Health Service Focus

03.10.16

The crown estate of health and care

Source: NHE Sep/Oct 16

Along with optimising land usage and promoting co-location, a radical new report makes the case for rationalising all local NHS estate into one body. NHE’s Luana Salles reports.

As with the rest of the public sector, estate management has been a key focus across the NHS in recent months. Whether that’s in the form of NHS England CEO Simon Stevens developing a plan to build affordable housing for staff on NHS land, or the Department of Health considering accepting land disposal receipts in exchange for lowering trust debt levels, it’s clear that much needs to be done to optimise the health service’s £31bn estate – which, at £7bn yearly management costs, is the third largest NHS expenditure after staffing and drugs.

 

Perhaps in part due to this unresolved issue, a recent Localis report pitching a series of practical ideas to reform NHS finance was welcomed by several cross-party heavyweights, including London mayor Sadiq Khan, Lib Dem health spokesperson Norman Lamb MP, and NHS Confederation chair Stephen Dorrell. 

Barriers to transformation 

The report emphasised how the NHS estate is “vast but used inefficiently”, even despite government programmes such as One Public Estate (OPE). For example, it said a major East Dulwich Hospital site was granted outline planning permission in 2003, but has been left unused since the hospital closed down 10 years ago. 

This, the report argued, is both expensive and an obstacle to local transformation and new models of care – despite these being the health service’s hallmark ambitions for this Parliament. Better managed land would also create revenue-raising opportunities, either through one-off receipts or long-term income streams in redeveloped areas.

Nationwide rationalisation 

As well as sticking to higher estate management standards, as previously advocated by Lord Carter’s major review of NHS efficiency earlier this year, Localis said local areas should consider rationalising all local NHS estate into one body. 

“As in Sweden – and similarly to Crown Estate – this could be transferred to a holding company structure that is arm’s length of the state, which then works alongside local authorities and one or more private sector partners,” the report argued. “Alternatively it could be led by a network of providers and local authorities working across a sub-regional geography, as is the case in north London.” 

Microcosmic examples of this are already cropping up around the country, most notably in London and Greater Manchester, the only two areas to sign up for a health devolution deal so far. Five north London boroughs have already agreed to collaborate in their estate strategy to share buildings. In Greater Manchester, the ongoing £6bn health devo implementation is sponsoring a city-wide reform of estates strategy, with an NHS Estates GM Delivery Team working alongside public sector partners to deliver an ‘OPE approach’ to property management. 

One Public Estate and STPs 

Bruce Mann, the executive director of Government Property Unit, which oversees the nationwide OPE programme, argued that the scheme is one of two possible routes to tackle the NHS estate problem, despite the Localis report arguing it is not delivering change “quickly enough”. 

He said: “The NHS has not historically done as much as central government in terms of rationalisation and utilisation of land and property – although you’ll see from Simon Stevens that he’s got some very significant developments going forward to do more and better. 

“There are two ways of tackling the NHS estate. The first is through the OPE programme, which is about saying to health bodies – and it is starting to happen now really quite well – in a locality: bring your assets to the table and let’s have a conversation. This is especially in the context of integrated health and social care and how we can best serve the citizen between local authority services and health services.”

But Mann argued this must also accompany a top-down approach by the Department of Health and NHS England through their flagship sustainability and transformation plans (STPs), which bring together health and social care bodies to transform the entire care journey locally. “There’s been a lot of work over the last year within the health family looking at what estate they have got, and how it might be used in the future to meet projected clinical need,” he added, “and that will be brought together inside the STPs.”

FOR MORE INFORMATION

To access the Localis report, visit:

W: tinyurl.com/NHE-Localis

Tell us what you think – have your say below or email opinion@nationalhealthexecutive.com

Comments

There are no comments. Why not be the first?

Add your comment

 

national health executive tv

more videos >

latest healthcare news

NHS race equality improving, but ‘hard work still ahead’

14/12/2017NHS race equality improving, but ‘hard work still ahead’

Race equality in the NHS workforce has improved over the past year, but officials agree that there is still a lot more to be done. NHS Engla... more >
Workforce strategy: DH has ‘turned on all the taps’, but can still do more

13/12/2017Workforce strategy: DH has ‘turned on all the taps’, but can still do more

Health Education England (HEE) has released a draft of its 10-year workforce strategy which is looking to create a long-term staffing p... more >
London trust fined after worker is killed by liquid nitrogen

13/12/2017London trust fined after worker is killed by liquid nitrogen

The death of a worker who was asphyxiated by liquid nitrogen in London in 2011 could have been prevented, says the Health and Safety Executive (H... 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

The Refugee Doctor Initiative

The Refugee Doctor Initiative

Terry John, co-chair of the BMA & BDA Refugee Doctors and Dentists Liaison Group and chair of the union’s international committee, talks about a brilliant initiative that is proving mut... more > more last word articles >
681 149x260 NHE Subscribe button

the scalpel's daily blog

Ten lessons to support new care models locally

29/11/2017Ten lessons to support new care models locally

Anna Starling, policy fellow at the Health Foundation, offers the top 10 lessons for local leaders seeking to make systematic improvements across services, all based on first-hand accounts from vanguard officials. Redesigning health and social care services across traditional boundaries is not easy. Making change in complex environments, with differing professional viewpoints and varying organisational priorities while getting on with t... more >
read more blog posts from 'the scalpel' >

comment

Strategic investment planning

13/12/2017Strategic investment planning

Paul Turton, head of solutions development at NHS Supply Chain, looks at how trusts can unlock investment in medical equipment to alleviate finan... more >
A fight worth fighting

13/12/2017A fight worth fighting

Professor Wendy Burn, president of the Royal College of Psychiatrists (RCPsych), laments the current lack of public understanding about severe me... more >
Developing a wellness workforce

13/12/2017Developing a wellness workforce

The entire health and care sector needs to come together to prepare for a shift towards health creation, writes Merron Simpson, chief executive o... more >
The future of the nursing workforce: what next?

13/12/2017The future of the nursing workforce: what next?

Janet Davies, chief executive and general secretary of the Royal College of Nursing (RCN), argues that the evidence of the importance of prioriti... more >
Strategic commissioning: what the future holds

13/12/2017Strategic commissioning: what the future holds

Julie Wood, chief executive of NHS Clinical Commissioners, looks at how the clinical commissioning landscape will change in the future after havi... more >

interviews

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 >
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 >