COVID-19 – Long term implications for NHS Estate
The Covid-19 pandemic has seen the NHS transformed in a very short space of time. But what may some of the longer-term implications be for its estate?
Even before Covid-19 threatened to overwhelm the NHS, its estate was not in a prime condition to weather increasing levels of demand. In 2018/19, an estimated spend of £6.5bn was mooted to be essential just to get the estate into a condition where it could provide acceptable levels of safety for delivering healthcare. The pandemic will only have exacerbated the need for spend on this backlog maintenance as resources have been redirected to respond to these unprecedented circumstances.
A significant issue is therefore going to be where to allocate future funding. Capital allocations have not typically been sufficient to keep pace even with the backlog maintenance requirements, never mind thinking about upgrades and new facilities. Whilst increased capital funding levels had been announced for the 20/21 financial year (and a pledge in the government’s manifesto to build 40 new hospitals over the next decade), those have inevitably been blown out of the water by the demands of the pandemic.
It is also important to note that the bulk of the NHS estate is not the large hospital trusts that we all see, but the primary care properties – the GP surgeries, community health facilities, social care provision, etc. The problems of backlog maintenance in this part of the estate are even greater, and it is here where new ways of working precipitated by Covid-19 may also result in the greatest demand for long term change.
We must also recognise that a large part of the NHS estate is owned by the private sector. The ongoing fight against the disease means that a large part of the privately-owned estate has needed to be repurposed swiftly. Doing this in properties owned by private landlords is not always possible or quick to achieve. However, the NHS does have some important collaborations with the private sector that may help. The estate developed through LIFT schemes, for example, was able to be quickly repurposed to provide community-based facilities and offers a model for how flexibility can be achieved to meet the changing demands.
What the Covid-19 pandemic has shown us
Long before Covid-19 though, a review conducted by Sir Robert Naylor in 2017 highlighted the need to remodel the estate to meet new ways of delivering healthcare. For some time now there has been a move to improve the join-up of primary and secondary care, to provide more of it outside of hospitals and in community settings. The need for that is only likely to accelerate. The pandemic has shown us the need to free up hospital space to allow them to do the work that only they can do.
One of the biggest changes brought about by the pandemic has been the acceleration of the use of digital technology. The move to remote consultations was swift, and it has been said that what was done in three months in this field would otherwise have taken five years. Although there will always be a need for face-to-face consultations, it is hard to see a return to the “old” ways of working. As a result, what are the requirements for future care facilities? Do GPs still need a certain number of consulting rooms of a certain size, what do outpatients’ clinics really need, do we need more remote diagnostics facilities, etc?
The pandemic also saw the creation of significant new facilities in a very short space of time: the Nightingale hospitals. Whilst these are only temporary facilities, they do give the NHS some headroom to start building back its elective and routine work when we start to emerge from the pandemic. They also show how rapidly the NHS can respond to increase capacity when it needs to. However, do we also need to start thinking about redesigning the delivery of secondary care? We have seen examples of trusts moving cancer and trauma care out to nearby “Covid-free” facilities to allow that care to continue in a safe environment and free up space for critical care. Might a model of similar separation be something that could continue to help long term?
We are only just beginning to see some of the long-term implications of the disease but already CCGs are commissioning facilities for the care of those suffering with symptoms of “long-Covid”. This is an early example of novel care facilities that may be required.
As we’ve seen, the pandemic has necessitated major transformation of the NHS estate, and the rapid response to that requirement is a very positive indicator of what is possible for its future development. To capitalise on this for the longer term, the NHS will require a more flexible estate to allow it to respond propitiously to new ways of working. Whilst it is the physical requirements of the estate that will deliver that, it is likely that flexibility in the terms of occupation of NHS properties will also play a significant part.
Concluding thoughts on the NHS Estate
- Backlog maintenance can’t be ignored if the NHS is to have a safe and efficient estate out of which to deliver its services;
- Space utilisation will be key. How can the NHS effectively reduce its non-clinical space so that it has headroom to deal with future pandemics?;
- Flexibility of use will be required. The NHS needs the ability to quickly repurpose its estate as required to meet new challenges. This requires not only flexibility of space but also of terms of occupation;
- New facilities will need to be reconfigurable to meet changing requirements for delivering services and integration of digital and other technology will need to continue at pace. New facilities will need to be designed with integrated IT front and centre;
- A multi-year strategy for government capital funding will be required to build back new capacity;
- What role do we want the private sector and private finance to play in all this? Private finance in the NHS estate has a chequered history but could it have a role to play in developing non-clinical space, allowing government capital funding to be targeted at critical space?
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