Assura boss’s treatment plan for a crisis-stricken NHS

The property sector has enormous potential to act as a force for good, and right now nowhere is this needed more than in the healthcare sector. No one can have failed to witness TV reporters camped outside A&E departments recounting horror stories around conditions and waiting times, highlighting the level of strain the National Health Service is under. Two weeks ago the government laid out a plan to fix things, which essentially amounts to greater partnership with the private sector as well as new community diagnostic centres so more treatment is carried out away from hospitals. On both fronts this will mean the sector needs new buildings delivered, and this has naturally been welcomed by Assura, which invests in and develops property solely in the healthcare sector. For chief executive Jonathan Murphy, the opportunities this presents both as a business and for wider society are huge, but he is in no doubt of the scale of the task ahead. “So ultimately the only way to fix the waits in A&E is to fix it at source, which is to fix it in the community,” says Murphy. “To date the money has gone to the hospitals, because that’s the fire. But you can stop it at source if you’ve invested more money in public health and in community healthcare.” Unblock the pipeline The government-commissioned Darzi report last year found a £37bn shortfall of capital investment across the NHS, which contributed to crumbling buildings. It also found 20% of the NHS estate pre-dates the founding of the service in 1948 and warned that too little of its budget was spent in the community compared with hospitals. Ironically, following the completion of a new GP surgery in Winchester, Hampshire, last week, it is the first time in 20 years that Assura is not onsite building any GP practice, something Murphy puts down to stasis brought about by the change of government as well as inflation pushing build costs up by 30% in the past three years. “What we are hoping is that the rhetoric about wanting to do more out of hospitals will convert into, ‘Therefore we need the facilities and the amenities to do that’ and that will lead to an unblocking of the pipeline,” says Murphy. “Our ambition for 2025 is that that part of our business unlocks, because at the moment it is stuck.” Murphy says the long-term benefits of new GP centres are obvious but believes too often decisions are taken on a short-term basis. “The NHS’s own data shows that it’s 10 times more expensive to be treated in hospital than it is to be seen by a GP,” he says. “So the economics there are compelling but you have to think outside of an in-year cash settlement, hence the problem we have as a country of just thinking March to March.” [caption id="attachment_1270364" align="aligncenter" width="847"] NPC Northumbria Way in Cramlington[/caption] Thanks to its acquisition of 14 private hospitals last August, Assura also has a fair amount of skin in the game on the second element of the government’s plan: greater partnership with the private sector in which private hospitals are used to get people treated faster. As Murphy acknowledges, the plan has its critics. “A lot of people have quite strong views on this, but it’s not actually privatising the NHS because the capacity that’s being created is free at the point of delivery for the NHS patients. It’s just being done in a private sector building, so the NHS is no worse off than it would have been before.” He has a compelling example of how this works in practice. “The classic one is the facility we have in Guildford,” he says. “We built a new cancer treatment centre on the site of the NHS hospital in Guildford, literally on its land, operated by a company called Genesis Cancer Care. We funded the building and it pays us the rent. It has then put the latest technology and cancer machines into that building, which the NHS can’t afford because it doesn’t have the capital budget – these things are millions of pounds each. It has put two state-of-the-art machines in next door to the NHS hospital and committed that 40% of its throughput will be NHS patients at NHS tariff. “So the NHS pays no more for them to be treated in a new facility with the latest technology in a private building. In that scenario, everyone is a winner because the two sectors work together and the consultants are happy because they can do their NHS work at the Royal Surrey in the morning and walk across the car park and do their private clinic in the afternoon. They’re happy and you’ve seen a net investment into the NHS that wasn’t possible otherwise.” Long-term solutions Because the private sector does not have to carry out A&E work, it is able to schedule all treatments in advance and operate with the efficiency this brings, says Murphy. He also believes the government’s commitment to private-sector partnerships will be hugely beneficial for future investment in the sector. “The NHS works year-on-year, so it will only commit to the local private hospital to give it a year’s worth of business. It will say, ‘Can you do X-thousand hip operations for us this year?’ but there’s no commitment in the year after, which creates a bit of uncertainly. [caption id="attachment_1165795" align="aligncenter" width="2560"] Assura chief executive Jonathan Murphy[/caption] “So now they are saying, ‘We are going to start working on multi-year programmes and that will help give the private sector confidence to build new facilities and expand the capacity’. So for our business, given that our business is building those new facilities, it’s a great opportunity for us and will make the whole market more attractive and more investible.” But Murphy is realistic about the ability of the private sector to help with the sort of scenes currently being witnessed in A&E departments across the country. “The private sector is not going to solve that because the private sector is about 8% of the market,” he says. “If you’re playing with 8% of the capacity, if you increase that significantly it might go to 10%, and if it went to 12% that would be a 50% increase from where it is. That’s huge, but still only 12%, so it’s not going to fix your 50-hour waits in A&E.” The solution to that, says Murphy, lies in community health facilities. “The sad part is that’s not even a one-parliament cycle, that’s a decade. But it is possible. Under the last Labour government they did materially reduce waiting lists. I think we forget but waiting lists were really bad in the 1990s and we did turn it round as a country, and there was significant investment in new GP surgeries.” If Murphy is right, property will lie at the heart of any successful effort to rescue the NHS. It is down to the industry to show exactly how much of a force for good it can be. Images © Assura/Paintercreative.co.uk