HEALTHCARE PLANNING SYSTEMS


status, severity of disease / condition, and characteristics of frailty and multi- morbidity. It can thus become the key clinical workload planning metric to determine how best, and where, patients receive their care.” The Acuity metric was also ‘scalable’ – meaning it could inform individual patient healthcare planning decisions, care pathways, individual or regional care facilities, the nature of the services within them, and the roles of the staff. The Working Group had also added ‘recovery’ to the broad compass of the term – to emphasise the importance of good care environments for rehabilitation.


Broader definitions Pete Sellars said: “These broader definitions are better aligned with the range of assessments regularly made by clinicians working in primary, secondary and tertiary care, and are frequently used in clinical care pathway development, referral, and discharge decisions, between health and social care bodies.” The Group thus proposes using existing clinical measurements of how ill or well patients are – as individuals or larger patient cohorts – as a core part of the common language, ‘to inform strategic healthcare planning decisions to determine where patients are best treated’. This would in turn inform key investment decisions on service planning, staffing, infrastructure, and new technologies. “So, to summarise,” Pete Sellars said, “our proposal is to use Acuity as the currency for future healthcare planning.”


Rethinking care pathways Pete Sellars’ next slide was titled ‘Rethinking care pathways’. The message here was that current care pathway models are dependent upon primary and secondary care clinical interventions, and patient movement across boundaries, which often ‘break down’ – frequently due to ‘outdated clinical gatekeeping and payment regimes from standalone clinical units’. This clinical gatekeeping model – ‘outdated, and often associated with siloed standalone healthcare providers’ – prevented fast, timely access to the appropriate level of treatment and care the pathways intended.


Hospitals should thus in future look to


work within, and become a key integral component of, a wider integrated health and care system. Pete Sellars said: “In England, with the healthcare system now recognising that this approach is needed to ensure patients are treated in the right place, at the right time, and with the right level of clinical care and expertise, we have seen Integrated Care Systems introduced. These new organisations are being given powers to oversee the management and delivery of services across health and social care. We believe using acuity as the planning currency is the most appropriate


The European Health Property Network’s Jonathan Erskine (pictured, right), and Professor Grant Mills, of the Bartlett School of Sustainable Construction at University College London, have both lent their considerable expertise to the Group’s work.


method to support ICS delivery of these strategic changes.”


Plan and design differently based on Acuity as the currency If future healthcare planning is taken forward using acuity as the common currency, Pete Sellars said it should then ‘become quite easy’ to translate these requirements to determine the healthcare care setting required, and the subsequent infrastructure requirements’. He elaborated: “By using patient acuity at the system and population levels, we can anticipate future needs, make rational judgements about the operational and capital resources required to meet them, and – critically – examine the most appropriate locality to deliver timely, appropriate patient care. Moving to discuss ‘Designing for Acuity’,


Pete Sellars said there was ‘a strong link between acuity and design here’, adding: “Just as ‘form follows function’ as a general design principle, in many healthcare settings buildings are designed to reflect how patients are treated, but very rarely by patients.”


Example of the ‘acuity approach’ Here he handed over to Paul Fenton, who he explained would discuss the next two stages of the Working Group’s healthcare planning process, and share examples of how its acuity approach was already being used to influence healthcare planning in the UK. Paul Fenton began: “Sometimes


patients, rather than clinicians or architects, provide the input concerning the ‘function’ of a healthcare facility, as seen in the Maggie’s Centres, which emphasise a non-clinical, homely design. Future hospital planning needs to review


the ‘departmental concept, and focus more on models of care and patient pathways.” Explaining why, he said: “Having a theatre department that carries out day, elective, and emergency surgery may seem to make logistical sense, but in the event of emergencies and bed blocking, day and elective lists may be cancelled. We must radically reorganise the constituent parts of the hospital if we are to reduce significant patient backlogs, and develop facilities better suited to the types of procedures, avoiding dependency on ICU beds.”


Addressing the ‘known unknowns’ Paul Fenton said ‘design for acuity’ must also address ‘the known unknowns – those semi-predictable or unpredictable events that can quickly overwhelm and destabilise hospitals and wider health systems’. He added: “As well as new technologies, new procedures are developing, and more operations are using ‘blocking’ rather than general anaesthesia (e.g. endoscopy facilities will change, due to orally administered devices that can relay images to a computer, and injections will be used instead of surgery in eye care). We propose a reorganisation that challenges the fundamental flows into, around, and out of, the health system. It will expand our knowledge of emergency and recovery through a focus on acuity, and thus drive integration around the health and support cycle. “Our proposition will radically challenge the settings for diagnostics, surgery, and recovery, and show how acuity adaptability can be enhanced through the creation of virtual or physical hubs. We will use acuity as the basis to evaluate and adapt systems, and will develop an advanced hospital system workload model.”


November 2022 Health Estate Journal 25


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