PATIENT-CENTRED DESIGN


A 3D model of an acute inpatient rehabilitation space. The therapeutic garden stimulates the senses while replicating everyday challenges


patients may encounter at home or in the community.


significantly reduce falls, pressure injuries, and length of stay, while also improving patient experience. In fact, one study showed that older adults can lose up to 10% of their muscle mass for every 10 days spent immobile in hospital with an even greater percentage of impact on muscle strength.


Rebecca Dunkerley


Rebecca Dunkerley is a Chartered physiotherapist with nearly 20 years’ experience across acute and community healthcare. She has developed deep expertise in how therapy environments influence patient outcomes, recovery, and safe discharge. Her skills span clinical delivery and senior operational management, enabling her to balance frontline therapy needs with large- scale hospital planning. With a dual background in patient care and operational leadership, Rebecca provides insight into designing spaces that are safe, efficient, and supportive of multidisciplinary working. She is passionate about embedding physiotherapy at the heart of hospital design to enhance patient care and staff effectiveness.


A gap in the guidance Despite the known benefits of early and targeted rehabilitation during hospital stays, national guidance has yet to catch up. Health Building Note (HBN) 11-01 outlines therapy facilities for primary and community care, including 64 sqm for a physiotherapy gym and up to 24 sqm for activities of daily living (ADL) spaces. However, there is no standard provision for dedicated inpatient rehabilitation spaces within acute hospitals. In contrast, the Australasian Health Facility Guidelines


explicitly recommend separate therapy areas for inpatient and outpatient use. Their model includes ward-adjacent ‘satellite therapy units’ designed to reduce travel distances, improve patient flow, facilitate quicker discharges, and to maintain patient safety and dignity. Replicating this model would provide obvious benefits to patients as well as the NHS, in terms of positive outcomes, service delivery, and cost. The NMGH multidisciplinary team consists of


healthcare planners, physiotherapy leads, hospital operations specialists, and data analysts. They assessed clinical demand, operational barriers, space requirements, and potential benefits of introducing dedicated acute inpatient gyms.


SPECIALTY TYPE


NUMBER OF PATIENTS FOR


EACH SPECIALITY


Elective orthopaedics Trauma


AMU/Frailty


Respiratory and surgery Medicine Total


28 44 50 78


134 334


Evidence-based approach Their investigation involved data collection across three core areas: the number and type of assessments currently undertaken, the percentage of patients by specialty who would benefit from therapy spaces, and a time-in-motion study examining the impact of current gym locations on staff efficiency. Findings were compelling. In one week, the team of


physiotherapists and occupational therapists recorded 58 stair assessments, 15 kitchen assessments, and a limited number of evaluations using plinths and parallel bars. It was stated that with better access to rehabilitation spaces, they could have carried out more assessments and interventions. This signals an unmet need for assessments requiring specialist equipment. Further analysis showed that 77% of patients (Table 1)


across five specialties could benefit from access to a dedicated inpatient therapy space, however only 21% were able to do so. The largest barriers were distance to the gym, limited space, and unpredictable caseload management. AHPs are almost exclusively the ones to go to the


patient’s bedside, help them transfer into a wheelchair and wheel them to the gym, unlike other clinical professions who use a hospital’s portering service. A time-in-motion study based on productive ward principles showed that a round trip to the central gym, which included time in the gym for rehabilitation, took 110 minutes, limiting staff to just four assessments per day (Figure 1). This was due to the walking time of the AHP to the ward, finding a wheelchair, transferring a patient to a


NUMBER OF PATIENTS WHO COULD HAVE


BEEN ASSESSED WITHIN AN ACUTE INPATIENT GYM


28 (100%) 38 (86%) 38 (75%) 52 (67%) 78 (58%) 234


NUMBER OF PATIENTS WHO WERE ASSESSED IN THE CURRENT CENTRAL GYM


6 9


11 16 28 70


Table 1: Number of patients who could have an assessment by specialty. (Key: AMU – acute medical unit) 146 Health Estate Journal October 2025


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96  |  Page 97  |  Page 98  |  Page 99  |  Page 100  |  Page 101  |  Page 102  |  Page 103  |  Page 104  |  Page 105  |  Page 106  |  Page 107  |  Page 108  |  Page 109  |  Page 110  |  Page 111  |  Page 112  |  Page 113  |  Page 114  |  Page 115  |  Page 116  |  Page 117  |  Page 118  |  Page 119  |  Page 120  |  Page 121  |  Page 122  |  Page 123  |  Page 124  |  Page 125  |  Page 126  |  Page 127  |  Page 128  |  Page 129  |  Page 130  |  Page 131  |  Page 132  |  Page 133  |  Page 134  |  Page 135  |  Page 136  |  Page 137  |  Page 138  |  Page 139  |  Page 140  |  Page 141  |  Page 142  |  Page 143  |  Page 144  |  Page 145  |  Page 146  |  Page 147  |  Page 148  |  Page 149  |  Page 150  |  Page 151  |  Page 152  |  Page 153  |  Page 154  |  Page 155  |  Page 156  |  Page 157  |  Page 158  |  Page 159  |  Page 160  |  Page 161  |  Page 162  |  Page 163  |  Page 164  |  Page 165  |  Page 166  |  Page 167  |  Page 168  |  Page 169  |  Page 170  |  Page 171  |  Page 172  |  Page 173  |  Page 174  |  Page 175  |  Page 176  |  Page 177  |  Page 178  |  Page 179  |  Page 180  |  Page 181  |  Page 182  |  Page 183  |  Page 184