Monthly Archives: July 2017

More on the Naylor Report

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From KONP

  • The Naylor Review 2017.
    A broad response to this review should have an approach based on the
    following.
    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
    authorities.
    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
    London?
    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
    London.
    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
    5YFV.
    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.