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Innovation in Hospital Design

Volume 671: debated on Tuesday 4 February 2020

I beg to move,

That this House has considered innovation in hospital design.

It is a pleasure to serve under your chairmanship, Ms Nokes, and to hold this important debate. Last September, the Government gave the green light to 40 new hospitals, as part of the health infrastructure plan. For my Basingstoke community this means support for a hospital replacing a much-loved building, built over 40 years ago.

We wanted a new hospital six years ago. While it is important to refresh those plans, because we are now talking about a district hospital, not just a critical treatment hospital, we already have a great deal of work in place. The initial community consultation has identified widespread support. The ambulance service has identified the location that would save more lives. The local council has given planning consent for a hospital to be built.

What about the building itself? If we are to realise the full benefits of this once-in-a-generation opportunity for our healthcare infrastructure, we need not the fad of the moment, but the best design for our hospitals based on evidence and the needs of clinicians, patients, staff and the community, as well as research at home and abroad, to create the best blueprint for local trusts to use for the next generation of NHS hospitals.

Guidance on how to design a new hospital, provided by the NHS to hospital trusts, has been called “out of date” by Architects for Health, an organisation dedicated to improving healthcare design. That should concern us. I hope that the Minister will reassure me that any new hospital will benefit from the best design thinking based on the best evidence around the world.

Many of the crucial design factors identified through research by design experts are completely absent in many hospitals within the NHS estate. Many of our hospitals, including our hospital in Basingstoke, were built for a different era of medicine. The buildings have been modified, added to, partially knocked down and rebuilt, and prefabricated units have been built in front of old units. Any sense of coherence in the design of our hospitals has long been lost.

I hope the right hon. Lady agrees that, historically, hospitals have been built away from where those services were most needed, causing issues with the recruitment of consultants and doctors, who then have to work with a demographically and geographically diverse population. I hope that location is given full consideration when new hospitals are designed.

The hon. Lady is absolutely right. That is why I was pleased that the NHS trust in Hampshire went to the emergency services and asked where the best location for a hospital would be. They identified junction 7 on the M3—an area not unknown to you, Ms Nokes—as a fantastic location. It would be convenient not only for staff, but for the ambulance service, so that it could save more lives. All these issues must be taken into account.

We have experience of building hospitals since Basingstoke and North Hampshire Hospital was built in the 1970s. Newer private finance initiative hospitals have often been debated in this place. Interesting research has been done on their design, showing that the innovative use design was inhibited because private finance saw those hospitals foremost as an investment vehicle, and tried to reduce risk by using conventional design and construction methods—looking to the past rather than the future. We cannot make the same mistakes again.

What makes a good hospital for now, or, better still, for 2060, when these hospitals will still be operating? Based on the past 40 years of experience, we know the next generation of hospitals must be flexible in their design, not only to accommodate change, but to be built with change in mind and not as an afterthought. I am sure that some elements can be standardised, but the overall design must be flexible. Some new hospitals are built with the intention that they may have an entirely different use in the future. In our communities there are successful examples of buildings that began with one intended use and have moved to another, but they are few and far between. We need to ensure these hospitals have that flexibility to scale up, change, scale back and even change use entirely.

Patient treatment is the prime function of a hospital, but so is patient recovery. The prevalence of multimorbidity requires a different way of thinking. Perhaps people with mental and physical illness—indeed, those with both simultaneously—should be treated side by side. Rightly, our focus is on early detection and prevention, so part of any new hospital must be mobile, to take prevention of disease into the heart of our community, with the permanent migration of some services from hospitals to the community, including simple diagnostics and therapies.

Research from the US demonstrates the importance of the right environment for patient recovery, including noise reduction, air quality, green space, daylight and seeing nature. Unsurprisingly, all those elements promote good health in well people, too. In 1984, a study by Roger Ulrich proved that a view through a window of a natural setting—perhaps the Hampshire countryside—would aid recovery. Those who had a view of a natural scene had a shorter stay and fewer complications and required less pain relief than those with a window facing a brick wall. Those are not new ideas. Florence Nightingale insisted on every ward being flooded with sunlight, with windows that opened to bring in light and ventilation lifting the spirits, but that is not the case for every ward in my hospital and hospitals around the country.

Staff retention is one of the most acute issues for the NHS. NHS staff are hugely loyal and dedicated. The hundreds of people in Basingstoke who work in my local hospital go above and beyond every day in bringing the best care to my constituents. However, where we work matters, and we should not rely on that loyalty and dedication but reciprocate it. We need to think about how design can improve everyday working lives.

Office design has evolved over the past 40 years, creating spaces that encourage creative collaboration. However, in hospitals things have not changed much at all, yet collaboration and creativity are just as relevant in medicine as in commerce, as are training and upskilling, which should be designed into these new buildings.

Of course, a hospital’s environmental impact also needs to be minimised. The importance of renewable energy and public transport links goes without saying, but we need to take account of the actual design of the hospital, to ensure that it is a design that the surrounding community can be proud of, and so the hospital does not look as if it has landed from outer space and instead fits with the natural setting; a hospital should be a building that will add to that natural setting and not detract from it.

For this new generation of hospitals to be truly sustainable, there needs to be a move away from the disposable hospital design of the 1970s, which was perhaps used when the hospital in Basingstoke was built back in 1972. A building that is flexible and that can be repurposed is a building that is sustainable, which is the approach that we must take.

Each and every one of the 40 new hospitals will be a huge investment for taxpayers, and it is right that approval procedures are rigorous. However, I hope that my hon. Friend the Minister can assure us that, despite that rigour, the long-term benefits of the best working environment for staff are not traded for a short-term reduction in cost.

Hospitals are absolutely extraordinary places that do extraordinary things on a routine basis. They are places where we experience the most emotional experiences in our lives; they are the places where new life is brought into the world and where we face our darkest moments. I will always remember the birth of my three children in Queen Charlotte’s Hospital in London, even though there was a decision to move the hospital after the birth of my second child and I had to go to a new location for my third child. Nevertheless, to be surrounded by experts in maternity and midwifery was an extraordinary experience, and we always have a debt of gratitude to hospitals that have served us in that way. Now Basingstoke hospital is looking after my mother and my father in an extraordinary way, and we should always recognise the incredible lengths that the NHS goes to, in order to ensure that we have the right support in place at the right time.

That is why communities have such a profoundly emotional attachment to their hospitals. That is a challenge that the Government face as they introduce their plans for 40 new hospitals, because they must recognise the impact of any change to a building with which people have an emotional bond and attachment, whether they have had a baby or visited a dying relative there. We need to understand that and take the community with us.

I hope that my hon. Friend the Minister can outline today how the Government will ensure that this once-in-a-generation opportunity—these 40 new hospitals for communities right across the nation—involves good design. That means design that helps to provide the best treatment, the best recovery, the best staff retention and the best for our environment, and such design should be at the heart of each and every new hospital, because we must build hospitals for the future and not simply replicate the past. We also need to recognise the emotional role that hospitals play in the lives of our families and our communities. We must work with the people the NHS serves to ensure that this groundbreaking development of the NHS estate is understood, embraced and welcomed.

It is a huge pleasure to serve under your chairmanship for the first time, Ms Nokes.

I congratulate my right hon. Friend the Member for Basingstoke (Mrs Miller) on securing this incredibly important debate about innovation in hospital design, which I know is an important subject for her. She has worked tirelessly to secure a new and better hospital to serve her constituents in Basingstoke, who I know are grateful for the enormous amount of work that she done. I also know that she will continue to hold our feet to the fire in the Department of Health and Social Care, to ensure that the new hospital is the very best that it can be.

As my right hon. Friend said, the Department has invested heavily in the NHS, providing large amounts of capital investment to hospitals, as announced last year by the Prime Minister and the Secretary of State for Health and Social Care. Ensuring that this investment delivers innovation in health infrastructure is absolutely vital, as we move forward towards a health estate that is fit and able to face the challenges of the future.

We announced a new health infrastructure plan, or HIP, to deliver a long-term programme of investment in our NHS estate, buildings and equipment. This will be the biggest and boldest hospital-building programme in a generation, supporting our health service so that dedicated NHS staff, who are quite marvellous, can give patients world-class care in world-class facilities.

Under the new HIP, we have made a long-term commitment to build 40 new hospitals over the next decade, including to the Hampshire Hospitals NHS Foundation Trust in my right hon. Friend’s constituency. As she knows, the trust will receive £5 million in seed funding to develop plans to renew the ageing estate and better align services at the hospitals in Basingstoke and Winchester.

The 20 hospital upgrades that we previously announced are already under way. That is on top of a capital commitment, amounting to around £3.3 billion, provisionally awarded to over 170 sustainability and transformation plans since July 2017. That capital investment is going into a wide variety of programmes right across the country, including new urgent care centres and integrated care hubs—which bring together primary and community services—and, of course, new mental health facilities.

This investment programme will totally transform the health infrastructure in this country. It presents a unique and exciting opportunity to implement the latest innovation in healthcare design, with all the benefits and advances of modern methods of construction. Getting this right will ensure that patients receive the right treatment—treatment that speeds up their recovery and makes the most of the working environment, ensuring that our wonderful NHS staff can work in facilities that support them to deliver the very best in patient care.

The impact of the built environment on patient outcomes and staff satisfaction is increasingly clear. My right hon. Friend has already referred to it, but academic research conducted by the University of Sheffield shows that patients make significantly better progress in new, purpose-built and designed buildings than in old ones. There are a range of impacts, including reductions in pain medication needs and shortening hospital stays. In the mental health sector, treatment times were reduced by 14%, and in the general medical sector, non-operative patient treatment times were reduced by a staggering 21%. That is the prize here.

There is also growing evidence that access to and visibility of green space is vital to promoting therapeutic environments that aid recovery, with positive health outcomes including reductions in stress and anxiety, increased social interaction and, of course, an improved healthcare experience.

There has been some really interesting recent work in this space, which the Department welcomes. For instance, the Royal Horticultural Society donated its feel-good garden from the 2018 RHS Chelsea Flower Show to Camden and Islington NHS Foundation Trust. Its permanent home is now at Highgate mental health centre, one of the trust’s two in-patient psychiatric sites, and it is dedicated to improving the care of older adults with acute mental illness.

As my right hon. Friend said, there is nothing new about that approach. Florence Nightingale—who I know is deeply ingrained in your constituency, Ms Nokes—had it right from the beginning. My constituency of Gosport houses Haslar, a military hospital built in 1756 that has long, well-lit buildings, beautifully landscaped gardens overlooking the Solent and, critically, many out-buildings—smaller structures where the war-wounded would be wheeled out to take the air and look at the beautiful views of the Solent that we still enjoy today. Buildings designed to maximise natural light and views of green space, with increased natural ventilation and reduced noise levels, make for a much more pleasant environment, not only for the patients, to aid recovery, but for the staff going about their work.

As my right hon. Friend said, there is mounting evidence that there are strong links between the design or layout of buildings and the job satisfaction of staff, thereby improving staff retention. Buildings should be designed in a way that makes it easier for staff to do their job. For instance, designing the layout of a health building in a way that aligns with patient flow and clinical pathways also contributes to increased staff satisfaction, which makes sense. Staff can dedicate more time to patients because the time spent walking between linked wards and clinical services is reduced.

Naturally, we want to ensure that the modern clinical design of buildings is also cutting-edge in the way it supports environmental sustainability. The large hospital projects selected for phases 1 and 2 of the Department’s health infrastructure programme have been instructed to ensure that they combine and contribute to the reduction in the NHS carbon footprint by following the framework developed by the UK Green Building Council on net zero carbon buildings.

As well as seeing innovation in hospital buildings, we want to see environmentally conscious design. The NHS has led a new-for-old programme, which improves delivery of local community-based infrastructure as well, so these things are not only for the big new acute hospitals. The new-for-old programme is adopting a variety of sustainability measures, including something called BREEAM, which stands for the Building Research Establishment environmental assessment method—that slips off the tongue. It will be incorporated as standard, as independent third-party verification of sustainability performance in infrastructure.

The design of estate has a massive part to play in achieving net zero carbon targets, and carbon efficiency measures can have a positive effect on both patients and staff. For example, installing energy-efficient LED lighting in every hospital will produce average energy cost savings of up to £33 million and, importantly, improve the clinical environment for patients and staff. Adopting renewable energy solutions in the design of clinical facilities also contributes to cleaner air for our communities and better health outcomes.

Our building programme will take advantage of innovative design and innovative construction methods, and we are encouraging the NHS to take advantage of a range of modern construction approaches, including off-site manufacturing and standardisation, such as repeatable room design. Such methods can enable new and better buildings to be built quicker than otherwise would be possible. They can open their doors to patients sooner.

The Minister rightly talks about new and innovative methods to build buildings quicker, and that is very important, but my concern about getting these things finished is not about the building; it is about the approvals processes. Given the benefits that she so eloquently outlines in having the additional 40 new hospitals—benefits to patients, but also to the taxpayer—what space is there for the NHS to speed up the programme? It is clearly long overdue and to the benefit of all our constituents.

My right hon. Friend is absolutely right to raise that point, and I will come to it later in my speech. The key thing is to ensure that all the relevant stakeholders and partners are brought to the table very early so that everybody understands exactly what the plan is and has a feeling that they have bought into and invested in how that plan unfolds.

Earlier, I mentioned the importance of innovation, repeatable room design and standardised components, which very much lead to the flexibility that my right hon. Friend talked about. That means that the NHS can adapt to future advances in delivering modern patient care, and it delivers time, cost and efficiency benefits. For example, the Wrightington Hospital orthopaedic centre uses repeatable rooms, and that is already delivering benefits to patients and staff, but it also means that the rooms can be changed in future as modern innovation delivers changes. It is also critical that innovative building design integrates the benefits of technology and infrastructure to make full use of its transformative potential for service delivery and patient care.

As my right hon. Friend says, it is important to ensure that the designs are delivered fast. The schemes must be built in a way that works with the local community. The buildings must be easily accessible, sustainable and integrated with the local planning infrastructure, and scheme proposals and business cases developed in partnership and in alignment with sustainability and transformation plans, integrated care systems and clinical and estate strategies. They need written commissioner support, alongside evidence of engagement with local stakeholders and their support for the plans. We hope that will speed up delivery of the buildings.

I hope that goes some way towards reassuring my right hon. Friend that the Government are absolutely committed to maximising innovation in the high-quality hospitals that we are delivering. We are going to seize this once-in-a-generation opportunity, and we will work tirelessly to ensure that the people of this country are receiving the care they deserve in buildings that are modern, functional and beautiful. I thank her for securing this debate, because it has given me an opportunity to outline how we intend to do that, but I am sure she will continue to hold us to account when it comes to delivering on that commitment.

Question put and agreed to.

Sitting suspended.