By Nathaniel Hobbs, MJ Medical Director
With the pace of change in medical imaging modalities such as MRI and CT, the ability to gain very early diagnosis of a whole spectrum of medical conditions will soon be available to healthcare providers. This will see a rapid increase in preventative screening rather than therapeutic uses of medical imaging equipment. In turn, the acute hospital based imaging will become more specialised and acute hospitals will evolve into a last resort treatment site, with only the most critically ill patients being admitted. With the miniaturisation and mobility of technologies, many imaging and diagnostic modalities will be delivered through the primary care sector. Preventative screening and diagnostic analysis will be taken to the patient using hand held devices or delivered through community based “bed-less” ambulatory care centres. In June 2008 Lord Darzi published his report “High quality care for all: NHS Next Stage Review Final Report” which focused the agenda of moving acute services into the community and delivering the desired ‘care closer to home’. Although the outcome of the Darzi review had limited impact in real terms, the movement of modalities to more community based settings is an aspect which was already on a separate trajectory and, budget allowing, looks set to continue.
Movement of medical imaging services to different settings, such as the community, is testing the inherent flexibility and adaptability of the current NHS Estate and in tandem kick-starting an increase in the refurbishing/reusing of existing NHS facilities.
In the context of the rapid evolution of technology and the movement of services to new environments, the research investigates how the more complex medical imaging, diagnostic and treatment technologies are considered during the briefing phase of a healthcare project. It analyses if the methods, processes, guidance, tools and techniques used by NHS planning and design teams are sufficient to allow the built environment to meet the evolving needs of the NHS and emerging medical imaging technology.
The research considers if the planning skills and capabilities of the teams involved in such projects, perhaps for the first time in the case of many Clinical Commissioning Groups and former Primary Care Trusts, are also sufficient. The engagement of clinical users for such facilities is often cited as a key to the success of a project, but the research investigates if this is a sufficient substitute for any lack of capital planning skills and experience within the NHS.
The research investigates the role that rapid technology change has within the NHS capital investment process and appraises the impact of different construction procurement routes (PFI, Procure21 and LIFT) on the planning and future flexibility of medical imaging facilities.
A mixture of qualitative research methods have been used, including desktop research, literature reviews, case studies and semi structured interviews with leading design professionals.
The research identifies the significant impact of medical imaging and diagnostic technologies on the built environment, from day one of a new facility and through the life of the building. The technology in this area is outstripping architecture response and the ability of healthcare institutions to organise using it. Changing patterns of healthcare delivery, new technology screening techniques and Government policy will continue to influence patient pathways and the physical locations for medical imaging and diagnostics. The primary care estate will increasingly find itself delivering medical imaging screening and diagnosis procedures and the acute estate will become concentrated specialist centres using medical imaging for complex treatment and therapy.
The types of medical imaging technology will evolve with some more harmful radiodiagnostic imaging becoming obsolete and replaced with new advanced MRI and CT technology. New and existing estate will need to be able to adapt to accept changes in technology and encompass planning for equipment replacement with minimal service interruption. The cost consequence of not doing so is likely to be high, in terms of capital outlay, service interruption and a reduction in income for the healthcare provider.
The research has found a constantly evolving NHS structure which has led to the fragmentation or decay of specialist planning skills and experience. The tools, guidance and planning processes which NHS planners use are underpinned by a strong framework. But having a chronic lack of investment over the last decade, has left aspects of the guidance and planning data (particularly around medical imaging) ambiguous, backward focused and out of date.
The concept of pre-planned adaptable room design is identified as a solution to save the cost of change over the life of the building. The research identifies future flexible concepts such as the built environment, being a minimal “hub” with mobile medical imaging and diagnostic units plugging in as required. The concept introduces the idea of total flexibility, with old technologies unplugged and driven away and new technology plugged in with minimal service interruption and building work.
The construction procurement routes are seen as biased to the private sector. The onus is very much placed on the NHS to be an informed client and provide a detailed brief and future strategy to the design team. Whilst the research has identified this paradigm, it does not appear to have been specifically developed in clear guidance for NHS planning teams when planning facilities for medical imaging or equipment generally. Alterations to PFI and LIFT buildings are charged to the NHS Trust as a variation order which, in the case of rapidly changing technologies such as medical imaging, creates a perverse incentive for the private sector to make the building inflexible.
The research concludes that there is a clear need for an over-arching planning framework to inform and support NHS planning teams for medical imaging facility projects. The paper develops the planning framework to support decisions around design, future flexibility, technology change and obsolescence. The guidance is aimed at both the acute and primary care sectors in the planning considerations for preventative and therapeutic use of medical imaging and diagnostic technology.
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