I lead Arup's global healthcare business. This...
One of the most popular questions that healthcare facilities professionals are often asked is “what will the hospital of the future look like?” Historically it has been about finding a fit between population and bed distribution and the clinical specialisms to be housed therein.
However, situations are changing in the lives of the global population which may offer us some clues as to the answer to that question: that is, the way in which the majority of us will die! The changing global disease burden means that practically for the first time in human history more people are dying from non-communicable disease (NCD) than communicable diseases.
Estimates suggest that some 60% of us now die from non-communicable diseases related to things like smoking, alcohol abuse, poor diet and lack of exercise. It is therefore imperative that government, the private health and wellness providers, individuals and healthcare estates professionals work together to understand the opportunities for the prevention and management of the problem and also the costs incurred by the system of not dealing with the situation.
In terms of prevention, it is more important than ever for the public to take responsibility for their own health and manage their lifestyles. Indeed, this is crucial to reduce pressures on health systems and make sure healthcare remains affordable for society, especially in developed and fast-developing countries. To do this we need help and information.
It is clear that some progress has been made with governments introducing smoking bans, taxing alcohol and having combined information strategies illustrating the value of exercise, nutrition, alcohol and smoking. In the UK, the Change4Life campaign illustrates this type of government information support. But of course more needs to be done.
A generally accepted view is that the management of chronic illness associated with NCDs can be managed in the home through the introduction of digital monitoring. This reduces unnecessary hospital visits and when check-ups are necessary local community facilities can fulfil the need.
Chronic illness is of course also prevalent in old age. It has been reported that the incidence of chronic illness will become more prevalent in the elderly, with 50% of over 65s having two or more chronic conditions and 50% of over 75s having three. Two other potential home-based care models involve dementia and mental illness, both of which are on the increase, both require community interaction and both require specific environments for safety.
The termination of all these illnesses is of course death – it is inevitable for us all. But there is now significant momentum in seeking improvement to the end of life care experienced by individuals. This is driven by a perception that the majority of people would prefer to spend their final days in their own home rather than in an acute hospital setting.
So now when we ask ourselves what the hospital of the future will look like, we can see that the home becomes an extremely important department. This is because existing hospital demand would be reduced, bed numbers would be reduced, many outpatient activities would be moved into the community and some hospitals will be taken out of commission. Our thoughts therefore need to focus on the strategic planning between acute sector and community healthcare facilities, the effective utilization of the existing acute estate once shrinkage has taken place and finally the infrastructure and architecture of the home as a department of a modern hospital.