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A look at the Health Sector

A look at the Health Sector

The government’s reforms of the National Health Service (NHS) are not only some of the most far reaching structural changes since Bevin submitted his blue print, they are also proving to be some of the most testing challenges for everyone to get an operational head around. The Coalition’s root and branch reforms of the public sector are testing the unity of all parts of the public/private spectrum.

It is fair to say that the NHS reforms have received a very mixed response and in some quarters have raised the blood pressure of health professionals across the whole market, even doctors have threatened industrial action in protest of aspects of the changes. With the launch of the new NHS underway we still see health sector unions and MPs from all sides of the House of Commons, uneasy and unclear as to what it all means. Whilst at the same time it could also be argued that the changes we see today are a variation of a previous incarnation , CCG’s and GP fund holding could be described as distant cousins.

Few observers would claim that the NHS is in perfect health, infact it is far to say that it is probably clinically obese and suffering all the associated ailments associated with that condition. However, debate continues as to how to cure this patient and at the core of this is what shape and configuration the new NHS needs to present its self as.

The quantum of the government’s original proposals feel to some as an invitation to the private sector to cherry pick the best opportunities available. The reality is, the private sector has been engaged in delivering healthcare since the dawn of medical treatment and in fact the GP’s have never been anything other than a private sector provision within the NHS envelope. Although the more visible and tangible part of this private sector engagement has manifest its self under the Facilities Management umbrella

It is unlikely that this will change the emphasis on moving non-core services out of the public purse has been targeted aggressively over the last few years and the reforms show little sign of this trend slowing down

All parties say they agree that the NHS has to cut costs and become more efficient and latterly there has become a realization that the costs associated with delivery are massively influenced by the configuration of estate which is operated from.

This is an area that attracts huge debate, on the one hand, the view that the public estate s record of disinvestment and occupation of outdated structures results in a huge mass of buildings and estates, ageing in profile, and described as inefficient and no longer fit for purpose and therefore needs serious investment? Against the alternative view which says, new build is the only solution and that demands vast amounts of private sector money needed to deliver a new NHS estate.

The reality is that there are lots of opportunities for the private sector in contributing to improvements in the running of existing estates and also building and managing new properties. However, the answer is not always huge investment. The private sector do not like funding retained estate schemes and the PFI experience demonstrates that. So there is a pathological drive to engage in funding new build schemes only.

An area that is questioned regularly is for better utilisation of property. Public Sector providers are been asked to share amenities with other public sector providers. Hospitals in particular are being encouraged to share facilities with other parts of the healthcare continuum and even sell off unwanted properties. The Primary Care providers are being encouraged to provide services under one roof. This is an area that with careful consideration and a willingness to co exist could be a space realization revolution. However, the internal market culture and the silo mentality that still exists in the public sector means those good examples of this are the exception not the norm.

However, the potential for outside contractors to run and maintain new ‘polyclinic-style’ facilities is a way of making this cross pollination a reality and is likely to grow, via the rejuvenated LIFT model which has been used to develop new facilities.

So what does all this mean in reality?

CPP believe that the market is not as bleak or as segmented as at first might be seen to be the case. Clients need to feel that there is not an either or situation but a menu of opportunities some involving the private sector but some may not. The Rush to deliver outsourced FM may seem logical but depending on the size and scale of the operation this may or may not be the right course of action. What is needed is a truly independent expert view that can help shape the right outcomes for an organisation.

It is too simple a statement to say the only game in town is via an outsourced root. The best fit for an organisation is the one that meets that particular organisations needs. Whilst the trend might be to move non-core services into the private sector, the first question is define non- core. For a GP practice many admin functions are core to the service, but in the acute sector many admin functions have been successfully moved into the private sector as non-core. Does this mean they should all be in house or outsourced. Is Pathology non- core, if so there are examples of good in house and good private sector provision.

So whatever the service, if it works, is effective, financially sustainable and not broken, why would you seek to change it.

Trying to understand the decision making journey should be surprisingly simple and can be based on a series of simple questions that are all open and all revolve around knowledge and consist of explanation type questions and statements.

  • Explain why you want to move, change a service delivery.
  • Explain how this all fits with long term planning
  • Explain the benefits and the risks and;
  • Explain how you future proof your decision

We can help get you to a place that allows rational debate around evidence based information that can be cemented in a plausible strategy. Nothing moves and changes like the NHS in an attempt to meet the ever increasing demands but often the outcomes have a familiar look and taste, so this is why we believe that understanding why you need or want to do something is the key to success.

One area that we believe should be given a serious consideration is Space utilisation, when ever we have undertaken this work the outcome has been a revalation to the organisation in question. This is backed up by a national position which recognises a collective understanding that there is around 2 billion square metres of under-used or unused space in the NHS estate. This figure has been reduced by some 200,000 square metres over the last 12 to 18 months and will continue to reduce in the immediate coming years. But reducing the underutilised space significantly will take careful planning and tough negotiations and no doubt take many years to achieve across the NHS.

However, CPP believe that careful understanding of space utilisation and challenging the perceptions of space management, ownernership and occupation are the key to maximising utilisation and reducing operating cost. At CPP we use visual interpretation, engaging our Architects to present a visual picture of an organisations use of estate and where possible get users to define need. Faced with a drawing and an occupation schedule is often all that is needed to demonstrate under utilisation and what can be achieved with the right buy in.

Over a number of years of data collection within the NHS from initiatives like ERIC has emerged an understanding of costs associated with running its estate. There is often a sea change in attitudes needed to move from inefficiency to effective estate management but if tackled sensibly estate running costs can come down significantly. It is suggested that the best performing Estates services operate at around £55 to £60 per m2 and the worst can be as much as £230.00 per m2. There are always many reasons for this but the reality is that such variations are common within the NHS and for a 1000 bedded hospital trust that could mean a financial drain in the millions.

The NHS is such a complex environment, having expertise committed to supporting your requirements and not simply focusing on the rhetoric or political agenda of the moment is what will help you deliver the best outcome for patients from the most efficient estate available to you.

CPP is different in how it thinks and how it engages, our clients are king in our book and we exist because we make it our business to deliver outcomes that have a real impact.

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