Select Committee on Health Memoranda


Memorandum by the Department of Health

PUBLIC EXPENDITURE QUESTIONNAIRE 2001

1.  CURRENT ISSUES

1.1  NHS Financial Balance

  Based on current forecasts, what will be the likely financial performance of the NHS in 2001-02 in terms of financial balance, "deficit" organisations and performance?

1.2  Social Services Waiting Times

  Could the Department provide a table showing the waiting times for receipt of care packages in each social services department for 2001-02 to 2002-03?

1.3  NHS Lift

  Could the Department explain the finance, funding and accountability processes of NHS Lift? In particular could the Department clarify the relation between NHS LIFT, the Minister and parliament and also the relation between NHS LIFT and Partnerships UK (PUK)?[3]

1.4  NHS Estates

  Could the Department describe how the NHS Estate will be disposed of. Could the Department list the directors of the new company Inventures and their connection with NHS Estates? Could the Department explain the process of dividing the proceeds from the disposal of NHS assets and the accountability for public funds.

1.5  Breast Feeding

  Could the Department describe what data it keeps on breast feeding rates and provide a table showing breast feeding rates for the last 10 years for which figures are available?

1.1  NHS Financial Balance

  Based on current forecasts, what will be the likely financial performance of the NHS in 2001-02 in terms of financial balance, "deficit" organisations and performance?

FINANCIAL POSITION 2001-02 AND DEFICIT ORGANISATIONS

  1.  The NHS has benefited considerably from the Government's new spending plans, in particular through the injection of significantly extra resources—part of which are aimed at ensuring that the NHS operates in future on a sound financial footing.

  2.  As a consequence the NHS has been able to set plans for 2001-02 that forecast each and every HA, PCT and NHS Trust achieving financial balance or better, ie no deficit organisations are planned.

  3.  However, it is recognised that there are a number of health bodies managing difficult financial positions, which may require longer-term financial recovery plans. In these cases the HA, PCT or NHS Trust concerned will be working closely with their host Regional Office to develop and implement appropriate strategies to manage the financial pressures.

  4.  Whilst recovery plans are expected to achieve underlying financial balance over the shortest possible period—this should not be at the expense of patient care/services.

PAYMENT PERFORMANCE

  5.  All HAs, PCTs and NHS Trusts must meet the Public Sector Payment Performance (PSPP) target of paying 95 per cent of non-NHS trade creditor bills within contract terms or 30 days where no terms have been agreed.

  6.  The PSPP target limits the extent to which HAs, PCTs and NHS Trusts can spend beyond their means by increasing the time they take to pay non-NHS creditors.

  7.  The DoH takes the issue of prompt payment by NHS organisations very seriously and has over a number of years taken action to emphasise the importance placed on prompt payment.

  8.  As a consequence, the performance of the NHS in complying with the PSPP target has shown sustained improvement over recent years with latest projections for financial year 2000-01 indicating that 85 per cent of bills are paid within 30 days/within the PSPP target. This in the context of the NHS processing and paying some 14m invoices per annum.

  9.  The DoH will continue to work with NHS bodies to achieve and maintain a level of payment performance consistent with Government Accounting Regulations and the CBI's Prompt Payment Code.

1.2  Social Services Waiting Times

  Could the Department provide a table showing the waiting times for receipt of care packages in each social services department for 2001-02 to 2002-03?

  1.  Information on waiting times has been collected for the first time for 2000-01 as part of the Referrals, Assessments and Packages of Care project (RAP) and is currently being processed. The data has dress rehearsal status, allowing councils to get their information systems up to date and clarify any definitions. Not all councils have provided information for this year. Information will be published in a report of the rollout of RAP for 2000-01 in November 2001. In view of concerns over data quality and completeness, Performance Indicators will not be calculated on waiting times until 2001-02.

1.3  NHS Lift

  Could the Department explain the finance, funding and accountability processes of NHS Lift? In particular could the Department clarify the relation between NHS LIFT, the Minister and parliament and also the relation between NHS LIFT and Partnerships UK (PUK)?[4]

RATIONALE

  1.  A large element of the current primary care estate is not suitable for the provision of modern healthcare. Survey data (collected by District Valuers) indicates that only around 40 per cent of premises are purpose built and less than 5 per cent of premises are co-located with a pharmacy (and around the same proportion are co-located with social services). Some 84 per cent of all primary care is provided by the private sector, either through the property being owned by GPs or leasing.

  2.  Practices leasing from private landlords are often very small and rundown: only one in three of these is in a good state of repair. These premises are often located in deprived areas, where health care needs are greatest.

  3.  The NHS Plan states that "the NHS will enter into a new public private partnership within a new equity stake company—the NHS Local Improvement Finance Trust (NHS LIFT)—to improve primary care premises in England. The priority will be investment in those parts of the country—such as inner cities—where primary care premises are in most need of expansion".

  4.  The NHS Plan included the following commitments.

    —  Up to £1 billion will be invested in primary care facilities;

    —  Up to 3,000 family doctors' premises will be substantially refurbished or replaced by 2004;

    —  500 one-stop primary care centres by 2004.

  5.  The Plan states that "new one-stop primary care centres will include GPs, dentists, opticians, health visitors, pharmacists and social workers".

  6.  LIFT will, alongside normal voted funds, be responsible for achieving these NHS Plan commitments.

MODEL OF OPERATION

  7.  The NHS LIFT will operate at two levels: there will be a national holding company (NatCo), in which the Secretary of State will be a 50 per cent shareholder with Partnerships UK (PUK), and at local level, where the national company will work together with the local health economy (and potentially Social Services) and the private sector to deliver the actual primary care infrastructure.

  8.  NatCo will be responsible for providing financial, contractual and commercial advice to each local health community, and help pull together each local LIFT. NatCo will also provide standardised documentation for each LIFT. It is envisaged that NatCo will be the catalyst to allow each local lift to start working together and find the partners it needs.

  9.  NatCo will be funded equally by PUK and the Department of Health. Initially, each will be injecting a total of £2m, in stages, for the funding of the preparatory work. The investment by the Department of Health will be in the name of the Secretary of State and he will be the sole shareholder as far as the Department is concerned. As this investment will be funded through normal voted funds, the Secretary of State will be accountable for Parliament in the same way as any other funds expended from Vote 1. The statutory power for the Secretary of State to invest in NatCo was created under the Health and Social Care Act 2001. The Board of Directors of NatCo will consist of three senior civil servants from the Department of Health and three representatives from PUK.

  10.  It is envisaged that each local LIFT will be funded partially by NatCo, partially by the local health community and partly by the private sector. It is envisaged that initially NatCo will want to contribute 20 per cent, the Local Economy 20 per cent and the private sector 60 per cent of the formation costs. The objective of local LIFTs is to use the Department of Health's purchasing muscle to change the way the private sector provides property to the primary health care market. Currently, the only mechanism available to GPs who do not have the capital to fund their own properties is through leasing accommodation. These leases are not particularly attractive to GPs as they are normally lengthy in duration (up to 25 years in some cases) and place substantial obligations on GPs in terms of maintenance, insurance and dilapidations. These leases are also unattractive to the NHS. This is because landlords use the GPs rent refunds provided by the Department as a guarantee, and they know that rents are adjusted every few years to bring then back into line with the market, with that change flowing straight through to the landlord. In addition, as these charges are calculated using local office rents as a proxy for market value, the Department is often forced to pay increases in rent above the RPI.

  11.  The intention of LIFT is to create a new rental market for NHS property that is based on shorter term leases for GPs, allowing them greater flexibility, with rents aligned to movements in RPI rather than local market rents. Other objectives include:

    —  The ability for GPs to take (or earn) an equity stake in the company;

    —  Offer accommodation areas that traditionally developers have not operated, principally in a city location;

    —  Take away from GPs the requirement to insure, maintain and be responsible for dilapidations on the properties they rent;

    —  Bring in the best of the private sector's expertise regarding use of additional capital for such services as chemists, opticians or retail uses;

    —  Provide a method for Social Services and the NHS to be able to operate from the same locations.

  12.  Each local LIFT will be a registered company, with local NHS and local health communities being represented on the Board of Directors. It will be constituted so the health direction and policy is dictated by the health representatives on the company, with the private sector being responsible for commercial aspects. LIFT will secure its income using the normal Red Book principles meaning the existing safeguards will remain in place regarding accountability and value for money.

  13.  In addition to the formation of NatCo and the local LIFTs, the Department of Health is investing Vote 1 money to enable the change to take place. It is envisaged that Voted funds be used to assist GPs to vacate properties that are unsuitable for modern primary care, for example by buying out leases or purchasing freeholds from retiring GPs. The task of providing newer accommodation, in accordance with the local health needs, will then rest with the local LIFT.

  14.  NatCo will receive its funding by way of a fee from the local LIFT once formed. This is a set fee and any premium paid above this by the local LIFT is for the Department to keep.

CURRENT STATE OF PLAY

First Tranche of NHS Lift schemes

  15.  Secretary of State announced the first six NHS LIFTs in February 2001. The six areas prioritised were all HAZ areas with relatively higher levels of unmet need:

    —  Barnsley

    —  Camden & Islington

    —  East London

    —  Manchester Salford & Trafford

    —  Newcastle and North Tyneside

    —  Sandwell

Establishment of National Joint Venture to promote NHS LIFT approach

  16.  The Department of Health plans to establish a joint venture company (PPP) with Partnerships UK to help develop the NHS Lift initiative in mid-September.

Additional LIFT Tranches

  17.  The Department plans to select a second tranche by the end of 2001 and a third tranche in May 2002

Publicity

  18.  A prospectus explaining the benefits of the LIFT approach was distributed to all NHS bodies as well as the private sector at the end of June. In July four regional presentations were made to increase awareness. These events attracted around 800 delegates. A communications strategy for NHS LIFT is currently being finalised in conjunction with COMMS.

1.4  NHS Estates

  Could the Department describe how NHS Estate will be disposed of. Could the Department list the directors of the new company Inventures and their connection with NHS Estates? Could the Department explain the process of dividing the proceeds from the disposal of NHS assets and the accountability for public funds.

Could the Department describe how NHS Estates will be disposed of.

  1.  The Secretary of State has given the go ahead for NHS Estates to prepare a Business Case for a public private partnership (PPP) for disposal of Retained Estate and NHS Estates Trading Activities.

  2.  The PPP is to in practice seek a sale of a surplus property portfolio and the true value will be determined by offers. The provisional value is around £400 million. We also need to ensure that the sale proceeds met NHS plan targets and that NHS Estates staff transferring to the PPP are treated fairly and properly.

  3.  NHS Estates trading staff will act within the PPP for disposing of property or as a developer, working in partnership with the NHS.

  4.  The control the Department would have will depend on the offers recovered and what interests the Secretary of State wishes to retain (ie—we are not yet ruling out the possibility of a total sale rather than a 49 per cent:51 per cent Joint Venture). The choice of shareholding will be clearer once potential private sector partners offers have been received.

  5.  The process being followed to achieve the PPP follows the OGC Gateway Review best practice. A copy of the outline milestones and a timetable is attached.

  6.  To achieve the project aims and objectives, new organisational arrangements have been put in place from 30 April 2001. This involved the establishment of two clear groups of staff, the Inventures group (transferring into the PPP) and the Vendor group (the remaining NHS Estates functions). The Project Organisational Structure is also attached.

Could the Department list the directors of the new company Inventures and their connection with NHS Estates.

  7.  Inventures has not been incorporated as a new company and as such has no directors under company law. It exists in shadow form only as part of NHS Estates which in turn is part of the Department of Health.

  8.  The membership of Inventures' board is as follows:—

    —  David Lawrence  

    Chief Operating Officer

    —  Martin Dove  

    Chief Financial Officer

    —  Tim Straughan  

    Non Executive DoH rep

    —  John Evans  

    Non Executive DoH rep

  9.  The Inventures Board reports to the main NHS Estates Agency Board. Kate Priestley, David Lawrence and Martin Dove will join the new PPP when it is established. These individuals are not members of the main NHS Estates Agency Board.

  10.  Tim Straughan is the Executive Director of Finance and a member of the main NHS Estates Agency Board. His role as non-executive on the Inventures Board is to represent the Secretary of State and Agency interests. John Evans is a non-executive of the main NHS Estates Board and also attends the Inventures board as a non-executive member, also representing the interests of the Secretary of State and the Agency.

  11.  These management arrangements have been approved by the Agency Main Board and Audit Committee.

Could the Department explain the process of dividing the proceeds from the disposal of NHS assets and the accountability for public funds.

  12.  In discussing the issue of participation in property profits (overage payments), the following terms have been used to identify the different levels of value at which the properties could be assessed :—

  13.   Base 1: This is the first stage, being the open market value of the Surplus Estate in its current state. It represents the price the market might pay at current prices reflecting the uncertainty of future planning permissions, regardless of whether overage affects a particular property. It includes an element of "hope" value. Both Base 1 and Base 2 will be provided by the District Valuer.

  14.   Base 2: This second stage represents the value of the properties in their ideal state for, generally, redevelopment. This would assume that all permissions, services provisions and access have been dealt with satisfactorily (typically referred to as "oven ready").

  15.   Base 3: A third stage would represent an increase in the values of the properties obtained by the PPP Company on the actual disposal of a property to a third party (or a market value on letting of a property).

  16.  Historically, many of the properties in the retained estate have been sold with the benefit of planning permission, ie at Base 2. It is suggested by that this historical practice should be imported into the structure of the PPP agreement such that the Secretary of State would be entitled to the following percentages of base values:—

Base 1 on completion of PPP deal 100 per cent
Difference between Base 1 and 2100 per cent less specified expenses
Difference between Base 2 and 360 per cent


  17.  On advice from our Property Advisors and the District Valuer it was considered that this overage structure would not be commercially acceptable to a Private Sector Partner (PSP) who would want to share in the increase in value achieved not only at Base 3 but also between Base 1 and Base 2.

  18.  An alternative structure would be to share in the increase of value above Base 1 between the Secretary of State and the PPP Company as to 50 per cent for the PPP Company and 50 per cent for the Secretary of State. This would meet the requirement to allow the PSP to share in the increase in value beyond Base 1. The PPP Company would bear any expenses during the interim (eg holding, obtaining planning consent and disposal costs) from its share. Any payments above Base 1 would be made at certain predefined trigger points—eg planning consent, sale or build out.

  19.  To enable a consistent approach and thus evaluation, in the Invitation to Negotiate (ITN) for the purposes of the compliant bids, bidders will be asked to assume that each of the properties in the Surplus Estate will be sold subject to an overage payment following the grant of planning permission. However, the ITN will make it clear that both the percentage and trigger event are fictional and that separate provisions may apply as relevant to each property. It will furthermore make it clear that the percentages are negotiable and that bidders may submit variant bids on alternative bases.

  20.  It is recommended at this stage that an overage structure is implemented that would enable the PPP Company to share in any increase in value of the Surplus Estate beyond the value attributed to it at the time of completion.

  21.  It is suggested that the sharing arrangement be at least 50 per cent for the Secretary of State but this will be subject to negotiation in respect of each individual property and will vary depending upon the initial guaranteed upfront payment.

The Sale Process and Prospective Timetable

  Notice has been given in the Official Journal of European Communities with respect to the PPP inviting requests from interested parties ("Candidates") to be selected to negotiate with a view to entering into the PPP arrangement.

  The procedure that it is being followed in the sale process, along with the timetable and approvals required at each stage, is outlined below:—





3  
Partnerships UK (PUK) was announced on 22 July 1999 by the then Chief Secretary to the Treasury, Alan Milburn. PUK will be a private sector body to help the public sector get the best deals from the Private Finance Initiative (PFI) and other forms of public-private partnerships (PPP). Back

4   Partnerships UK (PUK) was announced on 22 July 1999 by the then Chief Secretary to the Treasury, Alan Milburn. PUK will be a private sector body to help the public sector get the best deals from the Private Finance Initiative (PFI) and other forms of public-private partnerships (PPP). Back


 
previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2002
Prepared 17 January 2002