Health Service Focus

31.03.17

The shape of estates under STPs

Source: NHE Mar/Apr 17

NHE looks at the early proposals for estates efficiency already starting to emerge from England’s 44 sustainability and transformation plans (STPs).

While money (or a lack thereof) takes up most of the headlines in the national press, anyone who lives and breathes the NHS knows that reforming and upgrading its estates will be a critical step to harnessing significant service transformation. 

Last year, Lord Carter identified significant variation in how efficiently acute trusts make use of space – some have running costs of £105 per square metre, whilst others can be as high as £970 – and, more recently, the Health Select Committee argued that local health areas must assess the infrastructure investment needed to ensure 24-hour A&E departments are fit for purpose. 

The major channel through which to accomplish this will be sustainability and transformation plans (STPs). In fact, proposals for better facilities management will form the cornerstone of any successful plan – and, as chancellor Philip Hammond confirmed in his Spring Budget, any extra capital from central government will take into consideration whether the local NHS area is succeeding in raising proceeds from unused land to be reinvested in the health service. 

So far, STPs haven’t revealed much in the way of financial needs linked to proposed estates changes. When NHE spoke to Jon Rouse, who leads on Greater Manchester’s health and social care integration, in November last year, he told us that their business case was under development, but all that could be shared at that point was that health leaders would need to think “laterally and creatively” about releasing headroom for extra investment. 

When the King’s Fund published its comprehensive round-up of STPs at the end of February, it said these cash details were included in the overall financial template each area submitted to NHS England, which are not in the public domain. But some detail had started to emerge across a handful of footprints, both related to money and strategy. 

Early estate ideas 

According to the think tank, most STPs outlined ideas to make better use of their estate, such as disposing of assets considered to be ‘surplus’ to requirements. Staffordshire and Stoke-on-Trent found that “too much” estate and underutilised inpatient capacity is one of the key drivers of its forecast ‘do-nothing’ deficit. It is now considering several options to use its estate more efficiently and, if successful, could save £22m by the end of this Parliament. 

Importantly, many STPs have listened to widespread concerns about council involvement and have drawn up proposals to work alongside local authorities and the wider public sector on an estates strategy. The King’s Fund listed Leicester, Leicestershire and Rutland as an example: the STP footprint intends to work with councils, ambulance and fire services to identify service co-location opportunities, as well as rationalisation and consolidation of the estate. 

Bedfordshire, Luton and Milton Keynes wants to build on work already carried out by councils as part of the government’s One Public Estates scheme, with an aim to create local centres for health and social care staff alongside other public services, such as housing. 

As recommended by the Health Committee, Bristol, North Somerset and South Gloucestershire STP has looked at areas where the estate can be improved, such as replacing buildings that aren’t fit for purpose with new facilities. Where appropriate, this will be financed by a reduction in the overall estate. Similarly, North West London wants to upgrade the primary care estate by investing up to £100m alongside “minor improvement grants”. 

Cambridgeshire and Peterborough expects to develop new primary care and community facilities when GP practice leases expire, with plans to create “larger, modern, family- and frailty-friendly hubs” that bring together doctors, social care and community staff. 

A BMA investigation cited Cambridgeshire and Peterborough STP as one of a handful of footprints currently quoting capital needs of more than £500m to drive forward plans. Whilst it is still unknown how much of this would be tied to estates, some other areas have given an indication: Lincolnshire, for example, needs around £200m to finance projects including the estates requirements of new care models and service reconfigurations. Given that extra funding is “likely to be limited”, the STP is exploring other sources of money, such as third-party developers, public-private partnerships and county council funding, the King’s Fund explained. 

Others have taken different avenues: Coventry and Warwickshire STP, for instance, has called on the Department of Health to “revisit its overarching policy on capital receipts, allowing local areas to retain them for reinvestment rather than returning them to central government”.

For more information

The King’s Fund ‘Delivering sustainability and transformation plans’ report can be accessed at:

W: www.kingsfund.org.uk

Comments

There are no comments. Why not be the first?

Add your comment

 

national health executive tv

more videos >

latest healthcare news

Private mental health group The Priory fined £300,000 over death of 14-year-old girl

17/04/2019Private mental health group The Priory fined £300,000 over death of 14-year-old girl

Private mental health group The Priory healthcare group has been fined £300,000 for breaching health and safety laws following the death of... more >
Routine breech scans could lower mother and baby mortality rates and save NHS money, researchers say

17/04/2019Routine breech scans could lower mother and baby mortality rates and save NHS money, researchers say

Scanning mothers-to-be late in their pregnancy could prevent 15,000 unexpected breech births, 4,000 emergency C-sections, and the deaths of up to... more >
City council rejoins ICS after reforms agreed in privatisation and accountability row

17/04/2019City council rejoins ICS after reforms agreed in privatisation and accountability row

Nottingham City Council is to rejoin its local NHS integrated care system (ICS) after significant reforms were made to the way the system runs in... 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

Our Health Heroes

16/04/2019Our Health Heroes

Dean Royles, strategic workforce advisor at Skills for Health and co-author of ‘An Introduction to Human Resource Management,’ discusses the upcoming Our Health Heroes Awards. There are many metaphors to describe staff working in healthcare. Junior doctors have been described as the ‘backbone’ of the NHS, nurses are often referred to as ‘angels’, general practitioners as the ‘bedrock’ of t... more >
read more blog posts from 'the scalpel' >

comment

Turning blue lights green

11/04/2019Turning blue lights green

Polly Billington, director of UK100, a cities network that campaigns on environmental issues, argues that the NHS needs a national strategy for a... more >
Going back to school at Gloucestershire Hospitals NHS Foundation Trust

10/04/2019Going back to school at Gloucestershire Hospitals NHS Foundation Trust

Steve Hams, director of quality and chief nurse at Gloucestershire Hospitals NHS Foundation Trust (GHFT), demonstrates how cultural change has im... more >
How the new nursing associate role will break new ground

10/04/2019How the new nursing associate role will break new ground

Danny Mortimer, chief executive of NHS Employers, introduces us to the new nursing associate role, and how it’s set to complement the NHS L... more >
A smarter approach to tackling AMR

10/04/2019A smarter approach to tackling AMR

Antimicrobial resistance (AMR) is estimated to cause 700,000 deaths each year globally. This could rise to 10 million by 2050 if we do nothing. B... more >
Working together to improve volunteer impacts

10/04/2019Working together to improve volunteer impacts

Emma Easton, head of voluntary partnerships at NHS England, highlights the importance of volunteers in the health service and outlines the brilli... more >

interviews

How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

24/10/2018How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

A dedicated national social care service could be a potential solution to surging demand burdening acute health providers over the winter months,... more >
RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

24/10/2018RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

The president of the Royal College of Physicians (RCP) has told NHE that the college’s new headquarters based in Liverpool will become a hu... more >
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 >