More on the Naylor Report


  • The Naylor Review 2017.
    A broad response to this review should have an approach based on the
    A. The rushed sale of valuable NHS estate land and buildings. The
    NHS estate has taken generations to assemble, through purchases by
    public money and through centuries of charitable donations and
    legacies of money, land and buildings by public spirited persons. Before
    any sale of this precious NHS estate, the land that is likely to be
    required for the future development of the NHS, on a reasonable
    forward plan of at least 15 years, must be identified and safeguarded, to
    meet foreseeable patient needs, as part of a long-needed NHS estates
    strategy which should be open to public consultation and be agreed by
    Parliament. The NHS should not breach the trust placed in it by
    previous generations of donors and taxpayers.
    B. The offer of extra money to health authorities who sell quickly is a
    wholly inappropriate and wasteful incentive. It subverts their fiduciary
    duty of care to ensure that any sale, without undue haste, is able to
    achieve the full value of the land. NHS managers must not be placed
    under pressure to sell at an undervalue, causing financial loss to the
    public, merely to meet the unrealistic funding targets (ie cuts) of their
    current spending cycle. If this extra ‘incentive’ money is available, then
    it should now be added, unconditionally, to the budgets of the NHS
    C. NHS land was provided historically as a long-term capital
    investment. It should not be disinvested by frittering away sales
    receipts as short-term revenue payments to the detriment of future
    generations. Instead, such moneys should be safeguarded as capital
    investment to be used first, to purchase any other land and buildings
    needed for patient care and second, to fund other capital projects,
    including primary care facilities, for the NHS. Such projects should
    include the provision of affordable rented accommodation for NHS staff
    in all areas where a shortage or adverse pricing of housing makes the
    recruitment and retention of NHS staff difficult.
  • Questions.
    It is unfortunate that because of a lack of financial provision to the NHS, a
    need has been created: STPs must rapidly sell ‘surplus’ assets in order to
    continue the process of the transformation of health services and so attempt
    to meet stringent financial requirements. These assets belong to the people
    and their exploitation should be in our best interest. There is no long-term
    NHS Estates Strategy, rather a benchmarking exercise has been carried out
    by Deloitte to enable a powerful NHS Property Board to ensure rapid
    disposal. Rapid sales may be to the longer-term detriment of the public purse
    and, indeed, benefit private investors.
    Question 1: Rather than allowing the rapid sale of lands and buildings to
    private developers and investors, would it not be in our best interest to
    develop a longer-term NHS Estates Strategy, retain the buildings and land
    and exploit them for the benefit of Health and Social Care in North Central
    The Review believes that current low rates of return and the low risk profile of
    NHS investments means that there is likely to be no shortage of private
    capital finance available to the NHS. Government should borrow now for
    transformation and exploit our assets to the full in the longer-term.
    There is still some concern that a proportion of any capital released by the
    sale of ‘surplus’ estates may continue to be vired into running costs and
    disappear that way. Jeremy Hunt has recently made it clear that this practice
    will continue up to 2020.
    Question 2: Do we have any reassurance that money released from the sale
    of our assets will not be ‘lost’ in running costs but instead will be used for the
    development of our health service?
    Question 3: Do we have the skills required in our NHS Estates teams to
    make ‘good deals’ with any private investors or purchasers?
    There appears to be enormous pressure to strike deals quickly.
    Question 4: Do we have assurances that our NHS Estates team will walk
    away from any deal that is not in our best interest in the longer-term?
    Naylor states: ‘Even if the new models to be developed are fully successful,
    the STPs are likely to need the same level of hospital capacity (eg. in terms
    of bed numbers) as at present. The disposal of any estates must therefore
    not result in a reduction in bed numbers’.
  • Question 5: Do we have reassurance that hospital capacity (bed numbers)
    will not be reduced?
    There is a temptation, particularly in London, to want to increase the total
    national amount released from disposals to £5.7bn but this can only happen if
    the NHS agrees to adopt a “more commercial approach”. This apparently
    involves changes in the way planning consent is obtained; affordable housing
    quotas are negotiated; and value is maximised from the highest value sites in
    Question 6: What exactly does this involve that is different from a “less
    commercial” approach?
    Question 7: Does achieving more Capital mean losing ‘affordable’ housing
    needed for the benefit of NHS staff that is so important especially in London?
    The Review suggests that if STPs do not move quickly enough in the
    Government’s direction with provider plans embedded in STP plans;
    maximum possible disposals; addressing backlog maintenance; and
    delivering the 5YFV, then apparently STPs should not be eligible to access
    public capital funding.
    Question 8: If the STP plans do not hit targets and public capital funding is
    not given to or reduced for providers could this lead to unnecessary risks for
    the community? If so, then who has responsibility for any harm caused given
    that the STP has no legal status?
    There are plans for a ‘time limited offer, with a fixed funding pot and allocation
    on a “ first come first served” basis’, to match disposal proceeds with an
    equivalent amount of state funding. This is intended to encourage STPs and
    providers to act quickly and discourage them from holding on to any land.
    Question 9: Will the offer of extra funding for rapid sales undercut the NHS
    bargaining position because a fast deal may ensure twice the income, any
    purchaser slow to offer more money will put our staff in a bind (ie they would
    have to decide whether to go for the best deal with the purchaser or to speed
    up the process to get a ‘double deal’ from the Property Board)? Could this in
    effect mean sales on the cheap?
    The Naylor Review states that the creation of Accountable Care
    Organisations (ACOs) with population based ‘capitated’ budgets would be a
    way to overcome the conflicts of interest that currently exist between the
    “advisory” role of STPs and the statutory responsibilities of NHS provider
    trusts. An ACO would incentivise acute providers to invest property assets in
    primary, community and mental health services, alongside private investors,
  • and so enable more patients to be treated closer to home in line with the
    Question 10: As an ACO becomes a stand-alone, standardised, “public-
    private partnership”, will we not have then lost the sense of any National
    Health Service?
    Question 11: If Naylor is supported, will we not lose a lot of our public assets
    and public wealth into private pockets?
    The review recommends the creation of a powerful new NHS Property Board
    to address the challenges. In particular, the NHS Property Board should
    consider if it continues to invest in property or, given the direction of travel for
    greater local ownership, it divests to providers the residual assets it has
    inherited from the abolition of PCTs. But most providers are now, in effect,
    private businesses and the Secretary of State has no legal responsibility for
    the provision of the NHS.
    Question 12: Does the divesting of property to providers mean that our
    assets may in effect be handed over to become part of the portfolio of a
    provider and that such a provider may be susceptible to take-over if it “fails”?
    The Naylor Review will set up a bargain market of estate sales, healthy
    opportunities for matched-investments in integrated community services and
    create the managed-care environment of an ACO that is currently attractive to
    transnational corporations.
    Question 13: Is the Naylor Review the beginning of the end for any form of a
    National Health Service and therefore, as it presents us with an ACO, does it
    not also present us with enormous potential losses: the loss of any national
    pooled-risk, the loss of national equity of care and the loss of the enormous
    benefits of strategic and national planning?
    Question 14: Is the Naylor Review simply a means to bring about a structural
    change in the system of healthcare in England?
    It will also probably hasten the loss of publicly-owned healthcare paid for
    through taxation. All of this achieved without consultation with the public.

Do You Know What the Naylor Report Is?

Do you know what the Naylor Report is? Have you even heard ot it? Well, its one of those pieces of NHS business that is conducted in the background – not secret but certainly not headline news. It will radically change the character of the NHS and you won’t know a thing about it until its all over.

If you want to read up on it you can pore through the entire 65 page document at; however, a brief summary might get you up to speed. The author of the report, Robert Naylor, was asked to survey NHS “surplus” property with an eye toward increasing revenue. He recommended that anywhere from £2 billion to £5 billion worth of property might be worth disposing. This would include car parks, multi story buildings and redundant hospitals.

Note that last one.

In case the various hospital trusts are reluctant to part with their property, the report recommends a bonus for jumping on board and punishment in the form of denial of use of capital funds for building repair to organizations that refuse to go along.

Although some trusts, for example London area hospitals, may (or may not) be sitting on valuable redundant property, many in more rural areas have no assets other than cottage and community hospitals, which are often important to local communities. How do they get to be redundant? Well you close them.

And if these properties are sold, will the profits go to the local trusts? No, they would be returned to the NHS Property Services, a private corporation that manages and oversees sale of NHS property. There are suggestions that these profits might be used to fund as many as 2500 new houses, possibly for medical personnel, but then that might not happen at all.

The bottom line, and there always is one, is that this kind of sell off is only needed because Jeremy Hunt has determined that the NHS needs to save £22 billion over the next few years. This can be done with so-called efficiency savings, service cutbacks (for example, A&E closures), and of course the sale of property.

If you sell off the store, it will be so much cheaper to operate.



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Keep Our NHS Public 01/05/2015


Gerada quits NHS England to be able to speak out on NHS privatisation. Former RCGP chair Professor Clare Gerada has quit NHS England to be able to speak out against what she calls the Conservatives’ ‘desperate quest for privatisation’. She told Pulse that running the primary care ‘transformation’ programme in the capital as chair of NHS England London’s primary care clinical board had been ‘fantastic’ but that she saw her ‘bigger role’ as a whistleblower on NHS policy – especially in the run-up to the general election. Professor Gerada, who has filled the time by adding more sessions of clinical work as a GP in Lewisham in south London, said it was ‘no secret now’ that people working within the NHS both at senior and junior manager level were ‘frightened of speaking out and whistleblowing’ and she had not wanted to ‘embarrass’ her employer by doing so. She said: ‘I think the big things that are wrong cannot be fixed by me [working for NHS England]. These are big things like restoring the secretary of state’s duty to provide a comprehensive health system, like ensuring that we have equity of funding across different areas. Those are the things that are being rapidly removed and being put into the hands of quangos, really.’ The former RCGP chair said that the ‘important thing’ is to bring the NHS ‘back to public ownership, back into proper finance to being properly delivered – and stop this desperate quest for privatisation’ She added: ‘Despite what the Conservatives are saying, as GPs we only need to look around us to know what is going on, and that is that people are no longer able to access the care that they need to because of serious problems with funding and a constant move towards tendering and all things like that.’ Professor Gerada’s NHS campaigning work in the election run up has included an open letter to the Guardian signed by 140 doctors casting a damning verdict on the Coalition’s NHS track record, but she faced a backlash when Tories seized on her membership in the Labour Party, calling the letter a ‘Labour-instigated stitch up’. Professor Gerada, who told the Telegraph newspaper that she was ‘not a Labour Party activist’, told Pulse that ‘as an outed Labour card carrier’ she hopes the party will win but she thinks next week’s election is too close to call.

CCGs issue 40% of contracts to private providers. Two fifths of NHS contracts have been issued to private providers since the introduction of the Health and Social Care Act by the coalition in 2013, the Labour Party has claimed. A Labour FOI of CCGs found that 40% of all contracts put out to tender by CCGs have been awarded to private firms, compared with 41% being awarded to NHS organisations. Labour’s findings contradict the Government’s line that just 6% of contracts go to private providers, and shadow health secretary Andy Burnham pledged to repeal the ‘market framework’ that was introduced by the HSCA and which he said had put the ‘founding NHS principles under threat’. A Labour statement said: ‘Labour will repeal the Health and Social Care Act to scrap David Cameron’s NHS market. This will include scrapping the rules that force services out to tender and repealing the competition regime that is tying up hospitals in competition law. ‘And where private companies are involved in delivering NHS-funded clinical services, Labour will cap the profits they can make from the NHS to ensure resources are spent on patient care.’

KONP Updates Part 2

Monitor could be asked to examine £350m contract. A decision by NHS England to hand more than half of the country’s PET-CT imaging services to one company could be the subject of a formal complaint to market regulator Monitor, HSJ has learned. News of the potential complaint comes after the government was asked in the Commons to reassure MPs that no “undue influence” was brought to bear over the £350m contract. The decision in January to award all four regional lots to Alliance Medical sparked fears over the long term impact of the decision on competition. Concerns have also been expressed by another provider over the near “monopoly” Alliance Medical will have over the provision of PET-CT services in England for the next 10 years, as well as the majority control of production and supply of a radioactive drug known as FDG, which is vital to the PET-CT imaging process. HSJ understands Siemens Healthcare, which is the only other producer of FDG in England after Alliance took control of two other companies in 2013-14, is taking legal advice over the decision by NHS England. The company was not a bidder in the PET-CT imaging tender but could be heavily affected by NHS England’s decision.

The Telegraph

Lancet condemns NHS for creating ‘culture of fear’ in wake of scandals. NHS reforms introduced following the disclosure of serious failings at the Mid-Staffordshire Trust have left staff feeling fearful of persecution, according to a respected medical journal. The stinging editorial in the Lancet criticises the NHS’ efforts to rebuild the reputation of the health service following a string of high profile scandals. The journal has taken the unusual step of publishing its own manifesto for health ahead of May’s general election. The article says: “The regulatory regime created in the aftermath of Bristol, Shipman, and most recently mid Staffordshire, has created a culture of blame, fear, and intimidation in the UK’s health system.” “Instead of regulation being a means to bring the best out of our health professionals, it is used as a tool to threaten, punish, and harm. The conditions we have created for health professionals in the NHS mean that few people are cherished. “Instead, they are seen as problems to be managed. An obsession with inspection has also blinded us from thinking about health as more than a health-sector issue.” The piece has been timed to create maximum impact ahead of the election, even carrying a distinctive ‘Election UK 2015’ logo, complete with a stylised ballot. An NHS England source said: “It’s a very interesting article. The bit that focusses on the regulatory regime, it’s the Government that sets that up. For us its business as usual, we deliver what’s set out by the Government. There should be an NHS voice in this. But as for why things are the way they are that’s Government policy.” The editorial calls for a more open-minded approach to the issues facing the NHS, demanding “immediate action to improve the interface between general and emergency medicine”, describing the current situation as “atrociously poor”.

The Guardian

Focus on targets in NHS poses threat to patient care, says thinktank. A “targets and terror” approach to ensure large hospital A&E departments in England treat, admit or discharge 95% of patients within four hours may undermine their care, a former senior NHS official has said. The micro-management culture within the NHS and Department of Health coupled with increasingly tight budgets will hasten the point at which entire urgent care system reaches breaking point, says Nigel Edwards, chief executive of the Nuffield Trust thinktank. Senior managers in hospitals are so busy collecting information on how they are doing each week to satisfy regulators, NHS bosses, health commissioners and politicians that they are not sorting problems on their own frontline, Edwards and two co-authors claim in a briefing paper. Major A&Es have not hit the 95% mark since summer 2013 despite all the attention paid to weekly figures in recent months, they say. But emphasis on the four-hour measure distorts the picture of how big hospitals are doing in the face of a 12% increase in attendances at their A&E units and a 27% increase in emergency admissions in a decade. The A&E rise is “entirely in line with what would be expected based on population growth”, according to the paper, which warns that 17,000 extra hospital beds could be needed by 2022 unless more could be done to treat people outside hospital. The NHS response was based “on the anxiety of the hierarchy rather than on the care of patients and the flow of patients through the system”, it said.

Hospital Doctor News

Extra A&E funding didn’t reach the frontline. Only 1% of the £700m allocated by the government was spent on staff or other resources in their emergency departments. This is the key finding of research by the Royal College of Emergency Medicine which surveyed 142 clinical leaders in emergency medicine across the UK – representing about two thirds of emergency medicine units. Off the back of the survey, the college has released a report – called Ignoring the Prescription – which finds that implementation of recommendations to reduce the A&E crisis has been patchy at best. Last year, four medical royal colleges and many other organisations met to discuss how to make the urgent and emergency care system more resilient. Their report Acute and emergency care – prescribing the remedy was published in June and was welcomed by the NHS confederation and the Department of Health in England. But progress has been slow despite an additional cash injection of £700m. Less than half of EDs in the UK have fully implemented co-located primary care out-of-hours facilities. Less than a third of departments have an appropriate skill mix and workforce in place to deal with their patient volumes and case mix. It also finds that more than half of departments are not assisted by senior decision makers from in-patient teams at times of peak activity. The College concludes that a combination of failure to implement consensus recommendations coupled with the failure to invest allocated monies in frontline services has led to extraordinary winter pressures which were largely avoidable.

Lancaster Guardian

Sneaky way to privatise. Greater Manchester to control £6bn NHS budget – Greater Manchester is to become the first English region to get full control of its health spending, as part of an extension of devolved powers. Chancellor George Osborne said the £6bn health and social care budget would be taken over by the region’s councils and health groups. Mr Osborne said it was a “really exciting development”. A Labour spokesman said NHS workers would “want to be persuaded of the case for a new layer of management”. The plan will come into force from April 2016. Mr Osborne added: “This is what the NHS wants to see as part of its own future. And it’s also about giving people in Manchester greater control over their own affairs in that city, which is central to our vision of the ‘northern powerhouse’, so it’s a very exciting development.” The plan would see local leaders, and ultimately Greater Manchester’s new directly elected mayor, control how budgets are allocated. The government hopes integrating health and social care services will ease pressure on hospitals and help to improve home care services for patients who need it. A shadow Greater Manchester Health and Wellbeing board will be appointed, which will work closely with existing clinical commissioning groups of GPs. The board is expected to run from April, before control of the budget is handed over a year later. Manchester City Council confirmed 10 local authorities, 12 clinical commissioning groups, 14 NHS partners, NHS England and the government are in discussions on a “groundbreaking agreement for health and social care”. What will happen if Greater Manchester over-spends? And if this ‘Grandiose Plan for the NHS’ is extended to other parts of the UK, who will provide health care, should Greater Manchester, other Health Trusts run out of money? Therefore it begs the question, does it not, that I firmly believe is this – privatisation of the NHS by the back door by the Tory Party, and the only people to benefit will be NHS consultants, GPs and medical manufacturers; and also not forgetting MPs, who will, no doubt, have their snouts in the trough with ‘interested parties’. Therefore, may I respectfully suggest that if David Cameron MP is elected Prime Minister in May will he please confirm his Electoral Pledge of many years ago – ‘that the NHS is totally safe in Tory hands’.