New ways of working with the NHS
The BBC has been leading an expose into problems at hospital A&E departments. Our previous article in last Autumn's edition looked at opportunities for joint working with the NHS on new staff accommodation projects, or step down/intermediate care.
This has given rise to a groundswell of interest from housing associations supported by the National Housing Federation and the Housing Associations' Charitable Trust.
Inevitably housing associations and other voluntary organisations have a number of questions to ask about engaging with the NHS, including:
Who do I talk to?
The 2013 NHS reorganisation has only really just settled down. With the advent of Sustainability and Transformation Plans (STPs) there may be further changes ahead. Recent commentary by Simon Stevens, Chief Executive of NHS England suggested that STP leads may be in a position to recommend reconfigurations in relation to Clinical Commissioning Groups (CCGs) or NHS provider organisations. However, the NHS is generally shying away from mergers or creation of new organisations, given the serious business of delivering on the NHS Five Year Forward View targets.
Being connected to the local NHS decision makers makes good sense – you will have early warning of upcoming opportunities, the chance to influence these and be able to position your organisation to succeed.
The Chief Executive and Chief Financial Officer of your local CCG should be known to you. Linking up with Social Services may assist, as many NHS bodies and local authorities are working jointly on integration of older peoples and family services, with resulting opportunities to tender for services, with or without a built environment angle.
Another obvious connection to make is with the local hospital trust, i.e. where there is the most acute need for relief from "bed blocking". Person centred planning on individuals in their own homes and in care homes can also help avoiding their admission to hospital.
The same agencies are involved in discharge planning and housing associations have a role to play here. Early identification of necessary aids and adaptations and carrying them out could speed up discharge and make the receiving environment much safer.
Some housing associations are offering voids in existing sheltered accommodation schemes to hospitals. We know, however, from recent comments by a senior NHS hospital manager that hospitals are not generally aware of the range of discharge opportunities available. They are under the impression that there is no alternative to a care home bed if the person is unable to return directly to their own house. Housing associations could set out an attractive range of options and make sure that the Chief Operational Officer and their team at the local hospital are fully aware of these.
The issues are different in mental health, but again there are some good examples of discharges into the community or, at least, to lower secure settings. With the Government's emphasis on mental health and pilots in certain parts of the country, again for those organisations with a specialised care and support offering, there are genuine opportunities here.
The community health care estate previously held by primary care trusts is now owned by the two Department of Health owned companies NHS Property Services (NHS PS) and Community Health Partnerships. The latter holds the LIFT estate, approximately 330 new fit for purpose health centres, although there may be scope for variations and new models of service delivery. NHS PS owns the residue and may be a useful partner in terms of releasing land for development.
Do I have to tender for the opportunity?
Contracting authorities may be able to place opportunities without going through a full OJEU process. However even once Brexit is fully in place, best public procurement practice will still require following rules similar to those practiced today.
An exemption is a development opportunity based on a land deal, e.g. a lease of the land on which a new development is built, if the contracting authority is not overly involved in the specification of the development. The recent Berkshire West case has provided some helpful guidance as to what can be achievable.
Do I have to work with a Foundation Trust?
Foundation Trusts have greater freedoms. They are now monitored by NHS Improvement as are NHS Trusts, but the regime is somewhat different. It is not dissimilar to a bank's credit committee authorising transactions to proceed.
NHS Trusts can enter into joint ventures, either for income generation purposes, or using a contractual as opposed to a corporate joint venture mechanism. There is a degree of each side educating the other as to the opportunities available here – the sorts of joint ventures housing associations have worked on with developers and house builders over many years are not necessarily as well known to the NHS but can provide similar economic, social and wellbeing returns. Meanwhile the NHS has a complex, but not insurmountable, set of capital business case and other requirements which must be navigated. We have the legal and commercial knowledge of both sides and the contacts to pull ventures together where there is a will on both sides.
The key is to identify the benefits that will be realised, the inputs of the various proposed partners, and the proposed sharing of risk and reward. Then you can structure the correct organisational or contractual solution to achieve your aims.
We have a dedicated health and social care team, comprising expert property, procurement and public sector contract lawyers and would be happy to discuss any of the issues in this article with you.