If there is a Cinderella in health infrastructure, it is primary care
Chris Green MP, Chair of the APPG for Healthcare Infrastructure, calls for the government to properly prioritise the primary care estate in its upcoming refresh of the Health Infrastructure Plan.
In recent years, attention has been focused on a national level on the government’s headline hospital building programme. While investment in acute infrastructure is imperative, we have been waiting with bated breath for a year for the refresh of the Health Infrastructure Plan (HIP).
Addressing the NHS England and NHS Improvement National Estates and Facilities Forum in March 2021, Health Minister Ed Argar MP promised it would set out “the direction of travel for the primary care estate”.
Since then, the radio silence from Whitehall has been one of the factors behind cross-party parliamentarians coming together to revive the All-Party Parliamentary Group for Healthcare Infrastructure.
Our mission is simple: to highlight the importance of high-quality healthcare infrastructure to support the NHS in meeting the demands of the future, including post-pandemic care.
The state of the primary care estate and the lack of a long-term strategic framework is holding back everything from modernisation and integration of NHS care, to tackling the maintenance backlog and embedding new roles into primary care. A YouGov survey of healthcare professionals conducted last autumn found 40 per cent saying the premises they worked in constrained the services they could provide to patients.
In a report published in February on integrating additional roles into primary care networks (PCNs), The King’s Fund concluded that a lack of adequate estate was becoming an issue across primary care and would require expertise in the design and use of space to support multidisciplinary teamworking. This is just one area where the refresh of HIP must offer concrete solutions.
The direction of travel for the primary care estate must reflect the lessons we have learned throughout the Covid-19. A survey of professionals working in hospitals, health centres, GP surgeries and mental health sites at the height of the pandemic found that half felt the sites they were using were fit-for-purpose. In addition, 70 per cent called for more flexible space and 49 per cent for external space for patients and staff.
Work is going on to achieve these aims at primary care facilities across the country like Gracefield Gardens in Streatham or Lowe House in St Helens or at Bolton One which serves my constituents. But we need the refresh of HIP to prove NHS infrastructure is about more than just hospitals.
An analysis of PCN clinical directors conducted by the NHS Confederation last year found that more than 90 per cent felt a lack of estates infrastructure was hindering their progress, while more than 98 per cent felt more funding for primary care estates was needed.
One the important questions that the refresh of HIP must address is what the first iteration identified as a “significant unmet demand for capital in the system”. We need clarity how the necessary investment in primary care estates fits with the post-pandemic public finances.
There are steps that the emerging ICSs can take. Karin Smyth MP and I proposed an amendment to the Health and Care Bill to empower the new Integrated Care Boards to reclaim their stake in projects delivered under the NHS Local Improvement Finance Trust programme. We hope ICBs will take back their share in these vital schemes to ensure they are best used to serve the needs of the primary care estate in their local areas.
The APPG will be launching a call for evidence on meeting short, medium, and long-term health infrastructure needs shortly. We want to hear from those at the centre of ICSs responsible for primary care.
A refreshed version of HIP will be the bedrock for the return to normality as we move on from Covid. We want to hear what you need to succeed.