The future of healthcare. What do we really need from our hospitals post-pandemic? 

Our guests Smriti Singh, Lead for Healthcare Transformation at Arcadis and Simon James, CEO of KIMS hospital, discuss our healthcare systems post-pandemic and the challenges ahead. What did COVID teach us about what we need from our hospitals? From diverting resources and space, to infection control, our major medical centres had to be repurposed at breakneck speed to respond to a virus we knew nothing about at the time.

We examine what hospital buildings will look like and be needed for, what patients will experience, what staff need and how we can make our healthcare more human in this topical episode.

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Emma [00:00:15] Hello and welcome to Long Story Short, the podcast from Arcadis', where we focus on the recovery and revival of our cities. I'm Emma Nelson. And today we look at the hospital post-pandemic and the challenge ahead.

Simon [00:00:30] We went into COVID with waiting lists of just over four million. We've now got 6.1 million at the latest count.

Emma [00:00:37] We'll examine what the staff in our hospitals need from their workplace, and it's not smart a medical kit.

Speaker 3 [00:00:43] What would make my life better in the hospital improve my wellbeing would be a coffee shop,

Speaker 4 [00:00:48] changing facilities, staff rooms for staff and air conditioning. That's what I think would improve the environment.

Speaker 5 [00:00:55] One of the main issues I have is lack of parking,

Emma [00:00:58] and we'll hear some bright solutions to make our health care feel smoother and more human.

Smriti [00:01:04] There's no reason why we can't call cardiology heart, why we can't call orthopaedics bones.

Emma [00:01:11] That's all ahead on long story short. The Future Cities podcast from Arcadis. And a very warm welcome to today's programme. What did COVID teach us about what we need from our hospitals, from diverting resources and space to infection control? Our major medical centres had to be repurposed at breakneck speed to anticipate a virus that we knew nothing about at the time. Well, to tell us more about what we do with the future of health care in all hospitals, I'm delighted to say that I'm joined by

Smriti [00:01:43] Smriti Singh, I'm a director at Arcadis. I'm the lead for health care transformation and that means I work with health care organisations and systems to help make things better.

Simon [00:01:51] And Simon James, Chief Executive, Kim's Hospital, the largest independent Acute Elective Hospital in Kent.

Emma [00:01:57] Thank you both very much indeed for joining me around the table today. It's a joy to have you with us. Smriti may I begin with you? What were hospitals like before the pandemic?

Smriti [00:02:07] Before the pandemic for the last few decades, hospitals have changed dramatically. We've thought a lot about comfort. We've moved toward single-sex wards. We've thought about creating nicer environments. And we've also become a lot more efficient. Certainly in the NHS, we have a high throughput of patients. We have a high turnover of beds. We have high levels of bed occupancy. So certainly within the NHS and in the public sector, we've got super efficient hospitals and we've been thinking about how to also make them better environments for patients.

Emma [00:02:36] And where were you fitting in in terms of the private sector, Simon? Because at the time, the hospitals may be incredibly efficient, but they were full.

Simon [00:02:45] Yeah, that's correct. I mean, I think the thing to say about the independent sector is that the more modern hospitals and independent sector have been built to really smooth the patient pathways. So a good example of that would be that our operating theatres and our inpatient wards are all on the same floor, which may seem like a very simple thing, but it just means that we can get the patients from their beds straight into the operating theatre and then follow their safe surgery straight back into their beds again, which really makes a big difference in terms of the efficiency and the way that we're able to deliver safe care.

Emma [00:03:19] And that was obviously a safe and efficient and very well thought out plan. Then the pandemic comes along Smriti, and I wonder how much people had actually factored in a pandemic when they were designing hospitals and looking at layouts.

Smriti [00:03:33] So I think the main thing we've learnt is that we haven't had to think about airborne infections before the COVID 19 pandemic, not since the 1960s when we had outbreaks of TB. So in a modern healthcare system in a western country, airborne infection is not a priority, and infectious diseases generally were not a priority. And we're thinking much more broadly about health. So actually, hospital design wasn't optimal when it came to dealing with airborne infections. And that's been, I think, the big lesson from this pandemic.

Simon [00:04:02] Infection prevention is one of the primary focuses in running any hospital. And although we haven't had a huge number of airborne diseases around, we've had MRSA, we've had E. coli, we've had C. diff and winter flu to deal with. And so prevention and control is very much built into the way that we operate independent hospitals. And a lot of that is not necessarily in the design and the build of the hospital, but in the behaviour and the training of the staff that work in the hospital and support the care.

Emma [00:04:30] Simon, so were you ready for something like COVID?

Simon [00:04:33] No. I mean, it's a simple answer. I was just reflecting a little bit before I came here on, you know, what types of disasters we did plan for. We did attempt to disast for. And frankly, it wasn't much more than if there was a major plane crash or a major train crash in the local community and we were required to step in. Certainly, there was very, very little thought given to a pandemic.

Emma [00:04:54] And yet this thing stuck around, didn't it? So let's look at the situation now, and I wonder how much COVID has become the driving factor in when we're designing hospitals, when we're improving hospitals, Smriti, we're hearing that some trusts are being told that in the future, up to seven out of 10 rooms should be single rooms.

Smriti [00:05:14] Single rooms alone aren't going to prevent airborne infection of a highly infectious disease rate. You need to think about ventilation. You need to think about drugs trolleys going in and out of rooms. You need to think about drug boxes within rooms. Who's going to refill them? You need think about food, how it goes in and out. So it's single rooms have multiple benefits and as well as helping infection control, but they aren't solution and they're not going to completely pandemic proof any hospital.

Emma [00:05:40] Smriti, tell us a little bit more about the broader long term role of the hospital we've been hearing for quite a long time now about how the community will play a bigger part.

Smriti [00:05:50] There's been an ongoing recognition that what affects the health of the local population is not just the availability of hospitals, but hospitals are what you call anchor institutions. So much happens within the vicinity of a local hospital that actually the hospitals are well placed to start addressing what we would call the wider determinants of health.

Emma [00:06:10] Simon, what do you think about that?

Simon [00:06:13] I mean, one of the trends, if I want to put it in that way that we're seeing now is. More care being delivered closer to patients homes and where patients aren't necessarily being asked to come into a hospital? So, you know, the government's programme around Community Diagnostics hubs would be a good example of how the NHS is reacting to that and responding to that. And we already operate five what we call outreach clinics across Kent, where patients don't have to travel very far. They can go to the local GP practise and have what would traditionally have been provided in a secondary acute hospital. Now that's got to be a good thing because the patients not having to travel and are not having to go to an acute hospital where there will be a much higher risk of catching something that's sort of circulating in the air.

Emma [00:06:58] Where are you finding trends now? Simon, I mean, you mentioned a moment ago the idea of having more private care out in the community as well. Just tell us a little bit about what your patients are saying to you, because one of the rather the charming elements of being able to have private health care is that you can actually go into a hospital and see a surgeon or a doctor. Arguably much more quickly than you would do in the NHS. Do you have to override that feeling that doing something online or going to your local GP isn't isn't what they paid for?

Simon [00:07:29] It's a good question. We went into COVID with waiting lists of just over four million. We've now got 6.1 million at the latest count, so we can have to do something about that. And a lot of these patients are waiting for what we would call elective care, which is planned care. So mechanical type issues, if I could use that terminology, a new hip or a new knee doesn't make them any less needy and it doesn't make them any less deserving. So what seems to be happening now and what we're observing is models of care are coming out where they are splitting acute emergency care. From what we call an elective and planned care and the independent sector is very much in the elective and planned care piece, if that makes sense. So there is learning that we can share with the NHS in terms of how to operate facilities which are focussing on planned care, and the NHS has their own good examples of delivering that type care. There is a facility down in Epsom, which has been operational for the last 10 years, called South West London Elective Orthopaedic Centre. And, you know, they focus very much on orthopaedic surgery and don't do any emergency surgery. So I think there are. That in my mind is an area that the NHS should continue to explore and we are seeing them do that.

Emma [00:08:43] Smriti, How much is the NHS aware of the fact that, yes, we have this huge elective backlog. And as Simon mentioned, the mechanical stuff, the hips and the knees, which aren't life threatening but make someone's life miserable, are something which can perhaps be moved out into the private sector. But I mean, the fact remains is that it still has come out of an NHS budget.

Smriti [00:09:03] It does, and I think one thing to say is the challenges we're seeing in the NHS we're seeing all over the world. But when you think about it in other parts of our healthcare system, we do use private providers and we use them a lot. So when I worked for the NHS as programme director, I covered learning disabilities, autism and some mental health. And actually we used significant proportion of private providers, partly because of capacity, but also because they were very good at what they did.

Emma [00:09:29] How much is there still the sense that the NHS and the private sector are two separate things and should be treated as such because they've been running together for decades now, haven't they? Simon, could you just give us a little bit of an idea of the scale of the private sector's involvement with the NHS?

Simon [00:09:46] So the NHS budget is around 116 billion pounds and the private sector deliver about 1.7 billion pounds a year of NHS funded patients. Now, interestingly, last year, the government came out and said that they wanted to provide an additional 10 billion pounds over the next four years, so that will in effect double the amount of money available for patients to be treated in the independent sector. I want to stress something, though the independent sector on its own cannot solve this problem of the lack of capacity. We can provide some support and we can help deal with the beginnings of the solution.

Emma [00:10:28] You're listening to Long Story Short, the podcast from Arcadis, where we focus on the recovery and revival of our cities. I'm joined in the studio today by Smriti Singh from Arcadis and Simon James, who's CEO of Kim's Hospital in Kent, and we're talking about the future of our health care buildings. What are they going to look like? What are they going to be needed for? What will patients see and experience and what does the staff need? Let's hear from Stuart. He's a general manager of surgery at Medway Hospital. He has one very simple request

Speaker 7 [00:11:01] something around navigation. Number of patients that you see that walking around lost don't know where to go, so simple layouts, simple pathways, simple flow in the hospital, I think, is also important. It's more around making sure that it feels a nice environment to both be in as a patient and to work in.

Emma [00:11:24] So what we're hearing there from Stuart is that he wants the same thing that a patient wants. An easily navigable hospital, which makes his job easier and better for the patient.

Smriti [00:11:36] There's a window of opportunity to try and really do things we've been thinking about for years in terms of a better built environment. Arcadis submitted an entry for the Wolfson Economics prize, which this year was on hospital design, and we came up with an idea which nobody's challenged yet. And I just I wonder why it's not being implemented because a very simple one. One of the ideas we came up with in our post-COVID hospital design was to change all signage to plain language English. It's a thing I'm really passionate about because I've worked with people with learning disabilities, but there's no reason why we can't call cardiology heart, why we can't call orthopaedics bones. Why we can't call neurology brain making things, as Stuart was saying a lot easier to navigate for most people.

Emma [00:12:21] Simon, there's a real simplicity there isn't there in terms of making things as human as possible in a hospital.

Simon [00:12:27] Yeah, I mean, it's interesting what Smriti was saying, because that very much ties into patient communication from doctors as well. And one of the recommendations coming out of the Patterson review is that rather than doctors and consultants writing to GPs about a patient they've just seen in long technical terms, they actually write to the patient and explain what they've observed to the patient in patient friendly English. So I think it really, really ties in with the hospital signage and hospital layouts and guiding people around hospitals. You see it in a very practical sense as well. If you go into a hospital now, you see people with different name badges, which are dementia friendly name badges. You might have spotted them, you know, yellow with a black name on them. So we are moving in that direction very encouragingly, and I don't think that's because of COVID. I think it's because we are bringing much more focus on to what patients want.

Emma [00:13:20] And when you're also talking about the ability of hospital staff to do their job well, let's hear now from some clinical staff, some doctors, some surgeons and nurses about what they want in a hospital to make their jobs easier. Now you and I might initially think that this is cutting edge technology. It's quite the opposite.

Speaker 5 [00:13:39] One of the main issues I have within my workplace is lack of parking, is very limited onsite parking to staff and the criteria is quite strict. I think things like this would improve morale and be really nice for the people that work here.

Speaker 3 [00:13:54] What would make my life better in the hospital, improve my well-being would be a coffee shop. Give me a connection with the rest of the outside world,. Supermarket shop so that I could get things on the way home and also before work. A staff canteen within the theatre complex so that I didn't have to go anywhere during my theatre time. And I could spend this with my colleagues

Speaker 4 [00:14:20] changing facilities on all wards and areas, having staffrooms for staff and air conditioning. That's what I think would improve the environment.

Emma [00:14:30] Really simple stuff, isn't it? Car parks and improvements that actually have very, very little to do with the surgical procedures themselves Smriti.

Smriti [00:14:40] I agree with you. I think they're really quite simple things and things that somebody like me who works in a pleasant office environment with an M&S food next door taken for granted and has come out in the work that we're doing. So we've been commissioned by a number of trusts seeing the opportunities to get some funding to improve staff wellbeing. They've commissioned us to understand how do people work and how do they want to work. And what are the opportunities within that? And we've seen some really interesting findings. We've contacted 7000 staff and there are a few things which really jumped out. One of them was actually a number of staff could work primarily from home. One of the other findings was a lot of clinical staff wanted what we would call decompression space. They may not have expressed it like that. It's a space to just get some private, quiet down time, which they don't have at the moment. The other thing a lot of clinical staff wanted was privacy for meetings because there's a real shortage of meeting space. Now when you put all that together, you think actually, we could use space a lot more optimally.

Emma [00:15:42] Smriti, tell me how you solve this, though, because anybody who's ever been into a big hospital knows that it's grown up organically over the years, and the decades and whatever space you can see has something happening in it. So having a nice coffee shop, having a space to decompress and talk is wonderful for those who work in the hospitals. But there will always be that argument, won't there, that if you have a space, you really should fill it with a bed.

Smriti [00:16:10] You need staff to actually manage the bed, manage the patients. I think this is why I think COVID has made an impact actually and is allowing us to have conversations we couldn't have had for COVID.

Emma [00:16:20] Tell me Simon, what the private sector can bring to this, I mean, you do again have that added luxury of a single room of more spacious corridors. You can be more purpose built in a way that the NHS certainly can't. But if you had a few tips and tricks, what would they be?

Simon [00:16:37] So if you want people to deliver care, the first thing to do is to care for them and things like car parks and things like somewhere decent to go and get a meal and being very conscious of wellbeing of your team are things that we've worked on really, really hard. And COVID has brought a much sharper focus to that because whereas prior to COVID. People came to work with a degree of anxiety during COVID and in this post-COVID era that we're now living in. People coming to work with a lot more personal anxiety and we can't expect them just to leave it at the door.

Emma [00:17:13] Finally, Smriti and Simon, one big thing that we will see happen in our hospitals in the next decade. Simon.

Simon [00:17:21] So I think what we're going to see is an ongoing trend towards more day care surgery. So that's people not staying overnight in hospitals. And that's going to mean that we move away from wards where people are sleeping overnight to much more podded type environments where people come in and have their procedure, stay a few hours and go home.

Emma [00:17:40] Thank you very much indeed, Simon. Smriti?

Smriti [00:17:41] Okay. So I would say, first of all, hospitals don't exist in isolation. They aren't immune to wider trends and a big trend at the moment, and quite rightly so, is sustainability. So I expect to see hospitals really addressing the green agenda. We're starting to see a little bit of that now. I think hospital car parks will be very different, will have far more electric vehicle charging points, will have more public transport, will have more bicycle spaces. We may have charging points for electric bikes.

Emma [00:18:05] And that brings us to the end of today's show, the warmest of thanks to Smriti Singh from Arcadis. And to, Simon James, the CEO of KIMS Hospital in Kent. If you enjoyed that, then make sure you subscribe. You'll find fresh podcasts all to do with the future of our cities, our communities and their recovery. Popping up regularly at Arcadis.com and if you want to hear more, then head to Arcadis website for blogs and projects all about the future of our health care. You've been with long story short, the Future Cities podcast from Arcadis. I'm Emma Nelson. Goodbye. Thank you very much for listening.

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