In this article, Ian Gillespie, chief executive of Vanguard Healthcare Solutions, considers the impact of growing waiting lists and an ageing population on the NHS infrastructure, and explores the concept of customisable ‘health ports’ as a potential solution
The pressure on the National Health Service is growing day by day. Currently topping three million, waiting lists are at their highest since 2008. As of April 2014, 9.95% of patients were waiting more than 18 weeks for treatment – alarmingly close to the 10% threshold.
The NHS is ‘running hot’ 365 days a year, and the combination of an ageing population, endemic health problems, and an increase in surgical intervention is putting its facilities under enormous strain
The NHS is ‘running hot’ 365 days a year, and the combination of an ageing population, endemic health problems, and an increase in surgical intervention is putting its facilities under enormous strain. The question for budget holders and estates teams is how best to respond.
It’s widely accepted that the NHS estate is complex and varied. It owns some of the world’s-newest and most-sophisticated healthcare facilities; but also those that are old, rundown and inefficient. Indeed, NHS England chief executive, Simon Stevens, has put the value of redundant or underused NHS buildings at a staggering £7.5billion. Meanwhile, NHS England’s Five Year Forward View report has called for major investment to transform facilities into ones able to accommodate a range of new care models.
So what’s the solution?
When estates investments are made, it is either in refurbishing older facilities or constructing brand new ones. Rarely does the NHS invest in more-flexible assets, and this inflexibility can lead to problems
The common issue that must be tackled is a fixation with fixed, ‘bricks and mortar’ assets. When estates investments are made, it is either in refurbishing older facilities or constructing brand new ones. Rarely does the NHS invest in more-flexible assets, and this inflexibility can lead to problems.
Take a look at our Dutch counterparts, for example. Much like the UK, the Netherlands has faced growing demand for healthcare services in recent years, which, in turn, triggered significant investment in new permanent facilities. But, last year, a dramatic shift in Government policy resulted in an unexpected change in patient attitudes towards healthcare. The result: less visits to the GP, less referrals, and ultimately less hospital capacity required. In many areas, the Netherlands now has a legacy of empty and financially-unviable healthcare facilities to which the country is struggling to find a solution.
The error here was not the decision to invest in new facilities altogether, but a failure to recognise that these permanent facilities would struggle to cope if there were a significant shift in patient demand. Had the Dutch authorities invested in more multi-purpose facilities or in customisable, temporary facilities that can respond immediately to demand, the pressures brought on by these unexpected policy changes could have been better accommodated and absorbed.
In the UK, at a time when health policy is far from concrete, we need to learn from the Dutch example and break our obsession with bricks-and-mortar healthcare facilities. By delivering healthcare in a more-flexible way, the NHS could ensure that it only pays for facilities when they are needed, in line with changing patient demand.
By delivering healthcare in a more-flexible way, the NHS could ensure that it only pays for facilities when they are needed, in line with changing patient demand
But how would this work in practice? The concept of the ‘health port’ was created by Vanguard Healthcare and essentially consists of a static central area, with ports or doors that high-tech mobile units can ‘dock’ with to create a functioning hospital.
The fixed central area houses the necessary patient processing areas such as a reception, offices, wards, hallways, toilets and facilities services. However, the areas in which actual patient care is delivered – operating theatres, endoscopy suites, and diagnostics – are provided by the mobile facilities docked onto the health port. This allows the NHS trust to customise the ‘hospital’ based on the prevailing needs of patients in the area, and negates the need for significant upfront capital investment in permanent healthcare facilities.
By delivering healthcare in this way, NHS trusts would be able to continue to respond flexibly to demand and tackle waiting lists head on, while keeping care within the NHS. It also stacks up financially, because although there would necessarily be costs for the construction and ongoing maintenance of the central unit, the ‘bolt-on’ mobile elements would only be paid for when they are needed; eliminating the fixed overheads associated with wholly modular or traditional builds.
When it comes to the future of NHS estates, it’s time to think flexible, not fixed, if we’re to overcome the problems we face in this challenging time
The need for the NHS to find efficiencies is paramount, but this cannot be to the detriment of patient care or the standard of the environment in which they are treated. If, over time, these central ports can replace, or at least supplement, traditional facilities, there will be the option for mobile units to move around an area, docking onto ports at different hospitals as required. This, in turn, will facilitate more-effective sharing of resource, while maintaining levels of care. When it comes to the future of NHS estates, it’s time to think flexible, not fixed, if we’re to overcome the problems we face in this challenging time.
