In pursuit of true integration
Paul Fenton MBE, Strategic Estates Advisor for the NHS Suffolk and North East Essex Integrated Care Board, sheds light on his role in shaping the forthcoming estate infrastructure strategy, the pioneering Integrated Care System pilot scheme, and the overarching direction of the strategy
Paul Fenton, a seasoned expert in NHS estates, possesses a wealth of knowledge as a private consultant in the public sector, spanning over two decades. With a profound understanding of the UK’s healthcare system, he has ventured far and wide, exploring healthcare practices across the globe. In recognition of his dedicated service to the NHS, he was honoured with an MBE in the 2021 Queen’s New Year Honours List.
NHS Suffolk and North East Essex earned the distinction of being one of the 11 Integrated Care Systems (ICSs) chosen to participate in a ground-breaking pilot scheme. Tasked with formulating a comprehensive estates infrastructure strategy for NHS England, Paul joined the team to deliver the final version of the ICB’s strategy.
In this interview, Paul explains the progress of the pilot scheme and shares crucial insights for others embarking on this transformative journey.
Pilot objectives
“NHS England’s estate strategy has primarily sat at provider level. Following the publication of the Estates Workbook, which served as a good benchmark, it was the New Hospitals Programme (NHP) which really drove the need for an all-encompassing NHS estate strategy. Spearheaded by Matthew Ward, National Strategy Lead for NHS England, a pilot phase commenced – backed by expert support from Mott MacDonald – and funding was secured. The goal was to develop an overarching estates infrastructure strategy from all 42 ICSs in England, focusing on both workforce and digital elements. Unlike traditional provider-based approaches, this strategy would emphasise a comprehensive ‘healthcare system’ outlook, encompassing primary care, mental health and beyond.
“We were privileged to be part of this pioneering pilot phase, appointed as one of 11 ICSs (seven in the counties and four in London). Working hard with Matthew’s team since autumn 2022, we’ve aimed to establish common ground among the strategies and a guidance document will be shared with the 31 other ICSs. The Chief Executives of those ICSs have been asked to prepare their own estates infrastructure strategies for the end of 2023, too – with the 11 pilot ICSs understandably being ahead of the curve.
“To develop an estate strategy that really does serve the ICSs population, providers need to get around the table. The initial drive for Matthew’s team was to get to a point where the NHS, like other public organisations, has a detailed, comprehensive strategy that’s fit for purpose – ready for development, rationalisation and maintenance of their estate.”
The strategy in my region
“Progressing steadily, the pilot organisations are now submitting first iterations of the estate infrastructure strategy. Our ICS is awaiting input from three primary care networks (PCNs) that are crafting more granular strategies, which will feed into the Suffolk and North East Essex ICB’s overall estate infrastructure plan.
“They’re a component part of the overall strategy, but we won’t go into as much detail as they would go into in respect of the lease of rooms in community centres or changes in extensions to GP practice, for example. We’re still waiting on those three strategies, which should conclude at the end of July. We’re also still finishing the demand and capacity modelling. We’re hoping that both of those elements will be fed into our next iteration, which we plan to submit in early October. We’ve got until the end of the year to tweak it to make the final version as perfect as we can.
“Our estates strategy is built upon a foundation of extensive background information and data, providing us with a clear understanding of the current situation. With a well-defined destination in mind, we have a solid grasp of where we want to be. However, there remain crucial pieces of missing information that require articulation – the precise roadmap to reach our goals.
“In comparison to other strategies, some have already charted a well-defined course, detailing the route they intend to take. Yet, for some, essential data is still absent. To make informed capital investment decisions, it is imperative to rely on robust, baseline data and information. Those lagging in this aspect have some catching up to do. Furthermore, to be successful, many ICSs need to bolster their clinical strategies. Critically though, good progress is being made by everyone.”
Advice for ICSs
“Keep an open mind – don’t bring your scepticism or cynicism to the table. To achieve what we have, we’ve had to be open and honest about what this overarching strategy will deliver.
“Engage in the process – have a clear vision and actively in take part. You have to be in it to win. A lack of involvement may result in limited input and diminished capital allocation.
“Be ready for difficult conversations – as the ICSs control the purse strings and funding bids must align with the overall strategy, candid conversations on investment allocation are unavoidable. And we must ensure that the bid accords with the overall strategy and serves the population.”
System over individual providers
“It’s vital we adopt a system-wide approach to achieve the best outcome for our patients – and NHS staff. A good example is the rise of the Urgent Treatment Centres (UTCs), which demonstrates the need for capacity enhancement in primary care to alleviate pressure on acute facilities. Investing in prevention and primary care could potentially eliminate the necessity for many UTCs. It’s madness that patients choose to travel miles and opt to sit in a waiting room for 10 hours so that they can avoid a longer wait for a GP appointment. We want patients to be able to walk into a GP surgery on a Saturday morning and be treated with X-ray machines, CT scanners and other medical technologies. To address the entire spectrum of acute care effectively, ICSs must address primary care and social care elements.
“We have two issues with acute care: one is those going to emergency departments for non-urgent issues, and the second is the social care element to get people out of hospital. You’ve got this perfect storm. You can make your acutes as big as you want – you can put more beds in, you can put more diagnostics in, you can build bigger A&Es – but if you don’t answer either end of that equation, you’re always going to be failing. The system approach offers the most promising path forward; it’s where we need to be and demonstrates the power of the ICB.”
Conclusion:
In pursuit of true integration, the estate infrastructure strategy work conducted by the NHS Suffolk and North East Essex ICB exemplifies the NHS’s commitment to transforming healthcare delivery across England. With the pilot phase well underway, the focus is now on devising a comprehensive estates infrastructure strategy that harmonises all ICSs to ensure efficient and patient-centric healthcare services. The system-driven future sets the stage for a more integrated and interconnected healthcare landscape.
Paul is a chartered electrical engineer and worked for TXU Energy, eventually becoming Facilities Manager for 130 properties across the UK and Europe. Upon leaving, he joined Carillion as Head of Estates and worked on several private finance initiatives (PFIs) around England, primarily based at Colchester Hospital, where he joined the NHS. He has worked as Deputy Director of Facilities at the Norfolk and Norwich Hospitals NHS Foundation Trust and at the North Essex Partnership University NHS Foundation Trust and Southend Hospital. He was National Chairman of the Health Estates and Facilities Management Association (HEFMA) and President of the Institute of Healthcare Engineering and Estate Management (IHEEM). Before his current role, he was Director of Estate and Facilities for the East Suffolk and North Essex Foundation Trust since its formation in 2018 and prior to that when it was Ipswich Hospital. Paul is also currently Director of PNFM Consulting Ltd.
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This article was taken from the September 2023 edition of FORTIS magazine.
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This article was written for the September 2023 edition of FORTIS magazine; a forum for the NHS to share ideas, innovations and case studies. To read the publication in full and access digital copies, visit FORTIS magazine. FORTIS magazine is free for NHS change-makers and leaders and is available as a print or digital copy. FORTIS magazine is managed and owned by Health Spaces Ltd.
