Age and Adaptation

In some parts of the NHS there are buildings in clinical use that were built in the 1830’s – almost two centuries ago, when Florence Nightingale was 10, 120 years before the creation of the NHS. The estate that we manage and maintain now has to adapt and serve the medicine of the 21st century.

Figure 1. Breakdown of the NHS Estate, by age, alongside key events in healthcare (1,2)

In a paper on the health impact assessment of complex buildings in 2019 it was stated that in the next 20 years 80% of the current knowledge about medicine and technology will change, and healthcare facilities need to be resilient to this (3). This means that all of the hospitals and healthcare facilities built before the turn of the 21st century were built with a different expectation of healthcare delivery than they are currently being used for, but those built before the turn of the 20th century have seen healthcare dramatically change beyond what could have been even imagined.

The challenge in adapting the aged estate is not just linked to clinical use. While the estate can be adapted, to some degree, to keep pace with changing clinical landscape, Trusts are facing a greater challenge – how to keep pace with the change in the climate. Whether it is increasing electrical demand due to changing technology or the need for increased air conditioning due to increasingly frequent hot weather, the NHS must find a way to adapt the aged estate or agree that the estate is no longer fit for purpose and divest.

Reference

1. NHS Digital. ERIC - Summary page and dataset for ERIC 2020/21 [Internet]. NHS Digital. 2022 [cited 2022 Apr 8]. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/estates-returns-information-collection/england-2020-21

2. Smith PW, Watkins K, Hewlett A. Infection control through the ages. Am J Infect Control. 2012 Feb;40(1):35–42.

3. Brambilla A, Buffoli M, Capolongo S. Measuring hospital qualities. A preliminary investigation on Health Impact Assessment possibilities for evaluating complex buildings. Acta Bio Medica Atenei Parm. 2019 Sep 13;90(9-S):54–63.