Keeping capital supple for future flexibility

One of the key conclusions was the need to build into new healthcare facilities, from the outset, sufficient flexibility to cater for fast-changing care patterns and evolving technologies.

Our study aimed to extend the evidence base on how both to increase the long-term effectiveness and sustainability of newly built hospitals, and to ensure that they remain appropriate for the services provided from them. In the companion paper published in Health Estate Journal in February 2009 (Rechel, Wright et al. 2009), we described the methodology and many of the findings to emerge from our study. Here we turn our attention to the crucial importance of flexibility. Flexibility has several dimensions, including design, capital and service financing, and mechanisms for incorporating hospital services into the wider health system. Design When considering the various design options for hospitals with a view to ensuring their future flexibility, it is important to remember that, by their very nature, the inherent flexibility of different parts of of a hospital differs. Those areas providing core functions, including operating theatres, diagnostic imaging, and intensive care facilities (the “hot floor”), are very expensive to build, and tend to have a comparatively short technical lifespan. The “hotel” function, especially where it involves lowintensity nursing, is less specific, and has a longer technical lifespan, (although this is changing, with the introduction of variable acuity beds that can be adapted to the severity of the patient’s condition, rather than having to move patients within the hospital as their condition changes (Chaudhury, Mahmood et al. 2006)). The most flexible, and potentially durable, parts of a hospital are its office facilities, including administration departments and outpatient clinics (except ophthalmology, which seems, uniquely, to require specialist facilities).

Four ‘segments’