The government’s “biggest in a generation” pledge to build 40 new hospitals was a centrepiece of its 2019 election campaign—even when the claim came under fierce scrutiny. Before the events of 2020, the government had discerned the public appetite for better healthcare facilities.
Boris Johnson’s administration is now planning to turn its campaign slogan into a reality—and so the public, policymakers and healthcare professionals alike should consider what exactly we want to achieve from the most significant hospital investment in two decades. Spending the money is (relatively) easy. Transforming our health infrastructure is harder.
The programme has not been without critics. Some have pointed out that the original “40 new” moniker is misleading, given that several of the sites predated Johnson’s administration, with most of the genuinely new facilities unlikely to be delivered until after 2024. The number has now risen to 48, all to be completed by a 2030 deadline.
Others have argued that a round of hospital building feels old-fashioned and goes against the grain of technology and patient demographics, which are together pushing care increasingly closer to patients’ homes.
These debates will intensify as the number of Covid patients in hospitals recedes and we shift from pandemic to endemic. The contribution of our hospitals in the front line of the pandemic is unquestioned, but what sort of healthcare future do we want now?
That is a big question to answer. There are near-limitless ways in which our existing hospital stock should be improved. We can plan to incorporate the latest medical technology, or to build on-site laboratory facilities that will accelerate the provision of test results. We could investigate how novel approaches to ventilation could reduce hospital-acquired infections, or how greater use of modular and repeatable design can help us prepare for the unknown. We should also address apparently mundane problems. During a recent conference organised by Policy Exchange, one doctor mentioned that, ahead of ward rounds in his local hospital, there is zero space to meet with colleagues to discuss patients with complex care needs. The multi-disciplinary team are instead forced to huddle behind a drawn curtain, with other patients within earshot.
We have the potential to correct these problems in the new wave of buildings. This year’s Wolfson Economics Prize, in partnership with Policy Exchange, is seeking to generate some of these bold new ideas: asking entrants to set out a vision for how hospital planning and design can be improved. Maybe hospitals should be built on campuses and incorporate social housing for the medics who staff them. Maybe gardens and green spaces should be at the heart of every new hospital to promote wellbeing and aid recovery times. Should all new hospitals create art rooms, or gyms for social prescribing?
There are incredible opportunities here—but it is important to acknowledge that hospitals are not the only part of the healthcare system. Our fixation with them has historically been to the detriment of primary, social and community care. The upcoming NHS bill may go some way towards addressing that imbalance by placing greater legal emphasis on different local NHS bodies working together. With any luck, this will mark a shift towards a new and, hopefully, more mature way of thinking about our healthcare infrastructure, whereby the hospital is not planned in isolation, but is instead seen as just one part of the pyramid.
The Department of Health’s published list of hospitals offers glimmers of hope. Among the list are proposals for “cold” hubs providing elective-only procedures, community urgent care hubs and dedicated women’s and children’s services. This should just be the beginning. If the pandemic has taught us anything, surely it is that “more of the same” is not a sustainable healthcare strategy.
As both the opportunities and costs of modern healthcare inexorably increase, the provision of effective care will become an increasingly important economic question for governments across the globe. Already in the UK more than one in every five pounds of public spending goes towards health and social care. But as well as a cost to taxpayers, hospitals could be at the heart of the levelling up agenda: imagine them as local hubs promoting health and wellbeing for their communities, or driving innovation and growth by co-locating them with researchers and laboratories.
It was a year ago that the prime minister stood in Dudley and pledged that his government would “build, build, build.” This vigour for infrastructure development is Johnson’s calling card. And when it comes to our healthcare, infrastructure is sorely needed—especially after the frugal approach to NHS capital investment under David Cameron and Theresa May, which has led to a backlog maintenance bill approaching £10bn.
But to ensure we make the most of the new hospitals, we will also need to “think, think, think.” About the technologies around the corner. About the patients who need joined-up care in a calming and dignified environment. And about the NHS staff who deserve high quality workplaces. White elephants or anchor institutions? That is for us to determine.
