David Pokora, executive director of the LIFT Council, explains the effects the NHS reforms will have on the health service estate.
W
e will soon see the largest set of changes to how healthcare is de-
livered in the UK for more than a genera- tion – and one of the biggest packages of reforms since the NHS itself was formed in 1948. These are reforms that have been met with enthusiasm and caution alike – and perhaps it is best to say from the outset that the LIFT Council welcomes the Government’s plans.
If one thing is clear, it is that if these changes – hugely ambitious and far-reach- ing as they are – are to be met, healthcare in this country is going to have to embrace innovation and new ways of working.
That new way of working is as true of the management of the NHS estate as any other aspect of health care delivery. The reforms will require tremendous changes and innovation in how we perceive and manage the NHS estate, owing to two key principles: funding and responsibility.
While the healthcare budget is ‘ring- fenced’, and not at the mercy of cutbacks as other government departments are, the NHS will not be immune from austerity. Indeed various commentators put NHS inflation at 7% per annum. The focus will, therefore, be on making the most of exist- ing resources – and the NHS will be ex- pected to deliver greater value for money, including driving best value from its exist- ing estate.
This is not to suggest in any way that new infrastructure projects will be a thing of the past for those local communities that require new facilities. However, before such projects are approved it is essential the NHS ensures it is getting the most from what it has and that the new facility will deliver financial savings elsewhere in the budget. This will require both expertise and innovative thinking – and in the case of the existing estate clearly highlights the need for expert asset management.
The question, therefore, is how will this value from the existing estate be delivered - bringing us onto perhaps the biggest
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single change - namely that GPs will be required to form consortia that take over responsibility for the vast majority of the NHS commissioning budget from primary care trusts which, like strategic health au- thorities, are to be abolished.
There is debate as to the ability, in terms of experience and time demands, of GPs to commission care effectively. A further question is whether GPs are in a position to take on PCTs’ estate management responsibilities.
These two contributing factors – public finances and the GP consortias’ commis- sioning responsibilities – highlight the need for innovative new ways of working when it comes to the NHS estate and also the opportunities for models such as LIFT to provide solutions. If estate manage- ment needs are to be met, GPs will require support and considerable expertise of the sort available via local LIFT companies (LIFTCos) that possess an abundance of asset management experience.
“One of the biggest sources of public sector waste is the duplication of local services.”
As a joint-venture partnership, LIFTCos not only encourage but require high levels of local involvement in the development of facilities to ensure they best meet the needs of local communities. LIFTCos must develop strategic services development plans, identifying how current infrastructure is holding back the more efficient delivery of services – and to identify improvements.
One of the biggest sources of public sector waste is the duplication of local services, and if the NHS is to get best value from its existing estate, the co-location of services is an innovation that must be embraced, and one that LIFT is best able to deliver.
This does not automatically mean the end of a facility being developed solely as a GP practice, but in future it is reasonable to expect such facilities will only be approved if they are designed and maintained to the required CQC standards, avoiding a lo- calised overprovision.
They also need to function as community hubs and tools of regeneration, rather than solely centres of primary care. This is an area in which LIFT, since its inception, has had tremendous success.
One final area of innovation welcomed by the LIFT industry is leasing structures. LIFTCos have to date been obliged to of- fer new facilities based on one particular form of lease. Many alternatives exist, and a detailed review of available options and a critical review of risk transfer arrange- ments will also deliver financial improve- ments to the NHS.
The long-term nature of such a joint venture as LIFT - with LIFTCos contractually required to provide maintenance and estate management services for their facilities for a period of up to 25 years - means facilities can keep up with the times.
Hence, while simply bringing in a model such as LIFT to provide support and asset management to the estate is itself an in- novative solution, it can also mean that in- dividual premises are best placed to adapt and benefit in areas such as sustainability and carbon footprint – as LIFT facilities have begun to do.
LIFTCos the length and breadth of the country are extremely well placed to make use of their formi- dable asset manage- ment expertise to deliver the solutions and innovations on which best value from the NHS estate will be reliant in the future.
Visit
www.theliftcouncil.org.uk David Pokora
FOR MORE INFORMATION
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