As we loom towards a general election in May 2015 the NHS is facing £30 billion deficit over the next few years with increasing demand from patients with long term conditions and older people. Since its creation back in 1948 the NHS has struggled to manage demand for urgent and emergency care particularly over the last two decades. However, making better use of land belonging to the NHS provides a golden opportunity in using public assets to both improve health outcomes and provide an alternative revenue stream for the NHS. How can housing associations make the most of this opportunity?
The sad reality is that current approaches to selling land by public sector landowners is usually focussed on achieving a quick sale to the highest bidder. The high prices paid for land often prevents housing associations being able to access sites and build affordable homes. The open market is a tempting and alluring proposition for many NHS trust providers especially if they have foundation trust status.
Given the increasing financial pressures on the NHS the desire to maximise squeeze the most from land sales is understandable. However, there are smarter alternatives that would benefit both the NHS and housing associations. For example, housing associations could work jointly with the NHS to develop new homes that provide both ongoing revenue and a public health benefit, such as accommodation for patients recovering from mental health illnesses. As partner, the NHS could provide land from its estate in exchange for the housing association building and managing the homes.
Development of NHS land needs to be part of a wider strategy in solving the affordable housing crisis in the short term. David Cameron has already made a pledge for 100,000 new homes using public land. The Government has recently established the £100 million Growth and Efficiency Fund to incentivise and support NHS organisations to generate savings by releasing land for housing. A clear business model needs to be established to convince NHS trusts to take part in joint ventures with housing associations.
However, for housing associations to be a strategic partner in solving the NHS crisis it does require a change in the relationship between housing and the NHS, particularly if housing associations want to be seen as credible partners. We need to understand the service pressures, clinical priorities, disposal plans, and governance and accountability structures of NHS trusts. However, equally the NHS also needs to understand the role of housing in terms of its investment and business model in delivering affordable homes and a range of care and support services in the community.
In addition, we need break down the silos between governments departments, NHS England, Trust Development Agency, Monitor, and NHS Property Services in order to develop a strategic and coordinated approach in unblocking the current complex arrangements around land ownership. We also need more priority on social value and releasing land to prevent market speculation. It would be great for the political parties to explore the following ways of delivering better health care and tackling the affordable housing crisis: promoting integrated care models that make use of NHS land to deliver health outcomes; ensuring these health outcomes are factored into value for money considerations when the NHS sells land; recognition of housing associations to be the preferred partner working with the NHS to develop its land and deliver integrated care on estates; and formal recognition that housing associations can be part of the supply chain for NHS providers in delivering health outcomes.
We’ve produced a briefing providing more detail on the sale of NHS estate and how housing associations can be part of the NHS supply chain. This is a start of a journey that could be a ‘win win’ situation for patients and residents in delivering more affordable homes and better health care problem for the 21st century.
Originally published in The National Housing Federation