New care models
Frequently asked questions (FAQs)
A guide for vanguards on estates issues
April 2016
Our values: clinical engagement, patient involvement, local ownership, national support
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Contents
Context and background
2-3
The purpose of this guide
4
Frequently asked questions
5-19
1. Strategic estates planning
5-8
2. Accessing capital
9-12
3. Estate ownership
13-15
4. Estates disposals
16-18
5. Links / glossary and contact details
19
Our
Our
values:
values:
clinical
clinical
engagement,
engagement,
patient
patient
involvement,
involvement,
local
local
ownership,
ownership,
national
national
support
support
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Context and background
The 50 new care model vanguards are delivering a key element of the Five Year Forward View - the
shared vision for the future of the NHS, published in October 2014 and developed by the seven
national partner organisations: NHS England, NHS Improvement, Care Quality Commission (CQC),
Public Health England, Health Education England and the National Institute for Health and Care
Excellence (NICE).
Through the new care models programme, vanguards are redesigning local and whole health and care
systems to address the key challenges identified in the Five Year Forward View:
1. The health and wellbeing gap
2. The care and quality gap
3. The funding and efficiency gap
In practice, this could mean that people experience fewer trips to hospitals, for example cancer and
dementia specialists could hold more clinics in local surgeries, creating one point of call for family
doctors, community nurses, social and mental health services, or access to blood tests, dialysis or
even chemotherapy closer to home.
Estates has been identified by vanguards as a key enabler to delivering their new care models.
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The purpose of this guide
This document sets out a number of frequently asked questions (FAQs) on estates and answers them,
signposting the reader to useful information and existing guidance where necessary. The questions
captured here reflect emerging issues and key considerations as vanguards continue to develop estate
plans in support of their new care models.
The FAQs in this guide are grouped into broad themes:
1. Strategic estates planning
2. Accessing capital
3. Estate ownership
4. Estates disposals
5. Links / glossary and contact details
The document will remain ‘live’, acting as a useful reference tool for new care model account
managers and vanguards. It will be updated periodically so that all vanguards benefit from a shared
and consolidated response to recurring issues and questions.
Should vanguard staff or supporting teams have further questions and/or have useful information and
learning in response to the issues raised which you would like to share, or if you have any comments
on the document, then please do not hesitate to contact: [email protected]
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Estates FAQs – 1. Strategic estates planning
Q1. Why is local strategic estates planning important for vanguards? How do local
partners ensure that estates related issues are aligned and reflected in relevant plans?
•
Estates are a key component in strategic service planning for the delivery of new care models.
•
It is important that vanguards work with their partners and local stakeholders, through local strategic
planning processes, to feed into and align estates plans:
•
•
Clinical Commissioning Groups (CCGs) are required to develop a strategic estates plan (SEP)
and to lead/participate in Local Estates Forums (LEF). The strategies should reflect an overview of
the plans of all property owners within their footprint based on current and future clinical
requirements, supporting system-wide transformation. SEPs are living documents and need to be
refreshed to ensure service planning and the infrastructure required for service delivery remain
aligned. Working with their relevant CCGs, vanguards will need to ensure that their estate
propositions are suitably reflected in SEPs.
•
NHS Providers are required to have Board-approved estates strategies that align to the
requirements set out in Department of Health (DH) guidance:
https://www.gov.uk/government/publications/developing-an-estate-strategy
•
Local Authorities’ estates strategies, linked to the ‘One Public Estate’ programme, should align with
CCGs’ estates planning.
Local partners are encouraged to work together through their local estates forum (LEF). Further
information on LEFs can be found at:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/436185/LES_final.pdf
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Estates FAQs – 1. Strategic estates planning
Q2. How do vanguard estate plans relate to the sustainability and transformation
planning process?
•
Strategic estates plans (SEPs) will need to be informed by, and support and align with the sustainability
and transformation plans (STPs) which local health economies have been asked to develop and submit
by 30 June 2016. Local partners should be able to evidence the links between CCGs’ SEPs and the
STPs, recognising that the current iterations of SEPs reflect a smaller footprint than the parent STP.
•
Vanguard propositions need to be reflected in CCGs’ SEPs and in the STP for the wider health economy
footprint that the STP embraces.
•
Further information about the sustainability and transformation planning process can be found at:
https://www.england.nhs.uk/ourwork/futurenhs/deliver-forward-view/stp/
Q3. Do vanguard estates plans need to be reflected in wider service reconfiguration
strategies?
•
Yes - they should form an integral part of whole service planning which includes service reconfiguration,
transformation and sustainability programmes.
•
In developing vanguard estate plans, consideration should first be given to how the existing estate within
the locality, regardless of ownership, should be utilised to better effect. The SEP process should help
vanguards identify opportunities for the existing estate to enable development of new care models.
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Estates FAQs – 1. Strategic estates planning
Q4. How can I gain a better understanding of estates utilisation and opportunities within
my vanguard footprint? What tools are available to help me?
•
There are a number of tools available to assist vanguards:
o Hospital Estates and Facilities Statistics data sets are available from Health and Social Care
Information Centre (HSCIC). These include ERIC (Estates Return Information Collection) and
PLACE (Patient-Led Assessments of the Care Environment)
o Obtain a free registration to use the Strategic Health Asset Planning and Evaluation (SHAPE) tool by
following links at https://shape.phe.org.uk/. The application contains a number of key indicators
including: hospital activity, data from Joint Strategic Needs Assessments (JSNAs), public health
metrics, primary care metrics, programme budgeting and demography. Each indicator can be
mapped and is linked with information on healthcare estates and facilities location.
o Self-assessment tools such as the Department of Health’s NHS Premises Assurance Model (PAM)
o Data sets available to NHS Property Services (NHSPS) and Community Health Partnerships (CHP)
as well as the Department of Health; those used in the development of SEPs; and information from
the surplus land disposal programme.
•
Vanguard staff can engage with professional networks such as the Health Estates and Facilities
Management Association (HEFMA), Healthcare Financial Management Association (HFMA) and Institute
of Healthcare Engineering and Estate Management (IHEEM).
•
Teams can also access support from PMO functions in NHS England’s regional teams.
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Estates FAQs – 1. Strategic estates planning
Q5. How do the ‘Carter’ efficiency recommendations on estates impact vanguard estates?
•
The Carter efficiency recommendations are focussed primarily on the provider estate. However, all
property owning and commissioning organisations should be aware of the recommendations and be
striving for best practice and reducing property holding costs by working in partnership to achieve
efficiencies across the system rather than individually in isolation.
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Estates FAQs – 2. Accessing capital
Q6. What sources of capital are available to those vanguards who need capital
investment to deliver their new care model?
•
The way capital is accessed varies for different organisations within a vanguard. Requirements should be
assessed against availability of different sources of funds, revenue affordability and value for money:
o For non-foundation trust (FT) NHS providers – sources of capital include: internally generated
funds (e.g. depreciation and land disposal); externally generated funds; additional public dividend
capital (PDC) and capital investment loans (for exceptional quality and spend to save schemes only);
private finance initiatives (PFI); or other privately funded initiatives. NHS trusts must not exceed their
approved capital resource limits (CRL) agreed with NHS Improvement;
o For FT NHS providers – generally speaking FT NHS providers have greater flexibility than non-FT
NHS providers in accessing and investing capital. Sources of capital include internally generated
funds e.g. depreciation and land disposal, externally generated funds, public dividend capital (PDC),
and capital investment loans (for exceptional quality and spend to save schemes only);
o For GPs – GPs can raise their own capital through a mortgage, commercial borrowing or a third party
development with a corresponding right to certain types of financial assistance for General Medical
Services (GMS) or Personal Medical Services (PMS) providers. They can also submit bids for
improvement grants under the NHS (General Medical Services - Premises Costs) Directions 2013.
•
GPs can also submit bids, through their local Clinical Commissioning Group (CCG), to the Primary Care
Transformation (formerly Infrastructure) Fund (PCTF). This is a multi-year £1billion investment programme
to help general practice make improvements in premises and technology for the benefit of patients.
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Estates FAQs – 2. Accessing capital
Q7. What should I do if I have capital requirements and want to access Government
funded capital?
•
It is essential that capital requirements are identified at an early stage, through local strategic planning
processes, and that these are also reflected in the strategic capital plans developed by NHS England
regional teams, NHS Property Services (NHSPS) and Community Health Partnerships (CHP) and NHS
Improvement.
•
It is important to understand that available Government funded capital resources are finite so investment
proposals and supporting business cases will need to be robust and compelling.
Q8. Can I put forward a funding proposal to the Primary Care Transformation Fund?
•
The Primary Care Transformation (formerly Infrastructure) Fund (PCTF) is a multi-year £1billion
investment programme to help make improvements in primary care, including in premises and technology
to drive transformational change. A key aim is to help general practice increase the capacity of services
so that patients can access a wider range of clinical services.
•
CCGs can put forward proposals on behalf of local stakeholders such as GPs or, where relevant,
organisations within a vanguard where the proposals meet the PCTF’s eligibility criteria.
•
In October 2015, CCGs were invited to put forward proposals for investment in primary care infrastructure
for future years.
•
Further information about the PCTF and the application process can be found at:
https://www.england.nhs.uk/commissioning/primary-care-comm/infrastructure-fund/
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Estates FAQs – 2. Accessing capital
Q9. How do I go about making a business case for a capital investment proposal?
•
There is guidance already available to help organisations with business case development:
o Business case development guidance is available for commissioners at:
https://www.england.nhs.uk/resources/bus-case/
o Business case development guidance is available for NHS trusts through NHS Improvement and can
be found at http://www.ntda.nhs.uk/blog/2014/07/11/capital-regime-and-investment-business-caseapprovals-guidance-for-nhs-trusts/
o Foundation trusts will have their own business case processes, but as good practice they should
liaise with NHS Improvement on their capital programmes and major schemes.
Q10. How long does it take to develop a full business case from a standing start?
•
•
This depends on the complexity of the scheme. As an indicative guide, it could take over 6 months plus
for a straightforward primary/community care investment in existing premises. This could be over two
years for a more complex health service development. Vanguards are strongly encouraged to factor this
into their project planning and feasibility phase.
A key part of the project development process is a robust options appraisal and the sponsoring
organisation should take advice from experts in the area of business case development, or from the NHS
England Project Appraisal Unit (PAU) (via NHS Improvement for FTs and non-FT NHS trusts). This will
help ensure that the options appraisal is properly framed to provide the most appropriate preferred option.
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Estates FAQs – 2. Accessing capital
Q11. Who can vanguards contact about the estate/capital requirements needed to deliver
their new care model?
•
For primary care and community care developments sponsored by CCGs or NHS England, please
contact your local NHSPS and/or CHP contact.
•
NHS England can provide advice on delivery routes and the approvals process for various project
proposal options. Please contact your new care models (NCM) account manager or email the NCM
estates workstream team in the first instance at: [email protected].
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Estates FAQs – 3. Estate ownership
Q12. Who owns the property from which NHS services are delivered?
•
The property used to deliver NHS services could be owned by any one of the NHS providers, (NHS
foundation trusts, NHS trusts, or GPs), either of the NHS property companies (NHS Property Services
[NHSPS] or Community Health Partnerships [CHP]), or other third party organisations that lease their
premises to service providers (such as third party developers or local authorities).
Q13. Can commissioners own property interests?
•
NHS commissioners (NHS England and Clinical Commissioning Groups) should not hold property
interests in operational (clinical) estate, but can hold leases (usually through NHSPS) to deliver their
administrative functions which would normally consist of short term leases on office buildings.
Q14. Who pays for the occupied space within properties delivering NHS services?
•
Any occupier of space within a building who is not the freeholder of the building or who is occupying
space already secured under a lease should have an occupancy agreement in place providing for an
agreed term, rent and service charge. In some instances, particularly where the occupancy is not a
discrete space that is capable of exclusive occupation, this agreement may be in the form of a licence to
occupy.
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Estates FAQs – 3. Estate ownership
Q15. How are occupiers funded for these occupancy costs?
•
The occupier will be responsible for paying the rent due and applicable service charge (or premises costs
in respect of a freehold or long leasehold). The source funding will flow from the commissioning contract,
through tariff or, in the case of some GPs, could be subject to reimbursement under the NHS (General
Medical Services - Premises Costs) Directions 2013.
Q16. For vanguards who are integrated providers (a) do they have to take ownership of
community services premises from NHSPS? or (b) can they insist on taking ownership of
community services premises from NHSPS?
•
Vanguards cannot take over the freehold or the head leasehold interest in a property in the ownership of
NHSPS.
•
If a property is in the ownership of NHSPS and it is required for an ongoing service delivery then the
occupiers will be able to negotiate the appropriate occupancy contracts with NHSPS.
•
Guidance on estates ownership for NHS providers and GP premises can be found at:
o Healthcare Building Note (HBN) 00-08 - Parts A and B:
https://www.gov.uk/government/publications/the-efficient-management-of-healthcare-estates-andfacilities-health-building-note-00-08
o NHS (General Medical Services - Premises Costs) Directions 2013:
https://www.gov.uk/government/publications/nhs-primary-medical-services-directions-2013
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Estates FAQs – 3. Estate ownership
Q17. Who is responsible for the cost of vacant space within NHS properties?
•
Where vacant space in buildings that are owned by NHSPS or CHP is not subject to a continuing
occupancy agreement, the cost of that space needs to be met, and the responsibility for meeting those
costs depends on the property ownership structure.
•
In general, the cost of void or underutilised space in buildings in the provider owned estate is met by the
provider.
•
The cost of void space in either of the NHS property companies’ estate is funded by commissioners, but
noting that this arrangement is subject to the agreed charging policy that is in place at the time and whilst
now largely settled, may be subject to further fine-tuning from time to time.
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Estates FAQs – 4. Estates disposals
Q18. Who is responsible for declaring a site (or building) surplus to requirements?
•
•
•
The owner of a property can declare the whole, or part of a property surplus when it is deemed not to be
required any longer for the delivery of healthcare services. This process would normally require the
support of commissioners who may have need for the property for the commissioning of healthcare
services.
NHS Property Services (NHSPS) cannot declare its own property surplus without the explicit consent of
commissioners.
Where NHS trusts and NHS Foundation Trusts received property from Primary Care Trusts (PCTs) when
they were abolished in April 2013, the Trust is required to seek the consent from the Department of
Health over the future use of the property, and may require the Trust to transfer the property to the
Department (or its nominee).
Q19. Who is able to dispose of NHS owned land and buildings?
•
•
•
The owner of the property is responsible for the property disposal process.
The disposal should follow a declaration of the estate being surplus to NHS requirements, deliver best
value for the NHS, and be supported by local commissioners.
The Department of Health’s guidance note on efficient management of healthcare estates and facilities
‘Healthcare Building Note (HBN) 00-08 - Parts A and B’ set out principles and detailed guidance for those
leading local disposal processes: www.gov.uk/government/publications/the-efficient-management-ofhealthcare-estates-and-facilities-health-building-note-00-08
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Estates FAQs – 4. Estates disposals
Q20. Who retains the capital receipt from a property disposal?
•
This is dependent on a number of factors including who owns the property and what delegated authority
that owner has. Generally speaking:o A Foundation Trust can retain any capital receipt arising from a disposal of its own land for its own
account;
o An NHS Trust can retain the receipt of a disposal where the gross disposal value is less than the
Trust’s delegated limit for capital investment. For a disposal of an NHS trust’s property with a value
greater than the Trust’s delegated limit, the proceeds are returned to the DH unless the trust has an
approved business case for a reinvestment;
o The proceeds from disposals within the NHS property companies (NHSPS or Community Health
Partnerships) are retained by those property companies; and
o A GP retains the proceeds from the disposal of their own property after due consideration to any
restrictions or legal charges on title.
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Estates FAQs – 4. Estates disposals
Q21. Can vanguards repurpose surplus land?
•
•
•
•
This depends on the vanguard’s particular circumstances.
If the land is required for ongoing health use, such as within a different configuration of service provision,
the land is not technically surplus so will stay in the ownership of the original owner.
The owner can ‘sell’ the land to an alternative service provider but that sale will need to be in accordance
with accounting rules and the general principles found in HBN00-08.
The NHS should not enter into concessionary sales – this means selling for under market value, unless
the strict requirements set out in the Department of Health’s ‘Healthcare Building Note (HBN) 00-08 Parts A and B’ are met. See Q19 for more detail on the guidance note and supporting link.
Q22. Are estate rationalisation proposals subject to a business case process and
external review?
•
Yes - normal rules apply to those organisations proposing capital solutions and estate disposals and
existing business case approval routes apply.
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Estates FAQs – 5. Links / glossary and contact details
Q23. Who can I contact if I have need advice that is not covered here?
•
Vanguards with particular issues should contact your new care models (NCM) account manager in the
first instance.
•
You can also email the NCM estates workstream team at: [email protected]
Organisations and programmes
Tools and guidance
• NHS Property Services (NHSPS)
• NHS Community Health Partnerships (NHS CHP)
• New care models – vanguards - NHS England
website
• Primary Care Transformation Fund (PCTF)
• Independent Trust Financing Facility (ITFF)
• One Public Estate programme
• NHS (General Medical Services - Premises Costs)
Directions 2013 (PCDs)
• DH Healthcare Building Note (HBN) 00-08 - Parts A
and B
• NHS Five Year Forward view planning guidance
• Sustainability and transformation planning process
(STP)
• Hospital Estates and Facilities Statistics (ERIC and
SHAPE)
• NHS Premises Assurance Model (PAM)
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The NHS Five Year Forward View sets out a vision for the future of the NHS. It was developed by the partner
organisations that deliver and oversee health and care services including:
• NHS England
• Care Quality Commission
• Health Education England
• NHS Improvement
• The National Institute for Health and Care Excellence
• Public Health England
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