Facilities management special report: Integrate the estates

There are many facets to true integration of health and social care, not least funding and leadership. However, at the coalface, real integration is a practical issue.

‘The goals are to ensure access to the right services at the right time, without overlap or bureaucracy’

The goal for local authorities and health service providers is to ensure that residents access the right services at the right time, without overlap, duplication or bureaucracy.

Part of making that happen is to physically bring services closer together and often under one roof, according to Community Health Partnerships (CHP) executive director Dr Sarah Raper.

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How CHP works

CHP provides to local health providers and councils professional and dedicated strategic estate planning support, with the aim to help agencies integrate health and social care services, achieve cost efficiency from their buildings, and provide the best quality spaces for patients and service users. It works closely with its sister company NHS Property Services.

“While we are a property company on behalf of the Department of Health, we are about improving wellbeing,” Dr Raper says.

“Between ourselves and NHS Property Services we cover all of England and fit in with local government and NHS boundaries.”

‘Regeneration and housing has implications for health and wellbeing’

Dr Raper says research conducted in March on behalf of CHP found that the principle priorities for commissioners and local partners, including councils, are the integration of services and efficiency. With this in mind, the first stage of CHP’s work in many cases is to bring all the local partners together to discuss the needs of the population and how agencies can meet them to the highest standard and at the greatest efficiency.

“At a local level we have strategic partnering boards which come together to focus on estate issues and to discuss integration issues,” Dr Raper says.

“Half of these currently have local authorities on them. Other member organisations include CHP, NHS Property Services, clinical commissioning groups, NHS England, borough and metropolitan councils, and emergency services providers.

“The boards discuss what is right for the local population, whether there is a duplication of properties, and whether we can use properties for dual purposes. If buildings are not in the right place they won’t be used. Bringing everyone together leads to a much better patient or customer experience.”

The next stage, she says, is to identify how and where local authorities and health services can enter into joint ventures to create new properties, or better use existing ones, that are in locations and have the facilities that best suit the needs of the local population.

“In areas covered by the Local Improvement Finance Trust (LIFT) Programme programme, new developments are funded by the public-private partnership in a 25- year deal,” she says. “CHP and the public sector sign the leases, and the services that use the buildings pay rents. The returns or losses are shared on a pro-rata basis, which allows us to recycle the money back into the estate.”

The model appears to be working well in several areas. The LIFT programme companies set up by CHP over the past decade have built a portfolio of more than 300 integrated health centres, representing an investment of £2.6bn.

Dr Raper says the developments have been targeted where health and care needs are greatest.

“Nearly nine in every 10 of the centres have been built in areas of above-average health need, and over half of the money, £2.3bn, has been spent in the 20 areas of greatest deprivation. It’s about tackling the hard to reach places,” she says.

“It also creates employment; 30,000 opportunities have been created so far, of which 80 per cent are within the local [small and medium sized enterprise] sector.”

Dr Raper says CHP can help local authorities to combine various services, depending on what their particular populations need.

For instance, Birmingham’s Sparkbrook Community and Health Centre, set up by the NHS, Birmingham City Council the Diocese of Birmingham and Birmingham and Solihull LIFT, brings together a range of services, cutting costs and wasted space, while increasing residents’ use of the facilities.

The centre houses three general practices - a healthcare trust including a dental practice, a physiotherapist and district nursing; a library; the council’s customer services; adult education; the community centre; a church; and third sector services that provide an optician, help for victims of domestic violence, and drugs and alcohol support.

Some integrated facilities even include housing, as “area regeneration and housing growth has implications for health and wellbeing”, says Dr Raper.

The Parkview Centre for Health and Wellbeing in west London, completed in July, sits alongside four GP practices and contains a dental suite, a child development and speech therapy unit, diabetes care and heart unit and Hammersmith and Fulham council’s adult social care team, as well as 170 affordable housing apartments.

Local government expertise

Dr Raper says CHP is focusing now on helping local authorities get on board the integration agenda.

“We employ a number of people with local government experience, while increasingly building our relationship with the Local Government Association. We’re not just property surveyors; we have local government expertise,” she says.

“Every local authority in England has access to these services. We are happy to work with, lead and facilitate integration. We are working with local government and the message is: we are here to help.”

CHP’s message is timely: plenty of local authorities are focusing on this work.

Southampton City Council director of corporate services Mark Heath says the council is in the early stages of considering how it uses its estate.

‘It is a conversation about better ways of working, not just the bottom line of budgets’

“We’ve set up a public sector property board,” he says. “I spend quite a bit of time getting health, including CHP and the clinical commissioning group, around a table with us, and we now have police, fire and the government property unit. We have just been successful in bidding to government for the One Public Estate programme.”

One Public Estate is a Department for Communities and Local Government run programme. The LGA is administering the allocation of the programme’s funding pot, which is awarded to local authorities to assist them researching ways to reconfigure their estates. Southampton City Council will use some of this funding to conduct a study into the feasibility of the facilities spread around its suburbs, as well as looking at the use of some healthcare facilities, as part of a wider transformation programme.

“It isn’t just a conversation about the bottom line of our budgets and how we can reduce it,” Mr Heath says. “It’s about better ways of working.

“We have a city centre with little districts with their own shopping precincts, libraries, police stations, fire stations, car parks, drop-in health centres and leisure centres. We think: why have we got all of these things next door to each other?

“We don’t know yet whether we will keep all of it there, but if we do, why not put all three on one site and sell two sites? It might be a clever service offer if we did that.”

Mr Heath is keen to stress that no decisions have yet been made, but the council and the health service are eager to improve outcomes for service users and for the services themselves.