The pandemic has brought into sharp relief the dependence that societies have on their health systems; the people that work within them as well as the infrastructure in place to support those people. What became very clear during the heat of the pandemic is that the capacity of the workforce and the capacity of the infrastructure had to be planned in an integrated way. Additional ICU beds and ventilators were no good without the staff to support them (as was seen in some of the surge hospitals) and staff without access to appropriate space and kit struggled to deal with surges in admissions.
This is a lesson that needs to inform our thinking as we embark on planning our health systems and infrastructure for the future. We need to understand what works well—a current example of success is the Vaccination Programme across the UK. Here, there has been a combination of sound commercial approach through procurement (of vaccines) together with planning the workforce and physical infrastructure required to deliver the programme all supported by underpinning digital infrastructure and systems that ensure 58 million are called when they need to be, and they are directed to the right place and the staff are expecting them.
“We need to value our workforce and provide them with the tools, the training and the environments deserved of a group respected and valued by society”
The investment in 40 plus new hospitals in England is to be welcomed. For too long the fabric of the NHS Estate in England has gone without the investment required of a modern health system and too much care is delivered in old, dilapidated and inappropriate settings. But we need to be wary of just replacing old for new. Too much of what goes on in a hospital today is perhaps inappropriate for a hospital setting. The beds which are filled with our frail elders provide a level of care, but is it the right care? Are we just warehousing a problem because we lack the staff, the technology and the systems to care for our elders in more appropriate settings? Whether those settings are in the home or in specialist accommodation focused on care and rehabilitation. There is a real danger, if we are to replace like with like, that we will look back on large monolithic hospitals as we look back on workhouses today.
We cannot plan new hospitals in isolation. Like the Vaccination Programme, we need to think about procurement, design, digital and workforce. For procurement, just like the pharmaceutical companies there are a limited number of major construction companies that are able to build at scale. So, we need to consult with them and provide them with the certainty and even up-front investment so that they can tool-up their factories to support the manufacture of hospital building component parts that can be assembled on site. For design we must remember that healthcare buildings are part of their communities, and hospitals need to be civic buildings of pride. Our high streets can be reimagined to house a whole range of healthcare, diagnostics, information, and support for wellness for those communities. And the physical must go hand in hand with the digital. Over time, most of our interaction with healthcare will be digital, whether for consultation, diagnostics, or rehabilitation—all will be aided by remote monitoring and access to health professionals digitally. There is then the workforce, a truly scarce resource worldwide. We need to value our workforce and provide them with the tools, the training and the environments deserved of a group respected and valued by society.
So, as we embark on reimagining our health services of the future let’s do just that; reimagine not replace. Reimagining and rebuilding our health systems; what better legacy to come out of what we have endured and for our future generations to benefit from?
