Estates managers must develop a strategy to align with Transforming Community Services. Rachel Sudders looks at the issues they will face
The Transforming Community Services programme is a tremendous opportunity for estates managers to help to shape the long term future and stability of their primary care trusts.
As a tenant, a PCT will want to consider whether a building is adequate for the provision of services
To get there requires an analysis of the current assets and clear goals, with a strategy on how to achieve them to ensure the posterity of the estate.
The programme aims to improve community services so they provide modern, personalised and consistently high quality care. One aspect of that is to separate PCTs’ provider and commissioning functions.
The programme guidance recommends that responsibility for the estate should normally remain with the commissioners.
A deadline of April 2010 was set for PCTs to agree with their strategic health authority a commissioners investment and asset management strategy setting out how the PCT will ensure its estate commissioning. The strategy must cover all estates from which services are delivered.
Further guidance has been published recently on how the strategy can be prepared and developed and yet more guidance is on its way.
What are the issues faced in developing a strategy?
The commissioners investment and asset management strategy is based on basic information and assessment of fitness for purpose, using the Department of Health toolkit, to understand the cost, quantity and quality of the estate and whether it is adequate for the services to be delivered.
Once the audit has been carried out, the PCT’s budget for its estate requirements is essential to determining the strategy. Consideration will need to be given to matters such as can the PCT afford all of the space? Is there an opportunity to sublet space, share or surrender leases? Can savings be made by renegotiating rents or reconsidering the valuations of properties on the register?
The audit may reveal discrepancies such as premises on the capital register which the PCT no longer occupies or a lease which needs to be renewed.
Occupational arrangements need to be formalised regardless of whether the PCT is the landlord or tenant.
For the PCT as landlord, consideration should be given to the existing arrangements and ensuring that a recovery of a fair proportion of all outgoings, including maintenance costs, is secured from tenants. This will assist when budgeting for the cost of estate maintenance for the coming year.
As a tenant, a PCT will want to consider whether a building is adequate for the provision of services.
If not, decisions will need to be made about whether the PCT spends capital on the premises to bring them up to standard or whether negotiations can be entered into, or opportunities taken to exit the premises and find a modern alternative.
Structures for development
Structures such as management contracts, strategic partnerships, and joint ventures like strategic estate development vehicles and local improvement finance trusts, for both ownership and management of estates, have developed a lot in recent years.
Considering how property should be held and managed in these schemes is essential. Where exclusivity arrangements with a local improvement finance company that will be the first port of call.
Budget, method of procurement, land ownership, duration of proposed healthcare service and capital account treatment will all influence the choice of development structure.
When considering structures for new developments or letting structures for existing property, PCTs will have to be aware of how the property documents will provide for the cycles of various tendering requirements - linking property documents to commercial services contracts.
The results of the recent inquiry launched by the NHS cooperation and competition panel following the merger of Bedfordshire and Luton Partnership PCT with South Essex Partnership University Foundation Trust will be important, as it looked into how far the NHS should retain control of its property when it puts services out to tender.
It is hoped that the results of the inquiry will deliver some solutions which could be applied when dealing with the provider/ commissioner split issues that are arising. The ultimate result should be an efficient, managed, fit for purpose estate for PCTs.
Implementation of a commissioners investment and asset management strategy is obviously a time consuming and complex task and these are just some of the relevant issues.