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Dimly lit, abandoned corridor with peeling paint and broken windows, like a crumbling estate. An open door leads to a room where overgrown foliage is visible outside, hinting at nature reclaiming its space.

Own it

London Bridge is Falling Down…

Nursery rhyme from the 17th Century. I don’t suppose today’s kids would have any idea what I’m talking about. If it’s not on a screen…

… well I guess you know the rest.

Nursery rhymes do stand the test of time. This one is part of the history of a lot of other countries, including the US. They get adapted over time…

… perhaps there’ll be a modern version… the NHS is falling down.

Already the outstanding hospital estate, maintenance backlog comes in, over £14bn. Hospitals made of aerated concrete are well past their sell-by date and as we have learned, there are other parts of the estate are just too dangerous to occupy.

Bojo’s forty hospital programme was always a fairy tale and Where’s Streeting has continued the mythology by pushing the new hospital programme so far into the future I doubt many of us will be around to see the ribbons being cut.

The NHS estate is in a state and is now in the ‘something must be done’ category of management challenges. But…

… there’s no money, no borrowing, no growth in the economy and no prospect of fixing this.

What to do? There are always options. Some more palatable than others, some practical, some tough, some not. Let’s have a look;

Public-Private Partnerships 

Collaborate with private sector investors to fund estate improvements in exchange for long-term service contracts. 

I know… not popular and Streeting would have to dine-out on humble pie to do it but it is an option. We know a lot more about how to write contracts, so this time we don’t get ripped off.

On the downside, it would be a more expensive option than borrowing from the Treasury… but everything is.

NHS Infrastructure Bonds

Issue government-backed bonds specifically for NHS estate improvements, attracting institutional and retail investors. 

Likely to be popular with the public and pension funds. It would count against Treasury debt and someone clever would have to find a way around that, but I’m sure it could be done.

Private Finance Initiatives

A reformed deal. Likely to be toxic, but no worse than a hospital falling on your head.

Capital Grants from Central Government

Direct funding for urgent repairs via targeted grants. Sort of what happens now. It’s an unreliable source of funding but I’ve put it on the list to save people writing to me to tell me I’ve left off the obvious. There is a twist…

… the Treasury might be prepared to issue the money in exchange for changes to a Trust’s public dividend capital… like taking shares in a company, in exchange for bailing them out.

Land Disposal and Asset Optimisation.  

Selling underutilised or surplus NHS property to raise funds for critical repairs. There might be a bit of capital to revenue jiggery-pokery needed but it’s an option and might release land for housing.

Charitable Donations and Philanthropy.  

Is there something to be learned from Academy schools? Dunno. Giving locals the option to become shareholders in their local hospital? Might be financially attractive but would come with all sorts of rows about access and equity. Probably a non-starter.

Regional and Local Funding Initiatives.  

Empowering local NHS Trusts to explore business partnerships and community-based funding solutions. FTs can do that now but the Treasury sits on them.  

An NHS Levy or hypothecated tax.

Gordon Brown sort of did it and it wasn’t unpopular.

The Green thing…

… a really proper look at the future of the hospital. Massive changes to reduce carbon footprint might reshape what is done in hospitals. 

Limiting visits to hospital and changes how staff get to work. It’s worth a look. Use one problem to help solve another. 

A big investment, leverage technology to beef up the virtual ward programme to virtual hospital.  

Which leads us to the question…

… are we trying to fix the wrong problem? If we fix social care would we need more beds and bigger hospitals, that are predominantly full of the over 65yrs. Won’t remote technologies do away with much of the out-patient demand for space.  

Re-imagining the hospital doesn’t take a huge amount of imagination.

When is a hospital worth repairing and when is it better to re-imagine it?

Yup I know…

… there isn’t a perfect solution and there isn’t a silver bullet but there might be silver buck-shot. A combination of one or other of the ideas and I am sure you’ll think of more.

We can’t wait, we can’t delay. We need to find Where’s Streeting and he needs to find better ideas than pushing solutions into the cosmos and blaming the Conservatives.  

He wanted the job, now he has to own it.

News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.

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