HEALTHCARE ESTATE PLANNING


The PFI/PPP influence on NHS hospital design put form ahead of function, and this has proven to be responsible for many of the aforementioned failures. Some of my key conclusions – based on my experience and the work I have done in the planning and management of hospitals, include: n Hospitals need to be designed to suit the population they serve.


n NHS capital budgets need to be protected, and not raided by NHS revenue budgetary needs.


n Hospitals need a consistent development budget for new-build projects, renovation, and maintenance.


n With the footprint of a hospital tending to expand, rather than reduce, as a rule, the NHS must retain its land and avoid selling it off to help pay for the cost of development – a false economy. Land cannot be easily replaced.


n Planning of a hospital is about function – form is dictated by function.


n Hospital planning has two related elements: n The population that the hospital serves – the patients of tomorrow.


n The patients that a hospital admits and treats – including the understanding of oncoming new treatments and technologies. Both elements try to anticipate the future, and that requires building flexibility into hospital design.


I have shown some of the key characteristics of the NHS hospital building programmes of the last 25+ years, and how they reflect poor NHS strategic thinking – with insufficient attention to changing demographics, and the associated post-discharge challenges. Since 2007, I have been working on this combination of acute and stepdown. My company undertook a recent analysis on a new build 1,000-bed hospital, compared with a combined unit of 950 beds and 250 step-down beds. While the capital and operational costs were almost identical, the latter model achieved 20% more beds – a major aid in to relieving bed blocking My experience of working in many countries is that


integrated care is not just a health service responsibility, as the evolving nature of health has three pillars – health, wellness, and social interaction. Only through addressing these three pillars can health outcomes be both improved and more affordable. Such a solution requires three key initiatives: n New strategies. n Recognition that this is multi-sectoral – and beyond the responsibility of a single government department. n The ability to share ownership and/or responsibilities.


At the heart of the matter The key question, and one currently exercising the minds of those leading the NHS – is whether to keep hospitals as an isolated building or blend them into integrated care. Thus I present a contra-argument; Figure 1 shows a more flexible design approach. We had to provide a costing analysis when we first introduced this model to justify the case. In recent months, I used one of my company’s models to indicate the UK comparison of the cost difference between a 1,000-bed acute hospital and a 950-bed acute hospital combined with a 250-bed step down facility (i.e. a total of 1,200-beds). As previously stated, the capital and operational costs were almost the same. This is important even in the private sector where, in


many countries, the private health insurance companies use the ‘Diagnostic Related Group’ payment model, based on fixed term patient stays. By way of example, the integrated hospital could provide 4-acute + 3-sub acute stays for the same or lower price than 5-acute day stays. The associated advantages and key features of a ‘step-


down’ facility, for more inclusive integrated care, include: n A patient hotel – particularly important for children and relatives and those seeking out-of-hospital treatment, such as haemodialysis, and cancer treatment – such as chemo- and radiotherapies.


n Rehabilitation – both physical and mental. n The association of wellness to rehabilitation. n Social interaction facilities (lounge, café, sitting area, and even workshare) – particularly important for lonely people.


Such a plan also provides the capability for rapid isolation of the step-down component to create a Pandemic Isolation Unit. Figure 2 shows a briefing diagram for a MHealth project in the Far East.


Complementing and amplifying Hospitals complement and amplify the effectiveness of many other parts of the health system, providing continuous availability of services for acute and complex conditions. They concentrate scarce resources within well-planned referral networks to respond efficiently to population health needs. They are an essential element of Universal Health Coverage (according to the WHO, ‘Universal Health Coverage (UHC) means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship’), and will be critical to meeting the Sustainable Development Goals (SDG: according to the WHO, ‘a call to action to end poverty and inequality, protect the planet, and ensure that all people enjoy health, justice and prosperity’.)


Hospitals are also an essential part of health system


development. Currently, external pressures, health system shortcomings, and hospital sector deficiencies, are driving a new vision for hospitals in many parts of the world. In this vision, they have a key role to play to support other healthcare providers and for community outreach and home-based services, and are essential in a well- functioning referral network. Hospitals matter to people, and often mark central points in their lives. They also matter to health systems – by being instrumental for care coordination and integration. They often provide a setting for education of doctors, nurses, and other healthcare professionals, and are a critical base for clinical research.


Simon Lovegrove


Simon Lovegrove, Chief Executive of MHealth, has considerable experience as the lead and/or a contributor to the development of over 150 hospitals, as well as management of major hospitals and other healthcare facilities in the UK, Europe, the Middle East, Africa, Asia, and China. He has worked in managing hospitals in the UK, Hungary, the British Virgin Islands, Libya, and Turkey. His core skills are: hospital planning, healthcare planning, and the planning and development of UN- SDG-11 framework communities. Since 2007, he says he has been ‘taking the lead in creating the vision for how to move from cure to prevention, and the concept of integrated care’, with ‘new, but also classical models’ that take account of the cultural context within which he works, while anticipating the future – ‘including the increasing health burden of non-communicable diseases and an ageing population’. His work has included a focus on healthy living cities and communities, ‘motivated by the three pillars of health, wellness, and social interaction’. His projects also include tackling the impact of climate change.


Continuum of care requires ‘anticipation’ – forward planning – and benefits from a multi- sectoral approach.


January 2025 Health Estate Journal 51


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