Lewisham and Greenwich Nhs Trust

Justin Beardsmore

"There has been a domain shift in healthcare policy thinking over the past few years. Whether a post-industrial society or an emerging economy, the thinking has moved away from hospital provision to primary care to address the issues of an ageing population in the former and a growing one for the latter.

Spurred on by a mainstream technology industry looking to move into healthcare, conferences, and presentations are heavy on wearable sensors and now AI; in this brave new world, the bedroom is the new hospital bed. Nevertheless, it’s a good vision, and we need to keep an eye on the prize. No one wishes to spend more time than necessary in hospital, regardless of its scenic view or quality of service. However, the demand keeps on increasing. The ageing problem is in addition to the existing issues. The UK, which suffers from a low hospital bed capacity, spends half as much on health service capital as comparable economies internationally each year. It’s no surprise, then, that there is a consensus growing in senior UK healthcare leadership that the hospital estate needs refreshing. Regardless of what the long-term plan states, we have to be able to get there without sacrificing the present. The reality is that the hospital, like the grocery store, isn’t going anywhere soon.

It may not be going anywhere, but technology advancements will enable a different healthcare estate, rather than a smaller one. New technologies like AR, VR and robotics will gradually cross over into healthcare once matured in other verticals. However, these operational technologies will need to be underpinned by solid foundations.

Estates and technology infrastructure teams will need to work closer than ever before in creating the foundation. Before this can happen, we need to stop thinking about the hospital as a single monolithic entity. We need to break it down. In 2017-18, there were 119.4 million outpatient appointments in the English NHS, of which patients attended 93.5 million. These outpatient appointments account for the largest contact with patients in a hospital environment. This day time-based activity is a far cry from the 24/7/365 of hospital TV dramas.

The estate will need to be segmented and classified, with the appropriate type of reliance and solution design based hospital activity, like theatres and intensive care, will need to be separated from the rest of the estate and hardened. The growing cybersecurity threat against critical infrastructure may mean less about innovation and more around competency in terms of protecting essential plant and equipment. The physical and digital security layers will need to come together. It’s here that the government can support and prioritise.

The emergence of edge computing combined with the maturity of healthcare cloud services will assist this as they eat away at traditional hospital computer data centres, which are no more than computer rooms at the best of times. Here, localised digital cached services can be distributed, making hospital wings self-reliant.

To achieve this, the estate will need to become smarter. Buildings will have to be designed to capture the data that is generated within them; generating insights from the infrastructure and access controls will not only improve their efficiency and security but will also facilitate benchmarking against other provider buildings. The standardisation of the data that estates return to government statistical bodies will need to adjust to capture the complexity of this data. This will improve the overall strategic planning.

Sensors will need to become more prevalent. Enterprise resource planning will need Building Management Systems to interoperate with Electronic Patient Records to map resources to an activity, porter to a patient, and security to an incident in real-time. At a more granular level, smart metering will improve the visibility of hidden utility costs. Tracking footfall and office-space utilisation will allow planners to reprovision multifunctional spaces and decommission spaces to reflect changes in services.

A wireless first approach will need to be taken as the demand for monitoring will not just be for in-house-type services. As specialist critical care equipment becomes more available and sophisticated, providers will want to maximise the utilisation of the equipment, and suppliers will want to wrap in value add service support. Run time for equipment, as opposed to service years, like the airline engine industry, will become the new life expectancy. The ability to capture and monitor this information remotely will be the enabler for this shift.

It’s in the other areas like outpatients and community-based provisions where the opportunities for better utilisation lay, especially in urban environments. It’s here that space will have more potential to be multi-purpose and utilised by multiple providers. The trend here will be for the planner to look at using existing space for outpatient-type activity. Even in smaller towns, this space will be owned and managed by multiple agencies; therefore, the technologist will need to work on the principle that they will need to provide secure access to services over infrastructure they don’t own or trust. Services should need IP connectivity, with access control provided above the network layer, and be able to cater for a range of connectivity types.

Smart, however, will not be enough. The buildings will also need to be sensitive to the core business of patient care and the environment. Lighting and unwanted sound interrupting with the patient recovery process should be reduced. The mentioned technology and estates will need to come together as part of a broader plan. Engaging patients will also need to be a priority to ensure changes meet their needs, all contributing to a people-friendly estate.