ESTATE STRATEGY
Designing for the health of coastal communities
Lianne Knotts, director of Medical Architecture, looks at the ways in which an integrated model of care can, and indeed has been, used to address the complex health needs of coastal towns. One key benefit, she argues, will be greater ease in recruiting and retaining staff. She highlights her involvement in the design and delivery of two ‘forward-thinking’ healthcare projects for NHS clients in coastal communities which ‘embrace the integrated care model’.
According to 2017 data, there were approximately 11.8 million people aged 65 and over in the UK that year, and by 2050 that number could reach 19 million. Hospital admissions are also steadily increasing year on year, with a good proportion of these represented by elderly people, who rely on continuing care. In parallel, England’s Chief Medical Officer has signalled that we need a national strategy to tackle health inequalities for seaside towns. Coastal towns often have older populations with more complex health needs, but historical planning has often underprovided for areas where the geographical catchment is ‘one-sided’. Heart disease, stroke, mental health problems, diabetes, and higher rates of smoking, are all more prevalent in seaside populations. At the same time, local NHS services can suffer from recruitment problems, leaving gaps in health services where they are needed most.
Emerging models of integrated care Changes to the way that health is managed and delivered are enabling health and social care to operate together to support wellbeing, rather than responding to accident and illness. This integrated care model brings together primary, community, and social care from a range of organisations to operate together around the patient as a team. This requires new ways of working, with outreach and district nursing teams working alongside general practice, social services, and the voluntary sector, in care hubs, to provide more comprehensive support to individuals at, or near, their home. Some diagnostics, treatment, and follow-up services, can be efficiently relocated from larger acute hospitals to be provided locally. An efficient integrated care system reduces repeated use of overstretched emergency departments.
New ‘class’ of health infrastructure A focus on ‘wellness’ changes the type of environment needed, with less ‘institutional’ community space acting as a
An artist’s impression of the attractive main entrance to the new Whitby Hospital. Inset: An architect’s sketch of the new integrated community hospital.
‘forum’ for a multiplicity of diagnostic, treatment, and therapy activities. A therapeutic environment will provide excellent daylighting, ventilation, and views, and comfortable acoustics. Good landscape and accessibility are essential, so buildings should be well located, with some outside space. Social prescribing will extend the range of activities to include things like group meetings, cooking, gardening, and dance.
New facilities must be actively managed to ensure that they are well used and accessible during evenings and weekends. Flexible and adaptable planning mean that spaces can be used for a variety of functions that will inevitably change over the lifespan of the building.
Attracting the best staff Recruitment and retention of valuable staff is a problem anywhere in the NHS, particularly some coastal towns which may be poorly networked. The emergence of integrated care will foster entirely new professional disciplines and skills with
higher status. Good design can support professional development. Bases with seminar rooms, staff development zones, and technologically advanced multidisciplinary team spaces, will attract the best staff.
Alongside this, a high-quality workplace environment, that is both attractive and encourages high productivity, will represent a step-change from the typical, messy, call-centre-style NHS office environment. We know that the leap forward in remote working means that we must consider new kinds of workplace. We must use this as an opportunity to recalibrate expectations, and make working for the NHS in a coastal community an essential professional stepping-stone, and, with the right design, an enviable lifestyle choice.
Bringing healthcare innovation to coastal towns
As an architect and director of Medical Architecture, a practice which specialises in healthcare planning and architectural
November 2021 Health Estate Journal 53
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