EXECUTIVE SUMMARY
Following a Peer Review of the European Union Health Property Network ( EuHPN) Report titled Hospital Ward Configuration: Determinants Influencing Single Room Provision, a Steering Group was established in March 2006 to take forward the recommendation that further evidence in a Scottish context should be gathered. This Group's membership was drawn from those involved in the Peer Review event who were experts in their subject and who represented a broad range of professional disciplines, both from NHSScotland and Scottish Government Health Department (now Health Directorates).
This Steering Group had as its remit:
To consider the evidence supporting the establishment of the future level of single room provision within new-build hospitals and in the refurbishment of major hospital facilities in Scotland.
The Group also considered the related issue of the appropriate space around each bed where these are not located in a single room. For the purpose of the report a single room was defined as:
"a room with space for one patient which normally contains, at a minimum, a bed, locker, clinical wash-hand basin and also sanitary facilities comprising a toilet, shower and wash-hand basin".
The Group did not consider the requirements for "specialised isolation rooms" with fully engineered ventilation.
Members of the Steering Group recognised that there was a need for information which was specific to Scotland and commissioned a number of reports/studies as follows:
In addition to these reports the Group benefitted from a survey undertaken at the Golden Jubilee National Hospital of patients who had experience of both single room and multi-occupancy room provision. In relation to the financial impact of an increased level of single room provision, the Group referred to the outcome of a study undertaken in Northern Ireland of the financial impact of increasing single room provision from 50% to 100%.
Having identified and evaluated options appropriate in a Scottish context, the Steering Group noted that it is necessary to strike a balance between service quality and the opportunity cost in an environment which is influenced not only by clinical and "building" interest but also by the issue of patient safety and public expectation. It was also seen as crucial that any conclusions and recommendations made regarding single room provision in future new-build and refurbished in-patient accommodation should be future-proofed, and able to accommodate the changing standards expected by patients given the lifecycle of such facilities often extend beyond 50 years.
The Steering Group's recommendation was that all new-build hospitals or other healthcare facilities which provide in-patient accommodation there must be a presumption that all patients will be cared for in single rooms, unless a lower percentage provision for specific patient groups has been justified to and approved by the Scottish Government Health Directorate ( SGHD) as part of the Business Case approval process. Those patient groups for which 100% single room provision is considered mandatory must be agreed with the SGHD's Chief Medical Officer.
For refurbishment projects, the Steering Group recognised that it is extremely difficult to establish a definitive proposal as each of the buildings involved will present unique problems. That said, the Group recommended that in developing proposals for refurbishing healthcare facilities which include in-patient accommodation, Health Boards must seek to provide the maximum number of single rooms consistent with the approach recommended for new build healthcare facilities, and that the overall level of single room provision must be 50% as an absolute minimum.
For bed spacing, the Group considered that the current advice remains appropriate.
The Group also recognised a need for further work to be carried out and has undertaken the first stage of a Delphi Consultation exercise with the clinical speciality leads designated by the SGHD's Chief Medical Officer. When completed, his exercise should identify those specific patient groups for whom 100% single room provision should be mandatory.
The Group also agreed that it would be helpful to Boards in developing projects to make use of a Risk Matrix Tool. This could be based on the SCART (Statutory Compliance Assessment Risk Tool) recently developed by Health Facilities Scotland for use by all NHS Health Boards.