HEALTHCARE ESTATES 2021 PRESENTATIONS
Are we building the best hospitals for the future?
‘Do we know which hospital to build and why we’re doing it’ was the title of a first day presentation by Stephen Wright, an independent consultant and Honorary Professor at The Bartlett School of Architecture – who has undertaken economic consultancy across both developed and developing countries, with institutions including the WHO, the European Commission, and the World Bank, as well as for companies and governments – at October’s ‘hybrid’ Healthcare Estates conference. HEJ editor, Jonathan Baillie, reports.
Stephen Wright began his conference address by explaining that he would be focusing on ‘the hospitals we should be building, and why we’re building them – from an international perspective’. He told delegates he had spent much of his working life overseas, the majority of it in healthcare. He said: “I’m thus interested in the ‘compare and contrast business’ with the UK. He said: “The immediate reason for talking to you will in fact appear in another part of the conference today – a group of colleagues got together to make a submission for the Wolfson Economics Prize 2021 – a very eclectic, large, and interesting prize competition, which is not in fact run every year, and revolves around different subjects depending on the year. For instance, previously it’s been on the future of the Euro, and 'garden city' planning in the UK, but this year the topic to be addressed was: ‘How would you design and plan new hospitals to improve patient experience, clinical outcomes, staff wellbeing, and integration?’
Submission founded on four principles
His team had, he explained, founded its submission on ‘four main propositions’. He elaborated: “The first is that that the siloed hospital is a thing of the past; we need to think differently and behave differently. We do need much better measurements of hospital workload, and, indeed of hospital capacity. We came up with a sort of a slogan that ‘There’s no such thing as a good hospital; there’s only a hospital which is good in the context of its system’. We also need a common language. I happen to be an economist, but there are of course plenty of other stakeholder professions and disciplines involved in the hospital sector – most notably clinicians and patients. In this presentation, I’m going to touch more on numbers one and three in that list.” Before proceeding further, Stephen Wright told delegates a little about his own background, explaining: “I’m an economist, with a track record of working
18 Health Estate Journal January 2022
consultancy across developed and developing countries, with institutions including the WHO, the European Commission, and the World Bank, but also for companies, and in some instances, governments.”
Having touched on his professional background, the speaker said he would begin his presentation proper by looking at ‘what the wider health system is for’. Here he drew firstly on the World Health Organization’s World Health Report 2000, which sets out three key goals for this ‘system’: n Improving the health of the population; n Responding to people’s expectations, and
n Providing financial protection against the costs of ill health.
A WHO ‘vision’ of care
Stephen Wright said: “Many of these models don’t capture the physical processes; things like patient pathways model of care, education, and the economic issues – the value and cost.”
largely in market and capital investment appraisal, but I’ve worked in many, many, many sectors.” He continued: “I started in energy, spent a lot of time in industry, and have worked in the solid waste sector, but then – during my time at the European Investment Bank – focused in very much on health and education.” While with the EIB he had developed, and then run for a decade, the Bank’s economic policy engagement in the health sector. He said: “We were working in most parts of the world, including the developing world, and across Europe, including in the UK, and there was a substantial lending stream – in the order of a couple of billion euros annually.”
Health research centre
After leaving the Bank, he established a small health research centre, and has since also undertaken economic
This set of values had, he explained, led the WHO to ‘a set of ideas’, and ‘a vision of a primary care, public health-led health system’ – something the UK had experimented with, and ‘perhaps even still had’– an idea that the health system is led by the general practitioner and the other professions around primary and community care, and that it shouldn’t be led by the hospital. He expanded: “But where does the hospital fit in? One of the problems with hospitals is that we may not in health policy regard them as absolutely essential to the delivery of the care that the average person needs most of the time. They are incredibly expensive pieces of equipment to maintain, and in a typical health economy, more than a third of yearly health expenditure – probably over US$ 1,000 per head (around £1,400 per capita), is spent on hospitals in most developed countries, while often in underdeveloped countries the figure is higher. So,” he continued, “despite the fact you might think that primary care and public health would be crucially important, countries often spend a lot of money on hospitals – and I would just ask the question: ‘Do we know why we spend all that?’
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