HEALTHCARE ESTATE PLANNING
Above right: Figure 1. A flexible design approach for future healthcare facilities.
Above: Figure 2. A briefing diagram for a MHealth project in the Far East.
This demographic trend is one of the reasons that many of the problems within the NHS have built up over time, and they are related to underlying lack of long-term planning, and lack of consistency in capital investment. A look at international comparisons is not about technology (the NHS has superb surgical, clinical, nursing, training, and research resources), but rather to see how other health systems get the basics right in ways that the NHS and the politics around it fail.
The NHS focus on centralisation An observation of other countries indicates that often the best healthcare systems are less centralised. NHS England operates as a single health service for the country’s entire population of 56 million people from the centre. It even seeks to have a single hospital model. This is cumbersome and inflexible. Over-centralisation of the NHS creates the wrong attitudes within the management. Given the size of the country and the population, healthcare systems in other countries are delegated to give more genuine control at local levels, thereby enabling real ownership over how healthcare is organised and delivered within their population and communities. The inappropriateness of centralisation is indicated by
Table 2. NHS Digital & UK Census Information – 2021: The struggle to provide acute services.
YEAR
UK average age Avg admission age
London
South East South West Midlands
East of England North West
data from NHS Digital, which recorded the variance of the average age of hospital admission – a span of 49.9 years in London compared with 57.2 years in the South East. In Table 2, we show the UK Census average age in 2021 at 40.7 years. The UK average age projections for the year 2030-2050 are from Statistica, while the average hospital admission age for 2021, shown in the first column, is from NHS Digital. The projected average hospital admission age in the columns headed 2030- 2060 are from MHealth extrapolations. These average age and hospital admission figures
2021 40.7
54.8 49.9
57.2 56.3 55.5 56.6 53.9
North East & Yorkshire 55.3 50 Health Estate Journal January 2025
2030 41.6
57.5 52.3
60.0 59.0 58.1 59.3 56.5 58.0
2040 43.8
60.5 55.0
63.1 62.2 61.2 62.4 59.5 61.0
2050 44.9
62.0 56.4
64.7 63.7 62.7 64.0 61.0 62.6
2060 46.5
64.2 58.4
67.0 66.0 64.9 66.3 63.1 64.8
and projections have significant implications for hospital design if the NHS is to better manage issues such as how to relieve bed blocking – the term used to describe when patients who are medically fit cannot be discharged owing to inadequate community and social support, and difficulties in finding suitable residential care facilities. Nationally, bed blocking accounts for about 17% of acute beds, rising to one in three (33%) in the worst affected areas, a real factor in aggravating waiting lists. The projections show how this will further aggravate waiting lists. This is recognised elsewhere, where the importance is recognised of a different design of hospital, to replace large acute facilities with ‘integrated hospitals’ – a combination of acute and sub-acute beds fully connected on the same site. This hospital model is proving successful in countries like Singapore. Integrated care requires reform to reorient health
services, shifting away from fragmented supply-oriented models towards health services that put people and communities at their centre, and surround them with responsive services that are coordinated both within and beyond the health sector. Most importantly, an integrated hospital provides both better continuity of care, and connectivity to the community that it serves. The failure to embrace such a model within the NHS is a major strategy failure, and has an ever-growing impact on out-of-hospital services, such as primary care, impacting particularly pre-hospital admission and post-discharge care, including step-down (e.g. for those who live on their own), rehabilitation care, and care at home. The resulting strain on the NHS creates a comparable strain on social services. Affordability of health and social care is only achieved by continuum of care – which is a more multi- sectoral version of integrated care. I used to manage and participate in hospital design and build in many countries. Our success, with little or no cost or time overruns, was due to efficient planning and mutualistic contracts – a clear stakeholder agreement between finance and delivery. This requires managers who know how to develop without interference, thereby being more cost-efficient.
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