Last week, I wrote about how bureaucracy slows decisions across NHS Estates and Facilities Management. This week, I want to show what that looks like in an emergency, when delay isn’t just frustrating but dangerous.
During the first wave of COVID, I was working at Addenbrooke’s. As more patients needed oxygen therapy, the hospital’s Medical Gas Pipeline System (MGPS) was pushed harder than ever before. These systems are often 50 or 60 years old, designed for steady, predictable demand, not a global pandemic.
In early 2020, Cambridge University Hospitals NHS Foundation Trust faced faced the same problem that soon spread across the NHS: waves of COVID-19 patients drawing up to 60 litres per minute of oxygen, stretching pipeline systems far beyond design limits.
The increased flow forced the hospital’s oxygen evaporators to work flat out. At high loads, ice began to build up on the coils. A light frosting is normal. But as capacity was reached, the ice spread dangerously, raising the risk of liquid oxygen entering the system, which leads straight to a catastrophic scenario for patients.
At the time, the hospital relied on telemetry from its main oxygen tank (VIE). On paper it looked useful, showing pressure and fill levels. In practice, it was the wrong tool.
Readings swung wildly, with sharp peaks and even negative values. To make sense of it, the data had to be averaged over several days. That’s like trying to measure your car’s fuel consumption by glancing at the fuel gauge. It gave a general picture but missed the dangerous detail such as sudden surges in oxygen demand as patients were transferred in from other overwhelmed hospitals.
Oxygen use could double in hours, but the system only revealed patterns days later. Hospitals were essentially flying blind.
What was needed was reliable, real-time monitoring. The answer was non-invasive ultrasonic flowmeters, which could be installed without shutting the system down and gave accurate readings 24/7.
Working with the Trust’s MGPS Authorised Persons, we recommended installing ultrasonic flowmeters. Cambridge recognised the risk early and secured funding between the first and second waves in 2020. That foresight gave the team live visibility of oxygen flow as the second wave hit. This helped clinicians and EFM staff sleep at night, knowing they weren’t heading into catastrophe blind.
But Cambridge was the exception. Across the NHS, many Trusts delayed for years. Some only installed flowmeters in 2022, long after the worst COVID waves had passed.
Figure 3: COVID-19 admissions mapped against ultrasonic flowmeter sales. Procurement spikes followed admissions, not foresight.
Procurement data tells the story. Orders for flowmeters tracked admissions almost perfectly. Instead of learning from the first wave, Trusts scrambled once the crisis was already upon them.
Interviews revealed the same reactive pattern. One Authorising Engineer recalled: “I was surprised […] that they installed the ultrasonic flowmeters early this year [2022], which I thought was quite late because most hospitals in the UK started this in early-2020, mid-2020.”
A manufacturer described the panic:
“People were screaming at us to place orders and wanting everything by January. And I said: ‘Hold on, you’ve had the quote for six months.’”
Six months. These Trusts had quotes sitting on desks for half a year before crisis forced their hand.
This didn’t happen because EFM teams lacked skill. It happened because hospital decision-making is shaped by structural barriers:
The outcome is a system that reacts under pressure rather than plans ahead. A culture of fear over foresight undermines long-term resilience.
The tragedy is that COVID showed a different way was possible. A Director of EFM told me: “During the pandemic, most Trusts were able to do things quickly, similar to the private sector.” Yet, they concluded: “It just feels the pandemic never happened and we’re just back to normal ways of working.”
The oxygen monitoring case exposes the hidden costs of reactive decision-making:
The NHS can’t afford relearning the same lessons. Every crisis grows more expensive when knowledge doesn’t move quickly across the system.
What's needed isn't just more guidance documents or policy changes. It's better information flow that connects successful solutions with teams facing similar challenges. When Cambridge developed its oxygen monitoring approach, that knowledge should have reached every Trust within weeks, not years.
This is precisely why we are building INNEX: to break the cycle of reactive decision-making by ensuring critical insights reach the right hands before the next crisis hits. Because the next pandemic won't wait for perfect communication channels or updated guidance documents.
The oxygen monitoring story isn't really about technical equipment. It's about creating systems that learn, adapt, and share knowledge fast enough to keep patients safe and staff supported.
If you're interested in exploring how we can help transform your compliance workflows from bureaucratic burden to strategic advantage, reach out directly at carl@innex.ai.
Want to dig into the details? Read the full thesis here.