London’s health estate matters

A guest blog by Sue Hardy, Programme Director of the London Estates Delivery Unit (LEDU).

NHS estate is one of the key enablers to change in the health system, directly contributing to the delivery of high-quality healthcare. At the outset of a new era of integrated care, collaboration on estate to enable system aims and deliver better, more effective and joined-up care will be critical.

For a number of years now, GGI has been writing about the importance of estate in the provision of health and care services. We have conducted substantial research and collaborated with other specialist partners such as Primary Health Properties, to produce papers on the subject.

We commissioned Sue Hardy, Programme Director of the London Estates Delivery Unit, to write a piece on the work she has been leading across the capital.

Over the last few years LEDU has been doing some excellent work, providing a useful reference for integrated care leadership as they finalise their strategies and plans and start focusing on delivering the integration agenda against the four key national aims and local priorities.

Several important steps have been taken in recent years towards greater system working and collaboration across health and care in London.

In 2017, the Health and Care Devolution Memorandum of Understanding (MOU) was signed by the Secretary of State for Health and Social Care, key national bodies and all the main health and care partners in the capital, including the Mayor of London. The MoU outlined an agreement that decisions about London’s NHS estate should be taken by London for London.

A lot has changed since the signing of the MoU, including national, mayoral and borough elections, changes in the leadership of national government, a structural change to NHS governance through the unification of NHS England and NHS Improvement, the establishment of integrated care systems and the COVID-19 pandemic.

A strategic estates delivery unit for London

The London Estates Delivery Unit (LEDU), a dedicated, small core team with the ability to support a wider virtual team, was successfully established in 2018. It was designed to help coordinate and align regional and sub-regional NHS resource and provide strategic oversight to support local estates planning and delivery efforts.

The NHS and GLA agreed to jointly fund the LEDU as part of a shared commitment to bring resources together.

The LEDU is hosted and co-located with the GLA but reports formally into the London Estates and Infrastructure Board (LEIB) which in turn reports to the London Health Board, chaired by the Mayor of London. The LEDU now operates as a pan-London partnership of expertise, including the Healthy Urban Development Unit (HUDU), the NHS Estates Delivery Team and regional primary care estates programme management team.

Creating a strategic estates strategy for London

The initial significant task for the LEDU was to lead the production of the first-ever London Health and Care Estate Strategy (published in 2019). The strategy identified three overarching requirements of the LEIB/LEDU:

1. Support delivery of £8 billion of investment in the health and care estate by 2028

£3.8b delivered to date and developed a single framework for capital prioritisation across the five integrated care systems.

2. Support release of surplus NHS land (with a value of circa £2 billion) for alternative use over a ten-year period

Approximately 79 hectares of land have been released to March 2021 at a value of £500m.

3. Support delivery of 12,500 new homes for Londoners by 2028

It is estimated that land released by London NHS organisations since 2017/18 has the potential to deliver 7,500 homes.

Inspiring transformational change

The LEDU has been instrumental in the creation of an NHS Homes for Staff workstream. The London strategic approach from the LEDU has been to create a ‘minimum viable product’ approach and in 2018 the GLA/LEDU bid for and received a revenue funding grant from the Cabinet Office One Public Estate programme to deliver a Homes for NHS Staff London pilot, this funding resulted in three key outcomes:

• Funding was provided to support 5 pilot schemes, including a live project at Finchley Memorial Hospital, to help deliver these outcomes. Unfortunately, the remaining four pilots did not materialise due to the NHS reprioritising their requirements.

• Funds were also allocated to develop a delivery toolkit – a step-by-step guide to support providers looking to deliver homes for their staff. The toolkit includes advice on planning, legal implementation, demand, feasibility and business case development. This tool kit has been rolled out nationally.

• The LEDU then secured underspend against the total funding for the pilot to allow NHS North London Partners and Community Health Partnerships to procure Savills to deliver the Affordable Homes for NHS Staff in North Central London residential research report, to help better understand the key issues in relation to:
  • demand
  • requirements
  • costs compared to wages/salary bands
  • current available housing options for staff, and
  • affordability in North Central London in real terms.

In addition, a Homes for NHS Staff Roadmap was produced which details North Central London specific collected, collated and analysed information. This roadmap was designed to enable other integrated care system partners to understand the process of creating evidence of need and produce something similar for their areas.

The LEDU also supports the wider One Public Estate (OPE) initiative, which has invested in more than 100 projects in London (health partners are involved in over 50% of these). OPE revenue grant funding has been made available to support early-stage project costs and will fund land and property projects that demonstrate collaboration across local government, central government and wider public sector bodies and those that contribute to core programme outputs (homes, jobs, capital receipts and reduced running costs). OPE will prioritise projects which include housing benefits. The LEDU and GLA Public Land team have been working with local health and government colleagues to identify schemes that meet the necessary criteria.

A number of data/digitalisation programmes have been introduced by the LEDU across London to streamline and improve the management of the NHS estate and capital investment. All nationally funded capital programmes are now live on a single programme management system with the LEDU undertaking regional quality control and assurance prior to reporting back to national partners. This system is used by all five integrated care systems in London with some now implementing the system for internal use.

An asset database for internal LEDU use has also been developed. There had been no single point of access for NHS estate data across London. The objective for LEDU was to transfer existing data from spreadsheet form into an NHS estates database for London which allows users to view and edit records, query data and generate reports, automate data updates as far as possible using data from published sources, ensure a single property reference / code and geospatial data, with the ability to link other datasets. Work has been completed in restructuring and cleansing the data and linking sites to mapping coordinates using Unique Property Reference Numbers (UPRNs). The first phase of the system went live in summer 2021 with the scoping for phase two currently underway. The data held is commercially sensitive and will therefore not be directly available to all partners.

Capitalising on opportunities

The introduction of a prioritised capital pipeline along with a willingness across the region to maximise the impact of its operational capital has resulted in funding and spending resource limits to be redirected to where investment is most needed.

The introduction of several national capital programmes (critical infrastructure risk, oxygen resilience, A&E expansion, mental health dormitory eradication, elective recovery and community diagnostic centres) over the past two years has enabled the region to reprioritise its operational capital and accelerate investment.

Making a real impact

A recent independent review concluded that the LEDU is a well-established, trusted, and shared London resource well positioned to lead on many logistical and infrastructural priorities on behalf of health and care partners. There is a strong appetite to build on what has already been achieved through the LEIB and the leadership of the LEDU.