Essential insight into England’s biggest health economy

London property tulip fever has had largely deleterious effects on the NHS in the capital.

It’s asking a lot of the lowest paid staff to board expensive transport systems and travel four or more travel zones to work at one of the big name trusts.

As a chief operating officer told me a few years ago: “The NHS is good at specialist care, it’s routine care that the demographics are going to make a mess of.” Particularly in London.

But inflated land prices offer the NHS an opportunity here that other regions lack.

Sir Robert Naylor spoke to his report on estates at the King’s Fund this week and reiterated a couple of key points for the capital.

Ranking all 44 STPs by the size of the opportunity in using land better, London’s five STPs were the top five.

We’ve heard this before of course, and London Eye had a crack at working out what the four £1bn-plus sites were.

Sir Robert divulged two new things for London, though.

The national target is for the NHS to yield up 26,000 new homes from its surplus estate (but this was a David Cameron pledge, so how honoured it still needs to be is unclear). Delegates heard the former UCLH chief executive say London could hit this target on its own if it pursued an aggressive strategy.

This isn’t an example he gave, but it’s long been considered that you could sell 80 per cent of the St Mary’s site in Paddington, make a small fortune building flats and build brand new facilities there and elsewhere. New homes, new hospital and no backlog maintenance.

Sir Robert’s report has caught a lot of flak from the scantily informed, who think he’s proposing some kind of fire sale of assets.

But as he has said before, these housing units could be prioritised for lower-paid NHS staff, and they could be given equity to share in the price increases.

Sir Robert mentioned that the £5bn backlog maintenance cost estimated for English NHS was a “gross” underestimate. He cited one London trust that had an estimated backlog maintenance cost of £300m-£400m whose true total was more like £1.2bn.

He didn’t name it, but I’d be very surprised if it wasn’t Imperial College Healthcare Trust.

Introducing the session, the King’s Fund’s Siva Anandaciva wondered what it would take for the public to force the government’s hand on the NHS.

He said he’d expected this with finance collapsing and been wrong; with the welter of missed performance targets and been wrong; and now thought it might be when patients and their families noticed the dilapidation of buildings. He might have a point here: bricks and mortar are where the public’s feelings about the NHS coalesce.

The Care UK £55m

There was some confusion around the awarding of the North East London Treatment Centre contract last week.

Three of the relevant CCGs confirmed that Care UK had beaten Barking, Havering and Redbridge University Hospitals Trust to the running of the elective centre. They also beat a mystery third bidder.

The CCGs have stopped answering questions on this large-scale public procurement exercise, possibly because of its storied history, involving competition law challenges referred to Monitor (NHS Improvement still has these Lansley-era legal responsibilities, everyone forgets. Care UK didn’t forget).

BHRUHT is still recovering its elective treatment position. Although still treating huge numbers of patients who’ve waited more than a year, they are at least now reporting their data to NHS England and have some momentum behind them.

The trust chief executive issued a very dissatisfied statement on the outcome and there is the possibility it is not a done deal.

For one, Barking and Dagenham, Havering, and Redbridge CCGs (which were given legal directions of their commissioning of elective pathways by NHS England) have been weirdly coy about revealing how long the new contract is for, how much it is worth and other things you would have thought would be fairly straightforward.

For another thing, London Eye understands other stakeholders in the vicinity were not wholly happy with the outcome.

What with the resistance to top-down clustering in inner east London there’s a chance it could get more complicated before it gets less complicated.

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, STP 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 SEPs (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 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:

Revealed: How much NHS trusts made from land sales