A place of serenity

Mersey Care NHS Foundation Trust will be bringing a state-of-the-art mental health facility to Mossley Hill in Liverpool

A new, modern mental health facility on land at Mossley Hill owned by Mersey Care NHS Foundation Trust is on track for handover next year.

Before work on the new build began, there were mental health services at Mossley Hill which had been amended and added to over time, leading to an incoherent site. The new build replaces that, plus two old inpatient units – Broadoak in Broad Green and Windsor House in Toxteth – which have dated layouts and facilities.

The 80-bed Mossley Hill hospital will eradicate dormitory-style mental healthcare wards in the Trust, with each single room having en suite facilities to improve privacy and dignity for service users.

While one of the old wards was on a first floor with limited access to a shared garden dependent on staff availability, Mossley Hill has constant access to safe gardens for service users and a separate area for staff.

Inside, therapeutic light and airy environments will host co-located mental health services, including psychology, psychiatry, pharmacy, speech and language therapy, occupational therapy and urgent care services. The purpose-built Section 136 Suite, which serves as a place of safety for individuals who are detained under Section 136 of the Mental Health Act 1983, means Mossley Hill can support people in a suitable environment when they need it most. Alongside clinical spaces, areas for activities, entertainment, dining, family visits and multi-faith worship are also included to enable highly individualised recovery journeys.

The state-of-the-art setting extends to the grounds, with gardens, trees and facilities such as car charging points.

We start with Executive Director of Estates, Communications and Governance Elaine Darbyshire, who has overseen the opening or refurbishment of one hospital a year since 2015 and has won awards for each of these projects. Elaine’s background and dual role in communications and estates give her a unique perspective on project delivery.

Elaine Darbyshire, Executive Director of Estates, Communications and Governance

I have always been in marketing and communications. My first job was in advertising sales and I worked in different parts of the media before joining the NHS 15 years ago in a Communications and Governance role. When I moved to the Communications and Governance Director role at Mersey Care in 2013, I had quite strong opinions about how places should feel and ended up being part of the team that wrote the business case for our medium secure hospital. I enjoyed it so much and have such a passion for great quality environments that I ended up taking on the Executive Director of Estates role too.

Being a good communicator helps with any job. The word ‘marketing’ gets people in the NHS a bit twitchy because they think they’re going to be sold something but, during my post-graduate studies in the field, we learned about Philip Kotler, the guru of marketing. He defined marketing as: “The science and art of exploring, creating and delivering value to satisfy the needs of a target market at a profit”. In the public sector, your profit is social value, but it’s still finding out what people want and understanding what’s important to them, not what we think they should have. When we started planning Mossley Hill, we’d ask people what they wanted in a new hospital and they’d say: “a shower that works” or “bigger spaces”. You need to show them what’s possible and make space for innovation. It’s hard to visualise what buildings can do for your care and recovery, so being able to engage with people – which is the bedrock of marketing and communications – was essential.

I don’t do the technicalities of estates – there’s a great team of engineers, electricians, trade skills etc. at Mersey Care who do that. My bit is about how places feel. If you have a mental illness or you’re in mental health crisis, soft signals in the environment will say something to you. I think about what every bit of that journey says to patients. That’s also what you need to think about when marketing a product.

My advice for those in communications roles is don’t speak ‘bureaucracy’. There’s a different language in health because of all the acronyms. Make things as simple as possible to communicate in a way that your audience understands.

For those in estates roles, know your numbers and understand the data that drives what’s going on, or else you won’t understand how to put your finite resource to best effect.

The key to our success is engagement to ensure we’ve got the right solutions first time. We do external meetings, town hall meetings and internal meetings with service users and staff. We also use every capital opportunity to drive innovation, so it’s never just a rebuild of what we’ve already got. For example, we introduced avatar therapy in Rowan View and digital interactive screens in seclusion – in moments when patients aren’t in crisis, they can plan what imagery will come up to make them feel calm and safe, which means they calm down and get back into their clinical pathway quicker. The building is fundamental because we must build spaces that can accommodate innovation. It’s personalised because mental illness is personalised, like a fingerprint.

Attention to detail is also important – ensure every square foot of every building is thought about and works as hard as possible. Everything is worked through with all our stakeholders, keeping a vision for the endpoint. You must have a strong vision that you can engage people with and keep your eye on the point of completion. What do you get at the end of this? It’s going to be better.

Our new build methodology starts with engagement: what are we trying to achieve? What does great look like? The second stage is great planning to get it right first time. The third stage is making sure that we communicate in real-time, updating people on progress. Engage, plan and communicate – they are the bedrock of everything.

Having health planners and architects who understand mental illness is key. In Rowan View, for example, the paint colour in the dining area is a citric orange and it was chosen because some of the people there have learning disabilities and might have dysphasia, which is problems with swallowing. This citric orange paint stimulates salivation, so it helps people swallow. That’s the level of detail we go down to.

In terms of challenges, one of the biggest ones is, of course, raising money to build hospitals. The majority of our new estate have been built through careful housekeeping within the Trust, but the Mossley Hill build was slightly different. A huge amount of credit must go to Claire Murdoch, NHS England’s (NHSE) National Mental Health Director, who has continuously championed better mental health environment funding for the NHS. The Mersey Care business case for Mossley Hill was based on a transparent and collaborative business plan between us and estates experts in NHS England. This ensured a strong rationale and return on investment for the NHS and the taxpayer.

Another major challenge was getting costs confirmed. Normally, the procurement process guarantees you a maximum price. Unfortunately, the state of the market at the time of agreeing this business case meant nobody would give us a guaranteed maximum price. We fixed 75% of the cost and we had 25% that was movable because people couldn’t hold the prices on a two-year build. But we’ve got a good track record of doing what we say we’re going to do and, if we know it’s going off schedule for cost or time, we engage early. That probably gives our commissioners and NHS England confidence.

Deana Huizer, Estates Lead

I have been involved in the Mossley Hill project since 2015, when we did the initial design work. At that time, I was responsible for the co-ordination and development of the brief along with the architects, staff, service users, carers and the wider stakeholder groups, linking in with local ward councillors. The project was put on hold, but we were successful in securing funding through the Dormitory Ward Eradication Programme, so we were able to reignite the project in 2017.

We learned a lot from Covid-19 and the other Mersey Care builds that had happened in the interim, so we tweaked the design to reflect our solutions to some of the issues. A lot of it was around segregation and how to isolate service users who test positive.

Along with the communications team, we developed the communications and stakeholder engagement and identified our key stakeholders. It was during the pandemic, so we had to ensure we had the IT in place to facilitate remote engagement and consulted our clinical teams to facilitate safe face-to-face workshops, particularly for our service users. We brought them down from the wards into a meeting room where they filled sticky notes and created a wish list for the new building. Prior to 2021, we did public consultation events that were drop-in sessions, and we kept staff updated with posters, newsletters, emails and our website.

The overall therapeutic environment for patients is hugely improved and we’re making it a better place to work, which will encourage recruitment. I believe there’ll be a reduction in the length of stay for service users because staff are able to care for them in a better environment. It will also improve the estate’s sustainability and reduce our carbon footprint – it’s built to BREEAM excellence and will be the first hospital within the Trust to have a full air source heat pump.

I would advise others to get the architects on board from day one because they have the creativity and – in the case of Gilling Dod – significant experience within mental health design. They had that breadth, which they brought to the sessions, and would often take control to get out of stakeholders what they needed from an architectural point of view. Also, take your time when developing your schedule of accommodation and getting your design right. If you can, don’t leave anything out that will cost you more to put back in.

Donna Robinson, Divisional Director of Mental Health Care and Director of Mental Health

There were so many false starts due to land issues and availability of site. Initially, the big challenge was the land and the size we needed. We’ve fit the build into the land we have. And we had the pandemic right in the middle of the project! We’ve learned a lot about our buildings through the pandemic – including things we wouldn’t do again – and we’ve had four new hospitals built and several refurbished, so we’ve taken learnings from those projects. Mossley Hill will be the best building this Trust has. The pandemic also caused supply chain issues and, because of that, the availability and costs are significantly increased. From a mental health perspective, you cannot compromise on some products because they’re needed for safety. For example, there are only so many anti-ligature furniture and installation providers, so we can’t simply go out and find the cheapest and most readily available.

Our staff, service users and carers were all involved in the design and layout. I’m an RMN (registered mental health nurse) by background, so I know the flow of a ward and how things need to work. In the early days, I went to some of the design workshops and facilitated conversations asking staff: what are your day-to-day frustrations? What can you not access easily that you need? I had oversight through the formal project teams and also ensured we were getting value for money. From a leadership perspective, our role is remembering this isn’t about what we want in a build, it’s about what the staff need to facilitate them doing the best job for the patient and what the patients find is important to them.

There can be disagreements – do we want A or B? So, I go away and find out what A and B really do, what are the differences and what do those differences mean for the patient, does the choice meet any health building notes (HBNs), is it a safety feature, does it meet IPC, etc. We do a quality check on design team suggestions to ensure the HBNs are adhered to, we’re meeting the needs of IPC, the operational flow of the building works and that there’s appropriate access and egress.

Over the years, we’ve learned that, when moving into a new build, it’s important to remember it requires a different way of working for staff. They’re used to dormitory accommodation and managing shared gardens, which restrict how a ward works, so we do a lot of preparation before we move in on culture and change of practice. To do observation in a single bedroom is different than in a dormitory because you’re going in and out of rooms, so that might need a new policy. We get staff to live in a new building first; they have a sleepover and get to know what it’s like to have a shower there, to use the facilities, what the beds are like etc. You can’t pick them up and drop them into a new hospital and expect them just to get on with it.

There are so many improvements in this building. The big thing for me is the open access to outside space. When we opened Hartley Hospital in Southport in 2019, we found this was a game changer for our patients. They may not be able to leave hospital from a legal perspective, but they can open the door and go out into a purpose-built safe garden space. That’s really useful for managing somebody who is frustrated and needs to go out and decompress.

One of our older adult wards has got an immersive space, which can change the whole dynamic for a patient. At a different site, a patient with dementia was completely mute, but we transformed the immersive space into a football stadium for him and, because he was a Liverpool fan, we played You’ll Never Walk Alone. He sang along. It was heartbreaking, but beautiful. Before he was discharged, we brought his wife, daughter and granddaughter in and they heard his voice again.

I don’t think people always appreciate how difficult it is to get the space you need but, with the will of the organisation and the commitment behind us, we’re finally getting there and it’s massive for us.

Tonia Smith, Service Lead

I was originally the matron at Broadoak and have been involved in the project from the beginning. I’m now part of the project group – we meet once a month and it involves all departments (design, finance etc.) and report on where we are and updates for each month. A lot of the information we discuss and agree in the project group feeds through to the steering group, which involves more people who aren’t all necessarily involved in the project. The project lead and I have a meeting every Monday to discuss anything that comes up between meetings to keep things moving and prevent delays.

Currently, I have eight areas across several sites and four of them are going to the new Mossley Hill Hospital. Having all four of my acute wards together is going to be great. The geography of our Windsor House site is quite difficult at times and it’s a standalone unit, so we have to review and risk assess all of our patients that go into that unit separately. They’ll feel more connected and more part of the community. One of the additional services we’re going to have is the Section 136 Suite. I’ve been involved with these before, but it will be good for staff to see the urgent care side of things.

We’ve already started away days with the managers to develop a plan of how we’re going to move into the new build and support service users with that transition. We’ve done mock-up rooms for staff so they can go in and identify things we might need to change before moving in. Shortly, we will start establishing the wards and teams, and we’ll be mapping out how we’re going to operationally manage that environment, all before we transfer the patients.

We’re so excited and we all believe this is going to improve our service users’ lives. I get quite emotional because it’s going to allow me to provide basic things I’m not able to give my patients right now.

Jeanette Murray, service user

About 18 years ago, I found my dad dead and it tipped me over the edge. I had a mental breakdown. I was in and out of hospital for a few years and had no self-worth. Social services threatened to take my daughter from me. I realised there wasn’t anyone to wave a magic wand and fix everything for me – I had to do it myself. So, more than 10 years ago, I pulled my socks up so high they’re still up. I got my daughter back home and never looked back.

I used to go to the Mossley Hill site when the old building was up to do a thing called ‘PLACE’, where we’d go round the hospital and check that things like light bulbs were working and taste-test the food to make sure everything was good for patients. Leading on from that, my involvement as a service user with the new build is to make sure the hospital is planned out properly to keep the patients safe. As part of this, I went over to Belfast to check out a new mental health hospital to see what we could bring back to Mossley Hill. In addition, once a month I meet with the steering group to discuss how things are going. They really involve me in the conversations and it feels good to be part of that.

I’m on both sides of the coin – I’ve been a patient in the hospital and I’m also allowed to go back into the hospital to do this type of work. I feel very humble and blessed that I was asked because I like to give patients hope. You can come out the other side.

Patients are in shared bedrooms now, so there’s not much privacy. The hospital is supposed to be a therapeutic environment for people to recover, but if you’re exposed to the explosive, sometimes distressing behaviour of others where you’re meant to sleep, it doesn’t help you recover. You don’t have your own space to relax. As well as the single en suite rooms, the grounds are beautiful. It gives patients a chance to get closer to nature in such a relaxing, peaceful environment.

I just can’t wait for it to be built because I know what the patients are going to get out of it – it’s going to be a place of serenity.

Robin Graham, Director of Gilling Dod

Gilling Dod designed the exciting new hospital in a dynamic co-production with the Trust’s service users and staff. Light-filled and homely wards with en suite bedrooms for all service users overlook a nurturing ring of gardens and mature trees.

The collaborative design process has led to a series of patient-centred measures being incorporated into the final design, including two gardens for every ward with level access from lounge and dining areas, a series of therapy spaces including an art room, immersive room, gym, ADL kitchen, music room and a central café at the heart of the building.

Service users and staff have also informed the interior finishes, selecting colours and materials with the interior designers.

Sustainability has been central to the building’s development. The building is fully electric, using air source heat pumps to provide heating and solar panels to provide electricity. This will ensure the building can operate to net zero carbon as the national grid decarbonises.

To stay up to date with the latest news about Mossley Hill, scan the QR code: https://www.merseycare.nhs.uk/our-services/our-sites/liverpool/mossley-hill

Key stakeholders

Mersey Care NHS Foundation Trust

Gilling Dod architects

Graham builders

Project timeline

2017 – outline business case completed

2021 – full business case completed and competitive tender process held

2022 – HM Treasury and the Department of Health and Social Care approved the next stage of the scheme and work began on site

2023 – ‘ground breaking’ event held, jobs fair for construction roles on site to employ the local community

2025 – handover

This article was taken from the November 2024 edition of FORTIS magazine.

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This article was written for the November 2024 edition of FORTIS magazine; a forum for the NHS to share ideas, innovations and case studies. To read the publication in full and access digital copies, visit FORTIS magazine. FORTIS magazine is free for NHS change-makers and leaders and is available as a print or digital copy. FORTIS magazine is managed and owned by Health Spaces Ltd.

A place of serenity – Case study: Mossley Hill