Life After Covid: How the pandemic could change our approach to healthcare design

“Unfortunately both nurses and medical men, as well as medical students, have died of zymotic diseases prevailing in hospitals. It is an all-important question to decide whether the propagation of such diseases is inevitable or preventable.” Notes on Hospitals – Florence Nightingale

Pandemics aren’t new, but they’re rare, and rarely have we had such insight into the workings of the NHS. As a nation, we’ve been a fly on the wall of hospitals across the UK, watching medical staff at work and responsive environments being built, rapidly, in challenging circumstances.

In local communities, we’ve re-engaged with the crisis in our care homes: the ‘social care challenge’ of managing frail elderly people in residential care, or those with learning difficulties requiring specialist support.

There have been notable challenges, as ADP’s Health Sector Director Chris Thornton comments.

“Trusts reacted to the pandemic in several ways. Many were able to refocus teams on strategic projects, ensuring long-term plans weren’t derailed, while areas flagged for refurbishment were released to create space for COVID-19 patients.

“Hospitals that previously cut space standards found it harder to adjust: there simply wasn’t the room to add in critical dividers to minimise cross-contamination.

Trusts who had taken a more flexible approach to space found it easier to adapt, turning multi-bed wards into single-bed spaces. Health Building Notes came into their own and it was an interesting realisation for teams planning on the ground.”

So, while construction stuttered in every other sector during lockdown, healthcare stayed ‘healthy’.

For the ADP team, work on key projects for Guy’s and St Thomas’ NHS Foundation Trust in London has continued at pace. A contractor has now been appointed to deliver the first stages of a hybrid facility, co-locating departments from the Evelina London Children’s Hospital on the St Thomas’ Hospital site and research teams from King’s College London in the heart of a health campus, enhancing services and facilitating larger, strategic projects.

The team was also involved in another specialist COVID-19 scheme, exploring the design of temporary step-down facilities for patients discharged from hospital and not yet ready to return home.

Chris notes,

“As our understanding of the virus is evolving, demand for this new type of facility is emerging.

COVID-19 patients have uniquely challenging, complex issues, and a recovery period unlike any virus we’ve experienced before. Complete recovery is a long process, potentially 6–12 months for some patients, and requires specialist continuing care.”

Unlike Nightingale facilities such as Sunderland and ExCeL London, patients here are ambulatory: spaces need to allow for safe independent movement and rehabilitation.

Other considerations include:

• The need for higher staff/patient ratios, and facilities such as bathrooms and showers which have not been needed in intensive care Nightingale units.
• Integrating continuing care services for planned onward recovery at home or in care.      
• Complexities of patients with ongoing conditions and treatments such as renal, oncology and mental health issues.

Beyond the immediate crisis, what does this mean for our health sector? More funding, adjusted priorities and perhaps thinking differently about what makes a good healthcare environment?

Looking through the lens of an architect, the team has several recommendations.

• Focus on flexibility: Hospitals with the ability to flex bed spaces – male to female or speciality to speciality – are inherently fitter for purpose when priorities change. Considering this within the whole-life value/cost of a project could lead to greater efficiency in the longer term.
• Re-evaluate the scale and purpose of emergency departments. The recent drop in attendance raises concerns about patients ‘staying away’ when early diagnosis and treatment could save lives. Reduced participation in high-risk activities undoubtedly had an impact, but in the longer term, the pandemic could accelerate a rethink of emergency care design, and be supported by a reallocation of funding to provide focused, specialist and integrated community health solutions.
• Integrate health and social care facilities within town centre regeneration. Much of the groundwork here is already done – the gap in services was evident, but funding was challenging without a meeting of civic, NHS, community, and commercial minds.

When these minds meet, intelligent development happens.

At Gloucester Quays, ADP is on site with a local authority-funded mixed-use community health development. The three-storey building relocates the two health centres, combining GP surgeries with a pharmacy, office space and ground-floor parking. The project is one of several regeneration schemes helping to transform Gloucester, and will support 18,000 patients in the city with a growing range of healthcare needs.

Bringing health to the high street through the delivery of linked services, such as orthodontics and health education, widens access to health services in local communities – particularly for patients below the poverty line.

Further opportunities include integration of health and wellbeing facilities such as leisure and community centres, to enrich and complement the healthcare environment.

• Raise the bar for elderly care. Care homes should be centres of excellence, and not just meet minimum standards. Repurposing buildings with strong links to the community and surrounding landscape can significantly improve resident wellbeing.

In Dundee, ADP is working with private developer Consensus Capital, converting a former hospital into a 70-bed residential facility catering for elderly, elderly care and specialist dementia patients. Particular care has been paid to the layout, providing protective spaces both internally and externally within a beautiful, mature setting.

Chris concludes,

“ADP’s approach to healthcare has always been patient-focused with a holistic approach to wellbeing. In the rapid timeline of COVID-19, the need for capacity has trumped thoughts around patient and staff environments. With long-term recovery periods, the need for agility and flexibility in delivering diverse complex clinical services comes to the fore. We must focus on building users now, more so than ever.”