HEALTHCARE ESTATE PLANNING
Prescribing a greater role for ‘integrated hospitals’
Simon Lovegrove, CEO of MHealth, who has considerable experience as the lead on, or as a contributor to, the development of over 150 hospitals globally, and has managed major hospitals and other healthcare facilities in the UK, Europe, the Middle East, Africa, Asia and China, explains why – based on his own experience – he believes integrated hospitals achieve greater efficiency, and create more opportunity to draw the healthcare facility into the community, while simultaneously providing better continuity of care.
I am proudly British, a passionate advocate for the NHS, and work in developing and implementing new health and care models, both here and overseas. My company, MHealth’s skills include hospital and healthcare planning, and working to provide Healthy Living Communities – as per United Nations Sustainable Goal 11. During my career I have worked with the NHS overseas to support British export effort – a valuable resource that clearly highlighted UK expertise. This expertise is, in my view, still evident in many areas of the NHS, but not in hospital planning, design, and construction. Now we have the experience of learning from other countries – and this has been truly inspirational. Some of these countries have overtaken the UK in the world comparisons of health outcomes. This is a critical time for the NHS, with considerable recent activity surrounding the service, and some influential reports published, some of which I will refer to. While the Prime Minister stated, within the first weeks of becoming Prime Minister, that he would not increase the NHS Budget unless a new strategy is proposed and approved, the Budget increase was necessitated to resolve the staff payment disputes. However, it does not lessen, indeed it reinforces, the need for a new strategy. The pre-budget NHS expenditure showed that hospitals accounted for 78% of the overall spending. The greater emphasis on prevention is hard to afford by the DHSC Budget alone. This article offers some thoughts on the way NHS care is currently provided, and my own vision of the benefits that greater use of integrated hospitals, with increased focus on people, as well as patients, can bring, looking ahead. On 7 April 1948, the World Health Organization’s (WHO) Constitution came into force, with its definition of health stated as: ‘Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity’. On 5 July 1948, the UK National Health Service (NHS), seen as a forerunner of universal healthcare, was founded, with a stated aim of ‘providing everyone in the UK with healthcare based on their needs, and not on their ability to pay’ – i.e. healthcare that is free at the point of use. The comparison of the two shows that the aim of the NHS was political – and it has stood up as a worthy political aim. The WHO, unconstrained by political consequences, provided a more altruistic vision – one that anticipates evolution.
Hospitals ‘the backbone of the NHS’ The hospital has been the backbone of the NHS, as the institution that is built, staffed, and equipped, for the
diagnosis and medical and / or surgical treatment, of sick and injured patients. Here indeed is ‘the rub’: NHS strategy is focused on patients, not people – resulting in the failure of an important business and service discipline – ‘market awareness’. Through greater such awareness, the population and demographics would inform the delivery of health services. Understanding this better would allow the NHS to be more proactive, in place of what is – in my and many other observers’ view – its current reactive tack, i.e. of seeming to be always running to catch up.
Distracted by the political moment? An additional complication is that NHS strategic thinking has at times been distracted by the political moment, one example being the adoption of the PFI/PPP financial model, which – by its nature – was based on a contract related to the financial ‘security of form’, thereby frustrating the flexibility that is so necessary to respond to the dynamic human activity of a hospital. The iconic nature of the NHS gives it political status that
has defined the service as the sole custodian of all health services. While this has been its strength, it is now – I would argue – becoming its weakness. Health and care are evolving, as the WHO anticipated, to an ever-greater emphasis on ‘complete physical, mental and social well- being and not merely the absence of disease or infirmity.’ This is much more complicated to measure, and therefore, for politicians and managers to grasp. This is widening the scope of health and care to promote greater prevention of non-communicable diseases – a greater transfer from cure to prevention. Prevention is an increasing part of
January 2025 Health Estate Journal 47
Simon Lovegrove says: “The hospital has been the backbone of the NHS, as the institution that is built, staffed, and equipped, for the diagnosis and medical and / or surgical treatment, of sick and injured patients.”
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