Local Estate StrategiesA Framework for Commissioners

We take a closer look at the new guidance

Lester Wagman

Policy/Guidance (June 2015)

• Target audience- Clinical Commissioning

Groups- NHS England- Community Health

Partnerships- NHS Property Services Limited

• Secondary audience- NHS Trusts- NHS Foundation Trusts- Local Authorities- Other local strategic partners

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“By the end of December 2015, the majority of CCGs should have plans in place that cover primary and community care estate and non-clinical estate. The Department will continue to support commissioners through CHP and NHS PS as local estates strategies evolve alongside commissioning strategies.”

The NHS is a complex beast…

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Click on image above for video explanation!

…as is its (primary & community) estate

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NHSEnglandNHS

England

NHS Clinical Commissioning Groups

£

£

Private

GPs

GPs

Other Providers

NHS Trusts

Other Occupiers

NHS PS

GPs

GPs

Other Providers

NHS Trusts

Other Occupiers

CHP

GPs

GPs

Other Providers

NHS Trusts

Other Occupiers

£

Corporate Ownership GPs

Community & Primary

Services

Service Tariffs/ Payments

Other

L a n d l o r d s

£ Rent & S/C

Contracts

Rationale

• To support 5 year forward view (5YFV) NHS needs to:- fully rationalise its estate,- maximise use of facilities,- deliver value for money, and- enhance patients’ experiences

in collaboration with local stakeholders (& integrated)- Local Estates Forum (LEF)

• Local co-ordinators appointed from DH landlord companies:- NHS Property Services Ltd (NHS PS)- Community Health Partnerships Ltd (CHP)

• Groups of local CCGs may produce joint strategies

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Stated benefitsOperational

• Functionally suitable, high quality environments for healthier outcomes

• Flexible facilities to support multiple services

• Improved utilisation efficiency

• Enable new models of care

Estate

• Reduce costs- Utilities- Maintenance- Security- Rent- Depreciation

• Tackle maintenance backlog

• Statutory compliance

• Release surplus assets for disposal

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Scope

• Primary and community care estate

• Non-clinical estate, such as office/administrative bases

• Engagement with secondary and tertiary care estate

• Engagement with wider public sector estate

• Link with Cabinet Office One Public Estate programme

• Integrate with [existing] plans of Secondary and Tertiary care providers

• Costs to be met by commissioners

• CCGs to provide senior managerial and member inputs

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Strategic planning process1. Getting prepared

- Governance structures, terms of reference and processes- Identifying the sites/scope and/or data sources for the estate

2. The estate that you have- How it performs and how it is used- What are the opportunities and threats

3. The estate that you need- So much easier said than done!

4. Gap analysis

5. Options identification & testing

6. The local estate strategyClick here for the full guidance note

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“Strategic Estates Planning should be part of business as usual and not a one off activity. Each local area can decide how the strategy fits into what is already happening locally, as long as it meets all of the key characteristics detailed above.”

Shortcomings

• ‘Roadmap’ laid out is linear & prescriptive – fails to stress need for strategies to be adaptable to opportunities & threats

• Vital that full capacity over time is identified in collection of estate utilisation data.

• The ‘estate you need’ needs to reflect tri-cornered approach to service [re]design: people – buildings – technology

• No provision made for auditability of decisions made by stakeholders through us of transparent option scoring and weightings

• Process [and timescale] does not provide scope for vital iterativity

• Throwaway line says strategic estate plan should be part of business planning cycle but process described is a ‘one off’ solution

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Preferred iterative 3D modelA good estate strategy should be open to changing circumstances which represent opportunity and resilient to threat. It should not be rigid and prescriptive, better offering a unified approach and framework within which to develop locality plans and, for larger sites, development control plans.

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Data collection• Much of the data

needed has already been collected

• It just needs to be joined usefully (map-linked?) in a database and analysed

• Needs for change or even potential solutions should be identified by suitable queries e.g.

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• Consulting room capacity for all single-handed GPs on GMS contracts in leasehold buildings with 10 years or more unexpired and in areas of population growth

• Costs of occupation for GPs in leasehold premises where weekday room utilisation is below 50% and outstanding costs of compliance improvements exceed £50,000

Resourcing

• List of [local] ‘strategic estates advisers’ identified in NHS PS and CHP

• Both companies currently stretched – will individuals listed all have appropriate skill sets and/or sufficient time?

• Do commissioners have confidence that landlord companies will explore all options independently (conflict of interest)?

• Some will seek help from to independent professional practices

• Others will use or LIFTco frameworks but is this a serious conflict of interest too?

• CCGs to fund professional costs – value for money12

What next?

• First decide if intended to undertake strategic estate planning in conjunction with other commissioners, form a LEF, identify stakeholders and agree governance structures

• Early liaison with NHS PS and CHP ‘strategic estates advisers’

• In most cases CCGs should be clear they independent professional advice is required

Lester Wagman has over 25 years’ experience in providing strategic property advice to clients from the public and private sectors, including 5 years working in the NHS. He has spent the past 15 years advising the public sector and its private sector partners, focusing mainly on healthcare.

He specialises in strategic estate planning, working collaboratively with healthcare organisations to rationalise and harness their assets in the most effective way possible to deliver high quality services.

Email or call on 07765 220519 to discuss your project 13