RESTRUCTURING Phil Nedin – Global Healthcare Leader, Arup


Planning today’s estate to meet tomorrow’s needs


Healthcare requirements are changing rapidly and these changes will have a major financial and operational impact on the existing healthcare estate. Not only are costs increasing, but there are pressures on estates to reduce costs, reduce size, become more specialised, integrate more with the community and reduce energy and carbon emissions.


In addition, the estate also has to deal with the ongoing drivers of medical and scientific change (Fig. 1). So, the challenge faced by designers and construction professionals today is how to plan the adaptation of the healthcare estate to deal with the many changes to come and communicate these complex solutions to the clinical teams. The only part of this equation that is fixed


is the quantity and quality of the existing estate. Figure 2 illustrates the age profile of the National Health Service (NHS) estate in England. There can be as many as eight generations of building types in existence, with each generation having their own spatial, environmental and construction standards, potential for flexibility and maintenance liabilities. Many other healthcare estates in the world mirror this situation. Firstly, we must consider some of the changes that the healthcare estate will be forced to accept.


Healthcare under financial pressure The financial burden of an unhealthy population was recently estimated by the UK’s Department of Health in a report which stated that the annual economic costs of working-age ill health could be over £100 bn. In short, a healthy population drives successful business and has a substantial overall benefit to the economy. However, there is an enormous financial


burden on countries that maintain a sophisticated healthcare system. Given the complex evolving nature of healthcare, neither the costs of illness nor the benefits of health remain static. To maximise the benefits and minimise


costs, innovative solutions are required across each of the drivers of change. At the same


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time, identifying healthcare costs and potential solutions is becoming more complicated. Much of the ‘low hanging fruit’ has


already been picked so we need to consider the opportunities for savings as a series of co- benefits that is underpinned by a whole-life cost based financial model. The potential for a single solution with a zero cost implication to significantly affect the bottom line of a healthcare system is a mirage. Applying multi- faceted, innovative solutions are the order of the day. Yet to transfer this early adopter approach to a profession steeped in evidence-based outcomes can create discomfort, resistance and delay. In global terms, the result is that costs can


vary widely even in countries of similar economic standard. Table 1 includes the cost of some healthcare systems in different parts of the world. Table 1 reflects the cost of healthcare per


person as well as the % Gross Domestic Product (GDP) for some selected countries. GDP may be an acceptable metric for economists and politicians, but it does not easily allow the consumers of healthcare to understand the cost implications of the utilisation of the system. This is important because we are now experiencing a changing global disease burden where, for the first time, more people (60%) are dying from non-communicable disease (NCD) than communicable disease. One result of this shift is that it will be more important than ever for the public to take responsibility for their own health and manage their lifestyles to reduce their reliance on the healthcare system.


Phil Nedin


Phil Nedin is a Chartered Engineer and a Director of Arup, responsible for its global healthcare business. This role has taken him to many regions in the world to investigate best practice solutions in healthcare engineering.


Phil has been with Arup for more than 23 years, currently based in the London office. Previously, he worked for the National Health Service in a regional health authority design group in London.


Phil is a past President of the Institute of Healthcare Engineering and Estate Management (IHEEM) and is currently on their international committee. In November 2011 he was awarded the IHEEM Lifetime Achievement Award. He is also a Fellow of the Institute of Mechanical Engineers and a member of the UK Department of Health design review panel.


IFHE DIGEST 2013


‘We need to consider the opportunities for savings as a series of co-benefits that is underpinned by a whole-life cost based financial model.’


There must, therefore, be a greater


understanding of the financial cost to the system of ‘doing’ i.e. smoking, alcohol abuse, poor diet and lack of exercise and ‘treating’ i.e. diagnostic scan, diabetes treatment, emergency admission and a bed day in an acute hospital etc. The changing disease burden will involve a radical shift in the approach to population screening, treatment, medication and monitoring with the inevitable changes to the healthcare estate of scale, acuity and distribution. These being underpinned by information technology systems connecting between acute centres, acute centre to community and community to home. This will undoubtedly require significant short term investment to ensure long term benefit which, at a time of global financial constraint, will be a challenge. However, the alternative is an inefficient healthcare delivery system.


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