Living Through Interesting Times – How NHS Trusts in England can Protect and Progress their Capital Projects

Contact: Richard Robinson, Andrew Jeffery

August 17, 2021

With unprecedented pressure on NHS front-line staffing, facilities, funding and senior leadership, what should NHS Trusts in England be doing to protect and progress their capital projects through this time of change?

NHS Trusts in England are still fighting the ongoing COVID-19 pandemic, continuing to address the growing backlog of non-COVID-19 care and supporting and adapting to far-reaching change in the wider healthcare system. Some of the major changes include:

  • A Health and Care Bill is progressing through Parliament that, among other things, establishes Integrated Care Systems (ICS) as statutory organisations. Health and care partnerships are being established between NHS services, local authorities and other local partners, so they can work together to deliver integrated services to patients within their areas of responsibility.
  • A New Hospital Programme (NHP) has been set up jointly by the Department for Health and Social Care (DHSC) and National Health Service England & Improvement (NHSE&I), with a goal of delivering 48 hospitals over the next decade. The Government has confirmed an initial £3.7 billion funding allocation for NHP over the next four years, with presumably more to follow in the next Strategic Review Period.
  • NHP is reaching the end of its initial assurance scope. Six Agile projects have been designated for rapid implementation; maturity of eight larger Pathfinder schemes has been assessed and a competition has been opened for an additional eight Trusts to join the existing “40 hospitals” programme. A suite of draft/evolving guidance documents has been made available to Trusts. A Design Convergence Review is underway to establish a baseline of best practice to be implemented by the early schemes. A new Interim Commercial Partner is being procured, and a new framework alliance is being developed in order to build construction capacity.
  • Changes in senior leadership include a new Secretary of State for Health and Social Care and a new Chief Executive at NHS England (NHSE), while the NHP is recruiting for a new Programme Director. These changes in senior leadership open the way for new thinking to be adopted and new agreements to be reached.

 

What should NHS Trusts in England with capital projects be doing?

Except for the “small and agile” projects, very few NHS Trusts in England will be proceeding through detailed design to construction start because most will be waiting for the NHP Design Convergence Review to conclude. During this time, it is important that Trusts focus on developing their unique “case for change” and ensure their financial and clinical plans are aligned with clinical care transformation goals the government is seeking to achieve through the ICS implementation programme and NHP.

Trusts that are not already part of the New Hospital Programme have until 9th September 2021 to submit an expression of interest to redevelop or build new care facilities. This is the first of a 2-stage selection process; it will be followed by a more detailed process for long-listed schemes later in the year, with DHSC expecting to make the selection in Spring 2022.  Ankura recommends that Trusts with such requirements that are not already in the “40 new hospitals” programme should express interest, as schemes that are outside of the NHP will likely face an environment with limited available funding.

It is recommended that Trusts seeking to redevelop or build new care facilities should:

  • Obtain the draft/evolving guidance issued by NHP and ensure it is adequately and robustly reflected in their financial and clinical approach.
  • Engage Integrated Care System (ICS) partners, especially where ICS boundaries differ from current/previous CCG boundaries, to ensure:

a. Alignment on Demand and Capacity modelling and Models of Care and how these translate into a Schedule of Accommodation. Agreement on how demand will be managed between the different system partners, and wider system support to realise the Trust’s strategy.

b. Alignment on Social outcomes, including;

  •  Stakeholder Engagement Strategy, Social Value Strategy, EDI Strategy, Accessibility Strategy, social KPIs, and community benefits.
  • Benefits of health outcomes and reducing health inequality locally.
  • Defined goals for local work apprenticeships/local economy benefits.
  • Measurable KPIs around patient, community and social inclusion.

c. Town Planning Support for the scheme.

From Ankura’s experience gained while supporting one of the current Pathfinder schemes, successful submissions should:

  • Demonstrate how the estimated costs benchmark against comparable schemes.
  • Include project specific workforce modelling, coordinated with their clinical strategy and schedule of accommodation, to inform transition planning and the financial model.
  • Demonstrate the reduction in maintenance backlog that will be achieved by completion of the project.

It is clear that the competition for new capital project investment across the NHS is at unprecedented levels. There will be winners and losers. Successful Trusts will be those that win support for their scheme from regional and system partners as well from the central DHSC, NHSE&I and NHP teams. Obtaining funding will require more than developing a fully compliant business case submission; successful Trusts will likely be those whose schemes stand out from others as especially compelling. Trusts whose schemes that are not approved for funding during this cycle will likely have to wait until at least 2030 before another round of government funding becomes available.

Ankura’s healthcare team has the experience to assist Trusts with the development of a complete and compelling scheme. Our team is ready and able to support Trusts with the preparation of their bids for major capital funding. For an informal chat on how Ankura can make a difference to your submission please contact Richard Robinson or Andrew Jeffery.

 

Sources:

https://www.gov.uk/government/publications/health-infrastructure-plan-selection-process-for-the-next-8-new-hospitals

https://www.theguardian.com/society/2021/aug/08/the-next-battle-for-the-nhs-sajid-javid-v-rishi-sunak

https://www.hsj.co.uk/leadership/amanda-pritchard-appointed-as-nhs-england-chief-executive/7030602.article

https://www.hsj.co.uk/workforce/nhs-hospital-building-chief-to-leave-after-15-months/7030519.article?mkt_tok=OTM2LUZSWi03MTkAAAF-Tivxxi0syGc5rYWUSW4eSiWOWSyoqKYSNnX3WCKzYfaoltG2rt5I2JjvAhU7u13nAs5u_vAwoJlerD8YccTckpORvcceLC55XHthDCWxOiFMtS0

https://www.gov.uk/government/news/eight-new-hospitals-to-be-built-in-england

https://www.hsj.co.uk/finance-and-efficiency/shake-up-of-new-hospitals-project-after-construction-capacity-concerns/7030461.article

https://www.building.co.uk/focus/client-profile-emma-jane-houghton-in-charge-of-the-new-hospital-programme/5112442.article

https://www.digitalhealth.net/2021/07/nhs-overhaul-health-and-care-bill-formally-introduced-to-parl https://www.hsj.co.uk/policy-and-regulation/integrated-care-systems-to-set-own-constitution-and-pay/7030436.articleiament/

https://www.hsj.co.uk/policy-and-regulation/first-major-nhs-legislation-in-nine-years-confirms-dhsc-power-grab/7030432.article

https://www.nhsconfed.org/publications/health-and-care-bill

https://www.hsj.co.uk/service-design/new-hospital-programme-a-unique-opportunity-to-transform-nhs-infrastructure/7030297.article

*Ankura is not a law firm and cannot provide legal advice.