Title: Purchasing - a word that stands for seven million pounds a year to re-equip Britain's hospitals
Pages: 58 - 61
Text: Purchasing a word that stands for seven million pounds a year to re-equip Britain's hospitals
Hospitals no longer have to take what equipment they can get, and be thankful. With between £6 and £7 mill ion a year to spend on new equipment (quite apart from replacements), they have a great opportunity to insist on the best. The supplies officer is the man in the hot seat.
by W. Bowring
Before 1948, there was little chance to co-ordinate the purchasing needs of the hospital service. There were many voluntary hospitals - most of them purchasing their own equipment- and local authority services were limited. In any case money was scarce, and the over-riding need was to have the best equipment available at the lowest possible price.
In 1948, the new authorities set up by the National Health Service Act found a great variation in the standard of equipment available in the hospitals. A backlog of replacements and the task of making them good created many difficulties. The aftermath of the war, the continuation of rationing and the need to restrict imports resulted in controls which had a stultifying effect on design.
The shortage of money and the meagre standard of comfort provided meant that little - if any - attention was given to the luxury of even discussing design. There was, of course, no shortage of labour as there is today, no emphasis on labour saving features, and little real incentive either on the part of the purchasing officer or of the manufacturer to provide other than simple functional equipment, whether for poor law or for voluntary hospitals. Emphasis at that time was placed upon purchasing new equipment to meet a quantity need without particular reference to quality or appearance. This is not a criticism of either purchasing officers or manufacturers: the needs and problems of the day demanded this approach.
Perhaps during those early days the greatest advances were made in the mechanics of purchasing. Hospital management committees, regional hospital boards and the Ministry of Health began to encourage purchasing on a more competitive basis, and purchasing is now carried out through three main channels: central contracts developed from small beginnings by the ministry and other Government departments; regional contracts by hospital boards and the coordination of hospital management committees; and local contracts by hospital management committees or individual hospitals. This organisation can and should - meet the challenge of today.
Opportunities in design
Only in the last few years has it been possible to look at the need to provide improvement in quality and design, and at the same time to make use of the availability of many new materials, scientific advances
The purchasing officer
3 and 4 Nowadays, patients can relax in day/dining rooms that are purpose designed, instead of being stuck at a table in the middle of the ward. These pictures show the Ear, Nose, Throat and Eye Unit of Bradford Royal Infirmary, ., compared with its predecessor, the Royal Eye and Ear Hospital, Bradford.
and improved manufacturing techniques. The use of metal tubing, wood, laminates, veneers and plastics (and their improved use in other fields) has practically revolutionised hospital equipment.
This emergence from the period when hospitals to all intents and purposes bought what the manufacturer offered coincided with the stage when individual hospital authorities were trying to use the experience of earlier years to discuss with manufacturers ways and means of improving, not only quality and function, but also design. The idea of purpose-built hospital equipment was being accepted, and it is perhaps opportune that this development should coincide with the large increase in money becoming available for new hospital buildings.
The problem of standardisation
The spending of between £6 and £7 million each year on new hospital equipment (in addition to the many millions spent on replacements from revenue moneys) is an opportunity - which must not be missed - to provide equipment which is well designed.
Hospital equipment may conveniently be divided into three categories: medical or technical equipment required for diagnosis, surgery and other special departments;
equipment for wards and ancillary rooms; and residential furnishings of all kinds from tables and chairs to crockery.
The individuality of the medical profession has made for difficulty in achieving co-ordination and standardisation. There have been successful joint efforts by manufacturers and individual doctors to improve function and design. But although these may have satisfied the person concerned, the ideas have not always been acceptable to other colleagues in the service. However, advancement in medical science placed an emphasis on the design of medical equipment, and considerable improvement has been noticeable in the last few years. There is, however, less cause for satisfaction in other fields.
The gradual development of new materials and the appearance of more manufacturers interested in the hospital field is stimulating an improvement in the design of such articles as beds, bedside lockers, over bed tables, chairs and desks. The days of accepting unimaginative furniture are gone; manufacturers must now provide and design equipment to attract a better informed and discriminating buyer.
The introduction of the Ministry of Health Specification Working Parties should, by producing acceptable standards, create new designs - and provide keener competition among manufacturers in a comparatively short time. Any improvements in design in the past have been gradual, because of the
need to take into account the views expressed by a wide variety of users with little decisive authority to decide between them. The resulting slow evolutionary process is only now beginning to bear fruit.
Perhaps the bed, bedside locker and over bed table are the three items of hospital equipment which most affect the comfort of the patient. There is a multiplicity of beds available from different firms, and although there may well be a need for different types for special medical purposes, there appears to be no reason why there should not be a far greater acceptance of the need for a standard bed.
The experiment already carried out by the Leeds Regional Hospital Board and the one currently being carried out by the King Edward's Hospital Fund for London and the Royal College of Art - ie, the Bruce Archer bed - are steps in the right direction. But the real problem is to find a bed which meets all the needs of the patient, the nurse and the doctor at a reasonable cost.
So many people quote the wonderful beds now in use in, for example, America and Scandinavia; but these are very expensive, and this country cannot afford to pay such large sums when there are so many other high hospital priorities still to be met. Surely it is well within the bounds of our own hospital service and the manufacturers to provide a specification for a bed which meets most of the basic needs - at a cost which the country can afford ?
Agreeing a specification which is acceptable to all is, of course, a fundamental design problem. Standardisation in the hospital world is nearly a dirty word, but the time has arrived when - in the interests of both the service and the economy - it must be accepted in some form.
It is, however, important to ensure that standardisation is not accepted at the expense of function, quality or design; and the views of hospital authorities, and in particular those of user departments, must be given full consideration in the preparation of the specification.
Architects and designers need to work very closely with those officers in the Hospital Service (including nurses, doctors, technicians and administrators) who have had years of experience of the patient's requirements. Where there is any difference of opinion, the purchasing authority must have the last word - not because the views of the consultant designers and architects are unacceptable, but because aesthetic needs must be subordinated to function and quality. But even function and quality must be bought within a budget - whether you like it or not, hospitals have to be built and equipped to a cost limit.
Where the architect fits in
small number of hospitals built in that time has considerably restricted his experience in this particular field.
Some hospital boards have thought it advisable to employ design consultants. Other boards have taken the opportunity of using design consultants in association with the consultant architects employed for their major schemes. Whichever method is adopted, it can only be to the benefit of design in the long run. The advice of the specialist designer must be given (always bearing in mind the precedence of function). This will undoubtedly result in compromise, but the compromise should be a good one, given the experience and knowledge available to both sides.
Both hospital officers and architects are anxious to work as closely as possible towards this end. Naturally, within the service there already exist good relationships between hospital officers themselves (including hospital architects). They are all trying to provide equipment which will meet the needs of the patient and satisfy the hospital users. The consultant architect has not always had the benefit of this close liaison, and it is important that he should now share its advantages. The working parties are an excellent example of this kind of collaboration, and their reports should provide standards which are acceptable to all. When this stage has been reached, manufacturers will have to meet the challenge of rationalising their own industries to produce functionally satisfactory and well designed units at prices that a strained economy can afford.
The development of the capital programme, The role of and the appointment of consultant the supplies officer
architects hospital schemes involving many millions of pounds, has brought the architect very much to thefore, not
only in the design of the buildings but in the use of his training in both interior design and colour. No real effort has
been made to use this experience, and now is the time to correct this omission. Hospital supplies officers with 17 or
18 years' experience of purchasing equipment have built up a considerable amount of expertise on the subject. On
the other hand, architects have not yet had a comparable degree of experience in the building of hospitals, and they
have had to apply training and experience gained in other fields to this specialised work. The design of a building,
the design of a room, the shape of a room and the use of colour are all part of an architect's function, whether he is
building a house, a school or a hospital, and he is already in possession of a wealth of experience to provide
equipment for most of the buildings that have been developed since the war. Unfortunately, the
For some years, the hospital supplies officer has had little opportunity to consider design. His limited resources have obliged him to re-order equipment which had served its purpose for some years, and which could be obtained more reasonably than better alternatives. The considerable task of renewing old equipment has gradually been achieved, so that more money is now available. Restrictions which affected design development have been relaxed. Hospital officers have not been as fortunate as their architectural colleagues in being able to keep up to date in international trends in design, perhaps because of this lack of opportunity, if not inclination. Those officers who show initiative have available to them, particularly through The Design Centre, trade journals and hospital journals, a great deal of information which can be used to widen their knowledge and keep them up to date. If these officers can be given some freedom in collaboration with the architects W. Bowring DPA, FHA, entered the Hospital Service as assistant secretary to the Leeds Regional Hospital Board in 1947; in 1950 he was appointed group secretary/ supplies officer to the Pontefract and Castleford Hospital Management Committee; and in 1954 group secretary/supplies officer to the Wakefield (B) Hospital Management Committee. He has been secretary to the Leeds Regional Hospital Board since 1963. and designers, sufficient expertise is available to ensure a considerable improvement in the design of hospital equipment. There is already a vast amount of activity and interest in this field. Many articles have been published in magazines and journals. The King Edward's Hospital Fund for London and the Nufffield Provincial Hospitals Trust have stimulated interest by exhibitions and ad hoc investigations. The degree to which all this information is used depends to a great extent on the awareness and initiative of hospital administrators and supplies officers.. They must seek out this information, and their success will vary according to the calibre of the officer.. The supplies officer is very likely to be confronted by commercial pressure and high power salesmanship: but with a background of suitable/raining, complete honesty and courage, he can ably advise his authority on the best available equipment - after taking into consideration the need of the users and the advice of architects or designers. Perhaps this is a post which has not been given the importance it deserves, but there is no doubt that the hospital service badly needs such well trained and competent senior officers.. Acknowledgement
The author would like to express his appreciation of the help given in the preparation of this article by the Leeds region's Supplies Officers' Advisory Committee.
This model of a triple theatre suit shows the theatres within an industrialised building attatched to the side of an existing hospital. The existing hospital corridor is at the extreme top left of the picture, and the clean corridor runs down the centre under the air conditioning ducting - this is chopped off short for clarity. Between these two corridors are the theatre ancillary rooms, with the three theatres on the right of the clean corridor. This view shows quite clearly how the ancillary areas could be constructed with the same facility as the theatres proper.