Community Health Partnerships

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Establishing a vision for future NHS Strategic Estate Management

The Challenge: Reform of the healthcare system, particularly since the Health and Social Care Act in 2012, has put unprecedented strains on the health economy in England – for commissioners, managers and clinicians alike.  An estimated 90% of patient interaction in the NHS is with primary care services, with approximately 300 million consultations carried out in general practice and nearly 800 million prescriptions dispensed in the community.  Primary care space is the ‘cornerstone’ of the NHS and at the epicentre of debate about how to achieve efficiencies.

Fundamental changes to the structural management of primary care, where a system of national organisation through Primary Care Trusts and Strategic Health Authorities has been replaced by a system of local responsibility through Clinical Commissioning Groups, had created a significant degree of uncertainty in estate planning.

The two principal, public sector owned organisations offering primary and community healthcare estate services to local commissioners, and the wider NHS, are NHS Property Services and Community Health Partnerships (CHP).  CHP were established in 2001 and work to improve the community based NHS estate through the LIFT programme and Public Private Partnerships. They offer professional skills and expertise in setting up and operating joint ventures and in strategic estate management.  From 1 April 2013 CHP became the head tenant for over 300 NHS LIFT buildings.

By 2014, the health estate was being increasingly viewed as a strategic commodity which, like other technology assets and human capital, could be ‘managed’ to achieve better access for recipients of care and better efficiencies of cost and waste for providers. Against this backdrop our client, CHP, needed to get ahead of the debate and consider the strategic direction of NHS community based estate matters for the following three to five years. 

The Solution: CHP commissioned Research by Design to undertake an ambitious programme of independent research during early 2014 to help steer their thinking about the future demands on strategic estate management. The organisation recognised that formulating a vision needed some clear and independent evidence.

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Initially, the focus was on gathering the views of a range of key stakeholders about a future vision.  This included a range of senior commissioners and practioners within Clinical Commissioning Groups, Local Authorities (including representatives of Health and Wellbeing Boards), and NHS England Area Team Directors. Since the issues were so complex and inter-related, we recommended that face to face depth interviews would be the most appropriate technique for securing the necessary insights.      

As well as facilitating a detailed discussion about the future delivery of community and primary health care, stakeholders were asked about their vision for buildings.  This elicited a wide range of themes and led us to conclude that a single vision of what future buildings did not exist at the time. There was also little evidence of joint working such as sharing building space with other service providers.  

In parallel to this, the organisation also embarked on, for the first time, a tenant satisfaction measurement programme across the 300 strong CHP / NHS LIFT estate. This was a key mechanism for collating feedback on organisational performance and involved collecting responses from over 1,000 tenants, understanding the experiences they have within their surgery building and presenting findings to a variety of audiences. 

CHP Case Study We were also asked to undertake a separate, more detailed examination of general practice properties to provide evidence into a Department of Health and NHS England review into the key barriers facing primary care and community services. This involved qualitative interviews and ‘ethnographic observations’ across the health estate. The findings helped CHP develop practical recommendations to address under-utilisation of the system and drive innovation.

The Outcome (moving from vision to reality):

The programme of research in 2014 has been used throughout the organisation. The interviews confirmed that commissioners were most concerned about system integration – that is, a fully integrated way of working that produces better synergies between primary and acute care - and the need to find financial savings in the delivery of key services. The transformation of the primary care landscape in recent years has led to a fragmentation of estate-related skills and joined-up thinking across the marketplace. Looking forward, it was clear from the research that customers would welcome a dedicated expert that could provide strategic estate planning services. 

The stakeholder visioning project helped ensure CHP’s business model was fit for purpose and was featured in the Business Plan Summary 2014/15 – 2015/16.  Findings from the research were also delivered at an All Staff Meeting last Summer. The research highlighted the types of generic staff attributes and skills a strategic estate planning agency should possess. From top to bottom, the organisation has a greater confidence that they are delivering what the market place now expects.

The NHS ‘Five Year Forward View’ (FYFV) report was published on 23 October 2014; bringing together a range of agencies including NHS England and the Quality Care Commission to set out a vision of a better NHS.  Department of  Health have stated that a key way of achieving the efficiencies required by the FYFV is strategic estate planning that operates within a clear framework. The Strategic Estate Planning service, offered jointly by CHP and NHSPS, has very recently been launched and it is expected that the majority of CCGs should have estate plans in place by the end 2015. The extent to which the SEP service is utilised effectively by commissioners will be the ‘acid test’ of the policy and further evaluation may be required to validate this.    

Testimonial from Jane Batchelor, Head of Communications:

“The Health and Social Care Team at RbD rapidly got to grips with our needs and they have been an absolute pleasure to work with.  I have been impressed with how professional yet personable the team are. They have a customer focussed approach, communicate regularly throughout projects and highlight any urgent things that need my attention. The insight work they have supported me with has had a significant impact on the direction of travel at CHP."