Infrastructure decisions

A long time ago I worked with a local authority on a planning problem.  It was my first foray into problems of long range planning of that nature, and I had a great deal to learn.  I came away with several lessons for my teaching, and an increased awareness of how the infrastructure of a town is interconnected.

That episode was concerned with the development of a primary school to serve a large new housing development.  The simple question was how large to make the school.  But, it is relatively easy to decide on the ultimate size of a school, given a catchment for its pupils, but it makes sense to have a smaller school initially, and expand later.  At one stage we had a three-by-three matrix, with three sizes of school, and three scenarios for the demand in the first phase of the housing development.  Each of the nine cells had practical and political consequences.  It was a useful tool for thinking with.  To make the planning more complex, the estimated time for planning and constructing a school was about four to five years.  So, one might estimate the demand from the number of children on the estate ... except that families with pre-school children are (or were then) extremely mobile between houses.  So many of the children in the estate in year 0 will not be there in year 4 or 5. 

My home city of Exeter, and the county of Devon, are facing a similar problem, but one which is potentially more serious.  It is concerned with the provision of hospital facilities.  We have one large general hospital in the city.  (As an aside, the estate agent's publicity for the house where we live stated that it was "convenient for schools and hospitals".  The second comment was intended to encourage staff from the hospitals, and was not aimed at hypochondriacs or the long-term ill.  As it happens, we have one hospital consultant living close to us, and two more former consultants as well.)  It was built in the 1990s to serve the population of the city and the country around.  The problem now is that the population in and close to Exeter is set to rise with new houses, new estates, and a new town (Cranbrook), a few miles outside Exeter in the hospital catchment.  And as the population grows, so does the need for hospital facilities.  Already there are cases of "bed-blocking" when patients cannot be admitted because the wards are full.

So, what can be done?  There is not much scope for expanding the hospital on its present site.  There is scope for changing the regime of hospital treatment, and this is already happening.  Some patients can be discharged to smaller hospitals which specialise in post-operative care, but the expectation is that there will be increasing problems of capacity in the existing hospital.  And this is a situation which is repeated in several parts of the county, with four large general hospitals (Exeter, Plymouth, Torquay and North Devon).  There is a limit to how much the demand can be handled by changes to the regime.  There's no fifth large conurbation where a hospital could be sensibly placed. 

As an O.R. person, it is interesting to see how hospital management has considered decisions relating to the wider system, and not simply the capacity of the building.  The medical services work to reduce the need for patients to spend time in hospital (recalling the worrying statistics about how many patients catch diseases while in a ward overnight), carefully schedule the patients who can be scheduled, plan operations and the recovery afterwards.  O.R. people should always be encouraged to think of the whole system - it is not a problem of capacity alone.  The discussion that I have seen has not broached the possibility of building a new hospital yet.  I wonder how long it will be before this happens?

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