FUTURE ESTATE PLANNING
Sir Chris Ham, Co-chair of the NHS Assembly, told attendees: “We’ve had a decade or so of austerity, where growth and funding have not kept pace with the rise in demand, making the underlying shortage of capacity somewhat worse.”
is already acting on these lessons, and that the Treasury is willing to take the necessary actions, recognising that having some spare capacity is not a sign of waste, but rather prudent planning to deal with those demand surges. We need a funding system for the NHS, social care, and public health, that enables this.” He continued: “Go back to the evidence from (former Chief Medical Officer for England) Professor Dame Sally Davies, (former Cabinet Secretary and National Security adviser) Sir Mike Sedwill, and Sir Oliver Letwin, to the joint Inquiry by the Science and Technology and Health and Social Care Committees, and they agreed that immediate pressures in public services often crowd out the resources we need to invest as an insurance policy for the future to build that buffer. We’ve suffered the consequences of this during the pandemic.”
Institutional arrangements ‘found wanting’ The ‘broader point’, he contended, was that ‘our institutional arrangements in government for managing risks have also been found wanting’. He elaborated: “We have a highly centralised system of a government in the UK, but paradoxically, a weak centre – exposed in the shortcomings of the Cabinet Office, and the Civil Contingencies Secretariat, both in the planning, and the work on, managing national risks, but also in the more immediate pandemic responses. The issues around capacity aren’t just for the Department of Health and Social Care or NHS England; this is a whole
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Paul Maulbach, CEO of the Black Country and West Birmingham CCG, said: “It’s really important, particularly for students in the health service, to have access to affordable accommodation, especially in the larger conurbations and the south-east.”
of government responsibility if we’re to learn the lessons, and never again find ourselves in the position we’re in today.” The NHS and other public services had, he acknowledged, responded ‘with agility and flexibility’ to the pandemic, built, ‘at pace’, the Nightingale hospitals, and converted existing hospital accommodation to create surge capacity in intensive care. The Professor said: “That meant we were never overwhelmed in the way we saw early on in countries like Italy, but it was a close-run thing. If there’s one area – above all – that needs maximum focus,” he added, “it’s the staffing available for health and social care.”
Major staffing issues Pre-pandemic, he noted, there were over 100,000 vacancies within the NHS, the majority in nursing. He said: “To go into a pandemic with that scale of vacancies was a problem in itself, and yet we haven’t seen a credible, fully-funded workforce plan for the NHS emerge from the Government. Think-tanks and Select Committees have repeatedly made this point, and there’s a broad consensus that this should be the number one priority. We can’t deliver in normal times what is needed in the NHS, let alone during a national emergency. So that – for me – would be the most important priority, but in addition, the infrastructure we need – whether it’s buildings or equipment – and the ‘buffer’ I’ve referred to, needs a whole- of-government response.” Having thanked Sir Chris Ham for his
contribution, Lord Bethell introduced Paul Maulbach, CEO of the Black Country
Paul Maulbach: “We’re very dependent on GP practices’ willingness to participate in capital developments. Where practices in ‘high need’ areas aren’t keen to participate, you have no mechanism for investing in the places that need it the most”
52 Health Estate Journal May 2022
and West Birmingham CCG. He began: “I’d agree with everything Chris has just said. Especially during the height of the pandemic, we were monitoring ventilator capacity by the hour, and on a knife edge in terms of having sufficient provision. When the Minister of State for Health initiated this review, he noted that to learn the lessons from the pandemic, we needed not only to look at what’s needed in acute settings, but across the whole system – including primary and community services. It was the most deprived communities that were worst hit, and health inequalities have consequently been exacerbated.” Part of the solution to redressing the inequality gap was, he said, ‘making sure we make the right investments in the right communities that need it most – particularly in out-of-hospital care – to maximise the opportunity for ongoing prevention, and reduce unnecessary hospital admissions’.
Four key questions Paul Maulbach said he felt there were four questions especially worth considering: “The first is that the original Health Infrastructure Plan was focused on the acute sector, and, in addition to the original six, there are 21 hospitals in the pipeline. So, will there then be sufficient funding to also support the non-acute sector? Will we get the right investment balance between what is absolutely needed in the hospital sector, and elsewhere – this is quite a challenge? The second key issue is that there are real difficulties with the current capital funding model for primary care. We’re very dependent, planning-wise, on GP practices’ willingness to participate in those capital developments. Where practices in ‘high need’ areas aren’t keen to participate, you have no mechanism for investing in the capital capacity in the places that need it the most.”
Disparities in investment Currently, he said, there was a disparity between where the investment went in
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