorough longterm cleaning strategy. TACTILE FEATURES Possibly the biggest change since the pandemic is the reduction in the need for physical touchpoints, a benefit for both patients and hospital staff. No-touch technology, like motion sensors, are delivering significant improvements in risk reduction, while building patient and staff confidence, through touchless doors, lights, taps, and hand dryers. Conversely, high-touch surfaces like enclosed cabinetry are being dispensed in favour of no-touch alternatives. Staff handheld devices also create concerns about cross contamination and are being increasingly kept away from patient surfaces, such as overbed tables. We are also seeing designated ‘staff-only’ stations, provided in accessible locations to store equipment safely and make obvious for cleaners which surfaces run greater risk of containment accumulation. HAND HYGIENE Regular handwashing is recognised as a key practise to control infection and reduce contamination. Where possible, individual handwashing stations are being provided in all patient rooms, general wards, and all clinical spaces. To make this effort common behaviour, extra attention is directed to distinct visual cues that enhance desired behaviours among staff and patients. The stations should then be designed to accommodate recommended handwashing procedures, including features such as long-arm taps that enable elbows to be used to operate water flow. Handwash sinks are also being positioned away from staff working zones to prevent splash and cross-contamination, while examination gloves, alcohol-based sanitisers, and bins are placed in easily-accessible positions when entering and exiting patient rooms. CHALLENGING TRADITIONAL DESIGN As humans, we continue to evolve, and our healthcare facilities must continue to meet our needs. While some modern innovations and ways of thinking are born out of unexpected events, like the pandemic, we must all continue to invest time and resource into healthcare betterment. www.pickeverard.co.uk HAND DRYERS BLOW AWAY THE COMPETITION Two of the key issues facing hospitals, and in particular estates and facilities managers, are infection prevention and control and the need to reduce carbon emissions in line with tough government targets. Handwashing regimes in healthcare facilities have become more stringent a result of the COVID-19 pandemic. And, after hands have been washed, drying is an essential next step as it helps to remove microbes remaining on hands following poor handwashing and so reduces the spread of infection in the community. Traditionally, in hospitals, this means investing in paper hand towels and dispensers or using electric hand dryers. It is estimated that £496m worth of paper towels were sold in the UK in 2021 and many of these are found in hospitals and other health and care facilities. But, according to research by manufacturer, Airdri, the use of paper hand towels is adding to hospitals’ carbon footprints, with a single dispenser producing 160kg of waste every year – and as this waste is classified as contaminated, it cannot be recycled and instead ends up in landfill. Their production, transportation, packaging, and storage also have a huge impact on the environment. In contrast, Airdri’s research shows that hand dryers can reduce carbon missions within a building by nearly 70% and can pay for themselves within 18 months. Steve Whittall, chief operating officer at Airdri, said: “Hand dryers use a short burst of energy, don’t need to be constantly refilled, and leave no waste products. “They beat paper towels on the environment front hands down, with electric hand dryers proven in some cases to reduce a building’s carbon footprint by 50%-70% compared to using paper towels. “Paper towels can also cost approximately two to three times more per month than warm air hand dryers and up to 20 times as much as a powerful cool jet air hand dryer, which for any organisation looking at cost-saving measures is a no-brainer.” But he warned specifiers to choose energy-efficient models, adding: “It takes very little energy to dry one pair of hands. However, in public buildings where washrooms are used on a daily basis for many hours, these energy usages can mount up to a substantial expense. “Therefore, exceptional energy efficiency is paramount to ensuring an ecologically-friendly dryer.” www.airdri.com
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