NHS Property Board ‘unable’ to make important decisions, says outgoing government adviser

The board was set up in 2017 after Sir Robert Naylor’s review of NHS estates and was tasked with providing leadership and strategic direction. Speaking exclusively to HSJ, Sir Robert said the board had become a “classic bureaucratic NHS board with large numbers of people of insufficient seniority talking about details and unable to make decisions”.

The former chief executive of University College London Foundation Trust also said the board, which was created by the Department of Health and Social Care, fell victim to ministerial “musical chairs” and that it became more like a performance-management body than a strategy unit.

The DHSC told HSJ the Property Board has been repurposed as the Strategic Infrastructure Board. 

Sir Robert’s comments came in an interview with HSJ in which he reflected on progress made on NHS estates since his review four years ago.

In his review, Sir Robert recommended the creation of a “powerful new NHS Property Board” which would be an arms-length body providing leadership at the centre and expertise and delivery support to STPs.

The government, under then health secretary Jeremy Hunt, subsequently set up the board but chose to keep it within the DHSC and have it chaired by a minister. Its membership includes representatives from DHSC and NHS England, and it is currently chaired by health minister Ed Argar.

However, Sir Robert said the board has “not had great significance because of its membership”.

He said: “What I had in mind was a small group of very senior and influential people who would take a very strategic approach. That’s not what turned out to be the case.

“What happened as a consequence was that the Property Board turned into the classic bureaucratic boards that exist across the NHS, with larger numbers of people of insufficient seniority talking about detail and unable to make decisions.

“It had some excellent discussions – but a lot of it was more operational than strategic, and it became more like a performance management group than what I had in mind.

“It needed Sir Simon Stevens there, whereas what we got was someone third or fourth in line who would report back to him. If you’re thinking about something as important and strategic as this programme it was dealt with at a much lower level than was really needed.

“I would have preferred many fewer meetings with more senior people than more meetings with large numbers of junior people.

“Much of the discussion that led to the Health Infrastructure Plan (which includes the“40 new hospitals” scheme) came from outside the board, either in one-to-one discussions with ministers, the secretary of state or the prime minister.”

Sir Robert also said the board had been hampered by a high ministerial turnover.

At least four ministers (Lord O’Shaughnessy, Steve Barclay, Stephen Hammond and Ed Argar) have had NHS estates in their portfolio, and Sir Robert said he never met two of them.

“There was one period where there were three ministers in a matter of few months,” he said.

“When you appoint a new minister to take on such a complex area of work it takes some time to get to grips with it, and then they change. Playing musical chairs with ministers wasn’t helpful during this period and there was a lack of continuity.”

Sir Robert said the Property Board had been “reviewed” several times in the last few years, and that it was being “reconstituted” as he stepped down from his position as an advisor.

A spokeswoman for DHSC told HSJ the Strategic Infrastructure Board comprises ”senior leaders across the major national partners with a role in health and care infrastructure, as well as indepdent expert advisors, to discuss and advise on key strategic priorities for the NHS estate and healthcare capital investment”. 

She said the board’s “first big piece of work” was reflecting on lessons learned during the pandemic. The spokeswoman added: ”It [the board] is now in the process of setting new strategic direction: feeding into big cross-cutting priorities like the Health Infrastructure Plan refresh and sustainability.”

Story updated at 5.37pm on 21 April to include comment from DHSC.