HEALTHCARE ESTATES 2021 PRESENTATIONS
A range of not always accurate definitions
“So, what is the hospital?” Stephen Wright continued. Here he showed some definitions from well-known bodies. For instance, the WHO defines hospitals as: ‘Healthcare organisations that have an organised medical and other professional staff, and inpatient facilities, and deliver services 24 hours per day, seven days per week’. The speaker pointed out, however, that ‘not all hospitals have inpatient facilities, or operate continuously’. Meanwhile, the Center for Global Development says: ‘A healthcare facility that provides inpatient services with at least 10 beds, and operates with continuous supervision of patients and delivery of medical care 24 hours a day, seven days a week’. Stephen Wright asked: ‘Why the arbitrary threshold of 10 beds?’ The Oxford English Dictionary, meanwhile, defines hospitals as: ‘An institution providing medical and surgical treatment and nursing care for sick or injured people’. Stephen Wright noted, however, that ‘not all hospitals do surgery’, while ‘some institutions do
these things, but are in fact not hospitals’. He said: “As you can see, none of these definitions are very good, because, for instance, some hospitals don’t do these things, and others do more, so we need to have a better definition. However," he told the audience, “having hunted around, the NHS doesn’t seem to have a definition of a ‘hospital’, despite the fact that we have over 1,000 here in the UK.”
‘Just so’ analogy
Returning to the definition of a ‘hospital’, Stephen Wright used the analogy of a cartoon illustration from one of Rudyard Kipling’s ‘Just so’ stories – ‘The Elephant’s Child’, or ‘How the elephant got its trunk’. He said: “The story discusses how the baby elephant had its trunk stretched when it was being grabbed by a crocodile, and suggests that this is why elephants have long trunks, when it’s probably not right. So,” he continued, “we shouldn’t tell ourselves ‘Just so’ stories about hospitals
Stephen Wright described hospitals as ‘incredibly expensive pieces of equipment to maintain’.
being big places with lots of beds, and lots of doctors as well; I mean it just happens to be an attribute. It’s a correlation, not a causation of what they do, and what we tried to do in the book that I mentioned was to define hospitals by their functions. The hospital does a certain set of things, which are intrinsic to a wider system, but then you need to define that sub-set of things, and why you put them there, rather than elsewhere.” He continued: “In my involvement with the health sector, one of the things I noticed quite early on was that there are plenty of things which are done in all sorts of settings. You can do things in primary care that you can also do at hospital; how do you split those activities?”
Hospital capacity
Another question he and his colleagues had carefully considered was: ‘What is hospital capacity?’ He said: “Whenever I ask a hospital professional: ‘How big is your hospital?’, they’ll usually say something like: ‘It’s got 850 or 320 beds’,
or whatever the number is. While that’s one way of measuring capacity, I don’t think it’s a particularly good one.” One of the ‘classic reproductions of that way of thinking about hospitals’, he noted, had occurred in the United States immediately after the Second World War, where an Act of Congress had attempted to push extra hospital capacity into the south of the US, and had actually defined the number of beds which needed to go into that ‘whole region’ of America. Dubbed the Hill-Burton formula in recognition of the two Congressmen who took the legislation through Congress, the same formula was still used today, ‘in a lot of hospital planning, including in the UK’, although not in relation to the whole hospital, but instead ‘in a much more granular way in terms of departments or disease level’. The speaker said: “But I think that’s not a very good description of what the hospital is, because the hospital bed does two things for you – it’s a small part of the total capital stock, and clearly the
January 2022 Health Estate Journal 19
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68
