Why technology should influence your estate plans

Retailers such as House of Fraser and Debenhams know only too well the power technology has to bring about change. As online shopping has grown, many high-street shops have closed, with large distribution warehouses springing up to support online retailers.

The consequences of these changes have been significant; for some they have meant the end of a business, for others they have facilitated a start.

While we’re not expecting to see this type of change in the NHS, it’s clear that technology will play an important role in transforming health and care too.

Some of the long-term plan’s most ambitious commitments – including a reduction in outpatient appointments and ‘digital first primary care’ – are reliant on technology to shift activity from physical to digital space.

While the plan pays less attention to the NHS estate, it highlights opportunities for improving productivity, contributing to efforts to return the NHS to a more sustainable footing.

Both areas, then, are recognised as important enablers for change – as they have been in previous policies and reviews. So, why have they so often operated in silos?

Little research has been done to understand how technology and the estate interact or how developments in one area affect the other. This was the starting point for research conducted by The King’s Fund, supported by NHS Property Services, set out in our new report, Clicks and Mortar: technology and the NHS estate.

We wanted to understand how technology is affecting the NHS estate and to identify the opportunities that might come from planning these areas together in future. Of course, this leads to another question; how will we realise these opportunities?

Technology and estate

Technology is already supporting the delivery of NHS policy ambitions such as the delivery of care closer to home, and improved access to services. Examples highlighted by our research include the use of telephone consultations and self check in kiosks in hospitals.

We found that these changes are affecting the estate in different ways, for example, changing the balance between clinical and non-clinical space, or the way that waiting areas are configured.

So far, however, innovation has been patchy. It’s well known that the NHS is both an adopter of cutting-edge technology and, in many places, reliant on fax machines.

In future, the estate is likely to be more integrated, with technology supporting the sharing of information and expertise between services and sites

But our research suggests that, were this innovation embraced across the system, the estate of the future could look very different. We envisage a “smarter” estate that makes use of data to both improve the running of the estate in real time, and to inform long-term planning.

In future, the estate is likely to be more integrated, with technology supporting the sharing of information and expertise between services and sites. It will also aid strategic planning across health and care organisations and has the potential to support collaboration with those outside of health and care.

An important question for our research was, will the NHS estate of the future be smaller? Of course, in many sectors, the opportunity to rationalise the estate was an important driver for technological change – think online banking.

We concluded that while technological developments in the NHS may free up space, for example by releasing areas used to store paper records, in practice this space is likely to be put to other uses. Growing demand for services also means that an overall reduction in the estate seems unlikely.

Benefits both staff and patients

Most importantly, we see the estate of the future as one that benefits staff and patients. Technology has the potential to support more flexible ways of working, for example by providing staff with remote access to patient information.

For patients, technology opens up new ways of accessing clinical advice, including through online consultations. Technology can also support remote monitoring of patients, such as through remote devices, supporting people to be independent in their homes for longer.

The world of tech is awash with good ideas. Often the real challenge is how to put them into practice.

Our research found that the ability of NHS organisations to embrace technology – and for the NHS estate to respond to these changes – depends on many factors. For example, access to the right skills, both strategic and technical, is fundamental.

Although technology increasingly requires revenue investment, access to capital is also necessary if NHS organisations are to make the most of technological advances and develop the estate – an issue which many are looking to the government’s planned spending review to address.

For the future estate to truly benefit staff and patients, we must add meaningful engagement to this list

Building flexibility into the estate will also be key, so that it can adapt to changes in technology over time. Some of these require action from individual organisations, but others highlight an important role for systems and national bodies.

For the future estate to truly benefit staff and patients, we must add meaningful engagement to this list. Only by engaging widely on the design and development of changes will they properly meet the needs of the staff who will be working with them, and the patients whose care is affected.

Of course, this goes for any efforts to improve health and care and reminds us that changes in technology and the estate are not ends in themselves, but enablers for wider change. This underlines a key message from our research; to get the most out of technology and the estate, it is critical that they are not treated as silos.

Instead, organisations and systems must develop an overall vision for change in health and care and be clear about the important role that technology and the estate can play in delivering it.