Management of NHS Property

Debate between Karin Smyth and Julian Sturdy

Wednesday 4th July 2018 Westminster Hall

[Karin Smyth]

I cannot comment on the specific company, but trying to understand accountability and how systems work is frustrating for local people. Many of us are trying to make sense of it.

The estate was an afterthought for the coalition Government and their disastrous Health and Social Care Act 2012—the Lansley Act. Their laissez-faire approach, which bordered on contempt, has saddled communities across the country with burdens and consequences ever since. The current Government recognised that in their response to the Naylor review, stating:

“The structural changes in recent years have distracted attention away from the importance of the estate as an enabler of high quality care, and the NHS has lost valuable expertise and knowledge in strategic estates planning, development and management.”

As we are developing the 10-year plan to transform our NHS into a more community-based, joined-up system, the function of the community and primary care estate as an enabler of service transformation becomes more critical. Although the Government said in response to Naylor that they want to incentivise local action, in practice there are no mechanisms to do so. My focus is therefore on the local roles of two national bodies: NHS Property Services and Community Health Partnerships.

The Lansley Act nationalised health centres, GP premises and, in my constituency, the South Bristol Community Hospital overnight. When the Government realised that no one was responsible for property managed by primary care trusts—mainly GP premises and health centres in poorer areas—they set up NHS Property Services, which became the landlord and asset manager on behalf of the Secretary of State. Community Health Partnerships took over the primary care trusts’ 20% control of local infrastructure finance trusts—LIFT companies—which were public-private partnerships for new GP premises and community-based services, such as South Bristol Community Hospital.

A key part of the LIFT incentive was that the companies made a profit and from that a dividend was returned to all shareholders, including the primary care trust. The Lansley Act passed that 20% local share to the Secretary of State. That LIFT company is still operating, as others are across the country. Bristol Infracare LIFT paid dividends totalling £823,000 last year and £2,344,000 in 2016. Community Health Partnerships received 40% of that, but 20% should have been retained in the Bristol health economy. In the last two years, that amounts to £633,400 in Bristol alone, and that is replicated across the country. I am here today with a simple message for the Secretary of State, via the Minister: I want control of this asset to be given back to the local health economy, and I want our money back.

The closer one looks at the labyrinthine structures that govern NHS properties, the more it seems that the opaque and impenetrable way in which these companies operate is not accidental. They appear to be purposefully disenfranchising and disempowering local people. Whatever the merits of the Lansley Act—I contend that there are not many—it was supposed to drive devolution, liberation and accountability.

[Julian Sturdy (York Outer) (Con)]

The hon. Lady is making a powerful argument. One of the real problems we find in York is that NHS Property Services is very distant and difficult to engage with. It needs to sit down with local communities, whether in York, Bristol or elsewhere in the country, and engage with them about the assets that need to be reinvested back in those local communities.

[Karin Smyth]

That is exactly the point I want to make, but I will go on to show how that is difficult to do and make a difference.

Patients and frontline practitioners were supposed to be front and centre of the new NHS, but that has simply not happened because, as we have heard, control is ever more centralised. It really did not have to be that way. NHS Property Services was set up as a national body, losing a wealth of local expertise and institutional knowledge in the process. With expensive London headquarters, its teams across the regions are stretched. It spent its first period of existence creating a register of assets and a new market rent system. That resulted in disputed and unpaid rents, which necessitated additional loans from the Department of Health to keep the company afloat and a complicated parcelling of subsidy via NHS England to clinical commissioning groups and GP surgeries. The early years have been an expensive disaster, with GPs and managers across the country not knowing what they were being charged for or who to call to sort out the problems. The profligacy of the system is matched only by its utter uselessness, and that is why I have been pursuing this scandal since I was first elected.

In my constituency two GP health centres and a healthy living centre are directly affected by these problems. The Knowle West healthy living centre was set up in a joint arrangement on Bristol City Council land, with public health services delivered based on the needs of a community that has some of the highest health inequalities in the country. It is no exaggeration to say that for many in the area the centre is a lifeline. However, with public health taken out of the NHS into local government, and the services now largely contracted via a third party, NHS Property Services soon came knocking on the door, bringing with it a charges bill increased by more than 200%. There was no discussion, no legal lease was in place and there was no service level agreement. Not only has the charity that runs the centre been forced to operate under the constant threat of closure, but it is unable to access the simplest forms of support. It recently asked if the windows could be cleaned, only to be told that that was not in the contract.

It has taken me three years to get even a modicum of progress—lobbying the clinical commissioning group and Bristol City Council, talking to local media, and raising the issue at the Public Accounts Committee and actively on social media, which finally resulted in a helpful meeting with the chair of the NHS Property Services board. The issue is still not resolved, however, and we still have some way to go. It has been a battle. It is tiring for everyone concerned—frontline practitioners in particular—debilitating and, most frustrating of all, entirely avoidable.

South Bristol Community Hospital has a similar story. This facility was the focus of a 60-year campaign by local people, and it finally opened in 2012. Established by a partnership between the primary care trust, private equity and Community Health Partnerships, the local link was severed by the Lansley Act, as I said earlier. Now the board that oversees the community hospital meets far away from Bristol and with no Bristol involvement. An employee of Community Health Partnerships supposedly represents us in overseeing the management of the company that runs the hospital. Community Health Partnerships, like NHS Property Services, is an arm’s length body within the Department of Health and Social Care. The lease of the hospital is managed by a local foundation trust, University Hospitals Bristol, cobbled together in a last-minute deal with the primary care trust. Two other NHS bodies and a social enterprise are also tenants in the building. If that sounds confused, conflicted and convoluted, that is because it is.

I have been campaigning as the local Member of Parliament to get more services into the new hospital. It is a superb new building, with 96 community beds and an urgent care centre. A poll that I carried out among my constituents showed that 90% either were unaware of the services available in the building or felt that it was underused. A 2014 Care Quality Commission report found that the operating theatres were utilised only a quarter of the time, and the out-patient department only 55% of the time. We have made great progress since then, but the building is still underused as part of the health economy—on entering the building, people are faced with a whole floor with just a reception desk, and the corridors and lifts are typically empty.

The rehab unit, by contrast, is always full. The nurses, porters and other staff who keep it going all work tirelessly, but there is no escaping the sense that this facility is only rented or temporary. Everything is contractual and faceless, with rules abounding, while stroke patients spend their days and months staring at white walls because, according to the nursing staff, there are limits to what the landlord will allow—for example, there are no pictures.

The community hospital is on the southern fringe of our city, where 30% of residents do not have access to a car and the public transport links are historically among the worst in the United Kingdom. That same community has the highest rates of cancer, diabetes and asthma in Bristol, yet people are still expected to travel miles across the congested city for services that could easily be on their doorstep. I keep repeating the need for local health organisations to see sense, and my hope is that the logic is finally getting through and that we will see more facilities, such as diagnostics and perhaps even scanners, in the near future. Yet why has it taken such effort and such a long time?

South Bristol Community Hospital is perfectly placed to deliver the vision in the five year forward view and the aspiration of the 10-year plan—integrated with social care, providing a front and back door to other services to support the flow in the rest of the health system. However, progress towards those achievable goals is constantly frustrated by the fragmented ownership, the complicated money flows and the unfathomable accountability arrangements. My constituents, without fail, suffer as a result.

Time does not permit me to outline similar problems relating to the shady use of wholly owned companies, but chief among my objections to such companies is that every one of them is a lost opportunity to look at NHS estate management locally on a more joined-up basis, with some local accountability in the system. How can we promote a collaborative approach across healthcare systems when individual trusts go down their own selfish route?

The Naylor review offered some interesting recommendations to simplify the national management of the estate. The Government chose to establish a ministerial board chaired by a Minister at the national level, and it includes everyone—every NHS organisation seems to be on that board. I tried to map the board, who sits on it and how it links back to local communities, but I am afraid I gave up. Perhaps the Minister will help us with that.

Some big and controversial decisions need to be made about the estate, particularly in London, but they are being considered without any engagement with local communities. Not only does that ignore the wellspring of local knowledge that could help avoid a repeat of previous failures, but it fosters a feeling of communities being “done to”, and it makes any change hard—in most cases, impossible—to deliver. Hence, efficiencies that could be ploughed back into local health communities will not be realised.

Communities have been asked to submit estate strategies across their local health communities via the sustainability and transformation plans. They are now being asked to submit bids to a new capital programme, but how will estates run by NHS Property Services and Community Health Partnerships be factored into the mix? In addition to that complicated picture, NHS foundation trusts have their own schemes in play. Control and leverage of community and primary care estates cannot be done at the national level. That simply will not work. We cannot achieve the transformation for the next 10 years that is being talked about without local control of the architecture to deliver it.

When local leaders plan services as part of the sustainability and transformation plans, or whatever the next iteration of that is called, local people must have a say in how those services are delivered. There must be a mechanism to bring those properties, places and assets—and the people running them—back into the sphere of accountability of local health service communities.

Those are not bits of internal housekeeping; they are ways of doing business that are bad for the local health economy, bad for staff and, most importantly, bad for patients and taxpayers. Local communities across the country would like their voice back, and our local NHS would like its money back. The debate needs to do more than shine a light on a problem. I would like the Government to acknowledge that there is a problem and commit to fixing it, because anything less is a dereliction of responsibility and a huge opportunity wasted.

Free Childcare for 3 and 4-year-olds

Debate between Karin Smyth and Julian Sturdy

Tuesday 12th July 2016 Westminster Hall

[Julian Sturdy (York Outer) (Con)]

The hon. Lady is making some powerful arguments. I point out to her that one of the pilot schemes is in York. I have worked closely with the nursery providers in my constituency. Because of the funding stream and the hourly rates, there was a lot of concern among those providers to start off with about whether they would opt in to provide the second 15 hours, but the local authority and the Department for Education worked together closely and have now persuaded 60% to 70% of those providers to opt into the scheme. Does she not agree that we can persuade providers to opt in as long as there is good will from the Department and local authorities to deliver the scheme?

[Karin Smyth]

I certainly agree. That shows the importance of good pilots and good working nationally and locally, and we want to see that with the other pilots, which will start this year.

Private and voluntary providers reported to the Public Accounts Committee that the amount they are currently paid for providing free childcare is not enough to cover their costs, so in some cases they feel the need to charge parents for additional hours or obtain other sources of income to meet those costs. Providers can of course choose whether to offer parents free childcare, so there is a genuine risk that many businesses will simply choose not to offer the new entitlement because doing so could reduce their opportunity to charge parents for hours outside the entitlement. As hon. Members have said, it is important for that issue to be looked at, because different situations exist across the country.

Maintained settings—nursery classes and nurseries run by schools—tend to operate fixed morning or afternoon sessions and are less likely to offer additional chargeable hours, so their ability to offer the new entitlement is limited. That disproportionately affects children in disadvantaged areas, simply because those settings are more likely to operate in such areas. I hope the Minister will be able to outline how the Department will address the challenges of ensuring that there are enough people with the right skills to work in the sector in the years ahead. I also hope that he can reassure me that the Department will be able to use the pilots that will begin this year to test providers’ capacity to meet the expected demand for the increased entitlement. He may also want to explain how that will be done and how evaluation will be carried out, given that there is just 12 months between the start of the pilots and the scheduled full roll-out of the new entitlement, and I would welcome his thoughts on how the Department will ensure prior to the 2017 roll-out that the pilots have had genuine influence.

My third area of concern is the high cost of childcare. I know from my constituency that childcare fees present a real challenge for many working parents, as I am sure many hon. Members will agree. I have been contacted by parents who have been informed of some quite significant fee increases—up to 30%—being imposed by their private nurseries. Bristol already has some of the most expensive childcare outside London, as the Bristol Women’s Forum has highlighted, and I agree with the forum that childcare is an infrastructure issue and needs to be considered as part of our economic thinking. Indeed, the Women’s Budget Group in Bristol has indicated that 84% of the cost of universal free childcare will be recouped through taxes and reduction in welfare benefits.

High childcare fees are a key reason why the offer of 30 free hours is so important to so many working families and why I support that offer, but many parents have reported that some providers are offering the free entitlement only if parents also pay for the additional hours, and the charity Gingerbread receives calls from parents whose childcare providers have put conditions on the free offer. That contravenes the Department’s statutory guidance for local authorities, which states that they should ensure that

“if providers charge for any goods or services, this is not a condition of children accessing their place.”

The Department has acknowledged that issue, and I hope that the Minister will be able to explain what progress is being made on identifying the scale of the problem and how the Department plans to address it to ensure that those who are least able to pay do not miss out through such reverse means-testing.

My fourth and final area of concern is about measuring the impact of the offer to ensure that the taxpayer is getting value for money, which is why the Public Accounts Committee held an inquiry on this subject. As someone who is passionate about the value of investing in early years—I am a firm believer in the Labour Government’s Sure Start programme, for example—I am concerned that the Department’s most recent evaluations of the effectiveness of early years education and childcare are based on the academic outcomes of children who started early years education in 1997. I was surprised and alarmed to find that the Department had no routine data to assess the impact of its investment in the early years. That must be remedied, since such data must play a key role in helping to shape future policy. If the Department does not know what works well and how to get the best bang for its buck, taxpayers could be left short-changed. Since the Department appears to lack sufficient current data to measure the impact of free childcare, I hope the Minister will be able to explain, along with his responses to the other issues that I have raised, the steps that he is taking to bring its assessments up to date.