How to drive estate optimisation in the wake of COVID-19

This article was originally published in the May edition of the National Health Executive, which you can read here. 

As we begin to emerge from the pandemic, it is important to reflect on the past year. Our ways of working have transformed, and we have learnt lessons that will help us to improve the ways in which we optimise the Primary Care estate moving forward. The pandemic has emphasised the importance of understanding how best to do this through place-based partnerships, with local health hubs transforming at pace to provide vital treatment and testing facilities, while allowing regular healthcare services to continue.

NHS Property Services (NHSPS) owns around 3,000 properties, or approximately 10 per cent of the NHS estate. We collaborate with partners across the NHS to make the best possible use of our spaces. Over the past year, we have used our expertise in property and facilities management to build clinical capacity, increase testing capability and to promote better infection control in the sites that we own and manage. This could not be done without the collaboration between all of those within the regional estate delivery system, including the increasingly important Integrated Care Systems (ICSs). Our expertise supports local systems, relying on us to understand the data we have available from our sites, the demand on our estate, its availability for use and the resources and capabilities we have as an organisation.

Estates and utilisation data

Understanding the data that we have available and how best to use it is essential for efficient estate optimisation. The recent pandemic has identified the need for accurate data within our health service like never before. It can provide us with invaluable information about a facility’s capacity, cost, condition, or fitness for purpose and help us to identify underused or empty space.  For example, understanding the footfall in our properties, or the use of various rooms can help us to identify which spaces are being used most often, which types of services are most useful in a community, and which spaces could be repurposed to better serve these patients and ensure efficient use of NHS space.

A huge advantage of improved understanding of our data is the ability to identify opportunities for investment and transformation. We moved NHS trust staff from a dated and inefficient office to a better equipped vacant space in Moor Lane Mills, Lancashire, when the old site was deemed no longer fit for use. By running minor works and supporting the move, we have saved on £45,000 in running costs for the NHS and enabled a disposal of the old property. Ensuring that Moor Lane Mills is fully occupied also removes the vacant space issue, which had a liability of £159,000 per year. This is a great example of how, by understanding where unused space was residing in our facilities, we were able to adapt quickly, engage with NHS partners and efficiently support the health care service to provide better care to patients.

Understanding demand

Data, alongside insights from our local system partners, staff, and customers, also helps us to understand the demand on our facilities. We work closely with our NHS partners to understand the challenges and opportunities faced by occupiers, customers, and wider stakeholders. By working in partnership with ICSs to understand the current needs of local communities, and how they will likely change over the next few years, we can think about how our spaces could be better used to benefit more patients. Of course, the use of our spaces has changed drastically over the past year. From office workers moving to their homes, to GP appointments moving to a virtual format, many functions within our facilities are transforming. We are considering this within our own organisation too, moving to a Smarter Working policy, which was introduced in response to the COVID-19 pandemic in 2020. This policy looks to explore how to embed and enable smarter working, which does not centre around the physical office, and instead considers how NHSPS can boost productivity and wellbeing and enhance savings for the NHS through proactive management of the office estate.  

The best way to understand the future needs of patients is through creating strong customer relationships and partnerships. This involves our local teams working with ICSs to provide a targeted, place-based approach. We have introduced the role of ‘Regional Partnership Director’ into each of the seven NHS regions to support in these localised conversations, focussing on key customer and stakeholder relationship building as well as supporting property optimisation.

We have seen the tangible benefits from understanding local demand through our recent reconfiguration of space in Newton Health Centre, Manchester. This centre forms an important part of the local health estate, but it is a site that lacks enough clinical space for the growing service requirements. We have been working with Manchester Local Care Organisation and Manchester Health and Care Commissioning for over a year to identify potential solutions to address the demand for additional space. The need for additional space at the Health Centre was made more urgent when a local GP practice moved to the site after vacating its nearby premises earlier in the year and had to occupy the sessional spaces, which displaced other services. By reconfiguring the site to create additional capacity, we ensured that the new GP practice was able to move into the site and continue to deliver services to their patients with minimal disruption. By enabling the new GP practice to relocate a short distance to Newton Heath Centre, any inconvenience to patients was dramatically reduced given that they do not have to travel any further to receive health care.

Availability for use

While it is important to understand demand, it is equally as important to recognise and highlight the availability of these spaces. Offering flexible occupancy to clinicians can give them improved opportunities to source space in which they can provide patient services from. We have seen huge success from NHS Open Space, where customers can pre-book clinical and non-clinical spaces on a pay-as-you-go basis. We have this facility in over 100 sites across England, allowing both individuals and companies the opportunity to provide flexibility to their working day. This initiative also provides us with further data on how the sites are being used, helping us to improve the optimisation of our estate to ensure that it is being used in a way that is efficient and fits the evolving needs of our customers, staff, and patients.

Resources and capability

Lastly, you must consider the resources that you need, and the capabilities you have, to get the most from your facilities. It is important to use our specialist staff to the best of their abilities.  For example, with the support of our environment experts, over 50 of our sites so far have been upgraded with LED lighting. Between 2019 and 2020, installing LED lighting in over 30 sites resulted in a saving of £549,000 and a saving of the equivalent of 830 tonnes of carbon dioxide. These types of initiatives not only reduce the NHS estate’s carbon footprint, but they also save money, benefiting the NHS and importantly, patients too.  We share this expertise with regional estate delivery teams at strategic estate forums.

The NHS Long Term Plan emphasises the need for services to become integrated within communities, using methods like social prescribing to provide a wealth of services to patients on a local level which rely on the success of Primary Care Networks. We are passionate about ensuring the efficient use of the Primary Care estate and look forward to continuing our partnerships with local systems to improve patient care moving forwards.