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NHS reforms and the future built environment

For an essential public body as old and as large as the NHS, reform is inevitable, argues Andy Stuart, director, Future Health & Care Expo.

The UK Government's Health & Social Care Bill stands to be just as divisive as any other preceding set of reforms, and the NHS Future Forum's recommendations seem to have engendered even greater discord in the debate.

However, it appears inevitable that the amended reforms, which will now incorporate more than 16 of the Future Forum's recommendations, will come into effect and change the face of the NHS for decades to come.

For anyone involved in building and maintaining health and care facilities, both in the private and public sector, these reforms are going to have far-reaching consequences. While the health sector is being affected by a range of factors, there are three key areas that the built environment needs to focus on.

Impact of policy reforms on design and construction

In a recent interview, Health Secretary Andrew Lansley claimed that the NHS could be facing a potential funding gap of £20bn by 2015 with expenditure reaching £130bn by this point.1 This is despite the Government providing an additional £11.5bn in funding.

To curb spiralling costs, the NHS has to make tough choices as to how resources are allocated. With cuts to front line services, treatments and staff considered a last resort, the easier option is to cancel or postpone new facilities, and reduce the money spent on refurbishment and maintenance.

However, the need for new sites remains, and it will be up to those responsible for securing these construction projects to demonstrate the value they deliver. This is going to be a key consideration for the way in which the built environment interacts with the health sector.

Competing for care

Increasing the level of competition between different facilities, both private and public, was at the heart of the healthcare reforms originally proposed by the Government. The idea was that it would result in a greater quality of care, since facilities would be forced to maintain high standards in order to attract patients. In the amendments to the reforms based on the Future Forum's recommendations however, the competition aspect of the bill is scaled back.

However, encouraging competition is still recognised as a 'tool for supporting choice, promoting integration and improving quality',2 as Steve Field, chairman of the NHS Future Forum confirmed recently – although he argued that it should never be used 'as an end in itself'.

Competition is becoming a bigger part of the NHS, and is something that the built environment is going to need to play a larger role in as free-market ideas gain more prominence across the health sector. This pressure is only going to get larger as patients increasingly turn to providers of private care, and it is the built environment that is going to be the key facilitator in delivering cost effective and attractive facilities to help providers compete in the healthcare market.

Keeping up with the trends

In addition to the Government's NHS reforms, the built environment sector needs to adapt to meet the challenges presented by growing social and economic trends, and it is clear that the way in which health and care facilities are built and managed is going to have to change.

For example, Private Finance Initiatives, the scheme through which health trusts can outsource the cost of building and maintaining care facilities, are a constant expense for many NHS Trusts. Attempts to renegotiate monthly repayments will become more common as the NHS looks for ways to improve available resources. At the same time, there may be an increase in the number of PFI projects as the NHS looks to fund new facilities.

In addition, the way in which facilities are built and maintained must adapt in response to changing health demands from the public. For example, with hospital-borne diseases like MRSA constantly in the media, the need to update existing facilities and equipment to reduce the risk of infection is paramount, and care providers must ensure that the facilities they provide are modern and efficient.

The built environment will therefore continue to be an integral part of the way in which care is delivered in the UK, and the health and care sector will be increasingly reliant on its ability to adapt and support it in ensuring that patient needs continue to be met.

Conclusion

From architects and facility managers to local authorities and contractors, everyone involved in the health and care built environment is going to have to readdress how they serve the needs of the NHS and private sector health and care providers. Together, they must ensure that the sector remains healthy and profitable, and be able to guarantee that patient care maintains a high standard.

The process of writing the amended Health and Social Care Bill into law will take some time. Even with additional amends being introduced, the built environment clearly needs to scrutinise the changes and make adequate provisions for adapting to the changing landscape.

FOR MORE INFORMATION
www.futurehealthexpo.com

References
1. Telegraph.co.uk, 'Why the health service needs surgery', June 1, 2011
2. NHS Future Forum Summary Report

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