Representing estates and facilities professionals operating within the  



APPG debates backlog maintenance and more

HEFMA attended the second meeting of the All Party Parliamentary Group (APPG) for Healthcare Infrastructure, chaired by Faisal Rashid, MP for Wolverhampton South.


The meeting heard first from Richard Murray, Chief Executive of the King’s Fund, who made several key points around backlog maintenance, capital plans, the need for more expertise across the system and locating staff. 


The King’s Fund has just published a new report - ‘Clicks and Mortar: Technology and the NHS Estate’ - on which HEFMA will report in more detail shortly. Richard stressed the importance of both technology and the physical estate and that the two should be working together but all too often aren’t. Pulling them together is a challenge that will not be easy to overcome. 


He called for a reform on how capital money moves through the NHS, describing the current system as “broken” because few Trusts are ever in a position to direct a surplus to capital investment. He cautioned there is no time to waste if the NHS is going to deliver the Long Term Plan.


Richard Murray also made some observations around the availability of space in primary care, which the second speaker of the day, Dr Krishna Kasareneni from the British Medical Association followed up on with solid statistics. Richard referred to the commitment to recruit an additional 22,000 non-medical staff into the primary care sector over the next five years, for which the funding has been announced, but questioned, where GPs are going to put them, when few practices have spare physical capacity within their premises to allocate. How quickly can the estate respond, he asked?


Dr Kasareneni presented statistics from the BMA Premises Survey 2018 that reinforced this problem and highlighted that the primary estate is also suffering from a lack of investment in its estate . In the survey, 60% of GPs reported they had no more space to accommodate extra staff. Only two in 10 practices thought their premises were fit for the future and only half thought their premises were fit for the present (down from 60% when this survey was last done in 2005). 


The Shelford Group’s Managing Director, Nick Kirby discussed the capital agenda and priorities for investment, including the importance of defining need, resourcing capital and managing investment. He reiterated Richard Murray’s comments about the need for expertise across the system, with the ability to manage capital projects and reach upwards towards the Treasury.  


Finally, Paul Doyle, Deputy Chief Financial Officer of Imperial College Healthcare NHS Trust shared some of the issues facing this ageing estate. The Trust has backlog maintenance of £1.3bn across five hospitals – that’s almost one fifth of the reported backlog maintenance total for England of £6bn (which of course doesn’t include primary care or all community healthcare facilities). 


The particular problem faced by this Trust is that 25% of its estate pre-dates the NHS, with some dating back to the 1840s. The Trust is forced to spend around 50% of its capital plan just on keeping those buildings open. Even then, it is experiencing estates failures that impact operationally on patient care and create additional cost.


The aim of this APPG is to collate information around the key challenges facing the buildings, technology and facilities within the NHS, which will be used to inform a submission of evidence to the awaited Spending Review.