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Planning for future sustainable healthcare

Planning for future sustainable healthcare

Jonathan Standen 10 Aug 2022
Initially funded by charitable giving and local fundraising, there has been a hospital in Leeds since 1767. So, for around 250 years, hospitals in Leeds have led the way in offering patients of the city and surrounding Yorkshire area the very best treatment and care. Since 1862 when the initial commitments were put in place by the Infirmary Board to build a new hospital in Leeds to meet the needs of a fast expanding industrial city, there have been far reaching changes to the level of understanding and knowledge of medical practice. Hand in hand with this change, we have seen the rapid evolution of hospital design and practice to reflect not only the needs of medical science, but also the wider health and wellbeing of the patients who use hospital services. The Leeds General Infirmary as we know it today is made up of a medley of interlinked premises from the iconic Sir George Gilbert Scott designed buildings, commissioned in 1868, with notable additions including the modern Martin and Jubilee wing buildings, the latter accommodating a helipad used by the Yorkshire Air Ambulance. The condition and inflexibility of the healthcare estate (including also the St. James Hospital site located across the city, parts of which dates back to 1846) presents significant challenges in meeting 21st century healthcare needs. The Leeds Teaching Hospital NHS Trust’s Hospitals for the Future Project is delivering two new hospitals in one building at the Leeds General Infirmary – one for adults and a new home for Leeds Children’s Hospital and the UK’s largest single-site maternity centre. the scheme is part of the Government’s commitment to build 40 new hospitals by 2030.   Early design of the new Leeds adults and children hospital building Credit: Perkins & Will/ Penoyre Prasad and Schmidt Hammer Lassen. Leeds Teaching Hospitals NHS Trust The Trust employs 20,000 staff and each year and within the city provides care for more than 130,000 inpatients across 2,000 beds and coupled with this sees more than 100,000-day case patients each year and annually delivers over 1.15m outpatient appointments. Across two A&E Departments, the Trust’s sees over 200,000 ambulance attendances and over 200 air ambulance visits in addition to those who self-present at A&E. With a clear clinical strategy, a process of reconfiguring the estate has now begun. Lichfields obtained outline planning permission in 2020 for the Gilling Dodd designed new Leeds hospital development, and as part of a wider architectural and technical team led by Perkins & Will, Penoyre Prasad and Smidt Hammer Lassen architects, is now working towards the submission and approval of detailed proposals which will see the delivery of a leading, internationally renowned state of the art facility to deliver clinical needs and research throughout the 21st Century. The development will bring together specialist paediatric and maternity services, which are currently spilt across the city. Centralising the services under one roof for the first time will keep families together and enable the Trust to provide integrated family care. Patient care and wellbeing is at the centre of the design with all wards orientating toward the outdoors, maximizing exposure to daylight and good views. Green spaces are an important part of the design, including a new public plaza outside the hospital and garden terraces throughout, with planting inspired by the regional environment. The new hospitals development will also seek to improve access for patients, staff and visitors as well as supporting the redevelopment of a large city centre site that will open up local communities that are currently separated by the impermeability of the hospital buildings, consolidating also parking through the creation of a new multi storey car park which will provide for an increase in the number of car parking spaces available for patients. Cutting-edge twin technology will be used to track the building’s energy performance and other technology will reduce administrational processes helping to increase the amount of time medical and care staff can spend with patients. With embedded systems and controls the new hospitals will be SMART buildings. Sustainability sits at the heart of the new hospitals’ design, aiming for net zero operational carbon and minimising embedded carbon, conservation of resource and the use of nature-based design solutions, the new hospitals will adopt an approach which could never have been contemplated even in more recent times, certainly not in the earlier days of medical care in the city. The new hospitals development proposals are part of a much larger redevelopment and economic regeneration opportunity for Leeds. The new hospitals and existing infirmary is located within the city centre in the heart of the Leeds Innovation Arc, which is a strategic intent of the Leeds Teaching Trust, the University of Leeds, Leeds Beckett University and Leeds City Council to use their knowledge, assets and partnerships as a catalyst to accelerate innovation and economic growth throughout the city. Those parts of the existing hospital estate at the infirmary now outdated and which will become vacated will create a unique regeneration opportunity. The additional benefit of safeguarding those buildings of conservation importance for future uses including the Sir George Gilbert Scott listed buildings. The ambition is to create a new world-class hub for health research and life sciences, but there is the potential for business, residential and hotel accommodation, resulting in economic regeneration and employment benefits. Leeds General Infirmary, Gilbert Scott Building Credit: Lichfields The Leeds city region has much to look forwards to, with an exemplar standard of hospital design and medical provision to the latest technological standards. The development will also act as a catalyst for regeneration, attracting new med tech and related research to the Leeds Innovation Arc, with the added benefit of safeguarding repurposed buildings of conservation and heritage importance. Lichfields has built an enviable track record assisting in the delivery of significant healthcare projects all around the UK and is proud to be helping deliver the Leeds General Infirmary enhancements and those at St James’ Hospital. Some 100 years after the concept for the Leeds General Infirmary, Lichfields was itself established and now 60 years later, we work on the most prestigious proposals providing local knowledge and innovation in delivery of schemes across the sectors, no more so than within the healthcare sector. After 60 years of success in the planning and development industry, we now look forward to a more sustainable future, as we work towards becoming a net zero carbon business. The pandemic has been a poignant reminder of our wider social responsibilities and our need to support a better and more resourced and modern health service. We look forward to another 60 years of creating high quality environments for future generations!  

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Part 2: Households Renown for being amongst the hottest and driest places on earth, California’s Death Valley is also famous for periodically bursting into life with a “super bloom”. This explosion of golden wildflowers relies on exactly right combination of heavy rains followed by warm temperatures and lighter rain showers. In an area that is as inhospitable as Death Valley, this blend of conditions is not a common occurrence. The super bloom takes place once a decade. Just as it is with the super bloom, household growth in any area depends on the presence of the right combination of factors: in this case relating to demographic, housing and economic considerations. Fortunately, the conditions for household growth do not just occur once a decade although the decennial census does provide an opportunity to review the scale of change that has occurred and inform projections of future trends.This blog – the second in our series on the initial release of 2022 census data – considers the changing household trends in Wales and seeks to understand the implications of this for future housing need.   A greater number of smaller households Between 2011 and 2021, the number of households in Wales grew by 3.4% from 1.3 million to 1.35 million. This shows that actual household growth has slowed substantially from the 7.7% increase experienced between 2001 and 2011. It also equates to approximately half the level of household growth that has been experienced in England since the last census. A comparison with population growth, however, shows that there has been a disproportionately high level of household formation in Wales. This is an important but unsurprising trend which replicates that seen between 2001 and 2011 (albeit at a lower level) and underlines the extent to which new households are forming from within the existing population as well as resulting from population growth. Table 1 Relative population and household change in Wales Source: Lichfields analysis of Census results The implication of the rates of population and household growth is that Wales has seen a 1.9% decline in average household size over the past decade to 2.35 in 2021. This contrasts to the situation in England where average household size increased 0.3% to 2.41 in 2021 (compared with 2.4 in 2011). This decline in household size reflects a continuation of long-term trends in response to a range of social trends. It underlines the continued need for housing to attract and retain working age population but it is important that falling average household size is not conflated with the need for smaller dwellings. The provision of a range of housing types and sizes is essential to tackling the reduction in the number of working age and younger people – a significant challenge in Wales that was discussed in our previous blog post.     Regional Disparity Breaking down household change across local authorities reveals a more nuanced picture. Despite experiencing the highest population growth (accounting for 95% of the total population growth for Wales between 2011 and 2021) and being the only four counties not to suffer a decline in working age populations, Cardiff, Bridgend, Newport, and the Vale of Glamorgan only accounted for 40% of the total household growth in Wales – although three of these authorities (Bridgend, Newport, and the Vale of Glamorgan) were amongst the top five in terms of the level of household growth since the last census (along with Monmouthshire and Merthyr Tydfil). Despite experiencing the second highest population increase in the country (4.7%), the number of households in Cardiff increased by just 3.3%. This shows that despite strong economic prospects in these four authority areas and their attractiveness for younger people, household formation is falling behind and cannot keep up with population growth. Reasons for this include a failure to deliver sufficient new homes, the relative (un)affordability of housing in these areas, and the potential (un)suitability of the housing stock for newly forming households. These issues were particularly pronounced in Cardiff and Newport which were the only local authorities in Wales to experience an increase in average household size since the last census. Figure 1 Household change between 2011 and 2021 by local authority Source: Lichfields analysis of Census results Three counties experienced negative household change: Gwynedd (-2.6%), Ceredigion (-2.1%) and Blaenau Gwent (-0.4%). This reflects the trend of these being the only authority areas to experience population decline since the last census.When looking at the change in household sizes by authority, there are significant differences across the country. As set out above, there were only two local authorities – Cardiff and Newport – which experienced an increase in average household size (both by 1.3%). The previous blog noted that these were the two areas that experienced the biggest rate of population growth. This suggests that existing households have absorbed more of the influx of people, rather than population growth facilitating new household formation. By contrast, all other local authorities experienced a reduction in household sizes. The biggest decrease was in Merthyr Tydfil (6%) where there was a 0% change in population, with significant reductions also in Monmouthshire, Caerphilly, Ceredigion and Pembrokeshire. The population of Monmouthshire and Pembrokeshire increased slightly since the previous census but each of the other areas with the most significant level of decline in their average household size also experienced a loss of population since 2011. All of these authorities experienced a decline in young people and working age population and a significant increase in the number of people over the age of 65. These population trends help to explain the household patterns that have occurred as younger people tend to live in larger households (either in shared homes or families) than those of retirement age who typically live in couples or alone. Figure 2 Household size between 2011 and 2021 by local authority Source: Lichfields analysis of Census results     Implications It is instructive to consider how these trends relate to housing delivery in Wales. When comparing average housing delivery against Local Development Plan requirements, a clear pattern of under-provision emerges. Only one Welsh authority exceeded its housing target and the national average for Wales was less than 50%, as ten local authorities delivered less than half of their identified requirements. These levels of delivery are likely to have had direct implications on the population and household trends that have been seen since 2011. Under-delivery of housing can have consequences in terms of the demographic profile of an area, as well as its social and economic wellbeing.Whilst some may see census results in respect of limited rates of household growth as justification for less housing, the wider social trends and reflection in population demographics discussed in this blog series convey a different story. Boosting population growth and retaining younger age groups through the supply of housing will support a larger workforce and will inevitably offer social and economic benefits to Wales and individual local authorities. To do so there needs to support for a future step-change in housing delivery.  

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