Nightingale hospitals; an agile future for the NHS?

Ben Jones

Tackling the emergence of a new global pandemic is complex for any healthcare system. But can it offer us a blueprint for what health care services ought to look like in the 21st century?

Back in 2010, in its report entitled Fewer Hospitals, More Competition, the centre-right think tank Reform argued that while hospital bed numbers in England had nearly halved since 1987, we needed to go further and reduce bed numbers to just 130,000. While not without controversy, the report was indicative of a strong ideological movement at the time which sought to improve efficiency within the acute sector and ensure that system design reflected a shift to new models of care.

However, fast forward to the present day, and the intense pressure faced by intensive care units across the country brought about by COVID has underlined the importance of adequate surge capacity. But as we mark the peak of anticipated hospital admissions in the UK, we can begin to consider how the lessons learnt from coronavirus may reshape how we deliver acute care, particularly through the creation of a new phenomenon, the ‘agile hospital’.

Critical care bed numbers vary considerably between countries in Europe, with the UK coming near the bottom of the list at 6.6 beds per 100,000 people, compared to its neighbour Germany with 29.2. This presented a very real, and significant risk that COVID would quickly overwhelm the health service. In response, the NHS increased the availability of general and acute hospital beds in hospitals and chose to buy wholesale capacity from the private sector in order to segregate the treatment of COVID patients with those requiring other urgent NHS care.

The creation of seven critical care agile field ‘NHS Nightingale hospitals’ from design to build in a matter of weeks has become a defining symbol of the response to the pandemic, especially so given that historically NHS building programmes have been associated with enormous delays and cost overrun. The fact that not all capacity has been required – with the service currently operating with a comfortable ceiling of 3,000 spare critical beds – is testament to the effectiveness of other parts of the COVID response measures rather than reflecting any overreaction. With the Nightingale hospitals currently operating at 10 per cent of anticipated demand, and with the UK hopefully passing over the peak of COVID, it seems unlikely that NHS capacity will be breached in the coming weeks – something of a relief to health system leaders. Instead, excess capacity that the system now enjoys might allow NHS England to consider how the infrastructure of care could be optimised. It’s been achieved at a huge cost – not just financial – with the cancellation of elective, non-urgent surgery.

Once the last coronavirus patients have been discharged, what does the future hold for the Nightingales? The collaboration between the armed forces and the NHS proves that design and build can be achieved quickly and begs the question whether ‘pop up agile’ hospitals are the way forward particularly for inner city health care provision. We often hear about capacity issues throughout our healthcare system but in particular our major municipalities where waiting lists to be seen by clinical professionals are continuing to increase. The Nightingales could be repurposed to serve other healthcare needs in the community, with possibilities ranging from specialist care centres, integrated health and social care facilities to address the demands of a growing elderly population to mass immunisation centres.

By developing quickly, simple yet fully functional facilities, the NHS has a superb opportunity to not only address the pandemic but to leave a legacy with the Nightingale hospitals within which patients could be seen 24/7, thereby curtailing the length of waiting lists previously seen. Such facilities would complement the current only one specialist Emergency Care Hospital in the UK.

The speed of building the Nightingale hospitals proves that agility within a bureaucracy the size of the NHS is possible. It requires the breakdown of traditional siloes and increased collaboration across different sectors, but it can be done, provided the Government facilitates this work.

A willingness to deliver change at speed must be ‘baked into’ institutional memory once the crisis has passed, combined with a longer-term solution for the NHS workforce. This is a rare watershed moment, with the opportunity for system leaders to develop a more innovative , agile health care system which is better suited for the needs of future generations.