Health Service Focus

The shape of estates under STPs

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