To deliver a modern NHS, fit for the 21st century, buildings and equipment are required in the right place, in the right condition, of the right type and which will be able to respond to future service needs. The COVID pandemic has illustrated that even with careful planning unforeseen factors can have a profound impact on the demands of our services.

The Estate Strategy will seek to identify the steps which can be taken by the Trust to maximise the use of its assets in order to provide a productive, efficient, safe, and fit for purpose estate which will support existing and future clinical requirements. 
This strategy document is one of a number of enabling strategies that work in partnership to support the Trust’s Annual Plan and Clinical Strategy.

This Estates Strategy has been developed in accordance with the Department of Health and Social Care (DHSC) guidance document ‘Developing an Estates Strategy’, and is structured to reflect the following three key questions:

  • Where are we now?
  • Where do we want to be?
  • How do we get there?

Its aim will be to describe the current condition of the estate, (identifying its suitability, occupancy, tenure, physical condition, service and organisational constraints, capital investment decisions and occupancy costs), highlighting how the existing supply of capital assets meets current services and the needs of the community.

A recent Kings Fund review of strategic estate development has identified the following as important core components to a robust estate strategy document:

  • A strategic overview – estates strategies should align with and reflect the aims of any wider organisational or strategic planning.
  • Alignment with clinical strategy – as part of the above, estates strategies should align with the clinical strategy (at all levels), rather than being developed in isolation, driven by cost concerns, or based on existing buildings.
  • Customer focus – a clear understanding of what ‘customers’ require and value. This includes those who currently use the estate and those who may use the estate in the future.
  • Clear case for change – linked to the above, and key to implementation.
  • Understanding of the estates value – an understanding of the role and value of the estate within the context of other strategies, e.g. funding and sustainability, social value, value to the taxpayer.
  • Flexibility – any estates strategy needs to be able to respond to potential changes in demand or requirements over time. Where this does not happen, the estate becomes a constraint.
  • Understanding risk – understanding the risk appetite of the stakeholders involved.
  • Governance – a strategy should include clear systems of governance and responsibilities. This includes relevant government, and organisational bodies.
  • Clarity on outcomes – estates strategies should include desired outcomes (specific and wider benefits) and set out the approach that will be used to measure performance.

The Estate Strategy is a prerequisite to ensuring that these requirements are met in an effective and sustainable manner.

For a number of years, the Government’s overall aim for healthcare has been to improve the health and wellbeing of the population by: 

  • Tackling the root cause of ill health and cutting health inequalities.
  • Breaking down the barriers and focusing services on people’s needs.
  • Making services more efficient and more convenient.

Services should therefore be delivered in well-designed environments suitable for the needs of patients and staff. 

The changes in estate that have been successfully delivered over the last 17 years have been achieved by using the overarching estates strategies that were in place at the time to give direction to the key priorities. Not only do buildings impact on patient perception, they can provide a holistic care environment by ensuring good functionality, meeting expectations in terms of privacy and dignity, providing good access for all.

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The Estate is a significant area of expenditure for the Trust with approximately 15% of annual income being spent on its infrastructure. This is a significant financial commitment, which needs to be managed effectively, and this underpins the necessity of having an overarching Estate Strategy which sets out to ensure the following:

  • An assurance that investment identified to ensure the quality of clinical services provided will be supported by a safe, secure and appropriate environment.
  • A method of ensuring that Capital investments and rationalisation/expansion reflect service strategies and plans.
  • A plan for change that enables progress towards goals to be measured.
  • A strategic context in which detailed business cases for all capital investment can be developed and evaluated, however funded.
  • A clear statement by the Trust to the public and staff that it has positive plans to maintain and improve services and facilities.
  • A clear commitment to complying with sustainable development and environmental requirements and initiatives.
  • An assurance that asset management costs are appropriate, and that future investment is effectively targeted.
  • Assurance that risks are controlled, and that investment is properly targeted to reduce risk.
  • A clear commitment that surplus assets are and will be identified over time, and will be either disposed of or used for future service needs.

An Estate Strategy is the starting point for the implementation of performance management measures to improve the performance and utilisation of the Estate. In this, consideration will need to be given to procurement and disposal issues as well as operational issues.

The provision of safe, high-quality care to patients and the public is the primary concern of any health provider and NHS employee. Carter 2018

The development of an Estate Strategy is a complex process that must reflect service need and the foreseeable changes in pattern of service delivery. However, due account needs to be taken of the existing asset base and infrastructure which cannot be adapted or replaced overnight. 

The longer-term plans for services and the Estate should:

  • Meet the needs of the population.
  • Make the best use of available resources.
  • Be technically achievable.
  • Be financially affordable.
  • Be fit for purpose.

This Estate Strategy has been developed to respond to the vision, values, quality goals and strategic ambitions of the Trust as a whole.  This is to ensure that the buildings and infrastructure are managed and developed in such a way as to best support the Trust’s clinical service delivery.