Commissioning healthcare is a complicated process. From assessment of need and priorities to mass consultation to contracting for activity, the whole cycle takes time and skill to get the balance right. Perhaps, however, is there a step missing. Perhaps deciding where you are going to deliver the service from should be an early consideration, rather than a problem to solve once you a new service has been decided upon. If that’s the case, Estate Planning really needs to be in the Commissioning Cycle.
The situation today
Most NHS Clinical Commissioning Groups (CCGs) have health service commissioning plans that contain significant service restructuring that is needed to meet increasing service demand and strict service performance targets. Almost all CCGs will require skilled professional support to help deliver these changes successfully, with particular reference to planning and deciding the clinical infrastructure — i.e. the buildings and equipment — they need.
This is because the health commissioning cycle decides what the supply of each service should be to meet the predicted service demand, but rarely asks the question, “from where will this service be delivered”?
The consequence of this tends to be under-utilised health buildings, wasting NHS £1s that could be directed to patient care. To make things worse, it is compounded in many cases by new space taken on to provide a home for the newly commissioned service —wasting even more precious NHS £1s.
Adding estates to the commissioning cycle
A revised approach would requires each CCG to work through a series of analytical and planning processes that include:
- Painting a picture of the local health context, including demographic information and existing patterns of provision;
- Collating and assessing high level commissioning strategies, specific local service plans and areas of joint service planning with the local authority, with particular focus on health inequalities;
- Identifying gaps in service and setting out plans to address them;
- Impact analysis of such strategies and plans; AND
- Collating and assessing data and information about the existing estate and known/planned changes;
- Impact analysis of service proposals against the suitability, capacity and availability of the estate under CCG control within the local health economy;
- Generation of options for future scenario planning;
- Options appraisal of future scenarios (including financial constraints and opportunities);
- Development of high-level delivery plans for any required changes
The specific nature of the work required by each CCG will vary depending upon their starting point and the priority they place on developing additional Out-of-Hospital capacity. However, it is clear that local commissioners will need technical, analytical and strategic support to undertake this process. In addition, they should demand information on how their estate is performing to answer questions such as:
“What is the true demand for high quality health space over time?”
“Where are the gaps in asset utilisation?”
“How can health planning to fill the gaps in capacity within my estate?”
“What are the opportunities to reduce wasted overhead costs in my estate?”
Many parts of the NHS estate are under-utilised. Balancing the true demand for new health services with the available supply of health space is critical to ensuring the best return on assets for the NHS.
We believe estate planning should become part of the commissioning cycle — a joint activity with Commissioners and Estates professionals collaborating to seek early supply solutions to health service demands. We also know that infrastructure that is strategically managed and fully aligned with the CCGs commissioning strategy has the potential to deliver the following outcomes:
Improved patient and staff environment
- A built environment that offers a positive patient experience;
- Buildings that offer a healthy working environment that has a positive impact on staff recruitment, retention, satisfaction and productivity.
- an estate that is configured to optimise service accessibility (both in terms of building access and geographic location);
- a built environment that is designed to enable the required range of services to be delivered;
- an estate that has sufficient capacity to deliver the required volume of activity.
Better use of resources
- an estate that is managed in a way which optimises building utilisation;
- an overall estate that meets commissioning requirements at best value cost;
- an estate that is proactively managed and where potential opportunities for releasing capital or achieving revenue cost savings are realised.
Fit for purpose and flexible estate
- an estate that is compliant with building standards and regulations;
- an estate that is configured to be flexible and adaptable in response to changing needs;
- an estate that achieves mandatory energy targets and makes a positive contribution to reducing the NHS carbon footprint.
Greater integration of service provision
- efficiency gains through collaborative working opportunities;
- an estate that is configured to enable opportunities for innovation or seamless service delivery to be implemented.
- co-located complimentary services that can enhance the patient experience and improve accessibility.
Joined up planning drives sustainable change
Gaining an understanding of the actual service capacity of a building and measuring what it is actually delivering will open up a huge opportunity to reduce wastage, delay investments in new premises until absolutely necessary and improve the sustainability of the estate.
Commissioners are the health service demand professionals. Estates leaders are the health infrastructure supply professionals — without both working in concert, we all lose. However, with estates firmly embedded in a revised health service commissioning cycle, we can drive real, sustainable change that puts NHS £1s to work helping improve the health of the nation.