The ambitious Five Year and General Practice Forward View sets out a striking challenge to the NHS, and provides a vision which will only be met if providers and commissioners embrace significant transformation from existing models of health and social care.
Sustainable Transformation Plans (STPs), Devolution and the One Public Estate programme will all bring about significant change and challenge to the way health and social care are delivered. The planning phase for STPs need to be completed by December 2016, including full operational plans spanning two years.
Significant transformation will inevitably involve changes to the estate at a considerable pace, with a continued focus on optimising the asset base, co-locating with other public sector organisations, reducing costs and creating more flexible, multifunctional bases. Transformation of the NHS and Social Care systems presents an opportunity for the NHS, not only to ‘right size’ the estate and make it fit for future provision, but also to position itself to maximise returns from the proposed transformation that will take place.
The King’s Fund, together with the Health Foundation, have reported that the NHS surplus estate, which is immediately saleable, could be worth as much as £700 million. Department of Health data suggests more than 900 football pitches-worth of land owned by the NHS could also be surplus to requirements; the Surplus Land programme will seek to mobilise disposal and ensure capital receipts are realised for the health economy.
There is clearly a need and an opportunity to reduce the existing estate, to release capacity for additional housing and complementary care facilities, but it needs to be done without adversely impacting services or patients.
NHS leaders should be working proactively to prepare ahead of these changes and ensure master planning and strategies are robust and well thought out, and identify and understand the opportunities which exist to maximise returns from the asset base. This might involve commercial partnering, private investment or the potential for long-leaseholds with revenue gain as opposed to straight disposals. It may not require a long and expensive procurement process and the facilitation of land strategy advice could simply be procured through existing framework agreements.
Working in partnership with the NHS, Capita has identified key developments which could lead to redesign and optimisation of NHS estate in a way enabled them to enhance patient care. Success will depend on adopting a holistic approach across the many facets which affect estate decisions. Both Commissioner and Provider organisations are already getting on and delivering change, which does not need to be complex or controversial in all cases.
The five stages of estate transformation
Building a strong partnership between the NHS and trusted expert advisors will be key to realising the full potential of the estate. Expertise comes in many shapes and forms and via different routes, but it is important that strategic decisions are based on quality advice and information from people with the right sector skills and reach into the appropriate markets.
1. The right facilitator/advisor can assist realisation of the following five stages:Making better use of data, insight and analytics is the crucial first step if the NHS is to unlock the full potential of its existing estate. Applying its experience and expertise gained in the local government arena, Capita is leading the way in helping Trusts to better understand the populations they serve, health and social needs assessments, existing and future capacity demands, planned housing developments and what this will mean for the estate provision.
We can benchmark current performance against peer groups, highlight areas requiring service review and develop target operating models for healthcare that are based on future likely demand and calculated using population based health data. We can also work in partnership to support clinical and organisational change programmes to deliver the transformation to that target operating model.
2. Next, there is what seems like an obvious solution: co-locating some complementary services on the same site, thus cutting the cost of the estate. The National Audit Office (NAO) estimates that combining GPs and primary/community services into one centre could dramatically reduce (by a fifth) the number of people who needlessly go to A&E. Emergency and urgent care remains a key focus for transformation while the Forward View looks for integrated working and merging of functions to create contingency in the system while saving costs.
3. In reviewing community and acute estates together, it is possible to improve pathways without the need for a lengthy consultation and planning process. For example, we have found that there are significant opportunities to locate East London primary and secondary care services on the same campus, reducing both the time and cost associated with developing multiple sites.
Creating a better overall view of the estate will not only make better use of buildings and land, it will help identify potential for rental and sale of those parts of the estate which are no longer needed, helping to generate much needed revenue for providers.
This commercialisation of the estate is an important consideration; revenue can be generated through delivery mechanisms to fund, develop and operate the required support infrastructure. This may include retail outlets, car parks, patient hotels, pharmacy, step-down care or integrated health and social care campuses and other commercial infrastructure which generates revenue, including student accommodation, hotels and housing.
4. Technology is a key enabler in improving the adaptability of the estate. Consideration should be made of whether existing and new buildings are smart enough: whether they are making the best possible use of technology. For example, we reviewed clinical functionality, infrastructure and architecture at a community hospital and discovered outdated and inefficient IT systems, which developed ad-hoc over time and did not reflect the services provided, or meet the needs of patients. A simple rebalancing and understanding the of the IT architecture and governance significantly improved utilisation and efficiency.
5. Finally, there are many ways the NHS can harness behaviour change to reduce inefficiencies, for example through schemes designed to make employees and organisations more environmentally friendly and socially sustainable such as the Care Without Carbon model and Dare to Care initiatives developed and adopted by Sussex Community NHS Trust.
There is an opportunity to learn from the experiences of the NHS bodies around the country who are making significant steps to improve the way they manage and rationalise their estates. There are some great examples of work already being done to help drive efficiencies: but time is of the essence to ensure it meets the challenge set out in both the Five Year and General Practice Forward Views.
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