interviews

NHS property after April 1

David Pokora, executive director of the LIFT Council, gives NHE his impression of the job facing NHS Property Services from April, and his verdict on the outcome of the PFI review in the Autumn Statement on December 5.

NHS Property Services, which is to be offi cially launched in April alongside the other major structural transitions to the health service that came out of the Health & Social Care Act, will maintain, manage and develop around 3,600 NHS facilities following the closing down of the SHAs and PCTs.

It will have 3,000 staff and its main leadership team is now in place, under chief executive Simon Holden.

NHE got a view on its prospects from NHS property expert David Pokora, who spent 26 years in the NHS, including 11 as chief executive of an acute trust, and is now executive director of the LIFT Council, which represents 95% of the private sector companies involved in LIFTCos around the country.

Asked about the relationship between the LIFTCos and the new NHS Property Services, and he said: “I think it will be a good one. Simon Holden as the new chief executive is starting to get to grips with his job, but he only started in September. They have got the most massive agenda in being able to get ready to be the operational manager of all this estate by April.

“Their first job is to ensure that they don’t drop the ball, and that they are able to ensure the NHS estate that transfers to them – it’s a signifi cant amount of individual buildings – is going to be ‘open for business’ and there’s no cock-ups on 1 April. That’s got to be their primary aim to begin with, all the mundane things.

“Frankly if you turn up at your GP surgery or health centre and you fi nd out you can’t get in because someone’s forgotten to unlock the door or put the heating on, that’s a major inconvenience. Unlocking a door may be a minor thing – but it’s a major problem if you’ve got staff and patients on the wrong side.

“Once it has all the fundamentals in place, then it can concentrate on how to improve the estate, making it better for patient care.

“The activity between the LIFT industry and NHS PS will really crank up from spring/ summer [2013]. Up until then, it’s going to be about building relationships, making sure they understand that where LIFT exists – as it’s not universal throughout England – it actually can play a role in making sure the ball doesn’t get dropped.”

He said the formation of NHS PS was the “inevitable conclusion” once the decision to disband PCTs and SHAs was taken, but that it won’t remain a permanent organisation.

He said: “I don’t foresee that in a handful of years that it will remain a national organisation.

“It’s right for this to happen now because otherwise there would have been a high risk that things would have not gone right post- April 1.

“But after a relatively short period of time I think the DH and NHS PS will start to think that it can’t be managed longer term without local input. But nobody’s really going to be thinking about that yet, though I do think there will have to be local input into how that estate is managed.”

PF2

The December 5 Autumn Statement included a long-trailed shift in PFI policy, announced by chancellor George Osborne following the PFI Review.

‘PF2’ is described by the Government as “a new, faster and more transparent approach to securing investment in public infrastructure.

The Government will become a shareholder in future projects, to ensure a more collaborative approach to improving project performance and managing risk, and will share in the financial rewards alongside private sector shareholders.”

A greater public sector involvement in private fi nancing is at the heart of the LIFT model itself. Pokora said: “LIFT is very much a joint venture partnership, so having had the experience now for coming up to 7-8 years of working in a JV effectively with private and public sectors as equal partners in a company, we strongly feel this is the way to go.”

He said the 100% privately-owned arrangements caused some of the problems in the past due to a lack of trust and partnership in some cases.

“The fact that [the Treasury has] come forward with a JV structure is exactly what we articulated as being a wise move and a good way forward for both the private sector and public sector.”

Pokora has had experience of PFI health schemes from within the NHS, from within the private sector, and with joint venture LIFT companies. “I’ve seen all three aspects of these arrangements from a personal perspective: I know I am just one voice, but my experience is that the JV model works substantially better than any of the other arrangements.”

Upheaval and transition

Clearly the emphasis in terms of NHS and public sector property has shifted since the LIFT model originated, with the financial context now meaning that it is rationalisation and disposal of buildings that tends to take priority over investment in new ones.

Pokora said: “We’re not seeing as many newbuilds, and that’s a function of a number of factors.

“The financial constraint upon the whole of the public sector, we all know about, and it would be staggering if it didn’t have an impact on new developments – it has.

“The other side to it is that you can’t undertake such a major change in the organisational structure of the NHS and not have people focus on the more pressing requirements, i.e. ‘who’s going to do this job after April 1 and how does it get transferred to them’.

“Longer-term thinking frankly goes out the window, as the urgent crowds out the important. Today’s pressing requirements will always come fi rst and making these changes in the health service is that pressing requirement. Longer-term thinking about the shape of the NHS estate, and the way it can actually facilitate changes in clinical care, will come back in when CCGs and others have all the responsibility. By then, everything will be ‘real’ and they’ll start to think about what to do with these powers they now have, how they effect change and the impact upon the estate. We’ll start to see more of a focus on changing the estate to facilitate new models of care.

“It’s frustrating to have a hiatus while the NHS goes through this upheaval but that’s life and there’s no point moaning about it. The reality is that we’ve got the NHS going through such change and it will come out the other side and business will resume.”

Tell us what you think – have your say below, or email us directly at [email protected]