Do you really need to book that hotel room? How the NHS is learning to get the most out of what it has…
Since last autumn Citycare, the Lift (local improvement finance trust) public private partnership company for Hull, has been working with Hull clinical commissioning group to audit beds in the community. It aims to get a much clearer sense of what provision there is, what condition that provision is in and how that resource can be better applied to service needs.
“Buildings are vessels for services to be delivered from; you need to know what the building is going to be used for and consider how you are going to make the most back from it,” explains chief executive Jo Barnes.
Count your pennies
“In the current climate every penny, and every bit of space, has to be maximised,” she says.
“You do not want to spend money on something if there is no service need for it. There needs to be a link between service planning and estate planning. Often people do it just from either end,” she adds.
The audit is looking in detail at how space is used and booked, how well resource is allocated on paper versus what happens in reality and how to bring things more together. The second phase of activity will be to look at spending activity and, from there, draw up a new service plan.
‘In the current climate every penny, and every bit of space, has to be maximised’
“The estate is a dynamic thing. We have buildings that have been open seven or eight years and have been through two or three iterations of tenants. Things have changed, you cannot do things as you did them, say, 40 years ago,” says Ms Barnes.
“It’s not just a case of ‘is a space let or full?’ it’s a question of ‘are you using it for the greatest service benefit?’. Long term strategic planning has not always been knitted as closely together with estates as it should be. Often you find estates strategies will pay lip service to service strategies. Your head of service and head of estates should sit in the same office but often they do not,” she adds.
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Using space wisely
Another initiative will be the launch in the next few weeks of a new portal to encourage all public sector organisations within Hull to collaborate more when it comes to booking rooms or space. The aim is ensure organisations are using each other’s space rather than splashing out on a room in a local hotel.
“It should be a priority for the public sector to be booking rooms with other public sector organisations, perhaps with a common rate and a common website or phone number. It is so obvious, and everyone wins,” says Ms Barnes.
“Within the NHS we have a lot of properties that are treasures and a lot that are liabilities. We need to get rid of the liabilities and invest capital into improving the rest of the service space. We need to be much cleverer about integrating service delivery. It may be trite to say it, but it is a journey. One that will probably never end.
“We need to recognise there is no money, and there is unlikely to be, so we need to be working in more connected, realistic ways. It’s not all about shiny new buildings, it is also about making the best of the estate we already have,” Ms Barnes adds.
‘We need to get rid of the liabilities and invest capital into improving the rest of the service space’
The work Citycare is doing feeds into a wider landscape of integration, collaboration and transformation, argues Emma Latimer, chief officer at NHS Hull CCG.
The CCG is leading an ambitious transformation programme, Hull 2020, focused on developing a new landscape of integrated local health services by 2020. It will be one where the NHS, local authority, police, fire and ambulance services are all working more closely - and using their estate more strategically. Hull is also one of the pilot sites for the government’s One Public Estate initiative, which is aimed at encouraging public sector organisations to share or release unused buildings and land.
“We are looking to develop more community hubs, to ‘sweat’ assets, such as existing Lift buildings,” says Ms Latimer. “Overall, there is far too much public sector estate in this city and we need a system whereby we are better able to align strategies across the public sector.”
For example, the CCG is currently working on the business case for developing a new integrated care centre that can be used by other ‘blue light’ public services.
“If you are going to ensure that buildings are genuinely community assets it stands to reason they need to be available across the community,” says Ms Latimer.
“You need to make sure service transformation drives the estate rather than, as too often in the past, developing a building and then putting something in it,” she adds.
The Health Care Resource Centre (HCRC) in Widnes, Cheshire has been a busy, popular health resource for the local community in Merseyside for the past eight years. But this autumn will see it relaunched as an Urgent Care Centre designed to reduce the pressure on the acute sector and help the local Halton CCG meet government demands for 15 per cent cuts in A&E admissions over the next five years.
The £800,000 initiative is a partnership between Halton CCG, Halton Borough Council, Renova Developments (the Lift company covering St Helens, Knowsley and Warrington), NHS Property Services and Community Health Partnerships.
From a commissioning perspective, it is also a prime example of how a CCG is taking the lead in terms of driving and promoting a more strategic approach to estate management and planning.
‘Your head of service and head of estates should sit in the same office but often they do not’
Dave Sweeney, director of transformation at both the CCG and the council, has spent much of the past year working with Renova to put in place a collaborative, overarching estate plan for Halton - that overlays the NHS and Halton Borough Council plans.
It feeds into and complements the CCG’s priorities around improving health and wellbeing in the area and has also meant working closely with a wide number of local providers, including Warrington and Halton Hospitals Foundation Trust, St Helens and Knowsley Trust, Bridgewater Community Healthcare Trust and out of hours primary care service Urgent Care 24.
As Mr Sweeney explains: “We had the opportunity to reduce unwanted NHS estate, reconfigure the remaining space and improve patient care, and that just made perfect sense to me. We came together very quickly, set our stall out and established our joint vision.”
With the closest A&E departments several miles away and in an area that has one of the lowest levels of car ownership in the country, more strategic use of estate has meant providing a primary care based alternative to A&E as well as better integration of services such as mental health and wellbeing.
“We needed something on both sides of the water. In many ways we are as united as a borough as we are split by the Mersey. So it has been a question of looking proactively at creating a health ‘hub’ where people can go to access their GP as well as medical care; a building we can use to reduce the demand for non-elective activity and A&E admissions,” says Mr Sweeney.
The revamped centre will have a single new reception and waiting room (consolidating the six that used to be spread throughout the building); new X-ray, imaging, ultrasound and diagnostics facilities; an on-site pharmacy; wider doors and corridors (to accommodate trolleys); and a new children’s play area that will include state-of-the-art interactive media. This will ease the stress for parents and children awaiting treatment.
It is also expected to lead to the required 15 per cent reduction in A&E admissions over the next five years, as well as a 15 per cent reduction in non-elective admissions through A&E.
In the longer run, it hopes to deliver a 20 per cent reduction in A&E attendances.
‘We potentially now have so many different pieces of land or buildings that can be used in better ways’
Financially, the centre is expected to save the wider health local system £150,000 a year.
This is an important point, argues Mr Sweeney. The new centre has, clearly, required a significant investment upfront. While over time the savings will be significant, strategic estate management is often something that requires a longer term, system-wide perspective rather than assuming you will be able to achieve quick financial wins.
“The savings may be elsewhere. But, especially given the significant integration with our local authority, we potentially now have so many different pieces of land or buildings that can be used in better ways,” says Mr Sweeney. “If you are providing a local service where people do not have to travel, say, 20 miles to get to their A&E, the spin-offs are going to be really important. It is about investing for the long term.
“This is not about privatising the NHS, it is just about using its estate better. Estate management is, of course, not a panacea but, to me, it is absolutely essential, a key component towards creating a truly integrated approach,” Mr Sweeney adds.
The role of CHP in all this has been to, effectively, be the estate planning link between the NHS and other public services, says area director Mike Chambers.
“Rather than implementing plans from above, our partners rely on us to lead from alongside them,” he says.
“In Halton, success has been down to the energy and enthusiasm of the CCG. We have a local authority that is naturally collaborative and a Lift company with a great track record. Trust and cooperation are earned.
“Those are the ingredients that give real cause for optimism, because the resulting projects are ‘owned’ by local organisations and local people.” he adds.
Commissioning supplement: Time to step up
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