What the private sector can bring to NHS estates

The sheer quantity of column inches devoted either directly or indirectly to the NHS and healthcare seems to increase exponentially by the day. Broadsheet headlines produce an acreage of information and analysis on key reforms; top-down and bottom-up reorganisations; critical reports; statistics; innovation and initiatives (ministerial and local); the plight of the elderly; the future of the community hospital and cardiac care for children; the growing list of complaints about emergency and out of hours care; and so on, and so forth.

The most heartening stories are those that talk about the real momentum behind the drive towards the provision of truly integrated care, with the aim of putting the clinical, social and practical needs of the patient at the heart of everything. We recognise that the sort of care that we all need can only be delivered when local authorities, health and social care, public and private work together to deliver the best, for the least expense and with optimum efficiency and effectiveness.

The papers all agree on one thing: there are a host of strategic challenges facing our beloved NHS, largely encompassed in the myriad recommendations made by the Francis Report. Alongside urgent improvements in acute care, there are other drivers for change: the move towards seven-day working and changes to urgent and emergency care; health and social care agencies adapting to new working arrangements (again); reorganisation of out-of-hours care in general practice; and 330 new bodies figuring out how to commission in real time. The private sector is taking an ever-increasing role in the delivery of world-class services commissioned by the NHS. Lessons and themes are emerging to which all need to react and respond.

“The papers all agree on one thing: there are a host of strategic challenges facing our beloved NHS, largely encompassed in the myriad recommendations made by the Francis Report.”

Yet the aims of the NHS are still fundamentally very much as they were when it was conceived in the post-war era, when the high-minded notions of public service and public duty created a unique and extraordinary approach to public health: involving patients in the design and improvement of healthcare; qualitative progression of that healthcare, so as to keep as many citizens in good health for as long as possible; excellence that offers real value for money.

We are all in it together

The private sector is constantly evolving its services in order to provide what the public sector requires. At present it is clear that the regulatory bodies for the NHS are perhaps the biggest influence on its speed and direction of travel. Monitor and the Care Quality Commission are stepping up inspections and their findings will provide a balanced scorecard of progress as it becomes available over time. For those trusts yet to make Foundation Trust status, NHS Trust Development Agency scrutiny of those inspections may prove critical, in terms of timing and capability to achieve that vital independence and opportunity. Regulation brings its own challenges and increases the need for better information (and better use of it) in the redesign of healthcare services. A few key points to consider in the redesign of healthcare estates, and ways in which the private sector can assist:

• Strategic partnerships are becoming meaningful, valuable and enriching for the NHS and its private sector partners. Joint ventures and strategic partnerships provide economic and environmental benefits and they facilitate all that is best while sharing risk and rewards in an equitable way.
• The total NHS estate footprint is now under its most intense scrutiny in terms of optimising efficiency. The private sector has skills and systems that can assess estate optimisation, however defined. These skills and systems may not be needed full time or in-house, so are perhaps best provided by a knowledgeable private sector, capable of sharing best practice and innovation across a wide client base.
• Forward-thinking organisations are seeking training and advice about proven commercial best practice, how it relates to the NHS, and in particular, to the estate. Again, the private sector is best-placed to provide this.
• Back office functions are being analysed as never before: the NHS sees that the private sector (and other parts of the public sector) have made great strides in efficiency and it needs to catch up. Small efficiencies made in a few back office functions are not capable of realising the large sums that can be saved by taking the totality of these functions and re-thinking core approach to provision, it is now clearly understood. The private sector can bring experience from other sectors that provides quick wins and long-term efficiency gains for primary, community and secondary care estates.
• The huge benefits of increasing technological implementation, particularly around digitisation of records and mobile working, is beginning to reap rewards in the use and allocation of space, and this will only grow as benefits and returns on investment grow and are quantified. The private sector can bring inward investment and overseas innovation, assist with business process re-engineering and engagement with stakeholders to ensure success.
• Excellent customer care and improved patient care are not uneasy bedfellows. Trusts are using private sector methodologies to engage patients and their carers as never before. The new ‘friends and family test’ introduced by the Secretary of State for Health is a good example of this new approach. The private sector knows a heck of a lot about customer care – if it didn’t, it wouldn’t thrive. So, again, we know just how to help.

The future is here, and we all need to adapt and grow with it. For the NHS family, ‘we’ now involves a great many members: regulators, ministers, health and social care commissioners and providers, local authorities, private sector partners, multi-disciplinary estates specialists … the list is long and includes all the sectors and all the sizes, from technology giants and multi-national corporations to SMEs, social enterprises and teams of clinicians. We are, indeed, all in it together.

David Lawrence is head of Capita’s health property team