Wandsworth CCG. Estates Strategic Framework December 2015

Transcription

1 Wandsworth CCG Estates Strategic Framework December 2015

2 Contents Executive Summary 1. Introduction Scope Population & Locality Profile CCG Strategic Commissioning Intentions Local Authority Joint Health and Wellbeing Strategy & Core Strategy Current NHS Community Health Estate Current Acute NHS Health Estate in Wandsworth Principles for Future Estates Development Next Steps Recommendations v0.3 Page 2 of

3 Executive Summary In June 2015 the Department of Health and NHS England wrote to all Clinical Commissioning Groups in England to request that they develop a local approach in order to respond to the challenges set out in the NHS Five Year Forward View. In response to the request, Wandsworth Clinical Commissioning Group (CCG) established an Estates Working Group, through which this Estates Strategic Framework has been developed to respond to and act on the opportunities associated with implementing the strategic principles of the CCG, from which a subsequent Implementation Plan will be based. The Strategic Framework and associated Implementation Plan will provide Wandsworth CCG with a route map for the future development of the Primary Care and Community Services estate in Wandsworth. One of the key drivers for developing this Strategic Framework is our Out of Hospital Strategy, where we see more health services based in the community rather than hospitals, closer to where people live (including direct access diagnostic testing for primary care clinicians). This document will provide a high level review of the current Primary Care Estate, Community Estate and Acute Estate, as well as detail the principles we can apply when determining the future estate and the future approach to delivering this Strategy. Included in the document is an outline of the principle approach that will be applied when considering future investment opportunities; this includes that: It meets the needs of our local population There are no significant financial implications to the CCG; i.e. revenue costs It enables the CCG to utilise our estate to deliver our Multi-speciality Community Provider (MCP) Strategy It ensures future investment in sustainable sites/primary care infrastructure The development of the Strategic Framework should be seen as the first point in developing our approach to managing and developing estates in Wandsworth and as such will be regularly reviewed; a process led by the Estates Working group, to ensure that it takes into account any changes in the healthcare landscape or priorities within the CCG. The main drivers for developing this Strategic Framework and subsequent Implementation Plan are to: improve patient care, outline our strategic direction, in relation to estates development, including our Transforming Primary Care programme and implementing our Multi-Speciality Community Provider (MCP) Model, ensure efficiency and cost effectiveness support the delivery of National Policy v0.3 Page 3 of

4 1. Introduction 1.1 In June 2015 the Department of Health (DH) and NHS England (NHSE) wrote to all Clinical Commissioning Groups in England to request that they develop a local approach to respond to the challenges set out in the NHS Five Year Forward View. The DH/NHSE letter stated that a substantial improvement in the local management of the NHS owned and occupied estate was required in order to help commissioners deliver their commissioning intentions and ensure that patients receive the right care, at the right time, in the right setting, from the right provider. 1.2 In particular, the DH/NHSE letter identified considerable opportunity for the NHS to: (1) use the existing estate more effectively; (2) reduce running and holding costs; (3) reconfigure the estate to better meet commissioning needs; (4) share property (particularly with social care and the wider public sector); (5) dispose of surplus estate to generate capital receipts for reinvestment; and (6) ensure effective future investment. 1.3 In response to the DH/NHSE request, Wandsworth CCG established an Estates Working Group chaired by Kimball Bailey (Associate Lay Member for Governance), the purpose of which is to support the CCG's commissioning intentions by identifying and supporting opportunities to manage and modernise the estate in Wandsworth. This includes the coordination of projects and prioritisation of investment in the local estate and the requirement to identify and manage estate issues and risks. 1.4 The Estates Working Group has developed this Strategic Framework to respond to and act on the opportunities identified above. It will support the delivery of the CCG s Commissioning Intentions and outline the overarching strategic principles on which a detailed Estates Implementation Plan will be based. It is vital that service and estates planning are integrated to ensure that the best estate is available to deliver the best healthcare services, based on well-founded investment decisions providing an opportunity to ensure that the estate is fit for purpose and suitable to the needs of our population. 1.5 Some of the Wandsworth estate may no longer be suitable for the delivery of healthcare services or may be underutilised, vacant of used to deliver back office functions. Conversely there may be other areas where estate is under pressure to deliver more services, possibly as a direct impact of delivering our future commission intentions. The aim of the Strategic Framework and subsequent Implementation Plan will be to identify where these opportunities may exist and align our future estates requirements. 1.6 Wandsworth CCG already meets the costs of running much of the estate in its area, either directly at the CCG offices, or indirectly through commissioning contracts. Estate running costs represent the third largest cost to the NHS after staff costs and medicines. Better use of the estate will enable significant savings for potential reinvestment in patient care. 1.7 In order to realise the benefits outlined in the DH/NHSE letter, the CCG will consult with local health and other public sector partners in the process of developing the v0.3 Page 4 of

5 detailed Estates Implementation Plan to ensure that a truly holistic approach is taken to estates planning. The Estates Implementation Plan will therefore reference plans for: (1) primary and community care estate; (2) non-clinical estate, such as office/administrative bases; (3) secondary and tertiary care estate; and (4) wider public sector estate. 1.8 The detailed Estates Implementation Plan will be formulated from December 2015 and during It will include the current context, vision, gap analysis, initiatives, clear delivery plans and an achievable timescale for delivery. The first step in this process is to develop a service optimisation plan for primary care and community care. The estate optimisation plan including non-clinical estate will follow the clinical plan during The Strategic Framework and Implementation Plan will also need to feed into the development of the wider South West London Estates Strategy and Service Development Plan. 2. Scope 2.1 The purpose of the Wandsworth CCG Local Estates Strategy and Estates Implementation Plan is as follows: (1) to evaluate the current condition, suitability and usage of the existing estate in Wandsworth; (2) to identify the ideal quantum of estate required given: the CCG s Commissioning Intentions; the changing NHS landscape (e.g. the move to transfer more services out of hospital into the community); changes in population demographics (e.g. the ageing population); opportunities to increase utilisation of existing facilities (e.g. through seven day per week working), taking account of the NHS Property Services analysis of utilisation of the current estate; technological factors (e.g. telehealth); initiatives to bring about closer working between the NHS and local authorities; and other factors not included above but which may appear to be relevant in the future. (3) to identify and quantify the gap between the current and desired positions, including whether current estate is fit for purpose; (4) to identify the steps required to close the gap between the current and the desired positions (e.g. by identifying detailed data required to maximise opportunities for the increased utilisation of estate); v0.3 Page 5 of

6 (5) to advise on property investments and disinvestments to reach the desired position; (6) help to ensure that NHS services are delivered in premises that are: capable of meeting increasing demand; flexible to accommodate changing service models; and clinically safe and sustainable; and (7) enable Wandsworth CCG to evaluate bids for capital investment which may be funded through increased rents, NHS capital (including the Primary Care Transformation Fund), develop Section 106 funds, or Community Infrastructure Levy (CIL) capital. 3. Population & Locality Profile 3.1 The last decade has seen Wandsworth s population increase from 260,382 at the 2001 Census to 307,000 by the 2011 Census; this represents the fourth largest population increase in London over the period. 3.2 In addition to new population growth driven by housing development e.g. in the Nine Elms Vauxhall (NEV) Opportunity Area, Wandsworth also has the highest migration rates of any London borough and fourth highest of any local authority in England and Wales (ONS, 2012, Migration Indicator Tool): 30,000 migrants from within the UK and 7,000 from overseas. This includes approximately 300 asylum seekers who are likely to have specific health and social care needs 3.3 The health of people in Wandsworth is varied compared with the England average. Deprivation is lower than average, however about 11,800 children live in poverty. The life expectancy for both men and women is similar to the England average, although it is 8.9 years lower for men and 6.8 years lower for women in the most deprived areas of Wandsworth than in the least deprived areas. Over the last 10 years all- cause mortality rates have fallen. Early death rates from cancer and from heart disease and stroke have also fallen. 3.4 Wandsworth CCG consists of 42 GP Practices, with over 381,000 registered patients. The CCG is divided into three localities: Battersea, Wandle and West Wandsworth. The localities are geographically-based groups, which consist of GP Practices who work in collaboration with patients, the public and key stakeholders to influence health services commissioning. They focus on co-designing health and social care needs, which are then fed into the CCGs commissioning plans and activities. 3.5 The Battersea locality has a diverse and growing population of over 95,157 (July 2015) covering six wards within Wandsworth. It contains areas of high deprivation and has a strong inner-city profile compared to the Wandsworth average. With plans already underway for NEV (including Battersea Power Station) the population of the Battersea locality is expected to increase by over 28,000 residents over the next 15 years. Two schemes for primary care facilities are being developed for the new NEV population of 34,000 people across the north of Wandsworth and western parts of Lambeth. In addition, Doddington Health Centre is being developed as a LIFT scheme to replace the Battersea Fields Surgery. The Locality Leads are working closely with Lambeth v0.3 Page 6 of

7 CCG, NHS England and South London Health Partners on the impact of NEV on the healthcare infrastructure 3.6 The Wandle locality is the largest of the three Wandsworth localities with 21 member practices serving 204,605 patients (July 2015), predominantly inhabiting the electoral wards of Bedford, Earlsfield, Fairfield, Graveney, Nightingale, Southfields, Tooting and Wandsworth Common. In this locality a new scheme is being develop in conjunction with the Local Authority at Brocklebank Surgery to release land and air space for social housing and a new GP surgery. 3.7 The West Wandsworth locality covers the areas of Roehampton and Putney, and the nine practices that lie in these areas. The GP registered population (July 2015) was 81,645 and it is anticipated to increase by about 3,000 in the next five years. West Wandsworth represents a diverse demography, from Thamesfield (an area of low deprivation with an older population) to Roehampton (an area of higher deprivation and younger population). In this locality a key priority is making better use of the space at Queen Mary s Hospital (Roehampton). 4. CCG Strategic Commissioning Intentions Primary Care 4.1 Primary Care Transformation is critical to everything we want to achieve and at the heart of this is the need to support General Practice to achieve the series of specifications set out in the London Strategic Commissioning Framework for Primary Care. Transforming Primary Care services will ensure consistent, high quality Primary Care to all our residents 4.2 General practices in Wandsworth range in size from 34,000 registered patients with 21 GPs employed to fewer than 1,000 registered patients and only a single GP. Practices with four or fewer GPs make up nearly 40% of the providers across the borough. Smaller practices may lack resources and capacity to flex their workforce in the same way as larger ones and therefore may be less able to take on additional services and engage with quality initiatives. Facilitating the formation of larger practices over time will have estate implications, requiring a programme of disinvestments and new developments. 4.3 Seven day per week working could have a dramatic effect on available service capacity and estates utilisation, which in turn will impact on the quantum of estate required to deliver the required services. 4.4 The Transforming Primary Care in London: A Strategic Commissioning Framework states that All CCGs in London will become more involved in the commissioning of Primary Care services in 2015/16. Wandsworth CCG is potentially looking to commission Primary Medical Care services via Delegation from NHS England from April Demand for additional GP facilities is driven by population growth, which in turn is largely determined by housing growth. Estates planning for primary care facilities v0.3 Page 7 of

8 should therefore keep track with the London Borough of Wandsworth s Local Plan (Core Strategy) and its implementation over time. 4.6 As part of the plan to deliver the specifications outlined in the Transforming Primary Care in London: A Strategic Commissioning Framework, there is an intention to review the options to increase the use of digital technology where appropriate (including the possibility of providing medical appointments online). The increased use of technology could have an effect on the amount of estate space required over the longer term. Community and Out-of-Hospital Services Developing our MCP Model 4.7 One of our strategic intentions is to see more health services based in the community rather than hospitals, closer to where people live; including direct access diagnostic testing for primary care clinicians. Wandsworth CCG, in line with the Five Year Forward View and CCG Board strategy, will continue to work with our Practices to develop a Multi-Specialty Community Provider (MCP) to deliver co-ordinated, integrated Out of Hospital care to the Wandsworth population. 4.8 According to the King s Fund, The MCP sees groups of GP practices working together to deliver a wider range of services, coordinating input from Community Services, hospital specialists and others, and eventually shifting the majority of ambulatory care and outpatient consultations to out-of-hospital settings. 4.9 Developing an MCP model will not only deliver benefits for patients through providing better integrated care locally: it is also the logical next step in developing the various work programmes that are ongoing as part of the Five Year Plan for Out of Hospital Care; enabling us to respond to feedback from patients, the public and our member practices on existing Out of Hospital services and enhance the role of the GP as the co-ordinator of care. This is particularly important for high risk patients with complex needs who require the GP to bring together all of the relevant professionals to deliver joined up, out of hospital care which meets their needs In order to deliver our ambitious MCP Model, the estate in Wandsworth will be reconfigured around the CCG s MCP hubs: Doddington, Brocklebank, Queen Mary s Hospital Roehampton and a (yet to be identified) site in Balham. These locality-based hubs will be co-ordinated by GPs working collaboratively and they will facilitate a new, enhanced model of joined up care in which primary care, community services and other out of hospital functions can operate. Patients would move in and out of the hubs, accessing services in accordance with their needs. v0.3 Page 8 of

9 4.11 The services which will be included in the MCP development from April 2017 include (but not limited to) the following: Mental health & dementia Voluntary sector Rapid response Early supported discharge Social services Tier 3 services for Long Term Conditions Phlebotomy Therapies Specialist nursing 4.12 These shifts could potentially impact on the size of community healthcare facilities required. CCG Direction of Travel 4.13 The current general directions of travel that could affect the quantum of healthcare estate required are the following: Seven day per week working; A move to provide more health services in community settings, out of hospital; A desire to improve utilisation of current estate capacity; A greater use of information technology to improve clinical efficiency and safety; Closer cooperation between health and social care services 4.14 In discussing the future commissioning of General Practice services by Wandsworth CCG, it is important to understand the rapidly changing political environment and the various developing agendas that are likely to influence CCG plans. Of these external focusses, the ones that appear likely to impact Wandsworth in the near future are: v0.3 Page 9 of

10 (1) Co-commissioning; (2) The London Primary Care Transformation Programme; and (3) South West London Collaborative Commissioning. These factors could all impact on how estate is deployed across the health economy in the future. 5. Local Authority Joint Health and Wellbeing Strategy & Core Strategy 5.1 The Wandsworth Joint Health and Wellbeing Strategy (published in 2012) identified a clear intention to shift resources away from specialist health and care services in favour of primary and community care. Wandsworth Local Authority and Wandsworth CCG united around three core priorities: the promotion of resilience, the strengthening of prevention programmes, and the integration of health and social care. 5.2 One area where closer cooperation between the Borough and the NHS is critical is in providing a more integrated service to people with long term conditions. Within Wandsworth there are 31,000 patients registered with GPs who are known to have a long term condition, of whom around 2,500 have three long term conditions. There are around 5,000 people on the Adult Social Services caseload, the vast majority of whom are older people, with about 90% having one or more long term condition. Many of these conditions are better managed in community facilities and in people s own homes, rather than in hospitals. 5.3 The requirement to accommodate more services in the community will necessarily have estate implications. Co-locating services has the potential to improve the utilisation of existing facilities and therefore to reduce the amount of public sector estate required overall, or to relieve pressure in the system and free up space for providing alternative services. 5.4 The London Borough of Wandsworth adopted a Core Strategy in The Core Strategy committed the Borough of Wandsworth to a total net additional homes target of 7,500 between 2007/08 and 2016/17. The Strategy also stated that the Council would seek to achieve a further 3,750 net additional homes in the borough between 2017/18 and 2021/ At 1,800 to 2,000 registered patients per GP the new population would require c additional GPs in the planning period A major component of future development is likely to be urban intensification in the majority of Wandsworth, with major development in NEV and Central Wandsworth and the completion of developments in the Wandle Delta area. 5.7 Two Section 106 Agreements are in place for the creation of new health facilities in NEV. v0.3 Page 10 of

11 6. Current NHS Community Health Estate 6.1 The community estate in Wandsworth has been rationalised over the period leading up to Consequently the operational community health estate consists of 14 clinical sites Name Locality Content Ownership 1 Balham Health Centre Wandle 2 Bridge Lane Battersea 3 Brocklebank Wandle 4 Doddington Battersea 5 Eileen Lecky 6 Joan Bicknell Centre 7 Queen Mary s Hospital 8 St Christopher s 9 St John s Therapy Centre West Wandsworth Springfield Hospital Wandle West Wandsworth Battersea Locality Wandle Battersea & GPs + Community Health services GPs + Community Health services GPs + Community Health services Community Health services Sexual Health services Community services Health Community health services / Acute physical and mental health services Community Health services GPs + Community Health services 3PD PFI 3PD CHP/LIFT 10 Stormont Lavender Hill Sexual health WBC 11 Tooting Bec Medical Centre Wandle 12 Tooting Health Centre Wandle 13 Tudor Lodge Health Centre 14 Westmoor Clinic West Wandsworth West Wandsworth GPs + Community Health services Community Health services GPs + Community Health services Community Health services GP Practice 6.2 Of the 14 sites, eight are owned by NHS Property Services (), one is a PFI site, one is a LIFT site and four are owned by other landlords. 6.3 Some of the Section 106 capacity in NEV may be used for community services. 6.4 The most significant sites are St John s Therapy Centre and Queen Mary s Hospital (Roehampton); both are subject to external long term finance agreements. 6.5 The CCG is responsible for funding any shortfall in the QMH unitary payment of 17m per annum and the income derived from tenants at this facility. There is currently a total of 366 m 2 void space at QMH. In the medium to long term there is a significant v0.3 Page 11 of

12 risk that the void space at QMH will increase substantially if South West London and St George s Mental Health Trust s proposal to relocate the services they currently provide at QMH goes ahead. South West London and St George s Mental Health Trust is the second largest tenant on the site and occupies practically the whole of the second floor; if they were to vacate the facility it would result in significant additional void space costs at QMH. 6.6 There is therefore an urgent need to explore opportunities to improve space utilisation at QMH and, to a lesser degree, at St John s Therapy Centre. This work will be led by the Estates Working Group, who will work through the various options for the utilisation of the current and potential void space. The options to be explored will need to link to the CCG s strategic direction (i.e. the development of the MCP hub sites or primary care estate) and will include consideration of clinic bookings and patient throughput as well as the future requirements on the totality of the Primary Care infrastructure in Roehampton and the suitability of the current estate. 6.7 The CCG operates from commercial offices next to East Putney District Line station. The offices are occupied under a lease through and the CCG will develop a plan for future office accommodation. 7. Current Acute NHS Health Estate in Wandsworth 7.1 The acute estate in Wandsworth consists of two main sites: the St George s Healthcare NHS Trust campus in Tooting and the South West London and St George s Mental Health Trust campus at Springfield Hospital. 7.2 The St George s Hospital site is well located and will be developed as necessary to meet local and specialist needs across south west London. Developments over the period were highlighted in the St George s Healthcare Estates Strategy It is expected that further work will be undertaken between the Trust and the CCG on estates development. 7.3 The South West London and St George s Mental Health Trust site at Springfield Hospital is undergoing major transformation to create a modern mental health facility. Following a public consultation in 2014 the Trust's proposals to build a new state-ofthe-art mental health centre of excellence at Springfield Hospital were approved by all the local CCGs, local authorities and NHS England. 7.4 Following approval of the Outline Business Case a phased construction of housing and new state-of-the art hospitals will take place from 2016 to The new facilities could be open by around Principles for Future Estates Development 8.1 The principle approach that will be taken when considering future investment opportunities will be to ensure that: It meets the needs of our local population There are no significant financial implications to the CCG; i.e. revenue costs It enables the CCG to utilise our estate to deliver our MCP Strategy v0.3 Page 12 of

13 It ensures future investment in sustainable sites/primary care infrastructure 8.2 Strategic issues will cover demographic change and service design, while local issues will focus on compliance and sustainability. 8.3 Any future scoring of the cost/benefit analysis will include consideration of the following: Quality: privacy and dignity, reliability; Availability: timescales for implementation; Affordability: availability of funds 8.4 When addressing the future estates requirements we must also consider the current investment proposals that have been submitted to NHSE from Wandsworth practices as a way of ensuring that future requirements take stock of what has previously been approved or is currently in the pipeline. The Estates Working Group will provide strategic oversight of this process. 9 Next Steps 9.1 Development of the Implementation Plan will proceed in collaboration with local partners, including Wandsworth Council and other stakeholders. It is anticipated that a further stakeholder event will take place to support the development of the Estates Implementation Plan. v0.3 Page 13 of

14 9.2 It will also be necessary to develop site specific plans to improve the utilisation of the existing estate (including, but not limited to, Queen Mary s Hospital at Roehampton). 9.3 A financial planning model should be developed to support the Strategic Framework and Implementation Plan, to ensure that the implementation remains affordable and deliverable. 9.4 A review of the current estate should be conducted, this should include a specific focus on areas of where there are known pressures e.g. expiration of leases. 9.5 Develop site specific plans which will support the overarching principles as detailed in this Strategic Framework which will form part of our CCG Primary Care Transformation Fund (PCFT) bid proposal. 9.6 Continue to pursue site specific options for the MCP hub sites working with key stakeholders to look at potential options. Timescale 9.7 This Estates Strategic Framework document will be submitted to the CCG s Board for approval in December The development of the Estates Implementation Plan will follow the approval of the later in December 2015 and in The development of an integrated NHS Estates Strategy for South West London is expected to be completed by the end of March Recommendations 10.1 To approve the Wandsworth CCG Estates Strategic Framework To authorise the production of an Estates Implementation Plan based on the principles set out in this document and the content as set out in Section 9, to be reported back to the Board in v0.3 Page 14 of