Conference hears that despite unprecedented investment, NHS estate remains ‘unfit for purpose’

Over the past decade there has been unprecedented investment in primary care and hospital buildings through NHS LIFT, Procure21 and PFI, as well as public funding. But, at a conference this week, delegates heard that, in many cases, this had not been money well spent and estates remain unfit for purpose and underutilised in many areas.

Speaking at BBH’s Healthcare Infrastructure 2011 event in Birmingham yesterday, NHS commentator, Roy Lilley, said: “The NHS is now not really fit for purpose. There is something missing. It is not anybody's fault, but technology and events have overtaken us.”

The NHS is now not really fit for purpose. There is something missing. It is not anybody's fault, but technology and events have overtaken us.

Part of the reason for this failure, speakers claimed, is that money has been ploughed into new hospital buildings when the direction of travel from government has increasingly been towards treating patients in their homes and preventing admissions completely. This approach has been further fuelled by the recent publication of the white paper, Equity and Excellence: Liberating the NHS, which focuses more on social care and community delivery.

Another problem is that, with dozens of PCTs, SHAs, hospital trusts and primary care providers, the NHS is losing track of what estate it actually has, ploughing dwindling finances into maintaining buildings it has no intention of using.

Paul Kingsmore, president of the Institute of Healthcare Engineering and Estate Management (IHEEM), told delegates: “The NHS is not sure what its estate is, what condition it is in, and what needs to be done. At best the information trusts have is a bit patchy; at worst it is non-existent. Trusts have been busy firefighting in recent years and do not have a clear picture about how fit for purpose their estate is, and even what it is.”

Trusts have been busy firefighting in recent years and do not have a clear picture about how fit for purpose their estate is, and even what it is.

The NHS currently has in excess of 28.3million sq m of estate, of which 7.4% was declared as empty or unutilised in 2009, according to research by built asset consultancy, EC Harris. PEAT scores show that 58% of the current patient environment is deemed as ‘good’, 17.8% as ‘excellent’, 7.5% as ‘unacceptable’, and 16.8% as ‘unknown’. It is this last figure that speakers said was the most concerning, showing the scale of the problem with the knowledge base of estates.

Connor Ellis of EC Harris said: “There is some very good practice occurring in the NHS, but in isolated pockets. If we were sitting in government right now, would we be able to say that the investment made so far has led to productivity gains? Data shows that, in fact, productivity has gone down by 3% in real terms since 1997.

“To date, people have used capital schemes to try and alleviate problems. We spend quite a lot on maintenance, but we don’t get value for money from it and we are increasingly seeing huge gaps between the best and the worst and we have to get a hold on this.”

If we were sitting in government right now, would we be able to say that the investment made so far has led to productivity gains? Data shows that, in fact, productivity has gone down by 3% in real terms.

He also claimed that procurement methods such as LIFT and PFI had proved so restrictive that private sector partners were unable to question the brief and buildings had been delivered that did not fit the changing landscape.

“There's no form of procurement we have come across in 20 years that is without flaws”, he added. “The problem is the failure of the design brief that has meant we have ended up with an underused estate.”

This was a view supported by Susan Francis, special adviser for health at the Commission for Architecture and the Built Environment (CABE) and Architects for Health. She said: “It is not often the case that private sector partners can question the brief given to them. We have procurement systems that make it very difficult for them to do that and so we end up with buildings that are not fit for purpose in the longer term.”

We have procurement systems that make it very difficult for the private sector to question the brief given to them so we end up with buildings that are not fit for purpose in the longer term

With capital funding now severely restricted, speakers urged trusts to make more of what they have through smaller-scale refurbishment and the sale of disused estate.

Francis said: “Things are changing fast and we need to shift from investment to austerity. We need the estate to be fixed and adapted to be able to cope with the changes. We need to plan for uncertainty and design for change.“Up to now buildings have not come out of strategic planning, but from opportunistic moments. We need to change our model to meet the challenges ahead.”

According to Kingsmore, this will mean estates and facilities professionals getting more savvy in terms of cataloguing the estate and working with the private sector to find the best, and most cost-effective ways, of reacting to the changing environment. “It is going to be a real battle to see how to get money into the system for estates and there are a number of models at our disposal, but we have got to be open to anything that comes forward. Nothing is off the table.”

Up to now buildings have not come out of strategic planning, but from opportunistic moments. We need to change our model to meet the challenges ahead.

Commenting on the importance of good patient environments, he added: “The environment is really important to the patient experience. When people look at rating the quality of care they receive they will be considering the physical environment they are in, how safe it is and how reactive it is to their particular needs. “We need to be open and honest and say whether what we have is good enough. Estates professionals will need to respond to these changes as they are here to stay and it would be hard for another government to reverse. Therefore, we need to look at things in the long term and respond positively.”