As the push towards greater integration of health and social care gets underway, the challenge is on to provide more patient services within the community to reduce the over-reliance on the acute hospital. Trusts are going to need to think differently about how and where they provide services, the space they need to do this most efficiently, and what other services could - and should - be co-located and integrated, sharing the space and providing a more cohesive service to patients.
More flexible and efficient use of space has been moving up the agenda for the NHS for a number of years, but to create the transformation in healthcare that the Government wants the NHS to deliver it isn’t going to be enough to simply re-allocate under-utilised space within the hospital to another function, a complete re-think is necessary.
As IBI Group’s Tim Kilpatrick (Architect and Studio Associate Director) explains, speaking at Healthcare Estates at the end of last year: “This future trend involves a shift towards a service model involving more care out of hospital settings and closer to people’s homes.” This was reiterated in the Long Term Plan, which pledged to create “fully integrated community-based health care” for the first time within the NHS, with community hospital hubs playing an important role.
IBI Group has been involved in a number of projects taking an innovative approach to the allocation and use of space through the creation of Integrated Health Hubs, Locality Hubs, or Health and Wellbeing Centres. Each project is unique, however, what they have in common is a focus on the provision of community healthcare with fully integrated services that prioritise preventative healthcare and promote self care. They also introduce enhanced primary care services with a wider range of disciplines and move services out of the hospital setting and into the community to provide better care for patients.
Crucially, these projects bring healthcare together with other community services as different stakeholders work together to provide healthcare, education, training, or community housing and local authority services from multi-purpose, flexible and non-owned spaces.
“Each one is different and driven by the local needs,” says Justin Harris (Architect and Global Healthcare Deputy Lead with IBI Group). “There is no template. It comes down to the local estates programme in each area, driven by the healthcare strategy; these projects are great examples of local partners working together at the highest level.”
Examples
A typical application would involve multiple primary care practices moving into a single location together and then adding support from a range of services, including community nursing, neighbourhood teams, mental health teams and hospital outpatient services. Other supporting services might also be located in the space, reflecting community needs, for instance, housing services and leisure facilities.
The concept promotes a wider approach to wellbeing and involves a more inclusive nature of the use of space and facilities. It aims to move away from the current model where a room may sit empty for many hours of the day because the organisation that leases the space only needs it for a few hours in the morning.
Tim Kilpatrick provides a few examples. One scheme currently in development includes a GP practice, social care, out-of-hospital services, library, education, and training, all fully integrated. The scheme will contribute to the wellbeing of local people and provide a new community asset.
Similar schemes across South Wales are focused on empowering people and supporting them with the provision of new acute facilities, community healthcare projects and non-medical applications involving multi-disciplinary teams.
One area of increasing examination in projects is the nature and use of traditionally defined consulting room spaces, drawing upon evidence that in many instances the activities that take place in a traditional consulting room do not require a traditional couch. Re-imagining space to focus on the type of activities that take place begins to open up more opportunities for flexibility in use of space and increased occupancy by a wider range of stakeholders, leading to a greater consideration of more interview and group room type facilities.
Additionally, more interactive spaces and collaboration zones are being included. These support the integration of staff and services, and allow more space for creating therapeutic and relaxing environments.
These projects do not have to involve new-build. Part of the planning process should involve identifying surplus existing estate and assessing whether it can be re-purposed.
Making the asset work
“The premise is to drive down dedicated space to release the possibility of sharing more space,” confirms Tim. To achieve this requires more than simply the provision of a building, it requires a different management and organisational approach.
Those occupying the building will need different leasehold agreements that do not tie them to a specific space that they ‘own’ whether they are using it or not, because the space itself will be flexible. Managing that space will require a digital solution that tracks usage and interfaces with a scheduling system for room management. “Conceivably, it could be like booking a cinema ticket,” says Justin, adding that IBI Group finds this area of opportunity exciting.
‘The aim is also to make the asset work 24/7 so it is also available in the evenings and weekends for use by community groups, for instance, and other stakeholders. The aim is to not just co-locate but properly integrate,” confirms Tim.
Lessons and opportunities
These emerging schemes are pioneering a new way of looking at space. Integration is fundamental to the success of any project, with an integration group established to assess operational issues in detail prior to occupation. This also helps the design to emerge.
Challenging space conventions is also essential. For example, HBN 11 indicates that a consulting room should be 16sqm – but is that really necessary when talking can be as much as 70% of the activity that takes place in these rooms?
This is an opportunity to re-think the use of space with a view to delivering new types of facilities that are able to respond to consumer demands and provide flexibility in use, with limited specialist spaces.
Tim concludes with a question: “Is there an opportunity to develop solutions that respond to future healthcare where the premise is ‘we are well’?”
Image of Bolton One, an NHS wellbeing centre and community leisure centre.
