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May 21, 2014

Hospital of the future

The multiple benefits of local procurement make such a compelling case that it is difficult to understand why it isn’t the default procurement position with outsourcing to the likes of SERCO remaining the option of last resort. Rob Hopkins speculates about what a hospital organised along Transition principals and in particular what the procurement process for such a hospital might look like. Drawing on examples from around the country, he concludes it would be a win-win for both the health of the local economy and patients alike.



Rob Hopkins, Transition News

There is huge scope, as the Evergreen Cooperatives in the US demonstrate, to reimagine how the economy of a hospital work. It need not follow the neo-liberal model of out-sourcing everything which is being so pushed by the current UK government. Subcontract the cleaning to Serco, the catering to Serco, the cafe franchise to Costa, the security to G4S etc. While many in the current government look to the US for inspiration in terms of how to design and run a healthcare system, they are looking at the wrong models there.  Have a look at this:

Here’s an approach which offers a way of procuring services which keeps money local, builds jobs, ownership, training and so on.  Given the choice between promoting that, and the current approach which results in minimum wages and zero hour contracts, a strong argument can be made that the public health, financial health and mental health of the local community are far better served by taking a different approach. 

Kick out the Costas, and get in a locally owned cafe, serving local produce, indeed produce grown in the hospital grounds (see below).  Kick out Serco, and let a thousand co-ops bloom.   Place the hospital at the centre of the web of the new local economy.  Procure locally like they do in Nottinghamshire Healthcare Trust.

In an inspiring story that could be replicated anywhere, catering manager John Hughes shifted their procurement so they now source 90% of their fresh red meat and all of their vegetables, salad and fruit in season from within a 30-mile radius.  Now they have created a ‘super kitchen’ and have taken on to provide all the meals that Nottingham City Council provide to people who use the Meals at Homes service.  As Hughes said in a recent interview “we can continually change with the seasons”.  Anywhere else interested in such an approach can get great support from the Soil Association, who have been doing amazing work on this.

Hospital as Market Garden: Why not take a look at the grounds of the hospital and reimagine them in a different way? Gardens have been shown to have great benefits to peoples’ health.  A 2003 study from the Netherlands, based on interviews with 10,000 people, showed that the greener peoples’ environments, the better their general health and the less symptoms they report, and the better their mental health too. 

An evidence review for Community Food and Health (Scotland) showed how involvement in food growing is linked to improved mental health and wellbeing in a variety of ways, such as enabling people to learn new skills, have more physical exercise and relaxation.  So why not bring the two things together, and put food growing on hospital grounds as being central to their public health work? 

Instead of seeing hospital grounds as large areas of ornamental grass which no-one ever walks on, outsourced to a contractor who cuts the grass and plants annual bedding plants, rethink them instead as intensive market gardens, as food forests, as orchards undergrazed by chickens. Such spaces also serve a powerful role in creating stress-free environments for staff and patients, reducing sickness time in staff and hastening recovery for patients.  As Christina Fox put it in her dissertation for her Landscape Architecture degree at Leeds Metropolitan University:

“In the current economic crisis, budgets should be re-addressed with the emphasis on volunteering, fundraising, shared services and changes of use of external landscapes and gardens.  With a focus on educating staff and managers on health benefits of natural environments and links with external expertise such as universities and colleges should maximise the potential of hospitals landscapes and gardens”.  

Create a co-operative to manage them and to train local people to become growers.  Create walkways through them for patients and their families.  Focus on leafy greens, salads, and other high value crops which also introduce a healthy seasonal boost to the hospital meals.


Be ambitious in terms of scale.  Work the ground like you would work a market garden. Redesign the menus around the seasonal produce.  Grow produce that patients at the hospital who originate from oversees connect with home, and invite them out to see it, smell it, taste it.  Design into the business plan a percentage of food distributed free to local families struggling to provide good food.  Harness the healing power of food memories around food. Use the waste heat from the hospital air conditioning or from the incinerator to heat glasshouses to extend the season and the varieties that can be grown (NHS bananas anyone?).

Such an approach also tackles a range of other problems hospitals face.  It can reduce crime (a study from Chicago showed that that the presence of vegetation can significantly reduce both property crime and violent crime).  It can improve air quality and the problems associated with that.  It can be a sink for water, stopping surges associated with heavy rainfall.  It can reduce the heat island effect and therefore lead to reduced need for air conditioning.  It can provide enjoyable occupational therapy for patients.  Looked at in this way, although the ‘contract-it-out-to-the-guys-with-the-sit-on-mowers’ approach may be cheaper, in the longer run, the approach outlined above would make far more sense.

Hospital as community power station: Let’s take the WTO’s suggestion to “produce and/or consume clean, renewable energy onsite to ensure reliable and resilient operation”.  How about the hospital reimagines itself as a community energy power station, and invite the local community to invest in and benefit from the energy?  Hospitals often have some of the largest roofs in an area and the highest potential for installing renewables.  For example, Totnes Renewable Energy Society (TRESOC) recently invested £39,000 of members’ money in installing solar onto the local doctors’ surgery.