Published Articles

Andrew McLeman - Apparently now the number 1 authority on the cost implications of single bed hospital wards!!!!

In June 2008 just after the Scottish Government announced that any new hospital build would, to help combat MRSA and the like, only in the future have single bed rooms and no multi bed wards, a "Scotland on Sunday" newspaper journalist phoned me late afternoon on a Friday (was I the only QS still at my desk at that time?) for a comment from a Professional Construction Cost Consultant on the cost implications of this decision was likely to have.

Coming at it cold I however In a ten minute conversation considered various items such as the extra circulation requirements, the extra sanitary appliances etc, and the more inefficient shape - e.g. narrower wings to achieve single room outside windows, and so a greater external floor to wall ratio and more land required to build.

I discussed also that designers would have to be as ingenious as the could be to make it work, but that retrofitting, if that was the next stage , would be considerably more problematical. I thought on the whole it would be a good idea, and any extra building costs would be recouped fairly quickly in savings in less disease control.

I was put on the spot to say how much extra this was likely to be, and acknowledging that wards/rooms are only part of any ward equation, and that efficiencies would be found, I came up with a figure I thought was realistic of 10%.extra.

Of course this 10% is what the Scotland on Sunday (front page!) article homed in on, and repeated almost verbatim in the next days Daily Mail including my quote. I even thought my "well considered initial " figure might be shot down in flames, or raised a discussion somewhere? - but no ...it seems that it was accepted by everyone without any dissention!

Then as a result of this initial interview, I was approached by the magazine "Public Service Review" to include 200 words for their April 2009 issue on various aspects of single bed versus four or more bed wards, repeated below. As now I appear to be the primary "expert" on this subject, it is presumably only a matter of time till I get my TV break ! !

Single rooms only to beat NHS superbugs

Published Date: 29 June 2008

By Kate Foster

ALL new hospitals in Scotland are to be built with private rooms for every patient in a bid to halt the spread of deadly superbugs.

Traditional wards will be phased out to reduce the risks of patients catching potentially fatal hospital-acquired infections such as MRSA and Clostridium difficile.

The move follows an outbreak of C diff that caused the deaths of nine patients at the Vale of Leven Hospital and contributed to the deaths of nine more, while five babies in a special care unit in Paisley have tested positive for MRSA.

But experts warned last night that the single-room policy would increase the cost of building hospitals by around 10%, as well as raising running costs. There is also a debate over whether private rooms will significantly cut infection rates.

The new building for the Southern General Hospital in Glasgow, which has more than 1,000 beds and is due to open in 2014, will contain private rooms only. Health Secretary Nicola Sturgeon told Scotland on Sunday: "We are very keen to move to single wards."

Charles Saunders, chairman of the BMA's Scottish consultants committee, said: "Single-bed rooms are better for infection control, for patient privacy and (recovery]."

But Professor Allyson Pollock, head of the Centre for International Public Health Policy at the University of Edinburgh, said: "There is no strong research evidence that moving to single rooms is conducive to health and better outcomes or reducing the infection rate. Single rooms do not deal with hospital hygiene measures."

Andrew McLeman, a surveyor who has overseen large building projects, said a hospital with single rooms would cost around 10% more to build.

"It would be a less efficient use of space, would need more land and more circulation room," he said.

Public Service Review Article - April 09

A Ward 1950's Style

"There are a number of cost implications in designing for single room over four or larger bed wards. The first pressure on costs for a single bed is on floor area as the shared circulation space in a four bed ward has to be provided exclusively in a single room, plus the extra area for an ensuite toilet rather than a shared facility.

As bed spaces are only part of the equation in hospital wards designers are likely with ingenuity by adjusting ancillary areas to be able to achieve this within or close to existing area allowances. It is the other influences on costs such as extra doors, sanitary equipment and services provision that will however inevitably put substantial pressure on achieving this within the existing cost allowances.

The requirement to have windows in each single room will also mean that a narrower plan shape will be required resulting in a less efficient and therefore more expensive greater external wall to floor ratio, plus a larger footprint and more site area.

The savings on costs due to reduced Healthcare associated infections, additional flexibility, easier access and shorter patient stays should however provide lifetime benefits well in excess of these fairly minor additional building costs."

Andrew McLeman FRICS RMaPS

Chartered Quantity Surveyor

McLeman QS Network

Regulated by RICS