Health Service Focus

02.03.17

Capital investment critical to help weather the storm

Peter WardWriting on behalf of NHS Providers, Peter Ward, director of healthcare projects at John Laing, explains why trusts need a new approach to get the best value from their assets.

Our NHS providers are sailing into a perfect storm. Increasing volume and complexity of demand has not been matched by the money available, and there has been almost no capital investment over the last decade. After long careers, some of our most experienced leaders have left the bridge, taking with them knowledge gleaned from previous economic cycles. And as if that weren’t enough, parts of the health and social care system that have helped manage demand in the past have stopped working or can’t keep pace, and the supply of professional staff is diminishing even if the money is available to recruit them. 

Despite the gloomy outlook, there are flickers of light. One is the storm itself: the government recognises the need for change, and is concerned that it won’t happen at the necessary scale and pace. The second is historically low borrowing rates, and a wall of institutional funding seeking sustainable investment in infrastructure that could help transform the way services are delivered.  The third is that the status quo is not giving patients the best quality of care, even if it is outstanding in parts. If providers can use this goodwill and good credit to focus on improving care quality, they will garner public support for measures to join up fragmented services that will ultimately cost less. 

As William Edwards Denning, who led the reconstruction of the Japanese economy following World War Two, said: “Innovation comes from the producer – not from the customer”.  As the ‘producers’, our providers will need to prepare by: 

  • Acknowledging that things can’t continue as they are, and taking a system-wide view of the need for change
  • Building a culture of innovation and support for change amongst staff and partner organisations
  • Taking specific, visible and immediate measures to invest in people and services, to demonstrate that change is actually happening 

Infrastructure investment 

Physical infrastructure – whether it is new buildings, IT systems or equipment – can help transform the way staff work and care for patients, and make clear that things will be different in future. 

For example, the central and systematic management of resources to maximise throughput is often used in airports, power networks and in other complex logistical environments. In our hospitals it is often managed in a much more ad hoc and piecemeal way. It doesn’t have to be this way: investment in real-time asset tracking has transformed the way hospitals manage patient flow and use medical equipment and staff resources in US hospitals over the last decade.  

As well as investing to improve productivity, trusts will also need to get the best value from their assets. In the past, one common response to a financial shortfall has been the sale of land or other assets for non-recurrent capital. The effect of that approach is to lose control of assets that could help solve operational problems, and, of course, it can only be done once. Rather than selling land, trusts could use partnerships to develop extra care and key worker housing which they let at affordable rents to help solve problems with delayed transfers of care and staff retention, and generate revenue income in the process. Alternatively, they could develop facilities that complement their services and create revenue income such as hotels, rehabilitation centres, diagnostic facilities or care homes operated by their partners or third parties. 

Three key factors, then, will improve the chances of success in sustainably transforming our NHS: 

  • Be brave: We should be ambitious in our thinking, practical in our objectives, clear in our measures of success and ready to implement ideas quickly, to avoid ‘project fatigue’ amongst our staff, partners and investors
  • Believe in ourselves: Providers know the kind of partners they need to deliver transformational change. To deliver this change we should maintain faith in our own knowledge, expertise and systems of governance, rather than always falling back on a culture of exhaustive consultation with government and other national stakeholders
  • Trust our partners: Once they are on board, we should trust our partners for the duration of a programme of projects rather than taking a ‘transactional’ approach to each one. In that way, we will incentivise them to clearly understand and adapt to our needs, keep project overheads to a minimum and encourage them to innovate alongside us, and work collaboratively to solve problems when things go wrong 

There is hope that providers will weather this storm, but they must acknowledge the forecast, be brave and equip themselves with the best help they can find.

Have you got a story to tell? Would you like to become an NHE columnist? If so, click here 

Comments

There are no comments. Why not be the first?

Add your comment

 

national health executive tv

more videos >

latest healthcare news

Ear infections should not be treated with antibiotics, doctors advised

22/09/2017Ear infections should not be treated with antibiotics, doctors advised

Common ear infections should no longer be treated using antibiotics, NICE has this week recommended. Publishing new draft guidance into the ... more >
NHS staff paid £3,800 less per year compared to 2010

22/09/2017NHS staff paid £3,800 less per year compared to 2010

Years of real-terms pay cuts have seen NHS workers earn on average £3,800 less than they would have if salary rises had kept up with inflat... more >
BMA finds ‘chronic shortage’ of doctors across key medical specialities

22/09/2017BMA finds ‘chronic shortage’ of doctors across key medical specialities

Patient safety is at risk due to a “chronic shortage” of doctors across a number of areas of medicine, the BMA has today warned. ... more >

editor's comment

13/06/2017Tackling the major challenges facing the NHS

As you will have gathered from the front cover, a theme that runs throughout this edition of NHE is about empowering and involving the workforce in order to deliver innovative change across the system.  Professor Jane Dacre, president of the Royal College of Physicians, highlights on page 16 the importance of sustainability and trans... read more >

last word

Your personality, your leadership

Your personality, your leadership

Deirdre Wallace, clinical skills manager at UCL Medical School, discusses the importance of learning about leadership and self while at medical school. Approximately five years ago, I was ch... more > more last word articles >
681 149x260 NHE Subscribe button

the scalpel's daily blog

Ensuring quality in the new NHS

11/09/2017Ensuring quality in the new NHS

Dr Marion Andrews-Evans, member of the NHS Clinical Commissioners (NHSCC) Nurses Forum steering group and executive nurse & quality lead at NHS Gloucestershire CCG, sings the praises of CCG quality leads who are working in often unseen roles to help deliver safe and effective patient care. As the NHS goes through a time of change, we need to make sure that the quality of services that we provide for patients is protected. Patient ex... more >
read more blog posts from 'the scalpel' >

comment

We must ensure every STP succeeds

30/08/2017We must ensure every STP succeeds

Niall Dickson, chief executive of the NHS Confederation, considers what else must be done to ensure all sustainability and transformation plans a... more >
Changing our digital culture and safeguarding patient data

08/08/2017Changing our digital culture and safeguarding patient data

Joanna Smith, chief information officer at Royal Brompton & Harefield NHS FT (RBHT), says that as the NHS becomes more digital it has to get ... more >
A centre for medicines optimisation research and education

04/08/2017A centre for medicines optimisation research and education

Dr Yogini Jani, a consultant pharmacist at University College London Hospitals NHS FT (UCLH), discusses a collaboration with UCL School of Pharma... more >
Unlocking the benefits of age-friendly cities

04/08/2017Unlocking the benefits of age-friendly cities

Stefanie Buckner, Calum Mattocks and Louise Lafortune from the Cambridge Institute of Public Health, alongside Melanie Rimmer from the School of ... more >
A community service

04/08/2017A community service

Louise Watson, NHS England director of the New Care Models programme, discusses the emerging success stories from the vanguard areas across the c... more >

interviews

Improving care at the touch of a screen

08/08/2017Improving care at the touch of a screen

When it comes to dementia, having a calm and safe environment can have a substantial impact on a patient’s quality of life. NHE’s Jos... more >
A new approach to talent management

25/07/2017A new approach to talent management

Martin Hancock, national lead for talent management at NHS Leadership Academy, and Gill Rooke, the organisation’s senior operations manager... more >
Enabling greater integration through ACSs

25/07/2017Enabling greater integration through ACSs

At this year’s NHS Confed, Simon Stevens revealed the first wave of accountable care systems (ACSs). NHE speaks to Ian Dodge, the director ... more >
How NHS organisations can protect themselves against cyber crime

25/07/2017How NHS organisations can protect themselves against cyber crime

On 12 May, a global cyber-attack occurred on an unprecedented scale. It affected organisations across the globe and, though it did not specifical... more >
Working collectively to improve cancer outcomes for patients

20/06/2017Working collectively to improve cancer outcomes for patients

Last year, the cancer vanguard established the Pharma Challenge. Rob Duncombe, pharmacy director at the Christie NHS FT, gives NHE an update on t... more >