Glyn Davies is Head of Estates at University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT) (opens in new window). Here, he explains the challenges and costs involved in maintaining and adapting ageing hospital buildings. As well as the opportunity the New Hospitals Programme offers to transform the quality, efficiency and sustainability of the local NHS estate.
As Head of Estates, I am responsible for looking after the hospital buildings across University Hospitals of Morecambe Bay NHS Foundation Trust. This includes those at Royal Lancaster Infirmary and Furness General Hospital. This involves both the physical condition of the buildings and ensuring that they comply with required standards for modern healthcare. This is a major undertaking and I manage a team of 94 staff based across all our Trust sites.
Royal Lancaster Infirmary includes buildings of varying ages, some dating back to Victorian times. The site is very spread out, with little available space, and there is a lack of car parking.
Overall, we have identified £88million in backlog maintenance at Royal Lancaster Infirmary and £63million in backlog maintenance at Furness General Hospital to bring the sites up to an acceptable standard. However the age, current use and inefficient construction of some of the buildings does not make this a good investment. We are concentrating our efforts on doing everything we can to keep the key buildings linked to the delivery of patient care at an acceptable standard with a rolling programme of investment.
However, the challenge is not just about keeping buildings in an acceptable state of repair, but also about how much we would need to invest to make them meet the latest national standards for hospital buildings. The constraints of old facilities often mean they are physically unable to be adapted to meet modern requirements.
The Furness General Hospital site was opened in 1984 and has fewer problems overall than Lancaster. However, the fact remains it was built well over 35 years ago and standards for space in hospitals have moved on enormously in that time. Wards and clinical areas lack space, meaning they cannot easily accommodate the extra equipment which is now a routine part of modern patient care. The lack of flexibility means we cannot use the buildings in the optimum way to get the most out of the site.
Just like a domestic building, a hospital contains equipment which needs replacing periodically due to wear and tear. We have a risk register to identify the highest priorities and address potential risks of a failure that could disrupt the hospital and potentially affect patient care.
At Royal Lancaster Infirmary, a major project is currently underway to completely replace the boilers that provide heat and hot water to the site, replacing equipment that is around 30 years old. This is a multi-million-pound investment but is essential.
At the same time, we are aware that we are merely replacing one old-fashioned system with a newer one, as the age of the building does not allow us to consider more modern solutions such as individual heat pumps to serve wards and other clinical areas in a flexible way.
There have also been some recent innovative improvements to the wards at Royal Lancaster Infirmary to improve the care of frail and elderly patients with conditions such as dementia and confusion. Wards have been remodelled to extremely high standards and comprise of 24 beds, three day rooms, private rooms and communal areas.
The availability of single rooms means that any patients who need to be isolated for infection prevention, or other reasons, can be safely cared for. Every room has toilet facilities which also makes life more comfortable and dignified for patients.
In May this year, the Intensive Care Unit (ICU) at Furness General Hospital was relocated to enhance patient experience. One of the main benefits of the new ICU is that colleagues are now able to cohort patients depending on their infection risk. There are five areas, including two new fully equipped isolation rooms which will enable the team to keep patients safe from viruses such as COVID-19.
The new area, which can have up to 10 beds, also means that the ICU will no longer need to use any of the theatres or surgical areas, as has been the case in recent times. The new ICU, along with the changes to the wards at Royal Lancaster Infirmary, are both examples of the types of improvements we hope to make through the New Hospitals Programme.
We have a mix of old, separate buildings with external walkways between them, and a wide variety of building materials with glazing and insulation, which are far behind modern standards. This means our sites – particularly Royal Lancaster Infirmary – are very expensive and inefficient to run. Small improvements have been made over the years, but there is little that can be done to improve this within the current constraints of the buildings on site.
At the same time, efficient use of energy and reducing the carbon footprint of hospitals is now a national priority as the NHS strives to achieve its aim of becoming carbon neutral (opens in new window). Nationally, there is also a growing demand on the electricity grid and a need for more sustainability and local power generation.
Purpose-built, new hospital buildings with a smaller overall area and much more efficient use of space, based on the need for co-location of services in close proximity, would make a huge difference in reducing our energy bills and cutting waste. This frees up money, which can be then spent more directly on providing patient care.
Modern hospitals are designed with the latest materials to be as insulated as possible, so they stay warm in winter and cool in summer. They are adapted to meet the challenge of future changes due to global warming.
With the likelihood of a huge shift to electric vehicles by the end of this decade and less reliance on fossil fuels in the future, improving the resilience of the electricity supply will also be of increasing importance given the reliance of modern hospitals on energy. New buildings will give us the opportunity to address the needs of the estate and look at how we could generate our own power, using technology such as solar or wind power.
My ideal model for a hospital site is to have well-designed hospital buildings which inspire confidence. These will look far more attractive than our current buildings and will have been planned with the input of clinical staff and our patients, including thinking about staff areas and storage space, currently both in short supply.
Lack of parking is a huge issue, especially at Royal Lancaster Infirmary, and this needs to be addressed. There is also a great opportunity to have more outside space such as gardens for patients, families and staff to relax in a calming environment away from the busy hospital.
No-one can predict the future – the challenges of the Covid-19 pandemic showed us that things change and we need to adapt quickly. While it may well be that more services can (and should) be provided closer to patients’ homes, experience also shows we need flexibility in our hospital buildings allowing us to change quickly as and when required.
We already have an example in the Trust of how investment in a brand new, purpose-built facility can transform the way services are delivered and make a big improvement to the experience of patients, staff and the public. The £12million South Lakes Birth Centre gave us the opportunity to start from scratch and get the best possible use out of the investment available. I think gives us a model of how bold thinking can deliver excellent new facilities.
Author: Glyn Davies, is Head of Estates at University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT).
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