As with many other facets of modern life, the pandemic has accelerated and highlighted pre-existing trends in healthcare. Many of these are interrelated, so the most obvious emerging trend (towards remote working and consultation) has implications not just for work patterns and the provision of space in hospitals but also for the broader question of how health is promoted and sustained in the community. 

 

In the first part of the panel discussion, led by Charlotte Ruben, the focus was on health beyond the strictly clinical. Integrating hospitals more fully with their urban context was seen as pivotal to the healthy living agenda and in realising hospitals’ potential as catalysts for urban regeneration. Examples cited included Whipps Cross Hospital in London, now in early design with an ambitious mixed use vision, and the recently completed Karolinska in Stockholm, emblem of a new generation of flexible healthcare and research campuses. 

 

Urban integration is not just about the physical characteristics of the main hospital hub (its connectivity and permeability) but also about the wider health network, including care homes, so much in the spotlight during the pandemic. Simon Hudson pointed out the acute shortage of care home places in the UK, set to worsen over coming years as the baby boom generation retires. The discussion turned to how this and other health priorities might be addressed by capitalising on under-utilised retail space in shopping centres and High Streets, another trend accelerated by the pandemic. These spaces offer potential for a range of services, including care in the community, dispersed diagnostic centres, sheltered housing and other facilities for the elderly that keep people active and engaged.

 

Whilst some people see the trend towards greater community based care as the death knell of the old ‘super hospitals’, the second part of the panel discussion led by Benedict Zucchi suggested that one of the key implications of the pandemic was the need for renewed investment in major hospitals with the necessary know-how and infrastructure to deal with acute public health crises. The crisis has highlighted the UK’s very low number of beds relative to population with a particular shortage of ICU spaces. Other pandemic implications reviewed by the panel include the importance of streamlining flows, more flexible spaces that can be adapted quickly to different uses, and the need for more isolation capacity, sterile storage and surge space. An audit of how our newest hospitals, completed since 2000, have performed would provide valuable lessons for the next wave of facilities. Building these faster through increased adoption of Modern Methods of Construction and better IT-enabled collaboration will be vital.  

 

The panel agreed that the Nightingale field hospitals showed what can be achieved when necessity demands, interdisciplinary teams collaborate wholeheartedly and expediency trumps normal red tape. The question now is how best to channel this positive spirit and the rapid learning curve of the last nine months into the next generation of hospitals, new and refurbished, now being procured; and to do so in ways that consider healthcare provision more holistically and sustainably.