A singular obsession

As a result, in all new-build hospitals the presumption is that all in-patient accommodation will be in single rooms, unless there are clinical reasons why not. While recently rebuilt hospitals such as Glasgow's Victoria Infirmary and the Forth Valley Royal Infirmary have mixed accommodation, Glasgow's Southern General and the new Dumfries and Galloway Royal Infirmary will only have single rooms.

The impression given is of modernity, hotel standards, the slick personalised approach of American healthcare.

But is it right for all patients? And is the evidence really there to support it?

Critics have focused on the new Dumfries hospital, for which a site is currently being sought, and are asking why patients cannot be given a choice.

The objections have been reinforced by one doctor who works on an emergency medical ward at the existing hospital. Dr Chris Isles has carried out two informal surveys, 12 months apart, which, he says, both demonstrated that demand for single rooms is far from universal.

In fact it showed that 60% of patients in four-bedded rooms would prefer one again if they were re-admitted. Not only that, but 40% of those in single rooms felt they would rather be in shared accommodation if forced into hospital again.

The policy, Dr Isles says, neglects to consider the value of social stimulation to recovering patients. He argues that the local health board should carry out a more detailed survey before committing to the plans.

"The message fell on deaf ears, because it had already been decided that all the new hospital builds were going to be with 100% single rooms," he says. "I think it is an outrage that a vast sum of money is being spent on an environment which will basically amount to sensory deprivation."

The issue, he argues, may in part be a class one. "I think the rules are being made up by middle-class professionals. There is probably a class element to this. People who live on council estates on the outskirts of Dumfries – who form the bulk of those admitted to hospital as an emergency admission – appear to prefer shared accommodation. They are being studiously, contemptuously, ignored."

The plan for the DGRI is to incorporate "socialisation spaces", a concept which Dr Isles says is missing the point and ignores the problem that moving less mobile patients to such spaces will take manpower and time.

It isn't just a matter of social isolation, according to Molly McMillan, who has also attempted to influence the policy, from her position as a member of the stakeholders' group set up to advise on aspects of the new build.

She meets many patients through her work as a volunteer in the area, and claims a significant number have expressed concern about the single room policy. "In this area, that is certainly not what people want," she says. "I've asked them [the health board]: 'how many of you have actually spoken to patients?' Nobody has and nobody will.

"I would argue that patients need rather than want the support of other patients."

To back up this view she has gathered a number of experiences from patients she meets, which she says demonstrate some of the hard-to-measure benefits of shared wards. In two of the case studies, patients who have fallen or have choked have been unable to ring for help, but have been given assistance after another patient alerted staff. One elderly patient whom Ms McMillan was visiting in a double room where she was the only occupant clung to her, terrified and pleading for her not to leave her alone in the large room.

Another patient told her she was lonely and unhappy in her single room but it was bearable because the nursing station was next to the room and if she left her door open, she could see and hear other people. "Patients often tell me they get more help and assurance from other patients than from staff," Ms McMillan adds. Among reasons patients have told her they don't want single rooms, she lists fear of dying alone, of being forgotten, of time dragging, and of falls.

"I think there is a sense that they are keen to be the first to have 100% single rooms," she says of the NHS board. "Once it is built, it's built and what do you do about it?" she adds.

One insider at the health board told The Herald that there had been "robust discussion" at board level about the policy. However NHS Dumfries and Galloway's chief executive Jeff Ace has insisted that the board is bound by Scottish Government policy to provide 100% single rooms in any new hospital. The Scottish Government, which commissioned a steering group to look at the issue four years ago, says that the policy will increase patient dignity and privacy, future proof the hospital estate, reduce disturbance at night and facilitate patient care. In particular, the government says a large body of evidence supports the idea that single rooms will prevent Hospital Acquired Infections (HAIs).

Dr Isles claims evidence that single rooms can help reduce the spread of HAIs is weak. "There is no conclusive proof. What we do know is that handwashing is the best way to cut infection. I didn't really have a point of view on this, at first. But it is blatantly obvious if you speak to patients that a high percentage of them like the idea of company.

"Questions about dignity or the risk of someone overhearing medical details seem to be of secondary importance to them."

However he now thinks patients themselves must speak up, or the argument will be lost. He says: "If the Government is to be turned on this, it won't be by doctors, it will be by patients themselves."