A Nuffield Trust briefing has recommended a “national stocktake” of the shortcomings of hospital estates is needed urgently, in preparation for any future pandemics.
The briefing: ‘Overlooked but not overcome: smaller hospitals and the staff response to the COVID-19 pandemic,’ reviewed the response to COVID-19 in the context of smaller hospitals, although the problems discussed are equally applicable to many of the large acutes. It highlighted estates-related problems, alongside issues around staff redeployment, communication, management and insufficient support for staff, including mental health and wellbeing.
The all-too-familiar problems of ventilation and oxygen supply within an ageing estate, often necessitating the redesign of wards or relocation of patients whilst implementing infection control protocols, inevitably caused problems. The authors of the briefing state: “Problems with estates actually drove, and constrained, the pandemic response.”
As well as the recommended “national stocktake,” the briefing says the Health Infrastructure Plan needs to be reviewed in light of the pandemic, with a view to ensuring robust supplies of oxygen, adequate ventilation and appropriate infection control measures in all hospitals, not just planned new-builds.
Working with Archus, Nuffield Trust is conducting further research for the New Hospitals Programme, which it says should be incorporated into Health Building Notes and Technical Memoranda to inform future estates development. This should include lessons for areas not covered by Health Building Notes, such as staff facilities.
Related to the issues of estates and buildings, most organisations struggled with bed capacity in all clinical areas, even prior to the pandemic. It is essential that the capacity of smaller hospitals meets their current need, particularly with regard to intensive care provision, as well as considering how surge capacity can be embedded within organisations. The briefing recommends this may include upgrading non-clinical spaces so they can be used to safely bed patients during an emergency, through provision of spaces large enough for beds in cubicled areas, such as outpatients, oxygen in non-clinical spaces along with sufficient toilet and bathroom facilities. In addition, thought should be given to how operating theatre, recovery and other similar spaces can be kitted out as ‘shadow’ ICUs.
Other issues that the authors conclude require more attention are:
• Disaster planning. No hospital had disaster plans for a prolonged, non-influenza pandemic, and all failed to plan for a second wave that may be worse than the first. Templates for local responses to major disasters, developed by experts, would relieve smaller organisations of tasks for which they may not have the appropriate staff, skills or experience.
• Management. No organisation felt every aspect of their management and communication was entirely right. Failure to recognise that different stages of the pandemic would require different approaches was the most pervasive issue, alongside the extent to which organisations were able to put in place managerial structures that were robust, responsive and capable of making short-term/tactical and long-term/strategic decisions. Improving the situational awareness of executive teams would be beneficial. Aspects of the streamlined process and speedier decision-making introduced during the pandemic should be retained, whilst ensuring quality controls and good governance.
• Difficult behaviour. This is able to disrupt the pandemic response. Questions over who is responsible for the management of staff and to what extent staff can be compelled need to be explored at national and local levels, including determining the appropriate response.
• Mental health and wellbeing. Although all organisations took this seriously, the briefing notes the levels of distress shown from the cohort of interviewees was unexpected. This suggests that the resources put in place to support the emotional health and mental wellbeing of senior managers is inadequate and needs to be addressed urgently at local and national levels.
