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Democratic design

Patients, staff and the public should have a say in hospital design, according to the Department of Health. But how can this be done? Alison Moore investigates

Published: 10/07/2003, Volume II3, No. 5862 Page 44

Involving staff and patients in hospital design may sound like building by committee, but trusts that have been through the process say it is worthwhile and produces a significantly different outcome.

In 2001, then health secretary Alan Milburn announced that hospital designs would not be approved without evidence of the involvement of staff, patients and public. He argued this would ultimately improve the quality of care. Since then, the principle of enshrining involvement has been reflected through the Health and Social Care Act and in the recent document Keeping the NHS Local - though the Department of Health says it is up to trusts to decide how this consultation takes place.

The Commission for Patient and Public Involvement in Health is expected to produce a template soon.

Sylvia Wyatt, manager of the Future Healthcare Network, argues that public involvement has been patchy - but many developments at the moment were planned under the old private finance initiative system, which only allowed for limited involvement.

As newer schemes that allow for greater public and staff involvement progress, there should be more evidence of the effect this has had - and added opportunities for public input.

For example, involving the public in the final stages of fitting out a hospital can increase the sense of ownership, Ms Wyatt points out. Patients will also come up with suggestions hospital management may have missed - or that are counterintuitive. At Bristol Children's Hospital, for example, children and parents were involved in the design from an early stage.

Parents were swift to point out privacy problems with the en-suite shower rooms alongside single rooms when a prototype was mocked up in the old hospital, says Dr David Hughes, who was clinical director at the time. But it was perhaps the children's comments which were most surprising - they wanted the clinical areas of the hospital to feel clinical in their design, while other areas struck a different tone, allowing them to relax.

Janet Roberts, service design director for a£200m scheme at Hope Hospital, Salford, says public participation has been multi-faceted and covered design and location of new buildings and details of accompanying service redesigns.

An exercise in which members of the public were invited to stick a pin in a map to show where planned health and social care centres should be built has ultimately influenced their location. Suggestions have been, on the whole, very sensible and have recognised that money is limited.

Focus groups have been used to look at services for some longterm conditions; hard-to-reach groups have been sought out - for example, semi-structured interviews with nursing home residents - and stalls have been set up in town centres and at local events.

'Public involvement is one of those things that you have to take trouble to keep plodding on with, ' says Ms Roberts. 'It would be easier not to do some of these things but the government is saying more and more that this is the way things should be done.

'We have not identified a single right way of doing it. It seems as if you have to keep on trying different things which attract responses from different people.'

Involving staff is easier: both Bristol and Salford set up shortterm groups to look at the design of particular areas.

These include all potential users of the area - from the consultants to the porters. But with perhaps 50-100 groups for major projects, each involving six to 12 people, they can amount to a major demand on staff time.

Finding what people want from a hospital building may only be the first step. Those responsible for designing, building and eventually operating it need to understand what is being asked of them.

When patients' views on a new cancer centre at St James University Hospital, Leeds, were sought, they were turned into a drama which was then performed for staff, patients and potential bidders entering the PFI process.

'As a direct result, staff put forward initiatives to deal with the patient environment in the existing building, ' says Paul Stones, development officer with arts group Tonic, which coordinated the initiative.

This was followed by a second play and a forum where patients had the opportunity to say what elements of design they most valued - for example, choosing what changes would most enhance patient dignity. Mr Stones is hopeful that whichever company wins the contract, patients' preferences will be reflected in the eventual design.

But for many patients, it may be the little details which count.

When a new oncology unit was built for Leicester Royal Infirmary in the mid 1990s, a patient and carer group was asked for suggestions. These included a request that a radiotherapy suite be renamed:

the 'Megavoltage suite' was thought to be rather alarming.

The hospital was able to oblige and rooms in the unit are now called after local parks. l

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