FUTURE ESTATE PLANNING Capital investment in healthcare as a percentage of Gross Domestic Product, 2015 or nearest year 1.2 1.0 0.8 0.6 0.4 0.2 0.0
1.2 1.0 0.8 0.6 0.4 0.2
0
Notes 1 Refers to gross fixed capital formation in International Standard Industrial Classification (ISIC) 86: Human Health activities (ISIC Rev4).
2 Refers to gross fixed capital formation in ISIC Q: Human health and social work activities (ISIC Rev4).
3 Gross fixed capital formation is defined as “resident producers’ acquisitions, less disposals, of fixed assets during a given period plus certain additions to the value of non-produced assets realised by the productive activity of producer or institutional units. Fixed assets are produced assets used in production for more than one year” (European System of Accounts 2010).
OECD countries
Source: Graph courtesy of Richard Darch, based on ‘historic’ OECD data.
Figure 1: The UK was 26th out of 34 OECD countries for capital investment in healthcare as a percentage of GDP in 2015. In 2019, however, both health and long-term care spending in the UK were above the OECD average, although the number of hospital beds and doctors and nurses was slightly below it.
Paul Maulbach said, “I was allocated a space in nursing accommodation in a hospital. It’s really important, particularly for students in the health service, to have access to affordable accommodation, especially in the larger conurbations and the south-east. There’s a whole question about the affordability of accommodation for public sector workers that needs consideration.” Richard Darch said key worker
accommodation was ‘a different sort of asset’. Plenty of funders and developers would, he believed, be able to deploy their capital and expertise to deliver such assets or infrastructure efficiently if they were aware of the demand. He said: “We’ve seen this in the university world. A number of years ago, universities would have wanted absolute guarantees over the occupancy of those facilities, but now they are so comfortable with the market they will invest themselves, build it, and people will come. We need to give that same level of confidence in healthcare and social care settings.”
Investment in technology priorities The panel was subsequently asked how the ‘refresh’ of the Hospital Improvement Programme should drive investment in technology, and what
‘‘
those areas of investment should be prioritised. Richard Darch said: “Going back to the
university sector, and many years ago you would see a single university on the hill, in a town or city. Now, a university and its buildings and presence are endemic throughout the town or city, with several buildings, including key worker accommodation. This is the way we need to look at healthcare infrastructure and technology. i.e. it’s not about a single panacea of a new building – it’s about a long-term plan to deliver accessible healthcare where it’s most needed.”
The drive toward Net Zero Another audience member asked the speakers what needed to be set out in the ‘refresh’ of HIP ‘to carry the NHS towards its Net Zero ambitions’. Professor Sir Chris Ham said: “I don’t know if there is one single thing, because it’s such a highly complex area. The NHS is currently embracing a whole range of different changes, interventions, and improvements in relation to anaesthetics, drug use, transport, and so on. I was listening to Jackie Daniel, CEO at the Newcastle upon Tyne Hospitals NHS Foundation Trust, and its approach is very much embedded in the wider public sector approach to Net Zero, working with the local authorities
Paul Maulbach: “It’s not only about the equipment upkeep, but also about ongoing training and staff development. To keep up with the pace of technological opportunities, we need to invest more in this”
56 Health Estate Journal May 2022
and universities, and learning from each other. NHS Trusts need to embrace that sense of partnership with others in their communities.” Paul Maulbach said: “I believe it’s about maximising the potential for people to maintain their own health in their own home, and, wherever possible, if they have to see someone, to do so as locally as possible – since one of the biggest NHS contributors to climate change is travel-associated carbon emissions. If we can use new technology, and get the right balance of investment between primary and community services and secondary care, we can minimise unnecessary travel to healthcare facilities. That would make a massive contribution.”
Too much focus on hospitals? Richard Darch said: “I believe the greenest building is the one you’ve already got, so it’s about repurposing, and building less. We also focus too much on hospitals and delivering them. With hospitals, we tend to warehouse a problem; if we’re not sure how to address it, we wrap a warehouse around it, rather than thinking about the technology, and the type of asset we need throughout a community to be able to address health needs. The final point is that 3 per cent of all car journeys are NHS-related – that’s a lot of car driving related to the health service.” Here Lord Bethell thanked all the
speakers, and the online attendees, and mentioned that the Group would soon be launching its call for evidence on the short, medium, and long-term needs of healthcare infrastructure, and would welcome submissions ‘from all interested parties’.
Percentage of GDP (%)
Japan2 Belgium1 Austria Germany1 Spain2
Denmark Latvia2 Estonia Korea2 France
United States Australia Hungary1 Sweden
Czech Republic1 New Zealand2 Portugal1 Norway
Netherlands1 Canada Finland Poland2 Ireland Slovenia Italy1
United Kingdom Chile Israel
Slovak Republic Luxembourg1 Greece1
Russian Federation Iceland1 Mexico
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