A blueprint for smaller local acute hospitals

 In it the authors argue that there is no reason why “gold standard” acute hospital care cannot be cost-effectively delivered from small, well-equipped local hospitals in the future, but that achieving this will require “a number of (current) NHS conventions to be defied”. HEJ editor Jonathan Baillie reports.

Before the three individual speakers gave their own perspectives, John Cooper, AfH’s current chairman, set the presentations in context with his own brief observations on today’s fast-changing UK healthcare landscape. Comparing the NHS to “a behemoth”, he pointed out that, with a current annual budget of £105 billion, “not far short of the GNP of New Zealand”, and employing approximately 1 in 20 of the UK workforce, the service remained an extremely powerful organisation. Despite this overall “clout”, however, not all was well on the estates front. For example with some 21% of the existing NHS estate pre-dating 1945, a “very high proportion” of primary and secondary care buildings were “no longer fit-for-purpose”, while under-utilised NHS buildings currently had an overall footprint larger than the entire square meterage of all Tesco’s stores. John Cooper also felt much of the older existing healthcare estate was “drab, leaking oil like a Texan oil rig, and in need of substantial renovation”. Against this backdrop, the tough financial strictures currently facing all public services, and the under-utilisation of some healthcare developments (including a number of PFI hospitals) only completed in recent years, the NHS, and healthcare architects and designers generally, would, he said, “need to do a hell of a lot better in the future” in terms of planning healthcare facilities that would stand the test of time than had been the case in recent years. UK healthcare facility design had also, he argued, often been “too much in thrall to orthodoxies” in recent years, a situation he felt contrasted starkly, for instance, with the scenario in Scandinavia. Here, he said, such orthodoxies were “regularly challenged in the quest for a truly worldclass healthcare environment”. He told delegates: “One of the other anomalies in the UK is that, even when we succeed in actually constructing buildings with a firstrate internal design, we then fill them with furniture that looks as if it has been rejected from a 1950s Russian submarine.”

Excessive storage space incorporated