Design in Public Services

Part of the debate – in the House of Lords at 4:30 pm on 29th January 2003.

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Photo of Lord Chan Lord Chan Crossbench 4:30 pm, 29th January 2003

My Lords, I also congratulate the noble Lord, Lord Freyberg, on securing a debate on a topic that has enormous practical implications for the lives of users and staff of our health services. It was a particular pleasure for me to listen to the maiden speech of the noble Lord, Lord Foster of Thames Bank, and I look forward to hearing more.

I shall use examples from my professional experience to demonstrate the importance of good design for healthcare. One of the essentials for the care of new-born babies—especially those who are ill—is a clean, warm environment with electricity and a constant supply of clean water. The facility should be close to the delivery room with access to mothers. Those two facilities should therefore be on the ground floor of a hospital. But the environment of the delivery room where the baby is born is so different from the unit for the care of newly born babies.

Keeping a new-born baby care unit clean and free of infection requires, among other measures, that all adults entering it—including mothers and staff—wash their hands. Only when their hands are clean should they handle babies. That is difficult to achieve because most people do not wash their hands regularly.

A clean supply of water 24 hours a day, seven days a week, 52 weeks a year is a commodity that we take for granted. Most infections in a new-born care unit are water-borne because the drainage pipes of washbasins trap and breed germs, so they need to be sterilised regularly. Here is an opportunity for better design. Taps with long arms are necessary if we do not want to contaminate our washed hands when turning off the water supply.

Washing our hands with water regularly, before touching any baby in the care unit, will give us sore hands within two days. That is why today we wash our hands thoroughly with water and soap on entering the unit and then use antiseptic lotion to clean our hands before handling every baby thereafter.

Simple things can be difficult to achieve, particularly when a team of healthcare professionals is looking after a sick baby who will have visits from parents. Design and the proper use of facilities is a prerequisite for helping people who need clinical healthcare. The user of the service must be the one whose well-being determines our design of buildings and equipment. Today, we would not approve of any health service facility that does not have access for disabled patients or visitors in wheelchairs. But reception desks may still be above the eye level of people in wheelchairs.

Primary care trust boards are now conscious that small premises with a doctor working single-handed are no longer adequate for healthcare in the 21st century. A health centre should have facilities for services other than doctors, nurses and receptionists so that patients need not go to hospital for ECG tracings of their heart, blood tests and X-rays.

Automatic doors are common at the entrances of hospitals, but they are inefficient in keeping out the cold when patients insist on smoking just outside the doors.

Design for the safety of patients must be a high priority. For many years I worked in a unit for new-born babies that was on the fifth floor of the maternity building when delivery rooms were on the ground floor. I was informed that in 1966 the architects of that maternity building in Liverpool had not heard of the need for a new-born baby unit and had added one on the top floor rather than draw up new plans. But in Birkenhead we have the best-designed bus station in Europe. Staff working in the baby unit had to have regular practice in moving incubators and cots down five floors in case of fire. The unit was closed only two years ago.

Design for the safety of patients and their families requires attention to detail. Let us consider the example of the medicine bottle with a child-resistant cover containing small pills for an older person. How often have we struggled to get the child-proof top off the bottle, or heard grandparents asking a young grandchild to help remove the top in order to reach the tablets for their blood pressure or heart failure? There are effective bottle tops, which people with arthritis in their hands can open that are genuinely resistant to the child under five, but they are expensive.

Other design improvements can be life-saving, such as needles attached to syringes that do not need to be removed by hand, thereby avoiding needle-stick injuries and preventing the infection of healthcare professionals who take blood from patients with hepatitis or HIV.

Another improvement needed must surely be the colour coding of medical solutions for injection used for anaesthesia, treatment of severe blood-poisoning and cancers. Some injectable drugs given directly into the blood will be lethal if injected into the spinal fluid. Such drugs should be colour coded so that doctors will be warned, and patients protected from medical accidents and death.

Finally, I shall quote from the Design Council, which states:

"Good design creates products, systems and environments that can help improve the outcomes of healthcare, providing more effective and safer services".

Designing for patient safety must be the highest priority. Therefore, I welcome the news that the Department of Health is working with the Design Council to investigate the potential for a design-led approach to reducing the opportunity for medical error as part of its on-going "Building a safer NHS" patient safety strategy.

I look forward to the Minister's response to the debate.