Developing an NHS estate strategy strategy
In March, we held the ‘Transforming Healthcare Delivery through Estates Strategy’ Webinar. Building on content and discussion from recent FORTIS magazine issues which explored the development of robust NHS estate strategies and the benefits of Development Control Plans (DCPs) to NHS estate strategy, this virtual roundtable webinar gave a deep dive into best practice advice in developing estate strategies, discussing the latest work from NHS teams from ICBs, mental health and acute NHS Trusts.
Speakers:
- Sarah Clarke, Head of Strategic Estates & Capital Investment, Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV)
- Pradip Karanjit, Deputy Chief Operating Officer, Northwest Anglia NHS Foundation Trust
- Paul Fenton MBE, Strategic Estates Advisor.
Click here to watch the full webinar replay
Speaker Q&As
At the end of the webinar, we held a Question-and-Answer session where individuals dialling in could interact with the panel and delve further into the content that was previously discussed.
Read the dialogue below:
How can you use an estate strategy to tackle the funding challenges faced by the NHS?
[Paul] It is essential to have the strategy in place first in order to underpin any investment in the estate. Firstly, you need to know what you want to invest in. Any estate strategy should also address backlog maintenance and short-term and mid-term views.
You need to demonstrate that you can use the estate to the best of its ability in an optimised fashion while also giving some flexibility. In the past, we’ve tended to stick to the same model – keeping everything on the acute site – but as discussed today; we need to re-address this balance. The strategy needs to be owned and managed by the board, but it also needs that system approach with the ICB.
The two go hand in hand – you can’t make detailed plans around the estate without your strategic plan in place first.
How do you involve other stakeholders in your NHS estate strategy? How do you get that collaboration? Who should be involved?
[Sarah] It’s about ensuring the engagement is meaningful and you’ve got the right people involved in the conversation at the right times.
We’ve used online platforms, events and surveys for patients and partners to engage with.
We also have a lot of internal engagement projects running too – ensuring stakeholders from clinical teams and lived experience directors can be involved.
All our corporate teams are involved too – e.g. from healthcare planners, as well as outside agencies e.g. NHSPS and the local authorities engaging with local development plans, so we can understand what the local housing plan is and the impact it will have for our services.
The key element to getting rich engagement is understanding that it’s far reaching, and you need to have a bespoke arrangement for the population you are targeting. Engagement strategies need to be different for each community – the breadth of system planning and depth of place – will be unique for every Trust. For example, think about the population heath, the existing infrastructure available, the community assets that are existing.
Finally, you need to look at how you run your engagement too – make sure it’s meaningful.
Health on the High Street. There is an appetite to explore this, but it is a step away from the norm. Where can we get further support and what’s the starting point?
[Pradip] the starting point must be to look in detail at what the opportunity is. What are your biggest challenges and how can you resolve these?
It’s then about having a conversation – getting the wider ICB level support was key for us – and understanding the stakeholders involved in terms of who owns the infrastructure was a really important step.
Strategic vision must be prioritised – planning is key and then you can start to map out what support is needed – from planning to all the legalities.
Start having these conversations and that workflow will lead to the next step in your Health on the High Street journey.
It might be that the next step is to look at having private provider conversations, and looking the leverage you need to turn this strategy into a reality.
I would like to ask the panel about their experience with demand and capacity modelling to forecast future capacity requirements to be provided within the estate.
Are the provider organisations using the tools published by the NHSE Demand and Capacity Programme or by the NHSE Model Health System? If yes, what are the main limitations with these?
[Paul] In my experience, I would advise you use both but I would – as discussed today – welcome a single source of the truth for the estate – a single source of trust for demand and capacity modelling is what we need from the national teams.
You must also consider that these conversations must be done alongside the shift to moving services away from the acute setting, for example, to the high street. Therefore, you need to keep in mind this integrated approach when looking at your demand and capacity modelling.
Has the ICB started to review what a consolidated CAFM system and helpdesk offering across the entire healthcare estate can bring to ensure consistency in data?
[Paul] We have not considered that yet, but we are now embarking upon a system wide review of estates and facilities services by undertaking a benchmark exercise and pulling together ICB partners to discuss closer collaboration to look at possibilities of moving towards greater efficiencies in service delivery. The single helpdesk and CAFM system may be a little way off but is ‘in the pot’ for future consideration.
Do you have any guidance on how to ensure infrastructure is genuinely multi-functional, flexible and can easily adapt to serve future (currently unknown) needs when this approach costs more in the short term and is frequently an easy target for value engineering?
[Paul] Life cycle costing and system economic modelling will assist in design, procuring and constructing infrastructure which is flexible for future use and adaptation. The digital agenda, factored into new designs and development, will also assist with this issue, providing multi-functional infrastructure, devices and information that can change and adapt to future use. A degree of flexibility should be allowed in every design, cognisant of future demand and capacity of the healthcare environment and this can often demonstrate better value for money when calculated across net present value modelling.
NHS Development Control Plans (DCPs) – how often should a DCP be revised?
[Paul] As frequently as is required but no more than every five years would be my professional opinion. The engagement of the local planning authority can also be extremely beneficial.
How do you balance 10–15-year planning with ‘shovel-ready’ business case ready to go?
[Paul] It is always good practice to ensure that you plan strategically for the future but align these with those schemes that could be delivered in the short to medium term to ‘commence the journey’ to longer term change in the estate. The trick here is to ensure that those shovel ready schemes are co-ordinated in terms of the longer-term view of the estate and especially the DCP for the site/s. I have often seen developments constructed for a short-term gain which are often isolated from other, essential parts of the site/building giving long term problems in the lack of clinical adjacencies.
Can you give advice for working with outside teams where there is a skills gap – what makes a successful partnership?
[Paul] Good communication and the external teams understanding the brief, being clear on the objectives and understanding the risks and benefits.
