A solution for the NHS hospital shortage crisis: Designing the Hospital of the Future

The NHS is facing the most serious crisis in its 75-year history 

After years of funding restraint and an absence of strategic planning, over 7m people are now on waiting lists for surgery or specialist care; there are 105,000 vacancies for posts - numbers of doctors and nurses are especially low; there is a lack of true and effective integration between health and social care, with one in seven hospital beds occupied by patients who cannot be discharged; A&E departments are overcrowded; vital equipment is missing, or outdated, and some patients have had to wait for over 40 hours for an ambulance. Moreover, the welfare of patients and staff is regularly put at risk because many hospitals have fallen into an acute state of disrepair and /or have expanded as space allows, leaving tortuous and inefficient adjacencies.

In 2018, the Government committed £379bn to building new hospitals and upgrading outdated facilities. The focus of the programme is to increase the number of fit-for-purpose hospitals and situate them for optimal use, rather than attempting to update old buildings that may never be fit for purpose and may be situated in the wrong place for current and future needs. Replacing existing facilities would require increased footprint to comply with current Health Technical Memoranda (HTM) and the Health Building Notes (HBN) and the cost per square metre has never been higher. It is therefore imperative that acute hospitals focus on the essential and efficient requirements and remove non-vital services to reduce the cost of upgrades.

But how can these hospitals of the future radically improve patient experiences, clinical outcomes, staff well-being and integrate with wider health and social care? RSHP, Stantec and clinical consultant Jackie Churchward-Cardiff, have a proposal which is based on two propositions: The Vertical Hospital and Horizontal Healthcare, delivered on the High Street, which would become the Horizontal Health Street.

The Vertical Hospital would be located in mainly dense urban areas and reduced to its essential core, enabling it to provide acute and specialist, state-of-the art care in a safe and efficient environment that works for staff and acute clinical collaboration. This ‘science of treatment’ approach would be delivered in a stack of modular pods, highly serviced, scalable to need, and able to function independently to limit the opportunity for cross-infection which results in 28,000 deaths each year at a cost of £2.7bn. The pods would also provide the optimum working environment for staff, embedding design best practice to provide a comfortable, human, and therapeutic workspace that supports clinical staff to give their best. By removing long, random, and inefficient connections between departments, scaling facilities to maintain optimum layout and concentrating on acute facilities, only the vertical hospital becomes what it is meant to be: a clinically efficient and therapeutic environment where patient safety is maximised and staff are supported to deliver excellence.

As well as transforming clinical outcomes, logistics and communication and workflows would be improved as ‘vertical villages’ would create a human scale. Medical training and research would also be integrated into this one building with emphasis given to integrating decompression ‘soft’ zones adjacent to landscape opportunities for the benefit of staff and patients.

Horizontal Healthcare would deliver non-critical/post-acute or ongoing healthcare into the High Street and beyond, pushing care where appropriate back into people’s homes. Since the pandemic, shop vacancy on UK High Streets has increased to 14.5%, with almost one in five shopping centre units now lying empty. Not only would using these units be of huge financial saving to the NHS - High Street rents are 70% lower than rents in NHS Trusts and construction costs are 30% lower – it would also allow it to embed the prevention programmes funded by The NHS Long Term Plan (launched in 2019) such as cutting obesity rates, preventing Type 2 Diabetes, and limiting alcohol-related A&E admissions.

The Horizontal Health Street would also expand out-of-hospital care and remove the divide between primary and community health services. It would ensure that people with learning difficulties get better support; provide outreach services to people experiencing homelessness, help people with severe mental illness find and keep a job, and improve the uptake of screening and early cancer diagnosis for people who currently miss out.

The Health Street can save the High Street and extend its offer to local populations, becoming a health destination as well as a retail and social venue. Parking is already provided, and high streets are well served by public transport making it easier than current access to many hospitals. The High Street is often the heart of a town/village and the Health Street will maintain and enhance this key element of the community bringing health into the most accessible area for the local people.

The current NHS plan has established Place Based Systems within regional Integrated Care Systems. This strategy promotes integration across the care spectrum and requires local Authorities and health services to work together, integrating teams and facilities to deliver population-specific needs. The horizontal Health Street can be the visible manifestation of this strategy by repurposing retail spaces as community hubs bringing together local services under a House of Care model. As more and more care is able to be delivered within the patient’s home or community, the Health Street can function as the resource, knowledge and help centre that supports this strategy, and bring local care to the fore: care that is highly visible, integrated, and accessible.

Our propositions are bold, but we know they can be done. In 2016, RSHP, Stantec and Jackie Churchward-Cardiff designed the award-winning Cancer Centre at Guy’s and St Thomas’ Hospital. The hospital comprises a stacked village, each with a distinct identity, relating to patient need or clinical function. By dividing the 14-storey building like this, the environment is more human and manageable. We also designed Maggie’s West London, the charity which provides free cancer support and information next door to Charing Cross hospital. The centre puts a domestic kitchen at its heart and openness is enhanced by the surrounding winter gardens, sitting rooms and more personal caring spaces. Natural light enters the whole building, vistas connect with the external landscape public space and trees wrap around the existing building, filtering out noise pollution.

Not only would the Vertical Hospital and the Horizontal Health Street, improve clinical outcomes and staff well-being, but they would also drive genuine integration with health and social care, providing the NHS with compelling economic benefits and, ultimately, better healthcare overall.