19 January 2022
The Well Placed Hospital
We want to move future acute hospitals back into their town centres, make them smaller, (much) more convivial and better integrated with civic life and the other elements of health and social care.
The migration of the hospital from the town centre to a large self-contained campus hospital under one roof on the edge of town may have made sense in the planning frameworks of the last century, but that period may now be over?
The hospital will usually be the largest or second largest employer in the locality and often the largest single revenue budget. It leaves a large carbon footprint and provokes a large number of car journeys. The economic power of the hospital does not invigorate the local economy as much as it could. The NHS tradition has been for major national supply contracts which shut out smaller local providers.
The peripheralisation of the hospital has had other unintended consequences. It has allowed the gap between health and social care to widen (both figuratively and in actual distance.) It has also driven up the fixed costs of hospital care – the NHS builds its own roads, car parks, shops, etc., which already exist in the town. There is a large and growing backlog of maintenance costs for the NHS estate.
Major capital investment is now planned. Rather than double down on sprawling out of town general hospital sites, we see an opportunity for English towns to use this investment as the foundation for bringing the hospital back into the centre of civic life. Move it and change it. Good for hospital, good for town.
This submission considers hospital estates across England and leads to a worked example for a different local acute hospital set in a very different context.
Three interlocking ideas set this context and sit under the simple assertion that if the Local Authority and NHS combine their capital investments and the operational management of their assets, then greater social gain is achieved and better value for money.
The three ideas are:
Bring the hospital back from the edge of town to the town centre.
Tackle the interface between acute hospital and social care head-on by restructuring both.
Blur the dividing lines between different categories of health and social care staff.
Read the full report here.