Building a new hospital, particularly of the scale of the schemes in the government's health infrastructure plan (HIP), is difficult at the best of times, but if you can create something very different to a 'lift and shift', you can be both affordable and transformational. Malcolm Lowe-Lauri looks at the steps you need to take to do that.
An infrastructure renewal, such as a HIP scheme, can revolutionise your healthcare business, but it isn't always so straightforward. Consider the following to create a plan that's both affordable and genuinely transformative:
Follow the science - carefully
We frequently hear about game-changing scientific breakthroughs. But the fanfare doesn’t always seem to be matched by changes in the way services are delivered.
After all, genome sequencing has been with us for more than 17 years, but its influence on the work of the local acute hospital seems limited. The point is not to ignore the fanfare, but to understand and calibrate it carefully.
For advisers involved in the business case development, this needs more than referencing research papers, interviewing academics and citing case studies from different international contexts. It needs advice for the specific environment of our clients.
That means using genuine specialists – external clinical experts, who understand what will work and how easily it can be adopted - who can work with the local experts. Together, they can create the best fit of science, innovation and local models of care.
This will prepare trusts for a balance of innovation and continuity. It will also help with future-proofing. For instance, using the Learning Health System approach deployed in the Connected Health Cities initiative, championed by the Northern Health Science Alliance.
How does this help with affordability?
My work with clinical experts on a number of HIP schemes shows that the role of the clinician will be morphing into one of data analyst and population health adviser, as well as provider of end-stage diagnosis and treatment.
This will be based on the pool of data and insights available from an information platform driven by the hospital. So clinicians will be able to support their colleagues in primary care and the community in life-course planning, early disease detection and predictive prevention, stratified and ultimately personalised.
This is a lot more than general public health guidance, with the hospital using its specialist skills to contribute to health maintenance, rather a move towards precision prevention. You will be making real in-roads to demand management, patient self-management and reduced use of the hospital for breakdown
This is particularly true when you consider improving technology, the opportunity for diagnostics locations in local hubs, and slicker hospital operations arising from good data, as well as the best clinical environments and adjacencies in the new hospital.
Taking all this together, demand can be radically reshaped. That converts into a compact, highly effective new hospital.
If the hospital is small in net terms, it can be afforded. But, to be afforded, the accounting needs to be more user-friendly.
This will work if trusts are given credit for the abolition of unnecessary work, and the transfer of much necessary work to a virtual or advisory basis, ie, where other professionals are doing it. Otherwise, trusts will be penalised for doing the right thing for hospital sizing and conformance with Intensive Care Society (ICS) and the NHS Ten Year Plan.
We don’t want to go back to justifying business cases where it’s a matter of 'demand growth + current workload = revenue for affordable case'. That would cement the capture of the health system’s money in the traditional hospital model. Not where we want the NHS to go.
How does this drive system transformation?
Essentially, this gives the future hospital a pivotal role in health system transformation; rather than being cast as the resistor defending its current sources of revenue and victim of less-well informed attempts at service redesign. The challenge to existing specialists should not be underestimated.
Undergraduate and postgraduate medical school curricula will need to change to equip the new breed of specialists to assume these roles. And time and resource made available for continuing professional development for those currently in role.
The prize for the future specialist is that, rather than seeing their specialist role eroded, it is re-interpreted, taking best advantage of their expertise and advances in science and technology.
For the truly innovative hospital to work, we need a five-year journey for the ICS as a whole. This is entirely consistent with many Scientist Training Plans, ICS and the NHS Ten Year Plan itself.
Using science, data and insights to revolutionise the relationship between primary and secondary care, whereby the latter is a real-time adviser to the former, we take the patient back to their first point of contact with health services.
Behind that is a strong digital platform for artificial intelligence to draw on, as well as new technology, new role development, and new pathways and models of care. These components bring the health community together for life planning for its populations and create a basis for patients to manage their own health.
This sounds like a well-grounded approach to managing demand, not least by predicting it. So making the case for this new form of hospital can be key to system plans.
Who is doing this?
In the Netherlands, the integration of capital planning and system transformation is not unusual, as demonstrated by the reform programmes in Frisia and NE Groningen in recent years.
In Valencia, Spain, the Sanitas Manises Hospital development is predicated on system integration. While, in China, the financial incentives in Shenzhen were reset to ensure the new hospital became part of an integrated health system.
In the UK, the Connected Health Cities Programme will radically influence the content and shape of hospital redevelopments. We hope this example will be followed by the clinical service content for health infrastructure plan schemes, so that this generation of building will be truly forward thinking.
In a strange way, the COVID-19 situation and the need for renewing the NHS estate have one thing in common – they both destabilise the status quo and require new thinking about how health services are delivered.
Even in such difficult times, we should not forgo the opportunity.