Essential insight into England’s biggest health economy

Some clarity on estates

The minutes of the London Estates Board meetings over 2017 are anguished about the delays in getting clarity on estates.

The capital got passed over for running pilots of the new Strategic Estates Teams, which will advise the now-not-arms-length NHS Property Board and the sustainability and transformation partnerships.

Its STP plans didn’t receive a ringing endorsement from November’s budget, with London schemes being just two of the 12 approved.

A big issue was the retention of money earned from sell-offs. The Department for Health and Social Care’s assurance that sale proceeds can be “banked” with the department until they are needed for a redevelopment should reassure planners. But it’s not yet clear if that will reassure trust directors of finance, who were often sceptical about whether their specific organisation would get to keep the cash, rather than it being controlled by their STP.

Other problems around expertise remain.

North West London STP’s Clare Parker (who is absent and whose role is being covered by Jules Martin, managing director of Central London Clinical Commissioning Group) pointed to the lack of technical skills around things like sale and leaseback. Important things to get right, especially in the light of the ongoing uncertainty around NWL’s big capital scheme.

‘Expert resource’ brought in to look at King’s finances

Next week could be a big moment for one of London’s listing behemoths.

The public board meeting will be the first since new chair Ian Smith took over following the very public resignation under protest of former chair Lord Kerslake. Readers and even non-readers might recall the former head of the civil service said the situation the trust had been in was untenable and that he had no choice but to leave.

He was following in the path of the finance director and chief operating officer. The organisation was looking at a deficit of more than £96m.

In his leaving interview with HSJ, NHS Improvement chief executive Jim Mackey singled King’s College Hospital Foundation Trust out for some quite pointed criticism on finances, decrying the trust’s supposed inability to stick to any of the numbers it promised over the years.

A big specialist trust like King’s does a lot of its business with NHS England’s specialised commissioning team, and papers released by NHS England to Eye reveal they have hired in an “expert resource” to look at the coding coming out of Denmark Hill.

There’s a fair bit more to come out on this story and the approach of Mr Smith, a figure as deeply-steeped in the private sector as Lord Kerslake was with the public, can’t help but be decisive.

Were he to maintain his predecessor’s position in defiance of the centre it would effectively declare that flagship specialists in the capital cannot survive under post-Project Diamond rules.

If he tacks the other way then what remains of the senior leadership team at trust will be in a very uncomfortable position.

With the national picture for quarter three finance looking, perhaps, unhappy, the performance of King’s and a couple of other £1bn-plus turnover trusts could have an outsize effect.

I’m Still Standing up for public health

But let’s try look at something innovative in south London, a project that looks to improve a public health problem with a bold use of private funding and a sprinkling of stardust.

I’m talking about the HIV project piloted across Lambeth, Lewisham and Southwark by the Elton John Aids Foundation, and which is funded and governed by a social impact bond.

HIV service provision is commissioned by a combination of local authorities, CCGs, NHS England and Public Health England.

Under the social impact bond, investors provide a sum upfront for services which they gradually recoup as certain performance measures are hit.

The theory being that there is all kinds of preventative work that is a low priority for government investment because the results are not seen for some time, even though the savings could be considerable.

The funded outcomes in this case are the diagnosis of new cases of HIV; and re-engaging with people who have dropped out of HIV care.

At the moment, the cash comes from Sir Elton’s charity, plus a bit of lottery funding but the six year scheme hopes to attract other funders.

With public health budgets under unprecedented strain after repeated raids to shore up more visible bits of the NHS, it comes at an interesting time for private investment.

Last week HSJ reported Sir Robert Naylor’s revelation that one pension fund was prepared to invest £5bn in NHS estates programmes (that’s £200m more than the DHSC is prepared to invest per year).

When London Eye spoke to consultants in the pension fund world they said the direction of travel for these (often gigantic) funds was towards low risk, moderate return investments – of which NHS infrastructure schemes were a great example.

However limited London’s devolution is, there is a chance to do something quite exciting in the capital.

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, sustainability and transformation partnership 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 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 Social Care 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: https://strategicestates.hsj.co.uk/register-your-interest-attending