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Improving the primary and community estate: better quality, better value, better health

Dr Sue O’Connell, Community Health Partnerships’ chief executive, examines how the strategic use of property benefits the NHS, local authorities and local communities.

There are many challenges faced by the NHS and other public sector organisations when trying to improve community-based services, but two things are a given; firstly, we cannot afford to waste a penny of public sector money; and, we have to realise value wherever we can.

In many areas of the country, money has been wasted on old, inefficient estate that is not fit-for-purpose and is costly to maintain.
As a result, it is often seen as an historic collection of fixed assets that are perceived as a drain on resources.

Inappropriate planning and use can mean that the estate is often a burden on the system, but if it is planned and utilised efficiently, the estate is one of the most effective strategic tools available to commissioners – with the potential to save money and improve patient care.

Instead, the estate should be viewed as a necessary resource that contributes to the delivery of organisations’ objectives. It is there to support the delivery of services and the ideal local health and community estate provides a balance between four components:

• The service/health outcomes it delivers

• Its location

• The quality of the environment

• The cost of providing it

The implementation of NHS reform presents an opportunity to improve the utilisation of the estate and, at the same time, to secure further efficiency savings and promote greater service integration through collaboration between local authorities, health and wellbeing boards, clinical commissioning groups (CCGs), trusts and other local partners. However, it is important to remember that saving money through driving estate efficiencies is not the same as cost-cutting, as money saved on inefficient estate can be better channelled towards direct patient care.

But as we all know, collaboration and partnership working – whether that be public and public, or public and private – is not always straightforward. So what is the solution?

We believe it is essential to link commissioning and strategic estate planning, whilst taking sensible decisions that will improve patient care and save money. Undoubtedly, having suitable buildings enables the effective delivery of clinical services, so it makes sense for commissioning plans and estate plans to be aligned.

The reinvigoration of the local strategic estate forums, already in place in many areas of the country, is a key piece of the jigsaw. These forums bring together public sector partners, commissioners, providers and property professionals, enabling us to take a two-pronged approach: matching commissioning plans, service requirements and the demand for property to a review of estate capacity, condition, location and cost.

The aim of this approach is to ultimately ensure that health services are run out of the best possible buildings. It maximises the use of the estate that we do have that is in the right location and is fit-for-purpose, as well as realising value from the estate that is not. Simply building more and spending money on short-term fixes, without being sure it is the right solution in the medium and long term, is not the correct approach.

A two-pronged approach

This approach also enables us to look across the whole system, bringing health and local authority services together to provide opportunities for service co-ordination and collaboration, as well as to drive efficiencies.

For example in Hull, Citycare, the Local Improvement Finance Trust (LIFT) company, has recently been undertaking an audit of
the LIFT and retained NHS estate for the CCG to understand current utilisation and the relative condition of the entire primary and community estate.

Through this piece of work, Citycare aims to identify any opportunities for increased usage or possible reorganisation of the space to accommodate the transfer of health care from acute to community settings, and also to provide accommodation for other public services, using the current LIFT estate across Hull as ‘hubs’ in their communities. This will enable surplus properties to be disposed of and for further efficiencies to be found within service and estate costs. This is similar to work that is being undertaken in Portsmouth, which (if proposals go ahead) could mean savings of at least £2m per annum being delivered, alongside significant patient benefits.

Meanwhile, in Wigan, increased patient choice, greater utilisation of existing premises, cost savings and improved ways of working for NHS mental health staff have all been achieved through a borough-wide QIPP review, carried out through Foundation for Life, the local LIFT company. (See full case study below)

Hull, Portsmouth and Wigan are just three examples, and we are well aware that different geographical areas present different challenges and have very different needs, which is why locally-based strategic estate forums, involving all key stakeholders, are
so important.

There is no one-size-fits-all solution, but I believe partnerships that include local stakeholders and public and private organisations with shared goals and a genuine commitment to an area can ultimately improve services on the ground and drive much-needed savings for the NHS.

By working together with partners at a local level, we are improving the utilisation of modern, fit-for-purpose buildings and unlocking surplus estate, ultimately freeing up capital, which can be passed on to provide better services. Hard work and a united commitment to the long-term cause will ultimately create huge benefits for patients and communities alike, and that has to be worth it.

About CHP

Community Health Partnerships (CHP) is wholly-owned by the Department of Health. It was established in 2001 and until 2007 was known as Partnerships for Health. It has established 49 LIFT companies and with them delivered more than 300 buildings, with over 800,000m² of space, which are used by communities throughout England.

QIPP case study – Wigan

The QIPP (quality, improvement, productivity and prevention) programme in the NHS aims to improve the quality of care whilst making efficiency savings.

In Wigan, a borough-wide QIPP review undertaken by the LIFT company, Foundation for Life, led to increased patient choice, greater utilisation of existing premises, cost savings and improved ways of working for NHS mental health staff.

When Rita Chapman, chief executive of Foundation for Life, carried out a space utilisation review within the existing LIFT estate across Wigan, she found that about 20% of the most expensive areas of the estate were being used for non-clinical purposes.

During the same period, Wrightington, Wigan & Leigh NHS Foundation Trust (WWL) identified that it needed to transfer ophthalmology and paediatric services, currently based within its acute Royal Albert Edward Infirmary site, to enable the trust to continue the development of the site as a whole.

Initially, the WWL planned to extend its existing outpatient site, which was situated in a listed building. However, at an estimated cost of about £4m for the works, the trust was keen to explore more cost-effective solutions.

Chapman said: “Working closely with WWL and Ashton Leigh & Wigan PCT, Foundation for Life looked at how space within Boston House Health Centre, an existing LIFT building less than two miles from the Royal Albert Edward Infirmary, could be remodelled to accommodate a transfer of ophthalmology services – all at a considerably lower cost than the potential £4m capital cost identified by the trust.

“Following a review of the specific space requirements for the services, and approval of the subsequent project plan to carry out the work, existing mental health services, some clinical and all non-clinical services within Boston House Health Centre were relocated to another LIFT building, Claire House, which already housed existing mental health facilities.

“The services were also reconfigured, bringing them closer to patients by providing access to four additional LIFT premises across the borough, significantly improving accessibility and greatly increasing patient choice.

“Not only did this work enable us to free up much-needed space in Boston House to allow it to accommodate the transfer of ophthalmology services from the Royal Albert Edward Infirmary, it also acted as a catalyst for the acceleration of existing plans to pilot new ways of working within mental health services across the borough.”

Liverpool and Kensington Life

The tradition of effective strategic estates planning on Merseyside began over 10 years ago with the recognition that sustained and radical action would be required to close the gap between the poor health and high mortality rates that characterised some of England’s most deprived areas.

The planning process involved all of the key stakeholders in describing a vision of a pattern of healthcare provision that would put first-class facilities offering integrated care within easy reach of everyone.

The LIFT company, Liverpool & Sefton Health Partnership, became the tool for the development of these plans and drove their delivery. As a result of this activity, people living in the highly-deprived communities of Liverpool now have access to first-class
facilities offering high-quality, integrated health and social care services within a 15-minute journey of their homes – delivered through a combination of new buildings (14 new buildings have been developed by the company across Liverpool and Sefton) and the refurbishment of existing facilities. As each new centre has opened there has been an increase in patients registering with the GPs and dentists in them.

The £5m Neighbourhood Health Centre in Kensington, Merseyside, is one of the 14 buildings delivered by the public private partnership during that time. The centre, which celebrates its first anniversary in March 2014, provides patients with longer GP opening hours, as well as a range of enhanced health services, including dental, pharmacy, childhood immunisations and vaccinations, phlebotomy, sexual health, counselling, antenatal and baby clinics.

The Kensington scheme marked the completion of the final phase of Liverpool PCT’s wider vision for ‘A New Health Service for Liverpool’, which has seen £80m invested in new purpose-built and refurbished health facilities across the city since 2007.

Graham Pink, chief executive of Liverpool & Sefton Health Partnership, said: “When we first set out to undertake these plans for the ‘New Health Service for Liverpool’ programme, we had a very clear vision for delivering attractive and modern health
centres, which would transform the way NHS services are delivered and benefit thousands of patients across the city.

“Historically, Kensington has not enjoyed the same level of good health as other parts of the city – but this new, state-of-the-art health centre acts as a catalyst for health and wellbeing improvements. This centre is a huge asset to everyone living in Kensington and the surrounding areas, and provides a lasting legacy for the people who live here.”

Gideon Ben-Tovim, former chair of Liverpool PCT, which has now been replaced by Liverpool CCG, added: “This is one of the most extensive and ambitious health programmes the city of Liverpool has ever seen, and I feel proud of the work that has been done to improve healthcare facilities for different communities across the city.”