It is important that these measures seek to reduce occupancy of space and explore alternative ways of providing services, rather than using a greater floor area to ‘spread out into’ to implement 2 m distancing requirements.

Signage Additional signage will be beneficial on all sites including, for example: l ‘Instructional’ signage – guidance for maintaining safe physical distances, demarcation on floors to direct to ‘hot’ and ‘cold’ areas etc.

l ‘Educational’ signage – comprising numerous notices to building users and visitors to maintain physical distancing, and practice regular handwashing etc.

Even greater emphasis on infection control A heightened infection prevention control regime is required, for both clinical and non-clinical areas, for patients and (eventually) visitors, as well as for all staff. Individual and communal workspaces should be regularly disinfected, and shared desks disinfected between use by different staff. Where possible, there should be minimal sharing of desk space. This is in conflict with recent approaches to managing workspace, whereby the traditional ‘modular’ office design, and layout of one desk per employee, have been replaced with hot-desking and breakout space to encourage flexibility in the use of space and reduce the overall volume of space required. There will be a number of implications from the reversal of this practice, not least cost, but also in terms of the use and availability of space across healthcare estates, in addition to the additional staff resource and cost required to service additional cleaning requirements. In ‘hot’ areas, consideration should be

given to minimising surfaces that cannot be deep cleaned adequately, including but not limited to, noticeboards, shelving, and soft fabrics and furnishings. It is best practice that ‘hot’ areas have their own dedicated cleaning team and robust standard operating procedures to minimise risk. Thought and consideration need to be given to internal areas that were previously considered more appropriate to be furnished more softly e.g. counselling spaces, and staff lounges and breakout areas, and whether such areas continue to be practical or appropriate going forward.

Visitor policy With physical distancing measures in place for the foreseeable future, consideration must be given to longer- term measures to manage visitors to healthcare sites. There will likely be a short-term change in how visits to inpatients are managed,


An example of additional physical protection of reception areas at both the main reception and Cardiology Day Unit at the University Hospital of North Tees in Stockton-on-Tees.

and how clinical staff are able to keep families updated on patient care. Prior to the COVID-19 outbreak, the popularity of bedside communication and entertainment units had decreased, due in part to their relative value for money, and the increasing tolerance for, and use of, mobile phones within clinical settings. The focus may now therefore shift to widely deploying patient-accessible Wi-Fi throughout healthcare estates to facilitate and encourage personal use of smartphones and tablets.

Meeting policy Prior to the pandemic, there were regular visitors to healthcare sites for meetings with clinical and non-clinical healthcare staff, and there is a preference across the NHS for face-to-face meetings. The pandemic has necessitated the use of video conference facilities, such as Microsoft Teams, Zoom, Cisco Jabber, Webex Teams etc., and it is anticipated that in the longer term this may change the future requirement for large meeting rooms, and could see the reconfiguration of meeting space, from moderate/large meeting rooms to smaller rooms or soundproof ‘pods’ with improved technology access. Again, this is likely to have a significant impact on the design and use of the healthcare estate as its requirements change and adapt to a post- COVID world.

Peripatetic staff Peripatetic staff have been required to move away from a ‘back to base’ approach, and have utilised working remotely i.e. from home or from their nearest community site. If continued, this could mean a reduction in the requirement for breakout space for example, as face-to-face interactions are replaced with ‘virtual’ conferencing. There

will still be a requirement for direct clinical supervision and staff engagement and interaction, but this needs to be balanced with the need to minimise infection risk.

Communication ‘Hot’ and ‘cold’ sites operating within the same building are likely to cause anxiety for staff, patients, and visitors, due to the perceived threat of infection. It is therefore essential that while very visible measures are implemented to minimise and control infection rates, proactive communication as to what is happening, why, and how people are being protected, are paramount to maintain engagement and morale of the workforce, and minimise worry and distress for patients and visitors. Within community healthcare settings it may be easier to segregate ‘hot’ and ‘cold’ functions via the reconfiguration of buildings to ensure that such sites are sufficiently separated. Communication is especially important

where services are co-located with other providers. Cross-organisational dissemination of information is critical, and it is suggested that the organisation and use of multifunctional healthcare buildings are continually reviewed to understand how each service interfaces with another.

Lasting impact Healthcare providers and services will be required to do more – and differently – with the resources that are available, and potentially within a reduced estate area. As an enabler, the healthcare estate needs to be increasingly flexible and better equipped to meet evolving models of service delivery. It is expected that the COVID-19 crisis could have lasting impacts on the estate configuration. Likely changes include: l A reduction in face-to-face patient


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