Health services provision
How will cities provide health services in 20 years’ time? Living in a city can have a number of benefits for its residents. For example, it affords better access to healthcare and emergency healthcare services and city dwellers are less likely to be obese, commit suicide or die in an accident. However, while urban populations are usually healthier than their rural living neighbours, these benefits are not evenly distributed, and (as we write elsewhere) the urban poor typically experience more health disadvantages.
The Government’s Future of Cities programme looked at some of the big changes which city healthcare has undergone in the last few decades. Some notable findings include:
- People are more demanding of their healthcare services, with wider choice, more information and higher participation in decision making
- Services have become more specialised over time and provision is more personalised. New services, for example around mental health, have been developed
- Increases in longevity and a low birth rate have (relatively speaking) increased the proportion of older people accessing health services
- Private provision of healthcare services has grown alongside growing affluence in the UK population
- Technology has improved the quality of diagnosis and treatment, but also given people more control over their own health data.
It seems plausible to suggest that most of these trends will continue into the future. For example, the creation of the movement-sensitive, location-tracking smart phone has enabled a plethora of health-related apps to promote fitness or healthy eating outcomes. New online services like Babylon are driving disruption in health services through the provision of online GP consultations, and NESTA have suggested it’s only a matter of time before the tech giants move into healthcare too.
Other forces of change also seem structural. Increases in longevity seem unlikely to be thrown into reverse. And as some infections are brought under control, new infections present new threats (we write elsewhere about superbugs).
How will cities respond? Extensive research has been done to explore how cities can best manage and improve their health outcomes in future, which shows that a vast range of factors can influence these outcomes. But some specific trends are worth considering:
- With an increasing amount of credible and trusted data online, and a more educated population, city dwellers seem less likely to use their GP for advice, but are more likely to want quicker access to final diagnosis and treatment options
- City centre workers will routinely opt for walk-in clinics which fit in around their work, perhaps bringing with them their blockchain-secured health records on personal mobile devices
- As the traditional high street evolves, GP clinics might be found much more often on the high street, perhaps co-located with other services in polyclinics that are open 24/7 and boast integrated gyms – in line with the growth in fitness culture, there are now more than 7,000 gyms operating in the UK (Figure 1)
- Specialisation of healthcare services seems likely to continue, with world-class facilities in our main cities continuing to be associated with universities, driving economic benefits from the clustering of life sciences activity. The newest treatments are most likely to be available in the biggest and best-funded clusters
- We might see more active promotion of health tourism by our cities, alongside a growth in tourism more generally (see our views elsewhere), as new charges for overseas visitors come into force.
Figure 1: State of UK gym industry, 2018
Source: LeisureDB 2018
There’s also going to be a change in the way in which cities plan and deliver health services. Manchester’s new mayor has been given control of the city’s health and social care budget, an unusual provision which most other cities and their new mayors lack. This could cause Manchester to pioneer different forms of healthcare provision. Arguably it has already led to London’s mayor to also call for more powers to better integrate healthcare across the Capital and tackle health inequalities.
So, by 2040, cities will hope to have delivered on current aspirations for personalised, on-demand, conveniently located, and data-savvy healthcare that is integrated with fitness and leisure facilities and driven by a wider variety of providers – thus giving more choice to the end consumer. This should lead to healthier citizens. The big question is whether the NHS budget will be able to keep up.