Professor Mike Kagioglou is Dean of Engineering at Western Sydney University in Australia. Here he reflects upon why Covid-19 might enable the transition to major reforms of healthcare infrastructure.

Little did I know when I was making my keynote address at the 2019 IHEEM Estates Conference, calling for “Total Healthcare Infrastructure Delivery”, how pertinent those words would become in 2020. The sharp focus towards the need for mapping out, connecting and relating the healthcare system in its broader sense cannot be made more acute than it is today. I also called for the need to deliver such a system for “today’s world” when speaking to Hospital Times on the 19 December last year.

This short note is not to blame any political parties or the systems by which capital and other plans are put together, although all parties must now come together under a common, independent and representative commission.

This article aims to connect clinical practice, to policymaking and to an enabling infrastructure system that includes broader supply chains, capital infrastructure and capacity existing across public and private sectors, as well as repurposing of national assets to address another pandemic.

Globalism reimagined

Britain is blessed with excellent medical practitioners and highly committed nursing and enabling staff. They work tirelessly to provide the best medical care to the population. If this is the tip of the arrowhead then it is the following factors that enable excellence in medical care. These factors include the building assets; the technologies and equipment housed in these buildings and their mobile equivalents; and the supply chains that produce, distribute and maintain the infrastructure and the design, manufacture and distribution sectors at large.

At a micro and more contextual level, such systems have been included in extensive planning for dealing with terrorist incidents and localised and regionalised disasters. This exemplary work has been highlighted in recent events across the country. However, there are two significant factors that, evidence shows, have neither been considered nor optimised. These are major disasters that take place over a long period of time, and the fact that their catchment areas are both national and international. These two factors make all the difference in the eventual success or failure of response and on lives lost.

If there is one truth that Covid-19 has brought to light, it is that pandemics can happen and their impact is beyond what most people will have imagined in today’s world

Professor Mike Kagioglou Dean of Engineering, Western Sydney University

If there is one truth that Covid-19 has brought to light, it is that pandemics can happen and their impact is beyond what most people will have imagined in today’s world. This is not only in relation to deaths, however untimely and devastating they are, or in the impact these have on the wellbeing of society, but in terms of the imminent global recession. Additionally, we will be uncovering mental health issues for years to come, coupled with a fundamental paradigm shift in how normal life is lived in the future. This is globalisation re-imagined.

Scientists have been warning us for decades about the potential rise of respiratory diseases and the risk of epidemics. The management of SARS had given us false hope that such outbursts could be managed at the epidemic level and bounded within a country or region.

In pandemic circumstances, the issues of time and catchment area come into sharp focus. For example, in an epidemic you can rely to a certain degree on outside help for a shorter period of time. In a pandemic, a country is competing against others to source key material such as personal protective equipment (PPE) and respirators, which impacts on the ability to address the virus condition and hence increases the time it takes to flatten the curve. People die as a result.

A four-pillar strategy

While we still are not entirely sure which stage of the Covid-19 pandemic we are currently in, I am suggesting a four-pillar strategy that may help in tackling the next one.

Establish a Pandemic Independent Commission that considers the total healthcare infrastructure for a pandemic. This should include medical, allied health, acute, primary and tertiary sectors as well as care homes. It should also have representatives of equipment manufacturers, estates (e.g. Nightingale Hospitals and private hospital capacity) and logistics representatives as well as financial expertise, amongst others. This team should include every expertise needed to understand the implications, not only of the disease but of associated factors related to a broader healthcare infrastructure and the overall health and wellbeing of the population. They should form an independent and holistic group of individuals who not only provide the best science in medical terms but develop holistic models for potential actions to advise government for ultimate decision-making. A key component will be the creation of new holistic models with broader coverage than the current ones.

Establish a Country Preparedness Dashboard for regional and country responses to a pandemic in relation to key medical aspects but also in relation to the provision of key equipment such as PPE and respirators. Incentives should be provided to develop such critical industries and also identify, where possible, re-purposing of existing industries that can take place to cover demand. Innovations in product manufacturing and open source designs for key components will be critical to enabling distributed production and distribution. The key issue here is the time that it will take to activate such a system and therefore what the minimum level of stock will need to be carried at a national level. This approach would eliminate the need for costly stock carrying whilst developing an agile distributed production system at a national level. Self-sufficiency at a country level is critical.

Design and outline a Pandemic Supply Chain framework to cover demand at different levels. Key company and logistics companies’ representation will be critical to determine what is possible and at what speed, as well as ensuring local distribution and agility on meeting demand levels. It will also ensure that appropriate stock levels of core and finished materials are in place, at the right place and time, and in the right quantities, to deal with imminent actions.

Develop Activation and Monitoring Plans for chosen strategies. The timing of activating outline plans is critical and can directly correlate to their effectiveness. The same applies to adjusting plans and making timely decisions. The Pandemic Commission should have a direct and advisory capacity role in the key decision-making body e.g. Cobra. The activation and monitoring of these plans require significant collaboration and coordination across the civil service and the charitable and private sectors. There is a significant amount that can be learned from other countries and their responses to pandemics. All efforts should be made to learn and adjust any plans according to good practice at any one time.

We will need robust academic and industry collaborative research to reflect appropriately on Covid-19. We must learn from all good practice and from the decisions we didn’t get right, albeit made with the best intentions at the time they were made. Let us learn everything that we can from Covid-19 and make sure we are better prepared to deal with any future pandemic through Total Healthcare Infrastructure Delivery.