A ward-winning idea

Nineteen-year-old Joe Twyman's college gap year was certainly memorable - he was diagnosed with leukaemia.

As part of his treatment at London's University College Hospital (UCH) last summer, as he explained to the Guardian at the time, he spent several nights in the city's 330-bedroom Radisson Edwardian Grafton. "It's very comfortable," he told the newspaper. "The hotel breakfast is fantastic. It's not easy, but it's much more pleasant. It makes it more bearable."

The agreement between the Grafton and UCH to house a number of cancer patients on a regular basis is both innovative and, as yet in the UK, relatively rare. Hoteliers and hospital doctors or managers, whether because it hasn't occurred to them or because they're worried about the logistics, have tended to shy away from such arrangements.

But this may be beginning to change. UCH haematology consultant Prof Tony Goldstone, who is also director of the North London Cancer Network, has pioneered such agreements with a number of London hotels, and he believes many hospitals with hotels nearby are missing a trick. He thinks that both sides could benefit from emulating what happens in the USA, where cancer centres in particular have for some time used local hotels to house patients.

Different matter

"In all probability," he says, "the NHS's structures are not innovative or lateral-thinking enough to do something like this on a wide scale. But if the industry were to come to the NHS and say, ‘Look what can we do for you,' then it might be a different matter."

At one level, it's perhaps not surprising that the Grafton, on London's Tottenham Court Road, has its arrangement with UCH. The hotel was a nursing home during the Second World War and for many years provided accommodation for nurses. Most significantly, it's just a few metres from the hospital.

"We're no more than 50 paces across the road from the hospital," says house manager Peter Wardley. "I think it's a pretty unique arrangement. It's the only time I have come across it in 23 years of working in hotels."

Of 330 bedrooms, the hospital has a guaranteed allocation of 10, he adds. "It's an arrangement that we have with the hospital," he says. "The only thing we do that's different is that there are fridges in the room, separate from the minibar, for people's medication." Each patient is also issued with a panic alarm by the hospital, which puts them in direct contact with the hospital.

Patients will normally stay for about two weeks at a time, and may stay a number of times.

Beyond the normal health and safety and disability discrimination training, no specialist training is given to hotel employees, Wardley adds. "It's just about staff being aware that we have a sick person staying with us," he explains. "Most of them are patients with cancer and are undergoing chemotherapy, which can be very traumatic. We try to give people their privacy and make them as comfortable as possible."

Wardley strongly recommends that the issue of proximity be considered carefully before a hotel considers striking such an agreement. "There are few hotels that are this close to a hospital," he says, "and I think you literally have to be on the doorstep if you're taking in extremely sick people. If patients press the panic alarm, it's as quick to get to someone in one of our rooms as it is to get to a patient, say, on a sixth-floor ward. When the alarm is pressed, trained medical staff will come over, although there have been times we have got up to a room first, just to check everything is OK and that they haven't just pressed it by mistake."

Regular revenue

Financially, the agreement also makes sense. The hospital is charged the hotel's regular corporate rate of 168 a night. While this is not a massive revenue stream given the size of the hotel, it's still welcome regular revenue, says Wardley. "If you have 10 rooms each with two-week stays, it's obviously a cost-effective arrangement rather than just going from day to day," he says.

For the hospital, the rate is significantly cheaper than the estimated £500 a night it costs to house a patient on a ward.

Wardley adds: "The key to the success of an arrangement like this is the relationship between the staff and the hospital. We work very closely with UCH. But it's very important that we get a bit of background on the patient beforehand so that we can make sure we're meeting their needs."

Diet can be an issue for patients undergoing chemotherapy, as they can often become acutely sensitive to different smells and tastes. "In terms of dietary needs, the chef is very flexible and is aware of people's needs," Wardley says. "We're advised on this by the hospital."

Goldstone agrees that proximity and flexibility, rather than the hotel staff having any specialist training or equipment, are the main attributes for a successful local arrangement. "It's about access to the facilities and the level of risk to the individual patient," he explains. "We would never dream of doing this if we were a rural hospital and didn't have a hotel nearby."

He adds: "What we look for is a reasonable level of sophistication and a high level of cleanliness, but the issue above all is proximity. We're looking at several different hotels at the moment."

Another hospital/hotel arrangement that has been in place for the past couple of years exists in Southampton between the 15-bedroom Manor House hotel and Southampton University Hospitals Trust. Their arrangement is slightly different to the Grafton/UCH deal in that Manor House, a former maternity home converted into a hotel, is solely for the use of radiotherapy patients, rather than being a regular hotel. In fact, patients will often share a room.

The hotel is run by a charity, the Wessex Cancer Trust, but there is a patient liaison nurse supplied by the trust on site during the day. Out-of-hours queries or emergencies are directed to regular patient helplines and support services provided by the trust. And a minibus service, the Manor Link, takes patients to and from the hospital for daily treatment.

Generally, arrangements such as these are local affairs, says InterContinental, owner of the Bloomsbury Holiday Inn, another London hotel that takes in cancer patients on a regular basis. "It's not something we would co-ordinate centrally, as it's an individual hotel opportunity," says spokeswoman Emma Foster, adding that the normal route would be to set up an agreement with a local NHS trust or private hospital. "We wouldn't make a specific investment and wouldn't consider anything which impinges on normal operations and guest expectations."

Good relationships

For the hotel manager, there will always be challenges in such arrangements, particularly as dealing with sick people is a sensitive and emotional issue. But, argues the Grafton's Wardley, the benefits for employees, the hospital and patients go far beyond the financial. "In the hotel industry," he says, "it's unusual to have people staying for any length of time, so we get to know the patients. A lot of them come back for treatment maybe three times a year. Some good relationships and friendships have developed."

He adds: "We had one patient, for instance, who had cancer and stayed with us and who had a baby. The staff all went over and visited her with flowers."

How it works in the USA

In the USA, particularly at cancer centres, where patients come back for regular bouts of treatment, local arrangements between hotels and hospitals are commonplace, says Prof Tony Goldstone.

The MD Anderson Cancer Center in Houston, Texas, for instance, even has a hotel on site - the 322-bedroom Jesse H Jones Rotary House International, which is managed by Marriott Conference Centers. Its specialist facilities include kitchenettes, wheelchairs and medical equipment, specially equipped bathrooms and a shuttle service to local shops.

There are other hotels nearby that cater for patients, including the 120-bedroom Residence Inn by Marriott Houston West University.

Another major cancer centre, the Memorial Sloan-Kettering in New York, has arrangements with a range of nearby hotels, but uses mainly three: the Helmsley Medical Tower, the Lyden Garden hotel and the Melrose hotel.

Beyond the issue of cancer care, however, such arrangements are less common. The Thomas Jefferson University Hospital in Philadelphia, for instance, is pretty standard in advertising a range of nearby hotels, but it draws the line at housing patients. "If a patient requires hospitalisation, he or she stays in a bed in Thomas Jefferson University Hospital," stresses spokeswoman Nan Myers.

She adds: "We work with local hotels to provide special rates to people from out of town who need to see a physician or have a quick procedure at the hospital. These people are not inpatients; they may have to return to the hospital or the physician on the next day or days for some follow-up, which is why they stay in the area. But we don't place hospital patients in hotel rooms."