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Significant policy and operation changes in the healthcare sector

The past decade can be characterized by the rapidity, diversity and unpredictability of change within the health sector, in particular acute care. Across Europe there is evidence of change which despite differences in the structures of health systems appear to be strongly convergent. In the context of capital planning two distinct trends are emerging. First a shift from centralisation to greater local control and flexibility; second a move on from bed-based normative planning to a more integrated and responsive system which looks towards care (disease) pathways as the principal planning influence. What has been exposed by this comparatively sudden change in outlook is the tendency for capital investment over recent decades to have become dominated by an emphasis on the short-term tactical positioning of capital assets.  Many if not most health systems have been caught out by these unexpected shifts and are finding that the capital asset models employed look increasingly out of step with the future longer-term needs of the services they house and the workforce they accommodate. Unfortunately these are the models that are currently dominating the 2007/13 SF spending programme.

There tends to be general agreement on what can be described as the mega trends in healthcare, and which are likely to dominate policies and priorities in the coming decades, they are:


  • Demographic and epidemiological trends....READ MORE

  • The explosion in new clinical and ICT technologies...READ MORE

  • Patient safety and quality, including greater transparency in clinical outcomes...READ MORE

  • The need for economic sustainability within the health sector...READ MORE


In every case contemporary evidence demonstrates that overarching masterplanning, such as disease based (pathway) models of care, provide the best means of reconfiguring services and investment to tackle these challenges. Evidence also demonstrates that a whole systems integrated approach to investment is the best way to prioritise and invest resources within a masterplanning framework, for example an inclusive strategy which combines eHealth and capital reconfiguration strategies. SF processes however tend to favour stand-alone discrete projects as opposed to integrated portfolio spending plans. Furthermore measuring the impact of capital investment continues to remain a problem. Nolte E, 2007, in an extensive literature review of patient quality and care outcomes noted that almost all assessments are based on degree of compliance with treatment and care process. Furthermore capital asset contribution (in terms of health outcomes and health impact assessment) is rarely mentioned. This poses questions about how to assess future prioritisation of capital proposals for SF and additionally comparative assessment of benefit as between capital, eHealth and other spending submissions.


Mention should be made here of a WHO (2008b) report which highlights 4 criteria by which the right to health (health equality) can be evaluated – investing in the right type of capital and the balance between capital and other investment opportunities is implicit in supporting all four dimensions:


  • Availability. Functioning public health and health facilities, goods and services, as well as programmes, have to be available in sufficient quantity.

  • Accessibility. Health facilities, goods and services have to be accessible to everyone without discrimination, within the jurisdiction of the State party. Accessibility has four overlapping dimensions:

  • Acceptability. All health facilities, goods and services must be respectful of medical ethics and culturally appropriate, sensitive to gender and life-cycle requirements, as well as being designed to respect confidentiality and improve the health status of those concerned.

  • Quality. Health facilities, goods and services must be scientifically and medically appropriate and of good quality.




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