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The physical environment for care

 

Key message

All wards must provide a safe, stimulating and enabling environment both indoor and outdoor that respects the privacy and dignity of the individual.

The Commission regularly visits NHS admission and continuing care units for both adults and older people.Our service visit reports consistently highlight concerns about the physical environment in many in-patient units.We often find these environments to be uninspiring and poorly maintained.We noted that many of these poor reports related to services for older people.

Admission to an assessment ward can result in individuals feeling alone among strangers, distressed as they are separated from family and friends and disorientated being away from familiar roles, routines and objects.

The importance of the contribution of the physical and the psychological environment is well documented and in particular the importance of good building design for people with dementia.The Dementia Services Development Centre at the University of Stirling has produced an audit tool 'Design for People with Dementia' and this has now been adopted by the Scottish Government Health Directorate to support improvements in the design of NHS facilities for people with dementia. The emphasis of this audit tool is to promote "enabling design" and the good practice principles apply equally across care groups as a whole regardless of whether an individual has dementia or not. Our visits to older people in mental health admission wards included people who did have dementia and others who did not.

At these visits we carried out audits of the dining areas, living areas and bedroom areas on the wards visited.In addition we looked at the garden areas and considered some general questions about the ward environment. We wanted to see for ourselves as well as gather information and opinions from people on the wards.

We should point out that the buildings that we visited varied from brand new purpose built wards to some hospital wards that had been built in the Victorian era. Even so, we found some older wards where staff had taken time and creatively made the most of the environment, whereas in some new units staff felt inhibited in trying to improve the physical environment. For example they were told they should only use the same signage and decoration as the rest of the general hospital.

We made recommendations for action on thee following enviroments during our visits