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

DDRB must ‘reassert its independence’ as doctors’ morale and living standards continue to slip

20/02/2018DDRB must ‘reassert its independence’ as doctors’ morale and living standards continue to slip

The BMA is concerned about the ability of the Review Body on Doctors’ and Dentists’ Renumeration’s (DDRB) to serve its original p... more >
UK ‘cannot afford’ to lose EU health and social care workers

20/02/2018UK ‘cannot afford’ to lose EU health and social care workers

The UK cannot afford to lose the EU staff currently working in health and social care, the Cavendish Coalition has warned. Its comments come in ... more >
Ulster competence test centre opens for international nurses

19/02/2018Ulster competence test centre opens for international nurses

A new competence test centre has opened in Northern Ireland to meet the demand for overseas nurses and midwives wishing to work in the UK. The N... more >

editor's comment

25/09/2017A hotbed of innovation

This edition of NHE comes hot on the heels of this year’s NHS Expo which, once again, proved to be a huge success at Manchester Central. A number of announcements were made during the event, with the health secretary naming the second wave of NHS digital pioneers, or ‘fast followers’, which follow the initial global digital e... read more >

last word

Hard to be optimistic

Hard to be optimistic

Rachel Power, chief executive of the Patients Association, warns that we must be realistic about the very real effects of continued underfunding across the health service. It’s now bey... more > more last word articles >
681 149x260 NHE Subscribe button

the scalpel's daily blog

Trusts recognise the value of the GIRFT programme – but it must remain ‘quality first’

09/02/2018Trusts recognise the value of the GIRFT programme – but it must remain ‘quality first’

Cassandra Cameron, policy advisor at NHS Providers, says trusts must be given constructive support – without fear of failure – in order for the Getting It Right First Time (GIRFT) programme to succeed. The NHS GIRFT programme aims for better value in acute hospital and mental health care by using trusts’ clinical, operational and financial data for benchmarking and scrutiny of local performance. Along with efficiency, ... more >
read more blog posts from 'the scalpel' >

comment

Celebrating 75 years of healthcare

14/02/2018Celebrating 75 years of healthcare

Julian Amey, chief executive of the Institute of Healthcare Engineering & Estate Management (IHEEM), outlines what the coming year holds for ... more >
The HSIB approach to maternity investigations

14/02/2018The HSIB approach to maternity investigations

Jane Rintoul, director of strategy and policy and programme director for maternity investigations at the Healthcare Safety Investigation Branch (... more >
Data saves lives

14/02/2018Data saves lives

Kuldeep Sohal, programme manager at Connected Yorkshire, part of Connected Health Cities, discusses how data sharing across the north is improvin... more >
Our work can help ease A&E pressures

09/02/2018Our work can help ease A&E pressures

Last year, NICE guidelines recommended that the NHS should provide more advanced paramedic practitioners (APPs) to relieve pressure on emergency ... more >
Beyond scented candles and quick fixes

07/02/2018Beyond scented candles and quick fixes

Joni Jabbal, researcher at The King’s Fund, asks why quality improvements and innovations are failing to be adopted by the NHS. There ... more >

interviews

Duncan Selbie: A step on the journey to population health

24/01/2018Duncan Selbie: A step on the journey to population health

The NHS plays a part in the country’s wellness – but it’s far from being all that matters. Duncan Selbie, chief executive of Pu... more >
Cutting through the fake news

22/11/2017Cutting through the fake news

In an era of so-called ‘fake news’ growing alongside a renewed focus on reducing stigma around mental health, Paul Farmer, chief exec... more >
Tackling infection prevention locally

04/10/2017Tackling infection prevention locally

Dr Emma Burnett, a lecturer and researcher in infection prevention at the University of Dundee’s School of Nursing and Midwifery and a boar... more >
Scan4Safety: benefits across the whole supply chain

02/10/2017Scan4Safety: benefits across the whole supply chain

NHE interviews Gillian Fox, head of eProcurement (Scan4Safety) programme at NHS Supply Chain. How has the Scan4Safety initiative evolved sin... more >
Simon Stevens: A hunger for innovation

25/09/2017Simon Stevens: A hunger for innovation

Simon Stevens, chief executive of NHS England, knows that the health service is already a world leader when it comes to medical advances – ... more >