Community Hospitals The New Dawn

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Community Hospitals The New Dawn ? Introduction
Paul Willetts Healthcare Director Ryder
Architecture www.ryderarchitecture.com pwilletts_at_r
yderarchitecture.com
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Community Hospitals The New Dawn ? Introduction
Evolution of the Community Hospital, linked
to Clinical trends in the modern NHS NHS
policy and guidance Recent economic
events Community hospitals meeting this changing
demand Case study St Andrews Community
Hospital and Health Centre
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Community Hospitals The New Dawn ? Introduction
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Community Hospitals The New Dawn ? Introduction
Local Accessible Available Short waiting
time Dedicated staff
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Community Hospitals The New Dawn ? Introduction
Local Accessible Available Short waiting
time Appropriately trained and skilled
staff Relevant treatment Excellent clinical
outcome
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Community Hospitals The New Dawn ? Introduction
Local Accessible Available Short waiting
time Appropriately trained and skilled
staff Relevant treatment Excellent clinical
outcome Ideally, someone bigger than me to
tackle my elder brother ...
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Community Hospitals The New Dawn ? Clinical
Trends in the Modern NHS
Polarisation of clinical services Increased
specialisation in tertiary hospitals Clinical
governance A different balance of specialists
and generalists staff A change to the role of
the traditional general hospital New
technology drugs treatment regimes Increasing
application of community healthcare
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Community Hospitals The New Dawn ? Clinical
Trends in the Modern NHS
Polarisation of clinical services Increased
specialisation in tertiary centres Clinical
governance Surgery is like cricket If you
dont keep score you are not playing the game
properly H Brendan Devlin, FRCS. GI Surgeon,
North Tees Hospital. 1980 Multidisciplinary
Clinical Audit
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Community Hospitals The New Dawn ? Clinical
Trends in the Modern NHS
The aim (is) to ensure that all patients receive
the most effective, up to date and appropriate
treatments, delivered by clinicians with the
right skills and experience Clinical audit DH
definition
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Community Hospitals The New Dawn ? Clinical
Trends in the Modern NHS
Clinical governance is the system through which
NHS organisations are accountable for
continuously improving the quality of their
services and safeguarding high standards of care,
by creating an environment in which clinical
excellence will flourish Clinical governance
DH definition
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Community Hospitals The New Dawn ? Clinical
Trends in the Modern NHS
Clinical governancePatient outcomesMortality
rates Morbidity rates Length of stay Complication
rates Re-admission rates Life expectancy Quality
of life
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Community Hospitals The New Dawn ? Clinical
Trends in the Modern NHS
Consequence of clinical audit and clinical
governance is Increased specialisation of
staff, premises and equipment Improved
sensitivity and specificity of diagnosis Improved
patient outcomes A different balance of
specialists and generalists staff New
technology drugs treatment regimes Change to
the role of DGHs Increasing application of
community healthcare
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Community Hospitals The New Dawn ? Community
Healthcare Facilities
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Community Hospitals The New Dawn ? NHS Policy
and Guidance
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Community Hospitals The New Dawn ? Community
Care DH Definition
Our vision is for primary and community care to
provide high quality, personal care and support,
treating people when they're sick and helping
them stay healthy, where and when they need it
most.
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Community Hospitals The New Dawn ? NHS Policy
and Guidance
NHS Improvement Plan June 2004 A national
framework for service change in the NHS in
Scotland May 2005 Our health, our care, our
say January 2006 Our health, our care, our
community July 2006 NHS next stage review
October 2007 High quality care for all June
2008 Under one roof Kings Fund
2008 Changing care for the better DH May
2008
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Community Hospitals The New Dawn ? NHS Policy
and Guidance
NHS Improvement Plan June 2004 Followed on the
NHS plan of 2000 Re-shape the NHS around
needs/aspirations of patients Patient choice New
Treatment Centres More care closer to home GP led
(inc GPSI) walk in centres, including pharmacy
and diagnostic services
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Community Hospitals The New Dawn ? NHS Policy
and Guidance
Our health, our care, our say January 2006 90
of contacts with NHS are outside hospitals in new
generation of facilities Flexible, integrated
responsive community care Broadening of the
concept of community care GPs, physiotherapy,
podiatry, mental health, alcohol counsellors,
ophthalmology, rheumatology Extend role of
pharmacists diabetes clinics, repeat
prescriptions, More OPD clinics in community
care premises Step down care Minor
surgery Diagnostics Support
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Community Hospitals The New Dawn ? NHS Policy
and Guidance
Our health, our care, our community July
2006 Advances in technology support care in the
community Development means public capital,
LIFT, Community Ventures with a 3PD More about
changes to services than changes to
infrastructure
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Community Hospitals The New Dawn ? NHS Policy
and Guidance
NHS next stage review October 2007 Vision for
next 10 years Fair. Safe. Effective.
Personalised. New GP practices Flexibility in
opening hours Improving access to health social
care services Localise where possible
Centralise where necessary
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Community Hospitals The New Dawn ? NHS Policy
and Guidance The Kerr Report - Building a
Health Service Fit for the Future May
2005 Scotland the Grave ..the (Scottish)
population is ageing faster and dying quicker
than any other industrialised nation.
Ensure sustainable and safe local services NHS
is a service delivered predominantly in local
communities Preventative anticipatory
care Empower multidisciplinary teams in community
casualty departments to provide the vast majority
of unscheduled care Separate planned from
unplanned care Concentrate specialised and
complex care on fewer sites Much better
integration of primary, secondary and social care
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Community Hospitals The New Dawn ? Community
Care The Kerr Report
Current view Evolving model of careGeared
towards acute conditions Geared towards long-term
conditionsHospital centred Embedded in
communities Doctor dependent Team
based Episodic care Continuous
care Disjointed care Integrated care Reactive
care Preventative care Patient as passive
recipient Patient as partner Self care
infrequent Self care encouraged and
facilitated Carers undervalued Carers
supported as partners Low tech High tech
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Community Hospitals The New Dawn ? Community
Care The Kerr Report
Kerr report concluded that community hospitals
should include Diagnostic testing Routine
procedures, including day case surgery Renal
dialysis Rehabilitation Chemotherapy GP practices
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Community Hospitals The New Dawn ? Recent Events
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Community Hospitals The New Dawn ? Recent Events
2008
2009
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Community Hospitals The New Dawn ? Recent Events
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Community Hospitals The New Dawn ? Recent Events
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Community Hospitals The New Dawn ? Recent Events
NHS Alliance 40 of inpatients dont need to be
in hospital bedsMore care closer to the
communityRecognise the leading role of primary
care NHS London Acute Trusts must rationalise
their estatesMore care delivered through
polysystems, general practices and community
hospitalsWhole system approach
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Community Hospitals The New Dawn ? Case study
St Andrews Community Hospital and Health Centre
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
The project Client NHS Fife Right for
Fife Contractor Morrison Construction 10,700m2
27m PPP / PFI project Green field site to the
south of St Andrews Work commenced December
2007 Hospital operational August 2009
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
MODERNISING HEALTHCARE Combines existing
hospital and health centre services, plus new
services dermatology renal dialysis orthodonti
c services The design enables the functional
groupings of In patient services and
wards Acute care Diagnostic and treatment
services GP practices The design
provides Maximum flexibility in the use of the
accommodation Integration of staff across
disciplines and agencies Ease of access to
services by all sections of the community
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
FUNCTIONAL CONTENT 3 GP practices Community
services minor injuries unit consulting,
treatment and interview rooms OOH Primary Care
Emergency Service Diagnostic and treatment
centre out patients x-ray ultrasound orthodont
ics dermatology podiatry day surgery theatre,
and recovery beds endoscopy Renal
dialysis Physiotherapy Day care based assessment
and treatment 40 in patient beds Ancillary
accommodation FM services
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
MEETING THE CLINICAL BRIEF A clear
understanding of the clinical output
specification Generic room layouts to allow multi
disciplinary use Positioning the GP practices
around a central arrival point In-patient
accommodation on one level with access to secure
landscaped gardens and views A design which
integrates well into the sloping site and
delivers a human scale to the facilities Good
transport links Excellent line of site from the
hub to wards and departments Intuitive
wayfinding GP beds for enhanced patient care by
general practitioners Glazing detailed wherever
possible to floor level to maximise natural
daylight and nature views
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre

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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre

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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre

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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
SUSTAINABILITY Optimal orientation High
proportion of natural ventilation Ground Source
Heat Pumps Combined Heat and Power High
efficiency Heat Recovery Automated lighting
controls Expansion provision within building
envelope Expansion provision within M E
services Open structural grid for future
reconfiguration Generic consulting rooms Shared
GP admin areas Open access meeting rooms
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
CONCLUSION
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
KEY LEARNING POINTS Excellent engagement with
clinical teams and stakeholders
throughout Thorough interrogation of the
Brief The project was a vehicle for new ways of
working Extensive use of natural light and space
to optimise the environment Integration of
clinical services with community and other
providers Generic designs for clinical
rooms Energy saving measures Integration of
public transport to the new facility Flexible
working spaces flexible building layout Part use
of timer frame construction Life cycle and
maintenance informed materials selection
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
BENEFITS TO THE COMMUNITY Increased access
locally to diagnostic and treatment
services Improved accessibility to the community
of North East Fife Immediate referrals from GPs
to diagnostic services Reduced onward referral to
secondary or tertiary centres New local service
for renal dialysis patients Day surgery
re-established locally Improved integration
between health and social care Enhanced community
clinical teaching Flexibility in the building to
permit future expansion and change of use Most
importantly..
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Community Hospitals The New Dawn ? St Andrews
Community Hospital and Health Centre
patients and staff are delighted with it...
Thankyou