Integration – estate collaboration and rationalisation

This article featured in the September/October 215 issue of the Hefma Pulse publication

Historically, NHS estates strategies have been developed on a provider-by-provider basis, with a variety of approvals processes often with a lack of clarity as to the criteria that would apply to capital investment.

Generally estates strategy has been decoupled from commissioning and commissioning has become focused on care provision rather than how care will be provided and enabled within existing and new estate.

Following the publication of NHS England’s five year forward view there has been a push towards   the implementation of new models of care, which require greater integration of care commissioning across the NHS.

This commitment has been shown by the establishment of the 29 Vanguard pilot sites across the country.

The landscape of integration and new models of care is a dynamic one and brings both opportunities and challenges to the estates function.

NHS Trusts across the country are already participating in the introduction of the Primary and Acute Care System (PACs) model and are utilising their estate and infrastructure to develop upstream services.

The NHS Estate plays a key role in the development of the PACs model, whether this be occupational arrangements for partnering providers on a hospital site or collaborating more strategically in the development of new facilities.

With greater integration comes a need for estates strategies to be more co-ordinated to make best use of ‘community assets’.

This will mean that capital will need to be invested at a local health economy level to ensure that the broader health economy goals are reached.

The NHS estate as a whole is of variable quality, high value and very often under-utilised. The NHS does not have sufficient funds to improve its estate, which is something that was not addressed by the Five Year Forward View.

Set against this backdrop, NHS Trusts are looking to review existing rationalisation programmes and examine possibilities for co-location. Here an integrated approach to disposal would result in more surplus land being used for alternative health or social care uses, ensuring that any disposal supports the wider health economy goals whilst unlocking the value for capital development or improvements.

It is crucially important that NHS Trusts keep their rationalisation programmes under regular review, particularly with a new focus on the requirements of integrated care.

Any review should involve obtaining up to date accurate estates management information and a key step in this process is the review of legal title to the land and any occupational interests.

This will ensure that the NHS Trust has a clear view of the current status of its entire estate and allow the NHS Trust to make accurate decisions.

NHS Trusts are also becoming more innovative, such innovation being encouraged by the increasingly competitive NHS environment.

We are seeing NHS Trusts expanding their service delivery beyond traditional geographical boundaries in the pursuit of business opportunities.

Ensuring that the estates requirements for such expansion are met is crucial to its success and profitability.

Victoria Armstrong is a partner and Real Estate specialist in the Healthcare team. She advises numerous NHS Trusts in carrying out estates reviews, rationalisations, and Health Building Note (Estatecode) compliant disposals of surplus land. Contact: or 0191 226 7858.


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