As we come to the end of the strategy process and move into the strategy implementation stage, I’ve collected my reflections on the fantastic work across the system, along with my key takeaways for the future.
Understanding your estate is key
Before you even start planning, you need to build a clear picture of your estate as it is currently. You need to identify and engage with the relevant stakeholders to learn what work has already been done and ask the right questions to guide the strategy process.
You also have to consider the goals of the Integrated Care Board (ICB) that manages the ICS – what are the current priortities and challenges (like demand and supply), what is the capability to deliver and and how do you plan to measure success. Even once you adopt a strategy, you still need to keep asking these questions to make sure it evolves and continues to be the right one – with a clear delivery plan and roadmap.
We applied this approach when working on our first strategy with Cambridgeshire and Peterborough ICS, - and have continued to follow it with every ICS that has appointed us to co-author their strategies. It’s helped us to develop comprehensive and most importantly, realistic infrastructure strategies that will meet community needs and the goals of the ICB.
Dig deeper on data
When we talk about estate infrastructure strategies, we’re talking about the long-term plans for how we manage our healthcare buildings and infrastructure over the longer-term /10-year period. If you don’t have the right data to inform these plans, it’s much harder to develop and then implement a successful strategy.
However, even when you have collected data, it isn’t always perfect and is rarely complete. Through this process in particular, I’ve learnt that it’s important to take the time to study the data carefully and not just take it at face value.
For example, there may be gaps or duplicated information to address before you can get a clear picture of the estate. It’s therefore important to ensure that data is ‘cleansed’ to provide a true picture.
At the same time, making a call on when data is good enough to inform the strategic planning process is equally important. There will always be a level of ambiguity and this needs to be recognised and worked through.
Different perspectives bring better decision-making
Whether you’re preparing for population changes, redeveloping existing healthcare buildings or bringing more medical services to a neighbourhood – gathering different joined-up perspectives helps you make more informed decisions.
Engaging with various teams and stakeholders across the system gives you a deeper understanding and it helps to view estate options through multiple lenses.
For example, there are many things we considered from the supply side – such as the condition and quality of buildings, whether they’re future-proofed and their environmental impact. But we also needed to consider the demand side – understanding clinical and operational requirements and how these are likely to be impacted by demographic and technological changes, together with evolving ways of working.
Categorise healthcare facilities to build a clear roadmap
When making strategic decisions about commissioning, resourcing and investing in your estate, you need a systematic approach.
Categorising your healthcare facilities into Core, Flex and Tail makes it easier to identify your priorities and opportunities. This was critical in the estate strategies we developed so that ICBs have a clear roadmap for what to tackle first and their investment priorities.
- Core: these facilities are essential to population needs and should be high priority for investment and maintenance.
- Flex: these facilities can be used for future growth or temporary needs.
- Tail: these facilities are likely to be older, less efficient and not suitable to meet future models of care. They should be considered for disposal when feasible and reinvestment of any capital proceeds
Balance ambition with reality
Transitioning from strategy development to implementation can be very challenging. While it’s important to analyse data and develop a vision for future healthcare needs, it’s just as important to stay grounded in the present and focus on delivering solutions now, including additional capacity and improving the productivity, efficiency and resilience of the estate, particularly around critical infrastructure.
It may take baby steps and quick wins like improving an old facility or repurposing vacant space in your core estate to get the strategy moving. The bigger strategic choices will naturally take longer and progress over the medium to long-term.
Keep in mind that there will be external forces outside your control that will affect the delivery of your strategy. For example, the level of capital in the system going up and down will have a knock-on effect on your delivery plans. And also, the level of support from key decision makers will impact your access to resources that are key to delivering your estate plans.
Our new guide to ‘NHS Estate Funding’ can help you get the most out of capital and revenue funding. You can download it here.
When you’re balancing ambition with reality, you have to be adaptable to the situation. Of course, you’re not going to rewrite the strategy every 12 months, but you’ll probably need to adjust your delivery plans to make sure your strategy remains achievable.
A good strategy requires a fine balance of ambitious thinking as well as understanding the reality and limitations of the system and the tactical steps to move forwards.
It’s a real team effort
What I loved most about partnering with ICSs on their infrastructure strategies was the level of engagement and collaboration from everyone involved.
From gathering and understanding data on your estate, to engaging with senior leaders through workshops and presenting the strategy to the board, it’s been a joint effort across NHSPS, the ICSs, the ICBs, NHS England and the wider NHS we work with.
Our NHSPS Relationship Partners helped us to bring together relevant teams from across NHSPS and the ICSs to work on the infrastructure strategies.
And a similar joint approach is needed to deliver those infrastructure strategies effectively. Developing an infrastructure strategy is only the beginning, and it’s important to maintain a collaborative approach as you move into implementation. This will help you to keep sense checking your strategy is still meeting community needs and achieving ICB goals as it’s delivered. It is important that both demand and supply side decision makers remain joined up.
Collaboration is at the heart of how we work with ICBs. And we’ve been part of the process from the beginning, so we’re well set up to help you deliver your strategy. Because we’ve worked with every ICB across every region in England, we have an in-depth understanding of the local challenges you face – and how best to tackle them.
All our teams, from town planning to lease advisory, work together to develop creative solutions so they can support you every step along the way. You can learn more about our services and how they could help you here.
My key takeaways for ICBs going forward:
- Adjust your strategy if needed: keep gathering reliable data to gain a clear understanding of your estate and continue to assess your population needs - be ready to adjust your delivery plans as and when needed.
- Maintain stakeholder engagement: continue collaborating with others across the system to gather different perspectives as you move into implementation. Use this intelligence to assess ongoing impact of your strategy on the local community.
- Prioritise your estate and capital investment requirements: having categorised your healthcare facilities, use the opportunity to get more value from core assets.
- Keep an eye on funding opportunities: as capital in the system can fluctuate, be ready and prepared to take advantage of any funding streams when they come available.
- Measure success: keep track of your metrics and progress against key performance indicators (KPIs) to make sure you remain on track to achieve your infrastructure strategy goals.
