HEALTHCARE ESTATE PLANNING
third in the previous 30 years, and said the system had not been able to deal with the increase in the number of elderly people, in particular. At the level of ‘form’, the NHS argues that it has made considerable progress towards Net Zero impact in hospital building, and that deserves credit. However, that misses the point. While an important priority, it should not detract from a hospital’s functional activity. What is failing is the continuum of care. Continuum requires ‘anticipation’ – forward planning – and benefits from a multi-sectoral approach. If we are to accept that healthcare is evolving from cure to prevention, how does it affect the role of the hospital, and can we emotionally, politically, and functionally, accept the idea of integrating hospitals into the wider activities – including the community, or must it stay a separate function? Can we accept that that cure is the backstop to the failure of prevention? Early diagnosis and encouragement towards lifestyle
change are key to maintaining affordability. Early diagnosis is a combined effort of primary care and access to diagnostic equipment. Everyone is now recognising and accepting that health and care are changing ‘from Cure to Prevention’, but the strategic consequences of this are less well understood, and this is because the planners and deliverers of healthcare see it as an adaptation of what they have been doing for many years. A shift ‘From Cure to Prevention’ requires a real step change, with greater co- relations with other factors that are considered part of the wider health and care remit – the expansion from health to health, wellness, and social interaction. This change is easier for those countries that are still learning how to deliver universal healthcare; they do not have the NHS’s history and culture in terms of a tendency to hold on to a long-established working model despite an evolving society, and changing patterns and types of illness and demographics. How things have changed. For the moment, if we set
aside COVID-19, today the key health and care problems are more related to non-communicable diseases (NCDs) and the other largely lifestyle-related conditions that are preventable. The WHO definition is thus ever more pertinent. While, the NHS has consistently been in the top 10 as regards access and quality of hospital service, if one considers both the economic and social wellbeing required to sustain good health, including health outcomes, health systems, sickness, and risk factors, as well as mortality rates, the NHS slips to 34th in national ratings.
Some interesting projections Information from the ONS National Population Projections: 2021-based interim, released on 30 January last year indicate that: n Over the 15 years between mid-2021 and mid-2036, the UK population is projected to grow by 6.6 million people (9.9%), from an estimated 67.0 million to 73.7 million; this includes 541,000 more births than deaths, and net international migration of 6.1 million people.
n The UK population is projected to reach 70 million by mid-2026; this growth is faster than in the 2020-based projections released in January 2023, with the projected rise mainly resulting from international migration.
n The population projections for the UK are based on an assumption of long-term net international migration of 315,000 per year from the year ending mid-2028 onwards; this is based on expert views and the latest data covering the last 10 years. Note that migration assumptions do not directly account for recent and future policy or economic changes, and there is always
some uncertainty in estimates of migration, meaning that actual levels of future migration and resulting population may be higher or lower than those assumed in these projections.
n There will be an increasing number of older people; over the next 15 years the size of the UK population aged 85 years and over is projected to increase from 1.6 million (2.5% of the total population) to 2.6 million (3.5%). This is putting ever greater strain on social care and the services provided.
n UK health outcomes are falling, one reason being that old people who are medically fit to leave the NHS acute hospital cannot do so, due to the lack of social care packages to support them after discharge. One, and perhaps the main, reason for this is people living alone. This emphasises the need for a robust inter- generational delivery of both homes and services which will encourage interaction between those of different ages. This has the potential to mitigate, or even eliminate, escalations of local authority and private sector costs.
Demographics If we now we turn to the scenario in 2024, and start with the demographics, we are now an ageing society. Between 2010 and 2020, the ratio of over 65s exceeded the young, 0-14-year-old age group. It is interesting to look at the ONS data for the UK population demographic shift since 1970, looking forward as far as 2050 (see Table 1). n The significance of over 65s overtaking the 0-14 age group has tended to have been overlooked, thereby causing growing problems and increasing costs both to the NHS and local government social services.
n Although one in six of the UK population is currently aged 65 and over, by 2050 one in four will be. The pensioner population is expected to rise despite the increase in the women’s state pension age to 65 between 2010 and 2020, and the increase for both men and women from 65 to 68 between 2024 and 2046.
YEAR
0-14 years 15-64 years
Early diagnosis and encouragement towards lifestyle change are key to maintaining affordability, Simon Lovegrove argues.
Table 1: Demographic trends that affect population issues.
PROJECTIONS
1970 1980 1990 2000 2010 2020 2030 2050 24% 21% 19% 19% 18% 17% 15% 12%
63% 64% 65% 65% 66% 63% 63% 62+% Over 65 years 13% 15% 16% 16% 16% 19% 22% 25+% January 2025 Health Estate Journal 49
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