Professor Terry Young, a specialist in research in health technology, health services, and information systems, who runs his own consultancy, and Steve Powell, a former Consultant Interventional Radiologist and Clinical director at a large teaching hospital, discuss the sometimes conflicting demands of healthcare providers and patients in terms of the optimal location for medical care provision.
When planning new healthcare infrastructure there is a tension between those providing services and those needing to use them. Healthcare providers and their workforce are typically drawn to co-locate services close to a secondary acute site with generally bigger facilities. This makes sense with nearby support for emergencies, colleagues from different specialties available for opinion, and sufficient equipment to meet almost any eventuality. However, service-users can struggle to find their way around larger sites, while travel to them can be longer and more complicated, and parking congested. Users prefer smaller, more personal facilities within easy reach, but this means more of them. In this article we explore these tensions, and the ground rules for the optimal size and location for such facilities.
The idea of polyclinics that emerged in the latter years of the first decade of this Millennium has recently been revived, with an interest in community diagnostic and treatment centres, in order – for instance – to meet the inequity of access to diagnostic facilities in the UK as compared with European neighbours. This tension between developing larger sites on or near existing infrastructure, rather than smaller sites away from acute hospitals, has been all too evident. While some standalone centres have been built with easy access and good parking – meeting the needs of end-users – others have appeared in hospital car parks or next to hospitals, meeting the needs of healthcare professionals. Behind this lies a fundamental paradox in healthcare: the best ways to deliver care are often the poorest ways to receive it. Behind this is an information paradigm, since healthcare professionals need to ‘cluster’ to maximise their impact, while patients prefer a personalised experience. We show this in Figure 1, where the X-axis represents centralised to remote, and the Y-axis stretches from large to small.
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