Comment: Accommodating the care crisis

Jitesh Patel, senior development manager at Kajima, argues that the NHS needs to develop a new solution on a national scale to improve both the healthcare estate and the standard of care services in the UK

A £40m primary and community care centre is being built in Lisburn, Northern Ireland, marking a new approach to the design of health and care services, bringing together GP clinics, community services and mental health and elderly care facilities

With A&E services in crisis, escalating waiting times, and creaking healthcare facilities, the Government needs to consider a radical approach to the delivery of healthcare that will provide a workable solution on a national scale, improving both the NHS estate and the state of UK care.

The recent announcement from the Government that a cash injection of £3.5billion a year will see NHS patients being cared for at home and in their community to avoid them going into, or staying in, hospital unnecessarily, is welcome.

This damaging and costly cycle can only be halted by the adequate provision of step-down, community-centric care provision, supported by an appropriate physical infrastructure

However, if we are to truly see a decisive shift from hospital-based provision towards a community-centric care model, the supporting physical infrastructure must be put in place.

Systemic, structural problems in England, such as waiting times for elective care and a shortage of community and social care spaces, are currently exacerbating bottlenecks in hospital discharge, contributing to bed-blocking and revolving-door hospital readmissions.

In too many instances there is simply no alternative for patients other than a hospital bed, despite the fact they may no longer require inpatient treatment.

This damaging and costly cycle can only be halted by the adequate provision of step-down, community-centric care provision, supported by an appropriate physical infrastructure.

This infrastructure would include assisted living facilities, managed accommodation for the elderly and primary and community care centres offering integrated, multi-disciplinary health services. Such provision would enable patients to move confidently and efficiently though the healthcare system, ensuring a continuing level of appropriate care, while reducing the hospital bed blocking that is currently strangling the NHS.

Jitesh Patel

The recent funding announcement, which is a key part of the Government’s NHS Long Term Plan, could contribute to the capital investment for such infrastructure.

Ultimately, however, its cost would be offset against the potential savings it would generate.

The average cost per person per day in hospital is £400 - considerably more than the day cost of community care provision. In addition, the new model of care should see the integration of health and social care, incorporating mental health and elderly care, enabling it to access funding from the £3.8billion Better Care Fund.

Some early examples of this integrated, community-centric approach are already being developed.

Kajima was recently awarded the contract to develop a new £40m Primary and Community Care Centre in Lisburn, Northern Ireland.

The centre, which is due to be operational in 2021, will offer modern, fit-for-purpose consultation and treatment facilities for a wide range of primary care services including physiotherapy, low-risk elderly care, diagnostic services, children’s services, adult mental health, and addiction services.

if we are to truly see a decisive shift from hospital-based provision towards a community-centric care model, the supporting physical infrastructure must be put in place

When complete it will represent a transformation in the way that health care is delivered, and will be well positioned to meet the needs of patients for the 21st Century.

Despite unprecedented demand on its services, it should be possible for the NHS to continue to deliver world-class health care. It will, however, require a bold new approach to how that care is both funded and delivered, including an overhaul of the current NHS estate.

Only with a collaborative effort towards this goal can the substantial and rising pressures on the NHS – impairing treatment outcomes and weighing down trusts – be fully addressed and improved life-long care become a reality.

A more joined-up approach to hospital and out-of-hospital care is needed if the NHS is to work within dwindling budgets and enhance patient care

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