Analysis: The trusts targeted by Carter for estates savings

Lord Carter’s review of NHS productivity made key recommendations around non-clinical and unused space, which trusts will be expected to meet by April 2020.

Trusts have been told to plan to operate with a maximum of 35 per cent of non-clinical floor space and 2.5 per cent of unoccupied or underused space, where appropriate.

The Labour peer believes the new targets could help deliver £1bn of estates efficiency savings by 2020.

The 2014-15 estates returns information collection (ERIC) was used to estimate the savings. Benchmarking data was sent to every acute trust, but has not been published.

However, analysis of the ERIC data, which was possible after HSJ learned the methodology used by Lord Carter, suggests some trusts face a huge challenge to meet the targets.

There are acknowledged flaws in the data, however, with some trusts admitting they made inaccurate submissions.

A recent letter to trusts from Peter Sellars, who is leading the work for the Department of Health, said there would be engagement with trusts to develop a “monitoring and reporting framework”, and work to establish a “better understanding of the cost efficiency savings which will need to be delivered by your respective organisations”.

He said trusts with the largest proportion of non-clinical space and highest running costs for their estate were likely to be prioritised.

One factor to be considered is training and education space, as many of the apparent outliers are teaching trusts, which may need “non-clinical” space for teaching purposes.

HSJ has used the data to benchmark trusts on non-clinical space, unoccupied or underused space, and estates costs per square metre (see tables, below).

An estates director and a private sector source with knowledge of the issues both told HSJ the ERIC data has not previously been used to benchmark trusts in this way, and they expect there to be significant changes in this year’s collection, as trusts will pay far closer attention to how they report the data, and what they include.

Lord Carter’s report said savings could be made if high spending trusts brought their costs down to the median for the sector, with the current variation between £105 and £970 per square metre.

He acknowledged there were “imperfections” in the data, but stressed that reporting needed to improve as this is the data that will be used “for a more open and integrated approach to performance management”.

Trusts with the highest estates costs per square metre
Trust	Cost per square metre
Norfolk and Norwich University Hospitals FT	£970
Barking, Havering and Redbridge University Hospitals Trust	£837
Kingston Hospital FT	£812
North Middlesex University Hospital Trust	£764
Worcestershire Acute Hospitals Trust	£741

Trusts with the highest proportion of non-clinical space
Trust	Non-clinical space as % of total
Northern Lincolnshire and Goole FT	69
Bradford Teaching Hospitals FT	68
University College London Hospitals FT	65
Newcastle upon Tyne Hospitals FT	63
Sheffield Teaching Hospitals FT	62

Trusts with highest proportion of unoccupied/underused space
Trust	Unoccupied or underused space as % of total
University Hospitals of Morecambe Bay FT	36
Ipswich Hospital Trust	34
London North West Healthcare Trust	24
Barts Health FT	18
Hillingdon Hospitals FT	17

Of the trusts that responded to HSJ’s enquiries, about half acknowledged the work they needed to carry out, without pointing to flaws in the data or benchmarking process.

Ipswich Hospital Trust, where 34 per cent of space was classed as empty or underused, pointed to its single storey buildings and network of long, wide corridors, across a 46 acre site with buildings at each end.

Its recently published estates strategy laid out plans to close some buildings at the north end of the site and consolidate services at the south end. The trust said spare land could potentially be sold to residential developers.

North Cumbria University Hospitals Trust said its high proportion of underused space relates to a tower block at Cumberland Infirmary and parts of the old West Cumberland Hospital in Whitehaven, which need to be demolished. Many of York Teaching Hospitals’ underused sites are community facilities in the Scarborough area, and it said it had plans to dispose of sites, or bring them back into use.

Luton and Dunstable University Hospital Foundation Trust said its high costs “reflects both the age of many of the buildings (pre-1940s) and the range of specialist services we run from a relatively compact site”. Major redevelopments are planned.

Barts Health Trust said it is working to make better use of its surplus space, but pointed to its large education and training facilities as one cause of its high proportion of non-clinical space.

Portsmouth Hospitals Trust said there was an error in its submission which dramatically changed its “costs per square metre”, which should have been £387 instead of £571. Northern Lincolnshire and Goole FT also said an error may have skewed its figures, relating to residential buildings being included.

Norfolk and Norwich University Hospitals FT, which had the highest proportional costs according to the data, and University Hospitals of Morecambe Bay, which had the highest proportion of underused space, did not respond.