Design in Mental Health 2016 Keynotes
project team ‘probably underestimated’ the amount of change for individuals of taking staff out of the existing buildings to the new facility – including different working patterns, driving to different places, and working in unfamiliar environments.
SERVICE-USERS IN MIND Part of the striking external façade at Kingfisher Court.
‘remembering that this is not just about buildings, but about the care we provide’. He elaborated: “We thus looked at safe care models – a lot of which is about interaction with service-users, but also about the physical environment, and at how best to provide a freer and less oppressive environment that helps people get better.”
WORK WITH THE KING’S FUND The Trust also examined best practice, including guidance from The King’s Fund, and incorporated this into the design of one of its dementia wards, at Elizabeth Court in Stevenage. “We involved our service-users and carers in helping us design these new facilities,” Tom Cahill explained. “We took down walls and replaced them with glass; made sure that the wards were as open as possible, and, for example, looked at floorcoverings, and effective wayfinding signage. All had a significant impact on service-users. This was a small project, but the various measures helped us to reduce falls, led to service-users being less confused and knowing where they were going, reduced violent and aggressive behaviours, and helped to improve staff morale, recruitment, and retention.”
While the work on building on best practice in dementia care provision was important in its own right, Tom Cahill explained that at the heart of the Trust’s ‘transformation’ was the work it had undertaken around its acute inpatient settings.
‘Following the consultation, the Trust developed a transformation plan agreed on by both service- users and the public’
He expanded: “Firstly, we had five different acute inpatient settings across Hertfordshire, which has a population of about 1.1 million people, with some fairly poor road links in and around parts of the county.
NO LONGER ECONOMICALLY VIABLE “We talked to our service-users, explained that the services in their current form were no longer economically viable, and discussed how we would take things forward. Interestingly, our service-users and the public told us explicitly they could give a little ground on access and travel distances for enhanced quality of facilities and care. We looked at a number of new sites to centralise inpatient services on, but couldn’t find one that met all our needs. We thus decided to use one of our old hospital settings, Harperbury, to build a brand new 86-bedded inpatient unit, Kingfisher Court.”
START OF THE CULTURE SHIFT The ‘concept’ of building an 86-bedded unit on an old hospital site, with the previous hospital’s connotations, in some’s minds, of institutionalism, was, Tom Cahill admitted, a ‘big ask’. He said: “I must give our governors, board, and particularly our service-users, credit for their bravery in pursuing the plan. What we have done on the site is built a brand new unit, involving our service-users and carers in the design, and re-branded the hospital, re-naming the site Kingsley Green.” While this might seem ‘like a bit of spin’, Tom Cahill said it was ‘very important for people who were working or driving there’ to refer to the site in a new, modern way. He added: “For some former residents and staff, memories of the Harperbury Hospital weren’t very positive, and all this was the beginning of our culture shift.” The other key lesson learned was that the
In designing and building the new Kingfisher Court facility at Kingsley Green, the Trust aimed to put service-users at the heart, ‘imagining and listening to what they wanted’. Tom Cahill said: “We needed open spaces, and a welcoming and a therapeutic environment, and had a lot of discussion about our furniture, and about use of colour; in fact in the end we were almost breaking the mould, in my experience of 30 years in mental health services, of traditional NHS colours. We brought our service-users with us to help with that.
“Another very significant contributor were
the architects, P+HS Architects,” Tom Cahill continued, “because, as Henry Ford once said: ‘If I had asked my customers what they wanted, I would have been told faster horses’. This project was very much a combination of asking service-users what they wanted, but bringing in the expertise in the room – from the architects and designers – about how we could take that to the next level. That was a really good combination for us, because while I may not know a great deal about designing mental healthcare buildings, I do know what they are like to live and work in. It was our designers though who helped us take our ideas and turn them into something really imaginative and different; something that, to start with, we would never have dreamt of.”
COLLABORATIVE APPROACH Tom Cahill explained that the design of the gardens at Kingfisher Court, the artwork, the uniforms, the decoration, and the overall healing environment, were all ‘shaped by a collaborative approach’. The Trust, in fact, had 2,000 hours of ‘formal’ service-user time and input helping design the buildings, the artwork, the wards, and their layout. “Service-users raise issues important to them that we may not have thought sufficiently about,” Tom Cahill explained. “For instance, in a previous new facility we wanted to put in showers throughout, but many of our servicers-users told us they preferred to use a bath – small things as simple as that.”
Designing Kingfisher Court had also
The dining area at Kingfisher Court. The Trust had 2,000 hours of ‘formal’ service- user time and input in helping design the buildings, artwork, wards, and layout.
One of the active courtyards at the award-winning £42 m Kingfisher Court acute inpatient mental health unit near Radlett.
THE NETWORK OCTOBER 2016 11
©David Churchill
©David Churchill
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