As the parties set out their health pledges, one thing is already clear in this election campaign: the scale of the challenge and change set out in sustainability and transformation plans (STPs) for the NHS will be front and centre.
Whether it’s the Conservatives’ pledge for ”the most ambitious programme of investment in buildings…the NHS has ever seen” and GPs coming together to provide… “a truly seven-day healthcare service”; Labour’s promise of more funding for GP services and capital for NHS buildings; or the Liberal Democrats’ encouraging GPs to work together in federations and to lead multi-disciplinary health and care hubs, all the parties are setting out pitches around the vision we’ve seen in STPs.
In the heat of campaigning, it’s unlikely that parties will delve deep into issues such as strategy for local NHS workforce, operational structures, local patient demographics and technology. We saw very little detail in STPs on how primary care estate will need to improve; analysis by The King’s Fund found widespread recognition that estates will be a key enabler for delivery of NHS transformation, including access to general practice and the provision of a range of acute services closer to home. However, only around 70% of the plans touch on their primary care estate and only around four in ten discuss the issue of funding for improving primary care buildings.
But STP leaders are only too aware of the estates challenges they face. For primary care, particularly, it is an issue lurking underneath the innovative, ambitious plans to bring all sorts of services closer to home; to make them easier to access; and to allow GPs, community nurses, clinical pharmacists, health visitors, physiotherapists and many other staff to work much more closely together in order to do so.
And yet there is such potential for primary care buildings to help make this happen. It does not and should not be an issue that parties are afraid to confront. On the contrary: by creating a primary care estate that’s up to the job of transformation, those buildings will provide the strong foundation that primary care teams will need.
STPs are working on their delivery plans now and we can expect that to take some time – whatever the outcome of the election. Strategic estates planning is no easy task: translating that down to delivery is even more challenging. And much has been made recently of the NHS’ need to access private capital to improve estate: Sir Robert Naylor’s new review made clear it must be part of the solution, while NHS Improvement’s CEO, Jim Mackey, has set out his case for the role of non-government funding to improve our health service buildings under impossible strain. Accessing the private sector’s skills, expertise and funding to improve NHS premises can take many forms, but it is ready to provide a lifeboat.
Primary care estate is a shadow lurking beneath the waters of NHS transformation. Can campaign conversations on health help bring it to the surface and back on an even keel?
Jonathan Murphy is our CEO