PRIMARY CARE FACILITIES
It is believed that the assessment tools, including the ‘easy read’ versions developed with Dimensions, can play a vital part in improving the patient experience, engagement with health services, and reducing inequality of access to care.
and affording them choice and control. Of concern were the clear indications that a poor environment and lack of privacy could lead to significant stress for patients, and in some cases cause appointments to be missed.
and manages, health centres across the UK, and had commissioned reports from The Patients Association and Dimensions, a charity that supports people with learning disabilities and autism, to better understand the effect of the physical environment on the patient experience in primary care. Both reports confirmed the critical importance of the design of the built environment for the delivery of high-quality, patient-centred primary care services. There was an expressed need for health centres to be welcoming, calm, and comfortable, while being supportive of patients’ independence, privacy, and dignity,
Future design criteria Having gained the experience of designing a dementia-friendly health centre, and taken on board the findings from these reports, Assura wished to ensure, as far as is practical, that its future designs and refurbishments met the needs of those with dementia, learning disabilities, and autism (both of which increase the risk of developing dementia), and those who are neurodiverse. The Association for Dementia Studies, University of Worcester was commissioned to research and develop a suite of tools that could be used to support the design of health centres so that they could better support people living with neurodegenerative and neurodiverse conditions. The tools were to be capable of informing future health centre developments and major refurbishments, as well as providing a checklist for internal monitoring purposes.
A scoping review of the literature and published policies was undertaken, with a focus on design for dementia, learning disability, autism, and neurodiverse conditions. Design advice, guidance, and environmental assessment tools are now widely available for people living with dementia, although not all have a strong evidence base, and there is a lack of evidence for some more recent approaches – such as the use of floor-to- ceiling murals, assistive technology, and immersive reality, along with a critical need for the perspectives of people affected by dementia to be integral to all research. Autism is a lifelong condition, and not a learning disability, although around half of people with autism may also have a learning disability. It was not possible to identify any specific design advice for those with learning disabilities. To date, the majority of research on autism- friendly design has focused on younger people, either in school or residential care settings.4
The term, ‘neurodiversity’, was
most commonly encountered in relation to people with autism, and there appears to be little indication at present that there is a recognised difference between design for autism and neurodiversity. For example, guidance on creating more supportive workplace environments for those that are neurodiverse mirrored the design features identified for young people with autism.
A range of design features that are important to those with neurodegenerative and/ or neurodivergent conditions, particularly, but not exclusively, around the sensory elements of design, were identified.
52 Health Estate Journal June 2024
Mapping exercise The key design elements identified by the scoping review were mapped against areas accessed by patients in health centre premises with relevant data from the patient organisation reports. For the purposes of the mapping, people with dementia were deemed to be older people with associated disabilities of ageing and co-morbidities. A range of design features that are important to those with neurodegenerative and/or neurodivergent conditions, particularly, but not exclusively, around the sensory elements of design, were identified. This stage of development highlighted the importance of acknowledging the individuality of response to environmental design features. For example, someone may be highly sensitive to physical or emotional stimuli (hypersensitive), or conversely under-responsive (hyposensitive) to noise, smell, touch, or light. Critically, these responses are individual, and not determined by a person’s condition. Recognising the need to acknowledge individual responses, it was possible to identify aspects of good environmental design for people living with dementia, autism, and neurodiversity, that would importantly also enhance the experience for the general population
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