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Protect the NHS. What’s the future of our healthcare?


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Protect the NHS. What’s the future of our healthcare?

From the Government slogan - “Stay home. Protect the NHS. Save Lives.” - to the 8pm Clap for Carers, the NHS has been front and centre of the fight against COVID-19. But has our relationship with our national health service changed? And what have we learnt from the pandemic that could change the future of healthcare provision?

With capacity threatening to reach breaking point, the speed at which the seven Nightingale Hospitals were established showed us just how much can be achieved in a short space of time, by working together. But even though the immediate health crisis may have abated through efforts to protect the NHS, critical patient issues such as cancer, diabetes and mental health care still need to be addressed.

Chris Waine from Arcadis, who worked on the Nightingale Hospitals project, and our guests Richard Noble and Robert Hakin from Leeds Teaching Hospital discuss the future of healthcare and more in episode nine of the Long Story Short podcast series.

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Emma Nelson [00:00:05] Hello and welcome to Long Story Short, the podcast from Arcadis UK, where we focus on the recovery and revival of our cities. I'm Emma Nelson and today we look at the future of the institution the recent lockdown was intended to look after.

Government message [00:00:23] Stay home, protect the NHS, save lives.

Emma Nelson [00:00:27] From the government's slogan, to the Nightingale hospitals, and the eight p.m. clap for carers, the NHS and the people who work for it were front and centre of the fight against the pandemic.

Nicola Cotton [00:00:39] I'm Nicola Cotton, a mental health nurse managing a crisis team in London. And I'm really proud of how hard the team have worked and adapted their ways of working and still maintained high standards of patient care and safety.

Emma Nelson [00:00:51] But what are the long term lessons learnt and what changes could now be made to prepare our hospitals and surgeries for what lies ahead?

Chris Waine [00:01:00] Education is is one aspect to this and people taking personal ownership. And i guess in a post COVID environment, you would hope that people are a bit more aware about their physical health, safety and well-being.

Emma Nelson [00:01:13] That's all ahead on Long Story Short, the Future Cities podcast from Arcadis UK.

Emma Nelson [00:01:20] And a very warm welcome. Joining me today is Chris Waine, UK Account Director for Health at Arcadis UK. Richard Noble is Head of Estates Capital at Leeds Teaching Hospital. And Robert Hakin is Associate Director of Corporate Planning, also from Leeds Teaching Hospital. Welcome all three of you, to Long Story Short. Now, like many things in life, we are refocusing in the wake of the huge changes the world is going through. Let's look today at possibly the most important player in the fight against COVID-19. The NHS. A familiar sound from our Thursday nights during the pandemic. The clap for carers at 8:00 pm. So how has COVID-19 changed the NHS? And how will it shape its future and the way we look at healthcare?

Emma Nelson [00:02:15] Robert, if I may begin with you. I think it was commonly accepted that the NHS was struggling hard before COVID, and suddenly you all had to pull things out of the bag at top speed.

Robert Hakin [00:02:26] Yes, that's right. You know, we had a lot of pressures beforehand with a wide variety of diseases and patients coming through. But, COVID arrived and we had a very singular task to make sure we had enough beds and capacities for any patients coming through. And, looking back now, that's what we managed to achieve.

Emma Nelson [00:02:48] How did you feel and then what did you do?

Robert Hakin [00:02:52] So I guess the initial feeling was probably fear, like a lot of people. But we've got a lot of fantastic people within the NHS and within companies working with us. So quite quickly, we understood where the key pressures would hit the NHS. You know, we always knew that was probably going to be critical care. So that's the illest patients and then just general capacity within a hospital. So things like beds and ventilators. So what that allowed us to do was focus us as an organisation, as a sector on creating those things fast. And it really meant that the patients who came through did receive the best care that we could for them.

Emma Nelson [00:03:38] Richard, acting as the head of estates capital at Leeds Teaching Hospital, what was it that COVID taught you that you didn't know before about the way that the NHS works?

Richard Noble [00:03:48] So I think the best example of that probably is the establishment of the Nightingale facility at Harrogate Convention Centre, which we did in partnership with a number of other trusts in the local region, the local ambulance service, NHS England, council colleagues, as well as contractors, subcontractors and the consultants that help us deliver schemes, in a way that we we've never done so collaboratively before, really as a result of having to deliver what you would normally take a number of years and do within a matter of of weeks and in some cases days. And, you know, the ability to have those direct conversations with the key people and almost put the day job aside just to deliver on those things made a real difference.

Emma Nelson [00:04:36] Chris Arcadis was very closely involved in the commissioning and the organisation of the Nightingale hospitals. Tell us what Arcadis was doing in all this.

Chris Waine [00:04:46] We got the call to support a number of trusts across country. So we were involved in four Nightingale hospitals. And it is a very speedy response, collaborative arrangements, and effectively, we were there to help create the new spaces for the patients and ensure we delivered functional space within the timeframes that were stipulated, which were basically as soon as possible.

Emma Nelson [00:05:11] Well, let's hear now from someone who was really involved in this project. Julie Hirlam is from Arcadis' office in Leeds and she worked on the Nightingale hospitals. She was helping to convert parts of Harrogate's Convention Centre into an intensive care unit.

Julie Hirlam [00:05:26] We had enormous support from the local community during working onsite, with nearby restaurants opening to cook food for the site team who were working 24 hours, seven days a week, which was incredibly uplifting. Camaraderie between everyone onsite was fantastic, kept us going during the long working days, and it was teamwork in the truest sense.

Emma Nelson [00:05:45] And Chris, what was work like for you?

Chris Waine [00:05:48] It was a very different arrangement to a typical project that we've been involved in. A specific example would be procuring the contractor, you know, the builder to actually fit out the space. So absolutely, it was sort of boots on the ground delivery and working in a very, very different way.

Emma Nelson [00:06:03] Robert, where did things work well for you?

Robert Hakin [00:06:06] We got lots of benefits of having building contractors involved in our projects very early on. What it allowed us to do was get their input on early stage, which addressed a lot of the issues that we sometimes come to when we hand over either scope's or design briefs to somebody to ask them to build something for us.

Emma Nelson [00:06:30] Richard, what's your most vivid memory about working on Nightingale and how the NHS felt? Did it feel any different?

Richard Noble [00:06:38] The thing that I remember most is just how all the partners joined in to get things done. We had sessions, for example, where round the table we had the clinical leads, we had the contractors, we had the architects, the designers, down to the people that as soon as you've made the decision about what's going to be done are going to go down to the next level of the building and actually construct what you've just talked about, which is a level of closeness in working that, even in the best partnership arrangements that we see with the jobs that we do at the minute, is a step beyond what you'd normally expect.

Emma Nelson [00:07:15] This is, Long Story Short, the Future Cities podcast from Arcadis. We're looking at the long term future of healthcare in our cities and the shape the NHS could take a shape now highly altered by the COVID-19 pandemic.

Emma Nelson [00:07:27] So, Richard, Robert and Chris, we've established that you had to work really fast and really collaboratively in a way that you had not ever had to do beforehand in your jobs involved in the NHS. Looking ahead to the challenges that you now face within the NHS, what did the long term problems, such as how to deal with cancer patients, diabetes patients, obesity, this, that, the other, how did they feel and look like when the crisis had abated? Had they gone away? Or were you looking more at, you know, dealing with the same level of problems once again?

Robert Hakin [00:08:03] It is the same level of problems just starting to come back now. So we had a very welcome and sustained drop in people attending A&E, but that's on the rise again. And people will still get cancer. Obesity is still an issue. And it's something that as the NHS we now have to tackle going forward in in this new world.


Emma Nelson [00:08:28] Well, one of the issues that was rising fast to the top of people's agendas before COVID struck was mental health. Now, the first wave of the virus itself may now have passed, but let's hear from someone who knows why now it's more important than ever to focus on every aspect of our health.

Nicola Cotton [00:08:46] I'm Nicola Cotton, a mental health nurse managing a crisis team in London. We're a frontline community service and have had to transform our service to meet increasing demands during the pandemic. The Impact it's had on mental health is huge and really complex. And the peak of the crisis is still a long way off in mental health. The biggest challenge has probably been managing people in crisis who pose a high risk to themselves. And I'm really proud of how hard the team worked and adapted their ways of working and still maintained high standards of patient care and safety.

Emma Nelson [00:09:20] So we're dealing with the same issue of problems. But now that extra layer of COVID. Chris, tell me about what the NHS organisations are asking you for now. Given the fact that we do have that extra layer of problem that we need to deal with.

Chris Waine [00:09:34] Capacity has always been a challenge for the NHS. You've got the short term backlog. So actually, we are seeing a number of NHS trusts approaching us to help deal with that backlog, to create capacity. But I guess more longer term, we're looking at different working practises, different clinical arrangements. Probably one really good point to come out of the whole pandemic, in terms of the healthcare setting and delivery new spaces for health care trusts, we certainly find a lot of our clients now are much more open to different ideas, different approaches, and looking at spaces in different ways to help with this capacity issue.

Emma Nelson [00:10:14] Chris, when Arcadis gets involved in this, you hear all those lists of demands and needs of different people, patients, clinicians, buildings, governments, future health care. What is the right composite brief? Is there such a thing?

Chris Waine [00:10:31] Good question. I don't think necessarily there is one size fits all, you know. So although we may be creating similar facilities in different parts of the country, actually they have different USPs and specialities, if you like. So Leeds is a great example of that, where it's been very much a catalyst for the innovation district in the city with a real focus around health, innovation and life sciences, where you've got the university and the council and the NHS trust working very collaboratively, you know, effectively to change the world. Not too far away, you've got what's happening in North Manchester. And they're looking at a slightly different model in quite a deprived area of Manchester and actually see it very much as a catalyst for regeneration, you know, addressing social and economic issues in the local area. And hospitals have always been seen as a bit of a pillar of the community. So it's important that that remains. But I think their role to play in the community will look very different in 10-15 years time,

Emma Nelson [00:11:31] Richard, I think many of us have had experiences of travelling a long way into a city hospital, getting through the traffic, waiting for a long time to be seen. All that had to stop during COVID. How is your focus in dealing with patients going to change?

Richard Noble [00:11:48] From an acute provider's point of view which Leeds Teaching Hospital is, it means effectively, your planning for a different demand in the future. So it seems.slightly strange to say, but the hope, I suppose, from the hospital's point of view is actually we would need less capacity to see people because in an integrated system wide approach, people are seen more out of the hospital than in it. And that will enable the wider health economy to make better use of local facilities rather than the large estate hospitals retaining.

Emma Nelson [00:12:24] Let's look ahead now to the long term. Robert, we're talking about a shift to the community away from the big city hospital. What will a big hospital like yours be used for in 10 years time?

Robert Hakin [00:12:36] So we will still have operating theatres where surgery will be performed. We will still have beds where people will recover and we will get them better and, you know, things like critical care. So a lot of those things that people probably think of as when they think of a hospital will still exist. The pre and follow up care where we are monitoring our patients, making sure they're okay, it's those types of things where we think that there are potential options for them to be delivered in the community to get their treatment in the community and get better in a setting that's not a large hospital in the middle of a city.

Emma Nelson [00:13:18] Chris, how do you move care out of the hospital and more into a community and make it work?

Chris Waine [00:13:23] The health landscape is very complicated. It's very fragmented in many ways. It's not just the NHS and I guess all of these organisations have a part to play. You know, so we talked a bit before about more integration, collaboration. I think that's absolutely key going forward and obviously the whole social care agenda. You know, I think more direction, more leadership in that area will be extremely welcome. And all of these facilities, all of these issues are interconnected in many, many different ways. So, you know, I think it's a long winded way of saying more dialogue and more leadership from central governments is is absolutely needed, particularly in the social care space.

Emma Nelson [00:14:05] Robert, dialogue and leadership. But quite a tricky task when politicians come and go, as do governments, the NHS often has to turn around on a pin depending on whoever's in charge.

Robert Hakin [00:14:18] The mantra that was taught to me that I always come back to is we will always need hospitals, we'll always need GP surgeries. So making sure that how those services are set up have the patients and people who live in those areas at heart. If you get that bit right, the changes in direction from political parties have less of an impact on what you've decided to do.

Emma Nelson [00:14:48] So staying with you, Robert, looking ahead, what would be one fix that you could offer to inspire and encourage?

Robert Hakin [00:14:56] I think the one big fix is how we really run with the ownership of your individual health and how health and social care and the council can support our people within the country to stay well for longer. That has happened in COVID, people have taken to exercise, they are washing their hands, they are stopping smoking because they know it puts them at a high risk of COVID. So they've done it for that. How do we now continue to do that with lots of other different types of conditions.

Emma Nelson [00:15:32] Chris, what would be your big fix?

Chris Waine [00:15:34] For me we often focus on the health infrastructure. We focus on the physical. And actually, I think some of this is culture and a number of organisations can play their part. You know, education is is one aspect to this. And people taking personal ownership. And I guess in a sort of post COVID environment, you would hope that people are a bit more aware about their physical health, safety and well-being. So for me, I think it's everybody needs to play their part. I think the NHS can play a leading role in that and a facilitation role in that, but I think it's everything from education through to culture. And we mustn't lose sight of that.

Emma Nelson [00:16:16] And that brings us to the end of today's show. My thanks to Chris Waine, UK account director for health at Arcadis UK. Richard Noble, head of estates at Leeds Teaching Hospital. And Robert Hakin, corporate planning and business development at Leeds Teaching Hospital. Thank you all very much for joining us.

Emma Nelson [00:16:36] And if you enjoyed that, then make sure you subscribe. You'll find fresh podcasts popping up regularly at where there'll be lots of extras to all to do with the future of our cities and their recovery. You've been with Long Story Short the Future Cities podcast from Arcadis UK. I'm Emma Nelson. Goodbye. Thanks for listening.

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