Instead of mending wards and extending areas of the NHS estate in a piecemeal manner, we need a long-term development plan from well developed proposals


More recent headlines on unsafe clinical and managerial working practices show there is still a way to go to change the culture and current perception of the NHS. Much of the recent NHS news has been known about for some time, given the fundamental review of a number of NHS Trusts by Sir Bruce Keogh.

The stark conclusions are that the numbers of hospitals which are under examination are now reaching into the high teens, dispelling the early notion of a few bad apples. While the NHS has some real world class operators, it has its share of acceptable and its share of poor practice, the latter untouched for many years by successive government reforms. The public victory at Lewisham for the retention of services including emergency and the women’s unit means this territory may now be scrutinised even more than before. This may make it more onerous for health economies to drive both local clinical reform and secure economy savings via such “public consultation” exercises.

It is though important that while acknowledging such issues, the system can move on and face up to the difficult challenges of changing culture. Those working in and around the NHS understand the system pressures (clinical safety, financial, sustainable modern services and staff retention) but some senior decision makers have too often ignored tackling these issues.

Some of the solutions to solving the failing trusts lie in improving and removing buildings at condition C & D and failing functional suitability

The need for system compliance is a requisite issue. However, surely the key is not only concentrating on how to communicate, but also ensuring there is a clear plan for managing, over a clearly defined timescale. This is regardless of whether it is clinical, estate statutory or operational issues, it has to be aligned to a willingness to actually enact change and not simply internally report it.

So what does all the above mean for the estate, construction and consultancy industry given the context, scale of the need for investment and desire to increase community and home care? Sure, this means rationalisation and a reduction in some proposed plans, but an end to capital schemes may have been prematurely forecast given this recent compliance context.

Some of the solutions to solving the failing trusts lie in improving and removing buildings at condition C & D and failing functional suitability. Currently there’s around £1.2bn in critical risk backlog with a further 12.8% of the estate that’s functionally unsuitable, which is an additional operating risk.

We have talked explicitly about the opportunities to be derived from driving down operational costs which could reduce the cost of operating the estate by anywhere between £1.48- 2.95bn, if the NHS operated at median or top quartile. This alone would either offer up efficiency savings or the ability to reinvest in some priority clinical areas. Too often this year we find third and fourth quartile trusts that are fire fighting: mending wards, extending areas or tendering parts of estate service in a piecemeal manner without any long term development control plan. Good toolkits are there to be used, to better map activity, outcomes, FM, estates costs and risk profiling. Part of this is liaison with fellow health organisations and staff who have delivered this agenda effectively.

Kennedy had prepared for his speech in Dallas in 1963 a simple quote which said “leadership and learning are indispensable to each other”. We need to embed evidence based learning and to ensure trusts take advantage of these opportunities, to avoid an inefficient use of public money and promote sustainable high quality services.

The next stage over the next three years will see a growing focus on the twin aims of clinical improvement and service and estate risk reduction, hopefully with well-developed proposals. This will include some medium and larger scale construction with the aim of driving down operational cost, improving the patient and staff experience which will lower the NHS risk profile. All of this can run simultaneously alongside the aim of health regeneration and outcome improvement via primary care led services with significant community service enhancement.

Conor Ellis is global account leader, health, at EC Harris