Jonathan Waggott, of consultancy, Jonathan Waggott & Associates, a specialist in sanitary infection control issues, considers how the healthcare sector can adopt a broad range of more ‘sustainable’ practices – from using sustainable materials when building new hospitals, and implementing energy efficiency measures to cut both carbon footprint and utility costs, to a scheme where disposable shower heads and hoses are recycled into new ones.
During the last 15 years, many healthcare services across Europe have become more concentrated within larger and specialist hospitals, with the objectives of improving cost effectiveness, reducing the number of acute care beds, creating sufficient throughput that ensures high quality of care, and offering more sustainable healthcare provision. In the UK, the same trend has been evident, with a number of brand new ‘super-facilities’ completed over the past decade, or heading towards completion over the next few years. Table 1 shows three good examples.
Historically, most hospitals were of small bed capacity and attached to monasteries, (McKee and Healy 2002), but with the advance of medicine, specialities were introduced, and hospitals expanded, in an attempt to accommodate increasing change in service provision and use of technology. Nevertheless, European countries are still rich in small and medium-sized healthcare facilities,1,2 which are often either not in use, or only partially in use, but which nevertheless require maintenance, and account for healthcare expenditure. Recent research unveiled a considerable variation in average hospital bed capacity, ranging from less than 125 beds in Greece,2 to 227 beds in France, and 400 beds in Germany.1 An EU European Observatory on Health Systems and Policies report3 stated that ‘19 countries sped up the existing process of restructuring the hospital sector, mainly through closures and mergers’. This is leading to ‘centralised capacity planning approaches’,2 and to larger facilities becoming more common in Europe, in an attempt to concentrate acute service provision to help optimise hospital performance and efficiency. Nevertheless, centralisation of services may come with additional challenges, and will not always lead to sustainability if other focuses, such as simple cost reduction, are applied.
Florence Nightingale in the 1850s identified the hospital as a place where care was provided to patients in consideration of their needs as human beings (1859). These needs change over time, and they can be satisfied through appropriate integration of different aspects that are not only related to the actual built environment, but also to social, technological, and economic elements.4
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