Some housing organisations could be major partners with the NHS in the redevelopment and repurposing of NHS land and premises to deliver a transformation in out-of-hospital care. They are used to innovating and, being not-for-profit, they reinvest ‘surpluses’ from development into other schemes and programmes.
Housing organisations own, manage and develop property. Their property-related interests and activities include:
- ownership of millions of homes spread widely across the country
- offices and other premises within particular localities
- expertise in facilities management
- development of many types of housing, including extra care and other forms of specialist housing for older people, people with mental health problems and others requiring ongoing support
- development, redevelopment and repurposing of bespoke premises to meet particular community purposes, including for example GP practices and community health centres
- achieving optimum return from volume development of private sale housing with ‘profits’ being invested in social objectives (not share returns)
Those housing associations that are actively developing new housing have significant experience in joint ventures, risk management and innovative funding models. They are used to negotiating risk and reward sharing within joint ventures, attracting capital from various sources and working with local authority planners and commissioners of new schemes.
The larger care and support providers can work in joint ventures with mental health and acute trusts to build new community-based forms of rehabilitation for people with complex mental health conditions.
According to the BMA, over half of GP surgeries in England and Wales are unfit for purpose. This assessment was made before the publication of the NHS Five Year Forward View which points to the need for new premises to house new services within one or other of the New Models of Care.
In a few places, housing organisations are already collaborating with health to co-locate primary health care with community services. Their vision is to address both the causes and the treatments for people’s illnesses through clinical and non-clinical services and activities available at the same centre. This vision is consistent with the Multi-speciality Community Provider model described in the Five Year Forward View.
Some housing organisations have transformed Sheltered Housing Schemes into Community Wellbeing Hubs, providing a range of community and health services to older people living in nearby private housing as well as within the sheltered housing scheme itself.
The NHS typically sells its surplus land to private developers at full market price. Other models are emerging, however, in which the NHS keeps the land and achieves greater financial returns over the medium to long term by working with not-for-profit housing associations. By adopting these models, the NHS could use its land to help to bring about the required transformation in health and social care over the coming years.
This Smith Institute publication NHS surplus land for supported housing explains in detail why using NHS land for supported housing, in partnership with a housing association, offers better value for money than selling it for private development. The evaluation suggests that the NHS could make savings of around £6bn over a 25 year period in addition to reducing delayed discharges. Over a 25 year period, conservative estimates are of an annualised return on investment of 7% for mental health supported housing and 5% for older people.
This National Housing Federation briefing Surplus NHS land: a best value alternative explains various models and approaches to joint ventures with housing associations that can assist with the transformation of services, improve on quality, reduce hospital admissions and create an ongoing revenue stream resulting in cost savings.
Case study: Tile Hill Kings Cross
Case study: Heatherstones Court, Calderdale