Many hospitals designed for another era

As we continue to develop our health services, we need to consider the challenges that we will face. This is sometimes difficult to do as healthcare professionals and managers struggle to meet the current demand that they face, writes Dr. Peter Lachman.

Dr. Peter Lachman
Dr. Peter Lachman

It is said that the demand will continue to grow with an ageing population and growing complexity of the comorbidities associated with an aged population.

Ageing is one of the successes of the modern era, as is the growing number of people, young and old who have chronic conditions and who have survived due to the advances in medical care. Nonetheless, we still deliver care in a similar way as in the past.

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Nowadays, admission to hospital is often a failure of care and we should be trying to develop the services in the community to manage the needs of people with chronic long term conditions.

We have designed care around large inefficient hospitals, all designed for a different era. Many of them are not suitable for the new disease patterns – indeed most were designed for the era of infectious diseases. This means that the processes of care are not entirely suitable for people with chronic conditions. There are calls to redesign and refocus but this will require hard choices. Hospitals are in places for historical reasons, there may be hospitals in the wrong place, there is duplication of services and lack of economy of scale. And changes to this would be a politically difficult.

We need therefore to reflect on how we have organised our services in the past when hospital care was the main way to manage the diseases people had. Nowadays, admission to hospital is often a failure of care and we should be trying to develop the services in the community to manage the needs of people with chronic long term conditions.

A recent White Paper ISQua draws attention to the challenges that must be addressed (http://www.isqua.org/interest-groups/innovation-and-systems-change). The paper deals with the issue of a rapidly ageing world. Ireland is in the moderately aging group, and currently has 18.5% of the population who are over 60, with projections that this will rise to 24.4% in 2030 and 31% in 2050. With ageing comes more demand and we cannot continue to deliver the services in the way they are currently designed. It is time that we seriously look at a redesign with the development of services based in the community to deal with complexity rather than in hospitals to deal with failures in care. The ISQua paper provides a framework for dealing with this challenge as well as some possible solutions. It is worthwhile to access the free download.