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Robert Ede is policy manager for The LIFT Council. This article first appeared in Health Service Journal.

Sir Robert Naylor was first appointed as the government’s estates tsar in February of last year, tasked with developing a new strategy for the NHS estate.

His report’s been a long time coming, and in the last 12 months we’ve witnessed significant changes in the policy landscape.

The EU referendum outcome and new prime minister have been most significant, but other changes, such as the ministerial reshuffle which led to Lord O’Shaughnessy replacing Lord Prior as the minister responsible for NHS Estates, have contributed towards the delay. Was Sir Robert’s report, published the same day as the Five Year Forward View delivery plan, a damp squib or worth the wait?

It is worth reflecting first on why the NHS needed a Naylor Review. Over recent years, there’s been growing recognition that the lack of strategic oversight is hampering the development of the NHS estate, and ultimately leading to worse outcomes for patients.

As Sir Robert outlines, the shift towards autonomous local NHS organisations and subsequent reorganisations has slowly reduced the capacity for transformational property reform. The arrival of the 5YFV in 2014 highlighted this deficiency; whilst a British Medical Association survey in the same year demonstrated the scale of the task, finding that 40 per cent of GPs think their premises are not fit for purpose.

Put simply, without significant capital investment many primary care premises are unprepared for delivering the new models of out-of-hospital care.

This requirement is now recognised at the very top. Simon Stevens recently stated that “we need to be in a dramatically different position” in ten years’ time. Sir Robert’s report correctly identifies the barriers preventing this change:

  • Conflicts of interest mean acute providers are reluctant to give up property assets, even if this delivers benefits to the overall local health economy.
  • There are weak links between the Government and much of the primary care estate. Only 1,500 of the 7,600 GP practices in England are owned or controlled by an NHS body, and there is a lack of incentive for GPs to move into new facilities.
  • The existing structure with primary care estates is disjointed. The existence of two separate but complementary organisations – CHP and NHS Property Services – appears incoherent. Both organisations benefit from skilled teams with local understanding, and have developed capability in new areas such as Strategic Estates Planning. However, the report concludes this will be insufficient in developing a comprehensive estates strategy across England.

The report doesn’t dwell on issues facing the current system. At just 38 pages and with 17 recommendations, it quickly outlines a bold vision for the future of the NHS estate that can deliver improved outcomes for patients and the taxpayer.

The first step is the establishment of the new, powerful NHS Property Board, which must be fully in place by next April. This will oversee the functions of NHS PS and CHP as well as addressing the operational challenges that prevent the delivery of major projects. This process has been underway for some months following ministerial approval in November.

Sir Robert’s team have identified £10bn in capital requirements across the Sustainability and Transformation Plans, and calls for healthcare leaders to take advance of private sector investment (under models such as LIFT) in the continuing environment of public capital restraint.

To date, LIFT companies have generated more than £2.3bn in funding, and delivered more than 300 state-of-the-art GP premises and community facilities across the country which offer the integrated services patients want to see.

But in addition to offering high-quality, modern premises, the report recognises that investors provide long-term benefits to the local health economy, including local expertise and support services that are naturally developed under long-term partnerships such as LIFT.

The importance of successful STP implementation for delivering this change is clear. The estate plans and their delivery timeframes must be realistic and robust if footprints are to have access to capital funding, Sir Robert argues.

This is clearly a prevailing view within government – as evidenced by the £325m of capital identified at the Spring Budget for the most developed footprints. However, this approach carries political risk, and ministers will want to ensure assessment criteria is watertight if they are to avoid criticisms of favouritism.

Was the report worth the wait? Whilst predicated on the need to support the delivery of 26,000 new homes and £2bn of assets, Sir Robert’s report has taken the opportunity to outline a far-reaching vision for the NHS estate. Despite the delays over publication, it appears none of the punchier recommendations have been watered down by Whitehall.

The “2 for 1” proposal for match funding to incentivise estate disposal is retained – increasing the likelihood of this initiative being backed by HM Treasury and enabling the delivery of new capital schemes.

Whilst the report offers a blueprint, genuine reform may require legislation if we are to truly deliver a transformation in NHS property and estates. We must now wait to see if ministers are willing to grasp this nettle.

Robert Ede is policy manager for The LIFT Council. Washwood-Heath-Health-and-Wellbeing-Centre