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A focus on design has improved the quality of our healthcare

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Beatrice Fraenkel explains how putting building users at the heart of the design process has improved patient recovery at Mersey Care NHS Foundation Trust’s mental health facilities

Beatrice fraenkel bw

Since 2008, I have been chair of Mersey Care NHS Foundation Trust, which provides specialist mental health services in north-west England. I have a background in design and architecture (until last August I was chair of ARB) and was previously design champion for the city of Liverpool, so on joining Mersey Care I was keen to improve our approach to design.

We were about to commission the first of three new hospitals, Clock View in Liverpool, and wanted a new inclusive design approach that put building-users firmly at its heart. The resulting process meant that everyone involved in the project understood more about the way design affects behaviour; more about the importance of smells, sounds and touch in recovery and in reducing stress. In particular, Chris Shaw from Medical Architecture, our newly appointed architect, was a great support in working with me and the team.

Clock View opened in March 2015, demonstrating all the openness, transparency, and access to light, outside spaces, and nature asked for by our service users. Since opening, it has won a series of regional and national awards, and we are delighted that its design quality has had an impact on patient recovery.

We know from experience how design quality reduces anxiety and aggressive behaviour

Following the experience of working with service-users and staff and the excellent results evidenced, I suggested setting up a formal design advisory board for Mersey Care. This would take a whole-trust design approach to our estates strategy and the commissioning of the next two hospitals. The board, which I chair, was set up in 2014 and has responsibility to set and agree our design briefs, test and check design quality and appropriateness, and ensure learning and evaluation are carried out.

The design board membership includes estates, facilities management, finance, nursing and medical staff, medical consultants, and most importantly service users and carers as well as experts with experience in dementia. It also invites external participants, including members of the local community and architectural students. The Design Council has provided a number of excellent training days to create a shared understanding on how to approach a design brief and how to build design quality and evaluation into the process. The design board acts as a client for the Mersey Care, appointing architects and then working with them right from the start in formulating and testing the brief and design.

Clockview 070

Clockview 070

Clock View, Walton, Liverpool, by Medical Architecture Photo: Jennie Webb


The four key questions our design board members now ask of each other are how do you want to feel when you: see our building? approach our building? enter our building? and receive care within our building? Working through these questions has altered the trust’s whole understanding of what matters most to the users. We know from experience and evaluation how design quality reduces anxiety and stress as well as aggressive behaviour and violence, so we have recently decided to move our estate responsibility from our director of finance to director of operational (clinical) delivery, regarding our estate as part of delivering our model of care.

One of the most important design decisions we have made is that all reception areas across our 39 sites must be without barriers and must be friendly, homely and welcoming. We know that involving staff and service-users in designing spaces means this happens. Many people live in poor homes and poor environments so if we can create a place of beauty, this has a huge impact in itself. It makes someone feel cared for and valued, which is a huge step in recovery.

I know that any NHS Trust can take this kind of approach by following the basic rule of understanding the way to identify the users’ requirements is followed and demonstrating this in the brief. And it’s really cost effective.

Beatrice Fraenkel and Christopher Shaw participated in the AJ Twitter debate on #buildingsthatcare – click here to see the top tweets 

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