This document provides an update on the transition of NHS property assets to new organizational structures following reforms in the UK healthcare system. It discusses the transfer of assets from Primary Care Trusts to NHS Property Services Ltd. and some challenges in carrying out transfers, funding arrangements, and strategic planning. It also introduces the concept of "patient hotels" as a way to provide accommodation for patients awaiting discharge or treatment.

1. Update &
Strategic Estate Partnerships
Lester Wagman
Healthcare Environment & Infrastructure
Southampton, September 2013
PropCo

2. NHS PropCo – Principles (recap)
• Presumption that assets will be transferred to relevant NHS service providers:
- Foundation NHS acute/MH Trusts
- Aspirant Community Foundation NHS Trusts
• Full lists of property for proposed transfer to these organisations currently under consideration
by DH but some Transfer Orders made
• All other estate to be transferred to NHS Property Services Ltd.
• Likely to include assets formerly held/controlled by PCTs/SHAs:
- Administrative/support services buildings
- Operational community care property:
- in multiple occupation
- where the NHS provider is a minority occupier
- where the community provider is a non-NHS provider
- Operational primary care property, e.g. some GP surgeries
- NHS interests in established JVs such as LIFT Cos
- Surplus property (Trusts encouraged to release this ASAP to support HCA new homes initiative)
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3. What needs to be done (recap)?
Nationally
• Structure of eventual PropCo(s)
- Role of LIFTcos
- Governance arrangements
- Interim resource planning
• Procurement process
• Transfer orders
Locally/Regionally
• Housekeeping
- Compliance/Backlog maintenance
- Transfer/novation of contracts
- Lease management issues
• Strategic estate planning
- JVs & SEPs
- Shared/divided sites
- Capital programme
- Transfer valuations
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4. Update Nov 2012
Letter from Simon Holden (CEO)
„Core‟ landlord and advisory services that Primary Care Trust estates
teams currently provide or manage:
• Strategic estates management
• ƒ Property management advice
• The operational delivery of
[property] services:
• Refurbishment and maintenance
• Emergency/on-call repairs
• Quality assurance
• Compliance with statutory
regulations (such as fire, asbestos)
• Non-urgent breakdowns (electrical,
mechanical, building)
• Planned preventative maintenance
• Health and safety, fire safety and
risk assessment (landlord only)
• Mechanical and engineering services
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5. • ƒ Charles Howeson, Chair
• ƒ Simon Holden, Chief Executive
• ƒ Caroline Rassell, Finance Director
• ƒ Pamela Chapman, Acting Director
of Asset Management
• ƒ Alan Farmer, Director of Corporate
Services
• ƒ Andrew Millward, Acting Director
of Communications and Business
Services
• ƒ Chief Operating Officer, Vacant
• ƒ Kathryn Berry, Regional Director,
North
• ƒ Martin Royal, Regional Director,
Midlands and East
• ƒ Tony Griffiths, Regional Director,
London
• ƒ James Wakeham, Regional
Director, South
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Update April 2013
Leadership team in place:

6. Update 2 April 2013
Letter from Peter Coates (on behalf of Secretary of State)
To: landlords, sponsors and/or funders
Setting the Scene
• On 31st March 2013, Primary Care
Trusts ceased to exist
• A significant number of properties
previously owned or leased by
Primary Care Trusts (together
with all resulting liabilities) will
transfer to NHSPS
• The Secretary of State for Health
holds all of the shares in NHSPS
Statement of Principle
• SoS acknowledges fundamental
importance of…good quality
premises [for primary health]
• enshrined in NHS Constitution
pledge :
• “services provided in clean and
safe environment that is fit for
purpose, based on national best
practice”.
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7. Update 2 April 2013
Letter from Peter Coates (on behalf of Secretary of State)
To: landlords, sponsors and/or funders
NHS PS Role & Responsibility
• NHSPS to manage NHS' interest
in large number of properties as
best way of ensuring a coherent
strategy during the period of
transition
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Mixed Message
• NHSPS is not subject to s.70 of
NHS Act 2006 (any outstanding
liabilities of a PCT would survive
dissolution) – Gulp!
• “However, it would be wrong to
think that this signifies any
reduction in the commitment of
SoS to the assets and liabilities
that NHSPS will inherit”

8. Update 2 April 2013
Letter from Peter Coates (on behalf of Secretary of State)
To: landlords, sponsors and/or funders
SoS Role & Responsibility
• SoS is sole shareholder in NHSPS
- role taken very seriously
• Departmental director appointed
to the board - governance
protocol requires approval of
director to all board resolutions
• SoS will continue to ensure the
continued good running of
NHSPS & responsibility of
directors 8
“Untenable” that SoS would:
a) Allow NHSPS to run at risk of
administration/insolvency
b) Not take any action to remedy
administration/insolvency
c) Wind up NHSPS without first
transferring assets to “entity of
equal covenant strength” (i.e.
another NHS company, NCB or
CCGs)

9. Update 2 April 2013
Letter from Peter Coates (on behalf of Secretary of State)
Explanation of funding for NHSPS
• PCT PFI properties yet to transfer
but interim budget funding
arrangements now in place
- NHSPS entitled to receive any sub-
lease income
- NHS CB or relevant CCGs to meet
any funding shortfall
• Post 2015 Primary Care PFIs “will
be funded increasingly directly by
the occupants”
• “It is recognised that the
occupants' contracts for providing
services to the NHS will need to
be funded appropriately”
• “The anticipated move towards
payments flowing increasingly
through occupants is to incentivise
the system to optimise property
utilisation and value for money”.
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10. The official view
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11. From the coal face
• Land registry transfers went “eerily quietly”
• Some anomalies have emerged - some things may have gone
to wrong place
• Little or no activity on disposals or asset management
• Estates services still being provided to NHSPS by some
transferor (acute/MH) Trusts
• Resourcing - area team leaders in place but NHSPS still
recruiting
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12. From an outsider’s perspective
• Capacity Struggle
• 30-40 Local Area Team Co-ordinators appointed by NHSPS
• Interaction with NCB & CCGs still unclear
• GPs rushing to get leases in place [or not in some cases]
• DH focus on making sure Transfer orders in place
• Traffic light triage of transfer risk issues: 1st 100 days, 2nd
100 days etc.
• CHP has similar issues with LIFT estate
• NHSPS likely to be looking for „quick wins‟ but
• Nothing controversial expected pre-election!
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13. All Going Well?
• Some assets may have gone to wrong place
• Some sweeper provisions in place
• Legal charges vis a vis capital grant agreements
• Option to tax (VAT)?
• SDLT?
• Interim funding announced for 2013/4 but funding gaps
emerging - commissioners to take on in short term
• HCA Public Land Programme
• Funding of GP premises impovements
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14. What is a Strategic Estate Partnership?
• No single definition
• Often whole estate PPP principle
• Can be specific assets with option to widen scope
• Assets taken off balance sheet but can be just contractual
• Often includes asset management and [some] FM
• Can also include healthcare & support services
• Private sector partner brings development skills & finance
• With agreement can be extended to include other public sector assets
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15. SEP spectrum?
• Contractual/framework (e.g. Lancashire)
• Limited asset (e.g. Southend, Yeovil, Salisbury)
• Scheme specific (e.g. Cambridge, Kings College)
• Sample scheme led (e.g. CWP, IoW)
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16. Southampton CEDP
• MERA
• Parking
• PPU
• Patient Hotel
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17. Patient Hotels
• Planned early admissions
• Patients waiting discharge
• Relatives and friends
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18. Patient Hotels
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• Should there be any ongoing nursing care be provided?
• If so, who should provide this and what should be their responsibility?
• Should an emergency call button be provided?
• If so, who should respond and what should be their responsibility?
• How long should the patient be allowed to stay
• What happens at the end of this period?
• Who will pay for their accommodation, meals and care (and for how long)?
• Who will be responsible for the maintenance of the environment?
• Who will be responsible for the provision of hotel services?
• Under what circumstances and who decides if the patient should be readmitted to
hospital?

19. Commercial Option
• Forecast room
commitment
• Fixed discounted day rate
• Accounting period
adjustment
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20. Discussion
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