often connected via the IT infrastructure but, potentially, this could also be managed over a secure Wi-Fi network – perhaps even one dedicated to medical equipment. It is common practice, when building new hospitals and refurbishing existing clinical areas, to ‘flood wire’ with IT cabling providing flexibility in the clinical space. Should we now consider revisiting clinical areas built some years ago and upgrade the electrical and IT infrastructure?

Pandemic store

The Government gave the NHS over £6.6 bn pounds as part of a £14.5bn coronavirus emergency response fund. This has been used to free up beds and to purchase additional medical equipment such as ventilators, diagnostic tests, and protective equipment (HM Treasury, 2020). Some of this funding has also been used to equip the regional Nightingale hospitals. The question now, of course, is what do we use this equipment for now that the first COVID wave has passed? Clearly, there is an opportunity to use this equipment to ease the burden on hospital Trusts’ ageing asset base of medical equipment or bring forward replacement programmes. In spite of the Government’s welcome announcement, in August 2019, to spend an additional £1.8 bn on NHS hospitals, there has been a reduction in NHS spending over the past few years as a percentage of GDP.

Another view would be to retain the equipment in a state of readiness for rapid deployment for any future pandemics. Some of the equipment such as the COVID ventilators built to the MHRA RMVS001 specification will not be CE marked and so cannot be used as we return to business as usual (MHRA,2020). Most NHS Trusts will have a pandemic or major incident store, but these are likely to have a small footprint when spaces are premium meaning there is little opportunity to house additional equipment. There are a number of other options to consider; an off-site store in the neighbourhood but away from the main

Robust supply

Nightingale hospitals: what do we use this equipment for now that the first COVID wave has passed?

hospital for easy access or thinking more strategically then there’s an opportunity for a regional or national equipment store. With a regional or national store would come the challenges of transportation for rapid deployment and the decision-making process on how the equipment is allocated fairly based on risk and demand. The regional or national store however had the added benefit of economies of scale and less of a cost pressure on individual HNS Trusts to cover rental costs and insurance. Equipment could then be kept in a state of readiness, very much like the military field hospitals. Medical equipment retained in a store will still have a finite lifespan whether it is deployed or not because, as technology advances alongside new treatments, equipment becomes obsolete. Furthermore, manufacturers will only support devices for a period of time, typically 10 years, and so, alongside the maintenance of equipment in the store, there will need to be a rolling replacement programme.

There have been challenges around key equipment supply and manufacturers have struggled to meet the unprecedented demand. Rather than allowing individual NHS Trusts effectively competitively bid against each other for this equipment the Government set up a system of central procurement and allocation of key critical care equipment. Trusts could apply regionally for loan equipment based on the risk of reaching surge capacity within a specified period. It operates in a similar manner to a local Medical Equipment Library (MEL) with the equipment delivered to site. Moving forward we must ensure there is a robust source of supply for all our equipment and medications. Suppliers we work with must have multiple manufacturing facilities, not co-located and no single route for transportation. The Government has purchased equipment including ventilators from various countries but organisations may use equipment from different manufacturers so clinicians may not be familiar with their operation. Is there an opportunity here for ‘standardisation’ of key items of medical equipment which would overcome training concerns and at the same time maximising value for money by negotiating the best price through economies of scale?

New ways of working MS Teams, Skype for business and Zoom are just some of the video and audio- conferencing tools that enable discussions and meetings to be held remotely. Just imagine the space we could free up on hospital sites if all meetings were held virtually, not to mention the time saved by not having to commute to a different geographical location? Further benefits include a reduction in the environmental impact: l Going paperless (an aspiration for many years)

l Reduction of the carbon footprint due to reduced travel.




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