NHS pilot project puts healthcare estate under the spotlight

Running cost of NHS estate comes under the microscope as experts claim current services are 'unsustainable'

The sums do not add up. To protect NHS services moving forward, there are some tough decisions to make in terms of the estate

The running cost of the NHS estate is coming under the microscope as the Department of Health launches a pilot project aimed at spreading good practice across the country.

At last week’s IHEEM Annual Conference held in Manchester, delegates were told 10 trusts were taking part in a study to see why some organisations performed better than others and why success was not shared.

Peter Sellars, head of profession for the NHS Estates and Facilities Policy Division at the Department of Health’s Group Operations and Assurance Directorate, said: “We are working with a mix of trusts, some with good financial figures and some that are not so good. The work is detailed and we are diving deep into each organisation.

“It will be a bumpy ride to understand the variations in the running costs of NHS estates, but we are looking to report our findings in November. All trusts will then be meeting to look at the early evidence and we will be looking at things we can repeat nationally.”

A recent report from built asset consultancy, EC Harris, claims the NHS can contribute around £1.5billion to the Government’s efficiency agenda.

For me there is no doubt that the estates team are doing a great job, but to extract value from the estate and to deliver safe and quality and cost-efficient services, you sometimes need to make difficult decisions

“If every organisation could go from high cost to medium cost, it is predicted we could save £1billion,” said Sellars.

“The level of some of the innovative thinking we are starting to see is incredible. We need to come together and understand what the barriers are for other trusts. This means releasing assets we don’t need. The current way we manage the estate is clearly not sustainable.”

Julian Hartley, chief executive of Leeds Teaching Hospitals NHS Trust, agreed that estates and facilities professionals have a big part to play in driving efficiencies in public services. He told the conference: “Our estate has been a challenge. We have one of the biggest estates in the NHS and over the years it has developed in a piecemeal fashion. Ours is no different to other trusts.

“This is probably the most-challenging time financially in my career and we all have some major challenges to tackle. For me there is no doubt that the estates team are doing a great job, but to extract value from the estate and to deliver safe and quality and cost-efficient services, you sometimes need to make difficult decisions.”

Key will be ensuring buildings support the delivery of modern healthcare services, which are changing to become more patient-centred and community based.

Hartley said: “Many of our estates are made up of old and new buildings and that presents challenges. We have a whole set of services we are trying to reshape and remodel and an estate that, quite frankly, is not fit for purpose.

“Over the coming years we will be seeing a lot more specialist services, such as trauma and stroke, and we need to ensure our estate supports the delivery of these.”

Matthew Williams-Grey of Capita said economists estimate that to provide a national health service free at the point of contact, the UK needs to spend 10% of its GDP. At its highest, it has ringfenced just below 8.5%.

We have to change the way we deliver care. There will be no single approach or model across the country, but it will be based around a robust patient and clinical pathway

And, with an increasing birthrate and added pressure from an ageing population, experts say more than four million square metres of additional healthcare estate will be needed to maintain the status quo moving forward.

Williams-Grey said: “We have to change the way we deliver care. There will be no single approach or model across the country, but it will be based around a robust patient and clinical pathway.

“It is about reconfiguring the estate to deliver that, not to hamper it, and refocusing the estate on care and enabling technology. If we do that then hopefully we will not need to build 13 new district general hospitals over the next few decades.”

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