Over the past five years the health sector has seen an unprecedented amount of change. Two key areas have been the change in governance and a strong focus on improved value by creating greater efficiency and improving patient outcomes.
This is a major challenge in the context of a changing and ageing demographic where people have more complex service needs. If the health service continues to operate in the same way as it does currently, we will need an additional 40 acute hospitals by 2030 at a cost of £20bn just to meet this demand. Clearly things need to change.
The early years of reform resulted in some unpredictability in the health sector but in the last two years the NHS has understood and accepted the challenge it faces, and nowhere more is this apparent than in Simon Stevens’ Five Year Forward View (2014).
There is a need and an opportunity to reduce existing land on acute sites to release capacity for additional housing and complimentary care facilities. It is vital, however, that there is no adverse impact on continuing to provide acute services on the site. So, how can we redesign the NHS’s estate in a way that creates efficiencies without compromising on patient care?
We have been working closely with the NHS to review both its community and acute estates in a bid to improve value and efficiency. There have been a number of interesting findings and the work highlighted some common themes.
Make better use of technology
Technology is central to helping the NHS adapt its community estate to improve utilisation and value for money. We recently worked with a community hospital in the south of England where neither patients nor staff were getting the best use out of the building. We worked with the hospital to review the building’s clinical functionality, infrastructure and architecture to establish whether the hospital could be better used.
Our research revealed that following a number of years of alteration, changes in management and IT systems, the IT service was out of date and didn’t reflect the current services provided from the facility. It concluded that by addressing IT governance and IT architecture the utilisation of the building could be improved by 30% by sharing bookable space, such as receptions, consultant examination rooms and meeting rooms with other complimentary clinical services.
Take a whole system approach to estate and infrastructure design.
In reviewing both community and acute estates together, it is possible to improve clinical pathways for patients without the need for a lengthy consultation and planning process. For example, we found that there are significant opportunities to bring primary and secondary care services in east London together onto the same site, which would reduce the time and cost associated with running services from multiple sites.
Co-locate complementary services
The ‘Ready for Ageing report presented to the Select Committee on Public Service and Demographic Change in 2013 highlighted that in some cases a quarter of people in a hospital bed do not need to be there .
By consolidating and integrating GP, primary and social care services into community centres, the National Audit Office estimates that at least a fifth of cases could be managed in the community without anyone needing to visit A&E. We are currently working with a number of CCGs to review and shape their service strategies and link them with their strategic estates plans. These plans link the emerging service requirements for both primary and secondary care and give recommendations on how to make best use of the existing infrastructure across both areas.
Create smarter buildings
The cost of running estates needs to be apportioned to the level of care given in these buildings. An intensive therapy unit (ITU), for example, requires significant and complex infrastructure because there is a need for heightened medical care and room for specialist equipment to look after seriously ill patients. It would not make sense to develop or build such complex models in the same vein across the whole of the estate. Building design needs to be smart and match the changing service needs of the health service. Rather than building every type of facility, just in case it is required, we should look to build smaller units where service provision can be adapted and increased in size as and when needed.
By changing attitudes toward sustainability, marginal gains can actually have a dramatic effect on the bottom line. Developed by Sussex Community NHS Trust, award-winning programme, Care Without Carbon, helps healthcare organisations become more economically, environmentally and socially sustainable.
The scheme encourages employees to save as much money and energy as possible by reducing waste, travel and the amount of energy they use. Already, more than £1.5 million in savings each year has been identified.
Simon Corben is a managing director at Capita Health Partners.
Capita Real Estate and Infrastructure work with public and private sector organisations to design, build and optimise their real estate and infrastructure assets. From thought to finish, we apply our combined expertise to achieve more from the entire built environment.
We build competitive advantage through intelligently applied real estate and infrastructure solutions and enhance our clients’ standing in a forever-changing world.