Two ‘state-of-the-art’ new hospital wards have opened at the Western Community Hospital in Southampton, providing specialist rehabilitation care to people living in and around the area. Their opening has seen patients and staff re-located to the new facilities from two ageing rehabilitation wards at the nearby Royal South Hants Hospital, bringing together many of Hampshire and Isle of Wight Healthcare NHS Foundation Trust’s rehabilitation services as a centre of excellence. HEJ editor, Jonathan Baillie, recently visited to find out more.
Main contractor, Brymor Group Southern Construction, completed the two 25-bed rehabilitation wards — named Keats and Conan Doyle after two famous literary figures with local links — last September, after a two-year construction programme. The new inpatient rehabilitation wards are on the first and second floors of a highly impressive new three-storey building, the West Wing, at the Western Community Hospital on Southampton’s south-western outskirts, with the currently unoccupied ground floor likely to be used for rehabilitation services in the future. Featuring double the amount of single en suite rooms previously available, and considerably more space, the new wards, and the building that houses them, have been built for Hampshire and Isle of Wight Healthcare NHS Foundation Trust.
The Western Community Hospital already housed two specialist wards for people with complex rehabilitation needs, but with the new wards’ opening — in a new building connected to the existing hospital — all rehabilitation services in Southampton are now co-located to form the ‘re-branded’ South of England Rehabilitation Centre (‘SERC’), ‘a centre of excellence where psychological, neurological, and physical rehabilitation services are available’.
Greatly improved facilities
Improved inpatient facilities in the new Keats and Conan Doyle wards include a dedicated and larger gymnasium than at the Royal South Hants Hospital, a central courtyard and terrace giving accessible outside space, and an Assisted Daily Living (ADL) suite — a joined kitchen and bedroom/bathroom designed with features patients would have at home, to help prepare them for leaving hospital.
Eleven people made up the last patients to use the rehabilitation wards at the Royal South Hants, where services had been provided in the old Lower Brambles and Fanshawe wards for almost two decades. The staff and patients from these wards — which the Trust acknowledges were ‘ageing, cramped, and no longer fit for purpose’ — moved to the new wards at the Western Community Hospital last October.
When Chris James, senior Estate Maintenance & Infrastructure manager at the Trust, and Chair of IHEEM’s Southern Branch, first discussed the new rehabilitation facility with me last October, he spoke enthusiastically about the impact it would have on the Trust’s ability to provide high-quality rehabilitation services from a modern, purpose-designed space. To discover more, I met with him, and two of the other personnel who have played a key role in getting the new facilities built, at the Western Community Hospital in mid-November. The first, Maggie Stoppard, is a highly experienced senior nurse with a specialism in neuro rehabilitation. As the Trust’s head of Inpatient Nursing and Therapy, she manages all four rehabilitation wards at the site — the two in the existing building, and the two new wards. Also attending was Mark Maffey, an experienced architect, senior project manager, and the Project design lead. Alongside Mark was the Trust’s Communications manager for Estates, Liz Pusey.
Explaining that the Western Community Hospital had been built in 1993, Maggie Stoppard said: “With the West Wing’s opening, we now have four rehabilitation wards on the site. The new building houses our two new Level 3 rehabilitation wards, Keats and Conan Doyle, while in the existing building we have Snowdon — our neuro-rehabilitation ward for patients with neurological injuries needing rehabilitation, and Kite — our neuropsychiatric secure ward, housing patients with an acquired brain injury presenting with challenging behaviours. I manage all four, and we work alongside the hospital’s fifth ward, Primrose Ward — which delivers older people’s mental health services.”
To make space for the new building, a section at the side and back of the original hospital was demolished. Chris James said: “The scheme is part of a masterplan which recognises that the site has been underutilised. The building we demolished incorporated a decommissioned former single ward repurposed as administrative space.”
How the new wards came about
Mark Maffey said: “With two of our four rehabilitation wards — serving 43 patients combined — previously located at the Royal South Hants Hospital, as previous tenants of that facility, we have reduced our rental costs.”
Maggie Stoppard went on to explain: “Our rehabilitation services are split into three levels — as defined by national guidelines. Level 1 patients are the really complex patients in a low awareness state, often characterised by psychiatric or psychological conditions alongside other clinical care needs, while the Level 2 patients in our Snowdon neuro rehabilitation ward have slightly less complex clinical and care needs, but still need some specialist rehabilitation. Level 3 patients are those requiring more ‘general’ rehabilitation — typically having suffered something like a fracture, and needing help to get back on their feet, or recovering after a heart attack or stroke.”
Small cubicles and restricted spaces
At the Royal South Hants Hospital, rehabilitation patients were accommodated in one 24-bedded ward and one 19-bedded ward, in a mix of bays and side rooms. Maggie Stoppard said: “The NHS Property Services-owned hospital is very old, with small cubicles and restricted spaces, while only one had a day room, and the bathrooms were shared.”
Mark Maffey added: “We were thus paying NHSPS to rent an ageing building, suffering from disinvestment, that no longer met patient needs. In 2017 the Clinical Commissioning Group drew up an initial outline business case to determine how we should address this. Around 10 options were examined, the preferred one being to re-locate our patients to the Western Community Hospital site, in the process eliminating cross-site working. There was a long list of other positive metrics — including lower energy, food, and waste costs per patient, yet in a more spacious, fit-for-purpose environment.” Maggie Stoppard added: “Having the four wards on one site both makes the senior leadership team more visible, and gives me more flexibility in how I deploy my staff.”
A detailed business case completed in late 2020 was approved in June 2022, with the required funding — a combination of NHS England, Integrated Care Board, and Trust funds, becoming available in September 2022. The total project cost is expected to be around £22 m.
Mark Maffey said the full business case needed to be a fully designed and signed-off proposal. He said: “The design process saw our Estates team (on the capital side) lead the design, employing external design teams, and working with the clinical team — right from the ‘blank piece of paper’ stage through to the minute details, such as ‘Where do you want the light switches?’ The design team, the users, and our ‘technical stakeholders’, all contributed. So, we worked with Maggie’s team on the layout, and closely with Chris James in Operational Estates to ensure the new building would be easily maintainable. We also liaised extensively with the leads for cleaning, catering, security, IT, health and safety, fire, and IPC. Once the full design was signed off, the business case process required full market testing, so the scheme was tendered on the open market. It was thus fully ready to mobilise once the business case and funding were approved. Once the funds became available,” Mark Maffey continued, “we appointed the scheme’s preferred construction team, and then started work on site on 31 October 2022.”
Brymor Group Southern managed both the demolition and the main contract. Its three main sub-contractors were Reavey for electrical, ARB for mechanical, and Blanchard Wells as frame contractor.
Mark Maffey said: “Prior to appointing the project architect, the Estates project team launched a design competition to establish who we could work optimally with, and who best understood our aspirations for the project.” The practice appointed was Sonnemann Toon Architects, with Hoare Lea for MEP design, White Structures for structural, and McPhersons as cost advisor.”
Mark Maffey explained that the demolition and initial structural work took from October 2022 to February 2023 to complete. He said: “The building we demolished was of brickwork construction, so we crushed the masonry materials on site for re-use. The original building was on waste ground on a vibro raft foundation, through which we drove 196 piles, 15 metres deep, and averaging 300 mm diameter in size. The floor plates and roof were formed as 300 mm deep flat slabs.
An addition to the brief
“Despite the brief to relocate the two wards only requiring a two-storey facility,” he explained, “we had a three-storey building built, taking the opportunity to add a spare floor. This decision was driven because there was a planning precedent, and because at no other point in the building’s life will it ever be as cost-effective to add an additional floor plate. The ground floor is currently empty, but plans are afoot for it to have a rehabilitation function — with both inpatient and outpatient diagnostics to complement the other floors.”
Mark Maffey continued: “The occupied floors are designed as two wards with identical bed configurations. Both (Keats on the first floor, and Conan Doyle on the second) comprise 25 beds, with 16 patients in four-bed bays (each with two en suites), and nine in single en suite rooms. Currently we are commissioned to deliver care to 43 patients, but we capacity modelled for the future — hence we have delivered an additional 7 beds within the overall 50-bed unit.”
The Project manager added: “There is a sizeable first floor rehabilitation gym, patient dining spaces, two first floor external patient spaces — a courtyard and a terrace, and other ad hoc sitting spaces outside of the sleeping areas. These encourage patients to regain their mobility and move to other areas of the building for activities — with staff, family, and friends. Both floors house staff meeting, MDT, and working areas, staff rest facilities, and ward managers’ offices, with 12 staff touchdown spaces per ward.”
Alongside its ward, the second floor has an ADL suite comprising a bedroom, bathroom, and kitchen — where patients can practice activities they might do at home. I asked Maggie Stoppard about the key clinical priorities for the two new wards. She explained: “The plans were already signed off when I arrived at the Trust, but the team had done an amazing job — particularly in that therapists and nurses can all now work together on one floor, whereas at the RSH, the gym was a five-minute walk away. We can hold more therapy sessions, and with the more spacious layout, can do walking practice along the wider corridors. Alongside the enhanced gym, the ADL suite enables us to gauge patients’ progress toward regaining their mobility before they leave us.
“The ADL unit is used in a variety of ways,” she added. “The kitchen, for instance, is used several times a day by patients going and practising making a cup of tea, or cooking a hot meal. In the large first-floor gym area we can treat several patients simultaneously, and help develop strength and mobility, while the ADL bedroom enables us to test movements people would need to make every day, such as safely getting in and out of bed. There is a standard bath lower than you’d find in a hospital, selected deliberately so we can ascertain whether they can get in and out of such a bed safely on leaving the ward. Due to the ADL suite’s design, we can also turn it into an independent living flat, where someone could stay for 24 hours, and we can then can gauge whether the patient is actually fit to do so. We can also accommodate a patient’s relative overnight. It offers us so many options.”
Comparable facilities nationally?
I wondered how many comparable rehabilitation facilities there were nationally. Maggie Stoppard said: “The nursing and rehabilitation principles here, and the ADL suite concept, are certainly not new — but most rehabilitation units aren’t purpose-built like this one, What’s so exciting here is that we’ve been able to take what we know works best in rehabilitation, and collaborate with the design team to get something purpose built — an opportunity you get very infrequently. Equally, the way the teams have collaborated, and the involvement of the clinical team at every step, are things I’ve never seen to the same degree.”
The new West Wing connects to the existing community hospital at ground floor level via a link corridor, with the floor’s design consistent throughout to create a harmonious flow. Mark Maffey said: “Where once stood the Tannersbrook Ward, we now have the new West Wing, adjacent to Snowdon, another rehabilitation ward.”
He admitted that this proximity had caused some concern: “We were asked how we would demolish the interconnected Tannersbrook Ward, and replace it with a three-storey extension just six feet from a neuro rehabilitation ward without any associated disruption. We knew the building work would impact principally the Snowdon Ward, the Vocational Rehabilitation Service, and the Catering building, and any other service that required a delivery. It was key to minimise disruption to critical services. Vital to this was the close relationship between Chris James (Capital Projects and Operational Maintenance) and I, since the work to deliver the new building, and then connect it up to the existing one, was inextricably linked. That we have completed such a fantastic facility is a product of partnering with an excellent contractor with a positive approach. Brymor has a proven track record of live hospital work. From the outset, its team acknowledged that given that their task was to build a three-storey concrete frame within six feet of a live ward, it could only happen successfully with the correct, and a highly considerate, construction strategy.”
Mark Maffey added: “We managed the construction programme via weekly meetings with the contractor and the affected users — our technical stakeholders, and the clinical teams. In these non-contractual meetings we talked through the work that Brymor planned to do the following week, any impact on live services, and any input required from the hospital’s site teams. One thing nobody really sees is all the work that Chris and his Operational Estates team do to support capital projects when ‘in flight’. The West Wing is a large extension to the Western Community Hospital, and there comes a point when you must cut over the live services to feed the new building. Chris was responsible for maintaining the M&E services throughout the entire estate, keeping our resident patients safe, while ensuring the that new building received its vital infrastructure in line with the project’s tight programme. His careful choreography, fully in tune with the MEP sub-contractors, delivered this perfectly.”
“For example,” Maggie Stoppard said, “we switched water off, and Snowdon lost hot and cold water at one point, but it was planned, Chris managed the process, and deployed temporary sinks, with minimal impact. We were really concerned about the ongoing construction — especially given that patients on Snowdon have had brain injuries, and are sensitive to noise. However, we only stopped work once due to noise for 30 minutes in 100 weeks on site.”
Connecting the M&E services
I asked Chris James about connecting all the M&E. He said: “We had to divert all the existing services to connect to the new West Wing, and facilitate the demolition of the existing Tannersbrook Wing, through which the main arteries ran. We worked to a careful roadmap to keep services ‘live’ while we diverted all the heating, domestic hot and cold water services, and internal and external drainage. We also diverted local heating and cooling, and air-conditioning systems, and re-located a live hub room. One major challenge was the electrics, because the team had to very substantially adapt the site infrastructure.
“The site was historically fed from a low voltage supply, but as part of the scheme we strove to look to the future. Bear in mind that this was a 1980s-designed hospital, a little unloved in terms of its lifecycle, so the new wing would stress much of the infrastructure. In fact, it wouldn’t have supported the new-build, so we created a masterplan, which identified the site as ripe for development. Consequently, we had to bring the HV electricity network onto site, working with SSEN (Scottish and Southern Electricity Networks) to divert it. The site has moved from an LV-powered system to an HV-powered one.”
Mark Maffey explained that the Trust’s combined Estates team of Capital Projects and Operational Maintenance planned and managed the electrical reconfiguration ‘in house’, using 17 separate work packages. He explained: “While the main contractor managed a number of its domestic sub-contractors, we brought it all together. Brymor dug a 200-metre trench through the live site, into which SSEN laid its 10,000 volt cables. The project was responsible for laying the base for the ring main unit to a stringent specification, before SSEN landed its RMU.”
Not a straightforward step
Chris James added: “We also installed a new HV transformer in a new GRP enclosure. So, we dropped 10,000 volts of HV supply into the transformer, but that had to be timed with switching off the low voltage supply, because SSEN couldn’t allow us to have two supplies live simultaneously. It sounds simple just to turn one supply off, and the other on, but it’s certainly not. With meticulous planning and commissioning, the switching on of services to the new West Wing went seamlessly.” The Estates team’s contingency planning included bringing in a standby generator, with a second as back-up.
The new rehabilitation building is strikingly modern-looking, with extensive glazing, and is clad externally with Kingspan QuadCore Karrier metal ‘sandwich’ panels. The roofing combines Kemplas insulation with a Kemper roof covering. Mark Maffey explained that the building has achieved a BREEAM ‘Excellent’— thanks to features including a high level of insulation and airtightness, extensive access to daylight, and metered use of water and other utilities.
He said: “Interestingly, such have been the advances in ever-higher-performing materials that the glazing performs as well as the walls in the old building. Much of the super-neutral glass is triple-glazed, and argon filled, with a highly specialised reflective coating. Chris and I had used this system previously, and were genuinely surprised at its performance, including its excellent temperature stabilisation and low solar gain.”
The new West Wing is a fully ventilated building, with heat recovery, supplemented by radiant panels on both floors. The team extensively debated potential H&V solutions, but was keen to utilise technology that would not impede future re-planning of the floorplate. Mark Maffey elaborated: “We wanted to construct a building that would stand for 50 years, but to minimise challenge to any modification for future requirements. This drove us away from an underfloor heating system — thus allowing the floor plate (with its non-load-bearing walls) to be re-designed and replanned as many times as required in future years — towards ceiling-mounted radiant panels, currently fed from the gas-fired boilers within the campus’s existing energy centre, but sized to be able to run at low temperature. The combination of this and the new building’s airtightness and high insulation values means it is ripe for a switch to air source heat pumps when the time arises.”
Chris James and his team are looking at further decarbonisation measures, having submitted a number of bids for PSDS funding, principally to enhance heating. The new West Wing incorporates roof-mounted solar PV panels, and, as part of the ‘consequential improvements’ required on submitting a Building Regulations application for such an extension, the Trust also installed PV panels worth around £500,000 on the existing hospital’s western side, and replaced windows.
I asked Maggie Stoppard about some of the new building’s most notable features from a nursing standpoint. She said: “One is our new Ascom nurse call system — selected because it offered us a different nurse call intelligence. It offers regular nurse call features — such as ‘push the buzzer’, and crash call, as well as Mobility, which — once we have configured a new server — will allow my team to each carry a mobile device which will ring and vibrate when a patient makes a nurse call or a crash call sounds. That will bring many efficiencies, including the ability to harvest data — for example on how long nurses are taking to answer their buzzers.”
Currently, there are two Ascom display panels per touchdown base. Maggie Stoppard said: “Once you switch to Mobility, there’s the option to run the ward silently for patient call, with the lights still illuminating, but without the constant ‘beeping’, since the nurses’ call devices would instead vibrate in their pocket. I think it would be good, especially at night, to be able to just walk round with the vibrating devices, creating a considerably quieter ward.” The new wards also have Guldmann ceiling track hoists in every bedroom and bay.
Impressions of the new environment
Maggie Stoppard added: “We’re all very excited. It’s an amazing facility. We have 160 staff for our inpatient wards, and lost none as a result of the move. The new building is so much more spacious, providing considerably more flexibility in how we undertake our rehabilitation. Having the therapy teams on the ward means we get more scheduled Occupational Therapy and Physiotherapy sessions daily, and provides more opportunity for group therapy.”
She added: “I’m a great advocate of rehabilitation being a 24-hour process; it’s not just your morning physio session. Every time a nurse walks the patient to the toilet, that’s more physio — and they use exactly the same techniques the therapists do. This is what sets us apart from the acute wards. There’s plenty of light and space in what is a beautiful building, and in the four-bed wards we’ve included a table and chairs to allow patients to share their meals together and promote social interaction.
“Most of our patients come from an acute admission,” she added. “We have an in-reach coordinator at Southampton General Hospital. Patients get referred to him; he does an initial assessment, and they then go on a list. Average referral to admission time is about 2-3 days, and average stay length around 28 days. Traditionally, Level 3 rehabilitation inpatients have often been elderly patients who have had a fall, broken a hip, and come in for some rehabilitation because they’re not quite ready to go home. This still applies, but we’ve done considerable work recently on different pathways and admission routes. Currently, for example, we have a 20-year-old lady with us who damaged her spine in a trampoline accident. She’ll go to a spinal unit for her outpatient activity, but the wait is long — so we’re doing some excellent work with her here. Yesterday I watched her walk down the corridor, and she’s improving every day. It’s why I do the job.”
Maggie Stoppard said another popular feature was the outside space. She said: “We didn’t have any courtyard or terrace at the Royal South Hants. Knowing they can get outside really encourages patients to regain their mobility.”
Mark Maffey said access to external views — for example of trees and nature, was a key design component, with every bedroom having an external view. He said: “Details such as low sill heights are key. In the single rooms, the beds are positioned with the bedhead abutting the wall incorporating the inboard en suite bathroom, and opposite the feature window. This gives the inpatient a direct view of the outside world, but also, with the bed very close to the bathroom, reduces fall risk.”
Maggie Stoppard is particularly pleased with the incorporation of variety of spaces that patients can use when they want a break from their bed — whether the terrace, the day room, the gym, or the outside courtyard. The architects calculated the angle of the sun at different times of day to ensure that courtyard space is sun-filled whenever possible. Maggie Stoppard said: “The range of spaces is what really sets the new building apart from the service’s former location. As a patient at Lower Brambles, you’d get out of your bed and just sit in a chair. There was a corridor to walk up and down, but it still felt very much like a working hospital corridor.”
On-ward catering
The new Keats and Conan Doyle wards are served via a cook / chill catering service. Mark Maffey explained: “Our catering team moves the refrigerated or frozen food to one of the regen kitchens on both wards, and the food is then prepared on the ward. The ‘time of flight’ for it being delivered to the patient is thus reduced. This is key — as we know that vitamins in food degrade the longer it stays on the plate.”
Moving to another of the new building’s key features, the Project manager emphasised the impact of its extensive artwork. He said: “We developed a specific concept for this — around photographs of Southampton and the surrounding areas. We have generated a ‘picture postcard concept’, with over 200 images per floor — the aim being that people go and look at the pictures and recognise things from their own world. Once you start looking, you want to keep moving and see more.”
To ‘curate’ the images, the Trust’s Artwork co-ordinator, Abi Dowell, worked closely with architectural photographer, Joe Low, who was specially commissioned to take a large number of photographs of landmark features, recognisable buildings, and natural scenes from Southampton and the surrounding region.
Individual bedrooms incorporate their own large-scale photographs of nature — such as detailed close-ups of flowers or trees — to add some interest, and lift the spirit. Colour has been carefully considered throughout the wards to aid patients’ movement around the space, with the architrave and doors to each patient room selected for easy identification, and high contrast with the surrounding area. To counterbalance this, rooms for staff use, such as toilets and storage rooms, are coloured the same across the wall, door, and architrave, so they don’t draw the eye. This is particularly relevant for patients with conditions such as dementia.
Maggie Stoppard added: “It’s the much-improved environment here that is enabling us to deliver better rehabilitation. Nationally, the past 5-6 years have seen a big push for improvements in rehabilitation care, and we definitely see ourselves at the forefront of this. Equally, our development of additional admission pathways — linking with specialist services like those for spinal patients — opens up more opportunities for patients to come in that weren’t necessarily here five years ago.”
An ‘exemplary brief’
Mark Maffey said a major contributor to the project’s success had been ‘the exemplary briefing’ from the clinical team. Chris James explained: “One of the things in terms of the briefing and the design thinking — going back to COVID — was that ‘Yes, it’s a rehabilitation facility’, but once you get immersed in the pandemic crisis, you face having to stand up surge wards and vaccination clinics. We thus did some lateral thinking on the project so that if another pandemic occurs, and we need to repurpose, we can.” He elaborated: “As much as it’s two wards, it can transform to four. We have also invested in piped medical gases, with piped oxygen to every bedhead, deploying the learning from COVID, and sizing the system accordingly. Although not required in a Level 3 rehabilitation unit, we felt it a sensible move. We’ve built in some flexibility to cater for what the future might bring.”
Maggie Stoppard said: “People coming here have seen and recognised what sets us apart. For instance, a GP currently on rotation remarked that while there is always a process of user engagement and testing on healthcare construction projects, he had never before seen a facility that took the clinical needs on board so fully, right through to completion. He felt the new building had indeed been ‘properly clinically designed’. It wasn’t ‘just a hospital building’.
“While we’ve worked a lot with the clinical teams,” Maggie Stoppard added, “we’ve also involved service-users. The people who will be using our building have been involved with the artwork, and indeed with naming the wards. Great collaboration and team-working has characterised the process to get this fantastic facility built. Whatever complexity, background, or need, someone has when they come in for rehabilitation, we can now deliver it here — in a really high-quality, 21st century setting.”