Healthcare World’s expert panel delivers a vision for the future.

One of the challenges of healthcare is the fact that for the last 100 years or more, the development of infrastructure has been the solution to any healthcare problem.  Within months of the pandemic being recognised, enormous Nightingale hospitals were built in the UK that were never used. The pandemic shambles and the parallel acceleration of digital health has shown that the theatre in which healthcare is performed is going to be the home and the means will be digital. 

The Healthcare World Series debated this new development with leaders in this field who are spearheading the ‘revolution’.  Richard Cantlay, Head of Healthcare at Mott MacDonald, Elliott Engers of digital solutions Infinity Health, data guru Simon Swift of Methods Analytics, Carly Caton of lawyers Bevan Brittan and infrastructure specialist Barry Francis.

The balance between prevention and intervention

Reducing the healthcare demand at source by maintaining a population’s health is one way of approaching the subject, according to Richard Cantlay.  He quoted statistics showing that global deaths from non-communicable diseases are now around 60 per cent, and are linked to diet, air quality, exercise and other issues.  “We need a whole system approach to wellbeing, not the current system that sees maintaining a population’s health as the healthcare sector’s problem to deal with,” he said.  

He went on to illustrate how built environment projects can also put healthcare at the centre of its thinking, by reducing pollution or improving air quality through better building materials.  By changing the lens with which we view healthcare, we can redefine the word ‘infrastructure’ so that it becomes a balance of digital and built infrastructure, and we can look at the subject in the round by including prevention as well.

PPP expert Barry Francis agreed with Richard that the default position is often to build a hospital as a physical structure to show that something is being done about healthcare.  “Hospitals sound sometimes as the solution to delivering something which can’t be delivered,” he said.  “The huge advantage about these projects is they make people think about what is actually required and illustrate the risks.  But if we’re moving towards a more systemic approach, then PPP will still have a part to play.”

Carly Caton agreed that changes are happening apace, and had already begun before the pandemic hit.  “The system and the hospital system has been the same for decades,” she said.  “We think about medical innovation or digital innovation, but we also need to have  organisational innovation and system change innovation as well.”

The rise of the hospital at home

Elliott Engers of Infinity Health felt that it isn’t possible to build the amount of hospitals that are required to deal with the backlog of patients following the pandemic.  In addition, there aren’t enough people to staff them or sufficient training to upskill them.  “This is a problem that we have to look at more fundamentally,” he stated.  “It’s about using the infrastructure and the staff that we already have more effectively. And technology has to be the answer to that. 

Infinity’s software can be used to create a virtual ward that allows staff to monitor a larger cohort of patients remotely and more efficiently. “We’re seeing a big uptick in the demand for setting up virtual wards,” he added.  “The beauty of digital infrastructure is that it scales better and in a way where you can generate data that organisations can use to better assign and prioritise cases. Predictions around cases and demand will become more accurate and resources can be developed  to meet that demand.”

The consensus among the panel was that the wrong infrastructure can be worse than no infrastructure because of the lack of staffing and low uptake.  

Moving away from the hospital-centric health system

There was agreement that the shift from healthcare to health and wellbeing will take place within the next ten years.  As a result, there is a lack of clarity around how hospital infrastructure may be used on a daily basis in the future, felt Carly Caton. 

For Elliott Engers, the key point in new hospitals has to be the incorporations of modes of communication from the start.  The last mile of healthcare requires large numbers of staff coming together to exchange information face to face, so the digital infrastructure has to be up to standard and fit for purpose.  Following the pandemic, outpatient departments are now full to capacity and this is where digital solutions could halve the waiting rooms as consultations could be conducted virtually.  

Moving on from this, Barry Francis made the point that to build a hospital with empty beds makes no financial sense.  He also highlighted the growing role by insurers in minimising healthcare costs, so diagnosing and treating in the community makes sense as a result. He went on to ask how you finance a project with a much greater emphasis on the digital rather than the physical. 

If the aim is to keep people out of hospital, then for Richard Cantlay the combination of design and operational practices is key.  “Keep the higher acute facilities for those that absolutely need to be there because it’s much more efficient and it’s a much better patient experience,” he said.  “It delivers better health outcomes and is just  one reason why we need to move away from this hospital-centric health care system.”

Hospital-acquired infections were another important reason cited for keeping people away from hospitals.  During COVID, Infinity Health implemented a lateral flow testing system for frontline staff and the data highlighted which areas were at risk in a hospital.  

“It’s key that as we start to implement solutions such as virtual wards or patient-initiated follow up, which now puts the onus on patients taking more responsibility for their health, that we have checks and balances and ways of identifying where patients aren’t engaged or where there’s an additional clinical risk. I think it’s imperative that any new models of care take that into consideration,” he added.

Richard Cantlay highlighted the issues facing certain countries where technology is not as advanced or where connection problems often occur.  Simon Swift agreed, saying; “I’ve worked in East Africa and in Southeast Asia, where many doctors aren’t in hospitals. But patients can speak to somebody and leapfrog an entire phase of healthcare infrastructure.  We have to avoid ideology and focus on pragmatically delivering for all of the population, using whatever tools are most effective.”

Using digital solutions to mitigate the impact of infrastructure

The panel agreed that digital health is a really confusing picture. There are millions of products and it’s hard to understand how they can come together to create a coherent healthcare system. 

For Richard Cantlay, there are four solution areas that focus on maintaining the health and wellbeing of the population:

• Digital solutions for prevention, allowing individuals to be able to have better ownership of their own health and wellbeing 
• Digital solutions to gain better insights into the health of the population, which then facilitates better infrastructure planning
• All non-building infrastructure such as digital and physical
• Building infrastructure that enables digital to make the flow and the efficiency within the built infrastructure better 

As a result, he felt we should start to view the physical state as a blend of permanent, high acuity facilities, perhaps surrounded by semi-permanent, modular, rapid deployable buildings to create more adaptability.  Such a view would enable buildings to be transferred from one state to another, as opposed to a building that will exist for 60 years with only some amounts of adaptability flexibility built in.

Simon Swift was keen to show how using data to model population health would serve hospitals of the future so there would be more efficient use of facilities and staff.  “We can solve many things with data and thus understand how to shape our health care service optimally in terms of physical infrastructure, digital infrastructure and workforce,” he said.

Conclusion

While Simon Swift felt that healthcare infrastructure won’t change dramatically in the next 10 or 20 years, Richard Cantlay felt the important issue is the balance between prevention and intervention.  Elliot Engers considered the benefits of digital are so clear and scalable that he would be amazed if there isn’t an enormous uptake of digital solutions to mitigate admissions into hospitals.  In emerging economies,  Barry Francis felt there is a real opportunity to leapfrog to digital solutions if countries take the risk.  For Carly Caton, the key driver for the future would be a more integrated system with perverse financial incentives removed, thus allowing patients to receive more care at home and enabling more flexible physical infrastructure to be built.

In short, the panel’s vision consists of the integration of digital and physical infrastructure, with an engaged population that monitors health and wellbeing and only accesses acute facilities where strictly necessary.  It may take a while to get there, but we’re already heading that way.