Hospitals have always been the flagships of healthcare, their design capturing the ethos of the care model of their time. From Victorian statements of patronage, where the public were the lucky recipients of care; through 20th century municipal machines for healing, where the public were the objects of care, these older hospitals are now ageing and becoming less easy to operate,and the services provided in them and standards they must comply with are also changing.
In some instances new hospitals will be needed; however, do we always need to build anew? Communities and transport networks have grown up around our hospitals and these connections cannot be readily rebuilt. Therefore, this study tests the premise that the current healthcare and physical challenges facing Scottish healthcare facilities may, with a bit of skill and care, be tackled together through adaptation and renewal to provide an economic and sustainable way of developing hospitals now and in the medium term.
A new facility needs to support the changing model of care by reducing inappropriate admissions, treating emergency and elective cases differently, and facilitating earlier discharge from acute care back to community care. It also needs to improve the performance of the physical estate through the creation of better quality environments for both patients and staff through factors, improved wayfinding and enhanced energy performance. If this can be achieved through the adaptation of an existing facility, then there may be a valid case for adapting rather than disposing of existing hospitals when they no longer meet the current requirements of the service.
The study looks at the topic of regenerating existing hospitals and was tackled through research into the current and predictable future conditions and needs of NHS Scotland, and the development of a hypothesis on how to tackle these needs through adaptation. This is then tested through a live case study, the Raigmore hospital in Inverness.