Talking about a revolution

There is no doubt that the vast and far-reaching reforms that the Coalition Government is implementing this year will usher in the biggest changes to the NHS since its formation; and let us not forget that all of this is set against the backdrop of continuing economic uncertainty and an historic deficit reduction plan. The scale and pace of the proposed changes, with the Government committed to such an ambitious timetable, coupled with little or no detail as to how the estate will be treated, make predicting the exact impact for estates managers a difficult task. However, while the estates picture remains uncertain, a thorough analysis of the situation tells us that one thing is clear – the way that the UK’s health estate is run will never be the same again.

The status quo

More than a decade of Labour government spending, and the proliferation of PFI/PPP, LIFT, and ProCure21capital programmes, have led to significant investment and improvement in the UK’s health infrastructure. As we enter a new period of austerity following the Comprehensive Spending Review last autumn, it is clear, however, that this era of mass capital investment in the health estate, and the provision of shiny new hospitals, is now behind us; bar notable exceptions such as Liverpool & Broadgreen and Epsom & St Helier. However, the health estate continues to require significant updating and improvement, both to address an ageing and underutilised building stock, and to cater for new initiatives – all of which will require capital investment. Department of Health figures show that over 15% of the existing NHS building stock is classed as not suitable, and that a fifth of buildings pre-date the formation of the NHS in 1948. A significant proportion of the health building footprint is under-utilised, or not used at all. The quantum of empty or under-used floor area is estimated at over 3 million m2 across the NHS estate, which represents more than the total floor area of all Tesco’s UK stores (source: EC Harris, Health Estate Journal – November 2010). The issues also do not stop there. Added to these pressures are the proliferation of new initiatives and proposed improvements to performance and service delivery, such as significant fines for Trusts that do not provide single sex accommodation and satisfy privacy and dignity requirements; or the stringent carbon reduction targets imposed on hundreds of old and inefficient buildings.