Taunton & Somerset NHS Foundation Trust Design Vision A Working Document
1 Introduction This Design Vision offers a simple expression of our broad design aspirations for Musgrove Park Hospital based upon an understanding of the specific context of our site, its community and the changing demands on its services. We want to paint a picture of how we see the hospital looking, feeling and operating in the future so that everyone can play a role in taking forward this shared vision and so that we work effectively with colleagues, patients, public and private sector partners and the wider community to achieve our goals. It is important to recognise the history of the hospital s development and all its inherent compromises. This has required some degree of pragmatism in expressing our design aspirations reflecting the constraints of continuing to develop a busy existing hospital site. We have grasped the opportunity to consider what will work best for us and our specific set of circumstances; to look at our existing site with all its restraints and to ensure we don t go for the simple short term solution which compromises the future development of the site, but allows for a flexible and creative approach. But this document provides only the starting point of what will be a long and complex process of change. Its aspirations will take more detailed and practical form within further documents such as the Trust s Development Control Plan, Landscape and Interior Design Policies and most crucially within the Design Briefs for specific building projects, each will ensure sound leadership particularly in the management of architects and other contractors. The ideas contained within the Design Vision have been developed by the Trust s Design Committee through close working with architects and artists and most importantly by listening to the views of the hospital community, its patients, staff and visitors. The Design Committee will play a central role in ensuring that the Trusts design aspirations are consistently applied across all future developments. They will do this by setting out clear design requirements, monitoring progress and conducting Design Reviews on all major capital building projects. Taunton & Somerset NHS Foundation Trust Page 1 of 10
2 Context 2.1 Who we are and what we do Musgrove Park Hospital is, and will continue to be, the main provider of acute hospital services to the population of west Somerset. The hospital provides a comprehensive range of district general hospital services for its catchment population and also provides specialist vascular, haematology and cancer services for the wider population of Somerset. The hospital has 700 beds, operates at a turnover of 193m in 2008/09 and employs over 4000 staff making it one of the biggest employers in Somerset. The site covers an area of 32 acres. 2.2 Our buildings A third of the hospital s accommodation is in need of major repair or replacement with major failings in design and layout of clinical and non-clinical areas. Work to modernise the hospital site started in 1987 with the opening of the Queens building which includes A&E, orthopaedics, ophthalmology, endoscopy and therapy services. The Duchess building including all medical and care of the elderly wards, outpatients, pharmacy and imaging was opened in 1995. Most other clinical services, including many surgical and theatre services are accommodated in single storey accommodation dating back to the 1940s. Many parts of the site are now unsuitable for the delivery of modern healthcare. Six surgical wards are of Nightingale design, which the Government is committed to eliminate. Taunton & Somerset NHS Foundation Trust Page 2 of 10
2.3 Our History The Musgrove Park site was greatly developed as a Field Hospital by American forces for military casualties in WW2. The US 67th General Hospital occupied the site on 5th December 1942 having arrived in the European Theatre of Operations on Dec 1st. This heritage is marked by the enduring presence of the Eisenhower Tree by the Old Main Entrance. The site had previously been developed as a British Naval Hospital, but was never occupied as such. 2.4 The Future what kind of hospital will we become? The Trust s strategic vision is to provide the highest standards of service and quality and the Trust believes that the redevelopment of the site and modernizing the fabric of its buildings is a key enabler to achieving this vision. Based on the changing development in healthcare science, policy and public expectations over the last ten years, the only certainty the future holds is that change will continue. Previously many departments have grown in an ad-hoc way reacting to changing needs with disproportionate use of temporary accommodation leaving the site looking cluttered and piecemeal with poor adjacencies between clinical services and excessive distances between departments. The Trust started work on a master plan in 2002 attempting to create a framework within which the hospitals development can be planned in a coherent way to accommodate changes in services and allow the achievement of its strategic vision. The Trust is planning a financially sustainable phased redevelopment of the site and its buildings. The timescales will be dependent on funding availability as part of the Foundation Trust s long term financial model. Whilst detailed designs for these subsequent elements cannot be completed at this stage, the design principles for the site will be constant to ensure continuity and harmony between individual capital developments. The surgical development will be a catalyst to progress the hospital s overall site development control plan to achieve design objectives for the whole site, in particular, the freeing up of areas on site to enable subsequent capital developments to be progressed, including new pathology facilities and a support centre for portering, post, central stores and kitchen, and for the hospital s design vision to be realised. Taunton & Somerset NHS Foundation Trust Page 3 of 10
3 Our Design Aspirations The following aspirations will drive all future development of our site and our buildings. 3.1 Create a safe hospital People hope and expect to leave hospital feeling better than when they arrive so it is absolutely crucial that we create an environment that enhances patient care. The design of our future healthcare environments should take account of the increasing international and national evidence of the relationship between the design of hospital buildings and patient safety. This evidence shows how hospital design can help reduce staff stress and fatigue so reducing accidents as well as increase effectiveness in delivering care and staff morale. It can also improve the control of infection, reduce patients length of stay in hospital, reduce patient and family anxiety, improve treatment outcomes and enhance patients perception of the overall quality of their care. This is a guiding principle in our design vision and the Trust believes that this can only be achieved if the patient is considered to be at the centre of the design process. Security is also an important consideration in creating a safe environment for patients, staff and visitors and the future development of the site will seek to achieve an appropriate balance between the needs of security and the needs of easy access across and on to the site. 3.2 Promote best clinical practice We should seize the opportunity to effect positive change by designing buildings that enable us to adopt new and better ways of working. Improving the quality of clinical services for our patients is and will continue to be the central strategic objective for the Trust and our healthcare environments need to be planned and designed to achieve this. There is no doubt that the design has a direct effect on our working practices and we wish to work closely with staff and experts in their fields to plan and design the site and its buildings to enable the adoption of the most recent proven clinical best practice and evidence based care. This may be also be achieved by following current Department of Health building guidance, and also by reference to the growing body of national and international service improvement work (eg. sponsored by the NHS Institute for Innovation and Improvement), together with the published guidance of health professional organisations, including the various medical royal colleges. Those involved in planning hospital developments should take opportunities to visit other hospitals known to be at the forefront of clinical innovation to see and learn from the experience of their staff and observe the functioning of their new buildings. Designing new buildings with flexible spaces will ensure that they can be adapted to suit clinical best practice as it evolves over time. Taunton & Somerset NHS Foundation Trust Page 4 of 10
3.3 Create an efficient and co-ordinated campus We want to ensure our range of buildings sit happily within the site and link positively with each other and their wider surroundings. The development of the hospital necessitates a campus approach with a range of new buildings being designed to be distinctive in character but also to harmonise with the overall site, drawing together disparate parts of the hospital into one attractive whole. We will aim for an assembly of inter-related and well proportioned buildings of an appropriate scale and presence and with clearly legible entrances and routes between them. Each building will have a distinct zone of external landscape to help anchor and identify the services delivered there and creating garden rooms will make it more friendly and inviting. Overlapping elements within the planting schemes and shared material palettes allow for a softening of boundaries and a strengthening of familial and binding landscape characteristics on the whole site. By developing vertically on the site and demolishing parts of the Old Building, open spaces can be created to allow a mix of hard and soft landscaping to provide car parking and green open spaces. The design of all the buildings will balance the need to provide high tech facilities and equipment with the equal need to provide a healing environment which recognises the contribution a friendly, attractive environment has on patient experience and indeed clinical outcome. We will aim to soften the hospital s boundaries and make more overt links to the surrounding buildings, spaces and topographic features such as the Galmington Stream, Parkfield Walk, Galmington Playing Fields and the Magdalene Cemetery. Where possible clinical traffic should be separated from public movement so as to respect the dignity of patients and similarly routes should allow for the separation of public movement from goods traffic. Taunton & Somerset NHS Foundation Trust Page 5 of 10
3.4 Anticipate the changing needs of the hospital. The healthcare environment is undergoing constant change and healthcare buildings and the site in which they sit should be designed to be as flexible and adaptable as possible. This means creating buildings that can allow a change in use or that allow the potential for further development. The planning of the overall site and the buildings within it should be viewed as part of a hospital s longer term strategy and any development should not respond only to short term policy and targets but form part of a long term coherent framework that can flex accordingly. Buildings should be designed to anticipate change, the basic structures and services should be designed to allow for both a change in function and expansions in service. Any future design proposals that are developed should demonstrate how this might be achieved. The planning of the site and its buildings should be integrally linked to the Trust s overall strategy and reflect the future direction of healthcare. 3.5 Allow easy movement around the site Within our site it is particularly important to establish routes across the hospital that allows efficient, dignified, safe and easy movement for people and vehicles, goods and services. The current site does not allow for easy and safe movement, particularly of patients, staff and visitors accessing the site on foot. The future development of the site should aim to create an easily navigable site that allows fast and efficient access to services for patients and visitors. An integrated approach to this is essential, where roads, buildings, pathways, glass facades, landmarks, signage and entrances are all designed to work together to help people understand the site and find their way around. The total number of entrances into hospital buildings should be minimised and more clearly visible so as to provide a more obvious sense of arrival. The removal of visual and physical barriers to public access and navigation is crucial, as is the creation of site lines and framed views. Taunton & Somerset NHS Foundation Trust Page 6 of 10
The current hospital site has evolved in a piecemeal and opportunistic way outside any considered or coherent framework and as a result the hospital is less efficient. Some areas are severely overcrowded whilst others lay unattractive and unused. Travel distances between related clinical services, often located in different parts of the site, put constant pressure on staff and patients. Future site planning should aim to identify clear and well defined routes for public transport and emergency vehicles such as ambulance, fire and police. Future site planning will be informed by the Trust Transport Plan and the wider Taunton transport strategy. The creation of a perimeter road will significantly enhance the connectivity of the entire site, improving vehicular flow and reducing congestion. Road widths, turning circles, waiting bays and lay-bys are to be designed so that they are suitable for hospital and emergency traffic including service vehicles. 3.6 Make best possible use of space Space should be viewed as a key resource for the benefits of patients, staff and the wider community and the future development on the site should consider how space is used to maximise the benefits. Major developments should be used as a catalyst for reorganising the current site creating better clinical adjacencies that will save time, money and improve patient care. We should avoid the construction of single storey buildings and no single building should be designed in isolation from the rest of the site but be considered as part of overall coherent and cohesive hospital site. The design and planning of buildings and external space should also aim to maximise the amount of usable green space. The redevelopment of the site must allow for overall improvement, each new development should be able to stand both alone in case further phases of redevelopment do not immediately follow and in the context of a wider long term site plan. Not all development will be in the form of new buildings, refurbishment or reuse of existing space should also aim to improve overall use of space. 3.7 Create reassuring and comfortable environments It will be a priority to ensure that patients and staff are supported by a high quality environment that promotes confidence, dignity and a sense of well being. Taunton & Somerset NHS Foundation Trust Page 7 of 10
The location and orientation of buildings will be selected to maximise the impact of the sun s path across the site and to create sunny courtyards and maximise natural light within all wards, offices, consulting and treatment areas for the benefit of patients and staff. Interiors will be designed to calm and reassure patients with careful choice of furniture, lighting, colours and finishes and artworks to provide interest and diversion. 3.8 Put the park back into Musgrove Park There is significant evidence that attractive open spaces and gardens improve patient recovery rates and increase staff satisfaction. There is an important opportunity to reclaim much of the currently overlooked and disused outdoor spaces to create new landscaping, planted areas and walkways interspersed with much needed seating, shelter and facilities for children. We will aim to provide clean, uncluttered, light and airy spaces, attractive views, warmth, good ventilation and wherever possible the means by which individuals can control their own environment. People will be welcomed on site and to each building with a positive sense of arrival. Entrances will be obviously predicted and loudly announced and walkways and corridors will follow logical and energy saving routes. The removal of visual and physical barriers to public access and navigation is crucial as is the creation of excellent signage, sight lines and framed views. We want to create garden rooms and vistas enlivened by seating, lighting, stand-alone sculpture, arboreal architecture and topographical changes and with trees adding scale and an ever changing backdrop of seasonal colour shifts. We will explore opportunities for opening up the site and creating new health resources for staff and local people such as gardening clubs, walking trials and sports facilities. Design solutions should create a series of views to external spaces and internal points of reference that will enable patients, visitors and staff to navigate around the hospital Taunton & Somerset NHS Foundation Trust Page 8 of 10
and to understand its basic layout. Access on to and movement through the hospital site and to the hospital buildings should be clear minimising the need for signage, instead relying on logical way finding using landmarks. The future development of the site should occur along an efficient central spine or hospital street system. From it you can navigate the whole site, enabling you to locate your destination and negotiate its distinct zones with ease. An emphasis on nature, natural materials, local geography and the rich heritage of the site will guide the development of a palette of materials for building facades and landscaping. Art, design and sculptural landmarks will create special moments within the patient journey offering comfort, orientation, inspiration and a human dimension. Central to the Trust s approach is a commitment to working with artists appointed from the outset as members of design teams to plan for the incorporation of art to create special moments within the patient journey offering welcome, diversion, inspiration and a human dimension. But beyond creating one off artworks artists and architects will collaborate in the broader consideration of materials, texture and colour. 3.9 To create a distinct sense of place We want the hospital, its grounds and its buildings, to celebrate all that is special and distinctive to its locality, history and the communities it serves in Taunton, West Somerset and the South West region. Taunton & Somerset NHS Foundation Trust Page 9 of 10
3.10 To create sustainable hospital buildings The design of the external environment should seek to exploit rather than merely accommodate the new By sustainable we mean durable, energy efficient buildings that minimise their environmental impact. legislation. The development of a palette of materials to be used consistently around the site will not only promote a unified and harmonious environment but also offers the opportunity to promote the use of eco materials such as wood from renewable forests, locally sourced stone, brick with its extended life and as already mentioned recycled materials. The Trust, in line with new Government legislation, is working to develop greener energy strategies for both the existing estate and for future capital developments. New buildings will be designed to minimise energy costs and environmental impact whilst maintaining a comfortable patient environment. They will aim to use energy and resources efficiently through designs that maximise use of natural light and ventilation, use low-emission materials, finishes and fittings, and reduce pollution and waste to avoid health and other environmental impacts. We will consider the whole life costs of every project, ensuring design minimises the overall consumption of building materials and that those specified are durable and appropriate for their use, and where ever possible are from recycled or sustainable sources. We will aim to provide accessible transport options for all members of the community. 4 Conclusion The Trust is embarking on a range of new capital schemes to improve the environment for patients and enhance the services we provide. This presents an enormous opportunity to learn the lessons from the past and avoid the incremental spread of buildings on the site in the absence of a coherent development control plan. It also allows the Trust to look again at the vision for the site in terms of its impact on patients, visitors and staff. By adopting the principles set out above, the Trust can move forward confident that the site can evolve and grow within a well defined design framework rather than an ad hoc, reactive process. Taunton & Somerset NHS Foundation Trust Page 10 of 10