Reinventing the hospital

Please note that views expressed in guest articles on our website are the authors' own and do not necessarily reflect the views of the Nuffield Trust.

The 70^th anniversary of the NHS has been the cause of much reflection, both on what has been achieved and also on what the next 70 years may bring – the resources, technology and workforce that we will need. It seems the case for additional resources has been listened to, with a pledge of an additional £20 billion a year linked to a 10-year plan for the NHS.

While good news, we have been here before. We have a history of royal commissions, NHS acts and government advisory reports on funding. It is now likely that more money will flow and some of it will be well spent, but will it be discernable to people that use and access the NHS?

We need to create a lasting legacy that will outlive the current and future focus on funding – radically and fundamentally rethinking the hospital, and even discarding the term ‘hospital’ to the history books.

Bringing wellness back

The concept of a hospital goes back to Eastern civilisations, with earliest examples in Sinhalese culture (Sri Lanka), India and China – centres that not only included facilities for healing of the sick, but also common areas for learning and education around wellness. More recent westernised hospitals have increasingly moved away from the broader health needs of a community to the treatment of illness and trauma. The focus on wellness has been lost.

This has meant the burden of treating the sick has become greater, and the hospital has required more capacity to deal with the increase in demand. The currency for that capacity shortage is a lack of beds, but the one thing that a patient doesn’t ask to be admitted for is to be in a bed.

The focus on capacity should be on the workforce, space and technology needed to meet people’s diagnosis, treatment and rehabilitation demands. The bed is currently a function of inefficiency in those areas – somewhere to keep someone while they wait for one of those activities and/or are too ill to return home.

We can then work out what of that activity requires someone to be in a bed while they wait – and in turn what type of ‘bed’ it should be (and for how long it’s needed): emergency, elective or ‘step down’. The type of beds are more important than the number, as they each demand a different specialised workforce.

Think of it as a campus

This focus on diagnosis, treatment, rehabilitation and type of bed lends itself to thinking of the hospital as a campus, rather than a single building. Technology and clinical advances for each area will change over time – meaning that building flexibility into the ‘diagnostic zone’, ‘treatment zone’ and ‘rehabilitation zone’ will be important to ensure the right balance and size.

Most modern buildings have a 60-year-plus life, so they will change. Having a bed model that shows projections to 2020 (when the new hospital opens) is meaningless when that hospital could be there until 2100.

In a campus context, the asset can be used to deliver a ‘health return’ for the community. Areas focused on wellness, fitness and health education, along with housing for elders and the workforce. Add to this outdoor gyms, cycle paths, jogging paths, walkways and allotments and you build a vision of a health campus for the community, once again focused on wellness.

Where such assets are developed commercially, they can provide revenue and income streams to support funding of the health-related assets, with efficiency initiatives around energy generation supporting the overall affordability of new developments.

Anchor institutions

All of this fits with the emerging theme of hospitals being seen as ‘anchor institutions’ for their local communities.

Tyler Norris worked with Kaiser Permanente across southern California to help harness the health care group’s resources (whether physical, financial or human) to contribute to their population’s wellness, as well as addressing the local social determinants of health. His paper Can hospitals heal America’s communities? demonstrated how pooling resources and using hospital land for social housing, renewable energy schemes and commercial activity of local firms helped address housing needs, employment and affordable energy – which in turn supported the physical, financial and mental wellbeing of the local community.

This thinking around anchor institutions is being adopted in the UK by the Centre for Local Enterprise Strategies – promoting both their principle and the place of the hospital in a local industrial strategy. The principle of the health campus aligns completely with these emerging concepts.

Clearly there is no single model, and different communities and catchments will have different needs. But the concepts of a community health campus and a city health campus can be developed. The large city health campuses, linked to a network of local community health campuses, will attract interest from the medical science and technology research and development communities, which will all value a presence that allows them to build a direct relationship to support population health.

This will all support the creation of lively hubs focused on the maintenance of good health, prevention of poor health and treatment of ill health. A very different vision to the hospital of today.

Moving with the times

As for the recent focus on artificial intelligence in health, these developments will find an anchor in the health campus.

Even Amazon is now opening stores, as they see the benefit of integrating and aligning a physical presence with an online presence. The retailers that are thriving are those combining physical stores with online shopping. As it will be for health care, artificial intelligence will drive massive change but there will still be a need for a physical presence. It will be this combination that drives change, and it is where the flexibility of the campus concept will be critical.

So as the NHS turns 70, let’s do away with the hospital and introduce the health and wellness campus. It will be the most tangible legacy for many decades to come, and far more tangible than ‘system reform’. Something the public can really buy into and benefit from.

To take a line from Philip Betbeze: “The hospital of the future is not a hospital.”

Richard Darch is chief executive of Archus Ltd. 

Please note that views expressed in guest articles on our website are the authors' own and do not necessarily reflect the views of the Nuffield Trust.