Making the most of NHS estate

Source: NHE May/Jun 17

Clive Shore, acting executive director (partnering) of Community Health Partnerships (CHP), explains how the organisation’s expert facilitation can transform estate for local health economies, without laying a single brick. 

Last autumn, England’s oldest hospital – St Bartholomew’s in Rochester – closed. No new building replaced it. Yet the local paper reported not a single protest. Why? Because everyone accepted the move: local people, commissioners and providers. The plan, which CHP helped broker, gave them all what they needed – better care delivered from higher-quality, more modern infrastructure at lower cost to the health and social care system. 

Identifying the deficiencies at St Bartholomew’s – an ageing inpatient community hospital with significant backlog maintenance and capital investment requirements – was straightforward. More challenging for its owners, NHS Property Services (NHSPS), and CHP as facilitator, was securing a win-win solution – one redistributing inpatient and community services to fit-for-purpose estate, enhancing patient pathways and supporting the sustainability and transformation plan’s new models of care. The prize is capital receipts that can be reinvested in a modern NHS, the chance to build new homes on the site, plus lower annual estates costs, as well as significantly reduced backlog maintenance liabilities. 

CHP’s reputation was built by creating some of the NHS’s most innovative community estate through LIFT. Our fresh extended mission, working closely with NHSPS, is to innovate around utilisation and optimisation of NHS estate. To meet the St Bartholomew’s challenge, we offered our new strategic estates advisory service to Medway’s stakeholders as they planned their local health economy’s future. This service is now available to all CCGs across England via CHP and NHSPS. 

We identified early funding to explore feasible options, then provided facilitation for discussions and injected our expertise in clinical service planning, estate strategy and operational estate efficiency to find and implement a win-win solution. It was a great collaboration including Medway CCG, Medway Community Healthcare and the council, engaging staff, public and other stakeholders. As a result, services from St Bartholomew’s were successfully redistributed across existing healthy living centres – which had unused space – and other health and social care buildings locally without any loss of service quality. We’d helped engineer a whole-system solution that didn’t require costly new buildings. 

Master plan for North Manchester General 

Meanwhile, we’re helping to develop a master plan for North Manchester General, working across acute and community services and with Manchester City Council, to use the site for enhancing the area as well as health services. This broader approach doesn’t always happen. Planners sometimes over-focus on the hospital’s needs, not thinking enough about the place and the communities in which it sits. The Manchester project team likewise includes leaders from hospital services, the CCG, the local authority, CHP staff and experts that CHP brings in. 

“This is the first time,” explained Neil Grice, CHP’s area director, who facilitates the process, “that we’ve seen a process for a properly joined-up master plan for such reconfiguration, taking account of local people, health and community services, social care and local authority services.” 

Across England, we’re responding to NHS organisations asking us for an advisory service that plugs their skills gap around development, investment and asset management. They want it rooted in NHS values, providing a critical friend to them locally, bringing national learning to work effectively on complex issues with the private sector, local partners, the Department of Health (DH) and NHS England. 

As innovators in estate usage and planning, we’ve established a dedicated Centre Management Service to assume overall operational responsibility for the management of buildings, providing a single point of contact for our tenants, commissioners, clients and local authorities. The service can assist commissioners to fill void space, drive utilisation, secure greater community engagement and ensure that buildings are used optimally, for example by opening for longer hours. 

Recently, we launched the first web-enabled system which details the availability and price of hiring rooms in our buildings and will reserve, allocate and invoice bookings. Hopefully, more of our health centres will, in future, mirror the community engagement found in some CHP projects such as at Kentish Town Health Centre, a north London LIFT building, host to nearly 100 art exhibitions since 2010. 

Our approach in Medway, North Manchester and elsewhere highlights that building afresh is often unnecessary. But sometimes it is needed. We’re also developing, for the DH, a new public private partnership model – Phoenix – available to all local health systems in England. Subject to business approval confirmation, procurement is expected to begin this year. Then, we’ll have a full set of keys needed to unlock infrastructure to support the Five Year Forward View’s vision of transformed NHS service delivery and efficiency. We ask local health economy leaders to step forward and commit with us to a new spirit of co-operation around infrastructural change in their areas.

For more information


Image: © Clem Rutter

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