The NHS estate is potentially a huge asset. But only as long as it can adapt to changing demands. By that I mean the way we care for patients.
The country’s financial circumstances have been changing rapidly and this will have an effect on the delivery of healthcare.
In the UK we are facing a similar crisis to other developed economies in that not one of our healthcare systems will be sustainable in their current form in the next decade.
Taking the UK specifically for the purposes of this argument, I would say the NHS and its vast 17m-acre estate has not yet adapted properly to the changing patterns of ill health, especially the shift from communicable to non-communicable degenerative disease. It is fragmented and instead of concentrating fully on those who are in need of care, it has become increasingly dominated by providers of healthcare.
The NHS employs around 1.3m people and has roughly 1m patient consultations a day. But it has been estimated that for every hour of NHS contact patients engage in almost 5,000 hours of self care. That should give a pause for thought as we contemplate what form healthcare may have to take in the future along with the role of the NHS estate.
At one level, none of the estate’s challenges differs from those of any large industrial organisation, and healthcare is, above all, a service industry. Witness the transformation which overtook banking in the past few decades. Most modern banking is now virtual, with clients acting as their own cashiers, and banks’ former high street premises are often sold to become restaurants and boutiques. Also, consider the revolution in retail, where online shopping is giving the high street a run for its money.
The NHS estate currently owns floorspace equalling more than 300m sq ft, excluding primary care premises.
It has been estimated that the NHS estate’s assets in England are valued at £44bn. But there are other more worrying statistics. Current estimates of the total wasted space across the NHS amount to an area greater than the size of Hyde Park, or if you prefer, the entire Tesco estate in the UK. Dealing effectively with this level of waste and enhancing the management of the NHS estate could swell the health service’s coffers by around £2.3bn every year.
Even buildings that have been procured relatively recently are difficult to adapt to the rapidly changing demands of modern healthcare provision. The NHS estate tends to be tied to siloed healthcare delivery, but there is already a lot of boundary hopping occurring, such as GPs employing consultants within their own practices. But why can’t we see GP surgeries located within pharmacies, or even inside retail outlets? Wal-Mart runs a significant primary-care function in its retail outlets in the US. Freeing up the provision of care from the estate in which it traditionally has been provided could be a major catalyst for change. A recent example is the establishment of NHS Property Services Limited, which holds more than 4,000 properties, amounting to about 20% of the total NHS estate. The value of the business is around £3bn. It is one of the biggest property companies in Europe, but unlike Europe’s other property firms, which have been built over decades, NHS PropCo has had property thrust upon it.
NHS Property Services has a difficult task ahead of it, but I think it is a good model for what we might need in the future if only in the sense that it has brought into single ownership an unusually fragmented estate.
Podcast: hear more from Malcolm Grant
Malcolm Grant, chairman, NHS England
