Implementation Strategy

E L L I P S I S :

Urban Design for Dementia Prevalent Populations

Implementation Strategy

1

E L L I P S I S :

Urban Design for Dementia Prevalent Populations

Implementation Strategy

Jack Sardeson University of Cambridge An essay submitted in partial fulfilment of the requirements of the MPhil Examination in Architecture & Urban Design (2016-2018) October 2017 Word count: 4,994

Acronyms ONS – Office for National Statistics AD – Alzheimer’s Disease NHS – National Health Service PM – Prime Minister PCT – Preventative Care Typologies DOP – Department of Health ICC – Integrated Care Community WWT – Wildfowl and Wetland Trust 2014CA – 2014 Care Act AMH – Adaptive Mainstream Housing Housing LIN – The Housing Learning and Improvement Network pppy – per person per year CCRC – Continual Care Retirement Communities CIL – Community Infrastructure Levy CASSH – Care and Support Specialised Housing Fund LGA – Local Government Association NPPF – National Planning Policy Framework PPP – Public Private Partnership HNTP – Healthy New Towns Program BR – Barking Riverside BRCIC – Barking Riverside Community Interest Company GLA – Greater London Authority B&DC – Barking & Dagenham Council NELFT – North East London Foundation Trust CCG – Clinical Commissioning Groups UCLLP – University College London Partners STP – Sustainability and Transformative Plan LBHF – London Borough of Hammersmith and Fulham LBHFWBB - London Borough of Hammersmith and Fulham Well Being Board PLA – Port of London Authority MMO – Marine Management Organisation SSSI – Site of Special Scientific Interest EIA – Environmental Impact Assessment

Acknowledgements Thanks to the following for their contribution to the project: The Care Quality Commission, Dr Judith Torrington, Dr Dennis Chan, Sarah Waller CBE, Ivor Williams, Professor Carol Brayne, Henri Snel, Dr Keir Yong, London Festival of Architecture, Dementia Research Centre UCL, Brigitte Phillipon and Jean Kalt of Phillipon Architects, Floor Arons of Arons en Gelauff Architects, The Gradman Haus, Jorg Ziolkowski of ASTOC Architects and Planners, and the RIBA for awarding the project the Wren Scholarship.

2035

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Abstract The UK’s population is ageing, and it is doing so at such a rate that, by 2025, over 65’s will constitute 20% of the population, a figure that by 2050 is estimated to be higher still at an unprecedented 25%.1 This increase is, in part, due to the compounded effect of prolonged life expectancy, which can be attributed largely to advances in the medical sciences (particularly in areas of cardiology and oncology) and the rapid ageing of an abnormally numerous generation (‘the baby boomers’).

There are a number of physiological conditions associated with advanced age, such as frailty and sensory impairment, that, over the years the built environment has sought to support through design. For example, in England, the nationwide implementation of tactile paving at road crossings in the late 90’s intended to enable the independent movement of the partially sighted.2 However, as seen in the sanatorium movement in 1920’s3 Germany and the slum clearances of 1930’s inner-London, the wide scale implementation of architectural health adaptations have historically been either medically unsubstantiated or architecturally misguided; incidentally, a 2014 review of tactile paving found more people’s mobility to be impaired by its introduction than enhanced.4 While often well intended, the failures of such initiatives point to the need of developing evidence-based healthcare adaptations that are founded in science in order to respond to the growing needs of an ageing population.

In recent years, the leading cause of morbidity in the aged population has shifted from physiological to neurological, with the ONS in 2016 announcing Dementia to be the new leading cause of death.5 In response, the UK government has begun to adapt public policy in order to accommodate the projected dementia prevalent population.

The next decade therefore constitutes a pivotal moment at which to ensure the appropriate architectural response.

1 2 3 4 5

LGA, Housing Our Ageing Population, p. 5.

DOE, Transport and the Regions, Guidance on the Use of Tactile Paving Surfaces, p. 20.

Eylers, Eva, ‘Planning the Nation: The Sanatorium Movement in Germany’, p. 667–92.

Ormerod, Newton, MacLennan et al., Older peoples experience of using tactile paving p. 7.

McLaren, Elizabeth, Deaths Registered in England and Wales: 2015, p. 3

Alzheimer’s Disease Though not symptomatic of ageing, the probability of developing dementia increases exponentially after the age of 65, rising to a 50% probability by the age of 80.6 The focus of this paper is a subtype of dementia: Alzheimer’s disease (AD), which makes up 60-70% of case and is thus often used synonymously with dementia.7 AD is a neurodegenerative, non-communicable, disease, believed to be caused by a build-up of plaques or ‘protein tangles’ in the brain that leads to cerebral atrophy or progressive reduction of brain tissue. Observable symptoms differ between individuals and other forms of dementia often coexist but typical expressions of AD include: memory loss, aggression, insomnia, disorientation, perceptual difficulties, dysphagia, incontinence, and eventual loss of cerebral cortex function.8 These generally occur in a formulaic sequence, dictated by the spread of AD from the hippocampus to the exterior cortex. As such, the disease can be demarcated into three progressive stages: Mild, Moderate, and Severe, each with its associated symptoms. Due to the adaptability of the human brain, those with Mild-Moderate dementia often go undiagnosed for years and/or often decades and, therefore, for the most part, continue to participate in civic, commercial, and public daily life. Though no substantial risk factor(s) have been identified for the onset of AD,9 multiple epidemiological studies have suggested that early intervention during the Mild stage not only improves quality of life, but also significantly prolongs independence in the latter stages.10 The appropriate architectural response should, therefore, accommodate for a continuum of care, as opposed to a compartmentalisation of care.

6 Prince, M, Dementia UK: Update, p. 8.

7 WHO, Dementia: A Public Health Priority, p. 12.

8 Alzheimer’s Association, ‘2014 Alzheimer’s Disease Facts and Figures’, 9 Feddersen, Eckhard, Lost in Space: Architecture and Dementia, p. 42.

10

47–92

WHO, The epidemiology and impact of dementia: current state and future trends. P. 32

AD Contiuum 5 - 20 years 3 - 8 years 1 -3 years

Mild 54%

Difficulties with recent memory and forgetfulness Anxiety and depression often occur Loss of concentration

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Disorientation Ability to disguise difficulities with brain adpatation

Moderate 32%

Severe 12%

Impaired ability for Reduced capacity to reason activities of daily living or make decisions such as eating, dressing, or Significant shopping communication difficulites Significant memory including fragmented lapses such as not speech recognisisng a person Immobility, rigidity they know well and recurrent falls Challenging behaviour and social disinhibition Physical deterioration may be experienced and difficulties with eating result in progressive Sleep disorders are physical weakening common

An increasingly elderly population and the subsequent prevalence of dementia, coupled with austerity measures and a housing shortage, have prompted government and the NHS to seek alternative models of care. As outlined in the former PM’s ‘Prime Minister’s Challenge on Dementia 2020 ’11and the NHS’s ‘5 Year Forward View,’12 sustainable care can best be delivered through preventative rather than curative adaptations. In practice, this has shifted the responsibility of health from institutional forms, such as care homes and hospitals, to housing and communities. Present architectural endeavour, both in the UK and across Europe, has therefore been to provide a preventative care architecture that effectively bridges the gap between home and care home.

11 12

DOH, Prime Minister's Challenge on Dementia 2020 p. 7.

NHS, Five Year Forward View, p. 22

Preventative Typologies

Years in care integrated housing

+

Cost/time in care Institution Home

Cost/time in care Mainstream Housing

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Bridge The proposal exists within a spectrum of preventative care typologies (PCT’s) and, though it could be broadly categorised as an extra-care scheme – defined by the DOP as: ‘purpose built accommodation in which varying amounts of care and support can be offered and where some services are shared’13 – a more accurate term would be an ‘ICC’ (Integrated Care Community). Taking the form of an inhabited bridge over the Thames in west London, the proposal, for the purposes of this essay, will be referred to either as; Fulham Bridge ICC or ‘the project’.

The parameters of this essay limit the extent to which the implementation of an ambitious project like the Fulham Bridge ICC can be comprehensibly reviewed; therefore, the strategic partnerships enabling implementation will be the essays focus, in an attempt to resolve the ambiguous interdependency between state, health and development, which compromised health architectures of the past. This will be addressed within the following framework: Part 1, Present: Takes into account the political, economic, and planning policy context that will impinge on the implementation of the ICC Fulham Bridge proposal and provides a critique of present policy.

Part 2, Proposal: With reference to a contemporary case study in the UK, this section proposes a PPP framework, which, if implemented, would successfully navigate the issues facing alternative care typologies Part 3, Procedure: Identifies site constraints, development, and regulations (with a focus on the Thames), and how the project will address these issues. It additionally considers the phasing of construction, and sustainable use of materials.

13

King, Nigel, Viewpoint 20: Planning Use Classes and Extra Care Housing, p. 3.

Alternative Care Typologies

APPLICABLE POLICY AND GUIDANCE

FLEXIBILITY IN CARE OPTIONS Mainstream Housing

Adapted Mainstream Housing (AMH)

+55 Accommodation

Retirement Village

Continued Care Retirement Communities (CCRC)

Integrated Care Communities (ICC)

INTENSITY OF CARE SUPPORT

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Sheltered Housing

Extra-Care

Care Home

Hospital

Site The extent of the Fulham Bridge ICC site is approximately 250m in length and 80m in width, spanning the Thames from Rowberry Mead park on the north bank to WWT Wetland centre on the south. In addition to the bridge, the surrounding area (delineated by the orange boundary) will form, through minor adaptation, London’s first dementia friendly district, encouraging a permeable relationship between city and site.

Digimap data 2017

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Political Context In the UK, although the size of the elderly population has been rising consistently for many years, the sale and rent of extra and sheltered housing has not increased to reflect this change. Rather, over the last 20 years, extra and sheltered housing has seen several significant setbacks, as indicated on the graph above, which illustrates the impact of policy, irrespective of demographic trends, on the rent and sale of sheltered and extra-care housing during the 1950’s to 2014.14 The majority of care typologies, provide an adult social care function and, as such, were directly impacted by the amalgamation of health and state during the 1950’s, which oversaw the subordination of the architecture of care to the tenets of political doctrine. Almost thirty years later, the rapid decline post-1980, as a result of the 1990 NHS and Community Act, in short, devolved adult social care responsibility from the NHS to local community15. Enabling people to receive care in their own homes rather than entering the ‘continuum of care.’16 The NHS and Community Act resulted in a sudden decrease in the demand for sheltered accommodation, leaving many existing units unsold and stalling the construction of new units. Over time, this has subsequently led to a 400,000 unit shortage in sheltered and extra-care housing in UK17 and, in part, explains why, relative to population, the UK senior housing market is 10x smaller than its western competitors.

14 APGOHCFOP, HAPPI 3, p. 13.

15 Blood, Imogen, Supported Housing 16 Blood, Imogen, Supported Housing 17

for Older People in the UK p. 16. for Older People in the UK, p. 16.

Local Government Association, Housing Our Ageing Population, p. 15.

12,000,000

28,000

11,000,000 1986 Disabled Persons Act

26,000

10,500,000

24,000

9,000,000 1990 NHS and Communitiy Care Act

22,000

8,000,000

20,000

7,000,000

18,000

6,000,000

16,000

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14,000

4,000,000 2014 Care Act

12,000 1970 Chronically Sick and Disabled Persons Act

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3,000,000 2,000,000 1,000,000

6,000 4,000 2,000 0 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 Date

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+65 population in the UK

Sheltered/Supportive Housing Sold and Rented

30,000

In consensus with the 1990’s Act, the 2014 Care Act, introduced during the Conservative-Liberal Democrat coalition, broadly devolved healthcare responsibility from the state to the individual. However, it additionally required local government to have greater involvement in the implementation of this shift, which is still in process today. Delineated as a list of ‘statutory duties,’ the emphasis for local government is to provide integrated social care that ‘prevents or delays’ the need for intensive forms of care.18 The 2014CA does not, however, establish a definitive list of what this care support should consist of, therefore leaving it to the digression of local authorities to decide the form of provision that best meets the needs of the area. Though this has prompted Local Government to promote the development of extra-care schemes, as indicated by the recent increase on the graph, their obligation to do so has been undermined by the lack of specific political guidance. This has resulted in the use of ‘inappropriately located sites’ by developers, such as ex-retail parks, removing residents with limited mobility from local amenities.19 Perhaps the primary form of alternative supportive housing that the 2014CA incentivises, is Adapted Mainstream Housing (AMH). As a typology, it has significant advantages for Local Government over the other forms as it requires least investment and it is the fastest to implement. Additionally, over 2/3 of those living with AD live in mainstream housing and therefore it has the largest potential applicability.20 Indicative of this preference, Worcester Council established the first AMH non-means tested grant last year, encouraging residents to make their homes dementia friendly.21 However, as noted in; ‘The role of the home environment in dementia care and support: Systematic review of qualitative research’ there is inconclusive evidence on the preventative benefit of these adaptations.22

18 19 20 21 22

HM Government, CARE ACT 2014, p. 5-43.

APGOHCFOP, HAPPI 3, p. 13.

Torrington, Judith, ‘Future Proofing’, p. 5.

Torrington, Judith, interviewed by Jack Sardeson, 27 January 2017 Soilemezi, Dia., The role of the home environment in dementia care and support: Systematic review of qualitative research, p. 5.

Economic Context In the UK today, the biggest expense for any council is adult social care, for which the cost was calculated to be £7.9 billion in 2014 alone.23 Residential care is more expensive for councils than domiciliary care, incentivising councils to put off residential care for as long as possible.24 The cost of PCT schemes for councils is less clear, though two recent studies, one by Aston University and another by Housing LIN, estimated that councils could save £4,500 pppy by implementing extra-care and CCRC developments.25 Councils will not benefit from these schemes, however, until much later, in part explaining the preference for domiciliary and AMH schemes. Additionally, if the PCT scheme proves successful, individuals with potential care needs are likely to move across Local Authority boundaries, increasing the inevitable care population for the host council and thereby negating any potential savings. In response, national government issued in 2017 the ‘Better Care Fund (BCF) planning requirements’, which goes towards supporting the development of PCTs.26 However, with continued austerity cuts, councils will, in real terms, see a 7% decrease in funding for PCT projects even with the addition of the BCF and the recently approved 2% rise in council tax.27 For individuals looking to move into PCT schemes or to downsize into age supportive housing, the cost of moving and stamp duty are compounded by further systemic disincentives.28 Namely, the way in which councils assess eligibility for financial care support favours those who live at home over those in residential care. Additionally, those in residential care can lose the majority of their assets on care costs – though this may change in 2020 with the introduction of the care-cap – discouraging people from leaving their homes. Though most PCT schemes under council guidance are considered ‘homes’, and many are owner-occupied, the lack of clarity surrounding tenure types and support charges prevents more people from considering them as an option. The senior housing developer PegasusLife, operates an interesting alternative not-for-profit model of ownership, in which residents own 49% and PegasusLife own 51%, allowing residents the benefits of both ownership and flexibility. Additionally, all service charges are reinvested into a sinking-fund, ensuring tenants are protected from unexpected maintenance or damage.29

23 Mithran, Samuel, ‘Cuts and Reform – the Cameron 24 LGA, Housing Our Ageing Population p. 34.

25 LGA, Housing Our Ageing Population p. 25.

26 NHS, Five Year Forward View 27

28 29

.

legacy for adult social care’ p. 2.

Mithran, Samuel, ‘Cuts and Reform – the Cameron legacy for adult social care’ LGA, Housing Our Ageing Population, p. 20.

APGOHCFOP, HAPPI 3, p. 26.

Planning Policy Context As the proposal aims to bridge the gap between home and care home it falls between the relatively blunt planning categories of ‘(C2) residential institution’ and ‘(C3) dwelling.’ This reductive binary can create instability and conflict for prospective development, as is often the case with PCT schemes, because agencies and developers cannot be sure of what regulation may apply to the proposal.30 For example, if classed as C2, the developer does not have access to funding streams such as DOH’s Extra Care housing fund, but the developer does have greater flexibility; such as, not being obliged to meet the location requirements of general housing. If classed as C3, the developer may have access to funds but face the same Section 106 charges, even though the development would be providing a social function. Additionally, these typologies inherently contain larger areas of less-profitable accessible and communal space than typical residential development, yet still incur the same per m2 Community Infrastructure Levy charges (CIL).31 The combination of these factors discourage developers from investing in PCT schemes unless public funding can balance the costs. Of the funds that exist to resolve the problems generated by this binary, the Care and Support Specialised Housing Fund (CASSH) is potentially the most viable scheme for the Fulham Bridge ICC. This year alone it contributed £84.2million towards 79 PCT projects.32 Additionally, some recent regulatory guidelines have made the implementation of PCT projects more accessible to potential developers.

For example, the British Standards Institute has introduced PAS 1356:2015, which establishes a formal framework for the recognition of ‘Dementia Friendly Communities,’ of which there are now 82 across the UK;33 the Kings Fund have issued the EHE environment assessment tool, which provides guidance on dementia friendly features within development; and, the HAPPI (Housing our Ageing Population: Panel for Innovation) guidance and proposed ‘kite-mark’ intend to promote formalised dementia design standards across the building industry.34

30 31 32 33

LGA, Housing Our Ageing Population p. 18.

APGOHCFOP, HAPPI, 3 p .19.

Wenzel, Lillie, NHS Estates: Review of the Evidence p. 34.

Alzheimer's Society and BSI, Code of Practice for the recognition of dementia friendly communities in England, p. 33.

34 APGOHCFOP, HAPPI 3, p .19.

.

Critique of Current Policy The 2014 Care Act, in principal, requires Local Government to adequately adapt its care structures to meet the prevalence of chronic and degenerative diseases associated with old age. However, though the health benefits of PCTs are widely advocated by current research and policy, they are accompanied by considerable disadvantages in practice.

The first obstacle for development is the insufficient categorisation of care typologies within planning regulation. At a national level, the National Planning Policy Framework (NPPF) should make reference to the planning for ageing populations and recognise that shifting demographics require wider, flexible housing choices to mediate the impairments of age. The 2017 ‘Housing white paper’ goes some way towards resolving this, setting out amendments to the NPPF that expressly require local plans to consider the provision of suitable housing for the elderly and how this will be provided.35 The second challenge is the implementation of a long-term strategy of integrated supportive housing. Currently there are 850,000 people in the UK living with AD and it is estimated that 2/3 live in mainstream housing, of which only 5% is adequately designed to meet the requirements of neurodegeneration.36 Though AMH may, in part, support residents, it widens the polarity between home and care home and therefore cannot offer adequate support as a sole solution but only in cooperation with a broader network. The “suz-no-ya” and “Sakura-chan” schemes adopted in Japan are good examples of this strategy.37 At a broader level, the shortfall in developing alternative schemes decreases impetus in the property market, preventing an estimated 3.5 million family sized properties from entering circulation.38 Finally, without a sustained interdisciplinary collaboration between healthcare, policy, and development will not respond adequately to the specific needs of diseases like AD or to demographic shifts. The ‘2014 Memorandum of Understanding to support joint action on improving health through the home’39 is indicative of this shift towards a (re)unification of healthcare and housing, which, if established, will change the role of the architect within development. As unanimously expressed at a 2017 conference entitled ‘Doing Dementia Design’– at which the Fulham Bridge ICC project was presented - although the architect is well placed within the building industry to mediate between health and policy, there is currently little in the education or practice of architecture that prepares architects to meet this responsibility.

35 36 37 38 39

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Department for Communities and Local Government, Fixing our broken housing market, p. 52.

Torrington, Judith, ‘Future Proofing,’ p. 23.

Hayashi, Mayumi. Case Study 105: Japan, p. 5.

APGOHCFOP, HAPPI 3, p. 12.

Public Health England, (MoU), P. 4

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Case Study: Barking Riverside The NHS’s ‘5 year forward view’ highlighted the opportunity to improve population health, particularly mitigating the public health priorities of obesity and dementia, by integrating health and care services into new town development absent of any legacy constraints.

The subsequent HNTP identified ‘10 demonstrator’ sites across the UK in which to implement this new framework, of which Barking Riverside (BR) was the only London based site.40 The BR project, in the London Borough of Barking & Dagenham, hopes to build 10,800 homes by the year 2031, applying the latest health research to the development. In order to meet this challenge, the development employs a unique Public-Private-Partnership headed by the Barking Riverside Community Interest Company (BRCIC).41 This PPP primarily includes the Greater London Authority (GLA), Barking & Dagenham Council (B&DC), local representatives, and the residential developer L&Q. However, subsidiary health partnerships also have been included to provide ‘specialist input into the design.’42 The most significant of these health partnerships founded by B&DC and the North East London Foundation Trust (NELFT) is the organisation, Care City. Sometimes referred to as; an ‘Integrated Care Coalition’, Care City is a further systems partnership between the local council, NHS trusts, CCG’s (Clinical Commissioning Groups), and University College London Partners (UCLP).43 Though it provides predominantly technological solutions, it described as a ‘vital test bed’, which informs the wider partnership of beneficial adaptations to the development.44 There is growing evidence at a national level of the benefit of these partnership, with Section 106 agreements adapting Healthy New Town principles.45 This suggestion has more recently been taken up by Sarah Weir OBE, head of the Design Council, who called for the implementation of a similar model in the wider architectural profession during a 2017 public address.

40 41 42 43 44 45

NHS, Five Year Forward View, p. 23.

Barking Riverside, 2017, LBBD, Barking NHS, 2017, NHS Trust, Care City London, 2017, London BarkingRiverside, 2017, Alzheimer's Society, Dementia-Friendly Housing Charter, p. 5.

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https://barkingriverside.co.uk/assets/barking/img/sitemap/VI Z_Aerial.1920x960 .jpg

Site Partnerships Fortunately for the proposed scheme, an Integrated Care Coalition was formed in 2016 between the Local Councils, CCG’s, and NHS services of north west London to coordinate joint action on promoting health closer to home.46 The coalition estimates that by 2030 the number of people with advanced dementia in the area will increase by 40%, consequently increasing the adult social care budget by 44%.47 In response, the coalition issued a draft Sustainability and Transformative Plan (STP) in November 2016 outlining the areas intention to improve buildings and facilities. Correspondingly, The LBHF Health and Well Being Board (LBHFWBB), recently issued a Joint Health and Wellbeing Strategy 2016-2021, and cited infrastructural improvement as a key site for positive adaptation, however the details of this adaptation will not be outline until later this year in LBHFWBB’s; ‘Delivery and Implementation Plan.’48

46 LBHF CCG. Hammersmith & Fulham Joint Health and Wellbeing Strategy 2016-2021, 47 48 Health North West London, Sustainability and Transformation Plan Summary, p. 7.

LBHF CCG. LHBF Joint Health and Wellbeing Strategy 2016-2021 p. 12-31.

p. 12-31.

Proposed Partnership The proposed implementation framework employs a performance-based Public Private Partnership (PPP) model in order to achieve a high standard of affordable, long-term, preventative care housing in collaboration with the National Health Service. Though the role of the architect is generally diminished through a traditional PPP framework, a performance-based PPP incentivises the developer to deliver well-designed architecture and therefore the architects role becomes more central. As such, the integration of health principles can occur earlier in the concept stages of the design. Additionally, as contractual responsibility is retained for longer than other partnership agreements, there is added incentive to perform Post Occupancy Evaluations to inform future projects.

The accompanying diagram illustrates how this partnership would be formed, through the establishment of the Fulham Bridge Community Interest Company, encompassing an integrated care coalition with local health providers, local councils, the development team and specialised AD guidance from the Dementia Research Centre, UCL. Additionally, the introduction of a Preventative Adaptation Local Area Evaluation importantly conducted at the beginning of the project aims to accumulate health and building data and therefore guide from concept the appropriate architectural response.

HCA Homes and Communities Agency

LGA Local Government Association

TCPA Town and Country Planning Regulations 2011

DCLG Department for Communities and Local Government

HEALTH

HPA Housing and Planning Act 2016

HOUSING

PCPA (2004) Planning Compulsory Purchase Act

DCLG DOH Department forDepartment Communities and Local Government

2014 Care Act

TCPA Town and Country Planning Act 1990

NATIONAL

TCPA Use Classes Order 1987 Class Distinction

TCPA Section 106 HNT Obligations

Whit Hou (201

NPPF (2012) National Planning Policy Framework

NPPF (2012) National Planning Po Framework

White Paper: Fixing our broken housing market (2017)

White Paper: Fixing our broken housing market (201

HEDNA Housing and economic development needs assessments (2015)

HEDNA Housing and econom development needs assessments (2015)

British Standa Institute

British Standards Institute DFL (2012) Design for Life

LTHS Life Time Home Standards (SPG)

GLA Greater London Authority

LP 2016 London Plan

LP 2016 London Plan

£

REGIONAL

TFL Transport for London

C C Sp Fu

TFL Dementia Friendly Transport 2016

UCLP UCL Partners

LAND OWNERS

THAMES RIVER PLA Port of London Authority

DC Design Council

EIA Environmental Impact Assessment

LOCAL

HLIN Housing Learning and Improvement Network

WWT LWC WWT London Wetland Centre

TC 2016 Thames Concordat

ARUP Arup Engineering

FBA Fulham Bridge Architects

HAPPI 2016 HAPPI Design Standards HFHWBB Delivery and Implementation Plan ((2018)

FB CIC Fulham Bridge Community Interest Company

CIL Community Infrastructure Charges H&FC Hammersmith & Fulham Council CIL Community Infrastructure Charges

HFHWBB Hammersmith & Fulham Health and Well Being Board

Mc&S McCarthy & Stone Housebuilders

RC Richmond Council

Integrated Care Coalition

RIBA STAGES

Planning Documentation

H&FC Hammers Council

LDS (2016-2021) Local Development Scheme

DPD (2017) Integrated Care Development Plan Coalition Document

1

Development Strategy Construction Documentation

RC Richmon

FBA Fulham Bridge Architects

E L L I P S I S - Urban Des ign f or Dem entia

REVIEWING BODIES

MMO Marine Management Organisation

L&Q L&Q Housing Association and Developer

Construction Documentation

KEY

HEALTH

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DOH Department of Health

2014 Care Act

HACT Housing Associations’ Charitable Trust

Successfully Implemented

Company Policy

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Requires Alteration Proposed Existing

Healthcare Policy

Established Connection

Developer/Building Service

Government Policy

University

Development Policy

Intended Connection Policy Split

Partnership

Healthcare Board

HNTP Healthy New Towns Program (2015) AS Alzheimer Society Alzheimer Society Dementia Friendly Housing Charter 2017 BSI PAS1356:2016 British Standards Institute

Alzheimer Society Dementia Friendly London Manifesto 2016

£

CASSH Care and Support Specialised Housing Fund (Phase 3)

NORTH WEST LONDON COALITION UCLP UCL Partners

MHL My Home Life

DRC Dementia Research Centre UCL

HRCHNT Hounslow and Richmond Community Healthcare Trust

NHS CCH NHS Charring Cross Hospital

LDS (2016-2021) Local Development Scheme

DPD (2017) Development Plan Document

CNWLNFT Central and North West London NHS Foundation Trust

CCG Clinical Commissioning Group Hammersmith&Fulham

LNWHNT London North West Healthcare NHS Trust

ICHT Imperial College Healthcare Trust

NWL-SPT (2016) North West London Sustainability and Transformation Plan

POTENTIAL FOR COLLABORATION

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NHS England National Health Service

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PHE Public Health England

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IMPLEMENTATION STRATEGY

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Existing Development The Thames Tideway Tunnel and its accompanying Hammersmith Pumping Station, due to start in late 2017, are the most significant developments with potential to impact the project.49 Though much of the construction work will take place underground, there is likely to be a significant amount of waste and construction traffic occupying similar transport routes. Additionally, as part of the Hammersmith Development plan, the area immediate to the underground station and pumping station has been marked for regeneration, with the diversion of the current Hammersmith overpass to an underground tunnel representing the most significant change.

Importantly for the Fulham Bridge ICC, Charing Cross hospital, currently a 10-15 minute walk from the proposed site, may be reduced in size and a proportion of the land sold for residential development. However, the local CCG recently confirmed in a public address that no significant changes will happen to the hospital in the near future. In light of these potential obstacles, the Fulham Bridge ICC will continually review planning applications surrounding the site and recommend modifications to the design as and when needed.

49

LBHF, Proposed Submission Local Plan, p. 16.

Goldhawk Road

Shepherd’s Bush Market

Conservation Area

Listed Buildings

Care Home

Regeneration Area Hammersmith & Fulham Development Plan

Charing Cross Hospital

Thames Tideway Tunnel (construction)

Present Development

Hammersmith Underground Station

Paddington

Hammersmith Overpass Tunnel (proposed)

Thames The majority of the project exists over land or water that is managed by the Port of London Authority (PLA) and the Marine Management Authority.50 Recently, development on the Thames has been limited by the complex set of ownership and leasing rights associated with tidal bodies of water as well as by the lack of incentive on behalf of the PLA, who do not incur a penalty for keeping land undeveloped.

Some have advocated for a Land Value Tax to be applied but, perhaps less drastically, the Housing and Planning Act 2016 could be extended to include the PLA within its remit.51 At present, the most significant change is the 2016 ‘Thames Concordant’, which is designed to stimulate Thames development by streamlining the planning application procedure and introducing a ‘single point of entry.’52 The Fulham Bridge ICC will utilise this new legislation in applying for planning, and maintain a 12.6m clearance above the mean water height in accordance with PLA regulation.53

North Landing The North landing of the project utilises a council owned community park on the Thames path. Though the games court within Rowberry Mead park is used by students from the local school, the park, (based on evidence collected on frequent site visits), remains mostly underused. Therefore, in order to mitigate impact to the local area and to encourage use of this facility, the games court will be reintroduced into the design of the bridge. The adjacent school and its out-buildings are all Grade II Listed buildings and though not directly impacted by the project, site lines from the main structure to the river will be kept as far as possible. Planning permission will be obtained through application to the LBHF Planning Department, making specific reference to the benefits that the project will bring to the borough in alignment with the Local Plan and 2014CA in order to navigate the difficulty of the conservation area designation of the site.54

South Landing The south landing of the project will maintain a 4.6m clearance above the Thames path, managed by Richmond Council and will provide a covered walkway during construction to mediate disruption to this route. Planning will be applied for through the Richmond council and similarly outline the benefits the bridge will bring to the borough.

Additionally, lease negotiations with the WWT Wetland Centre will be conducted in partnership with the council.

50 51MMO, The Thames Concordat, p. 12.

52HM Government, Housing and Planning Act 2016, p. 5 53MMO, The Thames Concordat, p 5.

54MMO, Environmental Impact Assessment Consent Decision

LBHF, Proposed Submission Local Plan, p. 13.

Report: The Garden Bridge, p. 16.

WWT London Wetland Centre

Port of London Authority

Existing Construction

Richmond Council

Hammersmith & Fulham Council

SSSI

Marine Managemnet Organisation

Listed Building

Boundary Line

Environmental Impacts The WWT London Wetland Centre was designated a Site of Special Scientific interest (SSSI) in 2002 and, therefore, the development will face additional requirements for planning to be approved. In accordance with Town and Country Planning Regulation 2011, an Environmental Impact Assessment (EIA) will be carried out by the planning authorities. The purpose of this EIA can be roughly divided into four aims: first, to establish the baseline condition of the site; second, to identify potential impacts of proposed development; third, to identify features that may mitigate the impact of the development; and finally, to evaluate if appropriate steps have then been taken by the applicant to mitigate these impacts.55 In order to mitigate the potential impact of the south landing, the section of the bridge within the SSSI will not contain any accommodation or services, but will simply act as a pedestrian walkway, linking up with existing pathways on the site. Additionally, the last approved structure within the SSSI (Planning Application - 08/4588/FUL), provided ‘increased roosting opportunities’, thereby perhaps not conserving but enhancing the biodiversity of the environment.56 As the area is of regional importance for bats, the project intends to sensitively integrate a bat house into the southern landing of bridge. This solution, will also entail the need for a Flood Impact Assessment also submitted to the Planning Authority.

The structure over the Thames must be additionally environmentally assessed by the MMO. Fortunately, the site is not within a Marine Conservation Zone, however, further requirements specific to the Thames must be considered. The first of these is the Water Framework Directive, in which an assessment must be made to insure the project does not change the body of water concerned from its current status of ‘moderate’. It should additionally, if possible, incorporate measures to achieve Good Ecological Potential by 2027.57 The project aims to mitigate effects to the water body by minimizing construction time on the water and banks of the Thames. Secondly, the Waste Framework Directive — a council directive implemented to reduce waste — will be adhered to by minimizing the amount of dredging required during construction, and by reusing materials were possible.

55 HM Government, Town 56 656235 – 08/4588FUL: 57

and Country Planning Act 1990.

Nature England (London: 2009) MMO, Environmental Impact Assessment Consent Decision Report: The Garden Bridge, p 42.

https://www.wwt.org.uk/blog/wp-content/uploads/2012/08/Aeri alview_BerkeleyH omes.jpg

https://media-cdn.tripadvisor.com/media/photo-s/0c/3b/06/ab/lo ndon-wetland-cent re.jpg

Construction The phased construction of the Fulham Bridge ICC can be categorised into three broad stages: tiers, deck, and structure. The first stage establishes the two primary tiers in the Thames that will support then support the spanning deck. This step is the most complex of the procedure as it requires a secure interface between land-based and marine-based building works. As such, temporary trestles will be constructed across the foreshore, supporting the near-shore super structure elements and enabling temporary access to piers for workers and light equipment. The design intent at this stage is to make use of the excess earth produced by the near-by Thames Tideway Tunnel project as an aggregate in the concrete mix that will form the supporting load baring elements of the bridge. This is to be transported to site on the Thames to decrease construction traffic in the area.

After the completion of the bridge and removal of the trestles, the construction of services and inhabited structures are to begin, with the bridge providing the principal route of access for the remainder of the project. This will begin on the south landing and progress towards the north, impacting the WWT Wetland Centre for as short a time as possible. The inhabited structures are predominantly constructed of a structural timber system to reduce weight and allow for flexibility in partition arrangements.

1

Fulham Bridge ICC - Construction Timeline

Month 72 71 70 69 68 67 66 65 64 63 62 61 60 59 58 57 56 55 54 53 52 51 50 49 48 47 46 45 44 43 42 41 40 39 38 37 36 35 34 33 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Mobilisation, establishment, contractor design Install scour protection Piling Cofferdam construction Construct pile caps Construct piers Remove cofferdam Construct north and south landings Install bridge / concrete form-work Install closing span Foundation services Framing Roofing / cladding Plumbing Glass fitting Insulation Fit-out Completion

Conclusion State intervention can perhaps be held accountable for the fluctuating overprovision and under-provision of care typologies, however, not as a reflection of mistaken dogma, but due to the inherent unresponsiveness of legislation to the shifting requirements of idiosyncratic localities. This essay has outlined a strategic partnership framework for the implementation of alternative care typologies, that if realised could mediate some of the issues facing present development attempting to accommodate a dementia prevalent population.

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