Construction of the NIB-financed Bridge Hospital in Helsinki. The new building will ‘bridge’ two hospitals into one facility, bringing substantial efficiency gains through streamlining the treatment processes.

Construction of the NIB-financed Bridge Hospital in Helsinki. The new building will ‘bridge’ two hospitals into one facility, bringing substantial efficiency gains through streamlining the treatment processes.

28 May 2020

Looking for the silver lining: focus on Nordic sustainable healthcare

If there is a silver lining to the coronavirus pandemic, it is one that has increased focus on the accessibility and sustainability of healthcare services. In light of this, we look at some of the Nordic practices attempting to build and maintain sustainable health systems.

The coronavirus Covid-19 pandemic is the greatest global health crisis of our time.

In one way or another, it has and still is affecting us all; from those who merely had to move their workplace to their home, to those whose workplaces no longer exist due to the staggering economic effect on entire industries.

Even so, those most affected are the increasing number of families suffering the loss of their loved ones.

Unlike lockdown restrictions, this suffering might not be eased. But the pandemic has also given us lessons to learn in order to prevent, or at least limit, crises of such scale in the future.

Lessons learned

Although considered as having well-functioning healthcare systems, the outbreak took Nordic countries by surprise too.

“Despite national pandemic plans developed for the flu, the overall preparedness was rather low,” says Kjeld Møller Pedersen, Professor of Health Economics and Health Policy at University of Southern Denmark. “However, Covid-19 did not overwhelm the health systems in the Nordics in the sense that there was a sufficient number of ventilators which had been critical in many countries. It took some effort, but at no time was there an insufficient number vis-à-vis demand.”

Aaro Toivonen, Director of Security and Preparedness at the Hospital District of Helsinki and Uusimaa (HUS), comments that during the first wave of the pandemic the situation at Helsinki hospitals has been intense, but remained under control thanks to professionalism and devotion of its staff. He agrees, however, that there are already several important lessons learned.

“Firstly, the situation has reminded us that the healthcare system is an integral part of civil preparedness. Secondly, the weaknesses in the supply of the personal protective equipment has raised questions about the vulnerability of our logistic chains of supply. Thirdly, the Covid-19 pandemic has shown us again the importance of clear chains of leadership and management on the local, municipal and state level,” says Toivonen.

Need to respond to demographic change

These are all points to consider when building resilience to deal with similar crises in the future. At the same time, the Finnish healthcare system has to tackle other issues that came long before the current pandemic.

One of the primary challenges derives from its ongoing demographic change, which has seen the population in Finland age faster than in any other European country in recent years.

Currently, Finland has the third oldest society structure in the world, with more than a fifth of its population aged 65 and above. The European Commission estimates the percentage will continue to increase and one in every four Finns will belong to this age group already by 2030. According to another estimation by the OECD, Finland will be the only Nordic country to experience a sharp decline in the working age population during 2020-2060.

Such an outlook implies rising pressures on public finances — both from increased demand for health services as well as higher dependency on the working population. This remains a major challenge for Finland, and the new social welfare and healthcare (SOTE) reform has been at the centre of discussions for several years.

Alleviating challenges through hospital modernisation

NIB plays its part by providing financing to the country’s healthcare modernisation. Since 2016, the Bank has agreed more than EUR 500 million in loans for hospital infrastructure projects in Finland.

One example is the new Bridge Hospital in Helsinki. HUS’ largest construction project to date will bring two hospitals under one roof to synergize its different functions.

“The Bridge Hospital will be the National Trauma Centre after the functions of Töölö Hospital are moved there. The Trauma Centre is a key player in our system of medical preparedness and acute care. It will strengthen our system of Medical preparedness considerably’”, Toivonen comments on the scope of the project.

Other loans to hospitals in Vaasa, Rovaniemi, Jyväskylä or Kainuu are all expected to significantly curb healthcare costs in smaller regions, where problems related to ageing are even more challenging.

The willingness to invest in productivity improvements shows hope that increasing financial pressures can be alleviated. Most importantly, however, it also helps to ensure efficient treatment processes in the future.

As the Covid-19 pandemic has put some of the health services to a halt, an increased demand for treatment is expected in the coming years. According to Prof. Møller Pedersen, in Denmark, for instance, the backlog that has built up for elective surgery can persist into the first half of 2021.

Therefore, if investing in modern medical infrastructure was always amongst the priorities, no timing was better than now.

Shaping Stockholm’s leadership in life sciences

Sweden has seen plenty of such investments recently. A decade ago, it launched the Nordics’ first Public Private Partnership hospital project with the construction of the New Karolinska Hospital in Stockholm.

NIB took part in financing one of the world’s largest and most innovative healthcare projects, which is also one of the most environmentally advanced buildings in the region.

Earlier this year, Newsweek ranked the New Karolinska as the 10th most prominent hospital in the world (third in Europe and first in the Nordics). It was followed by Denmark’s Aarhus University Hospital, along with other health centres from Sweden, Denmark, Norway as well as HUS all making the list of the 50 world-leading health service providers.

Besides ensuring advanced healthcare, the New Karolinska Hospital paves the way for realising Stockholm’s vision of making the Swedish capital the world's leading region in life sciences.

Over the last few years, NIB also financed the constructions of “Patienten”, “Forskaren” and “Life City” — all in close proximity to the New Karolinska Hospital and the Karolinska Institutet medical university. These green buildings will house professionals working within the health sector, and are aimed to increase collaboration between academia, industry and society.

The development of such a business cluster is expected to strengthen Stockholm’s image as an attractive location for research and entrepreneurship as well as to further improve the city’s competitiveness in the area of life science.

Holistic approach on sustainability

When developing these projects, the health of the environment has also been taken into consideration.

Energy consumption at the New Karolinska is limited to almost climate-neutral levels. The hospital as well as the cluster’s NIB-financed offices have all been certified according to green building standards such as LEED, BREEAM and Miljöbyggnad for their environmental performance.

The WHO estimates that health services are responsible for some 5%-15% of carbon emissions in developed countries, and the focus on environmental buildings has been clearly visible in health sectors across the Nordics.

The Nordic Centre for Sustainable Healthcare talks about this shift in their recent white paper.

For instance, all hospitals in Norway are certified in the environmental management system ISO 1400114. Denmark’s new North Zealand Hospital will maintain top performance in economic, social and environmental aspects while also delivering 8% savings due to its efficiency. Sweden’s Skaraborg Hospital’s climate impact will be reduced by installing solar cells, which will also produce 1.3 GWh of solar electricity each year.

Yet sustainable healthcare buildings are not just about economic or environmental outcomes.

Various studies suggest that sustainable hospital environments can also have a positive effect on healing. The World Resources Institute agrees, saying that energy efficient buildings contribute to better indoor and outdoor air quality through reduced pollution and improved ventilation, leading to health and economic benefits.

Sustainable healthcare encompasses products, services and operations with superior environmental performance — without compromising the quality level of the care itself.

Therefore, as we are learning from the Covid-19 crisis while also increasingly looking at climate opportunities, perhaps these two approaches can be combined. If anything, the examples of Nordic sustainable healthcare solutions provide us with some guidance to follow.