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‘This is not a fire sale’.
Words are important. But sometimes words become little more than empty platitudes. And this can often be as true for the NHS as it is for politics – the cosy home of the empty platitude.
During a King’s Fund debate on the future of NHS hospitals and land – and a presentation to his report by Sir Robert Naylor – those six words, ‘this is not a fire sale’, were uttered several times in just the space of an hour and a half.
It might very well be unfair to worry about the intent behind the words – uttered both by Sir Robert and two senior NHS Improvement officials – but a healthy dose of scepticism and an hour spent listening to the context suggests questions should be asked, if these plans are followed through, at the very least.
Sir Robert’s second report could be out at any point during the coming months (depending on when Government sees fit to publish it. The last report was stored for months until that decision was made) and will set its sights on solving many of the NHS’ estates, and wider, problems – by milking England’s cash cow: London.
Sir Robert, it should be noted, admitted his plans detailed in the second report were ‘pretty controversial’.
He told delegates: ‘It took the Government six months to decide whether to publish it (the first report) or not – it was seen as quite controversial. In that six months of delay it became obvious that the big issue was in London or around London. That’s where all the money is and the lack of investment is.
‘We looked at London in much more detail to try to validate some conclusions from the first report. It (the second report) hasn’t been published – there was a general election. Some of the recommendations in the second report are pretty controversial.’
At the King’s Fund event last month some of these plans were hinted at. Sir Robert suggested London’s hospital sites alone could fulfil the NHS’ national target (set by Government) to free up space for 26,000 houses – if it pursued an ‘aggressive’ strategy for its estates.
He also revealed that the estimated £5bn backlog maintenance costs for English NHS trusts – tallied up in his own report – was a ‘gross’ underestimate, revealing that one London hospital trust estimated theirs to be £300m to £400m but their true total was treble that.
So what can be expected from the second Naylor report?
Sir Robert revealed that when ranking each of the 44 English STPs by their opportunities to make more efficient use of their land and buildings – for ‘efficient’ read selling, moving, demolishing, renovating or co-locating – the top five are all London STPs.
It’s been reported before that four of these have the potential to bring at least £1bn of cash into NHS coffers if they make changes.
Already plans are afoot to sell the Moorfields Eye Hospital buildings and create a new super campus – particularly focused on mental health – at St Pancras. But much, much more could be on the agenda, if Sir Robert’s plans are adopted.
In this vein, Sir Robert’s reports urge the NHS to adopt a ‘far more commercial’ approach to their estates.
Simon Corben, NHS Improvement’s director of NHS estates and facilities, echoed the suggestion that London’s estates could make a lot of money – and said Project Phoenix, a national NHS initiative to bring private firms to the table could be a big part of the future.
He said: ‘There are a lot of people parked up, ready to present finance to the NHS and we need to corral that and make sure it’s done in an appropriate manner.’
Project Phoenix looks like being a big part of the future – and it is likely to mean land or building sales will be conducted by public and private partnerships which use private cash and expertise to achieve best market price for sales potentially by converting or renovating sites or by helping with achieving planning permission. Any future profits would likely be shared.
If there is to be any confidence in a future strategy – particularly one which relies on the involvement of private firms – transparency will be key. Private involvement in NHS services has rarely ended well for either balance sheets or patient care.
On top of that sales have to be ultimately in the best interests of patient care, and result in investment; that means cash being poured into the frontline NHS both from receipts of sales and new money found with political will. The NHS’ buildings are crumbling – and the morale of its staff, and the consequences for patients are showing. Investment, and not just that siphoned from sales, is crucial.
Peter Blackburn is a senior staff writer at the BMA
The Naylor report is not just about selling off excess lands, but also about enforcing such sales of current, and essential, used NHS lands and Property, by penalising those trusts who refuse to do so. In effect all NHS owned clinics, Hospitals, etc are being forced to become private sector owned assets, and on the cheap too, and what will then happen is both a huge reduction in NHS services, and an increase in private healthcare clinics and hospitals where patients will no longer be able to receive treatment free at the point of service. The Naylor report is in effect the Hammer being used to nail down the coffin of the NHS.
Wasn't poor maintenance the reason for the Buckingham Palace getting a cash injection from the tax-payer? Think how many one-bed flats would fit onto that space?
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The commercial logic says concentrate resources (it reduces capital spend) And yet the evidence suggests small (300 to 400 bed hospitals) are the most cost effective. So please sell all sites with more than 500 beds and spend the money on a network of small hospitals......
I can almost hear the teaching trusts screaming, but the systematic reviews show clearly the big is better claim is a myth.
Why sell? Why not lease? Then you get a regular payback to offset other costs without losing your capital assets to prop up the revenue budget.
Many current NHS sites were originally created from funding from philanthropists and charities in the pre-NHS age. They all were put under the jurisdiction of the government once the NHS was created. There may be clauses when they were originally built restricting their use for anything other than healthcare. I wonder whether the land and the property is legally possible for the government to sell, or force sale?
I am far from convinced that NHS land should be sold off but if it is then what about some rules that limit its sale for affordable social housing that is reserved for low paid healthcare workers and other public service workers? At least that would retain some public service element and not be just about profits for developers. But I do wonder what happens when in the future policy shifts or treatment advances mean we need more space for patients. If the NHS (if it is still there) has sold off its land assets it wil lbe obliged to buy at commercial prices. Sean Cusack BMA SW Regional Coordinator
Selling the NHS land and property in the name of modernization is nothing but privatizing the health care through the back door. This is already happening to the community services.
This is a disastrous proposition! I have witnessed this many times already- selling the building inevitably means closure of the service housed in it, including services,which have been saving money for the trust and have been clinically very effective. It doesn't make any sense clinically or financially - clinically because the need doesn't decrease and therefore out of area services are seeked, which costs much more money to the NHS.
I find all this deeply depressing. The ruthlessness and surreptitious processing of Lansley's plan to dismantle our National Health service by the R Wing of the Conservative Party is so effective - Machiavelli would be proud to see. All my life as a paediatrician I have believed in the power of enlightenment reason and now I have been forced to realize that myth based ideology rules the world
Do they never learn? PFI has cost the NHS billions and the organisations running the hospitals are charging extortionate rates for any repairs or alterations to improve services.
It seems highly unlikely that the corporate financiers will not have much more profitable plans for use of prime sites in London than providing NHS services and social housing!
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