Innovation in Hospital Design

Alex Davies-Jones Excerpts

Tuesday 4th February 2020 Westminster Hall

[Mrs Maria Miller (Basingstoke) (Con)]

I beg to move,

That this House has considered innovation in hospital design.

It is a pleasure to serve under your chairmanship, Ms Nokes, and to hold this important debate. Last September, the Government gave the green light to 40 new hospitals, as part of the health infrastructure plan. For my Basingstoke community this means support for a hospital replacing a much-loved building, built over 40 years ago.

We wanted a new hospital six years ago. While it is important to refresh those plans, because we are now talking about a district hospital, not just a critical treatment hospital, we already have a great deal of work in place. The initial community consultation has identified widespread support. The ambulance service has identified the location that would save more lives. The local council has given planning consent for a hospital to be built.

What about the building itself? If we are to realise the full benefits of this once-in-a-generation opportunity for our healthcare infrastructure, we need not the fad of the moment, but the best design for our hospitals based on evidence and the needs of clinicians, patients, staff and the community, as well as research at home and abroad, to create the best blueprint for local trusts to use for the next generation of NHS hospitals.

Guidance on how to design a new hospital, provided by the NHS to hospital trusts, has been called “out of date” by Architects for Health, an organisation dedicated to improving healthcare design. That should concern us. I hope that the Minister will reassure me that any new hospital will benefit from the best design thinking based on the best evidence around the world.

Many of the crucial design factors identified through research by design experts are completely absent in many hospitals within the NHS estate. Many of our hospitals, including our hospital in Basingstoke, were built for a different era of medicine. The buildings have been modified, added to, partially knocked down and rebuilt, and prefabricated units have been built in front of old units. Any sense of coherence in the design of our hospitals has long been lost.

[Alex Davies-Jones (Pontypridd) (Lab)]

I hope the right hon. Lady agrees that, historically, hospitals have been built away from where those services were most needed, causing issues with the recruitment of consultants and doctors, who then have to work with a demographically and geographically diverse population. I hope that location is given full consideration when new hospitals are designed.

[Mrs Miller]

The hon. Lady is absolutely right. That is why I was pleased that the NHS trust in Hampshire went to the emergency services and asked where the best location for a hospital would be. They identified junction 7 on the M3—an area not unknown to you, Ms Nokes—as a fantastic location. It would be convenient not only for staff, but for the ambulance service, so that it could can save more lives. All these issues must be taken into account.

We have experience of building hospitals since Basingstoke and North Hampshire Hospital was built in the 1970s. Newer private finance initiative hospitals have often been debated in this place. Interesting research has been done on their design, showing that the innovative use design was inhibited because private finance saw those hospitals foremost as an investment vehicle, and tried to reduce risk by using conventional design and construction methods—looking to the past rather than the future. We cannot make the same mistakes again.

What makes a good hospital for now, or, better still, for 2060, when these hospitals will still be operating? Based on the past 40 years of experience, we know the next generation of hospitals must be flexible in their design, not only to accommodate change, but to be built with change in mind and not as an afterthought. I am sure that some elements can be standardised, but the overall design must be flexible. Some new hospitals are built with the intention that they may have an entirely different use in the future. In our communities there are successful examples of buildings that began with one intended use and have moved to another, but they are few and far between. We need to ensure these hospitals have that flexibility, to scale up, change, scale back and even change use entirely.

Patient treatment is the prime function of a hospital, but so is patient recovery. The prevalence of multimorbidity requires a different way of thinking. Perhaps people with mental and physical illness—indeed, those with both simultaneously—should be treated side by side. Rightly, our focus is on early detection and prevention, so part of any new hospital must be mobile, to take prevention of disease into the heart of our community, with the permanent migration of some services from hospitals to the community, including simple diagnostics and therapies.

Research from the US demonstrates the importance of the right environment for patient recovery, including noise reduction, air quality, green space, daylight and seeing nature. Unsurprisingly, all those elements promote good health in well people, too. In 1984, a study by Roger Ulrich proved that a view through a window of a natural setting—perhaps the Hampshire countryside—would aid recovery. Those who had a view of a natural scene had a shorter stay and fewer complications and required less pain relief than those with a window facing a brick wall. Those are not new ideas. Florence Nightingale insisted on every ward being flooded with sunlight, with windows that opened to bring in light and ventilation lifting the spirits, but that is not the case for every ward in my hospital and hospitals around the country.

Staff retention is one of the most acute issues for the NHS. NHS staff are hugely loyal and dedicated. The hundreds of people in Basingstoke who work in my local hospital go above and beyond every day in bringing the best care to my constituents. However, where we work matters, and we should not rely on that loyalty and dedication but reciprocate it. We need to think about how design can improve everyday working lives.

Office design has evolved over the past 40 years, creating spaces that encourage creative collaboration. However, in hospitals things have not changed much at all, yet collaboration and creativity are just as relevant in medicine as in commerce, as are training and upskilling, which should be designed into these new buildings.

Of course, a hospital’s environmental impact also needs to be minimised. The importance of renewable energy and public transport links goes without saying, but we need to take account of the actual design of the hospital, to ensure that it is a design that the surrounding community can be proud of, and so the hospital does not look as if it has landed from outer space and instead fits with the natural setting; a hospital should be a building that will add to that natural setting and not detract from it.

For this new generation of hospitals to be truly sustainable, there needs to be a move away from the disposable hospital design of the 1970s, which was perhaps used when the hospital in Basingstoke was built back in 1972. A building that is flexible and that can be repurposed is a building that is sustainable, which is the approach that we must take.

Each and every one of the 40 new hospitals will be a huge investment for taxpayers, and it is right that approval procedures are rigorous. However, I hope that my hon. Friend the Minister can assure us that, despite that rigour, the long-term benefits of the best working environment for staff are not traded for a short-term reduction in cost.

Hospitals are absolutely extraordinary places that do extraordinary things on a routine basis. They are places where we experience the most emotional experiences in our lives; they are the places where new life is brought into the world and where we face our darkest moments. I will always remember the birth of my three children in Queen Charlotte’s Hospital in London, even though there was a decision to move the hospital after the birth of my second child and I had to go to a new location for my third child. Nevertheless, to be surrounded by experts in maternity and midwifery was an extraordinary experience, and we always have a debt of gratitude to hospitals that have served us in that way. Now Basingstoke hospital is looking after my mother and my father in an extraordinary way, and we should always recognise the incredible lengths that the NHS goes to, in order to ensure that we have the right support in place at the right time.

That is why communities have such a profoundly emotional attachment to their hospitals. That is a challenge that the Government face as they introduce their plans for 40 new hospitals, because they must recognise the impact of any change to a building with which people have an emotional bond and attachment, whether they have had a baby or visited a dying relative there. We need to understand that and take the community with us.

I hope that my hon. Friend the Minister can outline today how the Government will ensure that this once-in-a-generation opportunity—these 40 new hospitals for communities right across the nation—involves good design. That means design that helps to provide the best treatment, the best recovery, the best staff retention and the best for our environment, and such design should be at the heart of each and every new hospital, because we must build hospitals for the future and not simply replicate the past. We also need to recognise the emotional role that hospitals play in the lives of our families and our communities. We must work with the people the NHS serves to ensure that this groundbreaking development of the NHS estate is understood, embraced and welcomed.