Agenda item

To receive an update on the NCL Estates Strategy including finance issues and an overview of key projects.

Nicola Theron, Director of Estates for the North Central London integrated Care Board (NCL ICB), and Adrian Byrne, Director of System Financial Strategy for the NCL ICB, introduced the report for this item highlighting the following key points:

• The recent transition from Clinical Commissioning Group (CCG) to Integrated Care System (ICS) had provided opportunities for Estates with a focus on delivering primary, community and acute investment across all five Boroughs. Recent examples included investment of up to £15m into primary care in Haringey with another £10m to follow, and investment into new Community Diagnostic Centres, including in Finchley and Wood Green, using a blend national and local capital to improve patient outcomes.
• New legislative powers for the ICB had been introduced mid-year and, with a lot of capital allocations sitting with key providers, there were tensions within the system as greater sums were being invested in primary care with a model of multi-purpose tenancies in some cases. There was therefore an ongoing process of engagement with NHS organisations across the NCL area to improve collaborative investment.

Nicola Theron, Adrian Byrne and Sarah Mansuralli, Chief Development and Population Health Officer for the NCL ICB, then responded to questions from the Committee:

• Referring to the figures on page 15 of the agenda pack, Cllr Connor requested further explanation of the funding sources for the capital and on the management of the maintenance backlog. Adrian Byrne explained that there was an annual capital resource limit of £200m but that organisations were funded on a revenue basis which included covering the costs of depreciation and the upkeep for estates. More of the funding allocations across the country were being used to manage the maintenance backlogs. NCL was in a relatively good position in relation to its maintenance backlog but did have a significant PFI (Private Finance Initiative) footprint resulting in regular costs. There were open conversations within the ICS on how to collaboratively achieve best value for capital funding, though there were some challenges posed to capital schemes by current supply chain issues. Nicola Theron added that there were around 180 primary care assets in the NCL area, mainly owned by primary care partners rather than the NHS, and that investment was taking place to assist in the delivery of more integrated models.
• In response to a question from Cllr Connor about the risks associated with £69m of acute backlog maintenance that was categorised as critical, Adrian Byrne said that this came down to assessment and prioritisation within the NCL system and that, while there were emergency funding routes available, he was not aware of any recent examples of these being used. Asked by Cllr Atolagbewhat was done to mitigate critical maintenance issues, Nicola Theron explained that, in such cases, work was required in the short term to support patient safety outcomes. For example, this could include electrical services where compliance was critical to prevent other risks. It was the responsibility of individual organisations to do this with a planned spend to maintain and replace where necessary.
• Asked by Cllr Clarke about the Chair of and representation on the ICB Board, Sarah Mansuralli, Chief Development and Population Health Officer for the NCL ICB, confirmed that Mike Cooke was the current Chair and that the Board included a lay non-executive member to represent the voice of local people along with Islington Council and Barnet Council representatives. There were also a number of sub-Committees that supported the Board which included local authority and community representation. Nicola Theron added that the Estates Board included an individual speaking on behalf of Islington Council but they were keen to ensure that a representative who was able to speak on behalf of all five Boroughs was on the Board in future.
• Cllr Cohen requested further details about local authority representation on the Local Estates Forums that were described on page 25 of the agenda pack. Nicola Theron explained that this was slightly different in each Borough. In Barnet, the forum was attended by planning and Section 106 officers, the Islington forum was co-chaired by representatives of the Council and the NHS and the Camden forum was attended by place-based, planning-led and regeneration officers. She added that these were important forums for conversations about joint priorities and optimising the abilities of the NHS and local authorities to deliver. Cllr Cohen suggested that health and social care services from local authorities should also have an input. Nicola Theron said that this tended to happen at project level, for example on the Colindale development in Barnet, where there was wider representation.
• Cllr Atolagbe referred to page 18 of the agenda pack which stated that “it is common to see slippage against planned schemes throughout the year” and that there was a £40m underspend against the plan. Adrian Byrne explained that it was necessary to operate within the revenue envelope provided. The plans were typically agreed in March with funding not then finalised until May/June and by October/November circumstances may have changed with challenges in the marketplace such as supply chain issues. This may result in less money being spent than originally planned and the funding may then be diverted to other emerging priorities.
• Cllr Bevan expressed concerns about the external conditions of primary care buildings which he felt were sometimes poorly maintained, including a GP practice on Tottenham High Road, and asked how often these were inspected. Nicola Theron responded that the £25m invested in NCL primary and community schemes (as set out on page 22 of the agenda pack) included a focus on the quality of smaller assets as well as the larger projects. While this investment improved the quality of the internal space it did not always reflect the external appearance of the buildings. This was partly because of the complex and varied ownership structures of the buildings themselves, though there was some pressure on landlords to ensure that they were properly maintained. Asked by Cllr Bevan how often the premises was inspected, Nicola Theron agreed to provide some specific details on this to the Committee in writing. (ACTION)
• Cllr Anolue expressed disappointment with the maintenance of some GP practice premises in the Ponders End area of Enfield and, referring to wider issues across the NCL area as a whole, requested further details about the responsibility for estate maintenance issues. Nicola Theron explained that the primary care assets had varied ownership, such as by GPs or private landlords, while many of the community assets were owned by NHS Trusts, NHS Property Services or Community Health Partnerships and the owners as landlords were responsible for maintaining buildings to appropriate standards. Responsibility for maintenance therefore sat with a range of organisations and the capital available to support this had to be prioritised based on greatest pressure and needs.
• Cllr Cohen asked for a list of estate assets that had been disposed of. Nicola Theron said that that there were very few of these but agreed to check this and provide details. (ACTION)
• Asked by Cllr Chowdhury about disability access at GP practice premises, Nicola Theron confirmed that DDA (Disability Discrimination Act) compliance was a particular focus when allocating funds, especially with some of the primary care improvements that had previously been discussed.
• Asked by Cllr Hutton about investment in digital capacity, Nicola Theron said that, as a baseline, this required ensuring that buildings had the right cabling, wifi and IT equipment. Examples of other requirements included that the digital equipment in Community Diagnostic Centres enabled x-rays to be read by GPs and Hospital staff. There were challenges in this area, and it remained a strategic estate objective in NCL. Cllr Hutton said that the importance of the digital aspect in estates in primary care and social care should be taken into consideration.
• Cllr Connor asked about the uneven distribution of CIL (Community Infrastructure Levy) money between the Boroughs as set out on page 26 of the agenda pack. Nicola Theron explained that this was largely driven by local housing growth, which varied in different areas, in order to create the appropriate corresponding health environments and required evidence to support the funding of new infrastructure.

Cllr Connor then summarised the requests for additional information and recommendations of the Committee as follows:

• A list of estate assets that had been disposed of to be provided.
• Details on how often primary care premises (including the external conditions of the buildings) were inspected to be provided.
• Further details to be provided on how the CIL money is distributed across the NCL area, including any constraints leading to lower allocations in some Boroughs. 
• Further information to be provided around the revenue limit and capital resource funding (including an understanding of what happens if hospital wants to invest and asks for capital funding, how much will they be allocated and how is this distributed across the NCL area). Also, clarification to be provided on whether capital funding is lost if it is not used within the 2-year period and whether this impacts on future allocations of capital funding to NCL.
• The Committee recommended that local authority representatives from Health/Adult Social Care should be included on Local Estate Forums because they would provide a perspective on the need in the local area.