For the latest in our ‘Lab’ talks in London, a panel on ‘The Health Economy’, we posed a question to a gathering of designers and healthcare professionals: how can healthcare developments impact the health and wealth of our cities?
The question comes at a time when the National Health Service (NHS) faces significant challenges in delivering effective local care, as John Kelly, director at Healthcare Partnering, told the group. The NHS, he said, is influenced by opposing forces, which he dubs ‘centrifugal’ and ‘centripetal’. The centrifugal forces — capacity, romantic localism, resilience and more — encourage the decentralisation of care services, whilst centripetal forces — NHS culture, individual behaviour, procurement routes and more — favour centralised care. (Forces such as finance and politics also compete for influence, but their effects are less predictable, encouraging consolidation in some instances and dispersal in others.)
Since the Health and Social Care Act 2012, the relationship between NHS hospitals and their local economies has worsened. The lack of connectivity between hospitals, social care and the community creates a wide gap in the quality of health in many areas. This would seem to argue against decentralisation.
Yet it is clear that the older, simpler model of the NHS and its organization — the centripetal, centralised model — is no longer applicable either. The NHS needs to take a wider view, to be more encompassing, more flexible and better networked. It will need to move beyond centralised healthcare if it truly wants to provide integrated, personalised services for patients.
Kelly quoted Simon Stevens, Chief Executive of NHS England, who produced the NHS Five Year Forward View to articulate what this change might look like. He proposes multi-specialty community providers, viable smaller hospitals and specialised care, with the goal ‘to dissolve the artificial barriers between prevention and treatment, physical health and mental health, and the historical silos of primary, community, social care and acute care — and the professionals who work across them’.
Fortunately the new Royal Liverpool University Hospital is moving in this direction, reported our second speaker, Helen Jackson, the Director of Strategy and Transformation for the new Royal and Broadgreen University Hospitals NHS Trust. Although Liverpool has some of the most deprived areas of the UK — life expectancy in the Kensington area is 10 years less than Kensington in London, and there are huge variations within Liverpool itself, in some places of up to 14 years — the new Royal represents an opportunity to build on the assets of the city and improve health and wealth.
The £1 billion development covers not only the hospital, but also research, education, public space and other opportunities for future growth. Its vision of an integrated campus is attracting key services and institutions such as the Liverpool School of Tropical Medicine and the Clatterbridge Cancer Centre. The aim of the Trust is to build a knowledge quarter: the hospital and the university will be closely linked to the cultural centre of Liverpool and the shopping district, making it attractive to researchers and clinicians alike.
And by siting research and healthcare on the same campus, the opportunity for clinical advancements is greatly increased. For the Trust, this represents a significant step change in the way they deliver services.
As Jackson puts it, the ambition for the new Royal is that job creation, investment, development, co-location and significantly improved health services will together improve the health of the city of Liverpool. Even more significant, if successful it will provide a roadmap for resolving the centripetal and centrifugal forces currently pulling healthcare in contradictory directions. In doing so it will provide a model for healthier, wealthier communities throughout the UK.
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