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04.10.17

The next generation of estate partnerships

Source: NHE Sep/Oct 17

Graham Spence, commercial director at Community Health Partnerships (CHP), examines how public-private partnerships (PPPs) could allow areas to rethink and redesign their estate.

We face an important and urgent question: how will the NHS and local authorities ensure services can be provided locally in the best facilities, which are efficient, local and are not hospital-based? 

Our solution must deliver buildings that are fit for purpose – that enable, rather than prevent, new cost-effective models of care. It also has to reflect public sector financial constraints, and offer environmental sustainability and flexibility to facilitate whichever models of service emerge in the future. 

So we’ll need a thrifty approach, making the best of existing estate. We must harness the full potential of taxpayers’ scarce pounds to refurbish what we have and – only when absolutely necessary – to develop new estate, possibly by leveraging funding from other sources. 

Two recent reports sketched the scale and urgency of this task. It would cost £10bn – some from beyond the public purse – to address NHS backlog maintenance and develop estate to realise the Five Year Forward View, said Sir Robert Naylor’s recent report, ‘NHS Property and Estates’. 

Lord Carter’s 2016 review of NHS productivity highlighted the urgency. It concluded that rethinking estate is vital to improve NHS efficiency and ensure that clinical expenditure can achieve more in the delivery of patient services. 

The LIFT programme 

Where should we look for inspiration? It’s worth recalling what’s been achieved by PPPs over the past two decades, notably by the NHS Local Improvement Finance Trust (LIFT) programme, used already by health and local authorities to modernise large parts of their estate portfolio. 

Since 2000, LIFT, overseen by CHP, has brought the largest, most concentrated investment by the NHS and private sector into primary care and community health estate: £2.5bn of capital development, raised from just £100m of public sector investment.   

When you find the best in NHS and local authority joint estate, it’s probably been developed by LIFT. That includes more than 50 health centres which integrate NHS, community and local authority services, many including swimming pools, gyms and libraries. They are great places to work and receive services.  

Typically built in areas of highest need, these developments are often vital for people who may have difficult lives. A dozen community hospitals have also been developed thanks to the LIFT programme. 

LIFT has had its critics. Some said it proved expensive compared to developments where maintenance costs were not locked in and were seen as a discretionary spend. But that’s precisely why these facilities are lasting so well and proving their worth now, with no backlog maintenance. They are as good as when first built, available for today’s shift to primary and community-based services. 

Others say some LIFT buildings have been underused. In reality, under-utilisation has been an issue across sections of the NHS estate. It reflects how services are commissioned, rather than how estate has been developed. Nevertheless, we’ve thought hard at CHP about how to shift service delivery from older, less efficient estate to newer, more productive buildings. 

That’s working well: better health centre management, electronic booking systems and simplified rental processes are leading local providers to shift services into the best available, most cost-effective estate. 

The local relationships and the strategic planning capacities that underpin the 49 LIFT companies – all still robust and working – have also helped development of Strategic Estate Plans, bespoke approaches for mixing old with new to meet local needs. These plans mean that the NHS, working with local authorities through the One Public Estate programme, could now embark wisely and speedily on ambitious infrastructure investments to transform their services. 

An updated PPP, inspired by LIFT, could allow local areas to rethink, reconfigure or refurbish existing infrastructure and, where necessary, deliver new buildings. Its design could reflect our learning on maximising utilisation and cost-effectiveness, while delivering best-in-class environments for transformed services. That’s why CHP has been asked to develop the next generation of PPPs.

FOR MORE INFORMATION

W: www.communityhealthpartnerships.co.uk

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