The NHS Long Term Plan recognises the need for the health service to move forward and evolve to ensure it remains fit for purpose in 10 years’ time – and an important part of that plan is the introduction of new integrated care systems (ICSs) to deliver a wide range of services across the NHS, local authority and third sector from shared physical or virtual ‘hubs’.
Stephanie Brada, Strategic Health Planner for Willmott Dixon considers how the latest version of Cura, delivered through Collida’s integrated construction platform, meets the challenges facing the healthcare sector whilst also delivering net zero carbon in operation and 20% lower embodied carbon than industry benchmarks…
“Cura is a pre-designed and sustainable solution that responds to the challenges the healthcare sector faces, providing flexible, best value buildings of varying sizes. The first project delivered using the platform, Chiltern Vale Hub in Dunstable, has just started on site and is due for completion in 2023. I want to explore how the theory behind Cura has worked in practice.
The Chiltern Vale Hub will offer fit-for-purpose space that not only serves the community now, but offers a flexible solution that will also allow for adaptations as needs and requirements change into the future. The hub will serve approximately 50,000 people and will include GP, mental health, NHS community, dental and third sector services, as well as social services teams. This new co-location approach enables coordinated, personalised care to each service user, who, over time, are likely to receive services from many of the onsite providers.
The building itself is based on the standard Cura layout with a central communication core that includes the main entrance, reception, lifts and stairs, with four 200m2 modules of accommodation leading off the core. At an overall size of 6,300m2 it is a large-scale hub, set across four levels; however, the design principles of adaptability, natural light to every room, standard room layouts, direct access to each module from the central core on each level and not having to pass through one department to get to another, have all proved robust at this scale.
Futureproofing community healthcare services is hugely important and the Cura model allows us to do just that. One of the major benefits of the model in the initial design phase is the 200m2 module. Time and again we found that we could fit individual or compatible services into modules so that they enhance close working between related services – 200m2 proved robust whether we were accommodating, for example, children’s physical and mental health services, a drug rehabilitation unit, a GP treatment suite or a multi-user shared clinical suite.
At individual room level, because we could demonstrate that our standard room layouts were based on published data and extensive experience, the 1:50 process required a single meeting per room instead of the usual round of three or more meetings. We were able to accommodate key services that required a ground floor location, such as children’s services, on that level, but also generic spaces, so that any user who needs to be on the ground floor for a particular reason can book an appropriate space. This also means that at weekends and after 8pm there is a wide range of accommodation on this level so that any service can be provided while the rest of the building is closed, thus providing greater security.
The biggest test that Cura has risen to is that of flexibility. As with most NHS buildings, there were service changes during the design process and we have also had to review the design in the light of the pandemic, which brought with it minor changes to the built environment. For example, we needed to increase PPE storage and waste holds, as the use of disposable items increased. We were fortunate that from the start we had planned standardised consulting and treatment accommodation on the ground floor; during a pandemic this can be used to deliver the services that have to be provided in person, with a clear, one direction route for patients in and out of the building.
The other change driven by the pandemic is the long-term reduction in face-to-face consultations across all services, including general practice and mental health, that might have resulted in voids in the building. We found that the modules could be easily adapted to accommodate new services in the spaces that were no longer needed by the original planned services. All of the new services could function in a combination of Cura’s standard room sizes of eight, 12 and 16m2 – for example, we fitted a new dental service into space vacated by community services, with minimal reconfiguration of individual rooms required.
We are encouraged that the Cura template was so amenable to bespoke planning for the Dunstable hub. It has stood up well to the challenges of the pandemic, whether to the need to have safe core accommodation easily accessed on the ground floor, or the challenge of filling spaces that became available as services moved online. The standard room sizes and layouts have proven robust to changing requirements, and have shortened the consultation process. And the 200m2 modules have also proven to be a good size for most clinical functions. All this proves that the Cura layout is flexible and can be adapted now and in the future to meet service model changes.”