Q) Have you found a way to provide access to NHS Open Space for local authority and other non-NHS building users? This is a key aspect of booking systems for Leeds NHCs.
A) Chris King - Yes, we can provide it for local authority users. We’ll get in contact with you after this and have a discussion.
Q) Would be helpful to understand step by step, how users gain access to the building, then to the booked room, what happens if any issues with the room (on the day) lighting/heating/IT, etc. without expecting/putting additional responsibility on the GP receptionists in the building?
A) Chris King - Each site has its own rules and instructions on gaining access to the building and booked room/s. Properties have some details on their listings, but full details are shared with the user once they've booked a room.
If there's an issue with the site or room/s booked, users should contact our customer service centre. If a patient has an issue with the service, they should get in touch with the user room user/service provider directly (details would normally be on their appointment confirmation letter/ email).
Q) Have you any thoughts about how to deliver NHCs without any additional revenue budget or NHS / Treasury / PPP funding? No additional revenue funding makes PPP less likely to be affordable.
A) Alistair Rose - That’s a really fundamental issue and constraint for all of these. So, for the new build PPP, some of the plans around left shift and what happens on the wider system estate including buildings on trusts if some of those start to change and services start to move, the community can bring budget with them. Every case is different. We’ve got two new builds in our pipeline plan, and we’re working on business cases for those. Haven’t got a solution that’s ready to show people yet about how affordability is addressed. We’re optimistic that it can be addressed but it will require service remodelling, mapping of how you deliver services, because the bulk of the service cost is the service, not the building. The building is a proportion, but it’s actually how efficient the service works helps drive the overall plan around neighbourhood health.
A) Simon Taylor - If you are going to build new, you should look at what you can actually take out around it to create that revenue headroom and rationalise the tail and flex estate in some cases.
Q) What’s the difference between Coproduction and Engagement? Can you share thoughts on how to successfully coproduce these hubs and best practice examples of coproduction? In principle, do you think a former locked rehab unit on hospital grounds, off a main road, which has been empty/derelict for years is a good location for a Community Hub? I'm concerned this will be chosen based on estates/ financial convenience - and that no amount of cushions and murals can de-NHS it.
A) Karina Dare - My understanding of engagement versus co-production is broadly that engagement is where you talk to people about what you're doing and maybe get feedback from them, whereas co-production is very much in the space that you're working together, defining your outcomes and thinking about the questions and the outcomes together. So far more involved. I think we don't often, from the estate side, get into co-production, and I think we often spend a lot of time working on design activity on buildings, when actually the amount of influence you have on clinical buildings is very light because there are so many rules around what you have to produce to provide for the clinical spaces. So actually, I think it's in the softer elements of how a building feels and how spaces are going to be used that it's actually more meaningful. And probably the best example I've seen of that recently is when we visited the mental health hub pilot that's happening at Acomb, where they had worked through co-production about how the space would be used, access arrangements, how it should be furnished, and what kind of services met the local need. That co-production has created a sense of ownership of the hub and really enhanced the service delivery there. So it was very interesting and exciting to see that. But it's probably not core of what we've been doing in the past, and maybe there's an opportunity for us as estates professionals to be more engaged in those elements, in the neighbourhood model as part of a wider team.
A) Kerry Bourne - Very topical for us because in the workshops that I mentioned, we had a very dominant attendance from clinicians: so GPs, acute community providers, clinicians, mental health practitioners. So we very deliberately organised those workshops so they had a clinical view, not just an estates view. And we said to everyone, "Look, we can host. What is it you want to do? We can change the internal reconfiguration or we can develop the properties, but you need to start thinking." And I know things are developing in terms of neighbourhood working but tell us what you want to do from our area. So we have borough-wide workshops, and now with obviously the Downham and the Erith examples, we're going to have specific property workshops with all the relevant clinicians involved. We've obviously discussed and agreed in Southeast London that we can't just run workshops just with estates people. We have to have the people that are actually delivering services from that area to help plan the activity that's going to end up in those buildings.
A) Alistair Rose - In Lancashire and South Cumbria, we've been running a number of workshops. If you imagine a Venn diagram, the overarching circle is neighbourhood health planning, workshops for that which is more of a co-production with voluntary services, community and faith sector, clinical staff, primary care, hospital staff, commissioners, local authorities, a big group looking at the service. So there's good interaction going at the service level. We've also run more estates infrastructure-specific workshops, looking at the overall approach to buildings, the edge of cake, those sorts of things, starting to drill into individual buildings. Once you get into individual buildings or neighbours or localities, there'll be different stakeholders in those different parts of the patch. So finding the relevant ones in that area. But it's taking the overall service approach, then the buildings approach, then a locality or a neighbourhood looking at what does it mean in this town or this suburb or borough. Just picking up Sarah's other point about a facility in Nottingham, I think, on a hospital site, I think that really needs to be one for the ICB for Nottingham to address. And they would have, I'd imagine, gone through similar processes about site selection, long list, short list and viability. We can certainly have a conversation outside of this if it's helpful, but I won't know the specifics beyond that.
Q) How are sites identified? And are (& how) local planning authorities involved in the development of neighbourhood health centres?
A) Alistair Rose - Just for brevity. We've got four strategic infrastructure groups across Lancashire and South Cumbria. They look at the wider infrastructure investment planning on a place-based footprint. They have representatives from local authorities. We've got the universities, a wide range of people. They meet every six weeks. And we've run workshops with those special interest groups (SIGs) looking at what does neighbourhood health mean, and inviting all the relevant players, which include local authorities and in some cases the planning leads for those local authorities into those SIGs to start really looking at what have we got. And for those organizations, not just the NHS, to offer in options and then work through a specific workshop piece about fine-tuning that, prioritizing those, and thinking through how do you then get a place-based approach, which we've then homogenised into our return.
A) Simon Taylor - It's worth saying that ICBs were asked to do their wave two returns at the end of May. Obviously, that will be a long list of options within each of the ICBs to prioritise for wave two and funding.
Q) Neighbourhood Health Centres aspire to operate as a single destination for patients rather than a collection of individual tenant organisations. Given this ambition, how should systems approach the transition from separate provider-managed reception and front-of-house arrangements to a single integrated building management and front-of-house service, and what changes in governance, workforce, culture and funding would be required to support this shift?
A) Simon Taylor - This goes to the heart of making neighbourhood health centres one welcoming facility for all those things under one roof. We've had many examples, actually, over the years where we've had two or more receptions and we've consolidated them into a single reception, and that whole patient journey way finding piece into a building to a single reception, to me, feels like a really important aspect of neighbourhood health. I guess it comes down to collaboration, bringing people together, generating the ideas, seeing how different people work. I think one of the speakers spoke about understanding how do you work, and we can then look at the estate solutions to support that. But I don't know whether Emma's got a view on that, but it feels like it's all about that early engagement that Emma talked about and then reconfiguring around it.
A) Emma Hau - I think it's just all about that kind of early discussions, developing that early model of care, and that would really help provide, I suppose, structure to all of the organisations that are really wanting to be involved in the healthcare centres. Because once you kind of get that early model of care and how you're planning on delivering that within the building and the services that you want to manage that, it all, I suppose, it helps ease that way forward of kind of how are we going to manage this space, how are we going to run it, and all of that.
Q) Is NHS Open Space data sharing inclusive of local authority (LA) estates data and visible to LA colleagues?
A) Chris King - NHS Open Space is used by different organisations to understand and manage their own space. Each organisation has ownership of their own data. We are in the process of agreeing the sharing of data for the better of the NHS and local healthcare and government. We hope to help enable a culture of data sharing to inform strategic estates decision making.
Q) Are there any examples of solutions that could be shared where traditional leases would have caused blockers but new ways of working have provided solutions and therefore enabled better utilisation?
A) Chris King - Yes, we have. So what we've seen, not for a neighbourhood health centre, but we've had instances where we've been able to provide the information. There's about four or five different examples that I can use, but I'll go for one and that will be is there's been examples where somebody has had a lease on the space and actually they've wanted to take more. And they've gone to the ICB and they've said, "Actually, we need to have an additional five rooms." And what we've been able to do is we've been able to provide utilisation monitoring into that space just to identify that not only do they not require those rooms, but actually their current usage was around sort of forty, fifty percent. It wasn't that they were asking for space just for the sake of it. They genuinely thought they needed that space because that was the intel that they were being provided.
What we were able to do is we were able to then show them, using data and using analytics, that actually they're not actually fully using the space they've got at the moment. And what that enabled them to do is actually look at the space they've got currently and use it in a much better way. And what it also enabled to do is, at the time when there was a lot of requests from the primary care networks, is that enabled those five rooms, that additional space that they wanted to take on, could be released to the primary care networks to then help them to reduce their backlog of appointments. So I think that's probably a really good example of how if you use the data and all engage together collectively, us, the ICB, and the provider or the trust and are all open-minded, you can come to a solution that works better for everybody.
Q) How has/is flood risk considered as part of climate adaptation for NHC sites? I am at the Environment Agency and would be keen to link up regarding opportunities for de-risking, particularly for optimisation of existing sites (noting this was mentioned as 'immediate' in delivery timescale?)
A) Alistair Rose- Yes flood risk was one of the fundamental considerations for "go-don't go" on the long list of potential NHC locations.
Q) We have a Wave 1 CHP Building in Derbyshire (Long Eaton Health Centre in Erewash). We've had excellent engagement with all partners so far, but it takes quite a lot of capacity/resource to support this collaborative approach. How are other areas addressing the issue of who drives the work forward? NB: we are also looking at NHSPS buildings as potential NHCs going forward.
A) Alistair Rose - Ultimately it needs to be the commissioner (ICB) to either "do" or be assured that the key stakeholders are "doing" something regarding taking this forward. Given a fundamental element of an NHS is Primary Care (DH "blue house model" as in the slides) the ICBs will always have some requirement to ensure their needs are also represented. There won’t be a simple single approach.
Q) Is there any info on when future waves of NHCs will be announced / shared?
A) Simon Taylor - We’re already speaking to Integrated Care Boards (ICBs) and NHS England about how we can work together on future NHC waves. There’s no confirmed timeline as of yet but once we have more information, we’ll share.
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