Interview of the month: Claude Rolland
Claude Rolland, Manager of Bouygues Construction Health Department, describes the care pathway of tomorrow and presents Bouygues Construction’s vision for health facilities of the future.
In tomorrow’s world, what will the main epidemiological patient profiles be ?
Today in France, 13 million individuals are affected by long-term disorders (LTD), illnesses such as diabetes that require long-term care and particularly costly treatment. According to projections, this figure could double by 2025-2030 due to the growth and ageing of the population.
Illnesses linked to the ageing population will also increase. In 2050, one in three people will be aged over 60 years old, compared to one in five currently. The peak increase in the number of senior citizens will be around 2030, as an effect of the baby-boomer generation. We are entering into a society of longevity.
What solutions have been thought up to pre-empt this increase in the number of patients ?
Today France has two times more hospitals per inhabitant than the average OECD country. The hospital has become a common place on the care pathway. However, in 80% of cases, medical and care treatment needs relate to everyday actions which do not require reliance on a technical hospital platform. In the future, in the context of a boom in patients, what sense is there in maintaining a system which is already at bursting point?
Several solutions are already envisaged, including efforts based on illness prevention, financing health facilities according to results with the famous price per activity (Ed.: allocating resources based on the nature and volume of a facility’s activities) or even developing ambulatory care activity, which would mean medically treating a patient over the course of a few hours maximum, without an overnight stay. There is a double benefit to ambulatory care: freeing up medical beds and enabling the patient to lead a normal life.
What is Bouygues Construction’s position on the subject ?
For several years, Bouygues Construction has taken part in the design and construction operations for healthcare facilities. This type of project requires you to increase your expertise and become true specialists, capable of designing healthcare buildings adapted to the needs of its users, and in particular to those of the healthcare staff and the patients.
To do this, we launched a collaborative and prospective reflection in 2015 with a panel of professionals from the medical sector to think about the care pathway of tomorrow. What developments are there in medicine, medical technologies, care and patients? What type of healthcare facilities will we need in 10 or 15 years? How can we best set up these facilities in an area? The analysis of these trends led to the emergence of a four-tiered care pathway, shared between home (for monitoring and surveying the patients), the primary care centre (for routine medical needs and prevention activities), the hospital (for surgery, emergencies and certain specialised consultations), and the university hospital (for rare diseases or those requiring advanced equipment).
In your opinion, the primary care centre would become the gateway to the healthcare system for patients. How does this model work and what are its advantages ?
These centres take the form of care homes, covering 80% of healthcare needs for an area of 20,000-25,000 inhabitants: a territorial anchorage which guarantees proximity to patients. Multidisciplinary care of patients is the other strong point of this model. In fact, all medical professions are represented in the care home: nurses, doctors, physiotherapists, podiatrists, dentists, nutritionists and social workers. This is a way to share knowledge of the patient, skills and supporting functions. Additionally, these facilities can also be equipped with a test centre for biology, and ultrasound scanner and a pharmacy.
This model knows great success in the United Kingdom and in Catalonia. By building a care home for every 20,000 inhabitants and by increasing the technical nature of hospitals, while decreasing their number, Catalonia has succeeded in maintaining an identical care quality and health level to that of France, for three times less money.
In order to support the development of this model in France, Bouygues Construction has devised a care home concept, which has been approved by the Fédération des Maisons de Santé and the Syndicat des Médecins Généralistes, and is ready to be rolled out.