Just because it’s a hospital, it doesn’t have to be institutional-looking or a turn-off for would-be patients. Pamela Buxton looks at new moves in the provision of healthcare buildings, and what may be ahead for the sector
Sixty-five years after it was founded, the NHS is under pressure like never before as it struggles to respond to the impact of an ageing population. We're all now expected to live into our mid to late 80s - approximately 10 years longer than 50 years ago. Huge changes are afoot in funding and service provision, and the role of design within hospitals will be fundamental to how these affect patients, from the rise of single-bed wards to the idea of NHS hospital 'hotels'. And what of smart mobile technology - how could that revolutionise the hospital experience in the future?
Outsized play items at the Royal London include a walk-in TV set and a part-sunk hideaway space in a world globe Photo credit: Tom Cronin
Below, we get the long perspective from Mike Nightingale of IBI Nightingale, who has been designing for health clients for more than 40 years. We talk to him about the many changes he's seen along the way, and then go on to look at some of the fresh and witty design thinking taking place in healthcare environments today, plus the crossover of ideas to healthcare from the other sectors such as the workplace and hotels.
The long view
As someone who's worked in the health sector since beginning his career in the early Seventies, Mike Nightingale has seen it all - public, private, UK, international, building up his own health design firm Nightingale Associates and since 2010, operating as part of the huge Canadian design, infrastructure and systems group IBI.
'The client has changed so much. Thirty, 40 years ago central government would produce the briefs and regional health authorities would hire the architects. Now, since PFI, architects work for consortia led by contractors so have a double-headed client [contractor and hospital client].'
'We've had to learn to work in consortia with contractors. But in the private sector we're still working traditionally with clients,' he says, adding that although design could be the differentiator between the consortia bids, the PFI system did not encourage design innovation because it was so risk adverse by nature.
Mike Nightingale, designing for healthcare clients for more than 40 years
Nowadays, as one of the biggest hospital building programmes ever in the UK comes to an end, there is a lull in the domestic market as spending is cut. 'Normally when there's a squeeze on the public sector, the private sector flourishes. but the UK market is pretty flat at the moment,' he says.
As a result, IBI Nightingale is currently concentrating more on its international work as well as proactively developing new opportunities through research arm IBI Think. One such venture is the BedPod (pictured below), a prefabricated bed unit developed with Billings Jackson Design and SAS International, which won a £25,000 award in the Design Council's Design for Patient Dignity Challenge. BedPod is designed to improve patient dignity by giving patients more control over their immediate environment. It includes better patient controls for lighting, plus a modesty curtain that allows patients to select to be either completely secluded, or to open the curtains without getting out of bed so that they can interact as part of a larger ward.
The concept is now installed in two NHS hospitals for evaluation, and Nightingale believes it has great potential for quick, cost-efficient roll-out during hospital refurbishments. 'Installing the BedPod doesn't disrupt, is done in a tenth of the time at a tenth of the cost. It's very good value for the client,' he says.
Looking to the future, Nightingale is excited about the cross-fertilisation prospects of combining mobile phones and intelligent systems in health applications in a 'smart hospital'. Externally, this could lead, for example, to a car-parking system where vehicles entering the car park are directed to a free space.
But the biggest impact would be in the hospital, where waiting areas would be freed up because those waiting to be seen would be sent a message half an hour or so before they were due to be seen, allowing them to spend the time leading up to it wherever they want. 'It's time for people to think and get some innovation going for when things pick up,' he says.
With so many changes afoot, such as the huge issue of whether and how to maintain the traditional concept of the NHS, the key challenge for designers is how to create something that is timeless and flexible enough, with a universal appeal so that it can adapt to changing future needs.
Nightingale anticipates more crossover between NHS and private heath sectors. For example the Monefiore Hospital in Brighton (see cast study) is a private hospital but will, says Nightingale, sometimes provide services for the NHS. So although the hospital has an environment akin to that of premium hotels, it must not seem off-putting to any part of the population.
After all this time, Nightingale is happy to keep tackling the new challenges of the changing health design landscape. 'It's so rich and broad and interesting. I'm a complete addict,' he says.
Playspaces at Royal London Hospital
Architecture: Cottrell & Vermeulen
Graphics: Morag Myerscough
With giant furniture and a television you can walk into, the new indoor play space at the Royal London Hospital provides a fun environment for child patients and their siblings to enjoy away from the more medical setting of the ward.
This double-height, 12m x 15m playspace was created on the seventh floor of the hospital by architecture practice Cottrell & Vermeulen, which also designed an external playspace as part of the same project.
Photo credit: Tom Cronin
The indoor room - known as the Ann Riches Healing Space - plays with the idea of domesticity by installing out-sized pieces that create different play settings. A submerged wooden dome, decorated with a map of London on the outside, provides secluded seating on the inside, and the space also contains a giant lampshade, tepee, chair and TV set, all created by Paragon Creative. The TV can be used for screenings and interactive games, with a blue den inside it providing a more secluded gaming zone.
'We're dealing with the home environment in an other-worldly way,' says project architect Maria Westerståhl, who said the priority was to create a variety of spaces to inhabit interspersed with moments of detail.
The room is enhanced by graphics by Morag Mysercough, who created an animal wallpaper design and animal characters in collaboration with her mother, textile artist Betty Fraser Myerscough. Their characters populate the room in giant form and are also animated in an interactive game, created by artist Chris O'Shea. Myerscough also created colourful giant spinning tops and a projection for the floor beneath the lampshade.
All areas are accessible for wheelchairs and hospital beds as is the outdoor play space, where the architects endeavoured to introduce as much natural materials as possible given the constraints of weathering and windloads. Here they took a flat-roof site and created a gently undulating landscape to enhance the views over London. A partially covered timber pergola-like structure unites the space, with a treehouse in one corner covered in wood shingles. There is a raised stage area with lighting and power source for music, a steel and PVC patterned tepee, other seating, planting and a mini allotment.
All materials had to be brought up in the passenger lifts. This led to modular structures with units of no more than 2.3m in length.
Burrell Street Sexual Health Clinic, London
Design: Urban Salon
Two railway arches at Bankside have been converted into the Burrell Street Clinic Photo credit: Gareth Gardner
When Guy's and St Thomas' NHS Foundation Trust commissioned the UK's first open-every-day sexual health clinic, it was keen to work with designers and architects from outside the healthcare sector to bring a fresh perspective to this taboo subject. Urban Salon, best known for its retail and exhibition design, won a limited competition for the project and has tackled the tricky brief with aplomb - and a touch of innuendo.
The challenge was to create a welcoming, relaxed environment that would encourage use of the clinic and ensure that clients were at ease, but at the same time respect their privacy. Rather than being sited in a hospital complex, the clinic occupies two railway arches in Bankside, and is a huge contrast with the institutional quality of many in-hospital clinics. 'People [coming to the clinic] are in a heightened state of emotion,' says Urban Salon's Alex Mowat. 'We have to provide a welcoming, calm environment.'
A communal table and more separate seating is provided in the waiting space Photo credit: Gareth Gardner
Every stage of the client's journey through the clinic has been designed with this in mind, from the booking in to the consultation and examination process. At reception, a cafe-style waiting area features colourful seating and a long communal table as well as seating for those who prefer to sit apart. Magazines and coffee add to the relaxed ambience. An opaque vinyl 'fog' applied strategically to the double-height window ensures privacy for those waiting, but allows passers-by limited glimpses of the colourful reception.
Some of the artwork that has been deployed throughout the clinic, adding a light touch to the ambience Photo credit: Gareth Gardner
To increase daylight views at either end of the site, the designers created two double-height circulation slots the length of the space - one in each arch unit - and cut through the central dividing wall in two places to unite the two and create a continuous circulation loop. Off this route are 16 consultation rooms, eight in each arch, with a lab visible at the rear of the right-hand arch. The first floor mezzanine contains a 112-seater presentation room and staff office, with a break-out space overlooking the waiting area.
Some of the artwork that has been deployed throughout the clinic, adding a light touch to the ambience Photo credit: Gareth Gardner
To keep down noise and echoes, the space has a perforated acoustic lining throughout. Doors to the consultation rooms are covered in blackboard laminate so that staff can chalk up their names when they are using the room in a step away from more formal name plates.
These consultation spaces are long and narrow, which the designers turned to their advantage by using a sliding door to divide each into a relaxed consultation area at the front with the clinical examination area - which not all clients will use - beyond. Examination equipment likely to increase stress levels, such as rubber gloves for example, is therefore kept out of sight until needed.
Some of the artwork that has been deployed throughout the clinic, adding a light touch to the ambience Photo credit: Gareth Gardner
Where the clinic scores most highly is its witty use of art, which not only visually embellishes the space but provides a distraction and talking point that contributes to the relaxed ambience. Large-scale vinyl illustrations by Alison Dring adorn corridor walls and the ceilings of examination rooms, inspired by colloquial terms for sexual organs - hence a giant cat and the crown jewels.
'This brings out the humorous side of sex, which lightens the mood a bit,' says Mowat, adding that staff take their lead from clients who may or may not get the various references and want to comment on them. Continuing this theme, mobiles inspired by the form of sexual organs hang in reception, designed by artist Arnold Goron.
The perforated acoustic lining applied to walls and ceilings Photo credit: Gareth Gardner
Even the signage is treated more informally than is usual in healthcare environments. Functional graphics with a friendly tone of voice for everything from mop cupboards to drop-off point for samples were created by Martin McGrath. These are implemented using a 17-colour palette created by Goron.
Feedback has so far been positive, with the hope that the non-institutional design will help encourage a higher take-up of the clinic's services in an area with an above-average prevalence of sexually transmitted infections.
Montefiore Hospital, Brighton
Architecture & design: IBI Nightingale
The crossover between hospitals and hotels is clear at the Montefiore in Brighton, a private hospital featuring artworks by Brian Eno and a stylish reception more akin to a boutique hotel than a healthcare facility.
The reception is more hotel than hospital Photo credit: Richard Chivers
Montefiore, run by the Spire Healthcare, is a 21-bed hospital occupying a century-old former furniture depository-turned-call centre. It was converted to its new hospital role by IBI Nightingale in a £35m project that retained and refurbished the neo-classical facade but extensively changed the building internally, adding a new steel frame and staircases and ensuring level access throughout each of the four and a half floors.
The overall aim was to create a serene, calm hospital environment, according to IBI Nightingale's Richard Richard Ager. 'The volume of the Victorian building was exploited to the max. We had the luxury of space where we could exceed design guidance,' he says.
All paitent rooms have huge windows and tall ceilings Photo credit: Richard Chivers
The reception sets the tone, conceived as a rich layering of textures and materials visible from the street. Furniture is a combination of leather, vinyl and fabric and although it may look like an upmarket hotel or airport lounge, it is robust, washable and antimicrobial.
Behind the reception desk is a damson glass backdrop while above is a bamboo 'wrap' around the inside of the ceiling and down the walls to signal the transition between the reception and moving further into the hospital for treatment or visiting. Selected materials and colours from the reception palette are repeated as appropriate throughout the hospital. 'We wanted most of all that it should be very simple, with very rich, beautiful finishes in very small amounts,' says interior designer Lynn Lindley.
Patients progress either to the ground-floor outpatients' spaces or up to the in-patients' on the first floor. Here each bedroom, some as big as 25 sq m - has a large semi-circular window with full-length curtains in bespoke colours, a walnut veneer bedhead and wood-patterned cushioned vinyl flooring. Lofty floor-t o ceiling-heights of more than 3m add to the pleasant ambience.
Recovery bays Photo credit: Richard Chivers
Two Brian Eno light and sound installations are incorporated into the design, one in reception the other in a 'quiet room' on the lower ground floor, and are intended for the enjoyment of patients, staff and visitors alike. 'We're trying to get people to slow down and have a bit more contemplation,' says Ager.
The chemotherapy suite on the lower ground floor has access to a landscaped courtyard. IBI Nightingale also plans to create a roof garden and hospitality space with sea views and a beached raft folly.
T7 Mobile Data Carts
Design: Humanscale
Ergonomics has long been recognised as important in the office workplace. Now, as changes to patient-record keeping begin to impact on the NHS, this thinking is being increasingly applied to hospitals.
Plans for an NHS-wide computer system were scrapped in 2011. This year the Government challenged hospitals to change to paperless records by 2018, leading to opportunities not just in developing the appropriate IT systems but in delivering an ergonomic, physical interface with the information in a ward setting.
The T7 mobile data carts could be integral to the move to paperless medical record keeping mooted for the NHS
Ergonomics specialist Humanscale is among those exploring the potential for using mobile data carts and monitors in ward settings, giving quicker, more efficient access to records and, in the long term a reduction in space and costs of maintaining paper records.
While the use of iPads and other tablet-style devices is a potential option for hospitals, Humanscale's data carts, already installed in three UK hospitals, offer a more robust medium with better screen definition and washable keyboards. Humanscale is now launching Touchpoint T7, available as a wireless doctor's cart and medical cart for both PCs and laptops. 'It has to be easy to get to grips with ergonomically,' says Colin Scott, healthcare EMEA operations manager at Humanscale. 'It's stable and is quickly and easily operable.'
These carts can be charged up to last a shift then moved around the ward as needed. As they will be typically used by between 20 to 30 users a day, they need to be ergonomically adjustable and stable. Users programme in their height and whether they want a standing or seated position and the keyboard height adjusts automatically.
The T7 mobile data carts could be integral to the move to paperless medical record keeping mooted for the NHS
The heavier medical cart, which is designed to accommodate clip-ons for medicines, label printers and other equipment needed on the ward, has powered steering for one-handed turning and pushing. The keyboard can be easily disinfected and washed.
A typical ward will require three or four carts, allowing for two to be charging at any one time. As hospitals consider the best way of moving to paperless records, the market for well-designed carts and wall stations is substantial.
At the moment, says Scott, most hospitals are delivering 21st-century healthcare with 19th-century record systems and this, he adds, has to change.
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