Regulations, 1999. Any estates maintenance work undertaken during the COVID-19 pandemic is likely to have included both previously identified planned preventative maintenance, and any additional compliance measures that may have been required as a result of the pandemic – for example the identification of an increased number of little used outlets that require a flushing regime to be implemented while areas have been closed off. As a matter of good practice, any unused areas during the pandemic response will need to be checked for continued compliance prior to recommissioning, and planned preventative maintenance measures will need to be reviewed to ensure that they are adapted to meet any new service operational requirements, as necessary. For example, where water management flushing regimes have been implemented, a detailed review of all aspects of the water management system should be undertaken before any areas are re- opened.2

Health and safety In addition to statutory compliance checks, a health and safety (H&S) risk assessment should be undertaken in parts of the estate that have not been in frequent use during the lockdown period. This should focus on the physical environment to ensure that the space is generally fit for purpose and safe, and that there has been no damage or issues caused by the property being vacant, while equipment (including ICT components, heating/cooling systems, water and coolers etc.) will need to thoroughly inspected for any signs of physical deterioration or damage ahead of recommencing use. The safety assessment should also

consider how the space will be utilised in the future, and provide information on how the physical environment can be designed to encourage additional public health measures such as stringent and frequent handwashing, and social distancing.

Office and administrative accommodation In addition to spaces for clinical care, the healthcare estate also includes significant office and administrative accommodation. The Government has issued public guidance to ensure that all workspaces are subject to ‘COVID Secure’ risk assessments prior to re-occupation. While there is no specific advice relating to health centres, much of the guidance for offices can be applied to and enhanced for healthcare environments. The guidance3


the implementation of control measures, provides information on where interactive tools can be accessed, and suggests five practical steps:


will undoubtedly require wider corporate commitment to look at the estate differently. As part of this, it is important to consider the organisation’s estate strategy, and key dates (i.e. lease breaks and lease ends), and use these to best influence how future estates should be recommissioned.

Physical distancing There are significant areas of healthcare buildings that typically attract high volumes of users, including reception desks, waiting areas, lifts, and hospitality and retail areas. Consideration needs to be given to managing physical distancing, and while minimising overcrowding throughout buildings is likely to be challenging, measures to assist with this include: l Capacity monitoring (either manually, through provision of barriers or other ‘crowd control’ systems, or specialist equipment).

Tape being applied to floors to ensuring physical distancing in health centre corridors.

l Risk assessment. l Good hygiene. l Working from home where possible. l Social distancing. l Managing transmission.

Our view is that there may need to be significant enhancements within the healthcare estate over and above what is set out in the standard guidance to protect clinicians, patients, and visitors, and other NHS staff, not able to work from home. This is based on our experience in implementing ‘hot’ zones within a number of primary and community care buildings during the height of the COVID-19 pandemic, and in undertaking risk assessments in line with the government guidance to provide safe working facilities for staff and safe access to healthcare for patients.

Space utilisation A crucial first step in considering how best to resume services is to understand space occupation within healthcare premises. This necessitates a good insight into how the space was being used before the pandemic, how it is now proposed for use, and how it is planned to be used in the future. The pandemic provides a significant opportunity to think differently about the use of both clinical and administrative space, and we explore this later in the article. It is essential that understanding how space is utilised and how it ‘performs’ in terms of level of occupancy are used to set a baseline. The temptation to allow services to

resume on their pre-existing footprint should be resisted if possible, and this

l Floor stickers providing delineation for waiting, and to restrict or minimise movement in some areas.

l Revision of waiting protocols. l Reducing touchpoints, e.g. installation of automatic doors; contactless access; replacement of light switches with sensors; the replacement of keypads and intercoms with swipe card entry, and contactless-only payment facilities etc.

l Increased monitoring of external areas or facilities which could encourage overcrowding, such as car parking payment machines.

l Increasing the extent of ‘no smoking’ zones to minimise the overcrowding of external areas, particularly narrow footpaths and doorways.

Hand sanitiser – whose use, along with a renewed emphasis on handwashing, have assumed ever greater importance during the coronavirus crisis.


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