A £1.5bn investment for new hospitals, maintenance of the existing hospital portfolio and improving A&E capacity was the focus of June’s Build, Build, Build government announcement. For many of us working within the healthcare built environment this commitment to rebuilding the economy through services for all – including healthcare – is music to our ears, even if the new deal isn’t really new after all. However, the big question still remains ‘how can we build a healthcare system fit for future purpose, when so much about our current healthcare situation is so unknown?’
Let’s start with the pandemic itself. Healthcare professionals including infectious disease specialists are openly claiming how little is known about COVID-19. Great strides have been made in a short time, but there are still many unanswered questions about how the virus started, how it spreads, its legacy and most importantly, how to cure and prevent it. While they continue their 24/7 research into understanding it more fully, they are concurrently trying to treat patients with the virus and those who are suffering long-term effects from it.
So, what does this mean for hospitals and the buildings in which these medical professions are currently working? How will COVID-19 impact these healthcare spaces in the future? These are questions which currently no-one knows the answers to. What we do know is that we need to rethink the design of our hospitals and healthcare estates provision. We need to look at the present space, imagine what a multi-bed ward might look like with possible social distancing in place and how to continue to treat as many patients with less beds per room. We need to think about how we ventilate our hospitals and other operational systems that are in place that might have been driven by an environment agenda to help reduce carbon and recycle existing energy, but now might bring an element of extra risk to patients. We might need to look back at the original Nightingale Hospitals that were built to treat patients with TB and their fresh air systems and take learnings from the past into the future.
We also need to look to the present to help plan for the future. Within the NHS we have a legacy of acute hospitals with some buildings aged up to 100 years and backlog maintenance issues that we already knew, pre-pandemic, we needed to fund and fix to make these healthcare buildings fit for purpose. In order to start any of these maintenance works, or for any construction to begin, we have a three-stage process in place. A Strategic Outline Case has to be approved before the Outline Business Case is considered, ahead of a Full Business Case being drawn up. Much of the process needs to be addressed and sped up, alongside the new guidance, before we can begin to move forward.
The government’s instruction to build for recovery is a grand, and great gesture. Its pledge to invest in healthcare, that the pandemic has put even more under the spotlight than ever before, is one that, of course, we welcome. Yet, we need to think carefully before we proceed. We need to focus on creating a value-based procurement process at the outset of the project lifecycle to ensure that the money is well spent, and that we are not just jumping through bureaucracy hoops for bureaucracy’s sake. And of course, we need to acknowledge that it might take time for us to understand what healthcare provision needs to look like before we can build to meet those needs. As we wait for our learned colleagues in the medical profession to understand the long-term impact of the pandemic, we need to create healthcare spaces that have flexibility and agility to allow adaption. We need collaboration with our colleagues across the built environment – the designers working on innovative solutions on how we design to meet these challenges, the expertise of building and M&E contractors and those who run healthcare estates to maximise the value of the investments.
The time is right to invest in our healthcare estates. However, we also need to invest energy and commitment into getting it right for future health estates to ensure that we are creating buildings that can resist another pandemic and provide healthcare environments fit for the 21st Century.