HSE’s Jim Curran on post-covid health infrastructure

Rebuilding health infrastructure for a post-Covid world

Jim Curran, National Director of Estates for the Health Service Executive (HSE) outlines how the Covid-19 pandemic has forced the health sector into fast-tracking infrastructure projects and how it will inform the rebuilding of that infrastructure in a post-pandemic world.

“There was quite a stark ask in relation to what was needed at the beginning of the pandemic,” Curran recounts. “Up to 10,000 beds were needed, we knew that we could not provide these overnight but that we had to act as quickly as possible to bring all our capacity into use. A lot of work was undertaken over a very short period in order to bring facilities back into use. A total of €240 million was invested in establishing some new facilities, such as test centres and swabbing centres.”

Field hospital plans were put in place should the worst have come to worst, with the Citywest Convention Centre and Hotel among the sites acquired on a licensed basis for this possibility. Thankfully, while the health system was under significant pressure, it did not result in the utilisation of field hospitals, Curran emphasises.

“Ultimately, we delivered capacity for circa 600 additional beds if required and that was achieved very quickly,” he says. “Thankfully we did not have to use the beds in Citywest but we are using the facility for other things such as outpatient clinics, test centres and vaccination centres. Our testing centres have been established nationally, with different models attempted. The most effective is the drive-through model where people drive into large car parking areas.”

Along with pressure on niche aspects of health infrastructure such as medical gas

HSE’s National Director of Estates, Jim Curran. supply, crucial amid increasing numbers of patients requiring ventilators, the pandemic also served to emphasise the need to modernise the HSE’s buildings and internal capacity. These processes were underway before the pandemic but fasttracked when the extent of the Covid crisis became clear.

“Limerick had particularly low bed numbers, so we undertook two projects there to increase capacity, one in the university hospital itself, and another in Croom,” Curran offers as an example. “Our building partners in Clancy Construction brought the project onstream in about 14 weeks, which was remarkable given that it usually requires an average of 14 months.”

Reflecting on the lessons from the Covid crisis, Curran says: “Looking at what we have learned, additional capacity has been a necessity during the pandemic. One of the reasons we have had to have lockdown measures is that the capacity in our health system was being stretched to the limit, so there is a need to create additional bed capacity both in hospitals and in critical care because that is where we are lagging in relation to international norms. We now have a programme to almost double that capacity in hospitals.”

Enhancing capacity in elective only hospitals in Cork, Galway, and Dublin is a component of the National Development Plan, with an emphasis on outpatient care. The objective is to mitigate record waiting lists. Curran expresses the hope that these projects can be fast-tracked and operational within three years. Consolidating additional primary care centres and community diagnostic facilities also aligns with the Sláintecare priority of bringing care closer to home, while ensuring additional mental health facilities and services for people with disabilities.

The rollout of national strategies such as the National Maternity Strategy, which involves the relocation of all standalone maternity hospitals onto hospital sites, are ongoing. The National Cancer Strategy’s radiation oncology programme has seen completion of one centre in Cork, with one in Galway currently under construction and the next phase of expansion into the Dublin centres ongoing.

“Our primary centre construction programme continues,” Curran says, adding: “That is a mix of state investment through the NDP and developer-led operation lease model where the developers construct to our specifications, and we lease from them. That is rolling out at pace, and we hope to have developed a total of 80 centres in 2021.

“Our replacement and refurbishment of existing Community Nursing Units, is a big focus of our next stage of development. The decongregation programme is focused on people with disabilities and mental health issues who were living in secluded residential settings, congregated together in some facilities and we are now realising that for the quality of life of these people, it is better that they are living in the community. We are now moving away from having those congregated settings to providing dwellings for no more than four people living together in the wider community.”

Again, these actions are concurrent with the health system infrastructure needs and the Sláintecare priorities, with the Trauma Strategy set to provide centres that will cover all major traumas in Cork, Dublin, and Galway. The HSE also faces a challenge in meeting its climate objectives with its infrastructure.

“The government mandate is to get down to near zero energy and the health sector, given the 24/7 usage of its buildings, is critical to the success of Ireland delivering on its climate action requirements,” he says. “Investment in infrastructure to meet these requirements will be essential. This will involve replacing a lot of our facilities and we have identified a significant number that we will require.”

Curran concludes: “Some projects to increase capacity that are currently underway include Mater Hospital and Mallow General Hospital, which were highlighted in response to Covid-19 and the deficit in those areas. We will be continuing our ward replacement programme and I think it is fair to say that every hospital in the country has ambitions of becoming a building site over the next few years as we gear up to deliver on the EU healthcare strategies.”

Infrastructure for the future

The cities of the future will be tasked with the gargantuan task of tackling the complex issues within the economy, society, and the environment in a rapidly evolving world of constant new technology.

McKinsey and Company identifies three key factors in delivering the “promise of technology in urban infrastructure” in the cities of the future: renewing outdated infrastructure; getting more out of existing capacity; and reducing the cost to build new.

The idea of renewing outdated infrastructure involves the building of smart features and technology, such as sensors and management system, into new projects that utilise old infrastructure in order to modernise said infrastructure and fit it with intelligent capabilities. While McKinsey and Co notes that retrofitting has typically been deemed too expensive, “several technologies have advanced dramatically over the past few years, making infrastructure renewal far more feasible today”.

An example given by McKinsey is the connection of a smart thermometer as the beginnings of a smart building, whereby for a small amount of money and negligible use of power, “WiFi communication allows devices to send intermittent streams of data… in a way that prolongs battery life” and “the evolution of both solar panels and batteries means buildings can harness more power at a lower cost”.

To get more from existing capacity, McKinsey recommends that digital information be used to reveal opportunities to turn waste into value, such as digital monitoring of car parks showing them to be underused, allowing cities to create parking networks across multiple car parks that would “increase real supply, free up land for productive development and remove street parking”.

In power generation, this approach can take the form of socalled virtual power plants that can be created through demand-response and actual microgeneration units. The city of Oakland is given as an example of a city that has embraced this idea, having created a virtual microgrid that operates directly to the consumer.

Newer technologies such as artificial intelligence and machine learning will improve both performance and economics in urban site planning, McKinsey says, reducing the oftenprohibitive costs of constructing new urban projects. Machine-learning-based planning tools can “help developers find additional usable space on a given parcel while improving… access to light and open space”, meaning that urban construction is now “likely to be disrupted by standardisation and automation”.

The example of companies such as the Boring Company, which has “demonstrated how to [reduce] tunnelling costs” through use of robotics, is one to be followed say McKinsey if cities are to reduce the costs in constructing the infrastructure of the future.