Fit for the future? 10 Year Health Plan aims to reinvent the NHS
Two weeks ago Sewell Advisory, public estates experts, shared our thoughts on the UK Infrastructure: A 10 Year Strategy, with the headline ‘Plans do not deliver outcomes – people do’. Swiftly following on the heels of the strategy, publication of the NHS 10 Year Health Plan for England: fit for the future has given us the detail behind the Government’s ambition for delivering a ‘neighbourhood health service’. The link between the documents is an important one because the ambition of the 10 Year Plan can only be achieved if backed by investment, both in service delivery and the infrastructure to support change.
In the new Health Plan, the Government says that the NHS is ‘broken, but not beaten’, and they want to fix it and make it fit for the future. How do they propose to do this? The answer is by delivering “one of the most seismic shifts” in the history of the NHS, which has been shaped by significant engagement through the biggest ever conversation about the future of the health service, including over a million insights from patients, staff and groups. Underlying this, the plan details three major shifts, which you may find vaguely (irony intended) familiar:
- From hospital to community
- From analogue to digital
- From sickness to prevention
These aren’t new ambitions, they’re just described using slightly different words. The ‘left shift’ has been long been talked about, whether your understanding of this is treatment of illness to prevention or hospital to home, the ‘shift’ intent remains the same in the new plan. The 2019 NHS Long Term Plan talked about reducing growth in demand for care through better integration and prevention, outlining five “major, practical changes”, three of which were:
- Boost out-of-hospital care
- Digitally-enable primary and outpatient care
- Local NHS organisations to have greater focus on population health
On the latter point, the Long Term Plan set out a whole chapter on more action on prevention and health inequalities, with the aim of “improving upstream prevention of avoidable illness”.
This point isn’t intended to relay pessimism; we need to have ambition, otherwise where’s our route map to change? We may not always get to the journey’s end, but at least we know where we are aiming for.
So, what are the reasons to be optimistic?
As a nation we treasure our health service, we want to protect it. The people who work in it may feel the relentless pressures of day-to-day survival under unabating demand, coupled with lack of resource, and patients may experience long waits in A&E or on waiting lists, but with commitment to a further £29bn per annum to support service delivery (as outlined in the Spring Budget 2025), £70bn infrastructure investment over the next five years and ‘potential’ public private partnership avenues to delivery of primary and community health estate, we have cause to be hopeful.
Of course, hope doesn’t deliver change, action does, and the Health Plan is light on delivery – instead setting out a vision under which we expect a more robust plan to be developed. It will take partners across, not just the public sector, but private and voluntary sectors to work collaboratively and innovatively, actively taking on the challenges of delivering change, rather than these challenges being the excuses for under-delivery as is sometimes the case.
By taking a deeper dive into the 10 Year Plan, specifically looking at what it will mean for our health infrastructure, we can see that there is a recognition that there needs to be a seismic shift in our healthcare estate. Central to delivery of the plan’s ambitions is the creation of a neighbourhood health service, with a commitment to neighbourhood health centres being “available in every community”, prioritising those areas first where healthy life expectancy is lowest. We know at Sewell Advisory that this plays to our strengths, given that we are rooted in similar successful initiatives which were developed at our inception.
The aim of these new centres is to bring care closer to where people live, shifting away from the hospital-centric model, as well as bringing together currently, predominantly disparate community health and care services, under a single roof working in integrated, patient-centred teams. The intention is that these buildings will be open at least 12 hours a day, 6 days per week and will house other complementary uses, such as housing and employment support or public health and preventative services, which will improve social and economic outcomes. There is a recognition that these developments should seek to re-use and regenerate public sector estate that is no longer fit for purpose, but where this is not possible, should draw on the successes of NHS Local Improvement Finance Trusts (LIFT). With coverage across 11 LIFT Companies across the North East, Yorkshire and Humber and the Midlands, at Sewell Advisory we passionately believe in the partnerships that can be formed and health outcomes that can be delivered using this type of model.
What constitutes a community is not determined, but the scale of these potential new developments feels substantial, with the Secretary of State for Health and Social Care stating in Parliament that the aim is to deliver 250 to 300 neighbourhood health centres over the plan term, with 40 to 50 during this parliament. Whether community-based assets already exist or not, the required investment, planning and mobilisation will be significant, delivering either transformation of existing estate or new build, with a focus not just on delivering the right space, but also ensuring it is flexible and digitally enabled.
So where will the investment into this estate transformation come from? One route could lie in the plan’s proposal for reform of the financial freedoms of Foundation Trusts, who in their most mature state will be able to retain 100% from asset disposals, access borrowing for capital investment, as well as secure DHSC bridging loans to front fund capital investment ahead of realising capital receipts through asset sales. The plan also builds on reference made in the UK Infrastructure: A 10 Year Strategy, on the potential for new (or existing) Private-Public Partnerships (PPP) to be used for “certain types” of primary and community health infrastructure. What this model may look like is yet to be determined, but the Government has already kick-started ‘Project Wings’, with the DHSC seeking preliminary market engagement on this, with a view to presenting a business case prior to the Autumn Budget in 2025.
At Sewell Advisory we know that through our management of LIFT developments, we are well placed to showcase our Public Private Partnership (PPP) history, demonstrating the benefit of the fully maintained approach and the way that multiple occupiers and services can work together to provide a community-first, neighbourhood level approach. We have some fantastic buildings which continue to be central focuses of health and social care activity in communities experiencing high levels of health inequality. By the nature of the financing model, these buildings buck the often-seen trend of under-investment, they are well maintained and offer flexibility to respond to changing local needs. Well located within communities where health improvement continues to be necessary, we know that they will be front and centre in considering where to achieve ‘quick wins’, and we’re really excited about this.
In the coming weeks we will be sharing virtual introductions to our portfolio, showcasing great examples of where Neighbourhood Health Centres already exist. As part of this we will talk about how we can support you through this journey, from the earliest stages of service and health planning, to where these services should be delivered to provide the most benefits and how you can deliver the ambitious changes required by the NHS 10 Year Plan. So, watch this space!