The number of patients on NHS waiting lists for acute care reached an all-time high of 6.2 million in April, with the pausing of elective care during the Covid-19 pandemic taking much of the blame. However, the mounting elective care waiting lists were an issue to be addressed long before the 2020 pandemic, with outdated hospital estates unable to keep up with rising surgical demands. Indeed, hundreds of elective procedures have been cancelled as a result of tired hospital infrastructure, with Robert Naylor stating in 2017 that without significant investment, ‘the NHS estate will remain unfit for purpose and will continue to deteriorate’, diminishing future elective recovery plans.
Indeed, the number of clinical incidents as a result of outdated hospital infrastructure in need of urgent refurbishment has tripled in the past 5 years, with incidents including an unconscious patient on a ventilator being trapped inside a lift for 35 minutes, a report by The Times has found. The report details the responses to freedom of information requests, illustrating the true extent of the devastating effects of the ‘crumbling NHS estate’ on patients, highlighting that existing tired infrastructure is unable to keep up with modern requirements.
It is evident that alongside the growing care backlog, there is a significant maintenance backlog across NHS Trusts and Health Boards that urgently needs addressing. Naylor states that the NHS estates covers a gross internal area of 26 million square metres, however around 1.5 million square meters of this is completely un-utilised as a result of infrastructure being too hazardous and outdated for modern requirements. In addition to this, a recent YouGov poll of 1000 private healthcare employees and 750 NHS employees has found that 50% of healthcare professionals believe that their workplace cannot house any additional staff due to a lack of availability of physical space. This therefore hinders recruitment efforts and reinforces Naylor’s statement that the NHS cannot most effectively address the growing backlog of care without the modernisation and refurbishment of infrastructure.
With pressures on the NHS at an all-time high, and maintenance costs from £5.5 billion to £9.2 billion, the idea of building new, modernised, hospitals seem appealing, however in reality this is a time consuming and expensive initiative that will not best address shorter-term issues. This is best demonstrated with the example of the Royal Liverpool Hospital, where redevelopment plans began in 2002 and are still yet to be completed.
In situations where urgent capacity issues need addressing but the exiting hospital estate is not sufficient to accommodate this, flexible Healthcare Spaces solutions can be deployed. Modern Methods of Construction (MMC), such as those used with the installation of modular healthcare facilities, allow for the accelerated delivery of additional capacity solutions to extend the existing hospital estate. Mobile, modular and mixed-modality Healthcare Space solutions can be installed during periods of refurbishment or strained capacity, providing a cost-effective and sustainable alternative to addressing growing waiting lists and transforming patient care. Moreover, the introduction of modern technologies and up-to-date infrastructure facilitates recruitment drives, offering greater opportunities for the development of skills within a modern working environment.
Following calls from the Royal College of Surgeons in 2021 for the introduction of surgical hubs, modular operating theatres were installed in Newcastle and Roehampton to combat growing surgical backlogs. The rapid delivery of these flexible Healthcare Spaces extended the existing hospital estate, providing additional capacity and ensuring that the hospitals were best equipped to tackle their acute care waiting lists in a matter of months rather than years. Additionally, a replacement CSSD capacity solution was recently installed in Reims, France to maintain and increase capacity whilst the current CSSD underwent a period of refurbishment. Recent demands on capacity have increased the attractiveness of MMC facilities thanks to the nature of their accelerated delivery and the benefits that are associated with off-site construction, such as minimal site disruption and cost savings. What’s more, the use of more sustainable materials, such as steel and timber, enhance the flexible nature of facilities, ensuring that they can be best adapted to the current need, unlike traditional bricks-and-mortar NHS buildings, many of which have been in place since before the establishment of the Health Service in 1948. This best demonstrates the multifarious benefits of installing bespoke clinical infrastructure solutions to augment the existing hospital services either as interim solutions throughout periods of refurbishment or as longer-term solutions to assist the NHS with their continuous improvement efforts.
Long associated with the terms ‘temporary’ and ‘emergency’, should the NHS look to effectively ‘build back better’ in the wake of the pandemic, it is time to start viewing flexible clinical infrastructure, in particular MMC, as sustainable and permanent solutions to rapidly improve the existing hospital estate, not only to increase and replace capacity but to improve patient outcomes and facilitate in recruitment drives. The existing healthcare landscape is littered with unused clinical space, and with time a crucial consideration in the current climate, it is time to consider alternative solutions to modernising the hospital estate.