This is one of the key messages of a report, released last month, of the All-Party Parliamentary Group (APPG) for Healthcare Infrastructure, which sets out a ten-point plan on ensuring the future of the healthcare estate in the face of rising demand and workforce challenges. Aiming to provide clarity on the future of both primary and acute estates, including addressing delays to the New Hospital Programme and the impact of the rollout of digital technologies and changes to NHS structures, the report provides recommendations to ensure the delivery of high-quality healthcare infrastructure in helping the NHS meet future demands.

The future of the primary care estate takes centre stage in the report. Titled ‘Built to last: A ten-point plan to secure NHS infrastructure for the future’, it observes that primary and community healthcare has long suffered from a lack of funding, with a recent report from the Royal College of General Practitioners finding that four in ten GPs are working in premises considered ‘not fit for purpose’, while nearly nine in ten reported an insufficient number of consulting rooms at their practices. Moreover, the APPG report cites little progress having been made since the 2017 Naylor Report, which itself asserted that in the absence of investment, the NHS estate would “remain unfit for purpose and . . . continue to deteriorate”.

The APPG report adds: “This shortage of capacity within the primary care estate is being exacerbated by the move to increase provision of care in community settings following the passage of the Health and Social Care Act 2022.” There is a need, it says, for parity in planning and allocation of funding between secondary and primary care estates, “to prevent the accumulation of future backlogs and ensure holistic healthcare infrastructure development”. Developing a better understanding of the NHS long-term strategy is also seen as essential, including investment and incentivisation to transition services from hospitals to primary care settings. This, it argues, will ensure a balanced and sustainable healthcare system that meets evolving needs.

Underutilised space

The APPG reflects on its earlier report from two years ago, which recommended that the Government and NHS England consider third-party partnerships for the construction of GP premises and provide a targeted fund to modernise the oldest parts of the estate. Its latest report states: “The focus should be on providing a modern, fit-for-purpose primary care estate that meets the needs of patients who have been identified locally, and the rules should be reviewed to make this easier to achieve.”

Alongside this, the APPG notes that too many primary and community care facilities have underutilised void space. It wants the Government to review funding restrictions and rules around utilisation, “so that these spaces can be made available for services that will support preventive healthcare”. One example would be to ensure that GP rent reimbursement rules do not prevent practices providing services in partnership with local voluntary and community organisations to meet local healthcare needs. In line with an effective estates strategy, the Government should include provisions to increase space for doctors and other healthcare professionals to train, the report adds.

NHP progress

The New Hospital Programme (NHP) is, unsurprisingly, considered another major element of ensuring the sustainability of the NHS estate and, here, the APPG recommends streamlining the approvals process to help accelerate delivery of the Programme. During its inquiry, the APPG heard that there have been delays approving projects across the Programme but was reassured that work is being done to expedite this process. According to one individual, the approvals process could become “a ‘simple box-ticking exercise’, which would lead to years being taken off delivery times in future”. The APPG concurs that introducing “a more efficient and transparent approval mechanism will help accelerate the delivery of the NHP”.

Further recommendations in the report focus on digital transformation, integrated care systems (ICSs), and the setting-up of a new taskforce.

NHS England, it says, should develop a centralised strategy to maximise investment in digital transformation, ensuring new technologies and systems can be used across healthcare settings. In addition, NHS England should encourage ICSs and trusts to trial new technologies to create a more efficient and effective health service. On ICSs themselves, the report underlines the importance of them developing robust estates strategies.

“Collaboration and co-ordination should be baked into ICSs, and health leaders should ensure that all available resources and experts within local systems are being utilised to support the development of estates strategies,” says the report, which also proposes that ICSs should improve partnership working with local authorities to ensure that their estates strategies inform, and are informed by, local house building plans.

Taskforce

Finally, the APPG suggests setting up a new taskforce to conduct a full review of NHS capital and revenue investment on the needs of the healthcare estate. The taskforce, it’s envisaged, would monitor activity to increase and improve funding for the NHS estate, in both the acute and primary care sectors, in addition to updating the Health Infrastructure Plan to support local and regional estates strategies. “This should go beyond the NHP and contain a particular focus on prevention, primary and community care, and the estate required,” the report says.

In his foreword to the report, Chris Green MP, chair of the All-Party Parliamentary Group for Healthcare Infrastructure, said: “This report – and the ten-point plan it sets out – is intended to serve as a guide for policymakers to address these pressing issues and set a clear path for the future of healthcare infrastructure. . . Healthcare infrastructure is simply too important to get wrong. The solutions seem evident. What we need is the political will to implement these now.”

The report was authored by Connect Public Affairs and funded by the APPG’s sponsors: Assura, Eric Wright Group, Fulcrum Infrastructure Group, and gbpartnerships Group. It can be downloaded here.