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40 PROJECT REPORT: HEALTHCARE BUILD & DESIGN


The staff have high praise for the effect of the new building on users


could be resolved, as this would be hard to do once patients had moved in. Designing the flats in close co-operation with clini- cians and using Revit ensured that they could be planned out in fine detail. The corridor design is where some of this building’s complexity emerges, as they are broken up at each flat door by square ‘knuckles’ which on plan continue the line of flats obliquely across the corridor to form seating areas adjacent to each door. As part of tackling users’ ‘threshold of space’ needs, staff can sit here whenever needed, as part of monitoring a patient, have a conver- sation with colleagues, or sit with patients as a stop-off as they move through the unit. The design provides a high level of flexibil- ity for the staff, as Yeomans says: “Staff can take activities to the patient in the room, sit with them in their lounge, or retreat to the circulation space outside and keep an eye on them.”


Environmental factors


Environmental conditions such as lighting and heating can be controlled individually via electronic panels mounted outside the flats. This is critical because severely autistic patients may not respond well to ‘normal’ temperature parameters and they may need precise adjustment by staff to make a room colder than usual, for example. The overall goal of the architects was to create a “calm and protective setting that offered comfort and privacy for residents.” Part of this is balancing the requirements for daylight and views with the need to ensure that patients are not disturbed by being overlooked. While the patients have views from their flats via their private garden, they are not overlooked within them, and all flats are oriented in the same direction (facing east) to ensure similar light levels through the day for all patients.


PROJECT SUPPLIERS: MITFORD AUTISM INPATIENT UNIT


Flooring: Forbo Sanitaryware: VRSG Acoustic Insulation: Ecophon Bricks: Ibstock Aluminium roofing: Kalzip Windows: Kawneer Ironmongery: Primera and Laidlaw Partitions: British Gypsum SFS frame: Orca Tap controls: Dart Valley


In circulation corridors, high level windows avoid overlooking the patients’ gardens, but enhance the spacious feeling of the corridors, and also avoid glare for patients. The ambience is helped by natural ventilation and the rounded corners in corri- dors (although the principal reason for these is safety). The building is rated BREEAM Excellent – thanks in part to its natural venti- lation but also the addition of renewables including air source heat pumps and PVs on the roof, plus locally sourced materials. User safety also meant that blinds were not an option in patients’ flats and bedrooms, and instead Medical


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Architecture devised a sophisticated lock- back timber shutter which recesses into the wall to reduce the risk of it being damaged by a patient. Shared patient lounges have TV and storage units which can be enclosed and locked shut by staff behind specially created joinery doors if necessary. Yeomans says the decor is deliberately minimal, and “pretty bland”, this is important to avoid overstimulating users – “it wasn’t that we like beige,” he remarks. The idea is that the resulting low-key feel of the environment is a starting point from which clinicians can build, as they work to discover what works with each particular patient. When it came to acoustics, one of the aspects that emerged from the mockup of a patient flat was that walls needed to sound ‘solid’ to users to discourage damage by patients, and the modular SFS frame – plus ply and plasterboard – would be a challenge on this front. Therefore a sandwich of different plasterboards and insulation were tested before an affordable solution was arrived at which sounded as robust as blockwork when knocked.


Conclusion


The building won the Best Mental Health Development in the Building Better Healthcare Awards 2017, and was Highly Commended in the European Healthcare Design Awards 2017. The judges of those awards commented on how the unit successfully combines resilience with care: “The project provides a robust and effective working environment that is compassionate to the resident group.” The staff have high praise for the effect of the new building on users – ward manager Pamela McIntyre said: “We are witnessing huge impacts on quality of life. Seeing a mother reacting to her son having his first incident-free day in seven years is very rewarding.” Medical Architecture’s Paul Yeomans says that the client seems “really satisfied” with the unit, now that it has been in opera- tion for a year. “It’s still early days, but there seems to be a lot of good evidence coming out of it.” Of course the ultimate testimony of such a specialised healthcare unit is from its clinicians, and the users, although in this case the latter have diffi- culty expressing that. However according to one staff member, whereas in the previous building one patient “lived in self-imposed isolation and crawled every- where, within a week of moving into Mitford he was having a drink with staff in one of the offices.” 


ADF JANUARY 2018


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