The future of healthcare and the implications for the built environment Candace Imison March 2014

Rising life expectancy

Rising numbers of older people

% Increase last 20 years

0-64

65-84

85+

1989/90-2009/10

An ageing and more demanding population

NHS Spend

Source: DH - Departmental Report 2006

133% by 2035

Population lifestyles present significant risks to their health

5

Behaviour change is not easy

Growing numbers of people with long term conditions and multiple conditions

Rising care needs

Significant growth in need for informal care

But - more people living on their own

!  A “cure” or “vaccine” for certain cancers.

!  An increase in the number of lifestyle drugs available

!  Devices that have the capacity to replace or integrate with human tissue

!  Biosensors that allow continuous monitoring of a patient

!  Pharmacogenetics support more effective treatments

!  In the longer term stem cells provide capacity to replace or repair organs

Increasing capacity to diagnose and treat

Continuing and rapid technological advance

!  Continuing growth in

computing power,

intelligence and access

!  The world of Big Data

!  Shift towards smart phone/

tablet and apps from PC

and web

!  Current digital divide

presents challenges

Ubiquitous access to the internet

Technology could support service transformation

!  Reactive to proactive !  Help patients help

themselves and each other

!  Personalised services !  Care to health and

wellness !  But !  One size does not fit

all !  Caring still counts

Virtual visits – remove geographical barriers to access

Health care can be done at a distance with video conferencing and remote monitoring of blood sugar, blood pressure, heart rate, and other health data.

!"#$%&%'%"(%')*"+"&,+-)#$%../$%.)

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The home as the locus of care

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Hospital of the future?

The hospital - part of a wider web of patient focused care

Home

Health and social care centres close to home

Community care centres heart of the community

Specialist care centres on central city sites

Self care Monitoring Automated treatment Information and advice NHS Direct

Social care Primary care Outreach care

Basic diagnostic services Day interventions Minor injuries Nurse led inpatient care Intensive rehabilitation Chronic care management

Home Nursing homes

Pharmacy Cyber café Health kiosk

Surgeries Drop in centres Healthy living

centres

Resource centres

Community hospitals

DTCs Secondary care

Tertiary care Planned interventions Emergency care Complex diagnostic Treatment & inpatient care

Adapted from:Building a 2020 vision - The Nuffield Trust (2001)

Bromley by Bow Health Centre

More integrated community based models of care

High tech

Automated pathology, digital imaging, telemedicine, IT links

Bringing health care into the heart of the community:

A new relationship with the public: Welcoming, therapeutic environment, integrated with other public services

Mobility centre for intensive care

rehabilitation

Consulting Basic diagnostics Day interventions

Nurse led inpatient care

Minor injuries

Child development centre

Hospices and nursing homes

Mental health resource centre

Education, leisure

Advice

Day centres for older people

Alternative health care providers

A new relationship with the environment Sustainable systems: water, energy, recycling, waste, emissions, bio-diversity

Adapted from: Building a 2020 vision - Nuffield Trust (2001)

Older people’s vision

› Connection

› Control

› Personal

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