The NHS estate dilemma - too much old, too much new

Posted: 17 September 2010 by James Barlow

As the Government’s Spending Review, due on October 20, takes a hard look at the NHS, our healthcare infrastructure faces a paradox. On the one hand, we have lots of new hospitals - perhaps more than we need, given the trend to shift care from hospital to home and community.

On the hand, we also still have too much old estate – 20 per cent is said to pre-date the foundation of the NHS in 1948. That’s a big drop from 50 per cent in 1997, but it still makes for a great many buildings that are inefficient, expensive to maintain and a handicap in the struggle to meet CO2 emission targets.

In these financially straitened times, when we must sweat our assets, how do we transform this situation? There is a danger that no-one will take real responsibility during a period of flux in the NHS. It is difficult, for example, to see GP consortia and foundation trusts – or the residual bodies holding onto what PCTs leave behind - being equipped to grasp the nettle. There is talk of local authorities taking over some PCT property, but local authorities are hardly renowned for success in strategic asset management.

An obvious first step is to focus on scoping the location and function of old estate as well as who owns it and how productive it is. We need then to create a clear plan for its future. The pre-recession solution tended to be to knock it down and build afresh. These days, we need more imaginative answers.

Germany may offer some clues. Because of over-capacity, the private not-for-profit sector is allowed to obtain a license to operate a hospital only by taking over an existing facility. It cannot simply build afresh. Once they have bought the facility, they can then build on and reconfigure the existing site. Perhaps there are some ideas there for engineering the change of use and refurbishment that the NHS needs.

No doubt there are other potential ways forward. But it is clear that, in era when decision-making is being devolved downwards, the Government cannot allow planning for NHS infrastructure to drift when the reconfiguration of assets is just as urgent as the reforming of service commissioning.