Let’s take stock and evaluate capacity
As the upheaval of the last six weeks has unfolded before us, a lot has been covered around the need for additional hospital bed capacity to help combat the effects of COVID-19. Almost the entire Government strategy has been focussed around providing solutions to avoid crippling the NHS.

As a response, we’ve seen the construction industry admirably join forces to design and construct temporary facilities, at significantly short notice. The heavily publicised Nightingale hospitals are providing an initial 3600 ICU beds with additional capacity available if required. This is in addition to the permanent hospital projects that have been fast tracked to complete early to create additional bed capacity.
These projects include two of which HLM has been involved in; The Specialised Critical Care Centre in Wales and Altnagelvin North Block development, Northern Ireland. In both cases and many others alike, the client has identified a local need in the short term and we, the design team have reacted accordingly.

Under this backdrop, we consider the reactive response taken and ask whether with careful consideration of existing capacity, disused sites and buildings we can maximise flexibility should we need to in the future.

Not Broken
We’ve seen sterling efforts from everyone involved as the pandemic has taken hold, from a Government level to the front-line NHS staff providing the day to day care. Thankfully, the temporary Nightingale hospitals haven’t reached full capacity. In London alone, the Excel Centre’s temporary hospital, with its stretched capacity limit reaching 3500 patients had an intake of 19 patients over the Easter weekend.

This is extremely reassuring and testament to the flexibility of our existing healthcare infrastructure. The utilisation of “soft spaces” to repurpose clinical spaces depending on need, innovative design and engineering solutions to increase ICU capacity has meant our existing hospital stock has, for the most part, coped with the pandemic and its bed pressures, with established London hospitals able to double their ICU capacity to 1555 beds.

The Future
We’re still in the midst of the global pandemic and once we can start to look past the virus and have the time to take stock, we can consider the lessons to be learnt from this and focus on what can be done further to improve the NHS’s ability to respond to emergencies. It’s hard to say exactly what the immediate future looks like, in some hospitals, capacity is reaching 80 or 90%, and if the Coronavirus curve had been steeper, the intake of patients at London’s excel and facilities alike would certainly have been far higher, there’s no denying it.

HLM has been researching hospital capacity and flexibility for some time and it is evident there is an opportunity to explore alternative solutions, and we’re seeing changes already being made to the system. NHS Trusts are conducting whole sale reviews of their estates, evolving decades old development control plans and commissioning new masterplans. This review of existing estates along with the introduction of more community-based care and integrated care systems, will have a significantly positive impact on hospital capacity.

In addition to this, we can look wider at the elderly care sector. Something HLM is very keen to look at is the provision for more suitable, flexible and desirable later living housing options. Our research highlights the benefits of developments that allow for early rightsizing and ageing in place, to not just the individual but also in the wider social context.

Let’s also look at the concept of ‘patient hotels’, widely used in mainland Europe. Ambulant patients that don’t require acute inpatient care are able to maintain their independence while undergoing outpatient treatment. With an operating cost a third of what it is to keep patients in traditional hospital accommodation, this warrants greater uptake for the cost savings and the potential to increase capacity in hospitals.

There is no doubt that the low number of patients admitted to the temporary hospitals is good news. Some will argue that the capacity created via the Nightingale Hospitals, in hindsight, was unnecessary however we should focus on the positives of our existing NHS system, adapting to cope with this unprecedented need and with the addition of further innovative thinking, the notion of field hospitals will not even need to be considered should a similar challenge confront us again.

Mohammed Ul-Haq, Associate, HLM Architects