Clicks and Mortar: Technology and the NHS estate

As technology increasingly becomes a part of the NHS, is the health service real estate portfolio ready? In Clicks and Mortar: Technology and the NHS estate, a brand new report from The King’s Fund, the influential think-tank suggests we need a different NHS estate, rather than a smaller one. Here are the highlights from the report

The NHS estate is a mixture – some might say a mess – of buildings that range from purpose-built, modern practices to dilapidated Victorian villas. Technological developments are at the centre of the NHS Long Term Plan, the health service’s blueprint for managing increasing demand and an ageing population in the face of flat-lining and reducing funding – but there are questions about how ready the infrastructure is to facilitate this.

In its new report, The King’s Fund tackles this question, and finds that technology and the NHS estate have, typically, been managed separately from one another, a situation that needs to change. To fully embrace the potential for technology, the NHS needs to consider innovation and the estate together.

The NHS estate is already undergoing a period of transformation, and not just in primary care. Currently this is planned in an ad hoc fashion, and that the 13 interviewees who contributed to the report agree this needs to change.  The NHS Property Service-funded report recommends developing an ‘overarching vision for how health and care will be delivered in the future’, which is clear about the role of technology and the estate in delivering it; this should be directed nationally, but involve local input.

As collaboration between primary, secondary and community care become more essential, the report proposes a collaborative approach that is able to take advantages of both technology and scale. A closer union could support the speedier discharge and transfer of patients between services, improving outcome and saving money.

The NHS estate of the future

When defining technology, the remit is broad. Online technology that enables video consultations, and the rise in wearable tech for self-monitoring, are the examples that immediately spring to mind. In the future, the report posits, we may see the need for large surgeries reduce as more patients choose to use technology. Alongside this, new innovations have a role in making the estate more efficient, managing resources and existing spaces more effectively.

The NHS estate of the future needs to be more patient-friendly, using technology to improve the patient experience, the report states. This is likely to include increasing the number of arm’s-length consultations, a shift that’s already gaining momentum. Sensors and wearable technology and apps can be used to monitor medicines’ adherence and health. The estate can change to embrace these shifts, with infrastructure improvements and technology better integrated into practice buildings and spaces. Patients should, where possible, be engaged in the design and planning processes involving new processes that may affect them.

Technology can improve the work environment for staff, supporting flexible working and allowing clinicians access to information, such as digital records, from different locations. Interestingly, the report cautions that a shift toward remote working could cause isolation – something it’s keen to avoid. The new systems, processes and products must be better-integrated into the system, facilitating better communication and collaborative working.

A smaller estate?

For those directing the NHS, the attraction of technology is not just its potential to improve patient outcomes, but also its potential for saving money. Many practices and patients are wary that the greater involvement of technology could lead to a reduction in physical buildings as we’re shifted toward an arm’s-length model of care.

Technology, like online consultations, may reduce the need for space within practices, but it’s likely that this space will be taken up by the expanding portfolio of services primary care providers are asked to deliver. In the future, we’re not likely to see the estate shrink, but how it’s used change – a process detailed in the NHS Long Term Plan.

You can read the full Clicks and Mortar: Technology and the NHS estate report here.  

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