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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 has been used as a template to increase the privatisation of the NHS. This has been achieved by excluding the NHS from putting forward a claim to continue to carry out medical services. Privatisation of the NHS is now the only area that the Conservative Government pursues. Matt Hancock, the Health Secretary, recently stated there will be no extension of privatisation within the health service under his watch. Yet since that declaration cancer services have been privatised and services auctioned off. To the highest bidder.Enough is enough. The NHS is not the property of the Government to asset strip at will. This service is paid for through taxation and National Insurance and is a not for profit institution free at the point of need. Vulture capitalists have taken far too much and the underfunding of the NHS by central government is an abuse of power. It’s time to call an halt and a future labour government will do just that.