provisions for people with disabilities

S T R AT E G I C

HEALTHCARE

DISCUSSION PAPER

P L A N N I N G

Designing for Disabled Users An introduction to UK Regulations November 2013

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Introduction During a meeting held on 23rd October 2013 between Turkish Ministry of Health consultants, NKY Architects and leading UK healthcare planning specialists Strategic Healthcare Planning discussions took place regarding the design requirements for disabled people in Turkish hospitals and the manner in which they compared with UK standards.

This paper is an introduction to statutory and non-statutory regulations in the UK and describes the type of information that is included within the documents referred to. Example diagrams from the documents have also been included.

This document in and of itself is not intended for use as technical guidance.

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Statutory Regulations Facilities Managers have a pivotal role to play to ensure their buildings are accessible. The Equality Act 2010 and Part M of the Building Regulations give responsibility to building owners and managers. It is therefore essential that FM's have the right information when looking to specify products and services to implement procedures for creating and managing an inclusive environment. This is true whether you are planning refurbishment, maintenance and management of buildings or estates, or new build.

Equality Act 2010 The Equality Act 2010 supersedes the former Disability Discrimination Act (DDA). Whilst the DDA only dealt with discrimination against disabled people, the Equality Act now includes the following protected characteristics: -

§ § § § § § § § §

Age; Disability; Gender reassignment; Marriage and civil partnership; Pregnancy and maternity; Race; Religion or belief; Sex

Sexual orientation An introduction to the Act, as published on www.legislation.gov.uk is as follows: An Act to make provision to require Ministers of the Crown and others when making strategic decisions about the exercise of their functions to have regard to the desirability of reducing socio-economic inequalities; to reform and harmonise equality law and restate the greater part of the enactments relating to discrimination and harassment related to certain personal characteristics; to enable certain employers to be required to publish information about the differences in pay between male and female employees; to prohibit victimisation in certain circumstances; to require the exercise of certain functions to be with regard to the need to eliminate discrimination and other prohibited conduct; to enable duties to be imposed in relation to the exercise of public procurement functions; to increase equality of opportunity; to amend the law relating to rights and responsibilities in family relationships; and for connected purposes.

The Equality Act 2010 (the EA) brings together existing equalities legislation, including the Disability Discrimination Act 1995, with the aims of strengthening and also harmonising

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existing provisions into a single streamlined framework of equalities legislation to deliver better outcomes for the protected groups listed.

Section 20 of the Act discusses a duty to make adjustments to physical features for disabled persons to ensure that they are not at a ‘substantial disadvantage’ compared with persons who are not disabled. Physical features include the following: -

§ § §

a feature arising from the design or construction of a building;

§

any other physical element or quality

a feature of an approach to, exit from or access to a building; a fixture or fitting, or furniture, furnishings, materials, equipment or other chattels, in or on premises

Building Regulations Approved Document M Building Regulations contain the rules for building work in new and altered buildings to make them safe and accessible and limit waste and environmental damage. All building work in the UK must comply with the Building Regulations. People carrying out building work must usually arrange for their work to be checked by an independent third party to make sure that their work meets the required standards. In some cases the installer can certify themselves that their work complies.

Building Regulations Approved Document M is concerned with access to and use of buildings.

The document provides guidance and solutions for some of the more common building situations. However, there is no obligation to adopt the solutions provided in the document as long as compliance with the requirements can be demonstrated.

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The following schedule outlines the requirement set out in the document: -

As can be seen in the above schedule, the document is divided into 4 sections; M1, M2, M3 and M4. For the purpose of this document, we can disregard M4, as it is solely concerned with dwellings.

Section 1 – Access to buildings other than dwellings -5-

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Section 1 is aimed at providing suitable means of access from the site entrance to the building entrance, and includes acceptable site gradients, disabled parking space provision, stepped and ramped access etc.

Section 2 – Access into buildings other than dwellings Section 2 looks at the main entrance into a building, and gives guidance on widths and types of entrance doors, thresholds, signage and lobbies.

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Section 3 – Horizontal and vertical circulation in buildings other than dwellings Section 3 deals with horizontal and vertical circulation in buildings other than dwellings, and gives design guidance for corridors, internal doors, stairs and lifts.

Section 4 – Facilities in buildings other than dwellings Section 4 looks at facilities in buildings other than dwellings and provides guidance the ensure that disabled users can make full use of facilities within the building. Facilities can include sleeping accommodation, refreshment facilities, audience and spectator facilities etc.

Section 5 – Sanitary accommodation in buildings other than dwellings Section 5 is aimed at providing suitable sanitary accommodation for all users, and includes guidance for the provision of wheelchair accessible toilets, bathrooms, shower and changing rooms. The document also provides guidance for design and layout of these facilities.

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Health Building Notes The Health Building Notes (HBNs) are a series of documents published by the UK Department of Health to provide guidance when designing all aspects of healthcare buildings.

While not statutory legislation, the HBNs are considered as the primary source of design guidance for healthcare premises in the UK. Most NHS Trusts will insist on projects meeting the guidance set out in the HBNs, and the Strategic Health Authority will usually only approve projects that demonstrate compliance.

Health Building Notes provide evidence based best practice guidance that is generally more onerous than Building Regulations requirements. HBNs are written by drawing on the expertise of focus groups made up of a diverse range of NHS workers, end users and healthcare professionals. Strategic Healthcare Planning had a significant involvement in the writing several current HBNs including Oncology, Outpatients, Critical Care, Cardiac, Emergency and Neonatal.

The HBNs are split into individual departments, with guidance specific to the clinical spaces within those departments. However, the current HBN 00 series of documents concentrate on areas and rooms that are common across whole hospitals: -

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HBN 00-02 – Sanitary Spaces HBN 00-03 – Clinical and clinical support spaces

HBN 00-04 – Circulation and communication spaces Due to the nature of hospital environments clinical spaces, by definition, cater for disabled users. For example, the space requirements for a hospital bed or treatment couch are greater than those for wheelchairs. For that reason, this paper will concentrate on HBN 00-02 and 00-04 because they deal with non-clinical spaces.

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Core elements: Health Building Note 00-02 – Sanitary spaces

Ambulant WC

3.26 The ambulant WC layou

3.22 The following activities take place in ambulant

WCs:

basin.

3.27 A space allocation for lug

allow belongings/bags to the WC for security.

HBN 00-02 – Sanitary t use of thespaces toilet; t disposal of sanitary towels (optional);

HBN 00-02 provides evidence based best practice design guidance for sanitary spaces for use Activity space drawings in healthcare settings to for the needs of patients, visitors and staff. This includes WCs, t cater hand-rinsing.

3.28changing See Figure 3 for ambulant shower rooms, bathrooms (for patients only), nappy changing (for public use), and 3.23 Ambulant WCs are only suitable for fully ambulant (for staff and independent adult patients).

users and should not be used in patient spaces.

3.29 See Figure 4 for ambulant

The document also provides recommendations on the nature and/or fixing position of fixtures 3.24 Toilet should be provided in ambulant WCs. and fittings in sanitary spaces,seats for example paper towel dispenser, shower controlsFigure etc. 3 Toilet:

ambulant

The sanitary spaces are categorised as follows: -

Indicative room layout

Ambulant: suitable for fully ambulant users (staff and visitor spaces only)

3.25 See Figure 2.

Figure 2 WC: ambulant Toilet activity space can overlap basin space by up to 100 mm

Basin activity space can overlap toilet space by up to 100 mm

Service duct

600

Coat hook Shelf (optional)

1000–1200

45 0

Large toilet roll holder will overlap activity area

1800

Soap dispenser

Toilet roll holder m zo in n c op e if lear en do s i or n

Paper towel dispenser

Disposal bin zone

Waste bin Service duct

Luggage zone

DO NOT SCALE

Space for pan 600

(400)

Space to use toilet 600

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80 Space t toilet, 6 low l

§

Semi-ambulant: suitable for people who walk with difficulty and/or are physically unstable and who may use a walking aid (sticks, crutches, walking-frame etc)

§

Independent wheelchair: suitable for people in wheelchairs, including inexperienced wheelchair users.

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§

Assisted: suitable for users who may be in a wheelchair, mobile hoist, sanitary or 4 Shower rooms and bathrooms shower chair or may use a walking aid, who need the help of at least two staff to use the facilities (patient spaces only)

Figure 43 Assisted bath Minimum space for hoist transfer to bath (1100)

Space behind bath to accommodate fittings 150

2250

Staff emergency ceiling pull cord

(1100)

Width of adjustable height bath depending on model 800

Minimum space for staff to assist bathing only (800)

Shelf

E

Minimum space for hoist transfer to bath (1100)

Length of adjustable height bath depending on model

Minimum space for ambulant passing end of bath (700)

Grabrail as towel rail @ 800

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57

HBN 00-04 – Circulation and communication spaces

n and communication spaces HBN

00-02 provides evidence based best practice design guidance for circulation and communication spaces in healthcare buildings. This includes the following: -

space and eneral traffic

Figure 5 Space for two independent wheelchair users to pass 1800 900

900

e with ee turn

10–20 m = recommended distance between passing spaces

2200 2200 allows attendant to turn wheelchair 180 degrees

1900 (1800)

10–20 m

2200 hairs

Figure 6 Space for independent wheelchair user and semi-ambulant person with walking frame to pass

150 (100) Zone for handrail/wall protection

1000 (900)

900

7 Space for wheelchair user and semi§Figure Corridors ambulant user with crutches to pass

§

Internal lobbies 1200

2100 900

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4 Internal lobbies

Lighting

4.15 For guidance on the appropriate width of door

leaves and required effective clear opening widths see paragraphs 8.13–8.21.

4.17 Internal lobbies should be well and evenly lit.

See also paragraph 3.26.

Surfaces 4.16 Floor surfaces in lobbies should be level without

thresholds at doorways.

door leaf ~930

1800 (1700)

150 (100)

Alternative door position

(1570) clear to alternative door swing

(1500)

See Chapter 8, Doors

900

See Chapter 8, Doors

1000

60 0

150 (100) Zone for handrail/ wall protection

Figure 18 Lobbies with single doors for general traffic

(1570) clear to door swing (3430)

(1570) Clear space in front of doors

150 (100)

(1570) clear to alternative door swing

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Handrail stops before door swing door leaf ~930

(1570)

1800 (1700)

(1500) 150 (100)

(1570) Clear space in front of doors, visually contrasting floor if door is automatic. See paragraph 8.47

Visually contrasting guard with cane detection at ground level.

See paragraph 4.14

See Chapter 8, Doors

900

See Chapter 8, Doors

1000

600

Alternative door position

Zone for handrail/ wall protection

(1570) Clear space in front of doors

500 500 of the rail to be knurled or patterned (2500)

(1570)

Lobby length = 1570 plus the length of the door swing into the lobby

Clear space in front of doors

Internal stairs Lifts 17

Handrails Doors that allow the circulation of general traffic

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Core elements: HBN 00-04 – Circulation and communication spaces

Figure 37 Recommended zones for vision panels and location of ironmongery

10º 30º

minimum zone of visibility

150

1423 1750

1500

1100

800

500

1320

minimum zone of visibility

150

900 400

500

zone for door protection

1400

minimum zone of visibility

900–1100

zone for handle

1500

200

minimum zone of visibility

250 150

900–1100

zone for door protection

400

500

min. zone of visibility

800

1500

1150

200

min. zone of visibility

Shaded area = possible zone of visibility

40

§ §

Beds Patient trolleys

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Further Reading As previously stated, the HBN documents are categorised by functional department.

Therefore, it is recommended to cross reference with the above with the relevant HBN for the department that is being designed.

There are also many other NHS Estates documents published by the Department of Health, which will provide useful when designing for disabled users. This includes, but is not limited to: -

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Health Technical Memoranda Health Facilities Notes Wayfinding Lighting and colour for hospital design

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Recommendations The role of the Strategic Healthcare Planning Strategic Healthcare Planning was founded in 1996 as the collaboration of former directors of 2 of the largest architectural practices in the West Midlands. That architectural background brings with it extensive knowledge of the Building Regulations, along with a deep understanding design and construction processes Over the years the company has developed into a team of specialist healthcare planners with unrivalled experience and expertise in the planning and development of healthcare services and facilities. That experience is founded on many years of work with a wide range of clients exclusively within the healthcare and related sectors. SHP is constantly looking to share, innovate and encourage best practice in the development of new services and facilities.

Strategic Healthcare Planning had a significant involvement in the writing several current Health Building Notes as national guidance for the NHS The unique blend of architectural and healthcare planning knowledge that brings with it in depth understanding of both the Building Regulations and the Health Building Notes makes Strategic Healthcare Planning a valuable asset when it comes to best practice advice and guidance.

NKY is invited to consider the contents of this paper and decide whether the documents referred to would be useful when moving forward with healthcare projects in Turkey

Paul Sheldon Strategic Healthcare Planning LLP November 2013

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