- Boroughs should work with Clinical Commissioning Groups (CCGs) and other NHS and community organisations to:
- identify and address local health and social care needs within Development Plans taking account of NHS Forward Planning documents and related commissioning and estate strategies, Joint Strategic Needs Assessments and Health and Wellbeing Strategies
- understand the impact and implications of service transformation plans and new models of care on current and future health infrastructure provision in order to maximise health and care outcomes
- regularly assess the need for health and social care facilities locally and sub-regionally, addressing borough and CCG cross-boundary issues
- identify sites in Development Plans for future provision, particularly in areas with significant growth and/or under provision
- identify opportunities to make better use of existing and proposed new infrastructure through integration, co-location or reconfiguration of services, and facilitate the release of surplus buildings and land for other uses.
- Development proposals that support the provision of high-quality new and enhanced facilities to meet identified need and new models of care should be supported.
- New facilities should be easily accessible by public transport, cycling and walking.
London’s health care services are vital to maintaining and improving Londoners’ quality of life. The health service is also one of the capital’s major employers, with over 200,000 people working in the NHS in London. Several factors affect the demand for health services and facilities. These include a growing and ageing population, an increase in complex and long-term health conditions that need an integrated approach, and changes in patients’ personal preferences. New treatments and technologies are also transforming the ability to predict, diagnose and treat conditions.
The NHS Five Year Forward View identifies the need to prevent avoidable illness and transform the way that care is organised and delivered in order to meet increasing demands for healthcare within the resources available. It describes the following priorities:
- supporting and enabling individuals to take better care of their own health and the health of their families and communities
- undertaking a higher proportion of healthcare in community rather than hospital settings
- making best use of available assets, including more flexible approaches to how facilities are used and the overall configuration of the health estate, which requires a mix of dis-investment in older, out-of-date facilities and re-investment in more modern, fit for purpose estate
- ensuring that models of care change and continuously evolve
- ensuring that existing and planned new health infrastructure supports and facilitates change.
There are currently four broad types of health infrastructure provision:
- primary care – GP practices, plus community pharmacists, dentists and opticians
- community healthcare – this covers a wide range of diagnostic and healthcare services, including non-acute mental health services, which provide a means of delivering care closer to home than from a hospital setting
- acute provision
- specialist provision.
Sustainability and Transformation Plans (STPs) were produced by the NHS and local Government in 2016 to set out how local health and care services would evolve and become sustainable by 2020/21. Five sub-regional STPs were developed in London. These five-year plans set out in varying levels of detail the proposed changes to NHS hospital estates and primary care facilities in each area.
Whilst there is no one-size-fits-all model of care, and an increasing blurring of the boundaries between primary, secondary (acute) and tertiary (specialist) health services, there are some broad underlying principles that underpin the planning of new facilities or changes to existing facilities. The NHS General Practice Forward View supports the provision of primary care at greater scale, with larger practices and/or more joined up networks of GPs offering a wider range of services to patients, including extended opening hours. This means fewer GP practices serving larger patient catchments (perhaps 10-20,000 people per practice) and operating from larger premises than is the norm at present. Models of community healthcare are based around larger population catchments (50,000 or more people) or localities to ensure individual services are viable, and to maximise the benefits of integrating and/or co-locating services in community healthcare centres or hubs, or in more flexible ways across localities or networks of service providers.
In assessing the need for new health and social care facilities, consideration should be given to the location, scale and timing of new residential development, and the quality, capacity and accessibility of existing health and social care facilities to meet some or all of the growth. Joint Strategic Needs Assessments produced by local Health and Wellbeing Boards describe the current and future health and wellbeing needs of the local population and identify priorities for action which are set out in more detail in the Boards’ Health and Wellbeing Strategies. These documents are valuable sources of evidence to inform the development and review of Development Plans.
Where population growth and change is taking place at fairly modest levels, it may be possible to accommodate this through a combination of efficiency savings, service reconfiguration and small adjustments in capacity, for example, through the conversion of non-clinical space to consulting or treatment rooms. In areas of high or concentrated population growth, particularly in Opportunity Areas, it is more likely that new primary and community facilities or capacity will need to be provided. Boroughs have a key role to play in ensuring that the need for health and social care facilities is assessed, that sufficient and appropriately-located sites are allocated for such facilities, and that mechanisms are in place to secure their provision through, for example, Section 106 or Community Infrastructure Levy contributions.
Development and regeneration proposals for an area provide an opportunity to re-think how land and buildings are used and whether there is a more optimal configuration or use of that land. Hospital reconfigurations are an example where more intensive and better use of a site can lead to a combination of improved facilities and the creation and release of surplus land for other priorities. The London Estates Board aims to improve the way surplus and underused NHS assets are identified and released, and provide a single forum for estate discussions in London, ensuring early involvement of London Government partners. Membership includes NHS partners, local Government, the GLA and national partners (central Government, NHS England, One Public Estate and the national NHS property companies).