01.06.12
A modern hospital for mental health
Source: National Health Executive May/June 2012
West London Mental Health NHS Trust has been planning to redevelop Broadmoor Hospital for a number of years. With the project currently at a key stage, Redevelopment Programme Manager Vivienne Mowatt and Consultant Forensic Psychiatrist Dr Amlan Basu update NHE on the plans.
Constructed in 1863, the buildings that comprise one of only three high-security hospitals in England are now very out dated. A modernisation programme for the facility is now underway, aimed at improving patient care, increasing maintenance efficiency and consolidating safety for patients and staff.
Vivienne Mowatt, Redevelopment Programme Manager, and Consultant Forensic Psychiatrist Dr Amlan Basu discussed the need for new accommodation and the benefits this will bring.
Victorian era
Mowatt said: “This is an important project. We’ve been trying to upgrade the hospital for some time. Recent government reports have clearly outlined the difficulties the Trust faces in providing modern mental health care in Victorian buildings, further highlighting the need for redevelopment.
“The old, Victorian, listed buildings are just no longer appropriate as the hospital does not include necessary facilities, such as individual shower rooms, which are standard and an NHS requirement for high secure hospitals. It also has very small rooms for the patients – you can literally put your hands out side to side and touch both walls they’re that small.”
The age of the buildings also makes them difficult and expensive to maintain. “As well as changes to the physical layout, the hospital’s internal processes will also undergo modernisation,” Basu said.
This could include moving away from paperbased systems and making more use of IT, such as introducing electronic meal ordering. This will not only improve efficiency, but also help equip patients with some of the necessary life skills they’ll need in the outside world.
Maintenance costs involved in chaperoning or escorting patients from one area to another will be minimised and there will be more flexibility in where patients can move around the site.
Minimising risk
Basu added: “One of the aims of the redevelopment is to make the care pathway for patients better. We have to ensure that we minimise any risk patients pose to themselves or the community as they move on into medium secure settings. We also have to keep them safe during their inpatient stay and ensure the safety of our staff at all times. Both of those things are going to be improved by the redevelopment.”
He labelled the Victorian buildings “increasingly unconducive” to treatment, with closed sightlines limiting observation of the ward and long, winding corridors.
“The new hospital will have much larger, more open communal living areas, more natural light, better sightlines and new therapy areas. These elements will work together to increase patient and staff safety and improve the patient experience,” Basu continued.
Treating patients through therapy and medication forms a major part of minimising risk. Basu said: “For the vast majority of our patients, their mental disorder is linked to their risk, by treating one, we also treat the other.
“We do specifically concentrate on risk issues, so we’ll offer psychological interventions which encourage patients to think about what heightens or lessens their risk. This gives them a better understanding of what keeps them and the community safe.”
The old building also presents risks which will be minimised or eradicated in newer accommodation.
Mowatt explained: “It creates difficulty for us in creating ligature-free settings. The internal design of the buildings makes it very difficult. That’s a major problem for us.”
The redevelopment will increase the size of the bedrooms, built to NHS standards, in a more compact layout. The design includes a central community area, which will house vocational workshops, patient shops and visiting suites. Having these facilities centrally located will increase patient flexibility and allow them to move around the site unescorted.
Ten new wards will go along six existing wards which will be retained. WLMHT will provide a total of 234 bedrooms, 210 for patients, with space for 24 flexible beds.
In terms of technology, the Trust will be developing a technology brief, investigating how existing equipment can be maximised to make the organisation more efficient and improve the delivery of care. This could perhaps include more opportunities for patients to engage in educational activities, Mowatt suggested.
She said: “We won’t be using technology for the sake of it.”
Complex construction
The construction process is “quite complex”, Mowatt said, as the new development will be built adjacent to the current site. A temporary secure perimeter will be developed to enable the demolition of one building and the new build to take place. Finally the whole secure perimeter will be recreated and separated from the old part of the hospital.
Since the redevelopment is taking place on the same site as the existing hospital, the transfer of patients will not involve significant geographical movement. The plan is to move patients in stages, and the teams that currently work with patients will be kept the same, to ensure the transfer is managed as carefully as possible, with minimal disruption.
Mowatt added: “It will have its challenges, but actually we’ve got very experienced redevelopment and security teams, many of whom have worked at Broadmoor Hospital for much of the design and planning stages.
“We’re well prepared and the programme is on schedule.”
Up to date
Basu considered the practicalities of the move to be the most difficult part of the project, but cited good communication on the development as the best way to manage a successful move.
He said: “I think logistically it is going to be challenging. Whenever you’re faced with a new build you expect these kinds of challenges. There’s an enormously efficient redevelopment team working on those areas so we’re hoping it will cause minimal disruption for our patients. Everyone working within the hospital is very aware of the types of issues that can arise with the redevelopment and we are all on board with the plan and being updated regularly.”
He outlined frequent patient forum meetings which give patients the opportunity to raise any questions about the redevelopment with senior management.
“We think it’s important to keep patients upto- date with the recent developments because otherwise not knowing causes anxiety.”
In March, the new facility received planning permission from Bracknell Forest Council, and the Trust is awaiting final approval from the Department for Health on its Outline Business Case.
“We know it’s with ministers, literally as we speak,” Mowatt said. “We aren’t sure exactly when we’re going to receive a response, but the signs are that they’re certainly considering it.”
If approval is granted, construction would begin next spring, with the first patients ready to move in at the end of 2016.
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