PRIMARY CARE FACILITIES
A look at, and questions on, some of the key elements that influence visitors’ first impression when they visit primary care facilities.
adult population. It was also evident that there is a need for further large-scale, multi- service evaluations of dementia-friendly design involving the perspectives of those affected by dementia, and particularly in areas involving new technology. The scoping review
indicated that the development of an assessment tool for cognitively inclusive design is innovative. Assessments using the tools are already informing Assura’s refurbishment and new build programme, and are encouraging those
developed an ‘easy read’ version of the guide and summary tool. It is important to recognise that the
toolkit focuses on the internal and external built environment, not the interactions between staff and patients – which are an integral part of the patient experience. Although it is possible to deliver exceptional care in a less than ideal environment, attitudes and behaviours can negatively affect the patient experience. Staff can equally well be affected by the environment in which they work, with experience from dementia-friendly design projects indicating improvements in recruitment and staff morale, and reductions in sickness absence, following refurbishments.5
Future design for neurodegenerative and neurodivergent conditions This project has confirmed that the principles of good design for people living with dementia are applicable, with modifications, to a wider group of people, including those with other neurodegenerative and neurodivergent profiles. With any environmental assessment it needs to be recognised that each individual will respond differently to their environment. Despite the higher incidence of dementia amongst people with learning disabilities and autism, their particular needs have not been addressed previously in relation to environmental design, and there is a paucity of research focused on autism-friendly design for the
54 Health Estate Journal June 2024
who have learning disabilities or who are neurodiverse to become involved in conversations about improving the environment. 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. The toolkit is available free to download as part of Dimensions’ suite of training resources for general practice in its #mygpandme campaign
Sarah Waller
Sarah Waller CBE is an Associate Specialist at the Association for Dementia Studies, University of Worcester, and has a particular interest in developing enabling environments for people living with dementia. She directed The King’s Fund’s award-winning Enhancing the Healing Environment (EHE) programme, and led the development of the EHE dementia-friendly environmental assessment tools. She continues to develop dementia-friendly environmental assessment tools for a variety of clients, and led the work for Assura plc.
Jennifer Bray
Jennifer Bray is a Research assistant with the Association for Dementia Studies, University of Worcester, and has worked in project research and evaluation since 2001. She has a particular interest in dementia and sight loss, intergenerational aspects, nature and the arts, the physical environment, and the use of technology with people living with dementia. She undertakes research to inform the development of the University’s dementia-friendly and cognitively inclusive environmental assessment tools and guides.
(
https://dimensions-uk.org/dimensions- campaigns/#mygpandme). Although most patient contacts in the NHS take place in health centres, little attention has been given to the design of premises from the perspective of an increasingly elderly and diverse population, and those with neurodegenerative or neurodivergent profiles. Although this project focused on the health centre environment, we believe that it has applicability across all health and care settings. The overarching concept of neurodiversity may therefore have the potential to bridge the gap between designing for separate conditions and ‘Designing for Everyone’ with a cognitive impairment, or who is neurodiverse.
References 1 Evans SC, Waller S, Bray J. Designing inclusive environments for people living with dementia: how much do we really know? Work Older People. 2022; 26(2):89-96.
2 British Standards Institution. Design for the Mind. Neurodiversity and the Built Environment. Guide. PAS 6463:2022. BSI, London, 31 October 2022.
3 Waller S, Evans SC, Bray J, Atkinson T. Designing for everyone: can the principles of dementia-friendly design inform design for neurodiversity in health-care settings? Work Older People. Preprint posted online 25 January 2024. [Accessed 25 April 2024]. Available from: <doi:10.1108/WWOP-09-2023-0038
4 Mostafa M. Architecture for autism: autism aspects in school design. ArchNet-IJAR 2014: Mar: 8(1):143-158.
5 Waller S, Masterson A, Finn H. Developing Supportive Design for People with Dementia: The King’s Fund’s Enhancing the Healing Environment Programme 2009-2012. The King’s Fund, London, 2013.
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