From KONP
-
The Naylor Review 2017.A broad response to this review should have an approach based on thefollowing.A. The rushed sale of valuable NHS estate land and buildings. TheNHS estate has taken generations to assemble, through purchases bypublic money and through centuries of charitable donations andlegacies of money, land and buildings by public spirited persons. Beforeany sale of this precious NHS estate, the land that is likely to berequired for the future development of the NHS, on a reasonableforward plan of at least 15 years, must be identified and safeguarded, tomeet foreseeable patient needs, as part of a long-needed NHS estatesstrategy which should be open to public consultation and be agreed byParliament. The NHS should not breach the trust placed in it byprevious generations of donors and taxpayers.B. The offer of extra money to health authorities who sell quickly is awholly inappropriate and wasteful incentive. It subverts their fiduciaryduty of care to ensure that any sale, without undue haste, is able toachieve the full value of the land. NHS managers must not be placedunder pressure to sell at an undervalue, causing financial loss to thepublic, merely to meet the unrealistic funding targets (ie cuts) of theircurrent spending cycle. If this extra ‘incentive’ money is available, thenit should now be added, unconditionally, to the budgets of the NHSauthorities.C. NHS land was provided historically as a long-term capitalinvestment. It should not be disinvested by frittering away salesreceipts as short-term revenue payments to the detriment of futuregenerations. Instead, such moneys should be safeguarded as capitalinvestment to be used first, to purchase any other land and buildingsneeded for patient care and second, to fund other capital projects,including primary care facilities, for the NHS. Such projects shouldinclude the provision of affordable rented accommodation for NHS staffin all areas where a shortage or adverse pricing of housing makes therecruitment and retention of NHS staff difficult.
-
Questions.It is unfortunate that because of a lack of financial provision to the NHS, aneed has been created: STPs must rapidly sell ‘surplus’ assets in order tocontinue the process of the transformation of health services and so attemptto meet stringent financial requirements. These assets belong to the peopleand their exploitation should be in our best interest. There is no long-termNHS Estates Strategy, rather a benchmarking exercise has been carried outby Deloitte to enable a powerful NHS Property Board to ensure rapiddisposal. Rapid sales may be to the longer-term detriment of the public purseand, indeed, benefit private investors.Question 1: Rather than allowing the rapid sale of lands and buildings toprivate developers and investors, would it not be in our best interest todevelop a longer-term NHS Estates Strategy, retain the buildings and landand exploit them for the benefit of Health and Social Care in North CentralLondon?The Review believes that current low rates of return and the low risk profile ofNHS investments means that there is likely to be no shortage of privatecapital finance available to the NHS. Government should borrow now fortransformation and exploit our assets to the full in the longer-term.There is still some concern that a proportion of any capital released by thesale of ‘surplus’ estates may continue to be vired into running costs anddisappear that way. Jeremy Hunt has recently made it clear that this practicewill continue up to 2020.Question 2: Do we have any reassurance that money released from the saleof our assets will not be ‘lost’ in running costs but instead will be used for thedevelopment of our health service?Question 3: Do we have the skills required in our NHS Estates teams tomake ‘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 walkaway 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 termsof bed numbers) as at present. The disposal of any estates must thereforenot 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 totalnational amount released from disposals to £5.7bn but this can only happen ifthe NHS agrees to adopt a “more commercial approach”. This apparentlyinvolves changes in the way planning consent is obtained; affordable housingquotas are negotiated; and value is maximised from the highest value sites inLondon.Question 6: What exactly does this involve that is different from a “lesscommercial” approach?Question 7: Does achieving more Capital mean losing ‘affordable’ housingneeded 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 theGovernment’s direction with provider plans embedded in STP plans;maximum possible disposals; addressing backlog maintenance; anddelivering the 5YFV, then apparently STPs should not be eligible to accesspublic capital funding.Question 8: If the STP plans do not hit targets and public capital funding isnot given to or reduced for providers could this lead to unnecessary risks forthe community? If so, then who has responsibility for any harm caused giventhat the STP has no legal status?There are plans for a ‘time limited offer, with a fixed funding pot and allocationon a “ first come first served” basis’, to match disposal proceeds with anequivalent amount of state funding. This is intended to encourage STPs andproviders 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 NHSbargaining position because a fast deal may ensure twice the income, anypurchaser slow to offer more money will put our staff in a bind (ie they wouldhave to decide whether to go for the best deal with the purchaser or to speedup the process to get a ‘double deal’ from the Property Board)? Could this ineffect mean sales on the cheap?The Naylor Review states that the creation of Accountable CareOrganisations (ACOs) with population based ‘capitated’ budgets would be away to overcome the conflicts of interest that currently exist between the“advisory” role of STPs and the statutory responsibilities of NHS providertrusts. An ACO would incentivise acute providers to invest property assets inprimary, community and mental health services, alongside private investors,
-
and so enable more patients to be treated closer to home in line with the5YFV.Question 10: As an ACO becomes a stand-alone, standardised, “public-private partnership”, will we not have then lost the sense of any NationalHealth Service?Question 11: If Naylor is supported, will we not lose a lot of our public assetsand public wealth into private pockets?The review recommends the creation of a powerful new NHS Property Boardto address the challenges. In particular, the NHS Property Board shouldconsider if it continues to invest in property or, given the direction of travel forgreater local ownership, it divests to providers the residual assets it hasinherited from the abolition of PCTs. But most providers are now, in effect,private businesses and the Secretary of State has no legal responsibility forthe provision of the NHS.Question 12: Does the divesting of property to providers mean that ourassets may in effect be handed over to become part of the portfolio of aprovider 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, healthyopportunities for matched-investments in integrated community services andcreate the managed-care environment of an ACO that is currently attractive totransnational corporations.Question 13: Is the Naylor Review the beginning of the end for any form of aNational Health Service and therefore, as it presents us with an ACO, does itnot also present us with enormous potential losses: the loss of any nationalpooled-risk, the loss of national equity of care and the loss of the enormousbenefits of strategic and national planning?Question 14: Is the Naylor Review simply a means to bring about a structuralchange in the system of healthcare in England?It will also probably hasten the loss of publicly-owned healthcare paid forthrough taxation. All of this achieved without consultation with the public.