Often overlooked or seen as a ‘bundle of problems’, estates should be considered a vital part of building improved services. Jennifer Trueland reports

Illustration of man looking under the roof of a small house



When Halton Clinical Commissioning Group wanted to bring the management of urgent care closer to patients’ homes, it turned out the answer was almost on its doorstep.

A hard headed look at local NHS estate revealed capacity at the then Widnes Healthcare Resource Centre, which was ideally located for an urgent care centre.

Not only would this solution mean that people from the town would be able to access urgent care without travelling eight miles to the nearest accident and emergency, but it also saved the cost of an expensive new build.

Strategic view

“It was amazing what we were able to achieve when we actually looked at the estate we had available,” says Dave Sweeney, director of transformation with Halton CCG and Halton Borough Council.

“Our eyes were really opened when we saw that taking a strategic view of estates, and making it a central part of commissioning, would mean saving money and improving patient care.”

‘It would mean saving money and improving patient care’

The Widnes Urgent Care Centre is the result of collaborative working between the CCG, Community Health Partnerships (CHP) and Renova Developments. The work to transform the premises is being done by Renova with the help of an £850,000 investment from the Department of Health, via CHP.

It is estimated that this investment will translate to:
● £150,000 savings to the local health system every year;
● a 15 per cent reduction in A&E attendances over five years; and
● a year on year reduction in non-elective admissions through A&E over the same period.

The centre is only one of many initiatives facilitated by CHP, an independent company, wholly owned by the DH, which supports commissioners, NHS England, GPs and local authorities to utilise their estates effectively.

Sue O’Connell on reforming the estate

There can be no question that interest in transforming the primary and community estate is growing rapidly. The NHS Five Year Forward View and the new deal for primary care have firmly focused attention on the drive towards new models of care and the integration of acute, primary and community based services in local hubs.

Add that to the announcements of combined budgets in Greater Manchester, 64 co-commissioning areas and 29 vanguard areas, and you can see how the momentum is really building behind innovation and change, and the role the healthcare estate has to play.

NHS England and the Department of Health are encouraging each local health economy to have a local estates forum in place, led by commissioners and bringing together NHS bodies, partners in local government, and other public sector voices.

It is expected that each of these forums will produce an interim strategic estates plan by the end of the year. To assist clinical commissioning groups in establishing and strengthening these forums and developing these plans, Community Health Partnerships, alongside NHS Property Services, has been asked to share our expertise across the country.

Every part of England will be offered a named strategic estates adviser who will provide free, independent advice to help fast track improvements in health facilities, laying the foundations for an infrastructure that is fit for purpose and able to deliver service changes. This will support cost reduction and optimal building use - as we are seeing in areas such as Widnes – and the identification of future need resulting from commissioning plans, the sale of surplus estate, and much more.

I’d urge all those involved to make contact with their local strategic estates adviser as soon as possible to get full value from this programme. Local health economies have already saved millions in recent years from improved property utilisation and we look forward to this work continuing.

We’ve seen how it really is possible to change the healthcare estate for the better, to divert finances from property to patient care by driving out inefficiency, and to improve facilities and utilisation of those facilities. With the right strategic planning and management the vision set out in the forward view can be turned into reality.

Alongside our target of supporting the NHS to deliver £100m of annual system savings by 2018, our business plan for the next three years is focused on sharing experience and expertise in strategic estates planning, through our customers, tenants, partners and stakeholders, to help them improve and gain better value from their estate and generate savings. We look forward to working with you on the journey.

Sue O’Connell, chief executive, Community Health Partnerships

Why better management?

At a time when commissioners and providers are struggling to get the best bang from the squeezed NHS buck, Antek Lejk, executive director and partnership lead for CHP, says they could be missing a trick in failing to see the potential in better estates management.

“I’ve been chief executive of NHS trusts and a primary care trust, and estates are too often seen as a problem rather than an asset,” he says. “Boards don’t look at buildings in the same way as they look at the workforce, for example. It’s a cultural mindset: estates are often seen as a bundle of problems, not a bundle of opportunities.”

‘Estates are often seen as a bundle of problems, not of opportunities’

One of the issues is a lack of ownership across the local NHS estate, possibly partly due to ongoing structural changes that can make it difficult to get a handle on where facilities fit into the local healthcare landscape. Add the move to greater integration between health and social care, and the estate question becomes even
more interesting.

Mr Lejk says the NHS Five Year Forward View, with its emphasis on partnership working, precisely chimes with the collaborative approach taken by CHP.

“When we read this new stuff, we think ‘yes, that’s us’,” he says. “But it is a change for the NHS. In an acute trust, you’re used to being in one world. But when you start to look at a system across a town, the complexity becomes harder and harder: there are so many things to consider, from the local authority to the police. That’s why we need to take a much more partnership approach to add value across the system.”

Crossing Boundaries

CHP brings the expertise and focus to help whole health economies work together for the ultimate benefit of local populations, he says. And one of the most important things is encouraging people to look beyond traditional boundaries and to make estate planning and management a central part of commissioning.

This is something that makes sense to Brian Ibell. Having spent around 40 years in the health service before taking early retirement, he is now local public sector director of Southern Derbyshire LIFT Company. “I’m enjoying trying to energise and empower people to make estates work better for them,” he says.

“The NHS talks about making efficiency savings and delivering better services, and there are two ways to do that: reducing staff or reducing overheads. Believe me, reducing overheads is less painful, and it upsets me that the NHS has not grasped the opportunity of reducing its estate and improving services for patients too.”

Out of the silo

He estimates that the health service has around 25 per cent too many properties, but says that the problem is that they are all in silos, with no one taking a strategic overview. “It can be difficult to get two or three different parties to agree. But estates have been largely ignored and they are large consumers of cash.”

In Derbyshire, he says, there is a growing willingness to work across boundaries to create integrated services that make sensible use of estate across the health and social care economy. Nationally too, he believes, it is only a matter of time before the Care Quality Commission starts cracking down on health bodies for failing to make the best use of their premises.

“I think estates will have their moment in the sun,” he says. “But you’ve got to have that strategic vision.”

That is something that rings true for Innes Richens, chief operating officer of Portsmouth CCG, which has been working with local providers and with CHP and its sister organisation NHS Property Services to optimise local estate.

“It involves looking at estates as a whole’

This major project involves moving clinical services from St James’ Hospital to St Mary’s Hospital, less than a mile away and previously underused. This means that the NHS can sell property at St James’ to be used for much needed local housing, while raising money for the health service.

Mental health services, currently based in contemporary buildings on the east of the St James’ site will remain in their current location. “It has involved stepping back and looking at estates as a whole,” says Mr Richens.

He believes that estates have often been seen as a “thing apart” in the health service, and that this should change. “I think estates have been in a separate silo, over to one side,” Mr Richens says.

“As commissioners, perhaps we have a different set of language and assumptions, but when we actually get involved with estates management then it really pays dividends. I think there has to be estates involvement in commissioning – it’s as vital a function as clinical leadership, finance, and everything else.”