NHS 70: Emergency Care


By Chris Thornton

Chris Thornton takes a look at ADP's emergency care projects, exploring how award-winning solutions are delivered in sensitive situations.

With bed capacity shrinking and admissions rising, Emergency Departments (ED) are under significant pressure to perform. More patients are waiting for more than four hours in ED than ever before – with only 84.6% of patients seen within the time limit in March 2018 (NHS England data). Not only does this compound patient stress and anxiety, it also has a significant impact on elective services. Reviewing and improving patient care in ED has consequently become critical to the successful operation of many NHS Trusts. 

Over a series of projects, ADP has worked closely with clinical teams to develop new care models which rationalise and refine the care pathway, from strategy through to detail level. At Luton and Dunstable Hospital, we developed an overall masterplan for the ED, which set in place a long-term strategy to create what is now, one of the best performing EDs in the country. Lessons learnt from this strategy were used at East Surrey Hospital, to develop a small project remodelling two rooms to create streaming facilities. This small project evolved into a six-year phased redevelopment of the ED.

By combining different specialisms in one facility, patient flows can be streamlined, enabling timely and appropriate care. The care pathway extends beyond the ED: at Worthing Hospital we worked closely with the clinical team to develop an ‘Emergency Floor’- creating a super ward of 68 beds based on a multidisciplinary clinical approach. This combined care for the elderly, ambulatory care, surgical and general medicine patients, enabling the main ED to become one of the top four performing departments in the country. The scheme is now a Royal College of Physicians, ‘Hospital of the Future’, pathfinder project. This ambulatory model has been applied to other projects, such as Frimley Park Hospital, to create efficient areas that take the strain off main accident and emergency areas.

In supporting both patient and attendants in the care pathway, ADP has built on the Design Council’s ‘Reducing violence and aggression in A&E’ infomatics concept, integrating artwork, graphics, wayfinding and colour along with information ‘slices’ at the 5500m2 ‘Emergency Care Pathway’ for St Thomas’ Hospital in London.

The changing context of the Emergency Department shows a move to more acute and complex admissions. Project RED at Manchester Royal Infirmary, redevelops and extends the A&E to provide a flexible series of standardised cubicles, allowing flex across resus, majors, minors and urgent care areas, recognising the need to future proof the department and maximise utilisation. This expands to include paediatric emergency services and interventional imaging, providing a truly holistic emergency service.

Often located at the heart of hospital sites, and surrounded by numerous supporting services, traditional A&E departments have little room to expand. Complex remodelling in a live hospital environment is typical of ED projects. Utilising our understanding of emergency service provision and construction logistics, we unlock solutions. One such example is the current reworking of the ED at Royal Surrey County Hospital, with over 15 sub-phases within an eighteen-month delivery programme.

We work hand in hand with the NHS to put the patient first; ensuring patients are promptly assessed and placed into the most appropriate care stream to meet their needs. The result is reduced patient stress and anxiety, improved waiting times, and critically, the protection of elective beds through the provision of flexible, future-proofed departments.


Chris Thornton

Chris Thornton

Chris joined ADP in 1991. Leading our healthcare team, Chris is instrumental
in developing our work in the
health sector. Chris draws upon
his wide experience of
managing projects and clients,
to become a regular speaker
at healthcare conferences.