ESTATE PLANNING
Artist’s impressions from Health Spaces and Fleet Architects showing what future similar healthcare facilities ‘on the high street’ could look like.
centres. Quite often the hospital and health system is one of the largest employers in the area, so there are key benefits to bringing healthcare to the community. “Employing the Housing and
Communities Agency (HCA) benchmarks, ‘the employment density of the optimal sites will increase up to four times when compared with the existing land uses in our case studies’. In other words, when you compare the typical health use of land, the employment density increases up to four times compared with various mean uses within town centres – you are creating jobs within a town centre. This effect is amplified when you consider the employment multiplication factor resulting from well-paid (greater than mean), highly skilled jobs, as found in the NHS. “There are benefits to patients having
access to diagnostics on their high street too – accessing screening in your lunchbreak, better working conditions for NHS staff, access to restaurants and cafés, and better parking, and benefits to the system – e.g. better access and shorter waiting lists. We are re-purposing builds too.”
A ‘one-stop-shop’ Combining the Health on the High Street model with a real-life example at Poole, Ashleigh Boreham and Jaime Bishop hosted the first Health Spaces webinar in February. A national first, Poole’s Outpatient Assessment Clinic was based upon the ideas used to create the Nightingale Hospitals and COVID-19 vaccination centres, which also used re-purposed buildings. The key lessons harnessed in creating the Poole facility (which was designed by BDP Architects, equipped by Innova Care Concepts, and with cfes as the principal contractor) were taken from these previous examples: robust governance structure, linkage to the local community, and the importance of high street locations. Ashleigh Boreham said: “The concept was the delivery of a high-flow clinical assessment facility in a safe clinical operating environment – to enable the triage / risk stratification of the waiting lists in Dorset, and in turn promote
the wellbeing and health of our population, and contribute to the recovery of elective waiting lists.” The Beales department store closed
after the retail chain fell into administration, but the Poole branch reopened in August 2020 under new ownership. The clinic, which is now run by up to 30 staff and 21 volunteers, started to see its first patients last November, with patient numbers now at approximately 130 a day.
Releasing capacity on hospital sites Presenting the Poole case study during the webinar, Ashleigh Boreham demonstrated that through increased space and flow, the space produced dedicated additional clinical capacity, as well as the potential to operate the facility from 8 am-8 pm, 6/7 days per week. Capacity was released on hospital sites to support specialties to see ‘long waiters’, and the new clinic created the opportunity to pilot the adoption of enhanced links to wellbeing and lifestyle support, and to use more conservative treatments. In addition, the clinic was able to create the opportunity to inform the development of Dorset’s Community Diagnostic Centres and ‘Health Village’ brand. Strategically located to support patients in the East and West of Dorset, the set-up of the Outpatient Assessment Clinic went through detailed scoping, planning, and delivery phases. The development of the clinical model by Rehearsal of Concept (ROC) drill marked the start of this process – testing the concept with patients, clinical, non-clinical, and support teams. From there the journey moved into development and sign-off of the Outline Business Case and PID (Project Initiation Documentation), and into the detailed planning and delivery phases.
Changes to pathways and diagnostics Highlighting the changes made to pathways and diagnostics, Ashleigh Boreham explained: “The reason why we chose specialties was because they were what we called ‘the early adopters’. We already had learnings from other systems – for example, we shared and learned from
Moorfields – so we knew the eye lane, and the consultant on board knew how to work that, and was really enthused. That was how we brought people on – that ‘ROC (Rehearsal of Concept) drill’ identified the people who wanted to play early, and that’s how we then brought those ones on first to get it going. It’s about great momentum. “You want a ‘one-stop-shop’. You
want one conversation; you don’t want your patient having five conversations, but certainly when you are dealing with inequality and deprivation, people cannot afford to go five times to these places, and if you’re working, particularly in an industry that doesn’t give you the leave for doctor’s appointments that some other industries have, and you’re maybe self-employed, four times out of your time is four times you’re not earning money. It also means that there are four instances when you may decide not to turn up, so your DNA (Did-Not-Attend) rates increase.”
Linking Diagnostics and Outpatients Ashleigh Boreham continued: “So, reducing the number of engagements is why we’ve linked Diagnostics and Outpatients, and pulled it altogether into a pathway approach – and all our pathways are designed with a front end of diagnostics, and then face-to-face as required, and then into action with the third sector.” The delivery of the assessment centre
was not without challenges – including building and maintaining momentum at the start, staff resistance, scope creep, unexpected costs, and maximising the phase 2 utilisation alongside operational pressure. Despite the challenges, the success of the new facility is clear. It has also added value to the local community by providing opportunities for health volunteers, increased footfall to support regeneration of the high street, allowed easier access to health and wellbeing support, and built links with education. Travel time for diagnostics has been reduced, with links to public transport. In addition, the clinic has been used
to test new digital solutions to support University Hospitals Dorset and Dorset ICS
September 2022 Health Estate Journal 63
Courtesy of Health Spaces
Courtesy of Fleet Architects
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