Primary healthcare is healthcare received in the community, and for most people it is the first point of healthcare. Primary healthcare services include: GP surgeries, pharmacies, community nurses and local clinics, but to name a few. One of the principles of primary healthcare is that it should be universally accessible to all.
In the UK, we are fortunate to have a wide variety of primary healthcare services which are universally accessible. However one of the challenges of providing universally accessible primary healthcare is making sure that the buildings in which these services are provided are also universally accessible; this includes for people with dementia and their care companions.
As dementia progresses the individuals care needs will increase which will in turn result in an increase in their need to access primary health care services. There is also an increasing will for people with dementia to remain at home within the community. Therefore proximity of primary health care facilities to the home is important, as is transport infrastructure and of course the design of the primary health care facility itself.
At a time where budgets are contracting, will primary healthcare facilities continue to be dedicated buildings to go to for receiving care or can these services and dedicated facilities be integrated into a wider programme of community health and wellbeing?
Let’s consider this against a backdrop of a general increase in the use of primary health care facilities, at a time where there is an increase in our ageing population and also an increase in the prevalence of dementia. Our primary healthcare facilities are under pressure to respond to the changing needs of the community.
One community who have embraced this challenge is the Great Sankey Integrated Neighbourhood Hub in West Warrington. In February this year the doors were opened to phase one of a two staged redevelopment and extension to the 1970s Great Sankey Leisure Centre. This new Integrated Neighbourhood Hub brings together a broad range of health, care and wellbeing services under one roof.
Livewire Warrington (a community interest company and provider of leisure facilities within the area) with their architects Walker Simpson Architects, Contractors BAM and the wider design team, have created a centre that is inclusive for all; one which combines a pharmacy, leisure centre, community hub and library facilities. The project integrates sport with health and wellbeing facilities alongside cultural experiences linked to library, arts and museum interests.
In addition to this complex programme of facilities the building has also been designed to be dementia-inclusive. The community hub is the first public building seeking the DSDC Gold Award for its dementia-friendly architecture and design. It is also one of the first integrated hub to support wellbeing and primary care prevention and public health programmes.
At a pre-audit visit I had the great pleasure of visiting the hub and witnessing first hand a truly intergenerational integrated community centre. Walker Simpson’s designs have created a civic building which captures all of the pleasures of a public building; a distinctive entrance with double height volume and extensive glazed elevations but which intelligently responds to the dementia design brief by orientating spaces to avoid shadows. Soft furnishings, acoustic ceilings and floating concrete floor slabs reduce noise transfer within and between spaces. Signage is clear, well designed and accessible; colours and pictograms aid orientation and match the interior colour schemes. Overall the design is calming yet visually vibrant, civic yet intimate, and dementia-inclusive. This community hub has responded in an innovative way to the challenges of providing primary healthcare in an ageing community.
Research shows that architecture and design can impact on people’s ability to stay more mobile, independent and at home for longer. Ensuring the primary healthcare facilities are designed to be enabling is vitally important to encourage people with dementia and their care companions to access these services, without anxiety, additional stress and for the benefit of both of their wellbeing.
Some key considerations for primary healthcare buildings, which are generally public buildings, is reducing the anxiety for the person with dementia and their care companion. To do so the building should be recognisable and easy to identify within an urban context. This may mean good external signage, investment in distinctive street art such as sculpture at the entrance or a distinctive building features. Once inside, the building should be easy to navigate (this requires a legible building layout and signage). A reception desk or information point with identifiable individuals available to assist will reduce the stress of arriving, orientate and finding your destination. Use of prompts or visual cues to remind the person with dementia of the function of the room or to where important facilities are such as the toilet or information desk. Clinician’s rooms should be relaxing. Medical equipment screened or concealed when not in use and simple steps such as providing artwork can reduce anxiety and provide a conversational point during the appointment.
In larger multi-purpose buildings which have complex plan layouts, with higher occupancy capacity this can be more challenging. The acoustics in waiting areas or circulation areas should reduce reverberation times (the echo) and noise sources should be easily identified. There should be a variety of places to wait, some quiet rooms, some with a social function such as having tea. Ideally there should be direct access to a secure outside space such as a small courtyard and visibility / sight lines between the outside space and any reception, appointment display screen should be achieved to enable the person to be outside without fear of missing their appointment.
In all buildings, irrespective of size light levels need to be bright, with consistent horizontal illumination within and between adjoining rooms thus avoiding sharp changes in light which can be difficult for the ageing eye to adjust to and which can cause the person to freeze or become unstable on their feet. Use of contrast between walls and floors can aid the legibility of the space and increase confidence in movement. Conversely no or low contrast between floor surfaces can reduce the likelihood of trips and falls.
Photo from Livewire Warrington Great Sankey Project.