The Future of Digital Healthcare Facilities
by 3PM, DesM and Exigere
Historically, the UK health sector has significantly lagged behind other industries in the use of digital tools and technologies. However, with the COVID-19 pandemic forcing a heavier reliance on the use of remote technologies, and the emergence of healthcare apps, technology is anticipated to be a key factor in moving the health sector forward and keeping healthcare practices relevant.
UK Health Trends
A survey of 70 organisations across the Clinical Commissioning Groups (CCGs) shows that digital transformation now sits high on the UK healthcare agenda. In a survey carried out by BT in association with iGov, most participants acknowledged that digital infrastructure is essential for the future transformation of the healthcare sector.
Health care app downloads
In the aforementioned study undertaken by BT in association with iGov, it was reported that 98% of NHS staff have seen increased demand for remote health services over the past 12 months. Use of the NHS app rose by 912% in 2020, whilst the NHS website, which usually attracts approximately 360 million visits a year, had an estimated 803 million visits in 2020. Meanwhile, the Organisation for the Review of Care and Health Applications (ORCHA) has reported a similar increase in the adoption of digital healthcare over the last 18 months. ORCHA, which provides data over the downloads of healthcare apps, found there has been a 25% rise in health app downloads. The report found that:
- Apps which support mental health needs increased almost 200% from mid-2019 to mid-2020.
- Apps which support diets and weight loss rose by 1294% from mid-2019 to mid-2020.
- Apps which help manage diabetes rose by 482% from mid-2019 to mid-2020.
Why hasn’t digital transformation been adopted yet?
Prior to the COVID-19 pandemic, the main reasons for the lack of adoption of digital healthcare services were:
- Concerns that the implementation of digital services would be too expensive.
- Concerns that patients lack the skills to use digital services.
- Concerns that patients lack access to digital services.
However, research from over the past year contradicts this:
“Whilst 97 per cent of UK adults have used technology this past year to connect with the NHS, only 18 per cent of health organisations currently use patient health apps. This is despite almost 70 per cent acknowledging smart apps contribute to better patient service”
Rather than end-user opposition being a reason to hold technological development in the sector back, evidence over the past year shows that the public are now driving a demand in digital services. With only 40% of NHS staff using online booking systems, the lack of digital adoption appears to be endemic within the healthcare system rather than being driven by external factors such as cost, design capabilities, and lack of patient demand.
There is still some underlying mistrust of the digital agenda in parts of the population about personal privacy on health records and its misuse in the insurance world (for example with the Digital Passport). In addition, there will always be a cohort of both patients and medics who see a move away from face-to-face encounters as detrimental, and prioritise the importance of seeing people physically. But as the BT/iGov survey surmises, whilst patient concerns about inexperience with digital technology have been considered a barrier to transformation, one of the positive legacies of the past year appears to be the public recognising the advantages of digital change.
Digital Health & Design
How can this be accommodated in the design of physical healthcare buildings?
The Department for Health and Social Care are currently updating their technical standards which sets out guidance for planning, design, layout, and delivery of healthcare buildings in the UK. These standards will include guidance on delivering intelligent hospitals that keep hospital designs in a format that accounts for both the digital agenda, in line with zero carbon targets, and allows for standardisation and delivery through modern methods of construction. The Intelligent Hospital project will provide a road map to delivering modern methods of construction in the NHS building programme including how to use common platforms to drive efficiency.
It is well acknowledged that digital technology allows for people to access services and generate data to improve these services. From a design perspective this will mean moving physical activities online, building more space for digital technology in-house, and requiring more flexible design of healthcare estates which are prepared to adopt new technology. The trick with digital health is not only designing for current digital trends and practises, but future-proofing health facilities for emerging and new technologies.
This will require a whole system adjustment:
- Setting out a vision which captures the goals and aspirations for the digital agenda
- Setting out a roadmap to achieve the core concepts from the vision
- Ensuring technology and estates are bought together as part of the wider plan rather than being developed in silos. This includes full engagement and buy-in of staff and end users. Buy-in of medical colleagues and end-users could present challenges and may require incentivisation e.g., gym club discounts, health insurance discounts, income tax discounts etc to improve preventative medicine.
- Embedding this at each stage of design to ensure comprehensive coverage
- Ensuring digital design is retained in line with the goal and not value engineered out – this requires consideration at the capital funding stage of a project to secure the upfront investment. Consideration should also be given to government funded NHS projects, writing this into their funding requirements and issuing penalties for not meeting these targets.
- Development of healthcare planning tools to be used on each project as per the ‘Wellness Agenda’ and the development of the Health Building Notes (HBN’s) and the Health Technical Memorandums (HTM’s).
- Designing in repeatable clusters that can be assembled to meet each brief, site, and context to maximise opportunities for modern methods of construction and offsite manufacture, and the need to rapidly expand facilities if needed for Pandemics such as COVID19 and Ebola.
There is of course the potential for the medical profession to become more remote at a local level, but as rollouts in digital health tools to date show, if used correctly these can free up time for meaningful consultations. This combined with the integration of mental and social care also may have the effect of more local consultation and a move away from large ‘do-it-all’ acute hospitals.
The effects of the digitisation of health may be to drive forward high-tech advanced medicine with established specialisations leading the way and primary care expanding to much larger facilities, like the old ‘cottage hospitals’. Areas of specialism could include general diagnostics and imaging, dealing with outpatients that can fill busy acute centres, more local minor injury units, and more local maternity facilities. These represent huge shifts in capital expenditure for possibly a reduced acute estate and many more low-tech facilities nearer to residential populations.
The Cost of Digital Healthcare
The integration of digital infrastructure into healthcare environments requires early planning and can have the following impacts on the operation of a healthcare facility:
- Digital consultations – increase efficiency of providing initial consultations. These do not necessarily have to be undertaken in a healthcare facility and can make it easier for vulnerable members of society to access healthcare.
- Digital check in points – reduce the number of administration staff required and/or increase their ability to become more efficient in dealing with greater value tasks within the facility.
- Digital triage – reduce the impact on primary care facilities by pre-screening patients, directing them to the correct facility to meet their needs and reducing pressure on GP surgeries. GP Surgeries may need to mutate to polyclinics or micro-hospitals, moving away from large hospitals. Finding land for Surgeries can be a difficult task, with unaffordable prices reflecting expectations for residential development, however with the emergence of smart cities and villages this is an opportunity which requires investigation at policy and planning level.
Getting this right can pay off hugely. Effectively incorporating digital services into physical assets can help mitigate some of the biggest issues facing the NHS and other healthcare facilities, namely staffing and funding shortages and reducing space needs, freeing up space for increased treatment facilities.
The capital cost of digital infrastructure in new facilities, when planned for in advance, is minimal at circa. 1-2% uplift compared to historic healthcare models of delivery. However, the value gain in terms of efficiency of space use, staff efficiency and future proofing far outweigh the capital cost.
Digital Healthcare Opportunities
The use of digital processes in the healthcare sector offers a variety of opportunities. Digital technologies can play a pivotal role in:
- Reducing administration time – thereby freeing up resources for better quality patient experience and to enable healthcare providers time to introduce new ideas and improve care. At the HFMA roundtable ‘Is automation the way forward for the NHS?’, examples of how automated technologies have already been releasing staff time for higher value work were tabled. For example, at the start of the COVID-19 pandemic oxygen tank readings being taken every hour throughout the day vs. using a bot to take automatic readings from oxygen tanks. Progress has also been made in other areas; the Electronic Prescription Service is now used in 93% of England’s GP practices and the NHS e-referral service covers every UK GP practise.
- Freeing up space in existing facilities – this will help address one of the biggest issues facing the NHS and other healthcare facilities by replanning adjacencies in current operational environments with poor infrastructure.
- Fostering greater collaboration – using technology to break down departmental siloes and integrating systems between departments into a multi-disciplinary approach, for example mental health / social health merging with general healthcare.
- Reducing inefficiencies & inconsistencies – by adopting a common approach that allows departments, hospitals, and practitioners to interact via a common mechanism for legally binding security, such as block-chain systems.
- Modern Methods of Construction (MMC)– enabling buildings to be designed for off-site modular construction, meeting higher sustainability targets, greater speed of construction with greater flexibility.
- Feeding into the Wellness Agenda – a proposal arising out of evidence-based design to induce a sense of Well-being for staff patients and visitors in the NHS Estate, something which the 2021 Wolfson Economic Prize encompasses by seeking proposals for a new breed of acute hospitals and healthcare facilities for the future.
- Cost effective – Digital transformation is demonstrated to only result in minor uplifts in capital costs
Conclusions & Next Steps
Most UK health providers believe digital transformation should be a priority when it comes to delivering better healthcare services. It is anticipated that digital technologies will start to dominate new areas within healthcare including mental health, maternity and women’s health services, cancer, and cardiovascular diseases, with the advances in imaging, non-invasive diagnostics, and interventional radiology, being one of the most dramatic improvements for medicine generally. Therefore, adoption of digital technologies in capital investment programmes is vital to ensure these are serviced correctly and the above advantages can be gained. There are clear opportunities that the digital healthcare agenda can bring to all healthcare users and administrators, helping to further the sustainability agenda, employ modern methods of construction, and design buildings to anticipate the changing needs of future generations.
 Progressing digital transformation in healthcare 2021, BT Enterprise in association with iGov Survey, BT. Available from: https://business.bt.com/content/dam/bt/business/v2/PDF/cps/health/Health-Survey-eBook
 Digital Inclusion in Health and Care: Lessons learned from the NHS Widening Digital Participation Programme, 2017-2020, Dr. Emma Stone, Peter Nuckley and Robert Shapiro September 2020
 Health providers accelerate digital transformation plans in response to Covid-19, 02 July 2021. Available from: https://www.localgov.co.uk/Health-providers-accelerate-digital-transformation-plans-in-response-to-Covid-19/52562
 Department for Health and Social care, Policy Paper The future of healthcare: our vision for digital, data and technology in health and care, 17 October 2018. Found here: https://www.gov.uk/government/publications/the-future-of-healthcare-our-vision-for-digital-data-and-technology-in-health-and-care/the-future-of-healthcare-our-vision-for-digital-data-and-technology-in-health-and-care
 Evans, Harry & Wenzel Lillie, The Kings Fund, Clicks and Mortar Technology and the NHS Estate, May 2019
 Based on Exigere internal benchmarking
 NHS (2018). Long Term Plan: Available from: https://www.longtermplan.nhs.uk/