In June 2014, recently appointed NHS England chief Simon Stevens outlined his vision for the future of the National Health Service in a key note speech to the NHS Confederation Conference. One of the main talking points was his thoughts on the delivery of care in the community, where he proposed a more flexible and adaptive model of ‘multi-specialty providers’ which could see closer working between acute, primary, specialist and community care providers.
To put this model into action, the current review of unlocking NHS property assets needs to continue to see exactly how future care services can be accommodated, particularly in a community setting. To build integrated primary care facilities may be one answer but the business case needs to stack up – and in our experience this means ensuring a suitable and affordable site can be found, there is money to commission the project and any development is future proof to provide the NHS with flexibility and value for money. This need for flexibility has even greater importance for today’s commissioners and providers, particularly with many short term provider contracts of 3-5 years.
There are many challenges in achieving the multi-provider facilities of Simon Stevens’ future but one of the fundamental development tests is the limited availability of affordable land in the densely urban areas where many of these facilities will be needed.
In Birmingham for instance, Sparkbrook Community and Health Centre brings together three GP practices, community health services and facilities for Birmingham City Council (BCC) in a dedicated community-based facility. With a shared need and collaborative vision for improving health and wellbeing in the region, the single facility is a more viable and sustainable way for the local authority and NHS to deliver both their individual and joint aims.
But this would not have been possible without an innovative land swap that saw Prime approach the Diocese of Birmingham to ask them to ‘swap’ their land for part of an adjacent plot of NHS and BCC owned land. This unusual step unlocked a large area of Sparkbrook for regeneration and saw a new church being built opposite the new community and health centre creating a wellbeing hub in a physical and spiritual sense.
The idea of bringing together multiple service providers to work more closely is not really a new concept but being flexible around where these services are offered will be critical for Simon Steven’s vision and Cobridge Community Health Centre (CCHC) is testament to how well this can work in practice.
In Stoke-on-Trent, CCHC brings together a number of primary, community and previously hospital-based services, including X-Ray facilities and a specialist chest clinic. The campus style development has been designed with built-in flexibility for the future incorporating possible service changes for example the recently added walk-in phlebotomy service.
However, what makes the centre so different is it also incorporates the UK’s first combined Sexual Health Unit and Sexual Assault Referral Centre, so victims of an assault no longer have to travel to hospital to be treated and then to the police station to be interviewed – it all happens in one building, reducing stress at a difficult time. The police’s permanent base makes this facility an example of best practice in co-ordinating wider healthcare, social care and criminal justice processes.
As momentum grows in the new housing market, competition for land will further restrict the availability for comparatively small footprint healthcare developments in highly populated areas. However, if the NHS is able to work with complementary partners, economies of scale can be achieved and difficult projects made viable.
The Mill Rise Village incorporating Mile House Primary Care Centre in Newcastle-under-Lyme is a multi-award winning housing, health and leisure development bringing together extra care housing for the over 55s, a state-of-the-art primary care centre and additional retail and leisure facilities including a restaurant, fitness suite, pharmacy and hair salon. It responds to the future growth in the elderly population and the associated extra demands for age-related services and was the result of successful joint working by eight public and private sector organisations.
Prime identified a larger 11acre development site earmarked for future housing but as the land was too expensive to purchase a plot for the small primary care centre they joined forces with a complementary service – an RSL partner – to deliver an extra care village and health centre, as economies of scale made it affordable for all the partners.
Identifying a strong service need is part of a sound business case, as is having available capital or access to funding. While public funding budgets are stretched to the limit, the NHS and other public sector partners can develop new projects from leveraging unused properties or disused land they already have within their estates.
In Birmingham the council moved services from eight sites into the new development, selling off surplus, unfit units and releasing costly leases to raise the funding for their part of the Sparkbrook centre, while further north Durham County Council and NHS County Durham sold their adjoining plots of land in Pelton to facilitate Prime building a new health centre and library for the rural village community. Pelton’s Lavender Centre incorporates two GP surgeries, other NHS services, a council library, community pharmacy, Sure Start Centre, as well as a new village green.
As Simon Stevens identifies, the NHS is ‘now in year five of essentially flat health funding’, therefore a strong business case for new healthcare developments is more important than ever. What Prime as developers and investors has seen is that with a creative approach to securing the right location and funding, investigating all the public and private sector partnering opportunities, creating future-proof designs and being a true partner for all the stakeholders involved – the development challenges can be overcome to make Simon’s vision a reality.