Space planning


A successful healing environment will be inviting, attractive, and hygienic, have natural light and views, and be warm and secure.


making a clear link between standards and policy. Today’s guidance is generally regarded as providing baseline recommendations or standards to which the design of healthcare facilities should conform. The DH space planning tool, Activity


DataBase (ADB), links to its Health Building Notes, Schedules of Accommodation, and Health Technical Memoranda, to provide a comprehensive suite of best practice guidance that drills down to finer details, and in essence provides users with a rationale for a set of minimum and recommended space standards for primary and community, acute and tertiary, and mental healthcare facilities. The focus of the guidance is on clinical and clinical support spaces. The DH ADB data can be manipulated by users to create bespoke projects, which can be exported to CAD programs, and Building Information Modelling (BIM) systems etc.


Off-the-shelf data The use of these tools and documents provides those planning healthcare facilities with a vast amount of off-the-shelf data, and access to a risk-managed, common set of genericised space and environmental standards optimised for infection control, privacy and dignity, and other considerations – reduction of falls, improvement of acoustics, etc. Since the early 1960s, a huge investment in evidence-based research by leading experts – architects, ergonomists, healthcare planners, healthcare engineers, and estates managers, supported by input from clinicians, Royal Colleges, and other user representatives – has built this catalogue into a resource of world-class significance. On occasions the guidance provides a range of ergonomic values, from ‘minimum’ to ‘recommended’ (as do Australasian Health Facility Guidelines). The use of a range of values tends to


30 Health Estate Journal September 2013


Studies show that the efficiency of staff when dealing with tasks of a repetitive, technical, or intensive nature, can be improved simply through provision of an external view.


reflect an emphasis on the need for local planning based on such factors as traffic type and volume, passing widths of specific equipment used, and functional adjacencies. Another consideration is the increasing prevalence of non-standard equipment required for special circumstances such as care of bariatric patients.


Paul Kingsmore


Paul Kingsmore, a Past President of IHEEM, and director of Estates and Facilities at NorthWest London Hospitals NHS Trust and Ealing Hospital NHS Trust, which is currently building a new £21 million Accident and Emergency Department at Northwick Park, and a £14m new theatre block, says: “It is important to understand that the space standards we use in health are often seen around the world as a benchmark for quality environments. While we need to challenge ourselves each time we use these, to ensure that we are applying the appropriate standard to the particular service or circumstance, it is essential that we continue to drive patient safety and privacy and dignity aimed at improving outcomes. Evidence points to the environment as a contributor to patient experience, which, if positive, can lead to more efficient treatment.”


Minimum space standards The benefits of minimum space standards include risk management through shared use of evidence-based design standards and principles across primary, community, acute, and tertiary sectors. They also mitigate the risk of over-sizing healthcare facilities – and thus capital and revenue costs. Healthcare planners, architects, and designers, are expert at using these standards as the baseline for their machinations, ‘right-sizing’ bespoke solutions where functional units, adjacencies, and other planning relationships and calculations, are based on service need and proven best practice. However, where pressures to reduce space standards to the bare minimum are overriding, complex trade-offs may not only reduce user satisfaction, but also the inherent flexibility and efficacy of a facility. The application of minimum space standards can be very limiting. A further consideration is that while creating the ultimate multi-purpose space is a fine aim, it, too, has its limitations.


‘Cutting space to the bone’ As Jenny Gill, a healthcare planner, and the owner of JG Consulting, as well as a Board Member of the Design in Mental Health Network (HEJ – May 2013), says: “Personally, I am concerned that mental health is already cutting space to the bone.We are seeing more and more multi-purpose rooms in schedules of accommodation, and, while we try to identify the different functions going on in the rooms, my concern is that spaces are being asked to accommodate too many and differing functions, and that, in the long-term, we are rendering the spaces non-functional. “Challenging and interrogating space


standards is, I believe, an integral part of any mental health project. The conclusion to the challenge is that it would be difficult to cut them further. These deliberations are one of the reasons for the rise of the


Courtesy of the NHS Photo Library


Courtesy of the NHS Photo Library


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