Where healthcare meets housing
The UK government has set a national target for the NHS to provide land for 26,000 residential units by April 2020. This policy sits alongside other key NHS policy drivers for efficiency and service transformation arising from the Five Year Forward View and the more recent Carter and Naylor reports
It is clear that the NHS, local authorities, housing associations and the private sector will need to work together to achieve it. But what are the challenges not only to achieving this ambitious target but also to ensure a better health and social care service is created as a result?
The recently formed Sustainability and Transformation Partnerships (STPs) are in accord that we need to deliver healthcare closer to where people live and complement this with specialist hospitals for critical care. There is evidence for and increasing interest – from the NHS and the healthcare sector in general – in the connection between the quality of a person’s housing and their health and wellbeing, both physical and mental.
Combined with the ageing UK population, there is also a drive to get people out of hospitals and into more appropriate settings to meet their needs in later life, providing a broader range of specialist accommodation than the traditional sheltered housing and residential care homes. Hilary Blackwell, Partner and healthcare specialist at Trowers & Hamlins, explains "What is needed now is effective communication and real partnership between the private and affordable housing sectors, non-NHS health and social care providers, the NHS and local social services and housing authorities working together to deliver these outcomes."
A major barrier to delivering these cross-sector solutions is that social housing, social care and healthcare are funded separately. This inevitably creates tensions and affects the ability to deliver joined up solutions. Another complication is that hospitals that are trying to move patients into alternative accommodation, often simply aren’t aware of the many reablement, step-up, step-down and other services offered by voluntary and private sectors in their area that could be accessed to reduce delayed transfers of care or reduce risk of hospital admission and readmission. Hilary believes that "It’s important to see the NHS not as one entity – it’s a combination of organisations."
"People within the NHS care hugely about what they do but it’s difficult for people to reach outside and communicate with those who might be able to assist because of the competing drivers on their time."
Trowers & Hamlins has been doing breakthrough work in the past year to connect housing providers and providers of non-NHS health and care services that are engaged with the idea of integrating NHS care into developments of accommodation and services and with NHS Trusts who are considering land disposals. "Trusts need to decide if they want a one off sale or to work towards a solution such as creating keyworker housing or a service-delivery model complementary to clinical care, or even just a revenue stream from market rented accommodation. This is a more long term solution and means that a trust can retain some value in the land to support future healthcare delivery," explains Kyle Holling, Partner and healthcare specialist at Trowers & Hamlins.
"Another major issue is expertise," continues Kyle. "The NHS doesn’t have development expertise – estates directors are often experienced in managing the estate not delivering a new one, which is understandable given the focus on delivery against existing services to a high standard. There are many options the NHS could explore, but the housing sector covers all the bases – it understands development and development risk, how to manage accommodation, how to deliver care and support services, but also market rent, market sale and mixed use development and can help to explore options the NHS might not have thought about."
"It can inject some fresh thinking into planning what can be delivered on a site after clinical service delivery is catered for and maximise land use, functionality and value."
"The same concept could and should be applied to GP surgeries and the NHS community estate – building new residential accommodation above and around these buildings to cross-subsidise high quality modern clinical facilities."
Despite having to navigate EU procurement regulations, where Trowers are able to offer some innovate solutions, the NHS should have the confidence to talk to potential partners and understand the viability of different approaches to land disposal and land use to maximise benefit both now and in the future. Housing developers are used to partnering with the public sector and have the opportunity to leverage the NHS’ 26,000 homes target to deliver favourable outcomes for all parties.
"There is a well-trodden route for selling NHS land but we believe it’s the partnerships which provide more long-term value," Hilary notes. "That is also where we find we can offer the most support to ensure each side understands the policy drivers, politics, business case requirements and legal hurdles of the other and where we believe we can provide genuine support."
The NHS and the housing markets have huge scope for growth. "With REITs like Civitas looking to invest in specialist supported housing, the significant growth in interest and investment in retirement housing, the continued need for better quality care home accommodation and the coming growth in the numbers of people aged over 85 as the baby boomer generation reaches that age bracket, it’s clear this is an area with good investment opportunities" says Kyle.
"The Aston University and Extracare Charitable Trust have researched the cost savings for running a retirement village that provides appropriate accommodation and care services, reducing the strain on NHS hospital care and social services budgets," Kyle continues. "But in order for these efficiencies to be made, different parts of the public sector need to come together to take risks, take responsibility and put their money in a pot and invest it for their mutual good. Joining up bodies via STPs has the potential to allow different budgets to look at savings across the board. It is a case of which organisations are given a role in that process."
The NHS can do a lot when its constituent parts work together effectively but can do so much more taking advantage of the whole-pathway opportunities that open up for local populations when other providers of accommodation and care and support services are given a role in service design and delivery. If delivered successfully this could significantly reduce the numbers of people needing to access GP services and NHS clinical care and the amount of time people spend in those services, by delivering less cost-intensive alternatives both before and after people need to access them – the global saving could be huge. At a time when austerity is a watchword, particularly around the NHS and the wider healthcare economy, that has to be a conversation worth having.