Hanging on to the title deeds of the community estate must have seemed such a neat idea last year, as primary care trusts pondered the future of their soon to be departing provider arms. 

Transforming Community Services, you’ll recall, envisaged community services floating off here, there and everywhere. Into the welcoming arms of an existing foundation trust, into a social enterprise, into a brand new community FT, into partnership with a local authority: at times it seemed anywhere would do, as long as the PCT was freed to concentrate on commissioning.

But it’s hard to let go. Keeping ownership of the community hospitals seemed an elegant compromise. For if the new organisation has the buildings, went the logic, who else will wish to bid when a service goes out to tender? And what if the new partners turn out to be the rapacious asset strippers at the acute trust, vultures who’d just love to find next year’s cost improvements by filleting much-loved community services? So, said PCTs, we’ll retain the assets.

A year on, three community service managers recently described their lack of access to capital to maintain and develop community hospitals:

  • “We were not allocated a sum for capital spend until very late… and it was woeful relative to other years.”
  • “The PCTs have no capital to invest, and trusts are not putting anything up themselves.”
  • “All the focus has been on structural change, due diligence and business transfer agreements at the expense of transforming.`”

It’s not altogether surprising. PCTs, as commissioning bodies, no longer receive automatic capital allocations. Trusts are rightly wary of investing where the current site configuration seems precarious; which means pretty well everywhere. And staff redundancies will be a major drain on capital.

Yet the potential for efficiency gain is arguably at its greatest around the hospital/community interface. Leaving community hospitals under the control of impoverished and distracted PCT landlords, rather than motivated and committed owner-occupiers, already seems the wrong choice.

No one will thank us if this precious infrastructure is allowed to crumble.