To receive an update on the Estates Strategy for hospitals and the Integrated Care System (ICS).
Nicola Theron, NCL Director of Estates, outlined progress with the Estates Strategy. The previous update to the Committee had been before the Covid pandemic. New governance structures had since been put in place. There was now an Estates Board which included Council representation, although it was not a decision making body. There were also local estates forums which included a range of representatives from individual boroughs, including Councils. These looked at how partners worked together, shared agendas and the securing of external funding. Representation from the Committee on these would be welcome.
More than 50% of primary care accommodation had been assessed as unfit for purpose. There was a driving need for investment and the realisation of assets. The process was also about reinvestment of capital. The aim was to ensure that all of primary care estates were fit for purpose but there was insufficient capital available currently. However, there had been some successful external bids for capital.
It was noted that it was important that there was system wide prioritisation covering the next three to ten years. There was not enough funding at the moment although some had been obtained though Section 106 agreements and the Community Infrastructure Levy (CiL). NCL were looking to work with partners on a local and national basis.
Ms Theron reported that there was a need to blend spending on estates and digital provision in a better way. There were some emerging examples of where this was taking place. There was also a need for increased capacity at borough level with consistency and improved access. Health inequalities also needed to be addressed as well as better coordination of governance arrangements.
The three year indication of capital allowances was useful as it facilitated planning. There was a £20 million reduction in capital though and consideration was being given to clinical led prioritisation. It was expected that the capital shortfall would reduce. There was a need for ambition to be maintained and external funding to be obtained.
It was noted that Estates Strategy was likely to be updated later in the year. It would need to ensure that Primary Care and Primary Network (PCN) priorities reflected local needs and optimises work with local authorities. There had been few recent estates disposals because of the pandemic.
In answer to a question regarding local estates forums, Ms Theron stated that they were similar in each borough. The Camden forum had met recently and the meeting had involved around 20 partners, including a number from the Council. They typically met quarterly but there were also informal monthly meetings. There were terms of reference for the forums. Representation from Councillors would be welcome, either on an ad hoc basis or more regularly.
The Committee requested further information regarding terms of reference, how local concerns were fed into the forums, their relationship with the NCL Estates Board. Details of membership and access to minutes were also requested.
In answer to another question, Ms Theron stated that she was happy to provide an update on property disposals for a future meeting. Some of the receipts had been reinvested in IT and supporting the workforce. Where divestment took place, the intention was for it to be done in order to re-invest. It was part of the process of developing the best possible care for local people.
The Chair stated that an update on disposal of assets would be welcome, including details of which estates had been sold and how the capital realised had been used. Assets could only be sold once and it was therefore important that the process was sustainable.
The Committee noted that there was a £40 million gap in funding for primary care. Ms Theron stated that more work was needed on how this gap would be reduced. NHS Property Services had less money at their disposal and strong cases therefore needed to be developed to secure funding. There was a five year plan and it was important to fund growth and the equalities agenda. Plans needed to be deliverable and each priority secured. It was important to ensure that the revenue implications of investments were affordable and space needed to be used as efficiently as possible. In addition, they were always looking to replace a capital scheme with an affordable revenue solution.
The Chair requested further information on how revenue fitted in with capital as well as to gain an understanding regarding capital receipts, including who they were retained by. It was important to avoid the selling off of estates to mitigate revenue pressures. In addition, further detail was requested on alternatives to disposals and what would be the impact of the £40 million funding gap not being breached.
That a further update be provided to the Committee on the Estates Strategy including:
· Governance including terms of reference, membership and minutes of estates bodies plus how local concerns are fed into local estates forums and their relationship with the NCL Estates Board;
· Detail on disposal of assets, including which properties have been sold and how the capital realised had been used;
· Alternatives to asset disposals; and
· What would be the impact of the £40 million funding gap not being breached;