IFHE 27TH CONGRESS, TORONTO – KEYNOTE ADDRESS


social care system they serve. We think that if they continue to plan, design, and are financed largely as independent standalone units, they will have limited ability to adapt and flex to meet the wider systemic healthcare challenges of the future, particularly as the delivery of patient care evolves through efficient models of care and emerging new technologies. Regardless of how healthcare was


previously organised and run, the time to change is now, to ensure that future health and care systems are embedded in an ecosystem of managed patient care. We strongly believe the era of planning and investing in a siloed standalone hospital is over. Investment decisions about healthcare


capital assets are almost always driven by business cases that link planned activity (outputs of hospital services) to an M2 cost value and are primarily focused on a hospital as a standalone entity. However, hospitals are only part of the wider healthcare ecosystem which serves the population catchment. We all want to see hospitals taking


advantage of new and emerging technologies, changing epidemiology and demography, and the taking into account of the requirements and expectations of clinicians, patients, and different modes of governance and public accountability. To achieve this, we have identified the


need to move to a more appropriate way of determining the clinical workloads of hospitals and the economic appraisals to support these investments. The move towards developing a common language provides not only the rational means to discuss and agree on what is to be delivered and constructed – it also ensures everyone involved understands how to effectively deliver future healthcare planning requirements; that it is not driven by whoever shouts the loudest.


A common language Our high-level three-stage proposal consists of three elements: Acuity, System Economic Modelling, and Using an Integrated Health Infrastructure Planning Framework, thus: l Using Acuity to determine the clinical care service and the appropriate setting for delivering healthcare.


l Using System Wide Economic Modelling rather than traditional M2 capital costs to determine the benefits of the investment.


l Expanding but standardising the language that describes various aspects of healthcare planning and avoiding the typical over-use of bed- centric language.


l Using an Integrated Health Infrastructure Planning Framework through a common language to facilitate and unite dialogues between stakeholders and decision-makers.


IFHE DIGEST 2023


Speed treatment and prevent critical patient illness (eg Moorfields)


1


Diagnostics Hub


Emergent settings 2


Home


Low Acuity settings


Planned Surgical Hubs


4


Specialist Hubs


High Acuity hospital settings


Recovery settings 3


Recovery Hubs


Connected clinical and support environment to treat the whole patient recovery and avoid readmission (eg SameYou)


Figure 1. What do we mean by Acuity?


l Enabling a scientific approach to healthcare planning that combines an arms-length methodology as a counter balance to opinion-based methodology.


Acuity (see Fig 1) is defined by the WHO as relating to the severity of a patient’s condition (Low, Emergent, and Critical). Our healthcare planning approach broadens this definition to also use Acuity to measure patient and population health status, and severity of disease or condition, as well as characteristics of frailty and multi-morbidity, so that Acuity becomes the clinical workload planning metric to determine how and where patients receive the best treatment and care. We also have added ‘recovery’ to emphasise the importance of paying attention to patient rehabilitation and the use of the home environment in new models of care. The Acuity metric is scalable to 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 who provide care. 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, and referral and discharge decisions between health and social care bodies. We are therefore proposing 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 in turn would then inform key investment decisions relating to service planning, staffing, infrastructure, and new technologies.


In short, our proposal is to use Acuity as the currency for future healthcare planning (see Fig 2).


Designing for Acuity Current care pathway models that are dependent upon primary and secondary care clinical interventions and patient movement across these boundaries often break down, even though our systems are currently organised to facilitate these activities. These failures and the resulting


breakdown of patient care are often associated with the outdated clinical gatekeeping and payment regimes from standalone clinical units. This in turn prevents fast, timely access to the appropriate level of treatment and care pathways intended. This model of clinical gatekeeping is outdated and is often associated with siloed standalone healthcare providers. Therefore, hospitals should look to


work within, and become a key integral component of a wider integrated health and care ecosystem. In England, the healthcare system, recognising that this approach is needed to ensure that patients are treated in the right place, at the right time, and with the right level of clinical care and expertise, has introduced ICS boards across all regions of England. These new organisations are being given powers to oversee the management and delivery of services across health and social care – the very first time this has happened in England. We believe using Acuity as the planning currency is the most appropriate method to deliver support for these strategic changes to the health system in England. If future healthcare planning is taken


forward using Acuity as the common currency (see Fig 3) to determine the level of clinical care dependent upon the


23


Comprehensive specialist network/technology access for the most complex patients (eg Christies)


Palliative care network/ end of life


Rapid patient access to the simple surgery or intravitreal injection (eg Moorfields)


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