Published: 06/05/2004, Volume II4, No. 5904 Page 37 38 39

A scheme to redevelop a mental health trust's offices and accommodation will see patients living - and playing - side by side with local residents. Emma Forrest reports

Approaching Cherry Knowle Hospital in Ryhope, south of Sunderland, is not unlike walking through the grounds of a stately home. The South of Tyne and Wearside Mental Health trust hospital is based on a 165-acre site, which features a scattering of low-rise buildings which house inpatient units for adults.

But although the buildings may be unremarkable, they are in grounds with large areas of open land, dotted with daffodils and crocuses. There is a view of the sea and miles of open countryside that lie beyond. The sight of a local man (Ryhope village is at the bottom of the drive) walking his dog only heightens the sense that you could be in a country park. In reality, the site is home to over 190 patients, in 12 units including a daycare centre for older people.

Now, an ambitious scheme to rebuild trust offices, inpatient and elderly care units, a psychiatric intensive care unit and a challenging-behaviour unit is planned.

So far, so expected, but the scheme also aims to provide social and key-worker housing, up to 1,000 units of private housing and a mixture of leisure facilities for service users and local residents on the same site.

There is also the potential for both shops and education facilities to be built in what is essentially an extension of Ryhope village.

Project director and head of estates Dave Hall has looked to start the project since the late 1990s. His determination is evident, not least because half of his old job (he was also head of facilities) has been seconded to a colleague as the reprovision project takes up so much of his time.

Key to the scheme are changes to the way mental healthcare is provided.

'Care programmes now are about rehabilitation, ' he says.

'They are about allowing people to live a normal life in the community. Building healthcare facilities into the community helps with that integration.'

Any additional facilities will be used by both patients and public.

'A lot of our younger patients are physically fit and need to have continuation of accessibility of services. Gyms and swimming pools have both been mentioned by our patients. They deserve the chance to keep fit, ' says Mr Hall.

Planning the scheme began in earnest last November, when a four-day 'inquiry by design' workshop asked service users, carers, staff and local residents what they would like to see as part of Cherry Knowle's new look. A core 18-strong team of planners and designers worked with workshop attendees - around 70 of whom made major contributions - on what should and should not be included in the reprovision. There were also two public meetings.

Mr Hall describes the process as intense and massively rewarding.

It has helped to shape the early stages of the project, and also threw up some surprises.

'We thought people would say they want large spaces of open land, but they didn't want large unlit spaces. They wanted smaller, more private areas with benches and landscaping and lighting. It was also felt that previous developments did not take account of the pedestrian and there were not enough paths.'

Talks have begun with the local transport provider, Nexus, to ensure that a local bus service that comes into the trust's grounds is at best retained and possibly expanded (the trust's facilities are a considerable walk from the village's main road).

The question of what to do with the 100-year-old Laurels block, an imposing building that housed the trust when it was an asylum and was closed seven years ago, also surprised some at the trust. It was thought that bad memories might induce workshop participants to call for it to be pulled down, but instead they see its potential as a prime piece of real estate. Commanding a fine view of the sea, and big enough to house apartments, Mr Hall hopes a developer will snap it up for private homes.

Laurels block aside, the trust certainly has plenty of other space to play with. Once you move past the cluster of offices and wards, the grounds are mostly unoccupied. Areas of natural beauty within the site, such as a small lake, are set to be preserved in the plans.

Mr Hall is clear that the community's involvement is vital. 'We have had tremendous support from the community. A lot of our staff live in the village and local people walk their dogs in the grounds and visit our summer fair. A local school holds its sports day in the grounds.

Perceptions about mental health have changed and barriers have been broken down.'

Breaking down barriers is also key to seeing social housing provided on the site and members of the local authority's housing department participated in the inquiry-by-design process.

'We do not want pockets of luxury housing and then pockets of social housing.

There should be no difference between them; they should be fully integrated.'

But passionate though he clearly is on such matters, Mr Hall is adamant about where his core principles lie.

'The market will determine the progress of the housing. My focus is the mental health element of the scheme.' He expects the development might be phased, depending on funding, but hopes for the reprovision of the trust estate, along with recreation facilities and some housing to have been completed, by late 2006 or early 2007.

One of Mr Hall's principal tasks now is to establish which funding stream the trust should pursue.

When the make-up of the educational and leisure facilities has been decided, partners from the private or public sector need to be secured.

'We are talking to our commissioners about the funding streams open to us and the revenue and capital consequences of all of them, ' he says. Capital funding and private finance initiative are both being considered.

'A lot of the facilities will be used by patients, staff and the community but not necessarily built or owned by the NHS. But they will support care programmes.

'It is a complex scheme and we are working with NHS Estates and the Department of Health about assessment for funding. It is likely to be an exemplar scheme with regard to funding.

'There is also the potential to become an exemplar scheme in terms of planning. Our workshops were filmed by NHS Estates with a view to it becoming part of guidance for all trusts.'

More consultation with staff and patients is needed. Interim planning permission was granted last June, and after being seen by the trust's board, a development plan is now being viewed by staff.

Detailed designs will progress after the development plan is approved.

Royal assent: Prince Charles's seal of approval

The Cherry Knowle scheme is one of five in the Building Better Health pilot, which NHS Estates is running in partnership with architecture charity the Prince's Foundation for the Built Environment. The aim is to improve the architecture of new NHS buildings and make a worthwhile contribution to communities.

Participation in the pilot prompted Prince Charles and health secretary John Reid to visit the trust in January. Prince Charles congratulated South of Tyne and Wearside Mental Health trust on achieving, through the four-day inquiry-by-design process, what could have taken up to two years through more conventional methods.

He said: 'I do believe this model could just have something to offer in terms of added value - which is what it all seems to be about - for the residual NHS Estates property portfolio and longterm value. The key will be to ensure the developers build what all of you, as stakeholders, would like, rather than picking off parts of the site for ad hoc development and purely for commercial profit.'

'Their visit helped to ensure momentum, ' says project director Dave Hall, who has also visited Poundbury, the urban extension of Dorchester designed by the Prince's Foundation.