Don’t put the cart before the horse

Without the physical space from which to deliver services, the ideal of integration that Provider Collaboratives are tasked (amongst others) with achieving, remains a concept. Not only this, but buildings are one of the most significant liabilities within the healthcare system and one of the most important elements of the NHS achieving NetZero by 2045, so why is real estate so often the elephant in the room when it comes to discussing the integration of services? 

Clearly it shouldn’t be as it is only through an understanding of the healthcare estate that the full financial impact and liabilities of plans for the delivery of integrated services can be appreciated.  For instance on a map of an area there could be two buildings occupied by NHS bodies, both within the vicinity of each other, both of which are reasonably appealing from a service delivery perspective, they are both are leased but on one the rent and service charge liabilities grossly exceed the other, sharing is prohibited and the Landlord is able to terminate the lease within the next two years at his discretion. None of this is apparent without a detailed understanding of the legal detail behind the buildings and also an understanding of the state of the building and a knowledge of surveying. Without this knowledge of the two buildings it is guesswork as to which should be used.  

Also key to any integration plan, and something that is very dependent on the estate, is the NHS Target to achieve Net Zero. This needs to be factored into any integration plan when considering which buildings services should be delivered from. By way of example, as a Tenant in a leased building and only occupying part of a floor you will very much be at the mercy of your Landlord in relation to any sustainability targets as it is likely to very much be at the discretion of the Landlord as to whether, for instance, utilities are purchased from a green provider or not. Yet this is something which will have a direct  impact on your ability to achieve Net Zero. Whereas if you own the estate, you are in control of these factors and can also invest in its redevelopment to ensure that it becomes more sustainable. 

Bearing all of this in mind, it is clear that when Provider Collaboratives are planning for the integration of services it is important that the estate is understood. However unless they work closely with Integrated Care Boards it is unlikely that they will have a full overview of all of the properties within an area – instead it is likely that they may only have knowledge of those that sit within the acute estate.  It is the Integrated Care Boards that have the overarching knowledge of the whole NHS estate (both primary and acute) and also the legal powers to dispose or acquire of property. Interestingly though Integrated Care Boards have little or no financial budget with which to undertake reviews of the estate to gain this understanding. Whether this is an oversight, or has been done on purpose to drive further integration and collaboration in the system between Provider Collaboratives and Integrated Care Boards, we will never know. However without more funding in estates resource for Integrated Care Boards there is a disconnect in the system. As such, it is imperative from a financial and environmental perspective that Provider Collaboratives work closely with Integrated Care Boards to ensure that the estate is considered at the outset when planning the delivery of any services so that it can be used as efficiently and effectively as possible. 

This piece is one of a series of articles on Provider Collaboratives, previously including an overview of the Hewitt Review and the implications on Provider Collaboratives.

We are delighted to confirm that we will be running a session at this year’s NHS ConfedExpo in Manchester on 15 June around developing collaboratives within the new NHS. The session will discuss successes and setbacks of collaboratives to date, as well as looking forward to 2023/24 and beyond to understand upcoming challenges and opportunities for provider collaboratives. Find out more at ConfedExpo’s website, and sign up now to make sure you don’t miss out the insights from our stellar panel of industry leaders.

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