The next five years could see large scale sell offs of unused NHS property to release funds to help the health service move rapidly to new models of care.

The prospect of coordinated land sale programmes to enable “pump priming” investments in service reform is set out in the NHS Five Year Forward View, a document expressing the shared view of national NHS leaders on the coming half decade.

The document, published today, says that the health service could achieve efficiency gains even greater than those accomplished in recent years if it “gets the needed infrastructure and operating investment” to rapidly introduce new service models and ways of working.

It also suggests some of that funding could be raised by selling off surplus NHS property and encouraging foundation trusts to invest their accumulated surpluses. FTs currently have cash totalling around £4bn sitting on their balance sheets.


NHS organisations could raise funds from selling off parts of their estates they do not need

The forward view says that the national NHS bodies will work with local organisations to design “a model to help pump prime and ‘fast track’ a cross section of the new care models”.

It adds that this model could “unlock assets held by NHS Property Services” and other surplus NHS property, and “support foundation trusts that decide to use accrued savings on their balance sheets to help local service transformation”.

NHS England chief executive Simon Stevens told journalists yesterday that “a certain amount” of the funding needed for investment was in “estates that we have got”.

He said there was an estimated £7.5bn worth of unused or underused NHS buildings across England, including in the largest cities. He added: “FTs have got accrued savings on their balance sheets but have been prevented until now from using them to invest in primary care services or out of hospital care.”

However, the tranches of property that could potentially be sold were not necessarily sitting in the organisations or local areas, where investment is most urgently needed.

HSJ understands it is not likely that transition funds raised from land sales could be pooled on a national basis, but they could be pooled regionally, for example within London.

The proposition that FTs will be encouraged to invest accumulated surpluses will also require significant further work.

Under current Treasury rules, any expenditure of cash sitting in FT bank accounts counts against the Department of Health’s departmental expenditure limit. It therefore needs to be offset by underspending by other NHS organisations to avoid blowing the DH budget.

Asked by HSJ how FTs could spend their accumulated surpluses on expanding primary care without breaching the limit, Monitor chief executive David Bennett said: “We will have to work out how to deal with that.”

The forward view says that the plans for reforming care models that will be fast tracked will be those “likely to have the greatest impact for patients, so that by the end of the next Parliament the benefits and costs of the new approaches are clearly demonstrable, allowing informed decisions about future investment as the economy improves”.