Daily Insight: Estate of the nation

Naylor’s gold

There is some comfort for NHS leaders in the government’s response to the Naylor review on NHS estates.

The Department for Health and Social Care has backed the idea of sustainability and transformation partnerships keeping land sale receipts.

Foundation trusts could always keep this cash (as long as they weren’t in special measures) but the privilege is now to be extended to humble NHS trusts too. But this freedom will only be with the approval of the STP.

The arguing over whether, for example, a trust would want to sell land to pay for the refurbishment of someone else’s GP surgery is yet to be had – though that’s what STPs/ACOs are there for.

The arguments will be overseen by the arm’s length Strategic Estates Partnership and the non-arm’s length NHS Property Board.

The latter will be chaired by health minister Lord O’Shaughnessy and it remains to be seen whether its firm retention by the DHSC – in opposition to Sir Robert’s recommendation – will make it more or less “powerful” than the former UCLH chief executive intended.

Sir Robert acknowledges in an HSJ interview that the sums at stake might warrant the board being held close to Whitehall, but implicitly questions whether the DHSC has the capacity to manage multiple multimillion pound schemes.

STPs are in different states of array nationally so progress will likely be uneven.

It seems bold of a minister to want to retain direct responsibility for something as potentially contentious as land sales. Imagine the responsibility as the business cases come in, each pointing to the avoidable patient harm that only capital funds can prevent.

More bureaucratically, NHS Property Services, the heir to more than 3,500 primary care trust properties, and Community Health Partnerships, the procurers of small scale private finance for primary care facilities, will not be merged with the NHS Property Board.

The implication is that NHS Property Services has too much fiddly tenancy and repairs work to get on with and would distract from the new board’s grander mission.

Sir Robert said he expected NHS Property Services to eventually disappear as it disposes of its portfolio.

The DHSC and Sir Robert trumpet the increased Treasury funding as one component of the £10bn required to bring NHS estates into a fit for purpose state. But it’s not going to feel like a bonanza; it’s important to stress this is an extra £3.5bn a year in 2022-23 – the amount added to the £4.8bn annual budget in each of the four years until then will be considerably smaller. The rest of the £10bn is selling land and getting private investment.

And Sir Robert is one of the people who believe that the NHS backlog maintenance problem is considerably worse than official figures indicate.

The better news might come from the place everyone is most fearful of: the private sector.

Sir Robert told HSJ he’d spoken to a pension fund willing to invest £5bn at 2 per cent interest over 20 years – and do it in such a way as to keep it off the Treasury’s official public borrowing total.

Will the fairly devolved Greater Manchester or the slightly devolved London reach out to grasp opportunities of this scale from private finance?