Sunday, 25 July 2021

Hospital Job

In the last few weeks, I have found myself in hospital. Luckily, it wasn't as an in-patient or a visitor, just incidental to some schemes I am working on and it's got me thinking.

Hospitals are funny things because that are not a place as such, they are often more like a large village or a small town. They have buildings with different functions, they have their own street networks and they have transport interchanges. Many also have to deal with significant levels of tidal motor traffic. Some areas are for people who work there, some areas are for people visiting and some areas have people staying long term. They are also a places of joy and misery, birth and death. 

Hospitals also have tentacles which extend and influence the communities around them, depending on where they are located. Some of course remain in urban areas, but many are on the edge of town where urban sites have been consolidated and the land sold. In some cases, they are as difficult to get to as the next town or village. Some hospitals started as a hamlet and have simply evolved to their small town status. Others have been planned, but changing needs have eroded the original vision and they have ended up being a sprawling mess.

Basildon Hospital in Essex. The main entrance is
over 300 metres from the nearest public road and
that public road is a massive roundabout designed
to move traffic around.

I guess some of these things could apply to higher education campuses, business parks, regional shopping centres and the like, but hospitals will always have that little bit more going on which makes them an interesting case study as a land use. The other dimension is that the largest hospitals are often up there as one of a town's largest employers and so the fortunes of that town and its citizens are inextricably tied to it.

City centre hospitals (in theory) should be simple enough to get to by foot, cycle or public transport and precious land reduces the ability of car parking to be provided. Because of building security, however, access is sometimes only easy from one direction with a main entrance. A key "journey end" of walkability is having easy to access (and legible) building entrances - if they are tucked away or require walking around a city block (depending where one walks from), then they are less attractive to the visitor. The same goes for cycling, although at least someone on a cycle can more quickly get round the block!

Queens Hospital, Romford, East London. An entrance point
is just to the left, 200 metres from the main public cycle
parking. The sign post on the left has a "cyclists dismount"
sign on the same sign as directing people to the cycle parking.

Out of town/ sites on the edge of town are a nightmare. They are often away from significant public transport interchanges and this immediately erodes the ease of walking there. Cycling access will of course depend on the quality of local cycling infrastructure which as we know will be highly variable. More than that, assuming someone makes it to the site perimeter, it's often a long walk to the reception and cycling is rarely provided for.

In terms of planning for walking and cycling for a new or existing site comes down to giving people direct options. Walking can of include getting from any site bus stops to the entrance and cycling becomes walking as soon as cycle is parked. Walking also becomes the mode of choice where people drive to the site and have to get into the building. Giving people direct options will be a combination of the following;
  • Develop a direct walking and cycling network from multiple points on the site boundary. Give people the option to arrive at plenty of points on the perimeter;
  • In this network, make sure there is an orbital route (with walking and cycling in their own spaces if possible). This helps people get around the site to get the right building/ building access point, plus the hospital estate actually creates part of a much wider traffic-free route;
  • Unless there are small blocks, provide multiple access points to the estate buildings. If someone has to walk for 10 minutes within the building that's an unseen barrier;
  • Provide secure cycle parking right by every entrance, both public and staff. Really make it easy to get right to the entrance nearest the department that people need to access. For staff this will mean the provision of lots of showers/ changing points rather than one central one that they have to schlep to
  • Get bus stops as close to the building as possible. Where set some distance away, then provide a wide, direct and legible walking route so people can see the main entrance from the bus stops and the bus stops can be seen from the main entrance. Real time bus information in the entrance area also means people can stay in the warm.
  • Place general car parking on the perimeter of the site - if people are going to be driving, then they will need to walk the last part of their journey, but it will be on the direct walking network provided. Blue badge parking should be placed close to entrances, but access to it should not be prioritised over walking and cycling routes.
  • Passenger transport and emergency vehicle access points should be provided at appropriate locations near the building, but care should be taken to make sure that maneuvering of ambulances and mini-buses should't conflict with walking and cycling routes.
  • Drop off/ pick up points can be close to building entrances, but access loops should not conflict with walking and cycling routes.
  • Develop a system of wayfinding which integrates with the same approach outside of the site. Of course, this relies of the site being plugged into a decent highway network, but getting the hospital right will help make the case for external investment.
Now, there will be all sorts of other soft measures such as travel planning for staff, but getting the infrastructure right will future-proof the changing needs of the site in future and soft measures will be about signposting how people can travel rather than encouraging them.

Westminster Bridge, London. A cycle track passing
Guy's & St. Thomas' Hospital (behind the trees). Cycle parking
is under the main building, but to get there one has to mix
with traffic in the undercroft service area.

Hospitals by their nature will have people visiting who cannot walk and cycle and that is fine, but many people (including many staff) can and we should be giving people real choices. If we got this right, then we'd see pregnant people cycling to antenatal appointments, people walking to get their blood tests, people cycling for checkups and staff being able to choose an active mode to help with their own heath and stress. People who have to drive could do so and they may stand more of a chance of getting a parking space.

Like anything in life, changing the transport footprint of a hospital takes effort and resources. It also requires thinking both within and beyond the site boundary to make sure everything is integrated. It is increasingly rare for people to go through their entire lives without visiting a hospital and so we really should be making this as easy and stress free as possible. For my mind, walking and cycling should be a key part of this. 

Have a look around your local hospital and I bet in most cases, you'll find another car-dominated mess which is reflective of our wider planning environment. You'll find archaic rituals for staff wanting to get car parking permits, cycle parking will be an add-on and walking routes will be confusing across sprawling sites. In many cases, direct walking and cycling routes will be through service yards or will have buildings blocking the obvious way through. As ever, I'd be interested in your views and experiences.


  1. Oooh, this is interesting as Basildon used to be my local hospital and I've travelled there by car, bicycle and on foot.

    Unsurprisingly, a huge number of people drive there, even though it's actually fairly accessible locally on foot or by bike. As I'm sure you noticed, the cycle parking leaves a lot to be desired, but its location isn't too bad and there are cycle paths of varying quality that can get you to the site. The hospital is also served by a few bus routes, including one from near Basildon train station.

    The roundabout you mention, and the road it sits on are probably the biggest external barriers to access. Rush hour queues can make it very slow to get on/off the hospital site by road (walking to/from home was quicker), which obviously makes public transport less attractive as well. Complaints about the queues and 'excessive' car park charges featured regularly in local press too, with little discussion of the alternatives.

    I've only been to Queen's hospital in Romford once (about 18 months ago) and found the public cycling provision virtually non-existent. Walking from the train station was okay, but less pleasant once you reached the main road near the hospital and access was not very well signed for pedestrians.



    1. You can now kind of get there by foot or bike fairly easily as a new crossing has gone in (badly). Hopefully this can be built on in the future.