CRISIS PLANNING
‘generic’ business continuity plans are of only limited value.
Hospitals feature extremely complex and interconnected infrastructures and ‘systems ‘that depend on each other to operate. Figure 4 provides a simplistic representation of a hospital to highlight the major influencers. It illustrates five major internal influencers – namely the building(s) with their structural and architectural integrity, lifeline utility networks, equipment, supplies, and staff. Hospitals also depend on external networks such as roads for access, and on suppliers to maintain their provision – e.g. of power, water, gas, medicine, and food. A major proportion of HBN 00-07 takes inspiration from the World Health Organization (WHO) Hospital Safety Index, which was developed by a global panel of experts, and captures the most common components of hospitals to provide an overall index on the level of preparedness of each such facility. The index is mostly used to identify the vulnerabilities at each hospital at an early stage, and as a measure to quantify the level of improvement or deterioration within hospitals. HBN 00-07 needs to be revised again, based on a different approach, driven by research, innovation, and stronger evidence, as a first step.
Opportunities to strengthen hospital resilience
Lack of finance and the adoption of prioritisation strategy makes us work in ‘fire-fighting mode’, where we neglect so many things and focus on those that have to be done immediately. Such a way of working also limits our knowledge, curtails opportunities to be more innovative in our thinking, and makes us
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0 20 40 60 Hospital age (years) Figure 4: Functionality of hospital critical systems (when well maintained).3
overlook opportunities. There are a significant number of examples from international experience that provide lessons for building a strong and resilient resilience approach. However, these are not well captured in the UK approach, which makes us wonder about the reasons. The belief that the UK is safe from disasters is perhaps one of the major myths we have created. Natural hazards occur according to specific cycle or time intervals, often referred to as the ‘return period’. UK records are not complete in showing previous events, and it can thus be difficult to identify when the last major earthquake or flood occurred. However, we know that the last pandemic was the Spanish Flu of 1918, which infected approximately 500 million people worldwide, killing some 50 million people, while the 1820 Cholera outbreak killed 100,000 people, and the Great Plague of Marseille in 1720, 100,000 people. Does this mean that outbreaks follow the same principles, with a similar return period to earthquakes and floods? This might be the case, but what we know for sure is
that medicine has developed substantially since these outbreaks occurred; however I am still not sure whether the development of treatments and the level of preparedness we have are adequate for what we face now.
The lessons learned from these experiences need to be well captured in our approach to hospital resilience. Earthquakes are another hazard often dismissed here, due to the belief that the UK is safe from seismic activity; however , should it occur, this particular type of hazard is a considerable challenge for any hospital, as earthquakes damage infrastructure, and thus not only reduce supplies to hospitals, but also damage internal networks and the buildings themselves, while often creating significant clinical demand.
Conclusions and suggestions There has already been considerable effort to enhance the resilience of the NHS estate – including the development and updating of guidance. While existing guidance documents have focused on
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July 2020 Health Estate Journal 21
Critical system functionality (%)
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