Essential insight into England’s biggest health economy, by Ben Clover

The first drafts of 2018-19 financial plans have to be in today, and it will be interesting to see how organisations reconcile “estates-disposals-to-break-even” with the top-down “estates-disposals-to-hit-the-national target-for-estates-disposals”.

There is pressure on both fronts but it varies.

Either way, it is supposed to be led (or at least coordinated) by the 44 sustainability and transformation partnerships (there are five in London). At a conference last week, Sir Robert Naylor told delegates their effectiveness varied significantly.

The conference heard from a non-executive director at one north west London provider trust that although he was supposed to be signing off disposals, the governance arrangements with the north west London STP were far from clear.

In fairness to North West London STP, it has been working on estates issues but came into conflict with NHS Property Services last year, which owns a substantial amount of the primary care and community estate in the patch.

Another speaker noted the difficulty the STPs were having pushing this agenda considering they were non-statutory bodies trying to twist the arms of organisations that actually legally exist.

Staying with NWL, it’s hard to discern the STP’s influence on the capital’s biggest estates story since the attempted closure of Barts in the 1980s: moving the Brompton to Waterloo.

The Royal Brompton and Harefield Foundation Trust is proceeding with this medium term plan despite the misgivings of its NHS and academic neighbours.

The board of Chelsea and Westminster Hospital FT last week received a report on the move saying “the view of many in NWL [is] that the move of services from Fulham Road threatens a far wider patient population than cardiology and respiratory alone, and the Royal Brompton board, and NHS England as the primary commissioner, should consider its obligations to all patient care in NWL. Acute, specialist trusts and academic institutions are part of a wider network that includes joint appointments, facilities and many shared services such as cancer surgery, specialist paediatrics, cardiology support and palliative care.”

It said Chelsea and Westminster would have “significant reservations” about a plan “that looked to move services from NWL”.

The Brompton would probably point out that the situation is not of its making and that as a national centre only about 5 per cent of its work comes from the north west London boroughs.

The centre’s threats about trusts not getting capital funding until disposals are agreed have not yet manifested themselves.

The system has yet to see a tangible example of an organisation punished in this way.

HSJ understands from a highly placed source that of the six STPs considered to be successfully pushing the estates agenda, none were in London.

In its defence, the strategic estates partnership (the national team set up to support STPs with this, which is not the NHS Property Board chaired by Lord O’Shaugnessy) now has advisers assigned to each of the 44 areas.

Another speaker at the conference made an interesting point about reluctance to move to new estate: it’s more expensive.

There’s not just the expense of decanting services, tearing down the old place, selling part of the land, and then rebuilding and moving back in – the estates charges paid back to the centre are higher than they would be on something built in Bevan’s time – even though actual maintenance costs would be lower.

Simon Stevens, Ian Dalton, Department of Health and Social Care finance boss David Williams and permanent secretary Chris Wormald were grilled by the public accounts committee about capital funding on Monday.

Mr Williams would not commit himself to a date by which capital to revenue transfers would be outlawed.

At his last board meeting before resigning as chair of King’s College Hospital FT, Lord Kerslake said “you wouldn’t run a fish and chip shop this way” about how the last minute, short term way capital funds were allocated by the NHS’s central bodies. Whitehall, which he previously ran, plans on 10 year cycles.

NHS Improvement’s Simon Corben, who runs the estates and facilities directorate, hit back at criticism of the capital approval process, saying many of the business cases that landed on his desk were not worthy of the name. He also appeared lukewarm about the momentum of Project Phoenix, the unfortunately named programme led by Community Health Partnerships (which leads on mini private finance initiatives for primary care developments).

Is there a way forward for London?

Sir Robert thought the mayor’s office was key to getting through the morass created by competing section 106 payment demands from local authorities for any development. He said this issue had complicated the plan to move Moorfields Eye Hospital to a site behind King’s Cross. The mayor’s powers to overrule local authority planning decisions could be key here, he said.

(Speaking of Sir Robert, it appears the DHSC will never officially release his second report estates report, the one specifically on the potential for development on NHS sites in London – a Freedom of Information Act request was turned down last week.)

The HSJ Strategic Estates Forum is taking place on 20 March at BMA House in London. This is a high level strategic forum that brings together estates directors, sustainability and transformation partnership estates leads and trust board leaders responsible for the estates function who are developing strategic plans for their organisations and local health economies. The focus of the forum is on issues such as the delivery vehicle for the Naylor Report, the creation of Project Phoenix, advice on establishing strategic estates partnerships and assessing progress of STP estates plans. Sir Robert Naylor, national adviser, NHS Property and Estates; David Williams, director general of finance, Department of Health and Social Care and Simon Corben, head of profession, NHS Improvement are all confirmed as keynote speakers for the event. Register your interest for this free to attend event on our website: https://strategicestates.hsj.co.uk/register-your-interest-attending