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STPs - what are the plans for the estate?

This article is taken from October's health newsletter. Click here to view more articles from this issue.

Now that Sustainability and Transformation Plans (STPs) have been released and in their respective geographical areas move towards implementation, various questions and thoughts may arise for NHS trusts (and other public bodies) involved in estates and facilities. Whilst often front line clinical care takes front and centre, the importance of modern facilities from which to deliver those great services cannot be underestimated.

From reading various different STPs it is clear that the estate forms an integral part of the vision for the delivery of improved quality of care and modern services. Whether this is expressly addressed by workstreams, primary objectives focusing on the estate, or by reference to the delivery of other key objectives, it is clear the estate must feature heavily in STP documents. Furthermore, with most NHS estates suffering from backlog maintenance, creating a modern fit for purpose estate will be an imperative to support the delivery of great clinical services.

Some STPs are clearly focusing on the issues which go to the heart of local concerns, but some interesting themes are developing.

For example:

The idea of a single estate

Some STPs are working together to set up estates groups (within the STP) with various skill sets to lead on delivery of their STP’s strategy for estates and facilities. Some appear to favour the idea of public bodies delivering care from effectively what would be a 'single estate'. Whilst it would be expected that the relevant bodies would probably continue to own their own respective freehold and leasehold properties, the idea would be to create a wide reaching public estate. Within this estate the bodies within the STPs would work together to bring the NHS, city, district and county councils, police, ambulance and fire services (as appropriate) together to collaborate and cooperate. In this way there would be better utilisation of the estate those organisations have (and at the same time would enable closer working and costs savings) and also allow rationalisation of their estates to dispose of surplus land no longer needed.

Closer working

Where STPs would likely benefit from such an approach as the “single estate” concept would include the ability to cost share on new development projects. Many primary care and blue light development schemes have been planned and business cases ready to implement, but due to the lack of central funding, many organisations have been unable to commence these projects. Cooperation between public body members of these STPs may mean that the sharing of land and capital could unlock these much needed schemes, allowing for the delivery of new and modern health and social care facilities at a reduced cost to the individual bodies. There are also suggestions of public sector hubs to support “place based” care and some STPs mention creating urgent care centres to support the delivery of greater care in the community. This can only be achieved by closer working practices.

The general public would no doubt welcome, and see the benefit of, various public services under one roof. This could also include sharing of back office functions between the STP members, something which many STP documents touch upon.

Estates teams within the relevant STP members may of course have concerns in relinquishing control over their estate but that would not necessarily be something which poses a major problem. No doubt the relevant STP members would need to all agree and sign off on any new development collaborations before they commence. However, it seems the sharing of estates resources, ideas and expertise within the public sector is something which should be commended in times of austerity.

If closer working of this nature is undertaken, then it would also support the drive for new primary care facilities in the Five Year Forward View.

Disposals (the Naylor report?)

The report by Sir Robert Naylor received significant coverage in the press and posed many questions about, and made recommendations for, the NHS estate and how it should be managed, including majoring on disposals of surplus land. A question for many STPs may be: does their estates strategy fit in with the Naylor report recommendations? If not, should this be considered and are there any benefits in applying those recommendations?

The Naylor report did focus quite heavily on disposals and that is certainly something many STPs may wish to think about as a means of securing capital receipts for vacant and surplus land that has not been earmarked for any development or retained for other strategic reasons. However, STPs could also consider the potential value in redeveloping sites already owned (and which are either not utilised or underutilised) through the sort of collaborative arrangements referred to above.

Whilst STP literature may or may not expressly mention the Naylor report, it would seem unusual if it were not considered in whatever strategy is being drawn up by the relevant STP. 

Data sharing

The proposals above naturally lead on to the idea of more data sharing of property and estates information as a way of identifying where new facilities, costs savings and estates rationalisation could be made. Member bodies within the STPs could use greater sharing of estates information on site utilisation, lifecycle costs, value (including potential development value for alternative use) and capacity for redevelopment to identify costs saving and co-location opportunities. Such sharing could also highlight the most cost effective and service delivery effective schemes which could be undertaken to meet the clinical objectives.

The themes above are not intended to be a finite discussion of all the issues which may arise or need to be considered by an STP in planning what to do with their wider estate. However, they raise some interesting themes and clearly something which encourages closer working and sharing of resources and expertise between public sector partners must be a positive thing.

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The content on this page is provided for the purposes of general interest and information. It contains only brief summaries of aspects of the subject matter and does not provide comprehensive statements of the law. It does not constitute legal advice and does not provide a substitute for it.

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