Architects for Health & European Health Property Network Event - How can we do more with less?

1. Hospital Buildings

2. Case Study - Torbay Hospital
Presentation to AfH / EuHPN event
20th May 2013
Duncan Finch

3. A bit of history…

4. Torbay Hospital - 1928

5. Torbay Hospital - 1968

6. Torbay Hospital - 2013

7. PFI redevelopment?

8. A daunting series of challenges…
Problems:
• Highly congested centre to hospital estate
• Layers of ‘improvements’ have degraded the environment
• Short term solutions have become permanent
• Abandonment of PFI redevelopment strategy has exacerbated
these issues:
• there has been minimal capital spending on new buildings for
the last 15 years
• there has been no long term strategy for the existing estate

9. A daunting series of challenges…
Effects:
• Accommodation not fit for purpose
• Fire strategy compromised
• Piecemeal additions result in:
• mixing of circulation flows
• confusing environment,
• doubling-up of services,
• poor and inappropriate adjacencies
• Lack of storage and support accommodation
• Services (AHUs, chillers etc.) spread
• No clarity of ‘front of house’ and ‘back of house’
• Public entrances are hidden by accretion of permanent and modular
buildings
• Maintenance and construction are complicated by congested site

10. Caring for an aging population
• The increasing number of older people as a proportion of
the population is one of the key challenges facing the NHS
• Torbay Hospital is particularly affected by this trend:
• As a proportion of the total population, of all age
groups over 50 are among the highest in the UK
• The Torbay area has the 11th highest % of people over
85 in the UK

11. The potential of integrated care
• In response to the challenge of an aging population,
healthcare organisations in Torbay and South Devon have
collaborated to integrate care
• The Torbay area was selected as one of 16 integrated care
pilots by the DoH
• Ongoing plans to further integrate care
• In Torbay, integrated care has focused on:
• Prevention of admission of older people to hospital,
• Enhanced discharge planning,
• People in nursing homes with COPD and CCF
• Services for low level dementia
• A smaller, more efficient acute hospital is envisaged,
working in close partnership with community health and
adult social care services

12. Experience of similar sites

13. the importance of the public face

14. welcoming, light and easy to use

15. designing for health and wellness

16. Our approach

17. Site analysis

18. Site analysis - slope
+75.57m
34m total level change across site

19. Detailed level study - existing

20. Detailed level study - Level 4 entrance

21. Detailed level study - Level 3 entrance

22. Site context

23. Site context

24. Site context

25. Site context - new main entrance

26. Site context - new main entrance
View from approach

27. Approach to Main Entrance

28. Main entrance and drop-off

29. Site context - views out
Views from new tower

30. Site context - views out
Views from existing wards

31. Landscape design
1 Drop off with Torbay palm colonnade
2 Courtyard provides views from main
entrance and emergency waiting
3 Green heart – healing garden providing
green access and views
4 Existing trees retained
5 Green roof to canopy
1
3
4
5
2

32. Building section

33. Building diagram -
Roof

34. Building diagram -
alternative organisation

38. Level 3 - Main Entrance

39. Level 3 - Phase 2 Emergency Department

40. Level 3 - Phase 2 Emergency Department

44. Level 4 ICU
• Standardised bays
• Daylight and views
• Observation

45. ICU nursing zones

47. 1 Privacy curtains
2 Glazed screens with
interstitial blinds
3 White board
4 Clinical station
5 Daylight and views
6 Pendant services
ICU bed space
1
2
3
4
6
5
6

50. Levels 5 to 8 - Wards
• 14 single bedrooms
• 4 three bed bays
• 54% single bedrooms
• Multi-bed bay layout provides optimum
standardisation, quality and space efficiency
• Alternative option with 2 three bed bays
and 1 four bed bay achieves 61% single
bedrooms

51. Wards - daylight and views

52. Wards - day and dining room

53. Evidence-based design for older people including those with
dementia

54. Acoustic design for older people including those with dementia
• Acoustic design will minimise
unwanted sound and ensure
good speech intelligibility
• Acoustics will support privacy,
dignity and independence
• Reduce risk of falls arising out
of a noisy, unfamiliar setting
• Reduce risk of challenging
behaviour increased by a noisy
and over-stimulating
environment
Hospital wards are amongst the most noisy and busy of all care
environments.
People with dementia can experience a great deal of distress and
disturbance in hospital wards … often just related to the experience of
being in an environment which is over-stimulating and, as a consequence,
over-whelming.
University of Stirling Dementia Design Series

55. Lighting design for older people and those with dementia
• Natural light and external
views will promote the well-
being of both staff and patients
and support Circadian rhythms
• Sudden changes of light level
and glare will be avoided by
the use of modified glass,
curtains or blinds
• Appropriate visual contrast will
be provided throughout
• Increased levels of artificial
light, including softer indirect
light, will benefit older
people and those with visual
impairments
• Innovative lighting and
carefully selected artworks
will enhance internal spaces
• Special light panels will
reduce the impact of SAD
and increase natural
production of vitamin D -
particularly low in people
with Alzheimer’s
• Higher levels of vitamin D
are shown to reduce falls

56. Interior design for older people and those with dementia
• Handrails and small seating
areas will enliven corridors
• Views to landscaped external
spaces, artwork and placed
objects will support intuitive
wayfinding and signage
• Non-contrasting floor finishes
and flush thresholds will
promote safe, unimpeded
mobility
• Multi-sensory design
addressing hearing, sight,
touch, smell and kinesthesis
(muscle memory)
• Unobtrusive safety measures
that allow patient
observation while preserving
privacy and dignity
• Design features to aid
independence and maintain
functional abilities,
particularly important for
dementia patients
struggling to maintain their
sense of self in unfamiliar
surroundings

59. 1 Glazed doors with privacy
option
2 Patient wardrobe
3 Clinical station
4 Fully accessible en-suite
5 Daylight, views, ventilation
6 Bedhead services
Single bedroom
1
2
3
4
6
5

60. 1 Glazed doors with privacy
option
2 Patient wardrobe
3 Clinical station
4 Fully accessible en-suite
5 Daylight, views, ventilation
6 Bedhead services
7 Touch down base with
clear view of patients
3 Bed room
1
2
3
5
7
4
6
3
5
5

63. Triple glazed window with interstitial blind
Timber window system
with aluminium external
capping
Side hung window,
fully openable for blind
maintenance and cleaning
High performance fixed
double glazed unit
Adjustable blind in gap between
fixed and openable units.
Blind automated for solar control
on west elevation only
High thermal
performance
0.91
W/m2K approx
Provision of a
blind system that
is easy to maintain
and meets
infection prevention
requirements

64. Concrete flat slab
Brick (panelised system)
Low window sill to suit
viewing angle from bed
Adjustable ventilator
250mm high
service zone
Construction and Environment

65. Environmental control of bedrooms

66. Access - during construction

67. Access - during construction

68. Access - new tower and entrance complete

69. Access - final condition

70. Enabling works

71. Enabling works build new Hetherington entrance

72. Enabling works demolish old Hetherington entrance

73. Enabling works modify outpatients entrance

74. Enabling works provide temporary Level 4 link

75. Enabling works demolish existing main entrance

76. Enabling works provide temporary minors unit

77. Enabling works demolish existing emergency minors

78. Enabling works re-model endoscopy portakabin

79. Construction site cleared for main construction phase

80. Construction construct new ward and ICU block

81. Construction construct main entrance & canopies

82. Construction construct drop-off & external works

83. Construction completed phase 1 works

84. Construction demolish temporary minors

85. Added Value
• Potential early delivery of Emergency Dept
improvements
• Enhanced Emergency Dept and co-locations
• Facilitates future change:
• Frees up of the refurbishment ‘jigsaw’ for the next
phase
• Space made available for enhanced assessment
facilities
• Day case improvements made more straightforward

86. Timelines

87. • Wholly delivers
clinical brief
• Bespoke
• Accessible
• An all ages internal
environment
• Comfortable,
simple &
sustainable
• Safe
• Deliverable
• Affordable
• Added Value