One of the keys to success of the community hospital.programme will be the development of sustainable partnerships, both within local NHS and local authority communities and also with innovative GPs and other private and voluntary sector providers

The Your Health, Your Care, Your Say white paper highlighted the desire to bring healthcare services closer to home and referred to a partial budgetary shift from acute to primary and community care. In practical terms, the change in emphasis is intended to enable some healthcare services, such as minor operations, various diagnostics and follow-up care, to take place outside acute hospitals and closer to home, with more input and management from primary care.

Last year, the Department of Health.announced it would be investing£750m over a five-year period, for a new generation of community-based facilities to:

  • build new community hospitals;
  • renovate existing community hospitals;
  • convert old acute hospitals into community hospitals.

One of the keys to the success of the community hospital programme will be the development of sustainable partnerships, both within local NHS and local authority communities and also with innovative GPs and other private and voluntary sector providers. The likely procurement delivery models do give hope for sustainable long-term joint working initiatives, because they are to be based on service-led considerations, which in turn rely upon detailed local planning, consultation and engagement.

This must include consideration of how any new and developed community services will relate to the rest of the local health economy..It will primarily be primary care trusts.that act as the commissioning hub around which community hospital plans can be developed.

Where the emphasis is on upgrading existing infrastructure, NHS local improvement finance trust (LIFT).arrangements may be attractive. The public procurement issues for PCTs should be manageable. There is also ongoing discussion about expanding the concept of NHS LIFT into the field of clinical service provision.

Risk management
More innovative service solutions may more readily be right for the new community venture approach. The contractual model is not a prescriptive one (it has to meet local needs), but the concept is essentially a true 50-50 joint venture arrangement, with local NHS/DoH (and potentially also local authority) shareholders, alongside private and/or voluntary sector providers in the same corporate vehicle..The increasing use of social enterprise structures, potentially as a kind of 'umbrella organisation' for the public sector stakeholders, may well be part of the community ventures picture.

If there is a 50/50 joint venture vehicle, linked to long-term SSDPs (strategic service development plans - a concept developed under LIFT) jointly developed by public, independent and voluntary sector bodies, and based upon detailed local planning and consultation, they could well be sustainable.

They should be better at taking an informed commercial view of risks and consequently have a better approach to risk management. They may also be able to operate more like real businesses, particularly if more flexible methods of funding than traditional ringfenced project finance can be used.

Lessons will need to be learned from previous healthcare procurements. For example, making available standard joint venture documentation plus extra procurement support and knowledge transfer from the.Department of Health to the PCTs undertaking local procurements..A DoH enabling (rather than a controlling) role could prove very effective in the development of the community hospital programme.

Colin Lynch is a partner at Capsticks

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