autumn 2010

the (small) hypermodern local acute hospital

providing acute care locally

durrow

1

“Yes, it is possible to provide gold standard acute hospital care in a small local hospital in a cost-effective way... it is just difficult and requires a number of NHS conventions to be defied ”

the people involvedthe challenge

Part 1 -towards an ideal brief

introduction background to the problem the problem 1984 revisited...consultation and doublespeak finding a solution...points of departure an ideal brief for Banborough 2025

Part 2 - worked example

local acute services 20 mins away towards a designed alternativethe vision

Part 3 - new concept

rethinking the relationship to the town how big?new formations for medical staffingrethinking the use of spaceyour challenge

6789

1012

161820

2425262830

... Andy Black

All illustrations included of projects by the authors of this publication. The front cover image is with permission of Tom Jones

23

2 the (small) hypermodern local acute hospital

Andy Black is well known in the UK as an independent thinker in healthcare planning. His main focus is now on the organisation of acute care and the managed introduction of innovation into healthcare practice. He has been a consistent champion of the concept of the hypermodern local acute hospital and the local emergency unit in the face of a strong NHS consensus for centralisation in bigger units. Andy is chairman of Durrow which is an international healthcare strategic consultancy active across public and private sectors. He is the author of the NHS Confederation monograph, ‘The Future of Acute Care’ .andy@durrow.org.uk

cv.1 andy black

Andy Black had a management career in the NHS between 1973 – 1994. During this time he held a range of positions: running a large metropolitan region, senior government adviser in Whitehall, and Chief Executive of a London Teaching Hospital (Central Middlesex) during which term he was responsible for the planning and execution of the NHS’s first stand-alone Ambulatory Care Centre.

Since 1994 he has been a principal in durrow. His focus has been on the managed introduction of innovation into healthcare practice. He is a regular adviser in the private equity and project capital markets on the issues around long-term investment in the health services. Andy is a regular author on the configuration and modernisation of health services with the current focus being on a hypermodern format for smaller local acute hospitals and the future of the Academic Medical Campus.

He was recently commissioned by the NHS Confederation to write the monograph, ‘The Future of Acute Care.’

Johannes Eggen is a partner at NSW Architects and Planners in Oslo, Norway. He was lead architect for the hospital planning and design of the award winning project St. Olav’s University Hospital in Trondheim. A frequent speaker at conferences, in the last year he has presented at health planning conferences in Europe, USA and Australia. Currently he is a consultant to the jury in connection with a competition for a new national hospital in Iceland and is a member of the Norwegian Health Authorities Competence Network for Hospital Planning.je@nsw-ap.no

Mungo Smith is a founding director of MAAP, a former head of design at the Medical Architecture Research Unit (MARU) London and was project architect for the pioneering Lambeth Community Care Centre. Whilst he continues to be actively involved in research through consultancy with the Department of Health, and is a member of their Design Review Panel for major capital projects, he is also regularly invited to speak on the design of healthcare environments in the UK, Europe and Australasia. Recently, he has been involved in developing the reference design for the New Royal Adelaide Hospital, South Australia and the latest masterplan for the Sunshine Coast University Hospital, Queensland. mungo@maap-architects.co.uk

the people involved

3

I hope you will find a few moments to scan this document. It contains a message of hope for those with a commitment to local acute services. It is also a very challenging message.

The first section is a review of all the reasons why most local health economies find it too difficult to provide their citizens with gold standard acute healthcare and perhaps why there are still NHS hospitals that are offering their communities sub-standard care that is relatively expensive. In some cases, defending local access has become confused with defending local hospitals that are really not very good.

The second section carries the message that you can have a modern and future proof local acute service: technically, culturally and aesthetically excellent. Sure you can have it, but it will be very difficult to implement with today’s NHS rules and frameworks. Difficult, but we believe, achievable: albeit there will need to be a number of points of departure from NHS traditions.

To try and illustrate and substantiate our conviction we have set out a worked example in an imagined market town called Banborough - although fictional in name it is numerically based upon a real locality.

There have been repeated messages sent from many local communities that they would value local access to services but the planning structures of the NHS have struggled to respond and regress too quickly to trying to convince their constituents that further centralisation would really be a better bet. In the modern political jargon, “they just don’t get it.”

We do get it! We are not interested in rhetorical slogans about moving care closer to home. We are interested in establishing tomorrow’s local acute services in the UK at a standard that might truly be the envy of the world and that will be affordable by tomorrow’s taxpayer.

the challenge

If you would like to discuss the issues raised in this document, please email me.andy@durrow.org.uk

4 the (small) hypermodern local acute hospital

5

part 1towards an ideal brief

6 the (small) hypermodern local acute hospital

introduction

1. Aron Nimzowitsch, the famous Latvian grandmaster who defied chess conventions of the day to become one the greatest players of his generation. His style and theories became known as the ‘hypermodern’ school.

Some smaller acute hospitals in England are finding it difficult to see their futures in an NHS where the financial and regulatory frameworks favour larger hospitals. However, these same hospitals are very popular with local citizens and are often fiercely defended. The decision makers of the NHS find themselves in the dilemma of being unable either to push through closure proposals or to come up with ways of making these smaller hospitals cost-effective success stories. The most common NHS strategy is to ‘prop them up’ with ad hoc arrangements and additional financial packages.

Despite its rhetoric of bringing services closer to where people live, the NHS has struggled with the future concept of the smaller acute hospital. We suggest that there is a deficit of imagination and creativity in the state bureaucracy and we see this as an opportunity. An opportunity to explore new formations that step outside of NHS tradition.

(In an homage to Nimzowitch1) we borrow the term the ‘hypermodern’ for the new local acute hospital - one which defies the conventions of both the Victorian Infirmary and the NHS District General Hospital.

We look towards a place that is integrated with its host town, which is a joy to work in and which creates a genuinely therapeutic environment for its users. We question the future division of the medical faculty into two separate groupings of GPs and hospital doctors. We question the separation of private and NHS care. We question the separate management of community services and ambulance response. We challenge the dismal,

institutional tradition of the NHS building culture. Aside from a few brilliant exceptions, our better hospitals just manage the ambience of the middle price hotel and our worst have all the charm of an East German police canteen of the 1960s.

This, surely, is an opportunity!