Apr 24, 2017 Last Updated 12:59 PM, Apr 20, 2017

A fresh approach to palliative care

Published in Upfront
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It’s always a momentous occasion when a project which has been five years in the making reaches handover; but never more so than when that project serves to be a legacy for the county, making a meaningful difference to individuals and families requiring palliative care for generations. Here, Architype explains more about the expectations and challenges of the build.

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Eagerly anticipated by patients and staff, the Phase One completion of St. Michael’s gives the hospice real reason to celebrate. Revolutionising palliative care for the patients, the new development provides state-of-the-art facilities for the dedicated and committed team, who have led a fund-raising campaign of mass proportions to accrue the necessary £9.6m required for this groundbreaking project.

St. Michael’s Hospice is an independent charity and has existed since the 1980s on a rural site, in Bartestree, a few miles east of Hereford and has provided free palliative care for the county for 30 years. Having outgrown their facilities, which were outdated for modern care methods, the Hospice set about appointing an architectural team for the redevelopment of the site, which comprises a new inpatient wing for up to 20 live in patients, as well as a complete refurbishment of the existing building, which will now house the hospice day-care unit.

Being new to hospice care design really helped Architype to form an open-minded and unassuming approach to this special project. Reassessing the requirements and questioning current practice in palliative care design to deliver honed solutions, underpinned by mindful collaboration with this complex and sensitive, client and user group.

The final outcome is a highly ambitious, bespoke arrangement, which is the result of in-depth consultation with patients, staff and infection control teams. This knowledge, confirmed by intensive research has culminated in a unique layout, that offers a variety of internal spaces, which are flexible to suit a spectrum of needs.

The floor plan is optimised to aid nurses in providing care effectively and efficiently. The nurse stations are positioned strategically to improve visibility to all patient rooms, whilst being in close proximity to necessary resources and information.

In line with Architype’s sustainable portfolio, the building has a simple and robust environmental strategy that focuses on passive principles such as rigorous insulation, exemplary airtightness, mechanical ventilation and heat recovery, breathing wall technology, optimised daylighting and solar gain. These integral sustainable features help to deliver a low-energy building that will require substantially less heating and artificial light; requirements of the upmost importance to the charitable client, who fundraise approximately £4m p.a to cover their running costs. The sustainable credentials deliver more than just financial benefits, providing a comfortable and healthy building for users, with a fresh supply of clean air, eliminating the stuffiness created by artificial heat and light that can attribute to fatigue, headaches and of course, the spread of bacteria.

Architecturally, the building has been designed to maximise the connection to external spaces and uses a natural material palette where appropriate to create a variety of supportive, calming and uplifting environments.

Developing a scheme that would deliver a non-clinical atmosphere whilst abiding to healthcare regulations, infection control and best practice guidance has challenged the design team to deliver a truly alternative response.

One of the most interesting aspects that really characterises this project and the contemporary response to the brief, is that this building is as much about ‘life-care’ as ‘end-of-life care’. The client was passionate that this building would enable users to become more independent. This is apparent in the integrated facilities such as physiotherapy suites that help regain strength with support; assessment kitchens and bathrooms where patients can practice daily activities, and even details such as the bespoke balustrades that indicate your location within the building.

On entering the building, a light and welcoming reception area immediately engages the building user with the beautiful Herefordshire countryside through a fully glazed wall. Beyond the reception area is integrated services such as therapy suites and guest accommodation with the inpatient wing beyond.

A central focus of the inpatient wing is the multifunctional ‘street’ – a central double height circulation space, flooded by light from the continuous roof glazing. It offers a variety of spaces from discreet seating areas, break-out areas and conveniently positioned nurse stations.

The private inpatient accommodation is accessed from the street in the form of five modular ‘clusters’, comprising four en-suite bedrooms that all open directly onto a communal living room. Moving through the building to the more private accommodation, the ceiling height gradually descends, creating a feeling of comfort, security and sense of a familiar, domestic environment.

Every entrance and connective space has been fluidly designed providing easy access, with large glazed double doors that are fitted with integral blinds between the bedrooms and social space. This design feature allows for varying levels of social inclusion or total privacy. From the centre point of the lounge, each bed head is visible to a nurse allowing for better communication and transparency. A strong connection to the surrounding landscape is proven to aid physical wellbeing and in response to this every room within the cluster offers every patient their own outdoor terrace. Each cluster is orientated to maximise on daylight, whilst a carefully chosen colour palette that distinguishes the cluster has been developed from the designers’ research into healing colours.

The design of the bedrooms has also been carefully developed to provide a functional but non-clinical feel. Features such as hoists have been included so that patients can be moved with safety into the specially fitted bathrooms. Despite the necessity for potentially imposing equipment, a simple, high quality feel is maintained, with all aid stowed in the custom-made integral cupboards specified in every bedroom. Containing a drugs locker and preparation space, hoist storage and motor, wardrobe, fridge, clinical wash basin and ventilation, this cleverly designed unit is a piece of equipment in itself, providing a one-stop station for nurses and patients.

Providing a non-clinical feel to the building has been a challenge; tackling the usual specifications of clinical plastics in exchange for natural materials. Although not possible in every instance when complying with hygiene regulations, natural materials such as timbers and textiles have been specified with unusual generosity for a hospice building. Where the direct use of natural materials has not been appropriate for infection control and hygiene standards in key locations, they have at least been made visible, as seen in the timber slat ceilings, the terrace canopies or the timber skirting, producing a visually softer environment with vastly improved acoustics.

The client and designers were ambitious to make this a building that was extremely functional but supportive, flexible and uplifting for the users, at times feeling more like a spa hotel than a hospice caring for patients with life-limiting conditions. Striking the right balance with a building that felt highly professional, whilst maintaining comfort and a sustainable living space has called upon skills from many staff at Architype over the five years. The relationship forged between the practice and the Hospice team has been one of shared vision, mutual respect and commitment, with both parties taking a responsible, sensitive and human approach to creating this new pioneering facility for Herefordshire.

Project architect Paul Neep described the experience: “St. Michael’s Hospice has touched the lives of so many people in Herefordshire and it has been a privilege to deliver this fantastic new facility that will enable them to continue with the highest possible healthcare standards in an uplifting, comfortable and relaxing environment whilst benefiting from significantly reduced running costs.”

As patients settle into the new building, work has started with immediate effect on Phase Two; the refurbishment of the existing building. The complete strip-out and refit will aim to offer more services and opportunities to day-care patients and their families, modernising, rationalising and improving the sustainable infrastructure of the 1980s building. Facilities will include respite care, holistic treatment, training facilities, community and recreational spaces in an improved environment. These will support the hospices activities and outreach, complementing the in-patient building and providing a sustainable future for the Hospice’s inspirational and commendable work.

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