BACKGROUND
The provision of single rooms and the related issue of adequate space around beds in hospitals have been topics of considerable discussion in recent years and these related issues are seen as important factors in achieving a number of key aims in the care and treatment of patients. These aims include:
- Preventing and controlling healthcare associated infections ( HAIs).
- Enhancing patients' privacy, dignity and confidentiality.
- Providing adequate space around the bed, arranged in a functionally suitable way to enable clinicians and carers to undertake their work efficiently and safely, particularly when using equipment necessary for patient care.
The publication of a report commissioned by NHS Estates in England in November 2004 titled Hospital Wards Configuration: Determinants Influencing Single Room Provision gave added profile of this topic.
Given the significant capital investment programme underway in Scotland and the lack of a clear policy on the level of single room accommodation deemed appropriate when planning new-build and/or the refurbishment of existing major facilities in Scotland It was considered appropriate that this report should be peer reviewed as a first step in developing thinking on how we in Scotland should address the issue. This Peer Review event was held in November/December 2005 and was sponsored and facilitated by the Scottish Executive and NHS Education for Scotland.
The Peer Review Group comprised experts from across Scotland representing a broad range of professional disciplines. It also involved the authors of the EU Health Property Network ( EuHPN) Report and the most influential of the expert contributors to that report. The presence of these European experts added considerably to the outcomes generated by the Peer Review event.
This peer review had 4 clear aims which were to:
- Undertake a critical review of the EuHPN report in the Scottish context.
- Identify gaps in that work.
- Recommend additional work.
- Consider resources required to take this process forward.
This event was the first in a 3-stage process which was be followed by the formulation of a policy recommendation to the Health Minister and if it was deemed appropriate for a policy to be introduced, the development of guidance to support the emergent policy.
The 2004 EuHPN Report included among its recommendations that:
- Guidelines should promote a good practice range of between 50% and 100% single rooms - [and that] there is a strong "confidence" base for this judgement.
- Design decisions on HAI risk and other single room determinants should relate to the profile of the hospital and its local catchment population - not on the evidence of currently observed rates of infection or standards but on a predictive model that translates population need and infection risk into a service language that is useful for planning and design.
These and the other general principles contained in the EuHPN Report together with the recommendations of the Property Environment Forum's report Space Around the Bed were accepted as valid conclusions by the Scottish experts at the Peer Review event. Those participating also acknowledged that specific evidence in a Scottish context was essential across a range of issues, particularly patient choices and preferences of accommodation provided in hospitals; the impact of single rooms on staffing ratios and ways of working; and on the economic implications of a move to a higher level of single room provision. The Peer Review Group concluded that consideration be given to establishing a small Steering Group to take forward the recommendation that further evidence in a Scottish context should be gathered possibly leading to the Steering Group developing a policy recommendation.
This approach was endorsed in the Next Steps outlined in the Peer Review Report - see Annex 1 for a copy of the Peer Review Report.