The future of the healthcare estate: A fixed-cost challenge

How Guy’s and St Thomas’ NHS Foundation Trust is leading the way in improving the performance and cost effectiveness of the healthcare estate

As one of London’s leading healthcare organisations, Guy’s and St Thomas’ NHS Foundation Trust is, like all operators across the UK, facing a significant financial challenge.

It needs to use its physical estate more efficiently and effectively, both to reduce running costs and to improve and expand services in line with growing demand.

To address this, Essentia Trading was commissioned to undertake a widespread Healthcare Planning Diagnostic Review, aimed at identifying the potential opportunities and key areas of focus. Known as The Fixed Cost Challenge, the objective was to identify where the trust could either reduce its fixed costs by releasing assets it no longer needed, or to utilise them more efficiently to increase income.

Speaking to BBH, John Kelly, director of healthcare planning at Essentia, explains: “There are a lot of good things happening in the NHS, but it’s patchy.

“A lot of the work we do with trusts is planning capacity for the future. Healthcare and healthcare delivery is changing and we need to look at what the trade-offs are when meeting these demands.”

One of the key drivers for change is the Government’s shift to a seven-days-a-week health service, meaning there will be demands on things like diagnostics and blood testing services 24 hours a day.

“There is a capital cost saving if you do more operations in a day,” he said. “But then it costs you more in staffing. The whole principle of extended working days is not easy and it calls for a different mindset, particularly around support services, and the estate itself, that seems to have been forgotten.

Of course we will need new facilities, but we are also going to have to look at what we already have and change the way we use them. That’s what Essentia is working with NHS to do. It’s about how we can do more, and work differently, with what we already have

“There is no point in having consultants on duty at the weekends, if they can’t get blood test results or order radiology tests.

“It is becoming very clear that we will only succeed if we see collaboration across the whole service.”

The current landscape also means that building our way out of trouble, which the NHS has done in the past, is no longer a viable option.

Kelly said: “All this change is happening at a time of real capital scarcity and that is scary, but it can be done.

“We can’t just build new infrastructure. We need to look differently at the problem.

“Of course we will need new facilities, but we are also going to have to look at what we already have and change the way we use them. That’s what Essentia is working with NHS to do. It’s about how we can do more, and work differently, with what we already have.

“Making services more efficient does not always mean increasing capacity.

“We worked with one hospital which was looking to expand its A&E capacity. However, it turned out it was not a space problem, but a bed-blocking problem. It’s about whole patient pathways.

“There’s a tendency to build infrastructure that will solve the problems of today, but does not necessarily deal with the right issues. We need a more-analytical approach.”

There’s a tendency to build infrastructure that will solve the problems of today, but does not necessarily deal with the right issues. We need a more-analytical approach

Essentia is part of Guy’s and St Thomas’ trust and manages its infrastructure, passing on findings and best practice to other organisations.

Its work in-house has already led to a rapid review of the opportunities available to the trust to release occupied space through applying planning benchmarks and space utilisation principles.

Kelly said: “We successfully identified a range of opportunities that would enable the trust to achieve its Fixed Cost Challenge target and also provide potential opportunities for future years to come. These opportunities were a mix of productivity improvements and space optimisation across the sites without restricting the trust’s future ambitions for growth.”

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