Kent and Medway Strategic Transformation Partnership (STP)

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This Estate Strategy is written in the context of a local and national NHS that is continually evolving in terms of policy and structure, driven by the K&M STP. The key drivers for change are identified as:

• The NHS Long Term Plan and Five Year Forward View
• Trust local strategies, specifically:
  
  • Clinical Care Pathway Strategies
  • Clinical Technology Strategy.
• Sustainability and Transformation Partnership (STP)
• CCG Local Estates Strategies.

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There has been consensus over the past five years that the NHS needs to change how it plans and delivers its services, including:

• Increased emphasis on prevention and public health
• Patients taking greater control of how they receive their own care and the option of shared budgets combining health and social care, where possible supported by clinical and information technology
• The need to break down organisational barriers in how care is delivered, particularly between primary care, hospital, community based and social care services and also between physical and mental health; some of this potentially facilitated by smart clinical technology solutions around patients appointment booking systems, for example.
• The emergence of a number of different organisational models, such as the multispecialty community provider, and accountable care organisations proposed to support better integration between different parts of the health and care system.

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These drivers, identified in the 2014 Forward View, have grown, not diminished. The last two - the breakdown of organisational barriers and boundaries and the emergence of new organisational models - may have particular implications for estate, in particular how it is used and how it will need to be shared in the future. The trust needs to continue to adapt its services to reflect the greater emphasis on primary and preventative mental health interventions, working alongside colleagues across health and social care. This should include greater use of shared facilities, and IT where possible and these factors must begin to inform estates-related and clinical technology investment decision-making.

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The national mechanism for driving county-wide change is the Sustainability and Transformation Partnership (STP), which requires NHS trusts and other organisations delivering NHS and social care services to prioritise partnership over competition within STP footprints. All parts of the health and care system are expected to increase collaboration through the STP, of which KMPT is an active participant, with KMPT estates personnel taking a lead on many STP estates issues on behalf of the health economy. In 2018 KMPT led the procurement of a new catering provider on behalf of the STP. Although the other trusts have not yet joined this arrangement, the mechanism for them doing so is established. Cross-organisational work is currently focussed on
generating capital through disposals of surplus accommodation, various projects to improve productivity and increase efficiency, developing shared strategic approaches and tackling the sustainability agenda. KMPT is also central to initiatives looking at shared transport, fire, linen and storage functions.

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Mental health features prominently in the Kent and Medway STP work. It is clear that greater collaboration and coordination will be required across services and organisations and, over time, the boundary between physical and mental health services will become increasingly blurred. There are strong associations between physical ill health and mental health and the trust is likely to find itself delivering more of its services from a wider range of care settings in order that care is organised around the needs of service users rather than organised around specific disciplines and specialisms.

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Partnership in estates planning is also extending beyond health and social care. Through the One Public Estate (OPE) initiative, increased collaboration across public sector bodies and agencies to improve strategic estates planning as a whole has begun to emerge, looking at opportunities to consider how the property needs of public service providers (including government departments, local authorities, NHS and other public agencies) can provide further opportunities to improve value when looked at “in the round”. The trust is the lead NHS organisation for OPE in Kent and Medway, with trust
personnel co-chairing the Kent Estates Partnership (KEP) Board, which manages the OPE agenda and budgets for Kent.

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The partnership model is welcomed by KMPT, since working in partnership is familiar to mental health services. The trust delivers population-focused health and social care through individualised care focussed around local communities, which can only be done successfully in partnership with others. KMPT has long-established relationships with health and social care commissioners and providers to ensure services work well for all the population affected by mental health. There is more that can be done to improve coordination and collaboration, both in the planning of services and in the delivery of
care directly to patients.

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The NHS Long Term Plan (LTP) sets out DH expectations to transform local systems of care delivery, with Integrated Care Providers (ICPs) and Integrated Care Systems (ICS) set to emerge in the coming months and years. Progress is already being made in the Kent and Medway STP work and implications for estate are gradually emerging. “Local care” suggests community-based multidisciplinary facilities, based on primary care organisation, and KMPT is a partner in hub development projects in Dartford, Sevenoaks and potentially, Tonbridge.

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The ICP/ICS agenda is focussed on “big ideas”, which have much in common with, and will inform future, strategic estate thinking. These include increased integration, a shared system concept, collaboration, value and creativity. The NHS estate has always out-lived particular system and organisational changes, alongside the workforce it is the great constant in the ever-changing NHS agenda. The trust will continue to play its part in this emerging picture.

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The NHS LTP provides an important opportunity for mental health services, nationally and locally. Investment in mental health over the next five years is promised at a faster rate than for the overall NHS budget. KMPT needs to ensure the mental health estate is improved as part of that investment - and the trust has registered two major areas for capital investment within the STP capital plans; a centralised emergency/S136 facility and female PICU. A third, relating to some of the many residents placed outside the county, is in development.

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While the LTP has a major focus on investing in expanded and more integrated primary and specialist community mental health care, it also acknowledges the need to ensure therapeutic inpatient environments - close to home rather than “out-of-area” - something the trust has focussed on with conspicuous success in recent times, and will continue to do so. There are certain to be estate implications in the proposed new Mental Health Safety Improvement Programme, another area of unrelenting focus to date for KMPT.

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The LTP also focusses on improved efficiency and cash-releasing and non-cashreleasing savings with an overall productivity gain target of 1.1 per cent pa for the next five years. Estates and facilities will need to continue to make its contribution to this agenda. Since 2013, the trust has improved efficiency by disposing of over 30 surplus properties, generating almost £25m in capital receipts. This has all been reinvested in the trust, with the added benefit of releasing the revenue costs of those buildings to support frontline clinical operations. Further disposals, enabled by improved efficiency in utilisation of accommodation, will continue this successful “pillar” of the strategy. Other LTP initiatives relevant to estates include proposed reductions in cost through improved procurement processes and improved use of land, buildings and capital investment strategies

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Investment in the estate enables more effective partnership working, as does the deployment of modern ICT systems that support more remote and flexible working. This allows trust staff to work more inpatients homes, collaboratively with colleagues from other agencies (through more co-locations and ICT-enabled communication) as well as offering new ways to engage with patients, e.g. through Skype consultation. The widespread availability of WiFi means that networks such as GovRoam can be accessed by trust personnel and there is potential to harness more integrated telephony
systems so the full power of mobile devices can be realised.

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Since 2013, the trust has had a comprehensive programme of modernising its community facilities through the Estates Transformation Programme (ETP). This programme was focussed on replacing out-dated and surplus facilities with modern, fitfor-purpose environments, either through upgrade or acquisition. Much of the original programme has been delivered and a new programme of community estate changes is in development, overseen by the Strategic Estates Group (SEG), chaired by the trust Executive Director of Finance. In parallel, community mental health services are also undergoing major transformation, under the trust’s Clinical Care Pathways Programme (CCPP).

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These two programmes are linked, dovetailing to ensure the requirements of clinical service delivery in the future are met. The nature of community provision, the number of assessment facilities and the location of buildings can all be informed by understanding the way services in the future will be delivered under CCPP. A good example is that of some clinical groups for whom it will make sense to be based in single locations with service users attending the hub to see them, as opposed to those practitioners visiting people in their own homes, which could be inefficient by as much as 100 per cent.