A number of pertinent issues underpin the complex future of the healthcare estate however, all roads lead to an estate which is more embedded in the local community, streetscape and economy.
The second meeting of the NLA’s Expert Panel on Healthcare was nicely counterbalanced by the presence of our guest Nicola Theron, Director of Estates at North Central London CCG, who set the scene for discussion.
Nicola led the discussion around the developing Integrated Care System model, currently more of an idea than an entity, but with great potential to enable identification of local need and consequent colocation of services. The importance of medical directors of ICSs would be critical in ensuring their efficacy. Improved provision of acute care (Moorfields etc.), the need to articulate the case for change in investing in Primary Care, and a nuanced understanding of how to find and robustly secure capital for projects were vital.
The panel moved on to how architects could support the briefing and capital allocation process. The challenge is to understand conflicting opportunities and priorities, balancing health outcomes with notions of efficiency and what that might mean in terms of what services are collocated. More so understanding the way they operate, especially arguing the case for mid to long-term investment, which leverages the benefits of efficient supply chain operation, effective delivery of health and social objectives and, critically, low carbon/net zero payoffs.
Commissioning bodies need to become “smarter” in terms of understanding their estates. How to avoid underutilised space, how to optimise a data and evidence-based use of space, and feed that knowledge into more informed commissioning, design and operation. Such de-risking could lead to ways to identify better colocation potential and to incentivise occupiers to use space for longer. We also talked about how this idea of a more integrated public, not just healthcare, provision is starting to be deployed in Borough Council thinking such as Haringey, where the idea of “15 minute neighbourhoods” is taking shape. Working with and connecting anchor institutions, with access to green areas, improved public transport links, increased clinical provision and inward investment in education was being promoted holistically.
We returned to discuss how the widening of locations, and models, for healthcare provision was being actively looked at. The pandemic in particular has shown that the NHS can change if it needs to and quite radically. COVID had enabled people to see healthcare delivery (e.g. vaccination centres) in new places. This raises the possibility of novel combinations such as health and sports centres being collocated. It was acknowledged that there had been some small steps taken by the private sector in terms of developing the “prevention” agenda in this regard, but it was difficult to know whether capital would be prioritised to develop this policy of making people take more responsibility for their health and well-being. How to build the case for this would be crucial.
We touched on how other countries, such as Sweden for example, treat primary care design and provision. Similar issues arise, especially in relation to the differing timescales that healthcare commissioning/provision and commercial imperatives require in terms of investment.
Lastly, almost as a test case, we discussed fascinating issues around the innovative delivery by Nicola’s team of a new NHS diagnostic centre in a shopping centre in Wood Green, with both synergies and challenges apparent. Taking on a longer 15 year lease for the diagnostic centre rather than the typical 1 year lease retail might attract provides security of revenue. What would have been non-rentalised basement space has been used for MRI and other heavy diagnostic equipment. The diagnostic centre is literally embedded within a community who use the shopping centre as a social resource. The unfamiliarity of its location could have been an obstacle in terms of how people think about the seriousness of healthcare (is it really an NHS centre?) and so careful branding and badging was critical to its reception as a bona fide, if innovatively unusual, element of normal NHS service. There are certainly challenges: for example, lack of daylight could put off potential staff and visitors.
The diagnostic centre shows that while there may be issues, there are real potential benefits to using new programmes and models to rethink the way healthcare systems are run. To de-risk this kind of innovation, careful thought needs to be applied to cultural and behavioural change, operation as much as if not more than initial delivery is key to long term success, that longer term investment models need to be promulgated and governance properly structured. This requires the NHS to have both tactical/technical and strategic thinking to bring this kind of service delivery forward.
There are clearly a number of issues around where the London healthcare estate is heading in the next few years, including efficiency of large healthcare campuses vs locally determined clusters; healthcare as part of mixed-use development; investment models which enable healthcare provision in the first place; people’s changing attitudes towards health and well-being; the more joined up provision of public services; “smarter” buildings for evidence-based design and operation; future-proofing vs tight-fit design, and of course, sustainability, net zero and the circular economy. We look forward to exploring these and other issues in future sessions.