FUTURE ESTATE PLANNING
Professor Jane Perry of the University of East London. In her role she has grown the nursing and allied health programmes substantially, forging close relationships with Trust partners for both undergraduate programmes and apprenticeships.
a strategy for capital investment. I use the word ‘investment’, not spend, because it is an investment, and one you get very real return from.” Richard Darch said that we should
have ‘the rigour and the discipline in our approach’ to measure that ROI, because ‘it does lead to improved services, which in turn leads to improved health outcomes’. He said – putting up two slides to illustrate his point: “There just hasn’t been enough capital investment in the system in the NHS, to the extent where the NHS and the UK lag behind a number of developed health systems across Europe, as well as in the US.”
How capital is being used There was, however, ‘a positive picture in terms of how capital is starting to be used’. His next slide, on capital spend on technology ‘per worker’, showed this was increasing ‘per worker’. He said: “We’re seeing a reduction in spend on things like land and buildings, but spend on IT and technology are rising. However, I’d still suggest that, overall, there is insufficient investment to deliver the sorts of changes Paul made in discussing the move of services into primary and community settings, to be able to support and invest in disadvantaged communities. We don’t have the planning mechanisms to support that.” Over the past two decades, he
believed the prevailing ‘competition- faced landscape for healthcare’ had ‘led very much to a bidding environment for capital’. Richard Darch said: “So even the ETTF was about putting in a bid, and
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Richard Darch, CEO at healthcare infrastructure specialist, Archus, said that ‘we need to re-discover planning in the NHS – in my view a lost art and science’.
getting a response back, putting in a business case and getting that approved, or not, or bidding within the New Hospital Programme. I’d suggest it shouldn’t be a bidding process, because it shouldn’t just be about the quality of a particular presentation or business case. That overly politicises the flow of monies, because individual cases are made. We need more robust strategic planning NHS- wide, where we can establish where the investment priorities are, and how they can best be met – whether via capital or investment in workforce., as well as investment in technology and buildings.”
Giving visibility Richard Darch said such an approach would not only give visibility to individual communities’ and health systems’ investment requirements, and how they can be prioritised, but also to external players in the construction industry. He said: “That visibility can tool up to be able to meet the requirements for longer-term investment programmes, rather than this bidding approach. In primary care, there are plenty of pools of capital available that could support investments in that type of asset – particularly in pension funds. “It’s not about a ‘one size fits all’ approach, but about understanding what type of assets will attract what type of capital.” This ended the presentations, and, having thanked the speakers, the chair opened the discussion to questions.
Up-to-date equipment Baroness Masham, a former Paralympian and notable disability, health, and penal
Richard Darch: “There just hasn’t been enough capital investment in the system in the NHS, to the extent where the NHS and the UK lag behind a number of developed health systems across Europe, as well as in the US”
54 Health Estate Journal May 2022
reform campaigner, asked about the importance of healthcare facilities having the latest equipment. Prof. Perry said: “This is a really valid point, because what we’re discussing requires absolutely huge investment. From an educational perspective, to try to mirror training with sports practice, we need good, hi-tech equipment. I think all universities would say this is highly resource-intensive, and very expensive.” Prof. Sir Chris Ham added: “We saw early in the pandemic the challenges around ventilators, and then the government responding with the Challenge Programme to increase their supply. Beyond that, however, look at the OECD data, and we have fewer CT and MRI scanners than other European or other comparable countries. The good news is there has been an investment in diagnostics, and community diagnostic centres are beginning to get up and running across the NHS. It’s not just, however, about buying the equipment, but also making diagnostics more accessible in community settings, often in high street premises. However, as Richard said, we must re-consider the value of planning – not just capital planning, but service planning based around populations, which the Integrated Care Systems are starting to do. The capacity must, though, include looking at equipment of all kinds, how it is used, and where it’s located from a patient and population, not just a service-provider, perspective.”
Maintenance and replacement Richard Darch said: “We absolutely need investment in equipment, but I’d also make a plea for its maintenance and replacement. About 10 years ago, there was a significant investment in linear accelerators – but the maintenance and replacement budgets didn’t follow on. So, we’ve now got a lot of ageing linear accelerators simultaneously, which suggests a need for an ongoing replacement budget, as well as the capital
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