HEALTHCARE ESTATE PLANNING
– the demographic change. Planning starts with understanding the demographic change over previous years and projecting that forward – this translates into a forecast of future (the lifetime of a new hospital), not just existing, patient needs. This demonstrates the clear need for flexibility of planning the facilities.
The author says: “When people do need care, they must be able to access the health services they need, when and where they need them, without facing financial hardship by paying for care out of their own pockets.”
the role of primary care, with the need for additional diagnostic services. The word ‘prevention’ changes the connotation of the function of a hospital. In 1948, the hospital was the key demonstrable function of the NHS, supported by primary care. Now ‘prevention’ requires increasing primary care and out-of-hospital services to promote it, and the role of the hospital is to take action when prevention fails. Lord Darzi’s recent report, Independent Investigation of the National Health Service in England, was published in September last year. An NHS Confederation summary and analysis, titled ‘The Darzi investigation: what you need to know,’ published on 12 September, said Lord Darzi’s review offered ‘clear illustrations of the key systemic and structural issues beyond NHS leaders’ control that if perpetuated will continue to set the service up to fail’. These include ‘the failure to divert resources into more preventative care and the pressure on primary care, an oversized centre (including regulators) with a heavy burden of regulation and inspection, and a lack of consistency and clarity around the role of integrated care boards (ICBs)’.
Clear illustrations of ‘system and structural issues’ The NHS Confederation briefing added that these ‘systemic and structural issues’ included ‘the growing focus of the NHS budget and staffing on hospital-based care… alongside factors that reinforce this distribution. Namely, performance standards focused on hospitals, not primary care, community services or mental health, single-year budgets, and politically driven short-term funding decisions that hamper innovation and transformation’. The briefing continued: ‘The investigation also helpfully illustrates that despite spending over half our budget on hospitals, we have not invested in creating a healthy ecosystem for them to operate in. This is both within hospitals, which have seen underinvestment in capital, hindering their ability to deliver efficiently and effectively, and lack of investment in primary, community, and social care services that keep people out of hospital and enable them to be safely discharged when ready to leave. The NHS needs to shift to provide more care closer to home, with a proportional increase in preventative investment upstream into primary care, mental health, and community-based services.’ However, there was no reference to two important
points that we come across in improving health outcomes in other countries. These are: n It is not patients that (should) determine the overall planning of hospitals nor healthcare. It is the population
48 Health Estate Journal January 2025
n Lord Darzi’s comment about ‘structural issues beyond NHS leaders’ control’ suggests prevention cannot be the sole responsibility of the NHS. Instead, it requires a multisectoral approach – and acceptance of this is enabling some countries to start to forge ahead of the UK with their health outcomes, incidentally often achieved with lower healthcare budgets at their disposal. As prevention becomes a shared responsibility across sectors, this offers the opportunity for private funding participation without compromising the public nature of the NHS. Both can lead to greater co- operation to achieve better health outcomes without placing it all on the NHS / DHSC budget, which, as we can see, cannot cope. More money will not solve the problem, because key areas of prevention fall outside their gambit, as Lord Darzi indicates. This is important, and raises many points over ‘integrated care’.
Today, health is one of three pillars of a healthy society – Health, Wellness, and Social Interaction. Where and how we live is the background of these three pillars. The term ‘integrated care’ is defined by the NHS as ‘care that is planned with people who work together to understand the service user and their carer(s), puts them in control, and coordinates and delivers services to achieve the best outcomes’. It goes on to say that Integrated Care Systems (ICSs) are partnerships that bring together NHS organisations, local authorities, and others to take collective responsibility for planning services, improving health, and reducing inequalities across geographical areas. The World Health Organization adds that a hospital
‘complements and amplifies other parts of the health system’. At a Summit of the Future on 2 September 2024, the Director General of the WHO, Dr Tedros Adhanom Ghebreyesus, made the following points as regards ‘a commitment to promote, provide, and protect health’: “Health is not created in clinics and hospitals. It’s created in streets, homes, communities, schools, markets, workplaces, and parliaments. It’s created in the air people breathe, the food they eat, the water they drink, the conditions in which they live and work, and in our changing climate. When people do need care, they must be able to access the health services they need, when and where they need them, without facing financial hardship by paying for care out of their own pockets.”
Hospital functional planning not sufficiently evolving The NHS has not sufficiently evolved its functional planning of hospitals for 30+ years. This was highlighted by Professor Ted Baker (Chief Inspector of Hospitals in England from 2017-2022) in an online BBC News Health story, NHS ‘not fit for 21st Century’, says Chief Hospital Inspector – published on 30 September. He said: “The model of care we have got is still the model we had in the 1960s and 70s. “One of the things I regret is that 15 or 20 years ago,
when we could see the change in the population, the NHS did not change its model of care. It should have done it then – there was a lot more money coming in, but we didn’t spend it all on the right things. We didn’t spend it on transformation of the model of care.” Professor Baker noted that the number of pensioners had increased by a
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