Are new hospitals really more efficient?

Posted: 15 October 2010 by Duane Passman

An extraordinary question mark looms over the billions of pounds we have spent on more than100 new hospitals in the last 15 years. Are they actually more efficient? Do they do the job better than the estate that they replaced?

This question might seem perverse to most people, to whom a shiny new building is obviously going to work better than the pre-war warren of corridors and tiny rooms it may have replaced. But we have precious little empirical evidence to prove that this is true. That’s because we did not measure key indicators for the old stock and then measure them again with the new facilities, so that we could compare like with like.

We should have the comparative statistics, for example, for patient outcomes, for patient satisfaction and for staff recruitment and retention. We don’t. There are other important questions that also elude us. For example, one would expect that moving from fragmented and elderly estate to integrated, well-planned facilities would mean clinicians spend more time with patients. But we don’t know that to be true.

In all this, it is worth remembering that the conventional wisdom is sometimes wrong. For example, in the US, central nurse stations have been broken up to encourage nurses to spend more time on one-to-one patient care. It sounds like a good idea. One problem – latest research suggests that the move is not making any difference to one-to-one patient time, but it is isolating nurses from their clinical colleagues.

These are financially difficult times. The big build era is over – at least for the forseeable future. But there are still at least six projects being developed for the acute sector in England that are costing more than £100m. And there remains plenty of unsatisfactory pre-1948 estate (20 per cent of the NHS). So, for the buildings we are creating, we should know what will ensure the best outcomes. And for the future, we also require evidence to answer a question that will increasingly arise: refurbish or rebuild?

In which case, it is time to start collecting sound evidence. As the heat goes out of the NHS building boom, let’s look at what has been created and ask some intelligent questions for the future. So we should not just be looking at, for example, very crude measures such as patient throughput/square metre. Let’s also find out about the equally important stuff - satisfaction for patients and staff – and, crucially, health outcomes.

Professor Duane Passman is Director of 3Ts, Estates and Facilities,
Brighton & Sussex University Hospitals NHS Trust