NHS Estates siphoning of £2 million a year from Brent health and care budget

Willesden Centre for Health and Care

NHS England policy that health organisations should pay market rent for NHS Property means that Brent Clinical Commissioning Group is paying £2 million annually for spaces (voids) that are not being used, Cllr Nerva established at the Community and Wellbeing Scrutiny Committee on Wednesday.

The Willesden Centre, built under the Private Finance Initiative costs £6.5 million a year with a void of £1m and other property voids gives a total of £2m. PFI costs were higher with additional ad hoc charges.

Monks Park is a joint local authority - NHS PFI initiative and the rents have been too high for most user organisations.

It is of course banks and shadowy investment trusts that profit from PFIs. LINK 
 LINK   LINK

Source

The Brent Clinical Commissioning Group (CCG) has to pay the market rent for the spaces whether or not they are occupied.  This is money that could otherwise contribute to the health and care budget.  The CCG is attempting to gather all out of hospital services in one of three centres. Some hospital services were over crowded and could use any spaces released spaces on their sites.

Councillors were told that NHS Estate advisers were experts in their field:

Health estate is a market of its own own. Our advisers are expert at health provision. They may be more expensive than other properties and not economically viable for general office space, but there are benefits of proximity to other health users.

When a councillor asked why the CCG should pay for space it wasn't using Sarah Mansuralli, Chief Operating Officer of the CCG replied, 'You may well ask - but that is the policy.'

Cllr Lesley Jones asked if there was any discretion over voluntary organisations having to pay market rents, giving the example of Brent Carers forced out of the Wembley Centre by higher rents.
Mansuralli said she would like to support voluntary organisations but it was difficult to have space occupied by a voluntary organisation that even with a subsidy would not be able to afford the rent. The CCG could not subsidise fully and also close the financial void.  She was willing to look to see whether some space could be used on a sessional basis, when other users were not using it.

Mansuralli added that Brent CVS were working with voluntary organisations to help them develop the capacity to afford the rents.

The practical impact of this can be seen in the case of Brent Advocacy Concerns LINK who have sent me this email about their situation:

I attended the meeting with our NHS landlords last Tuesday and received a 'fair hearing' but they only told us what we already knew.  That at some point in the future we will be sent the rent and service charges that we will have to pay to stay in our office.  The manager present said that her 'pay scale' did not allow her to make the final decision on our situation.

I just had a phone conversation with a disabled lady from Brent.  She needed face to face advice to help her with filling out her PIP FORMS. She had tried the council first at the Civic Centre in Brent who could not help her and they sent her to Brent CAB, who after a whole morning could not help her either and they gave her our number.  I offered to help her if she could come to our office this afternoon but she wanted an appointment for next week which I could not offer her, as my own health issues might cause me to miss it.  I then told her to try Brent Age UK but she had already tried them without success.

So my question is, where in Brent can she get face to face advice, as she told me she has both physical and mental health issues?

It is clear that voluntary organisations provide an essential service, that in the long term saves the NHS money, but the operation of 'the market' means that they cannot be accommodated in NHS or local authority property due to the monetisation of these estates.

Given these examples the Scrutiny Committee's recommendation that the  'social value' of organisations should be taken into account when filling voids will appear to have little traction.

Cllr Rita Conneely  asked about joint working between the regeneration and planning teams and health.  She was told that the council's strategy and the local development framework explored section 106 opportunities regarding local health care.

Conneely said that some developments had been ear-marked for primary health use and then were not occupied by them. This had been a contractual agreement with developers and so we ended up losing valuable community space.  She was told that the CCG was aware that this had been the case in the past with the primary care estate. These had been small spaces but larger spaces were needed to deliver at scale and thus be sustainable.

Conneely pursued this issue stating that the NHS Estates document had not designated South Kilburn a growth area despite its regeneration. The original idea was that young families would move in but rents were so high that they were not available for starter families.  Sarah Mansuralli answered that plans were made around 'units' and health impact studies for each area using Wembley growth as a model.

The Committee recommended that the needs of South Kilburn as a growth area should be factored into plans.

Cllr Hector raised doubts about the population data that was being used which apparently showed a decline in the population of Willesden and appeared to neglect the fringes of the borough. She was told that GLA data was used but it did not cover everything. Cllr Conneely asked if the CCG was looking at concentrations of older people in particular parts of the borough.  he was told that this was not easy because there was a diversity of population and age groups within single area. There was an annual review of GP surgery provision in terms of population growth.

The Committee Chair, Councillor Ketan Sheth, asked why three hubs had been chosen.  He was told that this was based on existing estates that could be expanded. Sarah Mansurali had spoken with Carolyn Downs, Brent CEO, about why Brent had three when some other boroughs have one, and others have five. There would be a review to see if this was appropriate.

The Committee recommended that much clearer consultation procedures on the use of NHS Estates should be adopted.

Early warning: During the meeting Cllr Hirani, Cabinet lead member for Community Wellbeing, seemed quite happy at the prospect of building on the Vale Farm playing fields when discussing the One Estate (combination of Council and NHS estates) strategy. Watch out!

A 2013 Panorama on PFIs as a scam can be found HERE