The government's ambitious vision for transforming healthcare delivery through neighbourhood health centres represents one of the most significant shifts in NHS strategy for decades.
Moving healthcare provision from hospital settings into local communities represents a fundamental pillar of the government's 10-year health plan, yet the financial reality of delivering this transformation presents considerable challenges.
The Department of Health and Social Care (DHSC) has already designated 42 locations for these facilities, in which healthcare professionals, social care workers and allied specialists will work together, adopting an integrated approach to patient care that aims to diminish reliance on hospital services.
For patients, they will be able to access a comprehensive breadth of services including diagnostics, mental health, rehabilitation, pharmacy and nursing under one roof.
But given that public finances are under considerable strain, the government must identify how it will finance what could amount to hundreds of community health hubs nationwide.
Strategic alignment of infrastructure and health policy
A potential answer is presented by the government's infrastructure blueprint, UK Infrastructure: a 10-Year Strategy, which was published around the same time as the 10-year health plan.
It acknowledges that private finance could potentially play a role in supporting the development of community healthcare infrastructure, alongside decarbonisation initiatives.
There will be no wholesale return to the Private Finance Initiative (PFI), the mechanism that delivered more than 700 public infrastructure projects, predominantly during the previous Labour government from 1997 to 2010. However, the current administration has committed to incorporating PFI's lessons into a fresh public-private partnership (PPP) framework, with comprehensive details expected this autumn.
While the exact structure of this new model remains undefined, the DHSC, working alongside the National Infrastructure and Service Transformation Authority (NISTA), has issued a preliminary market engagement notice for "Project Wings". This initiative encompasses the “design, build, finance, operation and maintenance of specific primary and community health infrastructure projects via a PPP framework”.
A crucial consideration involves determining which organisations will serve as contracting authorities for future healthcare PPPs. Integrated care boards, NHS trusts and local authorities may all participate in delivery, depending on the specific programme structure.
Learning from PFI controversy
Under Project Wings, NISTA will conduct further market consultation aimed at building upon "insights gained from previous government involvement" with PPP frameworks.
Before its termination in 2018, PFI was the predominant PPP model. Private sector partners would cover initial project costs, subsequently recovering this investment plus ongoing financing and operational expenses through long-term payments known as unitary charges from the commissioning body.
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