Sir Robert Naylor’s review, published on Friday, sets out an ambitious new NHS estates strategy focused on delivering improved care, the release of £2bn of assets for reinvestment and delivery of land for 26,000 homes. With thanks to the British Property Federation, the key recommendations are around establishing a new and strategic NHS Property Board at arm’s length from DH to act as the primary voice on estates matters.
The review considers the primary and acute estate in an integrated fashion and calls for an overarching estates strategy, incorporating a long-term vision for the NHS; a clearer understanding of the current estate; clarity on leadership; appropriate governance; and improved skills. There are some sensible links to primary care, including ensuring facilities meet the vision of the Five Year Forward View and improving guidance on building standards.
The review focusses on the following actions:
Improving capability and capacity to support national strategic planning and local deliveryThe suggestion is that a powerful new NHS Property Board should be established in shadow form immediately and substantively by April 2018 to provide leadership to the centre and expertise and delivery support to STPs. The organisation is intended to:
- be strategic in nature;
- consider whether the functions and residual assets it inherits from the abolition of PCTs should be divested back to providers;
- urgently bring together and expand the current strategic resources into a new national strategic planning and delivery unit to support local areas and strengthen capacity to deliver major projects;
- be the primary voice to the system on estate matters;
- work with national bodies to ensure that the system receives clear and consistent messages about the importance of developing a modern fit for purpose estate, releasing land and addressing backlog maintenance.
- be structured so that it empowers speedy executive action and professional credibility within the sector;
- include a regional structure aligned with NHS England (NHSE) & NHS Improvement (NHSI);
- bring together functions of NHS PS, CHP and other fragmented NHS property capabilities into a single organisation;
- involve key staff from NHS PS and CHP.
This is designed to enable NHS PS and CHP to focus on addressing operational challenges, but the key will be whether or not this new body, remarkably like the old NHS Estates structure, can deliver what is required or whether this will just be another expensive shuffle of the deck.
- produce improved guidance on estates planning and disposals for the NHS, covering the scope of estates planning, accessing private sector expertise, models for affordable housing for NHS staff and partnerships with both housing associations and third party developers;
- produce improved guidance on building standards so they support the Five Year Forward View (5YFV) and deliver value for money, gathering evidence on the most appropriate estate models (via the vanguards programme) and prioritising new guidance on primary care facilities;
- improve transparency and intelligent use of data, improving the quality of existing data collection and taking ownership for the future development of the benchmarking developed as part of the review;
- in partnership with other national bodies, review processes to ensure they are proportionate and effective, in particular considering the business case process, which is often seen as cumbersome, and a block to development.
Encouraging and incentivising local action
- STPs, supported by the new NHS Property Board, should develop affordable estates and infrastructure plans, with associated capital strategy, to deliver the 5YFV and address backlog maintenance. These plans should be supported by robust business cases.
- STP estates plans and their delivery should be assessed against targets informed by the benchmarks developed for the review. STPs and providers who develop insufficiently stretching plans should not be granted access to capital funding either through grants, loans or private finance until they have agreed plans to improve performance against benchmarks.
- DH and HM Treasury (HMT) should provide robust assurances to STPs that any sale receipts from locally owned assets realised in line with STP plans will not be recovered centrally. The report recommends that HMT should provide additional funding to incentivise land disposals through a “2 for 1 offer” in which public funds match disposal receipts;
- NHSE and NHSI should provide guidance on the roles of providers and STPs with regard to estate matters;
- NHSE and the NHS Property Board should ensure primary care facilities meet the vision of the 5YFV, and consider linking payments to the quality of facilities and greater use of 'fit for purpose' standards;
- The NHS Property Board should support GPs to meet these standards, taking advantage of private sector investment.
- Vacated land should be prioritised for the development of residential homes for NHS staff, where there is a need, and the NHS Property Board should support this;
- Urgent action should be taken to accelerate the delivery of a large number of small scale, low risk developments to deliver housing.
Funding and National Planning
- All national bodies should work together, sharing intelligence, to develop a robust capital investment plan for the NHS by summer 2017, maximising value for money and making a strong case for securing both the public and private investment the NHS needs;
- Substantial capital investment is needed to deliver service transformation in well evidenced STP plans, which could be met by contributions from three sources; property disposals, private capital (for primary care) and from HMT.