This week the UK Department of health issued guidance to CCGs and other healthcare commissioners requiring them to produce local strategies for the primary and community care estate by December 2015. We take a critical look at the guidance, flag up pitfalls and other issues to be considered, offer professional advice on how to fulfil the requirement and suggest ways of delivering and exceeding expectation.

1. Local Estate Strategies
A Framework for Commissioners
We take a closer look at the new guidance
Lester Wagman

2. Policy/Guidance (June 2015)
• Target audience
- Clinical Commissioning Groups
- NHS England
- Community Health Partnerships
- NHS Property Services Limited
• Secondary audience
- NHS Trusts
- NHS Foundation Trusts
- Local Authorities
- Other local strategic partners
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“By the end of December 2015, the majority of CCGs should have
plans in place that cover primary and community care estate and
non-clinical estate. The Department will continue to support
commissioners through CHP and NHS PS as local estates strategies
evolve alongside commissioning strategies.”

3. The NHS is a complex beast…
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Click on image above for video explanation!

4. …as is its (primary & community) estate
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NHS
EnglandNHS
England
NHS Clinical Commissioning Groups
£
£
Private
GPs
GPs
Other Providers
NHS Trusts
Other Occupiers
NHS PS
GPs
GPs
Other Providers
NHS Trusts
Other Occupiers
CHP
GPs
GPs
Other Providers
NHS Trusts
Other Occupiers
£
Corporate Ownership GPs
Community
& Primary
Services
Service
Tariffs/
Payments
Other
L a n d l o r d s
£ Rent
& S/C
Contracts

5. Rationale
• To support 5 year forward view (5YFV) NHS needs to:
- fully rationalise its estate,
- maximise use of facilities,
- deliver value for money, and
- enhance patients’ experiences
in collaboration with local stakeholders (& integrated)
- Local Estates Forum (LEF)
• Local co-ordinators appointed from DH landlord companies:
- NHS Property Services Ltd (NHS PS)
- Community Health Partnerships Ltd (CHP)
• Groups of local CCGs may produce joint strategies
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6. Stated benefits
Operational
• Functionally suitable, high quality
environments for healthier
outcomes
• Flexible facilities to support
multiple services
• Improved utilisation efficiency
• Enable new models of care
Estate
• Reduce costs
- Utilities
- Maintenance
- Security
- Rent
- Depreciation
• Tackle maintenance backlog
• Statutory compliance
• Release surplus assets for
disposal
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7. Scope
• Primary and community care estate
• Non-clinical estate, such as office/administrative bases
• Engagement with secondary and tertiary care estate
• Engagement with wider public sector estate
• Link with Cabinet Office One Public Estate programme
• Integrate with [existing] plans of Secondary and Tertiary care
providers
• Costs to be met by commissioners
• CCGs to provide senior managerial and member inputs
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8. Strategic planning process
1. Getting prepared
- Governance structures, terms of reference and processes
- Identifying the sites/scope and/or data sources for the estate
2. The estate that you have
- How it performs and how it is used
- What are the opportunities and threats
3. The estate that you need
- So much easier said than done!
4. Gap analysis
5. Options identification & testing
6. The local estate strategy
Click here for the full guidance note
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“Strategic Estates Planning
should be part of business as
usual and not a one off
activity. Each local area can
decide how the strategy fits
into what is already happening
locally, as long as it meets all
of the key characteristics
detailed above.”

9. Shortcomings
• ‘Roadmap’ laid out is linear & prescriptive – fails to stress need for
strategies to be adaptable to opportunities & threats
• Vital that full capacity over time is identified in collection of estate
utilisation data.
• The ‘estate you need’ needs to reflect tri-cornered approach to
service [re]design: people – buildings – technology
• No provision made for auditability of decisions made by stakeholders
through us of transparent option scoring and weightings
• Process [and timescale] does not provide scope for vital iterativity
• Throwaway line says strategic estate plan should be part of business
planning cycle but process described is a ‘one off’ solution
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10. Preferred iterative 3D model
A good estate strategy should be open to changing circumstances
which represent opportunity and resilient to threat. It should not be
rigid and prescriptive, better offering a unified approach and
framework within which to develop locality plans and, for larger sites,
development control plans.
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11. Data collection
• Much of the data needed
has already been collected
• It just needs to be joined
usefully (map-linked?) in a
database and analysed
• Needs for change or even
potential solutions should
be identified by suitable
queries e.g.
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• Consulting room capacity for all single-handed GPs on GMS contracts in leasehold
buildings with 10 years or more unexpired and in areas of population growth
• Costs of occupation for GPs in leasehold premises where weekday room utilisation is
below 50% and outstanding costs of compliance improvements exceed £50,000

12. Resourcing
• List of [local] ‘strategic estates advisers’ identified in NHS PS
and CHP
• Both companies currently stretched – will individuals listed all
have appropriate skill sets and/or sufficient time?
• Do commissioners have confidence that landlord companies
will explore all options independently (conflict of interest)?
• Some will seek help from to independent professional practices
• Others will use or LIFTco frameworks but is this a serious
conflict of interest too?
• CCGs to fund professional costs – value for money
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13. What next?
• First decide if intended to
undertake strategic estate
planning in conjunction with
other commissioners, form a
LEF, identify stakeholders and
agree governance structures
• Early liaison with NHS PS and
CHP ‘strategic estates advisers’
• In most cases CCGs should be
clear they independent
professional advice is required
Lester Wagman has over 25 years’ experience in
providing strategic property advice to clients from the
public and private sectors, including 5 years working
in the NHS. He has spent the past 15 years advising
the public sector and its private sector partners,
focusing mainly on healthcare.
He specialises in strategic estate planning, working
collaboratively with healthcare organisations to
rationalise and harness their assets in the most
effective way possible to deliver high quality services.
Email or call on 07765 220519 to discuss your project
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