Unique design enables observation - Healthcare Design & Management

Unique design enables observation

hdm editor, Jo Makosinski, speaks to the team behind the design of the new NorthWing at Altnagelvin Acute Hospital in Northern Ireland

Located in the Waterside area of Derry, Northern Ireland, Altnagelvin Hospital was the first acute medical facility to be built under the NHS after the Second World War. The original landmark nine- and 11- storey tower blocks, which were completed in 1960, housed the treatment and ward accommodation and, as the tallest building in the city, set a precedent for the subsequent development of high-rise acute hospitals throughout the UK until the early 1970s and the advent of low-rise configurations. The surrounding hospital site developed over subsequent years, changing to meet the operational needs of the hospital. And, since 2000, the Western Health and Social Care Trust (WHSCT) has been working with HLM Architects to establish and implement a Development Control Plan, which would allow the original 1960s tower to be refurbished as well as providing cohesion throughout the hospital site by means of orientation and wayfinding. The latest project to be delivered is the new £42m North Wing. Originally due to complete in June 2020, the building work was advanced to meet the need for additional capacity during the COVID-19 pandemic.

A cohesive approach

Opened in April 2020, the development created a new entrance and 144 single en-suite rooms for inpatients. Development of the existing connections, both externally and internally, was paramount to the success of the project. The creation of ‘hospital streets’ over the ground and first floors links the new building to the existing South Wing, tower block, nucleus, and daycase unit to the west and the North West Cancer Centre to the east of the site. These pathways help patients, staff, and visitors to move easily through the site while also significantly reducing travel times. In addition, the provision of a public route at ground-floor level, and a private patient transfer route on the first floor, improves travel times and optimises infection prevention and control. Nicola McKay, HLM director for Belfast and Dublin, explains: “We have been designing new buildings for the Altnagelvin site for several years and the purpose of this project was to decant ward accommodation from towers, which were Nightingale ward style, to 100% single-bed, en-suite rooms.”

Making an entrance

A key requirement of the project, the new North Wing main entrance rationalises the entrances, which were previously multiple, improving patient safety and security while aiding orientation throughout the site. It is one of the most-significant aspects of the new build, with a four- storey curtain wall that floods the atrium space with natural light and reinforces a sense of transparency and welcome. The granite-clad portal identifies and sets the architectural language for the main entrance and ward accommodation which sits behind this, and forms a cohesive relationship with the other buildings across the site. Inside the main entrance is a café, shop, public toilets, and reception, with patient services, administrative support, and sitewide management services located at first- and second-floor levels. The reconfiguration of the road layout rationalises access and links directly to the recently-completed multi-storey car park, with public drop- off, pick-up spaces, and bus stops located adjacent to the main canopy. “The overarching aim of the brief was legibility and ease of access and to provide a state-of-the-art facility which meets modern healthcare standards,” said McKay. “It was quite a constrained site to work on with a number of challenges, including a steep gradient. “But I think we have created a landmark building which brings the whole site together and provides a strong identity”.

A unique solution

One of the biggest challenges for the design team was to ensure observation of all bedrooms from the central nursing bases. And this led to a unique solution. “There are a lot of older patients coming into the hospital who have dementia as an underlying condition, so having a dementia-friendly design and ensuring observation was key,” said McKay. “We used a lot of the principles from Stirling University’s Dementia Services Design Centre and set out to maximise effective lines of sight. “The primary design concept, and the basis for the eight-bed cluster arrangement, was the ability for every bedhead to be visible from the staff base. “Combined with ward support facilities and the use of ICT and communication systems, the layout provides flexibility in ward sizes to meet changing demographics. “Because there are six eight-bed clusters, wards can be 16, 24, or 32 beds, ensuring both clinical and support services are integrated in a manner which optimises functional relationships and maximises space utilisation – all within an aesthetically-pleasing and cohesive environment.”

Maximising observation

The design of each cluster includes two bedrooms which are offset, achieving 100% observation from the central nursing station into all eight bays.

Kevin O’Neill, project architect at HLM, said: “We are really proud of how this cluster layout came together. “The way we have designed the clusters means observation is maximised and, with the two rooms being offset, it also works very well in terms of how the building looks externally, helping to articulate the façade. “The placement of the bedhead services and en-suites within each of the rooms was deliberate to maintain sightlines and maximise observation at all times.” The project also included a landscaping and arts programme: “The landscape strategy integrates the new main entrance and multi-storey carpark into the wider site context,” said O’Neill. “Consideration for site zoning ensured legibility of the arrival space, including the creation of a green corridor and cycle path, and a new continuous pedestrian route around the southern and eastern edges, which links the new main entrance, outpatients’ entrance, and daycase unit to the hospital site entrance on Glenshane Road.” And, as part of an extensive arts and wayfinding strategy, the ‘Princess Macha’ statue, by FE McWilliam, was relocated from the centre of the roundabout near the approach to the hospital into the new entrance hall. Another key aspect of the entrance atrium is the return of the ‘Altnagelvin Mural’. Designed for the hospital by William Scott, it has pride of place above the reception desk following many years on loan to the Ulster Museum.