Trusts advised to think more commercially
There are calls for the NHS to be run more like Tesco, with a reduced number of large hospitals supported by smaller, community-based services.
Speakers at the recent IHEEM Healthcare Estates Conference said that with the government reforms placing more emphasis on providing care closer to home, large district general hospitals could soon become a thing of the past.
And, despite moves to localise care services, they claim that where the future of acute hospitals is concerned, the Government needs to a take a more regional view, similar to the recent creation of stroke and trauma 'super centres'. These specialist facilities can then be supported by locally-based health and wellbeing services.
NHS commentator and broadcaster, Roy Lilley, said: "We are locked into a model of care moving forward that cannot support the estate. It is lunacy to build more hospitals.
"We need to do what Tesco does; build big centres out of town with good transport links, similar to the idea behind the Darzi centres, which we got rid of."
Kevin Oxley, director of operations at North Tees and Hartlepool NHS Foundation Trust, added: "We are being told that the future of the big district general hospital is terminal and that we won't need so many any more. We have built hospitals in the last 10 years that are in the wrong place and are of the wrong size. When looking at hospitals in the future, we need a regional or national vision."
This vision would mean that instead of a large hospital in each big town, there would be regional supercentres providing high dependency, intensive care and specialist surgical provision, while most other services would be delivered from smaller, community-based centres or via GPs or district nursing teams.
John Cooper, chairman of Architects for Health, said: "Despite the push for local healthcare delivery, we have a vacuum in the acute sector where we have got to view things regionally, if not sub regionally. The hospital needs to stop being the focus and admission to hospital has to be seen as a last resort when everything else has failed."
However, any scaling down of hospitals would need to be supported by a new tranche of healthcare facilities along the lines of the old convalescent homes, speakers said.
Nigel Edwards, a senior fellow at the King's Fund health thinktank and a director at healthcare consultancy, KPMG, said: "It is difficult to talk about the estate without looking at the wider model. It looks like massive shift towards homecare and large regional hospitals, but nothing in between."
Duane Passman, 3T programme director for the estates and facilities team at Brighton and Sussex University Hospitals NHS Trust, added: "We were talking several years ago about patient hotels where people could go once they had come out of hospital and did not need that degree of care any more but could not go home, but that idea has fallen away. It is this middle ground we have lost in this country and we are still missing."