After the Coronavirus pandemic forced most events online during 2020, the healthcare buildings forum returned live to Heythrop Park in Oxfordshire earlier this month.

And, once again, the event provided a crucial opportunity for healthcare product and service suppliers to meet key decision-makers involved in the design and development of health and social care facilities across the country.

Over the one-and-a-half days of meetings and networking opportunities, three speaker sessions were also held, where experts provided an overview of the opportunities and challenges facing the sector after an eventful and extremely-challenging year.

Getting the best from clinicians

Not only has the Government unveiled the biggest capital funding boost for the NHS in a generation; but the COVID-19 pandemic has seen the health sector changing rapidly, with increased adoption of novel technologies and an upsurge in the use of offsite and modular construction methods to help meet the need for new facilities.

The first speaker session kicked off with Alison Cann and Fiona Halstead, clinical compliance specialist nurses at Barts Health NHS Trust, revealing how they get the best from clinical teams when planning the design of new facilities.

They explained how it was vital to get clinical sign off on all design briefs and suggested using a Clinical Output Specification (COS) document, which helps to explain the plans and processes and provide a roadmap for projects.

This plan explores the specific details about current services, patient groups, and how services are likely to evolve in the future.

It also makes sense of room numbers, ventilation needs, and back-office requirements.

“Getting staff to put information into the COS concentrates thinking into what is actually needed,” said Cann.

“Some people get halfway in and realise they want something different altogether.

“It’s a bit like writing down your holiday clothes list and realising you have too many pairs of trousers when you really need shorts.”

This document, once agreed, can then be used by managers to feed the business case on which the eventual construction and design contracts will be based.

Engaging stakeholders

“It saves time, effort and money; means everyone on the user group needs to be signed up to it; and it also means no changes after the sign off,” said Cann.

But she warned that, often, simple things which are vitally important to the smooth running of a health facility can be forgotten and left out of the COS.

These include considering operating hours, how many people will use the building, key functional relationships between staff and spaces, new guidance from governing bodies, and ICT requirements.

Halstead advised ensuring the same people always attend the design meetings for consistency, that there is a person appointed to be responsible for the day-to-day running of the meeting, that infection prevention and control (IPC) professionals should attend regularly, and that sign off is given by IPC managers, planners, heads of service, the project manager, and at least two clinical leads.

She added: “To engage clinical teams in the design process you need to ensure the user group is committed and explain the design and project management processes.

“The writing of the COD needs all users to be in agreement, it must be fully signed off, and it must be seen as the bible in case members of the original user group leave to pastures new.

“But is it also important that it does not become a wish list and is in keeping with what the finances are and where the money is coming from.”

Healthy communities

They were followed by Paul Holt of MAC Consulting who explored the delivery of new homes and the creation of a healthy community within the grounds of Alder Hey Children’s Hospital in Liverpool.

He highlighted the impact of good design on overall health and wellbeing and the need to create communities that support people at every stage of life.

And Luke Smith, EMEA solutions engineer at healthcare cloud security specialist, Verkada, looked at how the health sector will need to further embrace technology if it is to keep up with service demand and evolving clinical interventions, but also protect staff and patients as well as sensitive information.

He focused on interventions including security cameras, access control, environmental sensors, and alarms and how these have been impacted by advancements in technology.

In the second speaker session, Karl Redmond of NHS England looked at how we can deliver the next generation of healthcare estates underpinned by digital technologies.

He said there were currently too many disjointed systems and solutions with limited integration, and which are producing siloed data which is difficult to manage and not conducive to the move towards SMART healthcare buildings.

SMART thinking

What is needed, he added, are fewer ‘best in class’ solutions which are integrated using open and interoperable standards, enabling a futureproofed digital roadmap and producing NHS-owned data.

And he called on construction companies and architects to embrace digital tools such as 3D modelling, Building Information Modelling (BIM), Common Data Environments (CDEs), and the Strategic Energy and Asset Management Performance (SEAM) framework.

This approach can provide vital information on the performance of existing and planned buildings and ensure key targets around things like sustainability, flexibility, and carbon reduction are met.

Cann returned for the second session with colleague, Jessica Shiel, arts manager of Barts’ in-house arts and health organisation, Vital Arts, to discuss how careful design is crucial to creating supportive spaces for people living with dementia.

Cann said: “The benefits of improving the environment of care for people with dementia include reducing incidences of agitation and challenging behaviour, promoting independence, improving hydration and nutrition, increasing engagement in meaningful activities, and encouraging greater care involvement, as well as improving staff morale, recruitment and retention.”

But she warned against common misperceptions on what good dementia design is, with clutter, indoor grass, World War Two-themed imagery, and the overuse of signage and handwritten signs on the hitlist.

Colour is key

“Ageing eyes increasingly require demarcation and contrast to aid depth perception and spatial awareness,” she said. 

“And while the use of colour is important, the specific colour is not as important as some people would have you believe.”

Shiel explained that hue, saturation and tone were more important considerations when choosing an interior design approach.

“Differential is more important,” she added.

“Blues and greens, shades of purple, purple, and brown can all blur together.

“Colour is key when deciding what to do, where – contrasting hues (e.g. black & yellow) are good for highlighting a hazard, while calm spaces, such as bedrooms, are better suited to contrasting tones.

“Use a good 50% LRV difference and THAT will count.”

And they warned against the trend towards using yellow accessories in the belief they stand out more for people with sensory problems.

“Yellow does not stand out well in low light, or at night, so is unsuitable for clocks,” said Shiel.

“Yellow can also be infantilising if not integrated into a well-considered colour scheme and can be interpreted as a ‘hazard’ warning in certain contexts, for example toilets.”

Wayfinding within dementia units can be enhanced through the use of both visual and tactile signage, artworks, and coloured doors, they advised.

And artwork can play a key role, but careful consideration needs to be given to how people travel around a space, how long people spend in waiting areas, whether they are mainly sitting or lying down, and if they would benefit from art that is colourful and distracting or soothing and familiar.

There’s something in the air

The final speaker session looked more closely at how controlling indoor air quality within hospitals has become crucial as a result of the Coronavirus pandemic, and how standardisation within the design of hospitals will help to create a more-flexible and responsive estate.

David Lilley of Estates Strategy Group said indoor air quality had been a long-recognised challenge prior to COVID-19, but had now taken centre stage as a key consideration for estates and facilities professionals.

He said that research by the UK Health Forum and Imperial College London for Public Health England had estimated that a 1 µg/m3 reduction in fine particulate matter (PM) could prevent approximately 50,900 cases of coronary heart disease, 16,500 strokes, 9,300 cases of asthma and 4,200 lung cancers.

And he revealed that opening windows, which has been a key combative measure throughout the pandemic, actually offers no control over ventilation or the direction of travel of potentially-harmful pathogens.

In addition, there is very little firm clinical evidence on the efficacy of many air cleaning technologies against COVID-19.

Instead, the ideal scenario for healthcare buildings, he said, was a carefully-calibrated system that ensures clean, filtered air is brought in from outside, which gently populates the room and circulates the air, and which extracts a proportion of air and filters it on exit.

And he outlined some of the research on the key technologies available and their efficacy, as well as highlighting a lack of knowledge among the healthcare profession on air quality and associated equipment.

The right choice

“Air quality monitoring and control will become a huge focus for the next 3-5 years and rightly so,” he told delegates.

“If you choose the right standalone air purifiers, with proven technology, suitable for your room activities, occupation levels, and size, then air filtration can remove 99.97% of particulate matter from the air.”

And, in the closing speech, Paul Sheldon, a healthcare planner at Archus, explained how standardisation of healthcare buildings would be a major step forward in creating intelligent, flexible hospitals.

These hospitals are designed for sustainability and embrace modern methods of construction and standardisation of design and technology.

The approach supports the delivery of the Government’s Health Infrastructure Plan, which will see 40 new, or updated, hospital projects undertaken over the next nine years.

Commenting on the need for a more-standardised approach, he said it would need to be adaptable to meet all hospital site types and with a floorplate and grid that can accommodate all major services.

“An intelligent hospital is not a ‘one size fits all’ template,” he warned. 

“Instead, it is based on a kit-of-parts approach.”

Key departments where this approach will work best include inpatient wards, operating theatres, imaging facilities, emergency departments, and outpatient units, he added.

Standardising digital design is key too. 

“Healthcare provision should be geared towards pro-active methods, rather than reactive, using data analytics, predictive models and artificial intelligence,” he told delegates.

This includes delivering more-personalised care, ensuring a smooth check-in and registration process, building on the increased use of virtual consultations, and using bedside digital devices for things like meal selection and pastoral support.

An opportunity to industrialise healthcare

Offsite and modular construction methods, which best align themselves with repeatability, can also prove more sustainable, helping the NHS to meet its carbon reduction targets.

“There is an opportunity to ‘industrialise’ the hospital development and construction process and move away from the stop-go capital developments to ongoing modernisation of the health estate,” said Sheldon.

Outside of the three speaker sessions, the forum offered 1-2-1 sessions where commissioners could find out about the latest products and services available from suppliers.

And an exhibition enabled delegates to test out these innovations first hand.

Commenting on this attendance at the forum, Emma Smyth of HDS Architects, said: “The quality of suppliers was, I feel, the best I've experienced. 

“I thoroughly enjoyed the event, and felt I gained a lot from the supplier meetings and networking with other delegates from both sides of the room.”

Andy Vernon of Hoare Lea added: “The speakers were very good with a highly-relevant subject matter. 

“It’s different to all other events that I attend.”

And supplier delegate, Ro Harper of Marcon Construction, said: “I believe there was an extra buzz within the room from everyone simply glad to return to this winning formula of actually meeting great people who are passionate in what they do. 

“Everyone was receptive and engaged.”

To find out more about how you can get involved in the next healthcare buildings forum, contact [email protected] or call 020 8288 1080.