Integrated care systems one year on: how the NHS ten year plan will affect your infrastructure strategy
Sewell Advisory’s Andy Muir has had an extensive career working in NHS estates, working with CCGs, Trusts, NHS England and CHP. He looks back at what the past twelve months have brought for ICSs, and examines what the NHS 10 Year Plan will mean for their infrastructure strategies.
In March 2024, Integrated Care Systems (ICSs) were tasked by NHS England with delivering their ten-year systemwide estates and infrastructure strategies to support recovery, optimise asset use, and align with the NHS Long Term Plan. With the recent publication of the NHS 10 Year Plan, these strategies will require a refresh to ensure they align with the ambitions highlighted in the current plan, and specifically the delivery of care closer to home.
Ten Year Plan priorities – what’s changed?
Key highlights within the plan include making ICBs the strategic commissioners of local healthcare services, and for foundation trusts to hold the whole health budget for a defined local population as an Integrated Health Organisation (IHO). The intention is to designate a small number of these IHOs in 2026, with a view to them becoming operational in 2027.
The plan sets out the following high level priorities:
- Shift care out of hospitals via Neighbourhood Health Centres (NHCs), to support home and digitally delivered care, while reducing hospital outpatient dependency by 2035
- Digital transformation pillars include an empowered NHS App (becoming the “front door” to services), a single patient record, AI augmentation, remote diagnostics, and app-based self-referral and monitoring
- Digitally enabled patient experience, booking, self-referral, care-planning, medication management, personalised virtual care and feedback via the NHS App
Furthermore, the plan allows for NHS trusts to now have the authority to retain 100% of receipts from the disposal of land assets they own, which can be carried across multiple financial years, and the prospect to be able to access bridging loans to further facilitate change across financial years. This should increase flexibility for ICSs and trusts and enable a more considered approach to estates and infrastructure requirements that supports the left shift/care closer to home focus. There is also potential to recycle capital into community hubs, digital infrastructure, or redeveloped estates that better support localised care models.
In summary, this will mean ICSs/ICBs will need to refocus their approach to estates and infrastructure over the coming years.
How should systems react?
ICSs will need to review and refresh their existing 2024 strategies to consider how they will:
- Revise infrastructure strategies to support NHCs, enabling flexible, multifunctional estates that can integrate digital triage etc
- Prioritise refurbishment or repurposing of existing estate over building new sites and focus on co-location
- Incorporate disposal opportunities to unlock capital for community-based redevelopment and identify a robust pipeline of surplus assets and use estates to enable net-zero priorities and ambitions
- Engage with local councils and primary care networks within estates planning, and co-deliver infrastructure for shared clinics, integrated stepdown services, and accessible locations
- Align workforce developments with estates, enabling integrated neighbourhood teams and digital
- Ensure ICS/ICB estate teams have the capability and capacity to manage disposals, loans, and reinvestment across years, and make sound project prioritisation and financial planning
- Explore potential public private partnership models once these emerge and consider longer term options for their estate’s requirements
How we can support you
We know that ICSs are pressed for resources, and our team of expert estates professionals can support you around adapting and implementing your strategy to the changed priorities.
The Sewell Advisory team is currently working with a large ICS to update and refresh their infrastructure strategy, centred upon engaging with a wider set of stakeholders than was possible when the strategy was originally written, and supporting their strategic estates team to develop a meaningful strategy that will support delivery of efficiencies and improve utilisation of their existing estate.
If you would like support with your infrastructure strategy, we can help with:
- Updating, refreshing or delivering your infrastructure strategy in accordance with the 10 Year Plan
- Supporting left shift through the use of data analysis, service and healthcare planning
- Business case support and development
- Guidance and expertise on PPP, S106 etc