Sean Woodhead, associate architect at global multidisciplinary design practice, BDP, looks at how the design of Heatherwood Hospital in Berkshire – which opened just under two years ago – has helped support positive outcomes at this specialist, planned care facility. He suggests that as a dedicated planned care centre, Heatherwood ‘undoubtedly represents a significant component of future healthcare provision’
It’s now just under two years since Frimley Health NHS Foundation Trust’s new centre of excellence for non-emergency care, Heatherwood Hospital, opened in Ascot. The new hospital has reduced waiting times for patients needing knee and hip replacements, with more than 1000 joint replacements performed in the first 10 months after opening – up 20% on the number of procedures carried out preCOVID. As a specialist planned care facility, Heatherwood has been able to perform surgery six days a week – with four out of its six state-of-the-art theatres dedicated to orthopaedic procedures.
The hospital performed around 1,300 procedures a month in its first year, and successfully reduced the length of time patients stay in hospital, with 40% of patients safely discharged within 24 hours. While historically, patients who underwent knee or hip joint replacement surgery would spend an average of three to four days in hospital to recover, at Heatherwood many patients have been able to go home on the same day as surgery. The average length of stay for hip and knee replacement has now been reduced to just 2.5 days, and waiting times for cataract surgery have been significantly reduced – to 2-4 weeks. This represents some encouraging initial data, and offers a good opportunity to pause and reflect on how the design of the hospital helped support these positive outcomes.
A century of care in Ascot
Ascot has been home to a hospital at Heatherwood for almost a century, and was originally a tuberculosis sanatorium for children. However, with ageing facilities and a growing need for investment, the hospital’s long-term future was in doubt prior to its recent transformation. Designed by BDP and built by Kier Construction, the new £98 m Heatherwood Hospital is an elective facility focused on orthopaedic and high volume, low acuity, procedures, set within beautiful woodland surroundings. In addition to its six ultraclean theatres, it features a 48-bed inpatient unit, plus outpatient and diagnostic facilities for orthopaedics, cardiology, radiology, lithotripsy, physiotherapy, and orthodontics.
Our aim architecturally was to deliver a fantastic experience for both staff and patients, with uplifting public space, and access – both visually and physically – to the surrounding woodland, providing therapeutic and wellbeing benefits for everyone using the building. Research (such as that from Roger Ulrich) has shown that having a hospital room with a window view of a natural setting has restorative influences, thus helping to reduce length of stay. At Heatherwood, all rooms have views over woodland, and access to terraces, and therefore fresh air. Inpatient accommodation is located on the top floor of the hospital, in what we refer to as a notional treehouse, with close views into the tree canopy. Corridors are relatively short, and, in many cases, single-sided, with additional full-height glazing at their ends allowing access to views and daylight. Outside, there is a large biodiverse pond area, with terraced access down to water level on one side, allowing safe interaction with aquatic life, and nearby nature walks.
A central waiting area
The hospital also benefits from a central waiting area for outpatients that is a welllit, double-height space, and patients have access to a café and terrace, strategically located on the corner of the building to provide a woodland backdrop, creating a tranquil environment in which to wait for the next appointment. Staff bases on the inpatient floor are naturally lit, with access to private terraces, while changing facilities are provided. The communal courtyard which links the main hospital with the GP hub and administration building includes semi-mature arboretum trees and sensory planting. Elsewhere, a sheltered roof garden enclosed on all four sides, offers a pleasant and relaxing view from the spaces that overlook it. Biophilic design was absolutely key to our approach when it came to Heatherwood Hospital, helping to create a calm and restorative environment that supports wellbeing and recovery. Hospitals can be stressful and intimidating places; we know that better environments secure better health outcomes.
A ‘purposefully compact’ layout
Another key plank of our approach was to ensure that the layout and arrangement of the hospital was purposefully compact, minimising travel distances, both internally and externally. The Outpatients’ Department, and indeed the whole of the ambulatory entrance floor, operates as a digitally-enabled ‘one-stop shop’ of clinical services for patients, which is to say that the patient can have a consultation, imaging, and procedure, all in one visit, delivering patient-focused care with high levels of efficiency and safety – reducing stress and saving on car journeys. In most traditional hospitals, the patient would have an outpatient appointment, but if an X-ray or imaging were needed, they would need to go to another building or return another day. At Heatherwood, the idea is that patients have a consultation, then return to the central waiting zone, before being called for their diagnostic test or procedure.
Meanwhile, the first floor is entirely dedicated to surgery, optimising the flow, with expansion space designed in to accommodate two more theatres, if needed, meaning that clinical efficiency won’t be compromised. In fact, the Trust is already looking at taking advantage of this opportunity by expanding the unit next year to provide additional capacity. Theatres are paired so that staff can easily go from one to the other, resulting in optimum efficiency. Indeed, the hospital has introduced several innovative ways of working to increase the number of operations it performs, such as trialling orthopaedic ‘super weeks’, during which surgeons managed to double the number of weekly joint replacement procedures from 40 to 80. During the ‘super weeks’, some individual surgeons were able to perform 10 joint replacement procedures a day by working between two theatres, and operating on five patients one after the other in each.
A ‘medi-room’ model of care
The day surgery unit itself operates a ‘medi-room’ model of care, and its design and layout are informed by Post Occupancy Evaluation analysis from the day surgery unit at Frimley Park Hospital. Following consent, the patient is allocated a medi-room for the duration of their stay. From this multi-functional room, they will change, meet with the anaesthetist and surgeon, and wait in a gown for their procedure. Following the operation and a short time spent in the first stage recovery unit, the patient will return to their mediroom for second stage recovery, before changing and being discharged. There are a number of benefits to this approach, including improved dignity, with no shared waiting in gowns; larger space to make changing easier, and the patient can be accompanied if desired; a patient-centred rather than consultant-centred approach, and better efficiency in terms of flow
The centralisation of elective services in Ascot, leaving space for enhanced acute and emergency care in other locations, forms part of the Trust’s wider goals regarding the rationalisation of their services across all its sites. Unlike other hospitals with A&E Departments, Heatherwood is not affected by the demands of emergency care. It can focus six days a week, morning to night, on operating, without having to manage emergency patients coming to this facility, stopping clinicians doing this elective work
Rakesh Kucheira, orthopaedic surgeon, Frimley Health NHS Foundation Trust, said: “We’re working extremely hard to reduce the waiting lists and get patients the right treatment they need at the right time. As a dedicated planned care centre, we don’t have the same constraints as an acute hospital, and can continuously change the way we work to meet our patients’ needs and really push the system. The results have come from great teamwork, with everyone involved in the patient journey working together to improve care for our patients. The feedback we’ve had has been really positive, and by safely discharging patients they get to recover in their own homes with our support, surrounded by their loved ones.”
Discharged the next morning
One patient, Amanda Leader, 62, from Wokingham, had a hip replacement before Christmas, and was discharged the following morning. She said: “I had waited four months after my X-ray for surgery, and the pain in my right hip was particularly bad at night time, so I couldn’t sleep. It’s amazing that I was discharged so quickly. I can go to my daughter’s house to recover, and I get to see my grandchildren at the same time. I also love dancing, and can’t wait to get back to it once I’m properly recovered.”
Steve Long from Lightwater, who was at Heatherwood in March for an endoscopy, said: “I think Heatherwood is a real asset because it doesn’t have an A&E department, so they are able to specialise in different areas. I’m very grateful to be part of this NHS system, which I’ve found amazing. The level of communication – from emailing and texting appointments to the follow-up and phone calls – has been absolutely first class. It’s so good to have this facility local to us; it’s an absolute gem.”
‘Fantastic facilities and staff’
It is heartening to hear this and to look through some of the Google reviews of the hospital online to find that users have referred to ‘fantastic facilities and staff’, and a building that is ‘lovely, bright, and clean’, with comments including: ‘I felt very calm from start to finish’, and ‘I am actually looking forward to my next visit.’ Another patient, Michael Grant, from Frimley, was being discharged following a hip replacement, when he said: ‘It’s been an excellent service for me. I only went to see my GP in January, and here I am all done and ready to go home just six weeks later. I can’t fault the hospital or the lovely staff.
Sue Darch, from Beaconsfield, who was recovering in Heatherwood a week after a total knee replacement, said: ‘I think it is wonderful; it’s extremely clean and modern, and it is lovely to have my own room. The staff and the service are excellent.’
These comments take us back to the crux of our design approach, which was focused on the question: ‘How does a building make you feel?’ The impact of how a building makes you feel should not be underestimated. Simplicity is also key; indeed, simple but beautiful geometry was integral to the architectural aesthetic of the new hospital. The site was designed to be legible – in other words, easy to navigate, with parking outside the front door, and a clear and intuitive journey into and through the hospital. On entry, the reception within double height space is right in front of those arriving, along with the waiting area. We have worked with the levels to reduce the perceived scale of the building at main entrance level, and allow good segregation of flows with distinct front and back doors. The previous hospital had 132 points of access; there are eight in the new one. The entire approach is about taking the stress out of the experience of going to hospital.
The simple form of the building, and its compact footprint, also have important sustainability benefits. This approach generates a good wall to floor ratio which – combined with a highly insulated envelope, limited areas of curtain walling, and the use of LED lighting throughout – result in a building which is highly efficient in terms of energy use. The use of timber cladding and hybrid curtain wall and window systems has also reduced the quantity of embodied carbon. Additional energy savings have been realised via the inclusion of two large air source heat pumps and a large PV array at roof level. Where possible, sedum roofs were included, which help with attenuating storm water run-off, whilst the large biodiverse ‘balancing pond’ of course has biodiversity benefits on top of wellbeing advantages; indeed in the height of summer last year deer were using it as swimming pool to cool off
A model for the future
Is this hospital a model for the future of the NHS? As a dedicated planned care centre, Heatherwood undoubtedly represents a significant component of future healthcare provision. As the periods of winter pressure extend into the spring and beyond, elective care will continue to be squeezed on acute sites, with the associated lengthening of waiting lists. Grouping specialist services in separate locations to mitigate this challenge makes a lot of sense.
Frimley Health NHS Foundation Trust – by enacting a long-term strategic vision, considering care provision across the region and its entire estate, has put itself in the enviable position of being able to make inroads into its elective backlog while freeing up space on its sites in Frimley and Slough for enhanced acute, emergency, and maternity services. At Heatherwood, a review of the local hospital estate identified an area of land, not suitable for residential development, but an ideal location for a healthcare facility imbued with the principles espoused by healthcare design researcher, Roger Ulrich, optimising the restorative benefits and improved outcomes of the woodland context. The existing hospital continued to operate unaffected throughout the construction phase, and was subsequently sold for residential development, partially funding the new hospital
Sean Woodhead
Sean Woodhead is is an associate architect at BDP, a major global, multidisciplinary practice of architects, designers, engineers, and urbanists. He has 20 years’ experience in healthcare design, particularly of large-scale healthcare projects. A client-facing design architect, he has a thorough understanding of the technical aspects of the profession, gained through many years’ experience delivering projects with different construction techniques and procurement routes.
Past projects on which he has worked have included Bristol Royal Infirmary; Heatherwood Hospital; Grange University Hospital, Cwmbran; Royal United Hospital, Bath; Musgrove Park Hospital, Taunton; Cancer Treatment Centre, Hampshire; Morriston Hospital, Swansea; Southmead Hospital, Bristol, and Sunshine Coast University Hospital, Queensland