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DESIGN GUIDE

The design of community hospitals

1991

STATUS IN WALES

ARCHIVED

Design GuideThe design of community hospitals

LONDON: HMSO

NHS EstatesAn Executive Agency of the Department of Health

0 Crown copyright 1991First published 1991

ISBN 0 11 321402 2

About this publication

This guidance seeks to explain andpromote the community hospitalconcept as an essential and integral partof both today’s and tomorrow’s healthcare system. It does not promote specificdesign solutions because there is no one“blueprint” for a community hospital.Instead it provides a framework ofguiding principles for communityhospital planning and design which can

be interpreted and acted upon toproduce design solutions to suit localcircumstances and requirements. These

principles also provide a basis forevaluating developing designs for newcommunity hospitals and for postoccupancy evaluations of completedhospitals.

service assessments and increasing costconsciousness will lead to greater

questioning of what services really needto be provided in acute hospitalenvironments. There will be increasingrecognition of the scope for“unbundling” of some acute servicesinto community and primary care

settings.

As these changes gather pace,community hospitals will have anessential role to play as a versatile,flexible, and affordable response to theneed for locally appropriate health careand health promotion services in non-clinical, consumer oriented settingswhich are close to people’s homes.

Technological developments,organisational change, needs-based

Contents

Preface

Acknowledgements

List of photographs

1.01.11.21.31.4

Introduction page 9Aims of documentAudienceStructure of guidanceExclusions

2.02.12.22.3

Concept and philosophy page 11What is a community hospital?What is the future role of community hospitals?When is community hospital developmentappropriate?2.3.1 Integration and decentralisation2.3.2 Rationalisation2.3.3 Expansion of services for elderly people and

local population

2.4

2.5

2.3.4 Flexible response to changeWhat are the benefits of community hospitals?2.4.1 Benefits for patients2.4.2 Benefits for staff2.4.3 Benefits to DHAs, Units and TrustsWhat are possible concerns about communityhospitals?2.5.1 Concerns for staff2.5.2 Concerns for DHAs. Units and Trusts

3.03.13.23.33.4

3.5

Service planning issues and options page 20Range and mix of servicesKey service planning issuesViability and scope of particular servicesRelationship with community health clinics andprimary care servicesInteragency co-operation

4.0 Assessment of demand and “sizing” ofservices page 24

5.0 Quality of environment page 255.1 Philosophy of care5.2 Ethos of environment5.3 Total quality management

6.06.16.26.3

Location and site selection page 26AccessibilityPhysical site characteristicsRelationship with primary care facilities

7.07.17.2

Whole hospital planning issues page 27Scale and styleIntegration with other facilities

4

7.3 Zoning and relationships between services7.4 Information technology7.5 Design of inpatient facilities7.6 Privacy and confidentiality7.7 Role of outdoor space7.8 Logistics and communications strategy7.9 Expansion strategy7.10 Flexible and shared use of space7.11 Interior design

8.0 Whole hospital operational policies withimplications for design and spaceutilisation page 38

9.0

9.1

9.2

9.3

9.4

Planning accommodation for communityhospital services page 39Inpatient accommodation9.1.1 Scope9.1.2 Sizing9.1.3 Other relevant guidance9.1.4 Operational policies9.1.5 Planning issues and options9.1.6 Relationship with other services9.1.7 Total quality management9.1.8 Interior designDay hospital services9.2.1 Scope9.2.2 Sizing9.2.3 Other relevant guidance9.2.4 Operational policies9.2.5 Planning issues and options9.2.6 Relationship to other services9.2.7 Total quality management9.2.8 Interior design9.2.9 Multi-use of spacePhysiotherapy9.3.1 Scope9.3.2 Sizing9.3.3 Other relevant guidance9.3.4 Operational policies9.3.5 Planning issues and options9.3.6 Relationship to other services9.3.7 Total quality management9.3.8 Multi-use of spaceOccupational therapy9.4.1 Scope9.4.2 Sizing9.4.3 Other relevant guidance9.4.4 Operational policies9.4.5 Planning issues and options9.4.6 Relationship to other services9.4.7 Interior design9.4.8 Multi-use of space

9.5 Clinic services9.5.1 Scope9.5.2 Sizing9.5.3 Other relevant guidance9.5.4 Operational policies9.5.5 Planning issues and options9.5.6 Relationship to other services9.5.7 Total quality management9.5.8 Interior design9.5.9 Multi-use of space

9.6 Minor casualty9.6.1 Scope9.6.2 Sizing9.6.3 Other relevant guidance9.6.4 Operational policies9.6.5 Planning issues and options9.6.6 Relationship to other services9.6.7 Total quality management9.6.8 Interior design9.6.9 Multi-use of space

9.7 Radiodiagnostics9.7.1 Scope9.7.2 Sizing9.7.3 Other relevant guidance9.7.4 Operational policies9.7.5 Planning issues and options9.7.6 Relationship to other services9.7.7 Total quality management9.7.8 Interior design9.7.9 Multi-use of space

9.8 Main entrance9.8.1 Scope9.8.2 Other relevant guidance9.8.3 Operational policies9.8.4 Planning issues9.8.5 Relationship to other services9.8.6 Total quality management and interior

design9.9 Catering and staff dining area

9.9.1 Scope9.9.2 Sizing9.9.3 Other relevant guidance9.9.4 Operational policies9.9.5 Planning issues and options9.9.6 Relationship to other services9.9.7 Total quality management and interior

design9.9.8 Multi-use of space

9.10 Administration, health records and officeaccommodation9.10.1 Scope9.10.2 Other relevant guidance9.10.3 Operational policies9.10.4 Planning issues and options9.10.5 Multi-use of space

9.11 Linen, sewing room and patient clothing service9.11.1 Scope9.11.2 Size9.11.3 Operational policies

9.12 Supplies and stores9.12.1 Scope9.12.2 Other relevant guidance

9.13 Domestic services9.14 Staff changing9.15 Mortuary

9.15.1 Scope9.15.2 Other relevant guidance

9.16 Engineering services, estate maintenance andcommunications9.16.1 Scope9.16.2 Sizing9.16.3 Operational policies9.16.4 Planning issues and options9.16.5 Other relevant guidance

10.0 Cost and area guidance page 84

Appendix 1 - Historical background

Appendix 2 - Recently completed community hospitals

Appendix 3 - Sizing methods

Appendix 4 - Schedules of accommodation

Appendix 5 - Other relevant Health Building Notes

Bibliography

Acknowledgements

Produced for NHS Estates by Rawlinson KellyWhittlestone (RKW) who would like to thank staff inthe health authorities and hospitals listed below fortheir help in the preparation of this guidance;members of the working party and steering group atthe Department of Health and other externaladvisers for their support, comments and guidance.

Particular thanks are also due to the Welsh HealthCommon Services Authority (WHCSA) for their helpin preparing the cost guidance.

Working group (NHS Estates - Department of Health)

Len Bartholomew-Architect - ChairJane Lamb -Architect - Project Liaison OfficerDon Eastwood - Quantity SurveyorGeoffrey Trubshaw - EngineerMrs Pat MacDonald - Nurse Planner (succeeded byKen Wood)Ken Wood - Nurse Planner, seconded from TrentRHAMaria Murray- Team Secretary

Steering group (NHS Estates/NHSMR - Department ofHealth)

Working group members plus:

l Dr Michael Lee-Jones RCGP Representativel Ray Greenwood - Nursing Officerl Dr Vivienne Press - Senior Medical Officerl Dr Michael Prophet - Senior Medical Officerl Kay East - Physiotherapist seconded from the NHS. Pam Green - Priority Health Servicesl Valerie Weeks - Nursing Officer

External advisers for guidance on specific services:

l Tony Jones - District Physiotherapist, Eastbourne HAl Susan Whiting - District OT, Oxford HAl Olive de Ville - District Superintendent,

Radiographer, Bloomsbury and lslington HAl Brian Frost - External catering adviserl Dr Peter Strangeways - Association of General

Practitioner Community Hospitals

Hospitals and health authorities:...............

Blyth Community HospitalBridlington Community HospitalIlkeston Community HospitalSouth Molton Community HospitalJarrow Community HospitalBolsover Community HospitalBlandford Community HospitalYstradgynlais Community HospitalMold Community HospitalWelsh Health Common Services AuthorityWest Midlands RHABath HACornwall HAHerefordshire HAPortsmouth & SE Hampshire HA

Photographs in the text

Cover (detail) and main photograph - Chirk CommunityHospitalPhoto: WHCSA

22. Gardens - Ystradgynlais Community HospitalPhoto: WHCSA

23. Courtyard - llkeston Community Hospital

Photographs by RKW unless otherwise stated24. Ward corridor - Ystradgynlais Community Hospital

4. South Molton Community Hospital

5. Mold Community HospitalPhoto: WHCSA

8. Ystradgynlais Community HospitalPhoto: WHCSA

9. Blyth Community HospitalPhoto: Trent RHA

26. Day hospital courtyard - Lambeth CommunityCare Centre

42. Physiotheraphy exercise area - Lambeth CommunityCare Centre

44. Physiotherapy exercise area - YstradgynlaisCommunity Hospital

48. ADL kitchen - Lambeth Community Care Centre10. Ilkeston Community Hospital

60. Main entrance - Lambeth Community Care Centre14. Location in the community

Photo: WHCSA

15. Mold Community HospitalPhoto: WHCSA

16. llkeston Community HospitalPhoto: Trent RHA

61. Reception - Ystradgynlais Community Hospital

62. Main waiting - Bridlington Community Hospital

63. Central atrium - Ystradgynlais Community Hospital

65. Staff dining room - Blyth Community Hospital

1.O Introduction

Over the next ten to fifteen years, both organisational andtechnological changes will have a significant impact on theway that the future health services are provided. There willbe scope for a radical shift from care in acute hospitals, tocare in community and primary care settings and inpeople’s homes. New and innovative models ofcommunity health facilities will be needed as a response tothese challenges.

With the increased emphasis on health promotion, theneed for resource centres to support home care, andincreased interagency co-operation in the provision ofcommunity services, renaming of community hospitals todo justice to their scope and role may well be appropriate.

Community hospitals already provide a wide range ofservices. The essence of community hospitals is theirdiversity, and their potential to respond flexibly to differinglocal needs and changing circumstances.

Community hospitals have many advantages. Thecircumstances prompting their development may varyconsiderably from district to district. Some districts seecommunity hospitals primarily as a means of extendingservices to elderly people, others as developing services forthe whole community, yet others as part of an integratedservice linked to and in support of acute hospital andprimary care services.

1.1 Aims of document

The aims of this Design Guide are to:

l define and promote the concept of communityhospitals

l encourage innovative development of communityservices and community hospital designs

l provide planning and design guidance specific tocommunity hospitals

9 collate and disseminate experience from otherprojects and from evaluations

l promote good practice and warn of pitfalls

1.2 Audience

The guidance in this Design Guide is of relevance to:

l District Health Authorities (DHAs), Family HealthService Authorities (FHSAs), GP Fund Holders(GPFHs) - as purchasers of community healthservices, other GPs, and also local authorities aspurchasers of social care services

l DHAs, Units, NHS Trusts and the private sector, asproviders of community health services

l Project teams (PTs) and design teams (DTs), asplanners and designers of community hospitals

l Voluntary groups and consumers.

1.3 Structure of guidance

Chapter 2 focuses on the concept, scope and role ofcommunity hospitals and their potential benefits,

Chapters 3-10 deal with service planning, whole hospitalplanning, planning and design for individual services, andcost and area guidance.

Guidance in this document covers community hospitals,and their possible integration with GP surgeries andcommunity health clinics. It does not cover residentialfacilities for elderly, mentally ill or people with learningdifficulties.

Diagram 1 indicates which Chapters are likely to be ofinterest and relevance to each of the above audiences.

l identify other relevant guidance material.

9

1.0 Introduction

1. Guide to contents

Audience

Chapter TopicDHAs/FHSAs

GPFHsDHAs/Units

NHS Trusts/GPsPrivate Sector

Purchasers Providers

PT/DTs

Planners/Designers

Voluntaryorganisations/

Consumers

Users

2

3

4

5

6

7

8

9

10

Concept andphilosophy

X X

Service planningissues and options

X X

Assessment ofdemand and “sizing”

X X

Quality ofenvironment

X X

Location and siteselection

X X

Whole hospitalplanning issues

Whole siteoperational policies

Planning individualservices

Cost and areaguidance

X

X

X

X

X

X

X

X

X

X

X = of particular relevance

10

2.0 Concept and philosophy

2.1 What is a community hospital?

A community hospital provides a range of services topatients living locally, who do not need the specialistservices and facilities available in an acute hospital.

Services may include:

l inpatient services - acute, rehabilitation, respite care

l day/treatment facilities, minor surgical procedures

l day hospitals

l rehabilitation services

l clinic services - run by GPs, consultants and otherprofessionals

l minor casualty

l diagnostic services

l resource base for community health staff.

These services may cater for a variety of different patientcare groups including:

l acute

l elderly

l mental illness - adult acute and elderly

l maternity

l terminal illness

l younger disabled.

The range and mix of services provided for each caregroup will vary according to local needs and the availabilityof other services. The essence of community hospitals istheir diversity, versatility and flexible response to localrequirements. (See Chapters 3 and 9).

A community hospital should be an integral part of thehealth care system in a district, providing an extension toprimary care services and a source of referral to and fromacute hospital services. Patients may be under the care ofGPs, consultants or nursing staff.

With implementation of the proposals outlined in theWhite Paper ‘Caring for People’, local authorities willbecome responsible for the provision of all social care from1993. Community hospitals may, therefore, also wish toenter into arrangements with local authorities interested inmaking use of their facilities.

The relationship between a community hospital and otherhealth care services is represented diagrammatically inDiagram 2.

GPsilI LL. I

Public

2. The community hospital in its context

Community hospitals have their origins in the cottagehospital, which first developed in the late 19th century. Abrief historical background to community hospitaldevelopment is provided in Appendix 1.

The last decade has resulted in a significant number ofnew purpose built community hospital developments. Theaverage size of these new developments is larger thannoted in a previous survey*. Their functional content is setout in Appendix 2.

Brief descriptions of five of these recent developmentsillustrate clearly their variety and diversity of provision andthe inappropriateness of a single community hospital“blueprint”.

* Footnote. ‘The role and function of community hospitals.’ H. Tucker,

Kings Fund Project Paper No. 70. 1987.

11


3. Functional content of five hospitals

Hospital District

Beds Other services

Y e a r Total Consul tant G P Day Minor Operating X-ray GP R e h a b C l i n i copen Elderly EMI acute hosp. casualty theatre premises services

on site

South Molton N. Devon 1987 28 17* 11 1 x x xMold Clwyd 1984 40 20* 20 1 x X x x

Ystradgynlais Powys 1985 52 30 8 14 1 x X x xBlyth Northumberland 1987 78 38 14 26 2 x x x x xllkeston S. Derbyshire 1987 92 48 20 24 1 X X X X X X

X=present *managed by GPs

South Molton Community Hospital (28 beds) is one ofa series of community hospitals being developed to servethis large rural area. It is a single storey development witha single 28 bed ward and incorporates shared use of spacebetween the ward and day hospital and between thelatter and rehabilitation. The ward design breaks awayfrom the traditional acute ward pattern. The four-bedrooms, which have ensuite sanitary facilities, are groupedto maximise patient privacy,

4. South Molton Community Hospital

12


Mold Community Hospital (40 beds) is situated in asmall country town and the services it provides are closelyintegrated with local primary care services and acutehospital services. Both acute beds and continuing carebeds for the elderly are managed by GPs. The hospital hasbeen built on a constrained site, which has resulted in oneward of 20 beds being provided at first floor level. Theremaining services are located around two courtyards witha central corridor across the centre of the development.The ward design is based on two eight bed echelon baysplus single rooms, the aim being to maximise observationbut also provide a reasonable degree of privacy forpatients. One courtyard is intended as a physiotherapyexercise area. 5. Mold Community Hospital

25423

4 8

11 -r- 1-1 -+

1 5 1 31 1 16 1 47 1 47 1 17 1 46 1 45 i

w

II

1

0 5 0 20m-P! I” ~‘I

/I

0 2b 50 6511

Extent of first floor wardIf

1 entrance foyer 13 dayroom2 reception and records 14 nurses base3 beverages 15 treatment room4 assisted shower 16 clean utility5 waiting 17 dirty utility6 sister 18 linen7 staff cloaks 19 rest room8 toi let 20 assisted bath9 cleaner 21 wheelchair bay

25 male staff cloaks26 geriatric day hospital27 day dining room/chapel28 dirty utility29 clean utility and treatment30 occupational therapy31 office32 ADL bedroom33 bathroom34 kitchen35 physiotherapy36 wax treatment

3738

common roomdental’ surgerydental recoveryX-ray waitingX-ray receptionx-raydark roomchangingconsulting roomconsulting and minortreatmenttreatment roomcourtyard

3940414243444546

4748

10 store11 eight-bed ward12 single bed ward

22 kitchen23 staff dining and lounge24 female staff cloaks

6. Plan of Mold Community Hospital

1 3


7. Plan of Vstradgynlais Community Hospital

r

11I:I1

A out-patientsB geriatric/EMIC servicesD day hospitalE GP wardI reception2 office3 cleaner4 toilet5 store6 clean utility7 sub-waiting8 sister9 consulting/

examination0 linent dirty Utility2 clinette3 changing

14 X.ray15 radiologist16 casualty treatment17 nursing officer18 conference19 day/dining and quiet rooms20 pantry21 EMI22 bath23 one-bed ward24 two-bed ward25 three-bed ward26 nurses base27 doctor28 linen29 luggage30 porter31 interview32 treatment33 quiet room

34 shower35 wheelchairs/trolleys36 beverages37 chiropody38 hairdresser39 physiotherapy40 day room41 occupational therapy42 ADL43 OT workshop44 treatment/clean utility4 5 H A O46 launderette47 staff changing48 staff dining4 9 k i t c h e n 50 staff room5 1 C S S D52 l inen53 medical gases54 plant55 incinerator56 viewing chapel57 body store58 chapel garden59 substation

62 workshop

D

Ystradgynlais Community Hospital (52 beds) is situatedin an isolated location and serves an area with highunemployment and heavy industry health problems.Because of its remote location and the lack of a DGH inPowys, it is more self-contained than most communityhospitals. The consultant lead services for elderly andelderly mentally ill patients include local assessmentservices, as well as rehabilitation and continuing care. Thefinger plan whole hospital shape provides convenientaccess for all departments, to the central entrancereception area. The ward design uses fixed furniture in thefour-bed bays to create a domestic environment and tomaximise patient privacy. The site has been sculptured(with earth mounds) and landscaped to provide anattractive exterior environment and to shelter thedevelopment from prevailing winds.

14


9. Blyth Community Hospita/

Blyth Community Hospital (78 beds) is situated in asmall industrial town. It uniquely combines a communityhospital, community health clinics and surgeries for 3 GPgroup practices under one roof. It also contains an acutepsychiatric day hospital for under 65s. The hospital is apredominantly single storey development on a constrainedsite, with little scope for expansion. The GP ward issituated at first floor level. Courtyards are attractivelylandscaped and are used both by patients and for housinghospital pets.

llkeston Community Hospital (92 beds) is apredominantly single storey development, serving a ratherdeprived urban area. The operating theatre is used on aregular basis by visiting consultants. A clearly definedhospital street, sometimes loaded on both sides, on oneside, or not at all, is much in evidence in this largerdevelopment. Here art works, by GCSE art students andother artists, have been used to creative effect in bothcourtyards and corridors.

10. llkeston Community Hospital


Even from this small number of examples, it is clear thatplanning and design of community hospitals, both nowand into the future, raises many issues. What range ofservices is appropriate in a particular locality? How canthese services be appropriately sized to meet varying localneeds? What future pressure to expand, develop ordiversify, should be anticipated?

There are also aspects of whole hospital planning likedepartmental relationships, communication systems,expansion strategies, etc. which are crucial to the overallfunctioning of the building, but which require a differentresponse from that which is appropriate for larger acutehospitals. Hospital streets and long blank corridors seemsomehow misplaced in a community hospital setting. At adepartmental level, privacy and confidentiality are arguablyeven more important here, where staff and patients aremore likely to know each other, than in a moreanonymous acute hospital setting. Adoption of standardacute wards may represent a missed opportunity to createa more appropriate and less clinical environment forinpatient care.

Interagency co-operation between the health authority,local authority and voluntary agencies, can be fostered incommunity hospitals by shared and multi-use of space.This enables a variety of compatible space requirements tobe accommodated effectively in an economical buildingenvelope.

The quality of both interior and exterior environments canalso make a major contribution to the positive image andfriendly, reassuring and welcoming atmosphere thatcommunity hospitals seek to engender.

2.2 What is the future role of

community hospitals?

If community hospitals are to develop their role as anintegrated part of the healthcare system, they need topresent their image and capabilities positively, so that theircontribution can be properly understood and their futurepotential fully exploited.

Contracting for services may result in greater clarificationand understanding of the role of community hospitals.

There is a variety of factors which may further extend thefuture role of community hospitals:

. Technological change: this will create scope formore diagnostic, treatment and care activities to beprovided in low tech settings, away from acutehospitals.

. Increases in home care: this will generate a needfor local resource centres to support it.

. Increased emphasis on health promotion andscreening activities: a community hospital can bea useful focus for these activities within a community

. Implementation of the NHS and CommunityCare Act 1990: this may result in an increased needfor access to community hospital services.

. Increased cost consciousness: White Paperimplementation, the purchaser/provider split,contracting and capital charges will all raisequestions about which services need to be providedin the more expensive “high tech” acute hospitalsettings and which services could be providedelsewhere.

. GP preferences: GPs may choose to retain care ofmore patients in community hospitals, if suchfacilities are available.

. Interagency co-operation: there may be increasedscope for joint provision of community servicesbetween the health authority and local authority,voluntary agencies and the private sector.

. Consumer expectations: increased consumerexpectations may create pressure for more locallyaccessible facilities.

2.3 When is community hospitaldevelopment appropriate?

The development of community hospitals can be anappropriate response to a variety of health authoritypriorities arising from a needs based assessment of localservice requirements.

A wide range of services is already provided in communityhospitals. Many existing community hospitals have plansto develop their existing services or add new services.

16


2.3.1 Integration and decentralisation

A DGH plus a network of community hospitals can providean integrated service which makes best use of both typesof services and facilities and provides “appropriate care inappropriate places”.

Centralised acute services based on acute hospital caremay not be feasible in some health authorities because ofgeography, long travel distances, and poorcommunications.

Community hospitals are appropriate, not only for ruralareas, but also for densely populated urban areas withpoor housing and poor family support.

2.3.2 Rationalisation

New community hospitals may replace hospitals which aretoo small to be viable, inappropriately located, or providesubstandard unsuitable accommodation.

2.3.3 Expansion of services for elderly people andwhole population

Community hospitals provide an opportunity to expandthe total quantity of health care provision in a healthauthority, for example:

l to create or improve local provision for rehabilitationservices, particularly for elderly people;

l to cater for the needs of the whole population inexpanding towns.

2.3.4 Flexible response to change

Provision of community hospitals, integrated with primarycare and acute hospital care, may create a pattern ofservice provision which can respond more flexibly tochanges in service patterns, brought about bydemography or technological change, than the centralisedprovision of all acute services on a single large DGH site.

2.4 What are the benefits ofcommunity hospitals?

The checklists below outline possible benefits ofcommunity hospitals to units, NHS Trusts, GPs and otherstaff, and to patients and visitors.

2.4.1 Benefits for patients

The benefits for patients relate to:

Quality of care: earlier discharge and bettercoordinated follow-up care for selected patientsdischarged from a DGH. Continuity of care forpatients admitted by GPs. Better co-ordination ofnursing care by community hospital nurses andcommunity nursing staff.

Access: community hospitals maximise accessibilityof services to consumers, by providing care andtreatment as close as possible to peoples’ homes.Unnecessary and costly travel time for patients andrelatives is also reduced.

Environment: this can be more appropriate to thetype of care offered, with greater scope for“humanisation”, than is possible in an acute hospitalsetting.

Contact and family support: provision ofrehabilitation services in community settings allowsfor increased contact with, and possible careinvolvement by relatives.

Community hospitals are a good base from which toprovide support to families. Staff can get to knowthe families as well as the patients.

Health promotion: community hospitals canprovide an important focus for health promotionand screening for the local communities served.

2.4.2 Benefits for staff

The benefits for staff relate to:

l Job satisfaction: community hospital provision canmaximise GPs’ contribution to health care, byproviding an enhanced role for GPs, in terms oftesting, diagnosis, monitoring and care ofinpatients, This, in turn, can provide bettercontinuity of care for patients and increased jobsatisfaction for GPs.

17


.

.

Improved contact between hospital and communitynurses, resulting from shared care of patients,provides a greater awareness of the socialcircumstances and progress of individual patients.This can also increase job satisfaction for thoseconcerned.

l Flexibility and versatility: decentralised services,consisting of an acute hospital supported by anetwork of community facilities, are likely to providea more flexible response to future changes in healthcare patterns, than a more centralised pattern ofprovision.

Professional interchange: participation byconsultants in community hospital activities canimprove the quality of care provided by GPs,because of the opportunities to exchangeprofessional views and directly seek specialist advice.There is also a reduction in professional isolation forGPs and nurses. Community staff may haveincreased access to other professionals.

The outposting of consultant outpatient clinics andconsultant managed beds in community hospitalscreates the opportunity for increased contact andcooperation between GPs and consultants, to thebenefit of both staff and patients.

Capital investment: provision of communityhospitals, will result in capital projects which aresmaller, and easier to manage than larger acutehospitals.

Community involvement: community hospitalsprovision may generate increased communityparticipation and increased financial support fromvoluntary organisations.

2.5 What are possible concerns about

community hospitals?

Extended roles: community hospitals can providethe opportunity to develop innovative methods ofservice provision which may create extended rolesand responsibilities for nursing and therapy staff. Itis not just a question of decentralising existing acutehospital services, but of organizing services and staffin a different way, for example, by developing therole of the nurse and encouraging the developmentof nurse managed beds.

Provision of minor casualty services may reduce the“casual patient” workload on acute hospitals,provide a further opportunity for GPs to exercisetheir skills, and reduce travel distances for patients.

2.4.3 Benefits to DHAs, Units and Trusts

The benefits to DHAs, Units and Trusts relate to:

l Appropriate use of resources: maximum use ofcommunity facilities can remove unnecessarypressures from acute hospitals, reduce bed blockingand, where new acute developments are proposed,may reduce the scale of acute provision which wilbe required.

The provrsion of “appropriate care in appropriateplaces” can reduce service overheads, as inexpensiveservices will no longer be provided in expensivesettings.

The checklists below note some of the concerns expressedby staff and providers about community hospitals.

2.5.1 Concerns of staff

Concerns for staff include:

l Travel time: consultants may be concerned aboutincreased travel time and their lack of availability foremergencies at the DGH. These issues may possiblybe ameliorated by careful timetabling andorganization of emergency cover.

l Commitment: decentralised service provision isdependent upon the commitment of local GPs, theirwillingness to put in time caring for their patients incommunity hospitals and on appropriateremuneration for services provided.

l Recruitment: in some rural areas, nurse recruitmentmay be difficult.

l Staff training: if decentralised provision becomesmore common, there will be a long term need fortraining of nurses, doctors and paramedics, toreflect this changed pattern of services. GPs mayalso wish to develop specific skills*. In the shortterm, possible lack of experience and variety fortraining purposes may need to be dealt with byrotation of staff between different health care

Decentralised provision of outpatient services canreduce pressures on and cost of patient transportservices.

settings

There may be lower non attendance (DNA) rate ofoutpatient appointments in community hospitals,

l Footnote. The Royal College of General Practitioners, Educational needsof doctors working in community hospitals; a report prepared for the

than in acute hospitals, resulting in less wastedresources.

Education Committee of the Royal College of General PractitionersJournal of Royal College of General Practitioners 26: 461-5. 1976

18


2.5.2 Concerns for DHAs, Units and Trusts

Concerns for DHAs, Units and Trusts include:

l Duplication of equipment: careful assessment willbe required of what equipment it is appropriate andcost effective to provide in a community setting.Service overheads will increase with the provisionand maintenance of more expensive equipment.

l Underuse of staff: where the workload isinsufficient to enable a service to be providedreasonably efficiently and economically, it may benecessary either not to provide the service at all, orto consider a more intermittent, or whereappropriate, a mobile pattern of provision.

l Bed blocking: beds may become blocked by longstay elderly patients. To avoid this, it will benecessary to have clear admission and length of staypolicies, in order to maintain reasonable throughputin the majority of beds and safeguard the ethos of a

community hospital.

l DGH referral: occasionally, there may be a need foraccess to specialist services and to move patients inthe event of complications. Clear admissions policiesshould help to reduce the incidence of suchproblems.

19

3.0 Service planning issues and options

3.1 Range and mix of services

Services provided in community hospitals fall into thefollowing broad groups:

.

.

.

.

.

.

.

.

.

.

.

inpatients

day/treatment facilities, minor surgical procedures

day hospital facilities

rehabilitation services

clinic services - consultants, GPs, health authorityclinics

minor casualty

diagnostic services

health promotion services

resource base for community health staff

educational support

general support services

Figure 11 overleaf shows the wide range of services thatare currently being provided in community hospitals.

3.2 Key service planning issues

Key service planning issues include:

l provision of services primarily for elderly people orfor the whole community. This will influence boththe range of services provided and the demands onphysiotherapy, radiodiagnostics, out-patients, etc.

l range and type of services to be provided for eachcare group.

l selection of an appropriate mix of services to suitlocal needs, allowing for the age structure of thepopulation, local factors affecting morbidity patternsand the location of other health facilities.

l the distance from the nearest DGH may influenceservice provision.

l new models of care may be appropriate incommunity hospitals, e.g. nurse managed beds

l the need to anticipate the likely future role ofcommunity hospitals:

(i) possible increases in minor operations,treatments, endoscopies and other investigativeprocedures.

(ii) increased demand for elderly and EMI services

(iii) developments in out-patient and clinic services

(iv) increased need for a resource base forcommunity staff to support home care

(v) increasing focus on health promotion anddisease prevention; provision of space for localself-help and support groups.

3.3 Viability and scope of particular

services

Services will be affected as follows:

provision of inpatient and casualty services will beheavily dependent upon strong GP support andcommitment.

provision and viability of a basic radiodiagnosticservice will be dependent on the scope and scale ofother services to be provided (especiallyout-patients, minor casualty, inpatients). (SeeChapter 4 - Assessment of demand and “sizing” ofservices).

occupational therapy and physiotherapy will provideservices for inpatients and day patients andphysiotherapy also for out-patients and direct GPreferrals. Speech therapy will also provide services tooutpatients and day patients.

provision of maternity servrces is likely to berestricted to ante-natal and post natal clinics andcare of post natal lying-in patients discharged fromthe DGH. In particular, local circumstances (e.g.where local populations are geographically isolatedfrom the nearest DGH) and where GPs haveappropriate experience and enthusiasm, provision ofGP maternity services for low risk consultantscreened patients may be justified. The viability ofthese services in terms of capital costs, staffing andlikely subsequent use of facilities will need to becarefully assessed.

20


l surgical services will generally consist of consultantout-patient clinics, and pre-convalescent care ofpost operative patients discharged from the DGH.Clinic services may also include provision fortreatment/endoscopy sessions and minor surgicalprocedures carried out by consultants or by GPs.Whilst operating theatres will not generally beprovided in new community hospitals, there areexisting community hospitals with a long establishedtradition of providing surgical services. If theoperating facilities in these hospitals requireupgrading, or replacement as part of aredevelopment scheme, appropriate guidance canbe found in Health Building Note 26 - ‘Operatingdepartment’.

l provision of pharmacy, pathology, and sterile supplyservices will normally be from the DGH. Localprovision is generally not cost effective.

3.4 Relationship with communityhealth clinics and primary care services

Health centres, or GP practice premises, may be providedon the same site, or as part of a community hospitaldevelopment. Where this is possible the advantages are:

l ease of access for GPs to inpatients and minorcasualty

l possible shared use of support spaces between GPsurgeries, out-patient clinics and community healthclinics

l access by patients to a range of services on one site

l potential for improved communication betweenhospital and community staff

Planning of such integrated facilities should take note ofguidance on General Medical Practice Premises andcommunity health clinics provided in Health Building Note46 (in preparation).

3.5 Interagency co-operation

l joint health authority and local authority provisionfor day hospital and day centre accommodation forelderly people

l sessional use of community hospital day hospitalaccommodation for Macmillan day hospitals forterminally ill patients and incorporation ofMacmillan beds into a community hospital.

The prerequisites for successful interagency co-operationinclude clear management arrangements and theestablishment of contracts for service provision.

There is a likelihood of increasing co-operation betweenhealth authorities, local authority social services (LASS),voluntary organisations and the private sector, in theprovision of services and facilities in community-basedsettings. For example:

21


II. Checklist of potential community hospital services

Inpatient. GP medical cover:l respite care - progressive diseasesl terminal carel minor acute -chest, urinary infectionsl stabilisation of diabetic patientsl intensive treatment of varicose ulcersl pre-convalescent care, rehabilitation (after DGH episode,

minor stroke, etc)l HIV positive, AIDS - convalescent, respite, terminal care.

l Consultant cover:

l geriatricl EMI

I

assessmentrehabilitationrespite carecontinuing care

l Nurse managed beds:l patients requiring 24-hour nursing care

Radiodiagnosticsl basic proceduresl ultrasound

Consultant out-patientsl General surgeryl General medicinel Geriatrics. Rheumatologyl Dermatologyl Audiology, hearing aid. Opthalmologyl Paediatricsl Psychiatryl Gynaecologyl Obstetric, ante natall Diabeticl Orthopaedicl ENTl Oncology

GP/Primary health care team (PHCT)l GP surgery sessionsl Cytology, cervical screeningl PHC for homeless, drug usersl Computer links to DGH for:

l requesting tests/receipt of resultsl making OPD appointmentsl obtaining bed state information

l Ante natal clinics

Rehabilitationl Physiotherapy - inpatient, outpatient, day patients,

GP referrals and domiciliary servicesl OT - inpatient, day patientsl Chiropodyl Speech therapy

Day hospitall Elderlyl Adult mentally illl EMIl Terminally ill

22


Treatment/screening etcl Minor casualtyl Treatment/Investigation sessions:

l blood takingl injectionsl eye/ear treatmentsl dressingsl blood pressurel ECGl chiropody

l Screeningl breast screeningl smokersl osteoporosisl diabetic retinopathy, diabetesl high blood pressure

l Procedures:l minor surgical proceduresl endoscopies

l Dentistry

Support servicesl Health recordsl Administrationl Cateringl Supplies, storagel Mortuaryl Domestic servicesl Waste disposall Building, equipment, engineering maintenancel Engineering services operation

Teachingl Consultant, junior medical staffl Consultant, GP interchangel GP, medical studentsl Nurse trainingl Community staff trainingl General staff training

Community health clinicsl Family planing, Well Womenl Antenatal relaxation, /parentcraftl Keep fitl Chiropodyl Child health surveillance - infant welfare, development

assessment, immunisationl Community dental servicel Health educationl Dieteticsl Speech therapyl Hypertensionl Obesityl Diabetesl Child and family service, therapyl Surgical appliancesl Orthoptics

Staff basel District nursesl HVs (PHCT)l CPNsl Practice nurse (PHCT)l Social workersl OTs, physios, community physiosl AIDS community care teaml Dietitiansl Chiropodistsl School nursesl Continence advisorl (Diabetic support nurses)l (Terminal support nurses)l (Clinical psych/psychoth)l (Speech therapists)l (Resource team for MH)l Interpretersl Community midwives (PHCT)l (Voluntary groups)( ) sessional base only

23

4.0 Assessment of demand and “sizing” ofdepartments

A key characteristic of community hospitals is variety, inthe range of services they provide and in the size and scaleof these services, This feature reflects and underlines therole which a community hospital has in meeting localneeds.

There is, therefore, no blueprint for a community hospitaland providers, in drawing up plans for new communityhospitals, will need to select those services which meettheir local needs and the requirements of purchasingauthorities. They will also need to decide on the mostappropriate scale of provision for each service.

Diagram 12 illustrates some possible combinations ofservices. The functional content of these four examples(A,B,C,D) generally increases in size from A to D. ExampleA contains relatively few beds and day places with minimalclinical support facilities, while D contains more beds, alarger out-patient department and a two-roomradiodiagnostic department.

Diagram 12 merely illustrates the range of services andsizes of services that may be provided. It does not imply,for example, that a small hospital would never contain aradiodiagnostic service. A smaller community hospital willnot necessarily contain only small services. For example, a28-bed hospital may have a 40-place day hospital and alarge out-patients or community clinic area. It will dependon the scale and mix of services which are mostappropriate for a particular locality.

Planners and providers of community hospital facilities willneed to “pick and choose” from a list, such as this, inorder to identify the range and scale of servicesappropriate to their local needs. The cost and areaguidance provided in Chapter 10 and in Appendix 4illustrate how this can be done.

When services are being planned in detail, there may alsobe choices to be made concerning the type and mix ofspace provision for a particular service. For example, forphysiotherapy, it will be necessary to decide on theamount of space to be dedicated to exercises, the numberof treatment cubicles required and whether the provisionof a gymnasium is justified. The detailed guidance onsizing provided in Chapter 9 includes suggestions on howsuch issues can be dealt with.

Services A B C D

lnpatient servicesGP acute bedsConsultant elderly bedsConsultant EMI beds

Total beds

20 20 30 3020 20 40 70- 10 20 20

40 50 90 120

Day patient servicesElderly day hospital places 15 20 20 25EMI day hospital places * * 20 20

Total day place 15 20 40 45*Combined with Elderly DH

Clinic servicesOPD (C/E rooms) 2 2 4 6Minor casualty (dept) 1 1 1 1Dental dept (suite) 1 1Endoscopy suite 1 1

Main entrance 1 1 1 1

Clinical support servicesRehabilitation (dept) * 1 1 1X-ray - RDR 1 1 1

- Ultrasound room 1 1Operating suite (suite) 1Pharmacy, dispensing (dispensary) 1

*Included in day hospital

Ancillary servicesCatering: main kitchen (meals) 78Catering: staff dining (places)

meals 20Mortuary: body store & viewing

room (spaces) 3Linen & sewing room (dept) 1Domestic dept (dept) 1Supplies & distribution (dept) 1Central staff change 1Works dept -

- boiler house/work-shop/stores 1

- Emerg. generator/elect.intake 1

-Waste disposal 1

99 183 324

25 45 60

3 6 61 1 11 1 11 1 11 1 1

1 1 1

1 1 11 1 1

I2 Typical examples of functional content

24

5.0 Quality of environment

5.1 Philosophy of care

Community hospitals provide the opportunity for:

l a more holistic approach to patient care

l a focus on caring for patients within their owncommunity

l continuity of care of patients by their GPs.

5.2 Ethos of environment

The buildings provided should:

l be on a scale appropriate to the range and type ofservices being provided; preferably single storey or amaximum of two storeys, with a ground floorlocation, where possible, for patient areas

l be in a style appropriate to the local context, withappropriate use of local materials and architecturalstyles, to blend buildings into their environment

l incorporate landscaping, which provides anattractive image and outlook, and safe and usableexterior spaces

l focus on the creation of a non-clinical domestic styleinterior environment, which IS welcoming andreassuring

l exploit use of colour, pattern, texture, lighting andart to maximum effect

l ensure that choice of furniture enhances, ratherthan detracts, from the interior environment andrepresents an appropriate balance between functionand aesthetics.

5.3 Total quality management

Operational policies and the design of the buildings shouldcombine to ensure appropriate:

Privacy: in bed areas, sanitary facilities andtreatment areas

Confidentiality: in reception, consulting andtreatment areas

Dignity: in all patient areas

Choice: of activities or spaces

Control: of temperature, personalisation of bedspaces, scope for relatives to care for patients

Independence: provision of facilities whichencourage independent use by patients

Access: both into and around the hospital forpatients and visitors in wheelchairs, and those withreduced mobility and/or sight impairment.

13. View through the main entrance and internal courtyard showing the scale and quality of environment

25

6.0 Location and site selection

Careful choice of a suitable site will be crucial to thesuccess of a community hospital. The following areimportant factors to be considered in selecting a site

6.1 Accessibility

To fulfill their role as part of an integrated health caresystem, community hospitals should be distributed andsited to provide coverage of, and access by, the localpopulation they are intended to serve. Communityhospitals may serve urban, semi-urban or ruralpopulations. The catchment area of a community hospitalwill be determined by the contracts taken out by DHAs orfund-holding GP practices, on behalf of their residents andpatients. GPs may be reluctant to use community hospitalswhich are an appreciable travel distance from theirsurgeries.

The site should be located, either close to the centre ofpopulation served, or easily accessible via public transport.

Site selection should not only be restricted to sites alreadyowned by the health authority, as these may not always beappropriately located.

6.2 Physical site characteristics

Restricted sites may make it difficult to provide the

majority of patient areas at ground floor level and mayprovide little outdoor space, or scope for landscaping.

Sloping sites may also result in the need for steps withinthe building and a first floor location for some functions.Sites should allow some scope for expansion, even if noneis initially envisaged.

A site which provides external interest, stimulus and asense of being part of the community has advantagesparticularly for longer stay patients and those attendingthe day hospital.

Sites should allow provision of adequate car parking,access by ambulance transport and for supply of goodsand disposal of waste.

6.3 Relationship with primary carefacilities

If a health centre or GP surgery is to be included as part ofthe development, site selection may need to cater forseparate access to each part of the building and foradditional car parking requirements.

14. Location in the community

26

7.0 Whole hospital planning issues

To provide an appropriate environment which reflects thequality criteria outlined in Chapter 5, whole hospitaldesign strategy should consider the following issues.

7.1 Scale and style

Either new buildings or adaptation of existing facilities maybe appropriate, as a means of providing accommodationwhich is suitable for modern health care requirements.

15. Mold Community Hospital

A single storey development is preferable to preserve adomestic scale. This may, however, create a conflictbetween locating patient services at ground floor level,and keeping the whole development reasonably compact,with short travel distances between related services. Twostorey development may be appropriate for some sites andsizes of hospitals.

16. llkeston Community Hospital

Separation of whole hospital traffic from departmentaltraffic is not as important as in an acute hospital.Boundaries between services are more blurred in acommunity hospital.

7.2 Integration with other facilities

Provision of a community hospital, in association with ahealth centre or GP premises, may result in someeconomies of space provision, through shared use ofsupport services. Integration may also affect the groupingsof services on the site. Where facilities are integrated,provision will be required for health education andpromotion activities.

7.3 Zoning and relationships between

services

The smaller scale of community hospitals generatesdifferent requirements for relationships between servicescompared to an acute hospital. Diagram 17 summarisesthese requirements, which are shown diagramatically inDiagram 18.

Occupational therapy (OT) and physiotherapy should beaccessible to the whole hospital and to patients coming infrom outside.

OT, physiotherapy and day hospital accommodation(including speech therapy and chiropody) will generally begrouped together at ground floor level, close to the mainentrance. This grouping provides easy patient accessbetween services. Care should be taken to provide directaccess for inpatients to specific day hospitals facilities (e.g.hairdressing), rather than access via the day hospital.

There are differing views on whether inpatient services forthe elderly should be physically linked to, or separate from,day hospital and rehabilitation services. This will bedependent on operational policies for use of day hospitalservices by inpatients, provision made for OT andphysiotherapy on wards and on rehabilitation staffingpolicy.

Minor casualty, outpatients and radiodiagnostics aregenerally small and sometimes single-handeddepartments. Physical grouping of these services allows forsome sharing of support spaces (e.g. utilities and waitingareas) and shared use of nursing staff. Reasonableproximity between minor casualty and one of the inpatientwards may also facilitate provision of night-time nursingcover for minor casualty by the ward night staff. Separateaccess to minor casualty is not generally required.

Inappropriate juxtaposition of departments (e.g. mortuarynext to outpatients) should be avoided. As far as possible,

27


Dept Relationship to Close Proximity Reasons

Essential Desirable

XXX

XX

X

X

X

X

X

X

X

X

X

X

GP beds

Elderly/EMI beds

Dayhospital

Ground floor

Day hospitalGround floor

Main entranceOTPhysiotherapy

Minorcasualty

Main entranceRadiodiagnosticsOutpatients

GP ward

Dining KitchenGround floor

OT/physio Main entranceOutpatients

Clinicservices

GP premisesCommunity clinics

Radio- Minor casualtydiagnostics Outpatients

GP premises Whole hospital

X = relevant

Optional

Access to outdoor space

X Scope for shared use of nursing staffAccess to outdoor space

Access for day patients from outsideEase of day patient access andpatient management

Easy access for patientsAccess to radiodiagnostics, and shareduse of support spaces and nursing staff

For convenient provision of out of hoursnursing cover

Access to outdoor space

Easy access for day patients/GP referralsEasy access for outpatients

X Shared use of support spaces,X consulting suites 84 treatment spaces

Easy access for patients

X Easy access for GPs for day-to-day involvementin community hospitals

28


----

----

4”

18. Who/e hospital relationships. Services for inpatients, day patients and out-patients are clustered in three main zones around a central main entrance/

admin core

l Zone 1 contains clinic services including treatment, and, where provided, dental and endoscopy services), minor casualty and radiodiagnostics. These

are primarily for out-patients, although some day and inpatients may use radiodiagnostics, treatment and endoscopy.

. Zone 2 contains the day hospital and rehabiIitation services. Primarily for day patients, session use may also be made by inpatient and out-patients(e.g. antenatal relaxation in physio exercise area).

l Zone 3 contains the main inpatient accommodation.

29


1 20 Bed Ward

OTphysiotherapy

20 Bed WardI

Plant &T-TWorks

30


Jh-I?- 20 Bed Ward

Plant &

Works

20. Schematic layout of a angle storey 90 bed/40 day place community hospital showing the size and relationship of the principal elements

31


10 Bed Ward

-I”“*’

21. An alternative schematic layout for a 90 bed/40 day place hospital with the wards arranged on storeys

32


inpatient areas should be provided at ground floor level.Even in urban locations it may still be possible to providereasonable access to outdoor space directly from first floorwards, (e.g. Lambeth Community Care Centre).

7.4 Information Technology

For maximum effectiveness, community hospitals will needto be part of an information technology network linkedboth to local GP surgeries and to the nearest DGH. Thiswill facilitate patient referral/discharge, access toappointment systems and to test results. Communityhospital design should provide adequate wireways fortransmission cabling, space and power supplies for visualdisplay terminals and storage for associated supplies,

7.5 Design of inpatient facilities

The’ choice of ward design will have a major impact onwhole hospital design strategy. The tendency to use

standard acute ward designs, which are intended for otherpurposes and do not provide an environment whichreflects the philosophy and pattern of inpatient careappropriate to community hospitals, should be resisted.Community hospitals provide tremendous scope forinnovation in inpatient ward design. (See Chapter 9.1).

7.6 Privacy and confidentiality

Ensuring privacy and confidentiality for patientsthroughout their stay is important in all health carebuildings, but is especially important in communityhospitals, where staff and patients are more likely to knoweach other. This concern may affect the location andposition of departments within the site (e.g. avoidingconsulting rooms overlooked by car parking) and also thedesign of accommodation for particular services.

Privacy is likely to be more important than goodobservation in the design of community hospital inpatientareas, in contrast to acute hospital wards, where the focusis generally on the latter.

22. Gardens - Ystradgynlais Community Hospital

33


7.7 Role of outdoor space

Courtyards and gardens should be designed, not only toprovide a pleasant outlook and view, but also as anamenity for use by staff and patients.

Landscaping should provide safe and easy access forleisure and rehabilitation activities, particularly for elderlypatients whose sight and mobility may be impaired.Courtyards can provide access to enclosed outdoor spacefor elderly patients with dementia to wander in safety,There may be occasional bedfast patients who wouldbenefit from access to the grounds.

Landscaping will generally be planned for easy and costeffective maintenance, but there should also be scope forpatients to garden, with suitable provision of raised beds.

Courtyards may also be used as a home for hospital pets(e.g. hamsters, rabbits, guinea pigs, ducks, etc).

7.8 Logistics and communicationsstrategy

In smaller community hospitals (e.g. less than 50 beds),most traffic involving patients, staff, supplies, disposal WiIItake place via departmental circulation space.

In a larger community hospital, greater differentiationbetween whole hospital communications space anddepartmental circulation may be necessary to avoid use ofof departments by through traffic to other departments.Where a ‘hospital street’ is deemed necessary, carefuldesign will be essential to avoid creating long corridorswhich conflict with the intended ethos of a smaller scale,non-clinical environment, as compared to a district generalhospital.

Where engineering services are distributed in roof spaces,safe and easy access is required by works staff foroperational maintenance purposes.

23. Courtyard - Ilkeston Community Hospital

34


7.9 Expansion strategy

24. Ward corridor - Ystradgynlais Community Hospital

Some limited scope for expansion should be provided, forexample:

l earmarked space in the development control plan(DCP) to add another ward, expand outpatients, etc.

l grossing up projected bed numbers, to produceeconomically-sized wards, may introduce someinitial spare capacity.

l careful juxtaposition of services may allow some ebband flow and shared use of space between them.This may be difficult to achieve where services areprovided in physically separate wings, rather than ina linked development.

. if significant expansion of local services is required,provision of another suitably located communityhospital may well be preferable to further expansionof existing facilities.

7.10 Flexible and shared use of space

There is an ethos of cooperation in community hospitals,which is less common in an acute hospital setting. Servicesin community hospitals have less watertight boundariesand may be more interdependent both in terms of staffingand space use.

Shared and multi-use of space may be perceived more asan opportunity than a threat. It can provide flexibility tocope with changing demands and allow each serviceaccess to improved provision of shared treatment,consulting or support facilities.

Many community hospital activities will occur onlysporadically and do not require dedicated space.

If the community hospital is to provide a resource for localgroups and a base from which voluntary agencies canprovide services, flexible use of spaces by different users atdifferent times (including evening and weekend use) willbe important, but will need to be properly managed.

There are a number of ways in which space sharing can beapplied in community hospitals to achieve overallreductions in area and to achieve functional relationshipsappropriate to a community hospital. Examples are set outin Diagram 25.

35


25. Options for increasing space utilisation

Wards

l Share pantry utility, staff facilities between two wardsl Use central equipment store for beds etcl Day space with option to share between two wards

Day Hospital

l Share reception, records, waiting, wheelchair bay with main entrance (where adjacent) and/or out-patients. Share space with rehabilitation (provided dining tables and easy chairs do not have to be cleared away for

rehabilitation activities)l Share some day space, quiet space, utilities with ward (if adjacent)

Outpatients

9 Share reception, records, main wait, wheelchair bay with main entrance and/or day hospitall Some utilities, treatment and patient facilities can be shared with casualty/day hospital (if adjacent) and

community clinics (if present)l Use of consulting room for counselling and screening activities

Radiodiagnostics

l Share reception and filing with main entrance/out-patientsl Share processing with dental (if adjacent and if systems are compatible)

Minor casualty

l Share reception, records, etc. with out-patients and/or main entrancel Share utilities, patient facilities with out-patients (if adjacent)

Rehabilitation

l Physiotherapy and OT can share offices, open exercise area and storage areasl Physiotherapy and OT can share reception, records and possibly wheelchair bay with main entrancel Physiotherapy and OT can be combined with day hospital and share utilities and patients facilities with day

hospitall Use of physiotherapy exercise area for health education activities

Staff facilities

l Shared provision of changing, rest, catering and seminar facilities

36


7.11 Interior design

Interior design can make a major contribution to theachievement of an appropriate quality of environment fora community hospital.

Issues are:

l Use of carpeting: in main corridors, ward corridors,bed areas and day rooms. Advantages are reductionin noise levels and injuries to elderly patients.Careful choice plus a well-managed cleaning policycan keep carpets stain and odour-free.

l Choice of furniture: should enhance rather thandetract from overall appearance. Function should bebalanced carefully against aesthetics.

l Soft furnishings: use of duvets, coordinatedcurtains and bed linen can all contribute to creationof a more domestic environment, especially ininpatient and day hospital areas.

l Colour and pattern: can be used to effect todifferentiate one department from another, todifferentiate bed bays from each other and aidpatient orientation within wards.

l Lighting: thoughtful coordination of artificiallighting with other aspects of the interior decor cangreatly assist the creation of a non clinicalenvironment. This particularly applies to entrance,reception, circulation, dining and sitting areas,where the introduction of decorative lighting maybe appropriate. However, it is essential to ensurethat any decorative lighting does not degrade theclinical quality colour rendering of the lightingprovided in clinical areas. A combination of directand indirect techniques can be used to achievevariety.

l Art: creative use of art in all its forms can be used to“humanising effect”. Colour, pattern, texture,paintings, textiles, sculpture, photographs, etc. canprovide visual relief in corridors, interest indayrooms, waiting areas and courtyards andimportant links with the local community. 26. Day hospital courtyard - Lambeth Community Care Centre

37

8.0 Whole hospital operational policies withimplications for design and space utilisation

Operational policies will influence the way that communityhospital services are provided and managed.

At a whole hospital level the following are operationalpolicy issues which have implications for design, spaceprovision and utilisation:

l Bed management: by whom (e.g. consultants, GPsor nurses) and on what basis?

l Patient management: who has overallresponsibility and day-to-day responsibility? Clearadmission and discharge policies and associatedreview mechanisms will be essential to maintain thecommunity hospital ethos' and avoid blocking ofbeds.

l Mixing or separate provision of services andfacilities for elderly and EMI patients:clarification of what is regarded as good practice.

l Shared and multi-use of space: evening andweekend use by local groups, voluntaryorganizations, social services etc. This will need tobe planned positively if it is to be successful.

l Catering policy: cook chill policy will haveimplications for design of kitchens, wards and dayhospitals.

l Storage policy: provision of hospital level store ordepartmental storage only.

l Waste disposal policy: arrangements will berequired for collecting, temporary holding anddisposal of clinical and domestic waste, given thatthe hospital is unlikely to have an on-site incinerator.

l Staff changing: provision of central changing area,or local changing for some services.

l Patients’ laundry: provision of personalisedpatients laundry service will have spatialimplications, if it is to be provided on site.

l Security: arrangements will need to be made toprovide adequate security for staff and patientsparticularly where a 24-hour minor casualty serviceis provided.

l Education and training policies: programmes andspace for in-service education and training will berequired for all types of staff.

Laundry, pathology, pharmacy, and sterile supplies will beprovided by the DGH or other off site district services.Detailed guidance on other whole hospital operationalpolicies and on policies and procedures for individualcommunity hospital services can be found in ‘TowardsGood Practices in Small Hospitals - Some SuggestedGuidelines’ (NAHA 1988).

27. View through the internal courtyard showing the staff dining area

38

9.0 Planning accommodation for community hospitalservices

This Chapter focuses on planning and design issuesassociated with individual community hospital services. Foreach service, material is presented under the followingheadings:

scopesizingother relevant guidanceoperational policiesplanning issues and optionsrelationship to other servicestotal quality managementinterior designmulti use of space.

The bubble diagrams which appear throughout Chapter 9are intended to illustrate possible relative locations ofspaces and/or activities. They do not necessarily indicateownership of spaces as some spaces may be sharedbetween two or more services. Plans are included forillustration purposes only.

Reference is made to other relevant guidance material butthis guidance is not repeated here. A complete list of otherrelevant Health Building Notes is provided in Appendix 5.

9.1 Inpatient accommodation

9.1.1 Scope

Inpatient wards in community hospitals may accommodateacute and pre-convalescent patients, patients requiringrespite care, rehabilitation and terminal care. Somecommunity hospitals may provide GP maternity beds forselected low risk consultant screened patients, or for useby postnatal patients discharged from the DGH. Respitecare may also be provided for younger disabled patients.All these patients will generally be under the care of theirGPs. Other specialties may include elderly, EMI, and acutemental illness patients. For elderly and EMI patients, thefocus will generally be on rehabilitation and respite carerather than on continuing care. These patients may beunder the care of a consultant, although GPs will take dayto day responsibility. Nurse managed beds, for thosepatients requiring primarily nursing care and rehabilitation,may also be a feature of community hospitals.

9.2.1 Sizing

Estimates of numbers of beds required should be carefullyco-ordinated with the provision of beds in the DGH andother local hospitals, so that community hospital beds arean integral part of a continuum of care for patients andare not seen as an optional extra. Careful assessmentshould be made of the extent of local support, GPcommitment to, and likely use of community hospital beds.

9.1.3 Other relevant guidance

Health Building Note 37 - ‘Hospital accommodation forelderly people’ provides guidance on inpatientaccommodation which is of general relevance to theplanning of GP acute wards, nurse managed wards andwards for the elderly in the community hospitals.

Health Building Note 35 - ‘Accommodation for peoplewith acute mental illness’ is of relevance to the planning ofaccommodation for elderly mentally ill people and elderlypeople with dementia. Health Building Note 4 - ‘Adultacute wards’ is of general background interest only, sinceit focuses on the care of acutely ill patients in a DGH.

Health Building Note 21 - ‘Maternity department’ is ofgeneral relevance in those relatively few instances where aGP maternity unit is to be provided in a communityhospital.

In applying these guidance documents in a communityhospital setting, the following points should be noted:

standard ward designs (such as those in HBN 37 andHBN 4) which are suitable for a DGH setting, maybe appropriate for the types of patients to be caredfor in a community hospital. The opportunity todevelop innovative ward designs based on moreinformal arrangements of single rooms and bedbays with smaller numbers of beds, should not bemissed.

bed spaces may need to be larger than DGH bedspaces to accommodate armchairs, wheelchairs,larger wardrobes for personal clothes, etc.

privacy, rather than observation, may be the moredominant factor in the planning of communityhospital inpatient areas.

39

9.0 Planning accommodation for community hospital services

Key zone

IIf

Bed orientated facilities .-NDay activii

28. 20 Bed ward showing zoning into bed related facilities, day facilities and support facilities. Points to note include:

l small day areas for 213 people within bed bays and off Circulation areas

l physiotherapy ‘areas’ within main circulation. appropriate supervision of both bed and day areas. flexibility to provide accommodation in either single rooms or 4 bed bays. sanitary accommodation strategically located to service both bed and day areas . the possibility of ensuite sanitary accommodation. separation of clinical functions from patient oriented areasl accessible storage and utility spaces

l choice of day and quiet areasl potential links to gardens and/or patios

40


V9

Y

,I ,/-/10 / ” /“’ /,,/’

29. Plan of a 20 bed ward with 12 single rooms and two 4 bed bays

41


30. 10 Bed ward. As with 20 bed ward, this arrangement is zoned into bed, day and support areas; the latter being located near the ward entrance to allowpossible sharing with another 10 bed ward

42


31. Plan of a 10 bed ward, all beds in single bed rooms

43


Aspects of existing guidance which should be stressedinclude:

l maximum distances (12m) from bed areas to WCs(HBN 37), to maintain patient independence

l inappropriateness of acute ward type staff base forEMI wards

9.1.4 Operational policies

The following operational policy issues require carefulconsideration:

l use of the same inpatient ward by different caregroups (e.g. elderly and EMI patients). Their differingrequirements may create operational difficulties forstaff and for patients. There may, however, beinsufficient demand to justify separate provision foreach group. Where sharing is necessary, increasedprovision of single rooms and provision of separateday space may obviate some of the difficulties.

l creation of a secure environment for EMI patientsmay require a means whereby staff can be alertedthat patients have left the ward. The choice of alarmor control system should be compatible with theethos of a community hospital.

l access to outdoor space. Provision of attractiveoutdoor spaces for patient and staff use isimportant. Many patients may be frail, elderly orconfused and will be dependent on assistance bystaff or voluntary helpers if they are to go outside.

l treatment. Inpatient treatment will generally becarried out at the bedside or in the treatmentbathroom.

l use of sanitary facilities. Policy here should strike anappropriate balance between safety and risk. Theprovision of sanitary facilities and operationalpolicies for their use should work together tomaximise patient independence.

l use of the TV in day areas. Local policy shouldensure provision of choice and avoidance ofnuisance.

l involvement by relatives in the care of patients. Thismay have Implications for provision of supportaccommodation in wards, for use by relatives.

l storage policy. If a hospital store is not provided,adequate storage will be required at ward level fordisposables and other bulk supplies.

l suitable choice of carpeting plus a well managedcarpet cleaning policy is essential to ensure thatcarpets remain stain and odour free.

l smoking policy in day/dining areas should cateradequately for non-smokers.

9.1.5 Planning issues and options

The following are issues to be taken into account in thedesign of inpatient wards:

an innovative approach to ward design is essentialto provide a non-clinical environment for differenttypes of patients, most of whom will not be in bedduring the day.

long, straight, corridors and large multi bed baysshould be avoided. Both will make it difficult toachieve a non-clinical environment.

choice of an appropriate mix of single and multi-bedrooms is Important to provide for flexibility in use,patient privacy, observation of acutely ill ordisturbed patients. Eight bed bays are generally notregarded as appropriate for community hospitals.

provision of designated single rooms, or adesignated multi-bed bay, for use by post-natallying-in patients will be essential on a GP acuteward, if there is no separate GP Maternity Unit.Ensuite bathroom facilities (WC and shower) willalso be required to reduce any risk of cross infection

ward design should reflect the different day andnight-time patterns of ward usage. Most patientsand staff will be in the day areas during the daytime and in the bed areas at night.

44


l location of day spaces within easy access from bedareas is desirable both for patient convenience andefficient ward management.

l consideration should be given to the installation ofan induction loop in the dayroom so that patientswith hearing aids can hear the TV at normal volumeand without disruption to other patients and activities.

l separate provision of adequately sized day anddining space and provision of a separate quiet room,will give patients a choice of location and activity.

l direct access to outdoor space from some singlerooms is desirable.

l suitable furniture will be required on which to standTVs in single rooms, or multi-bed bays.

l WCs should be within easy reach (12m) of dayspaces and bed spaces.

l adequate provision of washing facilities shouldprevent inappropriate use by patients of clinicalhand wash facilities in multi-bed rooms.

l design of bed areas should reflect an appropriatebalance between privacy for patients andobservation by nurses. The latter may be importantonly for a relatively small number of patients.

l adequately sized bed spaces should accommodate apatient’s personal clothes storage and a comfortablechair or wheelchair by the bedside. (See alsoChapter 9.11)

l siting of dayrooms should provide exterior visualstimulus and interest for patients (in both urban orrural settings).

32. View of 4 bed bay adjacent single room, showing the possibility of achieving ‘private’ areas around the beds without sacrificing observation Some day

space is provided within the bay for patients and relatives

45


preservation of privacy and dignity for patients isessential, particularly in the provision of sanitaryaccommodation. WCs should not open directly ontospaces in which people may gather (e.g. dayroomsor social spaces).

l adequate provision should be made at ward levelfor OT and physiotherapy. Circulation space can beused for walking bars, steps, etc.

For EMI patients, the following are also important issues:

l single rooms are preferable to multi bed bays topreserve patient privacy and dignity and minimisenoise and disruption to other patients.

l creation of separate sleeping and living zones isdesirable, to contribute to ‘normalisation’ and aidpatient orientation.

l an informal ‘gathering’ area or ‘forum’ for patientswithin the ward, perhaps as part of the circulationspace should be considered.

l access to a safe outdoor area is important, so thatpatients can wander without getting lost.

l if the ward is shared with elderly patients, aseparate day and dining space should be provided,for use by EMI patients.

l provision of an office rather than a traditional nursebase will generally be more appropriate.

33. View of a cluster of 5 angle rooms. This arrangement allows greater privacy and dignity for the patient without sacrificing observation. The space required

is identical to the 5 beds in figure 32

46


34. View of the day space in a 20 bed ward, showing separation Into spaces of a more domestic scale Including a separate quiet room. Note the access tooutdoor spaces

47


35. View of day space in a 10 bed ward. Note again the separate quiet room and access to outdoor spaces. The ‘nurses base’ is seen as an informal table andchairs adjacent to the office space

48


Where a local decision has been made to provide a GPMaternity Unit for low risk consultant screened patients,the following issues should also be considered:

l facilities should be seized appropriately to localneeds, taking account of the availability of DGHmaternity facilities. Ten beds and two normaldelivery rooms are likely to be the minimal viablesize of unit. Additional beds may be required if theunit is also to take post natal lying in patients fromthe DGH.

l the mix of single and multi-bed rooms will be amatter for local decision.

l provision of ensuite bathroom facilities (WC andshower) for each multi-bed bay or shared betweentwo single rooms is desirable. Provision of a bath forpain relief should be considered.

l ward designs in which the ward is divided intodiscrete modules of four or five beds may facilitateshared used of a 20-24 bed ward by differentgroups of patients. However, where shared use isenvisaged, it will be essential to provide ensuitebathroom facilities (WC and shower) for thematernity beds, in order to reduce any risk of crossinfection.

9.1.6 Relationship to other services

Inpatient wards should be located:

on the ground floor, where possible, (especially forEMI patients) to provide access to outdoor space

close to the main entrance, for easy access byvisitors and elderly relatives

within reasonable proximity to hairdressing and tothe day hospital, physiotherapy and OT.

9.1.7 Total quality management

Inpatient wards should provide:

l a choice of day areas for patients

l privacy in bed areas and sanitary facilities

l access to recreation, entertainment andrehabilitation activities

l scope for personalisation of bed areas (especially forlonger stay patients)

l access to outdoor space and activities

l an exterior outlook which provides interest andstimulus

l scope for relatives to participate In the care ofpatients

l accommodation for husband and wife admissions,especially on wards for elderly people

l a child centred environment for areas used byyounger disabled patients.

9.1.8 Interior design

Issues here include:

use of carpeting in ward corridors, day rooms andbed areas, can create a non-clinical environment,reduce accidents, noise levels, etc

use of duvets, patterned cur-tarns, wallpaper in bedareas in different colours and patterns, can alsocontribute to a non-clinical environment and aidpatient orientation

choice of dayroom and dining furniture shouldreflect an appropriate balance between functionand aesthetics. Use of sofas as well as arm chairsshould be encouraged

lighting. Use of table lamps and other decorativelighting in day areas, can create an informal setting.

provision of display space, in bed spaces, for photos,cards etc allows scope for personalisation.

use of art (e.g. murals, picture, photos, sculpture,textiles, etc) can enhance the ward interior andprovide linkages with the local community.

the design and furnishing of multi-bed bays shouldstrike an appropriate balance between privacy forpatients and observation by staff.

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36. view of the central area to the bed cluster in a 20 bed ward. The nurse base is an informal table adjacent to the office. Note the provisIon of seats forpatients and relatives and the integration of physiotherapy aids into the general circulation space

50


9.2 Day hospital services

9.2.1 Scope

Day hospitals provide medical and nursing care, socialsupport and access to physiotherapy, occupational therapy,speech therapy, chiropody services, etc. for a range of caregroups (e.g. elderly, elderly mentally ill (EMI), acutementally ill (AMI), younger physically disabled andterminally-ill patients).

The scope and type of services to be provided should beclearly defined. Some daycare may be provided by, orjointly with, other agencies, e.g. Macmillan, local authoritysocial services, etc.

9.2.2 Sizing

Estimation of day hospital places should be based on acareful assessment of the local population’s health needs,taking into account the availability of other daycarefacilities and the referral preferences of local GPs.

Demand may be difficult to assess, but a reasonableattempt is necessary to avoid the provision of oversizedand underused facilities, or facilities which are neveropened, because of lack of demand.


Health Building Note (HBN) 37 - ‘Hospital accommodationfor elderly people’ Chapter 3, Day hospitals, is generallyapplicable to community hospitals, except that:

l the OT, physiotherapy guidance and space standardsin HBN 37 will not be appropriate for a communityhospital, where rehabilitation services cater for thewhole hospital and for direct GP referrals andshould be planned accordingly

l day hospitals for elderly people in communityhospitals may be smaller than HBN 37 day hospitalsizes (25-40 places), providing as few as 15 places.Guidance on smaller day hospitals for elderlymentally ill people is available in Health BuildingNote 35 - ‘Accommodation for people with acuteMental Illness’.

Particular note should be taken of the maximum traveldistance (12m) to WCs and of the avoidance of open planday and dining areas, as recommended in HBN 37. Theseaspects have been ignored in some recent communityhospital designs.



l use of a day hospital by different care groups (e.g.elderly and EMI), either on different days or at thesame time

l use of the day hospital by inpatients and provisionof direct access for inpatients to specific services(e.g. hairdressing)

l use of TV in the day area. Provision of choice andavoidance of nuisance is important.


The following are issues to be taken into account in thedesign of day hospital accommodation:

9.2.6

scope for shared use of treatment spaces, activityspaces and WCs, with physiotherapy and OT shouldbe explored.

a close relationship between the day hospital wardsfor elderly and EMI patients may provide scope forshared use of nursing staff.

provision of separate rather than combined day anddining areas is desirable.

shared provision of day and dining space forrehabilitation activities may create operationaldifficulties.

consideration should be given to the installation ofan induction loop in the dayroom so that patientswith hearing aids can hear the TV at normal volumeand without disruption to other patients andactivities.

Relationship to other services

The day hospital should be located:

l on the ground floor, with easy access from the mainentrance.

l in close proximity to OT and physiotherapy.

l to provide direct access (not via the day hospital) tohairdressing, chapel, etc. which may be usedprimarily by inpatients, or during evenings andweekends.

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Garden 37.3

37.2

speech therapy to provide a full day hospital facility This concept a/so allows sessional use of the latter facilities when not required for the day hospital in

a small unit of up to 20 places, one core day hospital will suffice. In addition, certain shared functions (treatment, chiropody and hairdressing could beprovided in a central zone equally accessible to out-patients and inpatients

37.2 Rehabilitation and day hospital (larger unit) if the scheme is to provide 40 day places this might be provided by 2 core day hospitals sharing access to 0T,

physio- and speech therapy

37.3 Day hospital core The core day hospital comprises a central ‘forum’, day, dining and quiet rooms, together with a C/E room and WC/bath facilitiesPotential access to outdoor space is important, as is access to 0T, physio, speech therapy and other shared facilities (e.g. chiropody and hairdressing)

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O c c u p a t i o n a lt h e r a p y

Treatment

38. Layout of a core day hospital and its relationships to the 0T, physiotherapy and speech therapy elements of the whole day hospital

53


39. View of the core day hospital and its relationship to the outdoor spaces. Note the central forum used as an informal meeting space

54


40. view of the central area in the day hospital rehabilitation zone showing ease of access between the various elements

and back to the central hospital courtyard


The day hospital should provide: Issues here include:

l a quiet area for distressed patients, or those needingto withdraw temporarily

l adequate provision of WCs within 12m of main dayand dining areas

l WCs which do not open directly on to spaces inwhich people may gather (e.g. day spaces)

l access to outdoor spaces and courtyards

l a choice of activities and locations

l an exterior outlook from day areas which providesinterest and stimulus for patients.

l choice of furniture for the day area which representsan appropriate balance between function andaesthetics and which makes a positive contributionto the overall design

l informal seating arrangements in day and diningareas should be encouraged

l low tables, reading lights and decorative lighting inday areas can also contribute to an informalatmosphere.

9.2.9 Multi-use of space

Use of day hospital facilities by voluntary groups, duringevenings and weekends, should be encouraged.


9.3 Physiotherapy

9.3.1 scope

The physiotherapy service (see Diagram 41) in acommunity hospital will be providing services to:

l inpatientsl day patientsl out-patientsl GP referrals

It will also provide a base for outreach/domicilary services.GP referrals will generally be the largest component ofphysiotherapy service workload. A variety of active andpassive treatments will be provided, either on anindividual, or group basis: Many services for inpatients willbe provided at ward level.

In a community hospital, It might be expected that groupsof up to 12 patients with one or two staff might beaccommodated in an exercise area at any one time, whilethe provision of treatment cubicles in the ratio of two perphysiotherapist might be appropriate. Suggestions forsizing the treatment and exercise areas (which may besmaller than their DGH equivalents) are shown inAppendix 3. Antenatal classes which could contain up to30 patients, may be better accommodated in the clinicarea, rather than in the rehabilitation facilities.

4I. Source of workload

9.3.2 Sizing

Where a new community hospital is to be provided, dataon existing GP referral patterns to the nearest DGH willprovide the basis of workload estimates. Estimates mayneed to be adjusted upwards to allow for possibleincreases in referrals which may be generated by access toa local, rather than DGH, physiotherapy department.

42. Physiotherapy exercise area - Lambeth Community Care Centre

The inpatient and outpatient components of communityhospital physiotherapy workload may also be estimatedfrom those services which are currently provided at theDGH and which may be expected to transfer to thecommunity hospital.

Estimated workload will generate a need for a particularphysiotherapy staffing establishment. The number of staffin the department at any time and the maximum numberof patients that they can treat simultaneously will thenform the basis for estimating total space requirements.Subdivision of space between the exercise area for groupwork, and the provision of cubicles, for individualtreatment, will be a matter for local decision.


Health Building Note 8 - ‘Rehabilitation - accommodationfor physiotherapy, occupational therapy and speechtherapy’ provides useful background information but isspecifically oriented to rehabilitation services provided Indistrict hospitals and is not directly applicable to thesmaller scale and different mix of services provided incommunity hospitals. However, in those few instanceswhere a hydrotherapy pool is to be provided, the HBN 8guidance for this option is appropriate.

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43. Physiotherapy The physiotherapy sect/on of the rehabilitation service comprises physiotherapy cubic/es, wax and UV rooms, a treatment room and a largeexercise area This supplies services to the day hospital. in addition to inpatients and out-patients

physiotherapy, speech therapy and OT specificallyassociated with ward and day hospital accommodationfor elderly people. It does not, therefore, deal with thewider service provided by these departments in communityhospitals, (e.g. to other inpatients, out-patients, and mostimportantly, GP referrals). These guidance documents are,therefore, relevant as background material only.



l patient changing. Patients undergoing individualtreatment may prefer to change in the treatmentcubicle rather than In separate changing cubicles.The exercise area will require associated patientchanging provision.

44. Physiotherapy exercise area - Ystradgynlais community hospital

9.0 Planning accommodation for community hospital’ services

Layout of a physiotherapy section showing its relationsh!p to the other elements of the day hospital/rehabilitation area

58


l staff changing. Local changing may be preferred

l patient reception, If a reception area is not provided,patients need a means of notifying staff of theirarrival.


The following are issues to be taken into account in thedesign of physiotherapy facilities:

l overall space provision should take into accountthat physiotherapists cannot be working in wards,treatment cubicles and exercise areas simultaneously.

l scope for shared use of support spaces (e.g.reception, waiting, utilities, WCs) with OT and theday hospital should be explored.

l provision is required, either separately or within theexercise area, for physiotherapy staff to write upnotes and make appointments.

l provision of a space to interview staff, or relatives, isdesirable and could be shared with anotherdepartment.

l flexibility to alter the balance between the exercisearea and individual cubicles (e.g. to create additionalcubicles for specific treatments) is desirable.

l provision of storage to accommodate items offurniture, wheelchairs, walking frames andconsumables. Inadequate storage provision mayrestrict the capacity of treatment areas. Records canbe stored in the main health records area.

l a hydrotherapy pool plus support accommodationmay occasionally be provided in a communityhospital. Such provision will have significantconsequences for site energy consumption and forengineering and building maintenance.

l possible shared use of the exercise area with OT forgroup activities should be considered.


The physiotherapy facilities should be located:

l on the ground floor with access to exterior space

l adjacent to OT and the day hospital

l within easy access from the main entrance

l within reasonable proximity to the wards


The physiotherapy facilities should provide:

l privacy for patients in individual treatment cubicles

adequate ventilation for those individual treatmentrooms containing heat generating equipment.


Shared provision and use of reception, waiting areas,utility areas WCs, etc, with OT and the day hospital, arepossible and should be encouraged. Evening use of theexercise area for health education activities may also bepossible.

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9.4 Occupational therapy

9.4.1 Scope

An occupational therapy (OT) service (see Diagram 46) in acommunity hospital will be providing services to:

l inpatientsl day patientsl out-patients/health visitor referralsl GP referralsl domiciliary services, assessmentsl local authority day centre referrals.

Services to day patients, inpatients and GP referrals willgenerally be the largest components of OT workload.

Therapy

GP referrals

46. Source of workload

The main focus for OT work will be assessment andtreatment programmes for individual patients. Patientsmay also be grouped, for mental stimulation and support,to undertake particular activities and for effective use ofOT staff time. Most patients will require a combination ofaids to daily living (ADL) and group activities. Theincreased numbers of elderly patients is leading to adecreased focus of heavy/light workshop activities and to agreater emphasis of reality orientation and other lessequipment intensive activities.

9.4.2 Sizing

A similar approach to that outlined for physiotherapy willgenerate the need for a given OT staffing establishment.The minimum number of staff in an OT department islikely to be one OT plus two helpers, who between themcould cope with approximately 20-25 patientssimultaneously.

Increased workload and staff will generate a need for alarger exercise area, but will not affect ADL provision(apart from increasing the usage of those facilities). Thelikely proportion of wheelchair patients will also affect thesizing of the exercise area.


See physiotherapy Chapter 9.3.3.



l range and nature of group activities to be provided

l staff changing. Local provision may be preferred.


The following are issues to be taken account of in thedesign of OT facilities:

l overall space provision should take into account thatOT staff and helpers cannot be working in wards,ADL facilities, activity areas and in the day hospitalsimultaneously.

l scope for shared use of support services (e.g.reception, waiting, utilities, WCs, withphysiotherapy and day hospital) should be explored.

l scope for shared use of exercise area withphysiotherapy should be considered.

l provision of a space to interview staff, or relatives,separate from OT office, is desirable and could beshared with another department.

l flexibility to use the activity area for a wide variety ofdifferent types of activities is important. Provision ofappropriate storage for equipment and supplies isessential to allow this to happen.

l direct access to the ADL spaces should be possiblewithout going through the OT exercise area, inorder to avoid disruption of patients engaged ingroup activities.

Appendix 3 illustrates a method for sizing the departmentappropriately to the community hospital scale.

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47. OT. The OT section of the rehabiltitation service comprises ADL and activity spaces, supported by an OT office workshop, WCs and storage. Normally thisforms part of the day hospital but can also be used Independently by other out-patients and inpatients

ADL


The OT facilities should be located:

l on the ground floor with access to exterior space

l adjacent to physiotherapy and the day hospital

l within easy access for the main entrance

l within reasonable proximity to the wards



l the environment should be non-clinical, particularlyin the ADL area. The ADL bathroom should belocated adjacent to the ADL bedroom. The ADLkitchen should be an enclosed space rather than anopen bay.


Shared provision and use of reception, waiting areas,utility areas, WCs and an interview space withphysiotherapy and day hospital are possible and should beencouraged.

Shared exercise space, with physiotherapy, should also beconsidered.

48 ADL kitchen -Lambeth Community Care Centre

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P h y s i o t h e r a p y

Speechtherapy

Treatment

49. Layout of the OTsection showing its relationships to the other e/ements of the day hospital/rehabilitation area

62


63


9.5 Clinic Services

9.5.1 Scope

Clinic services in a community hospital may include:

consultant outpatient clinics in a variety ofspecialties (see Diagram 11)

clinics run by GPs (e.g. cytology clinics)

community clinics run by a variety of healthprofessionals and including dental clinics

endoscopy, treatment and investigation sessions runby visiting consultants or GPs.

9.5.2 Sizing

Where provision IS to be made for GP surgeries orcommunity health clinics, (because of existing shortfalls inhealth centre, surgery or clinic accommodation or where ahealth centre is being planned as an integral part of acommunity hospital development), space requirements forthese services should be assessed in accordance withguidance in the forthcoming Health Building Note 46 -‘General medical practice premises’.

Assessment of consultant out-patient clinic requirementsshould be based on local assessment of the target rangeof specialties to be catered for, the likely frequency ofclinic sessions and possible room usage pattern (i.e.number of consulting suites per clinic session) for eachspecialty. The actual range of clinics to be accommodatedmay sometimes not be known prior to the completion ofthe building and may be dependent on attracting specificconsultants to work in a local community setting.

Planning of outpatient facilities must, therefore, cope withuncertainty, provide the flexibility to cope with a variety ofspecialties and also allow future scope for expansion andfor the further development of treatment andinvestigation services.


Health Building Note 12 - ‘Outpatient department’ (andthe supplement on GUM clinics) are relevant sources ofgeneral guidance, but focus on the requirements of themuch larger outpatient departments to be found in acutehospitals. The sizing methodology provided as anAppendix to HBN 12 may be applied to communityhospitals. The assumptions in HBN 12 on clinic

throughput, room usage, number of doctors per clinicsession, etc should be modified to reflect the likelihoodthat outpatient clinics in community hospitals will involvefewer doctors, fewer patients who need to change, and areduced requirement for access to diagnostic services,compared to out-patient clinics in acute hospitals.

HBN 46 - ‘General medical practice premises’ (inpreparation) is the appropriate source of guidance on theprovision of space for GP surguries and community healthclinics.

Health Building Note 52 - ‘Day Unit’ (in preparation) wiIIinclude information appropriate to the design of anendoscopy suite.



l opening hours for clinic services

l numbers of consulting rooms allocated per doctorsession

l storage of equipment for use by different specialties


The following are issues to be taken into account in thedesign of clinic facilities:

shared use of reception and waiting areas betweenout-patients and other departments (e.g.radiodiagnostics and minor casualty).

shared provision and use of utility areas betweenout-patients and other departments (e.g.radiodiagnostics and minor casualty).

type of consulting suites provided. Combinedconsulting and examination rooms will provide moreflexibility in use than separate consulting andexamination rooms.

possible shared provision and use of treatment andutility areas between outpatient clinics, GP surgeriesand community clinics, where the latter are to beprovided as an integral part of a community hospitaldevelopment. Shared provision may enable

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51.1 Clinic services and minor casualty in a small community hospital incorporating a separate reception and waiting area. One zone would contain


52. View of the reception and waiting area for clinic services with out-pa bent facilities to one side and minor casualty and treatment to the other

66


improved facilities to be provided for use by l to facilitate shared provision and use of space whereconsultants, GPs and other professionals. possible with radiodiagnostics and minor casualty.

l clinics may vary significantly in size. There may beless flexibility in community hospital out-patientdepartments to cope with peaked usage of waitingareas.

l waiting areas should provide adequate space foraccompanying relatives and children and forpatients in wheelchairs. Provision of easy chairs willenhance the quality of environment, but must beallowed for in the sizing of the waiting area.

l consulting suites should be multi purpose, andavailable for use by different specialties andprofessionals. Local storage will be required to caterfor the supplies and equipment requirements of alarge variety of clinics, which may occur on afortnightly or monthly basis.


Clinic facilities should provide:

l confidentiality at the reception area and in theconsulting suites and treatment area.Interconnecting doors between consulting andexamination rooms should be avoided (asrecommended in HBN 12). Subwaiting directlyoutside consulting suites should also be avoided.

l privacy for patients in consulting suites andtreatment areas. These facilities should be located sothat they are not overlooked from car parks, orother parts of the hospital.

l privacy for changed patients who should not haveto pass public areas to reach consulting suites or theendoscopy suite.

l provision of a treatment and endoscopy suite (withassociated support spaces) for programmed use by l a ventilated and naturally lit waiting area with anappropriately trained GPs and visiting consultants, to exterior view.carry out a variety of minor surgical and investigativeprocedures, should be considered. It will also be 9.5.8 Interior design

essential to ensure that sterilising and disinfecting Issues here include:equipment and procedures comply with therequirements of good manufacturing practice. l choice of furniture for the waiting area


Clinic services should be located:

l on the ground floor with easy access from the mainentrance

l to provide easy access for patients toradiodiagnostics

l use of carpeting in the waiting area and consultingsuites.


Shared use of the waiting area, reception, utilities,treatment spaces with radiodiagnostics, minor casualty(and also with GP surgeries and community clinics whereappropriate) may make efficient use of both space andstaff time.

53. View through the out-patients and minor casualty with waiting/reception at the centre

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9.6 Minor casualty

9.6.1 Scope

The scope of services provided will vary according to localcircumstances (e.g. tourism, particular local hazardsavailability of other facilities, etc) and on the skills andexpertise of available staff.

A minor casualty service in a community will providetreatment by GPs and nurses of “walking wounded”patients with minor Injuries. More serious cases will betaken directly to the nearest DGH. Patients will generallybe self referred. Some follow up patients may be referredfrom other District General Hospitals for plaster checks,etc. Patients attending minor casualty will generally bedischarged home.

9.6.2 Sizing

The minimum provision for a minor casualty service is asingle examination/treatment room, with associatedsupport spaces (e.g. utility, WC, waiting area). Provision ofadditional examination treatment cubicles should be basedon local assessments of demand in terms of likely numbersof patients per day.


Health Building Note 22 - ‘Accident and emergencydepartment’ is of general background interest only, as itfocuses on DGH accident and emergency departments.



provision of daytime only, day and evening or 24hour service. This will have implications for nursingand GP cover

organisation of medical cover. This may be providedin a variety of ways including sessional cover, andon-call rotas by different GPs/practices

access to a basic radiodiagnostic service on site willbe required (see Chapter 9.7)

pharmacy and pathology services will generally beprovided by the DGH

out-of-hours access by patients and security for staff

l staff changing. Local changing may be preferred.


The following are issues to be taken into account in thedesign of minor casualty accommodation:

scope for shared use of waiting area, reception andutility areas with out-patients or radiodiagnostics

access to a room for private discussions withrelatives will be necessary

clear signposting from the main entrance and clearlyvisible instructions on how patients should gain outof hours access. A separate minor casualty entrancewill not normally be required.


The minor casualty facilities should be located:

on the ground floor with easy access from the mainentrance

in close proximity to radiodiagnostics andout-patients

within reasonable access to one of the wards, forpossible provision of nursing cover for those fewpatients attending out of hours.


The minor casualty facility should provide:

clear signposting from the main entrance

a welcoming reception point for distressed patients

privacy for patients in examination and treatmentareas. Care should be taken to avoid overlookingfrom waiting areas

confidentiality for patients in reception andexamination and treatment areas

a ventilated and naturally lit waiting area with anexternal view

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54. View of the minor casualty and treatment areas adjacent to the radiodiagnostic department



l choice of furniture and floor covering in the waitingarea, can help to create a reassuring and relaxingatmosphere

l provision of pictures and other visual interest in thewaiting area should be considered


Shared use of support spaces (e.g. waiting, treatment andutility areas) with out-patients and radiodiagnostics ispossible and to be encouraged.

Joint staffing of a shared reception area between minorcasualty and out-patients may sometimes be appropriateto make most effective use of staff time.

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9.7 Radiodiagnostics

9.7.1 Scope

The scope of a radiodiagnostic service in a communityhospital (and whether one is provided at all) will dependon the range of other services provided in the hospital. Abasic radiodiagnostic service (mostly chest and skeletalexaminations) may be augmented to provide anultrasound facility.

The radiodiagnostic service (see Diagram 55) will provideservices to:

l inpatientsl out-patientsl direct GP referralsl minor casualtyl day hospitals

Inpatients

plus support accommodation (waiting, changing, utility,processing, storage, office and reception). Approximately30 patients/day will be required to make effective usage ofone radiographer and one radiodiagnostic room. Localcircumstances may generate a higher estimated workloadwhich could justify provision of two radiodiagnosticrooms, but this is unlikely to be common.

Where antenatal clinics are held in the communityhospital, provision of an ultrasound room within theradiodiagnostic facilities may be justified.

Appendix 3 illustrates a suggested method of sizing l a separate waiting area for changed patients is

radiodiagnostic services for a community hospital. desirable


Health Building Note 6 - ‘Radiodiagnostic department’provides guidance which is of relevance to communityhospitals, particularly with regard to the design of theradiodiagnostic room.

l circulation space and room sizing should provideadequate access by wheelchair patients

Health Circular HC(89)18 provides guidance on healthservice use of Ionising Radiations.



l provision of services and facilities should satisfystatutory requirements under the Ionising RadiationRegulations 1985 and 1988 and should follow theguidance set out in HC(89)18

l procedure for reporting on films. Films may be sentto the nearest DGH for reporting, or may bereported on by a visiting radiologist. Space will berequired for this latter option.

l policy for storage of records and films. These maybe stored within the department or in the healthrecords area of the hospital

l reception of patients. This department is likely to besingle handed and procedures may be necessary fordealing with arriving patients, if the radiographer isbusy

l staff changing. Local provision should be assumed.


The following are issues to be taken Into account in thedesign of radiodiagnostic facilities:

l shared office provision for radiographer andradiologist (if reporting is done locally) will generallybe appropriate

l shared use of waiting areas, utilities, etc with minorcasualty or out-patients may be possible

l a WC Immediately adjacent to the radiodiagnosticroom is desirable

l WC provision should provide wheelchair access

70


l the film processing machine should ideally belocated in a dedicated space. This space will need tobe adequately ventilated. Viewing facilities can alsobe provided in this room

l If a separate ultrasound room is provided, thisshould also be adequately ventilated. A shower foruse by patients may also be desirable.

9.7.6 Relationships to other services

The radiodiagnostic facilities should be located on theground floor:

l with easy access from minor casualty and from themain entrance

l convenient access from out-patients is also desirable


The radiodiagnostic facilities should provide:

l privacy for changed patients, who should not haveto pass through public areas, to reach theradiodiagnostic room

l privacy for patients in changing cubicles and securestorage of personal clothes

l privacy for patients in radiodiagnostic or ultrasoundrooms.



l choice of furniture and use of carpeting in waitingarea.


Shared use of utility areas and waiting space, receptionand record storage, with minor casualty or out-patientsmay be possible and is to be encouraged.

56. A angle RD room with support facilities. Patients need a small sub-wait

and changing facilities

71


L

57 View of radiodiagnostics showing separate reception and sub-wait Note the separation of circulation for staff and patients

72


9.8 Main entrance area

9.8.1 Scope

The main entrance area of a community hospital mayaccommodate a wide variety of activities:

l main reception and waiting area. This may beshared with outpatients, day hospital or minorcasualty

l wheelchair parkl pram parkl mother and baby rooml vending machines-tea barl porter’s basel pharmacy (dispensing)l a shop and other income generating activitiesl WCs for patients and visitorsl payphones


Health Building Note 51 - ‘Accommodation for the mainentrance of a DGH’ is of general relevance to communityhospitals, although intended primarily for larger acutehospitals.


The following operational policy issue requires carefulconsideration:

l use of the main reception area as reception also forminor casualty, outpatients or day hospital.

l combined reception and general office

Inpatients

administration

73


59. View of the main entrance, central lobby and internal courtyard. This provides an informal meeting area and a focus of hospital circulation

74


60. Main entrance - Lambeth Community Care Centre


The following are issues to be taken into account in thedesign of the main entrance area:

l provision of automatic doors and a draught lobby.This will reduce draughts for waiting patients and

visitors and make access into the building easier,both for elderly patients and their relatives

l siting of the shop and other income generatingactivities, (e.g. optician, pharmacy) shouldencourage their use by staff, patients and visitors

61. Main reception - Ystradgynlais Community Hospital


62. Main waiting Bridlington Community Hospital


The siting of the main entrance area should provide easyaccess Into the building for day patients, out-patients,minor casualty, rehabilitation and radiodiagnostic patientsThe distance from the main entrance area to inpatientaccommodation should also be kept to a minimum, forthe convenience of relatives and visitors, many of whommay themselves be elderly.

The main entrance should also be sited to provideconvenient access from car parking areas.

9.8.6 Total quality management and interior design

The main entrance area should provide:

l a welcoming non clinical environment, which iscommensurate with the ethos of a communityhospital

l an environment in which creative use is made ofcolour, lighting, texture, pattern, artworks and plant

l a choice of furniture which contributes to, ratherthan detracts from, the overall effect

l patient WCs which do not open directly on tospaces in which people may gather

l a waiting area which is ventilated, naturally lit andhas an external view

l direct access where possible to courtyards or thehospital grounds.

63 Central atrium Ystradgynlais Community Hospital

76


9.9 Catering and staff dining

9.9.1 Scope

Kitchens in community hospitals provide meals forinpatients, day patients and staff. In some communityhospitals the staff dining area IS also open to localresidents as an income generating activity.

Staff dining areas generally provide a daytime meal andbeverage service for staff with evening and night-timeservice provided from vending machines.

9.9.2 Sizing

The options chosen for meal preparation (conventional,cook-chill, cook-freeze, use of ready made conventional orfrozen meals) will have some effect on the overall size ofthe kitchen, as will the meal delivery system (bulk orplated). For example, a cook-chill system may require10%-l5% less space in the hospital main kitchen, whenmeals are supplied by an off-site central processing unitand plated in the hospital.

The community hospital may be expected to provide under200 midday meals, and so the kitchen cannot necessarilybe sized on the same basis as for an acute hospital. Therewill probably be relatively fewer cooks and supervisorystaff, so some preparation areas may be more domestic inscale, and less off ice space will be needed.

Calculation of demand will require careful consideration.Bed occupancy rates can fluctuate widely in smallhospitals, and it may be advisable to assume 100% bedoccupancy, unless actual peak demand data are available.Day patients may attend for either a morning or afternoonsession, but in both cases may stay for lunch, and so aminimum of 120% of day place occupancy should beassumed. Staffing levels in community hospitals suggest aratio of one staff midday meal per two occupied beds, butwhere the proportion of part-time female staff is high and

they are close to home, demand for staff meals may besomewhat less. Demand from visitors and possible use bythe public should also be estimated in order to size thestaff dining area.


HBN 10 - ‘Catering department’ and HBN 11 - ‘Centralfood production unit and satellite accommodation’ (inpreparation) will be relevant concerning operationalaspects, but will not be relevant concerning the sizing ofcommunity hospital facilities.



l types of meals service. Cook-chill provision will havedifferent implications for space and planningrelationships both in the kitchen and in ward andday hospital areas, than a traditional kitchenproducing bulk or plated meals.

l staffing levels and design may also be affected,where it is planned to rely to a significant degree onready-made (conventional or frozen) meals. Equallythis policy may be desirable where trained staff aredifficult to recruit.

l smoking policy in the staff dining area. The needs ofnon smokers should be safeguarded.

l kitchens come In discrete sizes which may notprovide an exact match to a hospital’s requirements.Consideration should be given to marketing anyspare capacity to other agencies (e.g. local authorityday centres, schools, etc).

l staff dining areas can be made available for use bylocal residents, on an income generation basis.

64. View across the staff dining area

77



The following issues should be taken into account in thedesign of the kitchens:

l the flow of work and relationship of spaces andequipment in the main kitchen should take fullaccount of hygiene regulation requirements,

the scope for achieving a more domestic scale ofoperations should also be explored.


The catering department should be located:

l on the ground floor, where possible.

l with easy access from the kitchen to day hospitaland ward areas

l with exterior access for supply and disposal.

l with direct access, where possible, from the staffdining area to courtyards or the hospital grounds.

9.9.7 Total quality management and interior design

The kitchen should provide:

l a comfortable and safe work environment for staffwith adequate space, lighting and mechanicalventilation. The introduction of more stringenthygiene regulations, the removal of CrownImmunity, and the increased risk of infection due topoor hygiene practices, make these factors evermore important.

The staff dining area should provide:

l a comfortable environment for staff to get togetheraway from their working areas. If there are no staffrestrooms, this may be the only place where staffcan meet.


It may also be possible to use the staff dining room formeetings and seminars.

65. Staff dining room - Blyth Community Hospital

78


9.10 Administration, health records

and off ice accommodation

9.10.1 Scope

Accommodation may be required for each of thefollowing:

l receptionl admissions and health recordsl hospital and locality manager

l meetings space, for use by managers, GPs and otherprofessionals, voluntary groups

l teaching and seminar space, for use by all types ofstaff

l off ice base, for primary health care team staff(district nurses, health visitors, etc)

l chapel and quiet room, for use by relatives andvisitors

Primary health care team staff will generally be based inhealth centres, clinics or GP surgeries, but a communityhospital can provide an appropriate alternative location,particularly if GPs are also based on site, or close by.


Health Building Note 47 - ‘Health records department’provides guidance of general background interest, but it isaimed at the much larger health records department of adistrict general hospital.



storage of x-ray films. Films will either be stored inthe radiodiagnostic department or in the healthrecords area.

l storage of minor casualty, rehabilitation, dayhospital records. As for radiodiagnostics.


The following are issues to be taken into account inplanning space for these functions:

l use of main reception as reception for minorcasualty, out-patients or day hospital.

l shared use of meetings space(s) for teachingactivities.

l appropriate provision of office accommodation forprimary health care staff, which takes account ofthe likely peaked pattern of usage (e.g. busy earlyam, late pm, etc) and need for secure storage forpapers, records, etc).


Multi-use of the staff dining area for meetings or teachingactivities may be a possibility.

Health Building Note 46 - ‘General medical practicepremises’ whilst focusing on GP accommodation, alsodeals with the accommodation needs of primary healthcare team staff attached to GP practices. This guidancecan, therefore, be used to determine office baserequirements for these staff in a community hospital.Guidance is not provided in this document on theserequirements.

79


9.11 Linen and sewing room and

patient clothing service

9.11.1 Scope

A patients clothing system is likely to be in use in thehospital for elderly patients. Local facilities will be neededfor making, repairing and laundering patients’ ownclothing and clothing issued to them by the hospital.Facilities may also be needed for storage, measuring andfitting, and repair of staff uniforms, although this servicemight not be staffed full time. Laundry may be delivereddirectly to the wards and departments, where small stocksmay be held. Alternatively, a central linen store will beneeded.

9.11.2 Size

For a hospital of 60-I00 beds, a patient clothinglaunderette might comprise three 22lb industrial typewashing machines and two large tumble dryers, withancillary space for sorting, marking and storage.

On the wards, a separate patient clothing store, includingspace for a mobile dress rail, will be appropriate for elderlyand EMI wards. Bed spaces for the EMI and longer-stayelderly patients wiII need to accommodate a larger thanusual bedside storage unit with hanging space for clothes.These bed spaces will also need to be used for assisteddressing.



l it may be appropriate for the launderette to be usedfor other purposes, such as washing of domesticmop heads.

l foul wash may be done at the laundry, rather thanin the community hospital.

9.12 Supplies and stores

9.12.1 Scope

Community hospitals will generally receive the majority oftheir supplies from an off-site supplies and distributioncentre.

required at departmental level (particularly on wards), tocope with bulky disposables and storage of other itemswhich have to be ordered in bulk.


Forthcoming Health Building Note 49 - ‘Hospital receiptand distribution centre’ provides relevant backgroundguidance but it focuses on the accommodationrequirements of a district general hospital.

9.13 Domestic services

A base will be required for the domestic services manager,together with central storage space for supplies andcleaning appliances to serve the whole hospital.

9.14 Staff changing

Where centralised staff changing facilities are requrred,they should be planned in accordance with HealthBuilding Note 41 - ‘Accommodation for staff changingand storage of uniforms’. Care should be taken to ensurethat adequate provision is made for part time staff.

9.15 Mortuary

9.15.1 Scope

A mortuary (but not post-mortem facilities) with anappropriate number of body storage places and viewingfacilities will be required.


Health Building Note 20 - ‘Mortuary and post-mortemroom’ is of general relevance to the planning of thesefacilities. The total number of body storage places requiredwill generally be less than the minimum (six places)suggested in HBN 20.

A receipt and distribution area will generally be required ina community hospital. Whether or not a hospital store isalso provided will be a matter for local decision. If nohospital store is provided, additional storage space will be

80


9.16 Engineering services, estatemaintenance and communications

9.16.1 Scope

Accommodation will be required for:

l boiler plant, and associated fuel storage whereappropriate.

emergency electrical generator, and associated fueltank.

l local maintenance workshop facilities, andassociated stores.

l cold water storage tanks.

l plant rooms for centralised ventilation, and possiblerefrigeration, plants.

Accommodation may be required for:

l centralised medical gases systems

Appropriate provision of the following communicationsservices will also be required:

l telephones

l hospital radio and TV

l staff location

9.16.2 Sizing

l Boiler plant: The boiler house wiII usuallyaccommodate the boiler plant and hot waterstorage calorifiers together with associated watertreatment plant, pumps and controls. Its size willvary to suit the heating and hot water demands ofeach specific project. Space for solid or liquid fuelstorage, as appropriate, will be required. If gas ischosen as the primary fuel supply, a project decisionwill be required as to whether standby liquid fuelstorage should also be provided.

Electrical supplies: The intake switchroom will bethe primary electricity distribution centre for the site.Its equipment and size wiII be specific for eachproject. In some instances the supply authority mayrequire that electrical power be received at highvoltage and additional accommodation will beneeded for transformer(s) and associated highvoltage and low voltage switchgear. The primaryelectrical distribution system will serve local

switchrooms or cupboards which should be Includedas part of the functional content, as described in therelevant departmental HBNs.

l Emergency generator: The standby emergencygenerator will require its own accommodation in alocation convenient for economic cable connectionsto the site’s primary electrical distribution system,but away from the in-patient accommodation, tominimise disturbance from noise. For the range ofelectrical demands associated with communityhospitals it will usually be more economic to install astandby generator capable of supplying the wholesite, rather than provide separate essential andnon-essential electrical distribution systems and asmaller size of generator.

l Maintenance workshops and stores: Thedetailed guidance concerning building andengineering trades maintenance and associatedstores Included in Health Building Note 34 -‘Accommodation for estate maintenance and worksoperations’ is based on the accommodationrequirements for a DGH site and will only be partlyrelevant to a community hospital site, depending onthe level of support provided by offsite workshops.Consequently comprehensive engineering andwoodworking machine shops are unlikely to berequired, but a workshop with benches and alimited range of bench mounted power tools will berequired for a variety of trades together withadjacent secure storage for essential spares andconsumable materials.

For the servicing of the electronic and medicalengineering (EME) equipment at a communityhospital site, the guidance given in HBN 34 for asatellite EME workshop is relevant.

l Cold water storage: Accommodation at high levelwiII be required for cold water storage tanks. Thesupporting structure will need to be suitable for theweight of the water to be stored and safe access formaintenance personnel should be ensured. Theamount of cold water storage will be specific for thedemands of each project and may also have tosatisfy conditions Imposed by the relevant WaterSupply Authority.

81


Plant rooms: Accommodation will be required forcentralised and local ventilation (and possibly aircooling/conditioning) plants. These will usually besited near to the functions having the largestmechanical ventilation requirements, e.g.radiodiagnostic, kitchen (and, if provided, operatingtheatre and hydrotherapy pool). The size, numberand location of plant rooms will be specific for eachproject.

l Medical gases: It wiII be a project decision as towhether the functional need for medical gases andmedical vacuum is best served by portableapparatus or by a permanent distribution systemconnected to centralised medical gases storage andcentralised medical air compressors and vacuumplant. If a centralised system is selected, secureexternal storage accommodation, with vehicularaccess, will be required for medical gas cylinders andassociated manifolds. Central medical aircompressors and medical vacuum plant may beaccommodated in one of the plant rooms. Guidanceon medical gases installations and terminal outlets isgiven in HTM 22 - ‘Piped Medical Gases, MedicalCompressed Air and Medical Vacuum Installations’,and any subsequent published amendments.

.

Telephones: The space requirements for telephoneexchange apparatus and operators given in HealthBuilding Note 48 - ‘Telephone services’, are thoseassociated with a DGH site and will not be relevantfor the smaller telephone system required in acommunity hospital. An operating console in themain reception area and an associated equipmentcabinet will usually be sufficient unless the service ISprovided entirely as a satellite system coupled to aDGH or any other main site, as discussed in HBN 48.

Hospital radio and TV: It will be appropriate toprovide centralised radio and TV receiving apparatusto distribute sound and vision signals to the wardsand other parts of the hospital. The equipment willusually be contained In a vertical equipment rackwhich will require secure accommodation withaccess for maintenance. An enlargement of one ofthe electrical distribution switchrooms may beappropriate provision. A suitable site will be requiredfor the radio and TV receiving aerials.

l Staff location: It may be appropriate to provide astaff paging system similar to that at a DGH site.

Guidance on these systems is given In HealthTechnical Memorandum 20 - ‘Staff locationsystems’ and their possible integration with the sitetelephone system IS described in Health BuildingNote 48 - ‘Telephone services’.


The following operational policy issue requires carefulconsideration:

l maintenance of the buildings, engineering servicesand medical equipment at a community hospital sitewill involve the same range of maintenance tradesas a DGH site. However, the amount of activity wiIIbe less, due to the smaller scale of provision, withthe consequence that permanent on-site presenceof all maintenance trades is unlikely to be justifiable.The manner in which maintenance is organised anddelivered at a particular site will be determined byhealth authorities in accordance with their estatemanagement operational policies. The possiblepolicy options and the factors involved are describedand discussed in Health Building Note 34 -‘Accommodation for estate maintenance and worksoperations (in preparation).


The following issue should be taken In account in theprovision of the telephone service:

the planning and provision of the telephoneinstallation at a community hospital should never becarried out in isolation. A review of the overallstrategy for telephone services within the District IS aprerequisite. Guidance on the factors to be takenInto account is given in Health Building Note 48 -‘Telephone services’. This HBN also gives guidanceon the telephone facilities that can be provided by amodern telephone system with an electronicexchange.


detailed guidance for engineering designersconcerning the engineering service in the functionalaccommodation described in this Design Guide andtheir integration into systems suitable for acommunity hospital development is contained in theEngineering Services chapters of the HBN’s listed Inthe bibliography. The engineering design criteria,materials specifications and reference data given InHBN guidance are also relevant to the functionalrequirements of a community hospital.

82

10 Cost and area guidance

Because this document is published as a “Design Guide”rather than a “Health Building Note” there will be noaccompanying Departmental Cost Allowances (DCA’s).

Community hospitals are generally smaller in scale thanDistrict General Hospitals but still involve substantial sumsof money. To enable planners to assess the capitalimplications of these projects, cost guides for 50 bed and90 bed exemplar community hospitals are set out in Table66. From a survey of community hospitals it was foundthat the majority fell within the 50 to 90 bed range and bypresenting the costs of budget format, it should enableusers to interpolate and extrapolate to suit their ownparticular functional requirements.

The cost guides have been prepared in a similar manner toDCA’s (but they do not have the same status) andrepresent the standards that can be found in thecommunity hospitals described in this document.

Communications have been assessed from the schematiclayouts but notional sums have been included for thebalance of on-costs, such as drainage and external works,in order to Indicate the total cost.

The cost guides are based on the areas shown in Table 66and supported by the schedules of accommodation inAppendix 4. The schedules of accommodation are similarto those found in Health Building Notes and are publishedas background information and to assist at the earlydesign stage. The schedules do not representrecommended room sizes neither will they necessarilytranslate Into the project’s final plan form.

Costs are inclusive of preliminaries but a 5% designreserve and a 2% contingency have been shownseparately. Nothing has been included for equipment orprofessional fees. A survey of three recently completedcommunity hospitals in the 30-50 bed range showequipment costs to be averaging about 21% of the totaldepartmental costs.

The cost guides have assumed a fairly level site withnormal soil conditions. The merits of Individual sites shouldbe taken into account at project level and in particularthose conditions which affect substructure and externalworks.

Where the accommodation is biased towards the elderlyan allowance should be made for additional ventilation.For the 50 bed exemplar this allowance should be£ 53,000 and for the 90 bed exemplar £94.000.

No allowance has been made for on-site incineration asthis facility is not usually required at community hospitals.

On-costs include £35,OOO for a building energymanagement system. This sum includes for a remotecontrol outstation which is likely to be the preferred optionfor community hospitals.

The cost guides in Table 66 are at MIPS VOP 264 whichcorresponds with the DCA index at the time of publicationof this document. When using the cost guides it will benecessary to make adjustments for the index required andin particular for the “firm price” adjustment that is mostlikely to apply to community hospitals. The correspondingMIPS Firm Price Index is 277.

84

10.0 Cost and area guidance

Department

Example 1 Example 250 beds 20 day places 90 beds 40 day places

Funct’l Area Dept cost Funct’l Area Dept costcontent sq.m £'000 content sq.m £‘000

In-patients20 bed ward10 bed wardshared facilities

Rehabilitation20 place day/hosphysiotherapyOTspeech therapyshared facilities

Treatment and O/Pcentral treatmentC/E suitescasualtydental suiteendoscopyshared facilities

RadiologyRD rooms

Main en trancemain entranceadministrationreceptionrecords

kitchendiningmortuarylinendomesticsuppliesstaff changetelephonesboiler houseworks

2 wards1 ward

1,323 802365 23167 44

3 wards3 wards

1,985 1,2021,094 693

67 44

1 189 111197 110152 9428 14

152 97

2 378 223231 131183 11428 14

159 101

1 33 254 101 591 33 26

129 87

33 25145 8433 2663 45108 76161 108

1 room 160 124 1 room 197 154

153 101 176 116

178 98 215 118

99 meals25 places3 places

110 13445 2947 5366 3921 1078 44

100 555 17

50 17070 30

183 meals45 places6 places

32 extensions1OOOkW’s

58 extensions1600kW’s

140 17080 5152 6266 3921 10

118 66100 55

5 2965 22880 33

Departmental total

On-costscommunicationsint/ext engineering

3,852 2,604 5,983 4,017

630 275289

1.155 499363

Sub-totalExternal works/services

4,482 3,168391

7,138 4,879603

Sub-total 3,559 5,482Design Reserve 5% 178 274

Sub-total 3,737 5,756Contingencies 2% 75 115

Total 3,812 5,871

66. Community hospitals cost guides @MIPS VOP 264

85

Appendix 1 - Historical background

Cottage hospital origins. The first cottage hospital wasestablished in 1858 by Dr Albert Napper. It was literally acottage with an optimum number of 6 beds “identical tothe homes from which patients were drawn, differing onlyin warmth, proper hygiene and absence of overcrowding”(Loudon 1973).

Cottage hospitals were originally intended to serve ruralareas with poor transport facilities.

By 1934 there were over 600 cottage hospitals (a total of10,000 beds) with anything from 6-40 beds. They wereincorporated into the NHS in 1948 but often providedservices In an isolated manner unrelated to mainstreamhealth care. (While 1978)

1962. DHSS-Hospital Plan for England and Walesrecommended concentration of hospital care Into DGHsand created uncertainty about future of cottage hospitals.

Late 60s. Oxford RHB, in response to difficulty ofproviding DGH services to rural areas, developed conceptof community hospital, defined as follows:

“The Ideal model of a community hospital is seen tocomprise a health centre with accommodation forGPs, their staff, LA services, consultant clinics andcertain diagnostic services; day treatment facilitiesand in-patient accommodation. Thus a full range ofintegrated facilities is provided at community level toserve the needs of a defined population.”

“Patients suitable for admission to a communityhospital may be broadly described as patients who,while requiring hospital care as they cannot bemanaged at home, do not require the facilities of aDGH nor the services of a specialist team.” (Rue1972)

Experimental units were set up in Oxford RHB at Peppardand Wallingford hospitals. Community hospitals in OxfordRHB were seen as an extension of primary care not as aperipheralization of acute hospital services.

1969. Bonham Carter Report (DHSS Welsh Office)implied closure of small hospitals in describing the role ofDGHs.

1969. Association of GP community hospitalsestablished to encouraged further development ofcommunity hospitals and maintenance of standards ofcare.

1972. Community hospital concept endorsed jointly byRCP and RCGP. Concerns expressed about maintenance ofclinical standards.

1974. DHSS guidance on community hospitals (DHSSWelsh Office) recognised difficulty in providing health careto rural areas. Saw community hospitals as having 50-I50beds (seldom lower than 50 beds). Acknowledged theneed for variations In size and content to meet local needsand for community hospital planning to be fully Integratedinto regional plans and coordinated with social services.Community hospitals were seen as:

“providing medical and nursing care, includingout-patient, day patient and in-patient care forpeople who do not need the specialized facilities ofthe DGH and cannot be properly cared for at homein residential accommodation, Some patients will beadmitted direct to and discharged from them. Forother patients, the community hospital will be abridge (in either direction) between the DGH andprimary care.”

The circular suggested community hospitals could providefor-

* up to 1/2 the geriatric in-patient beds and dayplaces in a health distract

l In-patient and day places for elderly patients withdementia

l some out-patient clinicsl terminally ill patients and those with chronic

disabilitiesl medical and surgical patients no longer requiring

DGH facilities

GPs seen as having day-to-day responsibility for patients.Consultants to run OPD clinics. Scope for GPs andconsultants to work together.

Health centres and GP practice premises seen as closelyassociated with a community hospital.

86

Appendix 1

DHSS view was similar to Oxford RHB but with addition ofservices for elderly patients and those patients withdementia.

Envisaged some new purpose built community hospitalsplus conversion of some existing cottage hospitals.

Circular implied closure of smaller hospitals with less than50 beds.

1977. DHSS The Way Forward suggested a more flexibleapproach to provision of community hospitals.

1978. Study by Cavenagh (Cavenagh 1978) set out forthe first time the range and scope of work being done ingeneral practitioner hospitals. Study identified a total of350 general practitioner hospitals.

1979. RCGP-General Practitioner hospitals (RCGPPaper 23 published in 1983) - expressed concern aboutthreat posed by 1974 DHSS guidance to small GP hospitals:

l lack of support for surgical services other than minorsurgical and minor casualty services

l and focus of DGH for maternity services

Main criticism of 1972 circular was concern about theappropriateness of a uniform plan for communityhospitals. RCGP endorsed the argument for ‘local planningsensitive to local needs’.

1980. DHSS Consultation Paper-Future Pattern ofHospital Services. Change in economic climate andadverse public reaction to closure of small hospitals. Needfor peripheral hospitals acknowledged by DHSS.“Blueprint” idea withdrawn, health authorities encouragedto determine own peripheral hospital requirements withinthe context of national and regional policies.

1985. RCS-Commission on provision of surgicalservices for small communities; the role of the GPhospital expressed continued support for ‘surgical servicesin community hospitals for carefully selected patients’.

Surgical services seen to include:

Stressed need to define type of surgery appropriate for GPhospitals. Sets out minimal requirement for staffing andaccommodation. Notes a general decline in surgicalactivity as a total number of GP hospitals has declined.

1989/90. White Paper-Working for patients.Introduction of purchaser/provider roles, NHS trusts;internal markets, capital charges; These changes maycreate an even greater variety of community hospitalprovision.

l consultant OPD clinicsl post-op surgical carel in-patient or day patient procedures undertaken by

GP or consultant.

87

Appendix 2 - Recently completed community hospitalsBed complement Other facilities

Hospital Region

Date built GP Cons. Cons. EMI/ GP(not purpose Total acute acute elderly ESMI Other Operating Outpatient premises

District built) beds beds beds beds beds beds Casualty theatre X-Ray clinics on site

llkeston T S Derbys 1987 92 24 48Caithness Scot Highlands 1986 121 X 58 48Bridlington Y E Yorks 1988 206 16 72 72

Exeter 1988 24W Dorset 1986 66

N’land 1987 78Hereford 1989 20N Derbys 1988 72S Tyneside 1986 82N Devon 1987 28

Leics 1988 96Cumbr ia NK* 14Cumbr ia NK* 17

Scunthorpe 1988 154S Warks 1988 119NE Essex 1984 115)

1988S Lincs NK* 26 +Powys 1985 52Clwyd 1984 40

Winchester 1987 110

2015 mat’y

18 12 Ml16 mat’y

98014

X X X XA&E X X X

X X X X

Seaton SWBlandford WBlyth NBromyard WMBolsoverJarrow NSouth Molton SWCoalville TMillom NCockermouth NGoole YStratford W MClacton NET

152226

5121011241010

64055

XXX XXXX X

24381536461748

43

54 6024 55

6060

X302044

X XX

XX

2426 X

XX

24 X XXXXX X

XX XX X

24 10 mat’y X

XSkegnessYstradgynlaisMoldAndover

TWales

26142028

X X XXXX X

8 XXX

XX28 10 mat’y

Source: 1989, Regional telephone survey

Appendix 3 - Sizing methods

3.1 PhysiotherapyWorkload calculation

1. Determine nature of service to be provided

2. Estimate likely workload:l refer to existing DGH inpatient, outpatient and day patient workload from community hospital catchment areal deduct workload likely to remain with DGHl adjust remainder for likely OPD service at community hospitall adjust for known changes to pattern of contracts with purchasing authorities.

Schedule of accommodation

3. Draw up schedule of essential accommodation:

Standard spaces”’l identify requirementsl add standard space sizes, from HBN 8, adjust for

local needs

l estimate likely staffing level per dayl estimate likely maximum size of patient groups

l multiply by max number of patients & staffl add space requirement for any fixed/semi-permanent

equipment to be kept in space

= Net minimum area“A” sq/m

= Net minimum area= “B” sq/m

= Net minimum area= “C” sq/m

5. Net minimum area of department = “A” + “B” + “C”

6. Examine options for shared use of spaces with OT, Day Hospital

Notes.(1) Office, changing, storage, etc(2) Exercise area, etc(3) Four sq/m per patient is suggested(4) Ultraviolet room, hydrotherapy pool, etc

89

Appendix 3

3.2 Occupational therapy

Workload calculation

1. Determine nature of service to be provided

2. Estimate likely workload:l refer to existing DGH in-patient, outpatient and day patient workload from community hospital catchment areal deduct workload Iikely to remain with DGHl adjust remainder for likely increased usage by GPs and LAS

l adjust for known changes to pattern of contracts with purchasing authorities.


3. Draw up schedule of essential accommodation:

Standard spaces”’l identify requirementsl add standard space sizes for local needs

Variable sized spaces”’l estimate likely staffing level per dayl estimate likely maximum size of patient groupsl estimate likely proportion of wheelchair

patientsl calculate optimum space per wheelchair/non-

l multiply by max size of patient groupsl add space requirement for any fixed/semi-‘permanent

equipment in space

4. Draw up schedule of optional accommodation@

= Net minimum area= “C” sq/m

5. Net minimum area of department = “A” + “B” + “C”

6. Examine options for shared use of spaces

Notes.(1) ADL suite, interview, storage, office, etc(2) General activity space, craft workshop, etc(3) 3.25 sq/m per patient in wheelchair, etc(4) Splint room, heavy workshop, etc

90

Appendix 3


Workload calculation

l refer to existing DGH workloadl identify DGH workload referred from potential community hospital catchment

area

Staffing calculationl Examine options for

l Radiographer coverl Reporting by Radiologist

l allow for known changes to pattern of contracts with purchasing authoritiesl allow for likely increased usage by GPs of local facility

Estimate total patients per year Determine staffing arrangements

Non maternity

Determine viability threshold of

Maternity

Determine viability threshold of

I I

over 60patients

30-60patients

muchlessthan 30

2 RDR

2radiog’rsession

1 RDR

1radiog’rsession

Noservice

at/overthreshold

1 ultrasound

1radiographersession

underthreshold

No service


l determine schedule based on functional content ie 1 or 2 RDR, ultrasound rooml add standard room sizes from HBN 6

Notes

(1) Calculate number of days machine is available, net of maintenance, eg 235 days/year(2) Ultrasound equipment may need less maintenance; workload will come mainly from antenatal clinic(3) For example 30 patients/day(4) May be less than 30 patients/day for ultrasound

91

Appendix 4 - Schedules of accommodation

4.1 Functional content and accommodation by service

Example 1 Example 2

50 beds 90 beds20 days pl 40 beds pl

Service FC sq. m FC Sq.m

In-patient wards20 bed ward10 bed wardshared facilities

Day hospital and rehabilitation services20 place DH corePhysiotherapyOTSpeech therapyShared facilities

Clinic services and minor casualtyCentral treatmentOut-patient C/E suitesMinor casualtyCentral suiteEndoscopyShared facilities

RadiodiagnosticsX-ray (rdrs)

Main en trance and administrationMain entranceAdminReceptionRecords

Ancillary and support servicesKitchenDiningMortuaryLinenDomesticSuppliesStaff changeTelephonesWorks/plant

Departmental total

Whole Hosp circulation (say 10%)

Total

Gross area/bed

1

1

14

99253

132336567

18919715228

152

3310133

160

153178

1104547662178

1005

170

3 19853 10941 67

2 37823118328

159

331453363108161

197

176215

183456

14080526621

118100

5205

3902 6041

390 604

4292 6645

85.8 73.8

92

Appendix 4

4.2 Wards

Area20 beds 20 beds 10 beds

(1) (2) (1)

FC sq.m FC sq.m FC

Bedroom -singleMulti-bed room X 2Multi-bed room X 4Quiet roomDay/diningStaff basePhysiotherapyBath/treatment&VCBath assisted/WCBath/WCShower assisted/WCWC assisted/washPantryClean utilityDirty utilityCleanerOffice - doctor

wardStaff -WCs

- lockersStore - linen

- patients clothing-equipment

wheelchair bayDisposalSwitch

4

4

3

11114111111

48.0 10 120.01 24.0

160.0 2 80.012.0 12.075.0 3 75.0

6.5 6.513.0 13.015.0 1 15.014.0 1 14.07.0 1 7.06.0 1 6.0

22.0 4 22.012.0 1 12.010.0 1 10.010.0 1 10.03.0 1 3.0

12.0 1 12.012.0 1 12.03.0 3.02.5 2.56.0 6.04.0 4.0

10.0 10.06.0 6.02.0 2.03.0 3.0

48024.040.012.031.5

6.56.57.5

14.0

8 96.01 24.0

12.031.5

6.56.57.5

14.0

6.011.06.05.05.01.5

12.0

6.011.06.05.05.01.5

12.0

3.02.53.02.05.05.02.02.0

3.02.53.02.05.06.02.02.0

Nett totalCirculation, etc

Totals

35%474.0165.9 35%

490.0171.5

411

2

0.51

12

0.50.50.50.5

1

35%261 .O

91.4

2

0.51

12

0.50.50.50.5

1

35%270.0

94.5

639.9 661.5 352.4 364.5

Space/bed gross 32.0 33.1 35.2 36.5nett 10.4 11.2 11.2 12.0

Shared accommodationADL suite - kitchen/dining

- bathroom- bedroom

Relatives room

15.09.6

10.814.0

Nett total

Circulation etc

Total

49.4

35% 17.3

66.7

sq.m

10 beds

FC

(2)

sq.m

93

Appendix 4

4.3 Rehabilitation

AreaExample 1 Example 2

FC sq.m FC sq.m Comments

PhysiotherapyTreatment - cubicles

- exercise areaInterview/treatmentStaff workstationsPatient changingOff iceStorageWax roomUltraviolet room

3 30.0 4 40.010 48.0 12 56.0

1 12.0 1 12.04.0 4.08.0 10.0

1 12.0 1 12.012.0 17.0

1 10.0 1 10.01 10.0 1 10.0

Nett total 146.0 171.0

Circulation 35% 51.1 35% 59.9

Totals 197.1 230.9

Occupational therapyADL suite - kitchen/dining

-bathroom- bedroom

Activity areaInterview/treatmentStoreOff iceWorkshop

14

1

15.09.6

10.847.5

8.012.010.0

20

1

15.09.6

10.867.0

see day hospital11.512.0 see day hospital10.0

Nett total 112.9

Circulation etc

Total

Speech therapySpeech therapyStore

Nett total

Circulation etc

Total

35% 39.5 35% 47.6

152.4 183.5

1 15.5 1 15.51 15.0 1 15.0

20.5 20.5

35% 7.2 35% 7.2

27.7 27.7

94

Appendix 4

4.3 Rehabilitation (cont)



Shared accommodationReceptionWaitingInterview/treatmentWC assistedChiropodyHairdressingBath/treatment/WCClean utilityDirty utilityPantryStaff facilities - rest

- W C- lockers

DisposalSwitch

1 6.05 8.5

1 5.51 14.01 11.01 15.01 10.01 10.01 12.01 12.0

3.02.52.01.0

18

11111111

6.0 see also main entrance13.6 see also main entrance

see day hospital5.5

14.011.015.010.010.012.012.03.02.52.01.0


Circulation etc 3 5 % 39.4 3 5 % 41.2

Total 151.9 158.8

Day hospital coreForumQuiet roomDining/sittingC/E room/interviewAssisted bathroom/WCWCs assistedOT OfficePatients cloaksStore - linen

- generalWheelchair baySwitch

28.012.0

2 48.01 12.01 14.04 22.0

see OT4.53.06.06.02.0


Circulation etc 2 0 % 31.5 2 0 % 63.0

Total 189.0 378.0

95

Appendix 4

4.4 Clinic services



Out-patientsReception/control pointRecordsSub-waitConsult/exam

Nett total

34

6.0

5.164.0

75.1

36

6.0 see also main entrancesee main entrance

5.1 see also main entrance96.0

107.1

Circulation etc 35% 26.3 35% 37.5

Total 101.4 144.6

Dental suiteReception/officeSub-WaitTreatmentRecoveryLab/workroomStore

Nett total

Circulation etc

Total

TreatmentSub-waitTreatmentUtility

Nett total

Circulation etc

Total

Minor casualty

Sub-waitTreatmentUtility

Nett total

Circulation etc

Total

1 8.05 8.51 16.01 6.0

6.02.0

46.5

35% 35% 16.3

62.8

5 8.5 51 16.0 1

8.516.0

see shared facilities below

24.5 24.5

35% 8.6 35% 8.6

33.1 33.1

5 8.5 51 16.0 1

8.516.0


24.5 24.5

35% 8.6 35% 8.6

33.1 33.1

96

Appendix 4

4.4 Clinic services (cont)

AreaExample 1

FC sq.m

Example 2

FC sq.m Comments

EndoscopyReception/officeSub-waitPatient WCPatient changingTreatmentRecoveryClean utilityDirty utilityLab/workroomStore

1 8.05 8.51 5.5

8.01 20.01 12.01 10.0

6.02.0

Nett total 80.0

Circulation etc

Total 108.0

Shared facilitiesWaitingClean utilityDirty utilityPatients WCsEquipment storeWheelchair/trolleysOfficeStaff facilities WC

lockersLinen storeDisposalWeighing roomSwitch

15 25.5 20 34.01 10.0 1 10.01 10.0 1 10.01 5.5 2 11.02 10.0 2 10.01 5.0 2 10.01 12.0 1 12.01 3.0 1 3.01 2.5 1 2.51 4.0 2 8.01 2.0 1 2.01 4.0 1 4.02 2.0 3 3.0

95.5 119.5

35% 33.4 35% 41.8

Nett total

Circulation etc

Total 128.9 161.3


35% 35% 28.0

might be integrated with ME

see also main entrance

97

Appendix 4




ReceptionSub-waitPatient WC -WC

- changing- shower

UltrasoundX-ray roomProcessing areaViewing areaDark roomOff iceStaff facilities - WCs

- lockersStore - f i lm

- chemical- linen-filing

Nett total

Circulation etc

6.0 6.06 10.2 8 13.61 5.5 1 5.5

6.0 8.06.0

1 16.01 30.0 1 30.0

15.0 15.0

5.0 5.01 12.0 1 12.01 3.0 1 3.01 2.5 1 2.5

5.0 5.0

3.0 3.015.0 15.0

118.2 145.6

35% 41.4 35% 51.0

159.6 196.6

98

Appendix 4

4.6 Main entrance

Area

Main entranceReceptionWaiting - main

- playWheelchairPramW CMother/babyTea bar/VendingShopPortersPharmacy (dispensary)

Example 1 Example 2

FC sq.m FC sq.m

3 18.0 4 24.015 25.5 20 34.0

5.0 7.55.0 5.05.0 5.0

2 11.0 2 11.01 4.0 1 4.0

8.0 8.016.0 16.016.0 16.0

Comments


Circulation 35% 39.7 35% 45.7

Total

AdministrationAdmin (whole hospital)Health recordsSeminarStaff facilities - rest

- W C

153.2 176.2

8 60.0 14 72.010K 30.0 15K 45.0

24.0 24.012.0 12.0

2 6.0 2 6.0


Circulation etc 35% 46.2 35% 55.7

Total 178.2 214.7

99

Appendix 4

4.7 Ancillary services



MortuaryBody storeViewing

Total

3 210 6 26.026.0 26.0

47.0 52.0

LinenUniform/linen storePatient clothing laundretteSewing

26.0 26.025.0 25.015.0 15.0

Total 66.0 66.0

DomesticOfficeRestChangeCentral equipment/materials storeDepartmental cleaners

11.0 11.0

10.0 10.0

Total 21.0

5.0

21.0

5.0

StoresReceiving/holding/loading

PorteringEquipment/bed storeOfficeTrolley park

Total

Staff change (central)

WorksBoiler houseMaintenance/workshop/stPlant

Total

Total gross area 487.0 567.0

50.0 60.0

20.0

8.0

78.0

100.0

50.070.050.0

170.0

40.010.08.0

118.0

100.0

65.080.060.0

205.0

100

Appendix 5 - Other relevant Health Building Notes

1 Buildings for the Health Service, 1988. HMSO2 The Whole Hospital, (in preparation).3 The Design of the Hospital. Development control

planning, (in preparation).4 Adult Acute Ward, 1990. HMSO.6 Radiodiagnostic department, 1985. HMSO.8 Rehabilitation - accommodation for physiotherapy,

occupational therapy and speech therapy, 1991.HMSO.

10 Catering Department, 1986. HMSO.11 Catering - Central Processing Unit and satellite

accommodation (in preparation).12 Out-patients’s department, 1989, HMSO.20 Mortuary and post-mortem (in preparation).21 Maternity Department, 1989. HMSO.26 Operating department, 1991. HMSO.34 Accommodation for Estate Maintenance and Works

Operations (in preparation).35 Accommodation for people with Acute Mental Illness,

1988, HMSO.37 Hospital accommodation for Elderly people, 1981.

HMSO.38 Accommodation for adult acute day patients, 1982.

HMSO.40 Common Activity Spaces

Vol 1 Example layouts; common components, 1986.HMSO.

Vol 2 Corridors, 1986. HMSOVol 3 Lifts and stairways, 1989. HMSO.Vol 4 Designing for disabled people, 1989. HMSO.

41 Accommodation for staff changing and storage ofuniforms, 1984. HMSO.

46 General Medical Practice Premises (in preparation).47 Health records department, 1991. HMSO.48 Telephone Services, 1989. HMSO.49 Hospital receipt and distribution centre (in

preparation).51 Accommodation at the main entrance of a DGH (in

preparation).52 Day Unit (in preparation).

101

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102

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