Last month Building Better Healthcare revealed the results of research from built asset consultancy, EC Harris, which accused the NHS of being short-sighted when it comes to addressing the problem of disused and underutilised estate, which is currently estimated to be equivalent in size to London’s Hyde Park. In this article, PETER WEARMOUTH, director of Capita Symonds’ health team, looks closer at the challenge facing NHS estates professionals
The need for investment, innovation and transformation capability within, and for, the NHS in delivering solutions for property and technology has never been greater. Changing lifestyles, the rise in consumerism, and increased spending on the NHS have previously developed high expectations from local communities for clinical services. Today, QIPP targets and patient experience in tandem with the longer-term reconfiguration to meet demographic change are setting significant challenges.
The challenge will be delivering new clinical pathways and service reconfiguration underpinned, but not led, by property solutions
A recent report from EC Harris entitled Delivering Better Healthcare Outcomes More Efficiently 1 contended that the NHS is ‘short-sighted’ with regards to its property estate and that poor innovation and a lack of experienced personnel with technical understanding and the ability to deliver major projects is costing billions in lost revenue and missed opportunities.
But this is an over simplification of the complex nature of health and social care. The fundamental reason for the property portfolio is to support frontline care and deliver affordable working and healing environments. The challenge will be delivering new clinical pathways and service reconfiguration underpinned, but not led, by property solutions.
There are already many commissioners and trusts taking forward progressive and innovative approaches that will result in major structural change. The health property portfolio and facilities management services need to be planned and delivered to meet the basic care needs of patients by providing a safe, secure and warm environment for care while meeting fundamental standards. The way forward is to release cash savings through a balance of operational cost efficiencies, estate modernisation, regenerating surplus assets, and maximising income potential for core estate - not by simple salami slicing which will result in problems downstream.
The role of NHS estate professionals, and those who support the NHS - including The NHS Property Company - in delivering a fit-for-purpose infrastructure in the right place and at the right cost, is to take up the challenge by offering innovative commercial solutions that are affordable and support change. For example, in Staffordshire the responsibility for social care moving to an NHS trust provider offers innovative opportunities for better use of resources.
Many NHS trusts are also seeking collaboration with other trusts and partners to establish long-term strategic estates partnerships to deliver improvement programmes resulting in significant cash releasing savings. For example, trusts and CCGs are coming together in Leicestershire and Rutland, working in a commercial partnership with Interserve and Capita to regenerate and configure their estate. This programme will achieve considerable efficiency savings across the trusts that is available to be ploughed back into investing in new facilities and frontline services.
The way forward is to release cash savings through a balance of operational cost efficiencies, estate modernisation, regenerating surplus assets, and maximising income potential for core estate - not by simple salami slicing which will result in problems downstream
Trusts and CCGs will need to find new partnerships and funding routes to meet the scale and time for challenge. This is already gaining momentum in many trusts with the Government’s new approach to public private partnerships presenting a major opportunity as it will enable foundation trusts access to the capital markets and provide deleveraged capital structures facilitated by a commercial partner which will deliver the strategic estates partnership and, combined with better risk allocation, will allow greater access to institutional investor capital.
With emphasis on moving care within or closer to home, of hospital closures and local decision making, the old ways of looking at the NHS estate are rapidly becoming redundant and out of tune with a changing NHS landscape. Decisions will be need to be based on local need and solutions found that support local clinical decisionmaking. The balance between cost and value in delivering local clinical solutions must be one overriding factor - not all property solutions will be cost effective, but value for money in delivering clinical services.
The ECH report also calls for ‘benchmarking those best-performing trusts in all asset forms, from hospital throughput to clinical safety to hard and soft FM alongside management performance to ensure effective delivery – the so-called whole life/holistic model’. But as far back as August 2010, Peter Sellars of the Department of Health’s Estates and Facilities Policy Division was saying just this – and making it happen through the introduction of the Department’s Premises Assurance Model (PAM), which gives trust boards ‘important productivity and quality information integrated with their core business objectives’.
The challenge will be to deliver NHS care in a range of settings, not all will be in NHS ownership and many will be more community based. At the other end of the spectrum complex acute care will need hospitals that are technologically complex and have a catchment area and scale to meet the challenges of clinical excellence and affordability. There will be a need to benchmark and test for value, but while this major programme of change is underway a number of providers will have double running costs and PAM will be key to ensuring value for money.
The NHS landscape is about to undergo major change and it will be for all of us to rise to this challenge.
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