There are many challenges faced by 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.
The estate is often seen as an historic collection of fixed assets that are perceived as a drain on resources, rather than a necessary resource that contributes to the delivery of organisations’ objectives. The estate is there to support the delivery of services and the ideal local estate provides a balance between four components: the service/health outcomes it delivers, its location, the quality of the environment and the cost of providing it. If planned and utilised efficiently it is one of the most effective strategic tools available to commissioners, although inappropriate planning and use can mean that it is a burden on the system.
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, trusts and other local partners.
But as we all know, collaboration and partnership working, whether that be public and public, or public and private, is not always straight forward. So what is the solution?
Undoubtedly, having suitable buildings enables the effective delivery of clinical services so it is essential for commissioning plans and estate plans to be aligned. We also need to maximise the use of the estates we have that is in the right location and fit-for-purpose and realise 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.
The re-invigoration of the local strategic estate forums, already in place in many areas of the country, is one solution. These forums bring together public sector partners, commissioners, providers and property professionals to assess the way the estate is used and to re-design the estate to properly meet the service needs of the locality. This 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.
An example of where this approach has worked well is Merseyside. The tradition of effective strategic estates planning on Merseyside began 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, which started 10 years ago, 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 local joint venture company, Liverpool and 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 from 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.
Better management of the estate through improved utilisation and contract management in Merseyside is also driving real value from the property and contributing to wider QIPP savings. Liverpool and Sefton Health Partnership provide a centre management service that has resulted in buildings being utilised by over 80% and in some cases over 95% against a national average of approx. 50%. Marketing of the space has generated additional income streams from third party organisations.
Merseyside is just one example, 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 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 save much needed capital 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.