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Flexible thinking can help build for the future


The changing face of secondary care is never predictable and this awareness is crucial to future-proofing site designs

Brian Edwards
Emeritus Professor of Healthcare Development
University of Sheffield

Former President
HOPE (European Hospital and Healthcare Federation)
Brussels, Belgium

Every year or two somebody organises a European conference on the future of the hospital. The latest was organised by ERRIN the European Regions Research and Innovation Network. It is always a fascinating look into the future but to get the right answer we need to know what will have happened to medical sciences in the intervening period. An impossible task so we are left with best judgement and instinct to guide us. It is quite important because we still build hospitals with long life expectancies which become increasingly inappropriate buildings as times goes by with constant additions and adaptations. Populations also grow, shrink and shift and perhaps most important in many countries there is now an explicit policy of moving clinical work out of the hospital environment into primary care. So we can predict with some certainty that the number of hospital beds in any health system will continue to decline. We can also be reasonably sure that the inpatient component of high tech specialities will be increasingly centralised onto fewer sites in order to conserve clinical expertise and secure better clinical outcomes for patients. The small community hospitals that are fully integrated with primary care are also likely to flourish provided they are not an appendage to large general hospitals, where they usually became an early candidate for closure in hard times.

The surgical content of the future hospital will be small as day surgery dominates practice and lengths of hospital stay continue to decline. We are already seeing some centres with same day discharge for selected patients with new hips. Telemedicine is likely to connect smaller and more remote hospitals with larger centres particularly in so far as diagnostics are concerned. Non acute work will be increasingly separated out from acute work in order to improve flow patterns and efficiency. The danger for the public hospitals in some countries and in France and the UK in particular is that the non emergency work will move to the private sector leaving the public hospitals to shoulder the burden of emergency work.

More single rooms will be built to provide more privacy for patients and give a higher degree of protection against the spread of infection. Patients will be screened for MRSA prior to admission whenever this is possible.

One of the particular focuses of the ERRIN event was an exploration of the extent to which hospitals could become model companies demonstrating the best in energy efficiency and stimulation for regional economies given that they will usually be one of the largest employers in any local or regional setting. Seeing hospitals as economic stimulators rather than a drag on Ministries of Finance require a huge shift in political attitudes but it would be a most welcome change. They could act as development sites for health technology. Perhaps the only certainty is that all new hospitals should be built with maximum flexibility in mind so they are able to respond quickly to changing clinical needs. Rather than grand public buildings perhaps they should be designed with a thirty year life in mind so they can be more cheaply replaced when the time comes.

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