HEALTHCARE INFRASTRUCTURE


slow’ current healthcare planning and approval process – despite attempts to speed it up. He added: “Another current oddity is that current schemes in the pipeline effectively have to work to a budget, which is the number they first thought of. This means that an early estimate – before the full planning is undertaken, and all the strategic options are considered – becomes a hard budget constraint.”


Increased funding for diagnostics Recently, the Government had made ‘a welcome announcement’ about increasing the funding for diagnostics; but there remained ‘more to do’ here. He explained: “The development of offsite diagnostics, and offsite surgical services, will be an important part of relieving the pressure on some of our hospitals. One of the lessons when we look internationally is that if you try to mix your planned work with your emergency work, the latter swamps the former. While we’re trying to get hospitals to do both currently here, I think our chances of ever returning to a reasonable waiting list look small.” There were ‘big opportunities’ in rehabilitation services for private sector providers, who could not only build hospitals ‘much cheaper than the NHS’, but also provide a way to improve some of the outcomes for stroke and trauma.


Lessons from the pandemic He continued: “There are some lessons from the pandemic we should be building into our new hospital building programme – one positive outcome having been much faster decisions on capital. We’ve also learned we have too few single rooms, and, due to savings made to squeeze as much as possible from the available budget, have limited space in departments and corridors, and poor internal flows.” His view was that this probably accounted for UK nosocomial transmission rates ‘massively in excess’ of those seen in Germany and Austria, which had not ‘suffered from some of these problems’. The pandemic had also seen a realisation that UK hospital engineering tended to be ‘underspecified’. Although, in Nigel Edwards’ view, there was ‘no need to try to prepare strategies for the next war using too many of the lessons from this pandemic’, given that it was likely that the next pandemic would be ‘respiratory’, he said ‘we should at least do something about the problems we have encountered in the past 18 months with oxygen and levels of ventilation/air changes’.


Staff changing facilities Another important element ‘value engineered’ out of some new healthcare buildings had been staff changing/welfare facilities. The speaker said: “With 90,000


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vacancies, and staff catching COVID in their own inadequate facilities, when we rebuild, we should re-think more about what staff need.” Interestingly he noted, while Germany has twice the number of hospital beds as the UK, for COVID they had extensively used ‘hospital at home’ and virtual wards. Nigel Edwards said: “While the UK did similarly, it certainly seems to have been a crucial part of their early response, and among the reasons why – at least in phases one and two – they did better. “Finally,” Nigel Edwards said, “there is a need for more separation of planned and emergency work.” He pointed to the Netherlands, which – like the UK – has very small bed numbers per head, but is starting to build specialised elective surgery and diagnostic hubs. He concluded: “So, there is a lot to learn both from what has just happened, and what happened before. As Siva said, flexibility, imagination, and thinking beyond the hospital’s walls, are all part of the answer, which is where primary care comes in, because it’s absolutely crucial.”


Former Health Secretary’s standpoint


The day’s third and final speaker, former Secretary of State for Health, Alan Johnson, began by congratulating all involved in setting up the APPG. He said:


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