Effectively managing the NHS estate

Property companies, Community Health Partnerships (CHP) and NHS Property Services (NHS PS) are playing an important role in supporting the service transformation and system improvements agenda highlighted in the Five Year Forward View (5YFV), says Clive Shore, Community Health Partnerships’ executive director.

With more than 1,200 hospitals and 3,000 other treatment facilities across England, the NHS estate is huge, diverse and complex.

Property can be an important catalyst for wider system change, but to achieve that it’s essential to understand precisely what the estate comprises of; how it works together; how it meets the needs of the communities it serves; and how it can be improved to help deliver government policy, such as the Five Year Forward View (5YFV).

CHP and NHS PS are working hard to deliver an estate that is responsive to change, taking account of demographic trends, increasing specialisation, integration of health and social care, movement of services from acute to community, technological advances and new ways of working.

Last summer, the Department of Health (DoH) and NHS England provided guidance to clinical commissioning groups (CCGs) to improve the management of the NHS owned and occupied estate, which represents the third highest cost after staff and medicines. To help achieve this, CHP and NHS PS have supported CCGs with property expertise to carry out the largest and most comprehensive analysis of the NHS estate ever undertaken.

Among many other inputs, this has included detailed mapping and data capture, building utilisation studies and options appraisals for improvements across the health estate.

Local strategies
Bringing together key partners from local health systems to create Local Estate Forums (LEFs) has been critical to this. There is no prescriptive model, but LEFs are made up of CCGs, acute trusts, service providers, local authorities and many others with a direct involvement in the local health system.

The Local Estates Strategies, developed by LEFs, are designed to: articulate commissioners’ vision for their estate, based on the 5YFV and commissioning plans; bring together core information about the current estate; identify current and planned broad locations for delivery of services; identify any further data required to inform the strategy; outline the opportunities that exist within the estate to meet requirements for the delivery of services; and identify a high‑level next steps plan for implementation.

This extensive piece of work has captured a huge body of learning, insight and opportunity. While some of the headline figures confirm an urgent need to improve the utilisation and management of parts of the estate, there are also strong messages that offer a positive way ahead for improvement and delivery.

The major priorities now are to deepen engagement with secondary care and other public sector bodies, in particular local authorities, to encourage and enable partners to apply the learning captured in Local Estate Strategies to implement the changes needed across local health systems, in line with the 5YFV. In addition to this, CHP and NHS PS are playing a wider role in the transformation agenda. This includes active involvement in supporting programmes such as the Devolution agenda, the Government Office’s One Public Estate initiative, and the Vanguard groups being set up to deliver the New Care Models Programme.

CHP and NHS PS are also working closely with the DoH to identify potentially surplus NHS land that could make a contribution to the government’s house building targets, support economic growth and also enable wider provision of Extra Care and Key Worker accommodation. Strategic Estate Planning utilisation and appraisal studies are providing trusts and commissioners with options that give full consideration to, and assessment of, current and future clinical needs. Disposal of land for building development is one of the options accounted for in that process.

Primary care in hull
The centre Management pilot for primary care estate in Hull looked to deliver improved buildings management, better services for providers and patients, effective utilisation of bookable space, and the potential for £1 million p.a. extra rental income. Better management of property assets is one of the consistent themes to emerge through work with CCGs. Following a strategic review in Hull, 12 primary care centres are now serviced by a single, rationalised facilities management contract that has replaced four previous agreements.

Taking a strategic approach across the estate has seen improved services implemented for buildings management and maintenance; better administration and utilisation of bookable space; regular and constructive communication with tenants, and enhanced patient and visitor experience with improved front of house services. Within this new approach, the application of IT to manage room bookings is helping to deliver an annual equivalent of £1 million in extra rental income for bookable and sessional space. Alongside the obvious financial benefit, the new centre management approach will also help to identify and secure new clinical and social care services for the community.

Urgent care centre in widnes
The reconfiguration of the Widnes Health Care Resource Centre into an Urgent Care Centre last summer is helping to reduce pressure on local A&E departments, while delivering a range of new patient services closer to home and financial savings for the CCG.

Widnes in Cheshire has one of the lowest national levels of car ownership, but the closest A&E department is eight miles away. Responding to the need to reduce pressure on the acute sector and reduce A&E admissions, the CCG identified an opportunity for a new Urgent Care Centre.

Analysis identified under-utilised space in the Resource Centre, which was reconfigured to create a primary care-facing alternative to A&E. The project has delivered a single reception and waiting room, consolidating the six that were previously spread throughout the building. Administrative space has been converted to clinical rooms and new X-ray, imaging and ultrasound, diagnostics and on-site pharmacy added. In addition to improving patient services, the project aims to achieve a 15 per cent reduction in A&E attendance over five years and make £150,000 savings for the local health economy.

Integrated health and social care hubs in North Manchester

A joint study by partners in the local health system has identified practical opportunities to create integrated health and social care hubs in four communities across North Manchester. By moving services out of ageing infrastructure into under‑utilised modern buildings, the four bases could accommodate district nursing teams and palliative care services in community settings closer to patients’ homes.

The evidence produced by this process has delivered a strong foundation for conurbation-wide thinking as Greater Manchester takes on its devolved responsibilities for health and social care.

Four of the six primary care centres involved in the study show significant potential for improved space utilisation. The cost to the public sector of the currently under-utilised space is estimated at £900,000 p.a.

Further Information