Design & Health Europe Aki Linden Ceo Hospital District of Helsinki and Uusimaa

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1 Design & Health Europe 2012 Aki Linden Ceo Hospital District of Helsinki and Uusimaa 1

2 Public health care Finland s model MunicipaliEes are responsible for arranging social services and primary health care for their inhabitants. They do it alone or joining together with several municipaliees or by purchasing some of the services from private sector. For special health care a municipality is obliged to be a member of a hospital district. Out of municipal health care expences in Finland special health care forms now 60 % and primary health care 40 %. 2

3 HUS Hospital Areas and Hospitals Hyvinkää Hospital Area HUS is a municipal federation owned by 26 Uusimaa area municipalities. Hospitals belonging to HUS number 21. Hanko Lohja Hospital Paloniemi Hospital Länsi-Uusimaa Hospital Area Lohja Hospital Area Raasepori Karjalohja Nummi- Pusula Hyvinkää Hospital Lohja Inkoo Karkkila Vihti Tammiharju Hospital Länsi-Uusimaa Hospital Kellokoski Hospital Hyvinkää Askola Nurmijärvi Järvenpää Pornainen Tuusula Kerava Porvoo Espoo Vantaa Kauniainen Siuntio Helsinki Kirkkonummi Jorvi Hospital HUCH Hospital Area Mäntsälä Sipoo Peijas Hospital HUCH Hospitals in the Helsinki Area Lapinjärvi Loviisa Porvoo Hospital Porvoo Hospital Area

4 Hospital districts and specialised areas of responsibility Finland has 20 hospital districts, which have been formed into five university hospital districts. Finland has 20 hospital districts, which have been formed into five university hospital districts. Number of separate hospitals (real estates) in special health care is about 70. OUH KUH HUCH Helsinki University Central Hospital KUH Kuopio University Hospital TAUH Tampere University Hospital TUH Turku University Hospital OUH Oulu University Hospital TUH TAUH HUCH l Helsinki l Kotka l Lappeenranta

5 Key indicators in HUS according to the 2011 accounts NordDRG products: 593,301 Treatment days: 249,173 (psychiatric, rehabilitaeon and respiratory paralysis paeents) Use of services in relaeon to PopulaEon in the area: more populaeon than 1.5 varies million significantly (+1% on 2010) between municipaliees. OutpaEent care visits: 1,567,593 Surgical operaeons: 92,027 Deliveries: 18,328 PaEents: 451,038 ( 2.2% increase on 2010) ElecEve referrals: 256,089 (60% of all referrals) PaEent beds: 3,106 Number of staff: 21,322 OperaEng income: EUR 1,674.9m OperaEng expenses and depreciaeon: EUR 1,678m Average contribueon by member municipaliees per inhabitant: EUR 861

6 Many of the Central Hospital buildings have already had their 50th or 60th anniversary The first hospital in Finland was on Seili Island (1619). The first county hospital was built in Turku in Carl Ludvig Engel s LapinlahE Hospital was completed in 1841; it served as a hospital of psychiatry unel the year Today our oldest hospital in use is the Surgical Hospital in Helsinki, from Between the years altogether 45 tuberculosis sanatoriums were built. One of them was Alvar Aalto s Paimio Sanatorium from were decades of founding and building of the central hospitals network in Finland. 6

7 Challenges in our old hospital facilices Unhappily these fine hospital faciliees are gegng not only old and weary, but tecnically they fit badly for today s and tomorrow s specialised care and its growing high tecnology that needs more and more space and higher storeys they are gegng unsafe in respect of fire safety, work safety etc. they were planned for yesterday s quiet and easy paeents and their expectaeons they were not planned for modern paeent processes or nowaday s severe infeceons 7

8 (more challenges) indoor air quality problems are growing hospital real estates are too small or too large; squeremetres are in wrong departments their locaeon is not opemal new energy efficiency demands and naeonal building code regulaeons are difficult and expensive to complete some of the hospital buildings are of high architectural heritage and they are officially protected as a part of our designed environment 8

9 How to finance A Finnish financial advisory Ltd INSPIRA recently collected a wide database concerning the coming investments of the hospital districts in Finland. The results show that Need for renovaeon is high and acute all over the country There is more and more interest in alternaeve models of designing, contraceng and financing the projects There is a rising interest in collaboraeon with other hospital districts: planning phase, technical innovaeons, models of financing and maintaining, how to esemate operaeng expenses and reduce them, tendering process etc. 9

10 Today in Finland most of the municipaliees and the hospital districts have no difficulees in financing their investments. The problems come with the yearly operaeng expences: Can we afford the growing costs. And how to compare and priorieze the pros and cons of building new hospitals or renovaeng the old ones in accordance with our share holders (poliecal decision makers). 10

11 Facility investments, years

12 Regional distribueon of the investments, years

13 Impact of the facility investments on the loans, years

14 Economic cycle of the construceon

15 Expences of construceng compared with operaeonal costs of the core services is low

16 Summary InvestoinEohjelma n miljoonaa euroa vuosina (13 vastannuka SHP:ä) Toiminnallisen tehokkuuden mahdollistavat säästöt voivat olla varovaisenkin arvion mukaan 10 % sairaanhoitopiirin ydintoiminnan kustannuksista = kymmeniä miljoonia euroja vuodessa yhden sairaanhoitopiirin tasolla = satoja miljoonia euroja vuodessa koko sairaanhoitopiirien kentässä InvestoinEohjelman toteukamiseen liikyvisestä osaamisesta on pulaa Yhteistyö on mahdollisuus haasteiden voikamiseen kustannustehokkuuden aikaansaamiseksi