HOSPITAL DESIGN
Making facilities adaptable and fit for future needs
In the wake of lessons learned about existing healthcare infrastructure, its ability to cope with exceptional clinical demand and pressures over the past year, and where some of the main challenges lay, Sophie Crocker and Dan Flower of HKS Architects consider ‘the optimum model of hospital for pandemic preparedness’.
We write this from the middle of England’s third lockdown. To date, as we write, there have been over 3.75 million cases of COVID-19 in the UK, and recorded deaths have just surpassed 100,000. However, a glimmer of hope has arrived on the horizon, as the Pfizer/BioNtech, Moderna, and Oxford University/AstraZeneca vaccines are all currently reporting high rates of effectiveness.1
By the time you’re
reading this, the situation here, and around the world, will no doubt have changed – hopefully along the same trend of positivity. 2020 was a tumultuous year (perhaps the understatement of the century), and, as the world continues along its expected trajectory, a certain level of turmoil must be assumed as the status quo. Pandemics are not the only shared health threat resulting from our increased global spread and impact. The climate crisis is intensifying natural disasters like wildfires and floods, making them increasingly devastating, and the very human threat of terrorism unfortunately persists through it all. What the last year has given us is a wake-up call. Around the world countries have dealt and are dealing with the virus differently. The UK’s healthcare estates have been put under pressures they have never before experienced, with many wards, and much of the infrastructure, services, and social facilities, designed in a time that did not – or could not – envisage the world of today, with all of its potential healthcare ramifications. This is because the impact of the pandemic is not only seen in the number of patients testing positive; there is a long-lasting ripple effect, the full extent of which healthcare organisations around the world may not be able to measure for many years yet.
Elective procedures cancelled In England, in order to cope with the number of patients needing general acute and critical care beds due to COVID-19, 80-85% of elective procedures and surgeries were cancelled during the first peak of the pandemic, last spring.2 Elective provisions slowly returned over
The FleXX Hospital prototype, designed employing the FleXX Hospital principles of a regular grid, standardised slab-to-slab heights, and pulling the MEP and vertical circulation to the perimeter of the facility.
the summer, beginning with oncology and mental health services, but last August’s day case elective activity was still only at 63% of the same month in 2019, and patients were waiting an average of almost 15 weeks for specialist treatment following a referral, seven weeks longer than in August 2019.3
In addition, attendances at Accident and Emergency Departments fell to less than 50% of the five-year average in April 2020, and a few months later were still well below normal levels for that time of year.4
above the normal rate was mostly attributed to COVID-19, there was a not insignificant number of deaths above this rate not attributed to the virus.5
This could
This is likely due to a combination of factors: people staying away from hospitals for fear of hospital-acquired infection, and for not wanting to overwhelm the health service, and the dramatic reduction in road traffic and other activities that commonly generate visits to A&E. While the number of deaths
be due to the ways we are counting COVID-related deaths, but it could also be a concerning result of the reduction in hospital attendance, both for A&E and routine care. These figures only represent the months during, and immediately following, the first wave of COVID-19 in the UK. It will likely take years to assess the full impact of the pandemic on the public’s physical and mental health.
A need for better preparedness What we already know, however, is that we need to be prepared and able to respond more effectively next time, and while the control of infection demands particular preparedness, this ripple effect
March 2021 Health Estate Journal 47
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