1. Action after Andrews Transforming Care & Environments Morriston for the Future

2. Background Majority of Morriston Hospital ambulatory services operating out of pre WWII buildings Location of services spread out across the site, large distances involved and steep sloping site Facilities completely outdated and not fit for purpose Established practice of patients being seen in offices not clinical areas because of space restrictions – safety concerns

3. Morriston Site – Jan 08 Good Quality Clinical accommodation Good Quality Support accommodation Service Hubs Poor Quality accommodation

4. Scope of Services Main Outpatients Children & Young Peoples Outpatients Fracture Clinic X-Ray Pre-assessment clinics Head & Neck services Blood tests South Wales Centre for Cleft Lip & Palate Maxillofacial laboratory Lung Function / Tests Education Centre Endoscopy Renal Dialysis Main Concourse / retail outlets

5. Our Aim – Transforming Care Reorganise Morriston site for best patient experience – Flow – Co-dependencies – Minimal travel Mapped all departments / services Identified characteristics of patients involved Identified critical co-dependencies with other departments / services Worked with patients / carers to understand their “ideal” experience

6. Transforming Care Project Groups established for each key service area in Phase 1B (282 people) Support Services Forum established to ensure views sought and influenced design (70 people) Presentations to key staff groups (869 people) Disability Reference Group established to ensure people with a full range of disabilities influence design (22 organisations) Some service users on Project Groups where appropriate Patient / Carer forum involving third sector groups / patient groups / carer groups (48 people) Ongoing discussions with local interest groups

7. Transforming Environments Disability Reference Group established in 2010 with representation from wide range of disability groups Involved in detailed planning of £60m redevelopment of Morriston Hospital * Agree jointly how best ABMU should address issues to meet all needs Equality Act & BS8300 focus on physical disabilities Aim – if we get design right for people with disabilities, will be more accessible for everyone In hindsight, lack of focus on dementia

8. Way-finding / use of art to help (attractive / too busy) Signage using plain English and pictograms (childish) Colour contrast (bright / too garish) Eye level and high level signage (clear / confusing) One size / approach does definitely NOT fit all (multiple types of seating) There’s always room for improvement Use of electronic options – with support There will be differences in opinion about what’s best Transforming Environments

9. Dementia Trusted to Care (2014) recommendation: The Board should review how well ward accommodation supports care for those with dementia, delirium, cognitive impairment or dying at both hospitals, covering physical design of the clinical spaces and equipment available It is counterproductive to invest in the skills and knowledge of staff if the environment is actively harmful to care. It is suggested this should be externally validated using established international standards leading to a programme of change and development. Audit tools are available and on line guidance Now incorporating the needs of people with dementia & cognitive impairment in planning new facilities

10. Consideration of Dementia Alzheimer’s disease – 55% of cases (gradual deterioration, perceptual problems common) Vascular dementia – 20% in western societies Lewy Body Dementia – 20+% (tremors, unexplained falls, hallucinations) Total population age range% with dementia 60-640.6 65-691.6 70-743.5 75-797.4 80-8415.7 85-8926.2 90-9441.0 95+46.3

11. Impairments of dementia usually include Impaired memory, particularly recent memory Impaired learning Impaired reasoning High levels of stress Perceptual problems for many Difficulty adjusting to the sensory / mobility impairment of normal ageing Reduced ability to cope with noise / lots of people (hospital noise averages 72dB & 60dB at night – 65dB is harmful to health)

12. Design for dementia Room / space adjacencies (particularly toilets) Clear visibility (clear contrast / Visual cues –toilets) Way-finding / navigation (recognisable areas / landmark objects / signage / personalisation) Privacy (offset doors) / sociability Easily accessible outdoor space Use design to help patient flow No inlays in floors Courtyards OK but only if sufficient sun access Views of nature are very therapeutic Homeliness / familiarity for patients is key

13. Noise – a Design Challenge Keep noise sources as far as possible from quiet areas (we have no “ear lids”) Use structural design to reduce noise penetration & transmission Ensure correct internal acoustics of individual rooms (reverberation time) Improve visibility to replace noise Install appropriate assistive technologies “Noise to a person with dementia is like stairs to a wheelchair user” Knudsen & Harris

14. The Importance of Colour Tone (how much light the colour reflects) – measured in LRV – grayscale! Hue (position on the colour wheel) Saturation (depth or vividness of colour) “The main feature of a surface, which appears to be strongly correlated with the ability of blind & partially sighted people to identify differences in colour, is the amount of light the surface reflects, or its light reflectance value (LRV)” – BS8300:2009

15. Tonal Contrast Minimum of 30 LRV to provide acceptable contrast Walls, floors, doors, furniture, sanitaryware to contrast by 30 LRV More critical in small areas Skirtings & architraves – pick out edges, particularly useful in corridors

16. Some Key Issues in Design Good lighting Clear Contrasts Minimise reflection / glare Recognisable approach Logical flows Daylight Access to outside Domestic fittings Acoustics Communal / activity areas Reduce noise levels Minimise clutter Provide quiet areas Mirrors (but coverable) Clear purpose for areas Don’t assume architects / designers understand our patient’s needs Don’t assume we do either!

17. In Conclusion Over 1,300 involved in design & planning the new facilities, but there are still things we would change in hindsight Benefits to large numbers of patients can sometimes be to the detriment to smaller groups with specific needs – mitigation / plans needed Lots of people will have different views about what services / buildings should look like, needs to be clear, continuing focus on needs of patients to ensure these benefits aren’t lost Need to have transparent process for considering / making decisions / feeding back on issues

18. Thankyou for listening Happy to answer any questions