A lot of the media coverage of the Government’s Health infrastructure Plan (HIP) published this week has focused on big, shiny hospitals and how many of them actually got the go-ahead — should we be discussing the six that were funded for building or the 34 that will receive some seed funding to make a plan for a plan (and possibly funding at a later date if the plans are good and the money available).
Given the current political climate ( and potential proximity to a General Election), the focus on headline grabbing numbers was inevitable.
But the scale or otherwise of the investment in hospitals is neither the most important issue nor the whole story of the plan.
It’s not the whole story because there is also plenty of reference in the plan in terms of aspirations for other important elements of infrastructure investment — the primary care estate, the technology through NHSX, public health, social care and mental health, and wider health and care activities. It has references to the need to take account of changing delivery models as Integrated Care Systems get into their stride. All of that is good.
A more important issue, though, and one that you might expect to be raised by the authors of Beyond the Fog, is the framing of the plan.
When we’re talking about building hospitals, the investments might be planned to take place in the next 10 years; but they will be in service for many decades. The nature and role of hospitals is likely to change hugely in the next 10 years, let alone the period of service.
What is lacking from the Plan (as it is from much of the healthcare debate) is an overarching vision for where healthcare is going. There is a focus on replacing some badly outdated facilities with shiny new buildings that sound like a 21st Century monument to the 20th Century monoliths of acute care.
But what is needed (and perhaps this is at the next stage — and maybe even using Beyond the Fog as a framework for debate) is some thinking about what the future of hospitals will be. Today, hospitals symbolise and represent what seems to be the very essence of what the NHS is all about; but change is coming. Rapid advancements in technology mean that what is today provided by hospitals such as routine diagnostics and treatment will increasingly move out into primary care, the community and to patients themselves; and the potential for data to transform the way we think about medicine offers the possibility of a sustainable model truly focused around the patient.
Major long-term investment decisions need to be built around a vision for the long-term destination, so that they can be flexible and adaptive to the transformational change in healthcare that is coming down the line; and also so that plans can be developed and co-ordinated to be effective within a framework of system-level change.