CRISIS PLANNING


Bracing healthcare facilities for impact of pandemics


Nebil Achour, Director for the MSc Healthcare Management programme at Anglia Ruskin University, argues that while frontline NHS clinical staff and their estates and facilities colleagues have undertaken tremendous work as the pressure on healthcare facilities has ramped up during the UK coronavirus outbreak, a re-think is needed on making hospitals and other healthcare facilities more resilient and able to ‘cope’ in the face of events such as pandemics, where existing guidance and contingency plans may no longer be up to date or relevant enough to today’s healthcare, or to the mass casualties that such events can cause.


The ongoing COVID-19 outbreak has demonstrated its ability to disrupt healthcare services globally, and afforded some sense of scale as to what a severe mass casualty event looks like. The pandemic started in China in December 2019; however, it did not cause any significant concerns for the Chinese authorities until January this year, when the number of infected people started increasing exponentially, forcing such authorities to look to immediate solutions. The WHO declared COVID-19 as a pandemic at a later date, when there was sufficient evidence that it was beginning to rapidly spread across the world. At the time of writing this article, over 8.7 million people have become infected, hundreds of thousands are receiving care , and around 462,000 people globally have lost their lives as a result of contracting the virus.


Risk is often modelled as a combination of hazard, vulnerability, and exposure, which tend to affect the risk as they increase or decrease (Fig. 1). In the case of COVID-19, ‘hazard’ (i.e. the coronavirus), and vulnerability (i.e. lack of health immunity), are perhaps difficult to control at this stage, for a substantial number of reasons, meaning that exposure to the virus (i.e. the number of individuals exposed) is the only one of the three aforementioned factors that nations and societies worldwide can influence; this explains the lockdown policies implemented in recent weeks in many countries, including the UK. Via such a lockdown, the hope is that the numbers of casualties, and in turn the resulting pressures and demand on healthcare systems not designed to cater for such a sudden influx of patients, can be reduced.


Need for good preparedness In the first instance, the problem can be viewed as a public health issue; however, as hospitals play a pivotal role in healthcare systems, they need to be well


Vulnerability Hazard RISK


personal protective equipment (PPE) for their staff, many of whom are anxious, yet are doing their best despite the loss of some of their colleagues. Staff are, of course, the core component of the operation of hospitals, and stress and anxiety among them can lead to a total failure of the healthcare service.2


Many Exposure Figure 1: Risk components.


prepared for such eventuality. This article is very much a reflection on how the NHS has responded to this pandemic, but with particular emphasis on its estate. While fully recognising the tremendous work that colleagues in the NHS have been undertaking, regardless of their role, background, or level of seniority, I argue for a revision of the current approach to healthcare facility resilience so that the NHS is significantly stronger and can better deal with such major emergencies in the future. My aim is to identify key weaknesses, develop opportunities for improvements, and to propose suggestions for enhancing the resilience of this vital resource, keeping in mind that ‘the most expensive hospital is the one that fails’.1


Impact on society and response On 22 June 2020, according to the Government’s own figures, there were at least 304,331 people infected with the coronavirus across the UK, with some 42,632 people having died in hospital after contracting the virus. Hospitals have – in some cases – been stretched beyond their limits in terms of staff, equipment, supplies, and space, and a number have struggled with the lack of ventilators and


GPs, dentists, and other medical professionals have already closed their doors, and referred their patients to ‘111’, even if their urgency is not related to COVID-19; the result was further pressure on the 111 service, and even longer waiting times. These issues suggest weaknesses in the system, and raise questions about the effectiveness of such measures; specifically, experience shows that demands on the healthcare system do not reduce when major disasters strike. For example, in recent research, a colleague and I discovered that a sample of 118 hospitals in Japan’s Kumamoto prefecture accepted 6,688 patients (i.e. 240% the total number of earthquake- related injuries) following the earthquake in the region in 2016, highlighting the importance of maintaining hospitals’ normal clinical activities for patients with non-earthquake-related conditions.3


Space and bed availability With the growth in the number of UK coronavirus patients, many clinical services – including operations – were cancelled to reduce infection risk, but, more importantly, to create further space to accommodate the surge in cases. However, many hospital and emergency department buildings are very old, and were designed based on ageing approaches and guidance. Health Building Note (HBN) 22 guides designers in determining the space required space for Accident & Emergency Departments. A comparative study concluded that the guidance in the HBN provides for the lowest space among the various international standards, such as the


July 2020 Health Estate Journal 19


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