Outline structure for a
Local Estates Strategy
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What’s needed in a Local Estates Strategy?
A Local Estates Strategy helps health economies to turn properties into flexible
assets that can support changing services. It has an important role to play in enabling
change, delivering savings, reducing running costs and ensuring that all investment
is properly targeted.
There is no absolute template for Local Estates Strategy. Every plan is different,
depending on local circumstances and the complexion of the estate. However, a
strategy should be able to deliver an estate which will be responsive to change,
taking account of demographic trends, increasing specialisation, integration of health
and social care, provision of care closer to home, technological advances and new
ways of working.
1. Executive Summary
The Executive Summary should begin with an introduction explaining what the plan
will cover. It should then overview the existing estate and examine how service
developments, based on the Commissioning Plan, as well as associated estate
needs, are driving the case for change.
A vision for the estate to meet these health and social care requirements should then
be laid out briefly. Any gaps in estate between what exists now and what is needed
are identified. The Estates Options for Change are then identified. From these is
evidenced some preferred opportunities, with the services benefits demonstrated and
the financial impact at a system level of any proposed changes.
Finally, this section summarises delivery of the vision with, first, the immediate
priorities in terms of particular sites, including opportunities for investment or
disinvestment that would be implemented as ‘no regrets moves’ within two years.
Ideally, a longer-term, five year work programme is also specified. An implementation
schedule explains how the plan’s conclusions and recommendations should be
actioned.
2. Introduction
Objectives and scope
The introduction explains the purpose of the exercise and the approach used to
develop the Local Estates Strategy, including how the local health economy has
been brought together to understand service priorities, the estate that is already
available and how it can be changed to deliver those services.
This section should detail the scope of the plan. In terms of property, this is the main
NHS estate (Acute, community, primary care and administrative facilities), plus
accommodation supporting social care functions with close links to health should be
included, such as domiciliary care, clinics and local authority residential care. It does
not include private sector estate such as residential homes or non-NHS facilities
providing services under contract.
Additionally, the main stakeholders should be detailed, including Clinical
Commissioning Groups, NHS Trusts, Local Authorities, NHS Property Services, NHS
England, Community Health Partnerships as well as local GPs and any non-NHS
organisations providing services from NHS estate.
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Methodology
The methodology should highlight how regular, structured conversations over several
months have generated fresh thinking among local leaders to achieve the best
outcomes for patients. It should cover the series of steps that have gone into creating
the plan, leading to an evaluated, well justified set of options and a schedule for
implementation.
3. The Current Estate
Estate summary
This section reviews the current estate delivering services in the area. It should focus
attention on those sites whose cost and size make them central to any analysis.
Include the proportions of the estate that are dedicated to certain functions (acute,
community, primary, administration etc.); that are held by particular owners (Trusts,
NHS Property Services, CHP, local authority etc); and that are part of major sites.
Site reviews: Asset condition, suitability, utilisation and occupation, financial summary
A review, no longer than a page, of each major site should be included in the
Appendix. The main acute site can have a longer review. These reviews should
involve a brief description; main services delivered from the site; building condition;
current utilisation; forecasts of backlog maintenance; any significant changes either
already agreed or proposed; suitability for long term retention; re-development
potential; current view as to likely future (usage and configuration).
This review mustn’t prejudge the strategic estates planning process but should
capture honestly the strengths and weaknesses of each site. It should draw on the
data collected, including current estates strategies.
Supporting information, such as plans, photographs or detailed financial breakdowns,
can be appended. Data might come from many sources including: SHAPE (Strategic
Health Asset Planning and Evaluation application); Commissioning Strategies and
Plans; Provider Strategies and Plans including Estates Strategies and Business
Plans; Public Health data; Demographic data including Planning and GP practice
data.
Key Estates Issues: Performance analysis and surplus assets
Next, a short high level summary report should be created that sets out themes, such
as:
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Existing space that is (or will shortly be) no longer fit for the delivery of modern
health care services and/or has significant maintenance/condition challenges.
Void space in long-term core buildings.
Modern high quality space that is under-occupied.
Bookable space that is not well used.
Occupied space that is often badly utilised.
Standard hours of working and potential for 7-day opening.
Modern space filled with administrative, rather than clinical, activity.
Incompatible ICT systems preventing joint use of clinical space.
The section should summarise all the key issues that the Local Estates Strategy
must tackle with respect to specific sites.
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4. Vision for the Estate
Drivers for change: socio-economic/service/estate/external
Summarise, perhaps in tabular form, the main drivers for change to explain, in high
level terms, the chief differences between what is happening now and what is
expected to happen in the projected model of service delivery. These drivers might
include changes in population, new housing, shifts in disease profiles as well as
innovations in medical procedures and technology, plus new models of care, all of
which may have important impacts on service models and therefore estate needs.
Commissioning Objectives and overarching principles
Identifying the estate you need is probably the most important stage of the process
because it aims to define the shape of services in the future that the estate must
support.
This section should show a clear understanding of where services are currently
delivered across the system, and how some are co-located, within the different
localities and various care settings. It can be useful to collect the information in
tabular form and then summarise the existing pattern of delivery in a schematic
diagram. Then set out a cohesive strategic direction for future service delivery for the
locality, presenting the outcome in a similar manner to that used to describe the
current service delivery model.
Finally, combine this future service delivery model with high-level schedules of
accommodation to set out a vision for the estate of the future. This sketch should
build in the following facilities: Community hospitals; Community/locality hubs;
Community mental health facilities; Health centres/clinics; GP surgeries; Team bases
and support facilities; Administrative office space. It is also important to assess the
impact of these changes on the main acute site serving the local area.
5. Gap Analysis
In this section, identify the discrepancies between the present and future estate and
set out the key priorities for change. Some buildings may be fit for purpose and be
needed as core estate in the future. Investment may be required to improve the
flexibility of some buildings for services. There may also be facilities that are not
needed anymore as technology changes and more people are treated at home. So
some facilities have a long-term future, some are clearly no longer needed and some
estate requires investment so it is flexible enough to deliver the health vision. The
plan can divide existing estate into three broad categories:
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Suitable for long term use and able to meet future requirements with only routine
adaption. These are the core sites, part of the ‘estate of the future’.
Suitable for long term use, but likely to meet future requirements only with major
investment and change.
Unlikely to be suitable long term. These buildings could, potentially, be disposed
of, or disinvested from.
In addition, the plan should clarify where there are gaps with no current estate
capability to meet future service requirements. At this point, the plan has established
the overall strategic direction of the estate: what needs to change over time – and the
relative urgency - to meet future service requirements.
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6. Estates Options for Change
Summary of estates options
Next, the plan summarises the estate options, the key priority areas where the estate
will need to change over the next five years. These might include:
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Substantially consolidating activity on a site to reduce operating costs and
release land for disposal and capital for reinvestment.
Closing a site and moving activity elsewhere, where there is spare capacity, to
reduce operating costs and free up capital for reinvestment.
Replacing a number of poor quality buildings, that are no longer fit for purpose,
with a new facility that can support a wider range of services.
Providing a new facility in a particular locality to meet changed models of care
and service delivery.
Option evaluation criteria
The plan should include a high level evaluation of the options against both
operational and financial criteria. These should be devised locally, but are likely to
include the relative impact of each option on clinical services and patient care;
compatibility with commissioning and provider strategic plans; ease of
implementation; acceptability to stakeholders; strategic flexibility and the impact on
both revenue and capital budgets.
Option Evaluation
Finally, the options need to be evaluated. It is too early to undertake a detailed five
case business case, but high level analysis of each option against the evaluation
criteria should be completed to confirm those initial options that should be
progressed as part of the Local Estates Strategy.
7. Local Estates Strategy
Outline of preferred options
The next stage is the preparation of the Local Estates Strategy. This should include
setting out the ‘No Regrets’ moves that have wide support and should be prioritised
over the next two years. The Strategy should also identify plans for a longer five year
period, where further analysis will probably be required. This option appraisal
process offers a more detailed picture of how to deliver the key estate changes.
Combining these two outputs – overall estate strategy and means of delivery creates the essential elements of a high level estate development plan for the next
five years.
The level of detail that is possible may differ for each local area: more
comprehensive in some cases and amounting to a long term development plan for
their estate. In other instances, the plan may just have set out a direction of travel,
focussed more on specific opportunities and addressing immediate concerns.
Financial analysis
A single summary report should estimate the financial impact of the changes to the
estate over the next five years. It should include details on: efficiency savings and
savings targets; capital funding requirement and the investment pipeline envisaged;
any disposals in the period and projected capital receipts (if any).
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Service benefit
The estates development plan should include analysis of the patient and service
benefits that it provides as well as the impact in terms of efficiencies and other gains.
8. Implementation Planning
Implementation priorities
The Local Estates Strategy will be the agreed view of the Local Estates Forum which
should then seek endorsement of the plan from individual Boards and typically the
corporate leadership of the local health and social care system. If the Local Estates
Forum cannot agree a particular element of the proposed plan, issues should be
referred upwards to help resolve these disagreements. The corporate leadership
group will also approve the mandate and arrangements to proceed to
implementation. The plans should set out the implementation priorities.
Programme plan and milestones
The plan should articulate the implementation work streams, covering both the “no
regrets moves,” and issues requiring further analysis. It details actions for what the
implementation groups will be doing along with delivery timescales and a series of
milestones, as well as identifying resources to support the changes.
Managing constraints and risk
With so many parties involved and so many potentially competing views, it is easy for
the process to become stuck. The plan should identify enablers of change. For
example, the National SEP Steering Committee can help unblock constraints, if it
can. The local Strategic Estates Adviser (SEA) should help organisations work
collaboratively rather than simply self-interestedly, so that the system operates as
well as possible for patients. The plan should also include a full assessment of risks
and mitigating factors.
One possible outline structure for a Local Estates Strategy is shown in Appendix 1.
July 2015
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Appendix 1:
Illustrative Local Estates Strategy Outline Structure
1.
Executive Summary
a. Introduction
b. Overview of Existing Estate
c. Vision for the Estate
d. Estates Gap Analysis
e. Options for Change
f. The Local Estates Strategy
g. Implementation Planning
2.
Introduction
a. Objectives and scope
b. Methodology
3.
The Current Estate
a. Estate summary
b. Site reviews
c. Key estates issues
4.
Our Vision for the Estate
a. Drivers for change
b. Commissioning objectives
c. Our Vision
5.
Gap Analysis
6.
Estates Options for Change
a. Summary of estates options
b. Evaluation process and criteria
c. Option evaluation
7.
Local Estate Strategy
a. Outline of preferred options
b. Financial analysis
c. Service benefits
8.
Implementation Planning
a. Implementation priorities
b. Programme plan and milestones
c. Managing constraints and risk.
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