Partnering for an efficient NHS Estate
Published 3 May 2016
That pressure is reaching a critical point. The obvious route has been to dispose of surplus land and, indeed, the Department of Health is still calling for the release of land and its translation into housing units. For a Trust sitting on a large plot of vacant land, or a surplus hospital, it may be relatively straightforward to proceed with a disposal on a project basis.
Far more common is the Trust with inaccessible surplus estate, a multi-occupied operational estate and an undecided future. Not untypical is the Trust, which, while putting a coffee outlet into its entrance atrium, is at the same time facing downgrading to a district hospital or upgrading to a superhospital depending on the outcome of a regional clinical review. The lease is for a term of 10 years and the rental is based on turnover. The Trust doesn’t know even know what the footfall is going to be in 5 years' time, let alone whether the atrium is still going to be in existence and is finding it, unsurprisingly, extraordinarily difficult to agree terms with the coffee outlet.
Existing efficiency moves must tie in with the Carter recommended plans and contribute to the resulting savings or generation of income or capital. Collaboration and looking outside the castle walls will be key to future-proofing the estate. This will require confident collaboration and partnering with other NHS bodies, local authorities, third sector organisations, and the private sector to come up with a suitably flexible and adaptable estate.
There has been much talk recently of the partnership model. A Strategic Estates Partnership (SEP) must sit in the broader efficiency context and, possibly perversely, the Carter review has probably had the effect of pushing SEPs ahead of any new models of care, while Trusts are considering how much support they may need in achieving the Carter recommendations.
A SEP is an enabler, appealing in its flexibility and the opportunity to harness expertise, including skill in bringing partners together. There may be also be scope for fast-tracking projects so that service requirements on commission and delivery are more closely aligned. Any Trust's appetite for any given model of SEP is going to be affected by all the moving parts involved – where it sits on the integration spectrum in terms of new models of care, what outputs it conceivably wants to see and which vehicle suits those variables. Culturally it will be driven by external forces (such as the Carter demands) and internal Trust values, resistance to change and appetite for risk.
In the shifting sands of new models of care, integration and devolution, service transformation and improvement, it is critical that different initiatives across the wider NHS are tested against each other to make sure they dovetail and work together to drive efficiency. Organisations are likely simultaneously to be considering new models of care, service reconfiguration and how to squeeze more efficiencies from their assets.
Ensuring that a partnership is future-proofed, and fits in with a potential new model of care is critical to its success as are levels of assurance, not only on financial matters, but in terms of governance and risk. The right fit of SEP can deliver benefits at speed, but care must be taken to ensure that right fit.