RESTRUCTURING
8 7 6 5 4
SEGMENT 1 2 3 4 5 6 7 8
YEARS
2005–Present 1995–2004 1985–1994 1975–1984 1965–1974 1955–1964 1948–1954
Pre 1948
Figure 2: Age profile of the NHS estate 2007-2008.
responsibility for their own health, then it is good that they have the information to do so – as long as that information is correct. As well as being more tech savvy, this
future demographic is likely to be far more demanding about their need for privacy within the acute hospital environment. This trend is already happening, with single bed units increasingly viewed as an essential requirement in hospitals and not just for reasons of privacy. Reduced spread of
3 %
10.00 19.00 21.00 15.00 14.00 3.00 1.00 17.00
2
1
Country USA
Norway Denmark
Netherlands France
Sweden Germany Belgium Australia Ireland Finland UK
New Zealand Italy
Spain Greece
Portugal Poland
SouthAfrica China India
GDP/Head (US$) 47,150 85,390 56,240 46,900 39,450 48,900 40,120 43,080 50,750 46,170 44,380 36,340 32,370 34,080 30,550 26,610 21,490 12,290 7,280 4,430 I,410
Table 1: The cost of healthcare. Health GDP
%
17.9 9.5
11.4 11.9 11.9 9.6
11.6 10.7 8.7 9.2 9.0 9.6
10.1 9.5 9.5
10.2 11.0 7.5 8.9 5.1 4.1
infection, flexibility for more bedside treatments, family and friends support, the full use of digital systems and multi-cultural acceptability are all co-benefits of this change. There is a cost to this single bed room
provision, with a new build floor area reducing the number of beds by 30% when moving from a multi bed ward to single bed rooms. This is reduced to possibly 50% when the transition takes place in a refurbishment
Figure 3: Components of a modern acute hospital and the requirements for flexibility. HIGH Hot floor
(clinical diagnosis) 24%
Ward (hotel) 27%
Office 36%
Industry 13%
LOW Clinical Operational Cultural Decay rate – over lifecycle 16 Building standards
Science and technology So far the changes we have touched on have been financial, societal, public health and demographic. There is, of course, a relentless march of science to add into the mix. Take the relatively new science of
molecular biology, which has given us a deep level of understanding of the human body through the sequencing of the human genome. Understanding how we are constructed at base level means that we not only have the chance to gauge our vulnerability to disease but also to predict how the immune system might respond to different diseases – and more crucially, to tailored therapies. This may lead to more preventative strategies and reduced attendance as in-patients. A further scientific area of activity is
nanotechnology. In terms of medical research, there are opportunities here for advanced therapies and drug delivery, innovative diagnostic imaging and structural repair. In the near future, the process of
IFHE DIGEST 2013 US$
8,439.85 8,112.05 6,411.36 5,581.10 4,694.55 4,694.40 4,653.92 4,609.56 4,415.25 4,237.64 3,994.20 3,488.64 3,269.37 3,237.60 2,902.25 2,714.22 2,363.90 921.75 647.92 253.93 57.81
Healthcare cost/head €
6,680.69 6,420.17 5,076.68 4,418.77 3,719.21 3,716.74 3,687.12 3,649.88 3,495.23 3,355.10 3,162.20 2,763.84 2,587.71 2,473.42 2,299.34 2,149.98 1,872.49 730.13 512.87 200.98 45.76
£
5,297.02 5,090.46 4,023.25 3,502.56 2,946.84 2,946.09 2,907.87 2,893.05 2,771.29 2,659.44 2,506.84 2,189.87 2,052.07 1,992.88 1,821.49 1,703.77 1,483.86 578.59 406.66 159.37 36.28
(Data source – World in Figures 2013 Conversion $ to € to £ Sep 2012).
project. This can, however, be offset by the possible reduction of in-patient accommodation in many countries, which may balance the equation. We can therefore conclude that these
trends point to some radical changes in how and where we deliver healthcare in the future. What’s more, the healthcare facilities we are designing and building today, given a typical 60-year life will be in service to experience these new patient groups and the changes they will bring to bear on the system.
Probability of change
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