A range of actors is needed to put surplus land to better use and help tackle NHS shortages of space and money
Great expectations, without a budget to match. This is a story that NHS practitioners are all too familiar with, at a time of tight budgets that coincide with unprecedented challenges to the healthcare establishment.
Equipping hospitals to provide modern treatments and keep pace with advances in medical technology, coping with an ageing population and the attendant shift in medical conditions, and efficiently processing and treating patients when there is a lack of hospital beds are daunting tasks.
A new generation of hospitals is needed, made possible by the use of existing surplus land, and designed to offer the best in modern care, whether through sheer technological sophistication or by humanising medical environments and offering integrated care.
A lack of space is taking its toll on UK hospitals. The well-documented shortage of beds per person – 2.8 beds per 1,000 UK inhabitants compares to 8.3 for Germany and France’s 6.3 - makes our hospitals susceptible to dangerous levels of overcrowding.
Simultaneously, overflow from other quarters – a dearth of ready beds in nearby care homes, for instance – contributes to delayed discharge in hospitals. Patients healthy enough to leave the hospital frequently occupy expensive acute care hospital beds instead of less costly alternatives for lack of appropriate lower-intensity facilities.
Against the backdrop of an NHS deficit projected to reach £2.2bn deficit in 2015/16, it is clear that a range of actors will need to cooperate to make this happen
The delayed discharge predicament matters because of its impact on A&E performance, general patient care, and a knock-on effect on hospital revenue when it causes delays in elective procedures. It’s also a burden for those patients restricted unnecessarily to a hospital environment.
Official figures release last month on Delayed Transfers of Care in England estimated that the total number of registered instances had grown a worrying 10 per cent - or an extra 15,035 cases - year on year in December. This brings the Q4 annual increase to 11 per cent, equivalent to fully 44,444 more cases than in Q4 2014, a rapid pace of growth that is placing significant pressure on the country’s hospitals.
No single party can offer a solution to this. Instead, a joined up approach is integral to developing a new generation of facilities to remedy the dislocation between supply and demand. Against the backdrop of an NHS deficit projected to reach £2.2bn deficit in 2015/16, it is clear that a range of actors will need to cooperate to make this happen.
Repurposing or selling surplus land to build and finance new projects circumvents high property prices, opening up new possibilities to power the redevelopment of the NHS estate. Where there is no urgent need for new build locally, surplus land can be transformed into housing, with receipts allocated to the responsible authority.
The advent of Strategic Estates Partnerships is a welcome sign of a more holistic approach to the public estate along these lines, as are the Department of Health’s efforts to systematically survey NHS trusts, the most recent of which found that over half the trusts in England identified at least one parcel of surplus or potentially surplus land that might be put to better use.
While concerted engagement should unlock significant resources for development, we must also strive to keep the hospitals that we build at the state-of-the-art spectrum to enhance treatment through ambitious design. In oncology, for instance, the next generation of facilities must meet the full range of patient needs in one building: from screening and diagnosis to therapy and monitoring.
The same principles that govern major hospital projects should hold true in community facilities
At the same time, the therapeutic benefit of access to the outdoors, and open communal spaces is increasingly recognised, calling for a blend of highly technical infrastructure for some areas and a more lightweight approach in others. This might involve integrating radiotherapy, traditionally consigned to stifling underground environments, with above ground, naturally lit areas, to soften the patient journey.
There is also a need for lower-intensity, non-acute care facilities to reduce pressures on acute beds and provide integrated care close to home. The same principles that govern major hospital projects should hold true in community facilities, where it is easier to build in line with best practice as laid out in the Carter Report: patient centric care with single rooms to increase patient privacy, dignity, and control.
This need not clash with budgetary prudence, as many important measures – dementia friendly designs, integrated care through proximity of pharmaceutical, GP and overnight services – are virtually costless when designed sufficiently in advance.
It is absolutely possible to live within our means with world-class care. It will, however, take a bold review of existing resources in the NHS, and the public estate more generally, so that under- or unused assets can be deployed or reclaimed towards areas of greater need. Only with a joint effort towards this goal can the substantial and rising pressures on the NHS – impairing treatment outcomes and weighing down trusts – be fully addressed.
Richard Coe is head of business development, healthcare, Kajima Partnerships.