The Future of Healthcare Estates

The event was energetically chaired by Roy Lilley and we had a great range of speakers from public and independent sector, specialists in technology, the built environment and financial management. The full event can be viewed on periscope here.

Against the backdrop of Sir Robert Naylor’s report setting out that there are billions of pounds needed to invest into the healthcare estate, the appetite for more remote consulting and constant structural and strategic changes, we share the main themes discussed at this estates event.

Releasing land for housing need.

NHS strategic partnering with developer investors has enabled those land rich trusts to re-provide their facilities by in effect “swopping” land for new clinical development.

New Primary Care Networks

The new Primary Care Networks and other drivers from the NHS Long Term Plan will increase the opportunities for more community based multi service premises with potential for providing more services out of the traditional hospital environment – the anticipated growth in GP recruited staff will bring its own opportunities for creating new health facilities.

Technology

Technology and advances in remote consulting, patient health information management and the delivery of pharmaceuticals – all of these will surely transform the way we get diagnosed and treated prompting creative primary care planning and designs.

• Mindy Daeschner, Chief Commercial Strategy and Marketing Officer, DoctorLink, talked about how we can maybe take some lessons from other industries, such as banking. It was noted that the full transformation from premises to online banking took eight years to get established.
• She highlighted the way in which the model of GP practices “chokes” up the flow of patient appointments and discussions and processes take days when they could take hours. She has a vision of seamless 24 hour care achieved through the use of technology, with informed patients being able to take control of their own care and accessing the right services – in many cases online or remotely.
• Primary care is a gateway but it needs to change in order to join-up a system that is hugely fragmented. For a digital world which is 24/7, DoctorLink is creating a digital front door that is complementary to what exists, but allows it to transform and change at a regional and national level.

Commissioning changes and trends

• As mentioned by Adam Thompson at Primary Care Surveyors, there has been a rise in social prescribing, which has resulted in new design and site inclusions, such as in one case, the “Grow and Cook” initiative requiring there to be space for allotments and a kitchen included in a particular health centre.
• Tony Coke of Octopus questioned the fact that as 40 per cent of appointments relate to mental health issues, why is there a need as standard to have 16 sq. m consulting rooms with couches?
• There is a need for people to see health systems in the context as wellness management not just episodes attending premises.
• Keeping up with tech is vital, for example considering the need for electric charging points when designing new developments.

Pragmatic and practical advice

We received lots of good advice from Ian Greggor. Ian has just taken on responsibility for the Berkshire Healthcare NHS Foundation Trust estate and was able to share his thoughts and experience.

• Always check OpEx as well as CapEx to ensure that a new building is affordable.
• Use the “Model Hospital” system as an aide to identify best practice but don’t be a slave to it or any other benchmarking models.
• As well as keeping an eye on ensuring everything keeps ticking over in the “here and now” make sure your other eye is on the horizon.
• Make use of the apprenticeship scheme to build your own team. Growing “in-house” is incredibly effective financially and for succession planning.
• Talk to your local authority and other public sector agents to see if they can help invest on your behalf through borrowing or developer contributions (emulating the Northumbria structure where Jim Mackay’s Trust worked with their local authority who borrowed enough from the Public Loans Board to repay their expensive PFI debt).

Maximising the use of estate

• For example, this may be relocating services to free up one chunk of land for disposal for housing and making best use of part vacant properties.
• A few speakers mentioned the danger of clinicians being asked what they want and their asking for an updated modernised version of what they have already got.
• Mark Simpson of AA Projects set out his team’s methodology, which prefers to ask what problems clinicians and service providers face and then building up objectives to deal with these problems.
• Increase in numbers of frail elderly continues the call out for more fit for purpose care environments (a great example is the Hull ICC with the key aim of keeping elderly hospital admissions down) but also more clinically focussed care home environments.

Devolution

The anticipated devolution of powers and budget priorities to health and care leads in centres such as Manchester and London will facilitate local decisions about capital allocation.

Commenting on the event, Roy Lilley said:

“The well-attended ‘Breakfast with Health Estates’ conference looked at a range of options for estates, focusing on primary care but taking in issues around the future of PFI as well. The changes proposed in the Long Term Plan are deliberately aimed at changing models of care and with that will come changes to the estate and how it is used.

The attractions of video consultations with GPs are emerging, with their popularity amongst commuters and the working well, undeniable. All of these issues were dealt with by a range of speakers who brought a breadth of experience and covered the complex landscape of the future supremely well.

The complexity of ownership and the sustainability of the GP partnership model, plus joint working across health and social care, point to an interesting future for the sector, where staying across the issues and being well informed is vital.

This was one of the best breakfast briefing events I’ve been to, the product of a close collaboration between our generous sponsors, Mills & Reeve and the IHM.”