Agenda item

To receive an update on the NCL Estates Strategy.

Nicola Theron, Director of Estates for the NCL ICB, introduced this item noting that a number of specific questions asked by the Committee were addressed in the report. She highlighted the recent progress of the Estates Strategy including investment in the Primary and Community estate, with a number of new build and refurbishment projects set out in the report. An update was provided on the St Pancras Transformation Programme and asset disposals were also described in the report with an uptick in 2027/28. The graphs on page 18 of the agenda pack illustrated the critical backlog maintenance of around £121m with the effective maintenance of estates essential to deliver good quality patient care.

Nicola Theron explained that there were corporate expenditure limits on the overall capital and leasing spend for NCL which was £178m this year. It was necessary to work carefully and creatively to use not just national capital but also other sources of funding. NCL was one of the few ICS areas to set aside 5% of the capital budget for primary/community services. The Community Investment Fund/Section 106 (CIL/S106) funding was a significant source of funding as illustrated in the report.

With regards to Local Estates Forums (LEFs), the list of local authority representatives was provided in the report and this included a good range of senior officers and policy leads but more limited representation from Councillors.

Nicola Theron then responded to questions from the Committee:

• With regard to the St Pancras Transformation Programme, Cllr Connor asked about risk and financial stability for the second site. Nicola Theron said that the Moorfields site was being delivered separately from the second site where there were a series of other transactions, including a partnership with the private sector that was adding skills and expertise to the project. The programme was operating in difficult market conditions in terms of disposals and construction. The objective was to align the whole long-term programme and various sources of funding with the objectives of optimising health outcomes and ensuring minimal disruption. Sarah Mansuralli added that the programme involved a sequence of planned transactions so there was always a risk concerning the transactions being completed within the planned timescales. There was therefore a lot of focus on risks and mitigations throughout the programme. Cllr Connor requested that progress with the project and the associated risks be included in the next update report to the Committee in 12 months’ time. (ACTION)
• Asked by Cllr Connor about the 28% of NCL patients who access primary care from inadequate ‘tail’ estate, as illustrated on page 18 of the agenda pack, Nicola Theron said that the principle worked to was that health outcomes were better achieved in larger, better quality estates and the national policy was that commissioners should promote the delivery of services from ‘tail’ estate to ‘core’ assets.
• Asked by Cllr Cohen whether the Edgware disposal was linked to the overall major planning changes for Edgware town, Nicola Theron confirmed that this was dealt with as a separate issue.
• Cllr Cohen queried why 60% of the £9m allocated to NCL health from the planning system so far was from Barnet. Nicola Theron explained that this indicated the current degree of involvement between Barnet Council and the NHS in supporting development, including through S106 agreements such as a long-lease on two units for primary care services in Colindale. Cllr White questioned whether other NCL boroughs were expected to contribute more in future. Nicola Theron said that there were a lot of asks for CIL/S106 funding so the aim was to work in a more integrated way across NCL. Barnet had contributed a high proportion recently due to the large amount of recent development in that Borough.
• Asked by Cllr Cohen how often the LEFs met, Nicola Theron said that this was typically once every two months.
• Cllr Clarke requested further explanation of the proportion of capital funding provided by the government and whether this was sufficient. Nicola Theron clarified that the Department of Health and Social Care provided the £178m referred to earlier but that the capital ask in NCL was around 5-7 times that amount to bring the whole NHS estate up to modern fit-for-purpose standards. This was why it was necessary to recycle and find other sources for capital investment.
• Asked by Cllr Clarke about the limited amount of affordable and key worker housing involved in the development resulting from the Edgware disposal and asked why the NHS did not make this a condition of the sale of the land. Nicola Theron responded that NHS Trusts were sovereign organisations and that 50% of the capital from the disposal would be reinvested back into the Edgware Hospital estate with the other 50% going to NHS PS (Property Services) to be reinvested elsewhere. She added that there was work ongoing throughout NCL to maximise the number of key worker units and that there was a balance to be struck between developing affordable housing and securing capital receipts to be recycled into new projects.
• Cllr Connor noted the high level of critical backlog maintenance for NCL ICS provided and requested further explanation on how this could impact on frontline services. Nicola Theron said that hospital Trusts had a lot of capacity to plan how to manage a backlog and that, while they were sovereign organisations, the ICB had a role in working with providers to ensure that there was a consistency of approach on risk registers, the management of critical items and ensuring that the system as a whole was not exposed to unmitigated risk. She also noted that around 70% of the £178m capital spend in NCL was allocated for maintenance issues. She acknowledged that the critical backlog maintenance figures had risen in recent years with various contributory factors including aging assets, greater mechanical/ventilation requirements resulting from Covid and two hospitals with RAAC concrete issues. Sarah Mansuralli added that there was a huge evidence base on the importance of delivering care in a fit for purpose environment and the ICB was constantly seeking to attract capital from a range of sources. Nicola Theron commented that all Integrated Care Systems across the country were facing similar issues and that it was necessary to make the case nationally to the Treasury that more capital resources were required to bring the NHS estate up to the required standard.

Cllr Connor proposed that the next update report in 12 months’ time should include:

• A progress update on the St Pancras Transformation Programme, particularly the various transactions relating to the second site and the associated risks.
• A breakdown of the critical backlog maintenance by provider, including details of the year-on-year changes and any identified potential risks to patients. (ACTION)

It was also suggested by the Committee that there should be a clearer understanding of how the planning departments of local authorities could work with health partners on CIL contributions. (ACTION)