The delivery of healthcare tends to be neglected in much of the policy discussion despite its crucial role in determining many important health outcomes. Our new book, The Changing Role of the Hospital in European Health Systems, published by Cambridge University Press for the European Observatory on Health Systems and Policies, follows up earlier work looking at the future of hospitals. Rather than looking at hospitals as institutions, we focused on key areas of hospital activity, and asked experts to look at the current and future states of their specialty or disease area. This was before the pandemic, but in most cases this will have had the effect of accelerating previous trends rather than changing the direction. A number of common themes emerged.
Firstly, the impact of new technologies will be profound. Information technology will improve the safety and efficiency of care, while telemedicine and other communications technology will allow treatment at a distance and the creation of virtual teams. During the pandemic, the potential to provide a significant amount of hospital outpatient and home care by telephone, video or other uses of information technology has been demonstrated to an extent that makes a return to previous ways of working unlikely.
Artificial intelligence is clearly going to be important – especially in image recognition – but is generally seen as a support rather than a replacement for specialists. Imaging, laboratory and monitoring technology have driven many changes in practice in the past and this will continue, often with implications beyond the individual specialty. For example, the growth of interventional radiology has profound implications for the treatment of stroke, for the work of surgeons, and opens up the prospect of being able to treat patients who would not previously have been able to survive an operation.
The growth of multimorbidity and the increasing age and complexity of patients is another important theme. Patients do not neatly fit into the disciplines of medicine, which means that more multidisciplinary team working is required. It also seems to suggest that the move away from generalism in hospital medicine needs to be corrected, and that in future more geriatricians (specialists in the holistic care of older people) and general physicians will be needed.
These changes in the nature of patients have implications for primary care as well. The specialties that are particularly concerned with the management of chronic diseases will need to develop new ways of working that go beyond the traditional model based on gatekeeping and referral.
In response to these and other opportunities and challenges, there are a number of important implications for policy and practice:
• More needs to be done to evaluate changes in hospital care and assess the effectiveness of the models that are developed
• The changing nature of the workforce required to support many of the new models needs to be better understood and managed more strategically
• Hospitals need to think much more about how they fit into both their local systems of care and the wider economy in which they sit, especially given their importance as employees and purchases of local goods and services.
• The learning from the pandemic about the importance of connectivity and the opportunity to move more care away from face-to-face encounters needs to be capitalised upon.
Hospitals will continue to change rapidly and in some cases radically, and the increased centralisation of some specialised services, the growth of groups of hospitals and other major shifts in patterns of care will require more flexibility in the design of buildings and use of the workforce. It will also be vital for there to be a better dialogue with the public and politicians about the reasons for and advantages of change.