Just three years after it opened, Heatherwood Hospital in Ascot, Berkshire, has been named the best elective care centre in England by patients. In this article, Jo Makosinski speaks to Sean Woodhead, associate architect at BDP, about the approach to the design and its positive impact on all building users

 

Ascot has been home to a hospital at Heatherwood for almost a century, originally serving as a tuberculosis sanitorium for children.

In 2018, with ageing facilities and a growing need for investment, the hospital’s long-term future was in doubt and plans were made for a replacement building.

Designed by multidisciplinary design practice, BDP, and built by Kier Construction, the new £98m Heatherwood Hospital is an elective facility focused on orthopaedic and high-volume, low-acuity procedures, set within picturesque woodland surroundings.

The 11,500sq m hospital opened in 2022 and its forward-thinking approach to the delivery of health services has since been widely recognised, not least with the recent announcement that it has been named the best elective care centre in England by patients as part of the Care Quality Commission’s National NHS Adult Inpatient Survey.

We jumped at the opportunity to be involved as it is not often you get the chance to design a hospital in a location like this

The annual NHS appraisal looked at the experience of 63,573 patients across 131 NHS trusts who stayed at least one night in hospital during November 2023.

And, between January and April 2024, 1,250 patients at each trust were invited to give their views, answering 55 questions about hospital admission and discharge, care and treatment, communication with staff, involvement in decisions, respect and dignity, and the hospital ward and environment.

The average score of Heatherwood patients asked to rate their overall experience was 9.7 out of 10, the best of any individual hospital included in the survey. 

The brief

The 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.

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.

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 the design approach, helping to create a calm and restorative environment that supports wellbeing and recovery.

The simple form of the building and its compact footprint also have important sustainability benefits.

By paying careful attention to design, including access to nature, daylight, and fresh air, and an optimised approach to layout with built-in flexibility, patients have better health outcomes and reduced recovery periods, while the wellbeing of all those using the building is supported, including staff

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, results in a building which is highly energy efficient.

The use of timber cladding and hybrid curtain wall and window systems has also reduced the quantity of embodied carbon.

And 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, while the large biodiverse ‘balancing pond’ has biodiversity benefits on top of wellbeing advantages, with deer using it to cool off in the height of summer.

Operational benefits

Unlike other hospitals with A&E departments, Heatherwood is not affected by the demands of emergency care.

Instead, it can operate six days a week, morning to night, without having to manage emergency patients and clinicians are not taken away from elective work.

In addition to its six ultra-clean theatres, the hospital features a 48-bed inpatient unit and outpatient and diagnostic facilities for orthopaedics, cardiology, radiology, lithotripsy, physiotherapy, and orthodontics.

The hospital was commissioned by Frimley Health NHS Foundation Trust and, since its launch, has reduced waiting times for patients needing knee and hip replacements, with more than 1,000 joint replacements performed in the first 10 months – up 20% on the number of procedures carried out pre-COVID.

The hospital has also successfully reduced the length of time patients stay in hospital, with 40% of patients safely discharged within 24 hours.

Sean Woodhead, architect associate at BDP, said: “When we first bid for the project in 2015 and discovered that the trust was looking at using the existing woodland site with this lovely kitchen garden from the original hospital, we jumped at the opportunity to be involved as it is not often you get the chance to design a hospital in a location like this.”

Patient impact

The design of the hospital and ward environment was one of a number of topics addressed in the National NHS Adult Inpatient Survey and plays a key role in shaping patient experience.

Research (Roger Ulrich) has shown that having a hospital room with a window view of a natural setting has restorative influences, therefore helping to reduce length of stay.

And, at Heatherwood, all rooms have views over woodland, access to terraces, and therefore fresh air.

Inpatient accommodation is located on the top floor of the hospital, in what is referred to as a ‘notional treehouse’, with close views into the tree canopy.

It is our belief that this model should form part of the future of healthcare and bringing together specialist services makes absolute sense, rather than combining lots of different services into one site

Corridors are relatively short and, in many cases, single sided, with additional full-height glazing at the ends, allowing access to views and daylight.

Another key plank of BDP’s design approach was to ensure that the layout and arrangement of the hospital was purposefully compact, minimising travel distances, both internally and externally.

The outpatient department, indeed the whole of the ambulatory entrance floor, operates as a digitally-enabled one-stop shop of clinical services for patients, where they can have a consultation, imaging, and procedure all in one visit, delivering patient-focused care with high levels of efficiency and safety – as well as reducing stress and saving on car journeys.

Meanwhile, another floor is entirely dedicated to surgery, optimising the flow, with expansion space designed in to accommodate two more theatres if needed in the future.

And theatres are paired so staff can easily go from one to the other, resulting in optimum efficiency.

This approach to design has enabled the hospital to introduce innovative ways of working to increase the number of operations it performs, such as trialling orthopaedic ‘super weeks’ where surgeons managed to double the number of weekly joint replacement procedures from 40 to 80.

The day surgery unit itself operates on a ‘medi-room’ model of care and its design and layout is 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 ready for their procedure.

Following the operation, and a short time spent in the first-stage recovery unit, the patient will return to their medi-room for second-stage recovery, before changing and being discharged.

There are a number of benefits to this approach including improved privacy and dignity; larger spaces to make changing easier; and the patient can be accompanied by family members if desired.

Staff were also at the forefront of the design, with staff bases on the inpatient floor naturally lit with access to private terraces, while changing facilities are also provided.

Community values

The optimised approach to building layout has supported the trust’s wider goals regarding the rationalisation of services across all of its sites, by centralising elective services in Ascot and leaving space for enhanced acute and emergency care in other locations.

Woodhead said: “By paying careful attention to design, including access to nature, daylight, and fresh air, and an optimised approach to layout with built-in flexibility, patients have better health outcomes and reduced recovery periods, while the wellbeing of all those using the building is supported, including staff.

“Of course, many hospitals have started as a central hospital and grown organically, but where there is the opportunity to step back and take a strategic and holistic view of the wider healthcare system or an individual trust or facility, then we should embrace it.”

It is hoped the hospital will act as a benchmark for delivering out-of-hospital services in more-therapeutic environments.

Speaking to Healthcare Property, Woodhead said: “It is not often you have the opportunity to work on a site like this and what has been really gratifying is that our aim to create a building that is people focused and destressing has been realised and recognised by patients in the National NHS Adult Inpatient Survey.

“It is our belief that this model should form part of the future of healthcare and bringing together specialist services makes absolute sense, rather than combining lots of different services into one site.

“By keeping clinical pathways separate, you create efficiencies.

“But, while a number of trusts are looking to do a similar kind of thing, these developments tend to be on acute sites. It is rare you get the opportunity to build on a site such as that at Heatherwood.”

Flexibility and adaptability have been incorporated into the design, which could allow the delivery of additional services in future, if required.

“For example, there is an opportunity to repurpose rooms to deliver additional, less-interventional treatments, freeing up time the theatres for more elective surgery”, said Woodhead.