Naylor Review

Establish a powerful new NHS Property Board which provides leadership to the centre and expertise and delivery support to Sustainability and Transformation Plans (STPs). It should be a strategic organisation, at arms-length from the Department of Health and structured so that it empowers speedy executive action and professional credibility within the sector. To include a regional structure, which is aligned with NHS England (NHSE) & NHS Improvement (NHSI) and brings together functions of NHS Property Services (NHS PS), Community Health Partnerships (CHP) and other fragmented NHS property capabilities into a single organisation.

STP estates plans and their delivery should be assessed against targets informed by the benchmarks developed for this review. STPs and their providers, which fail to develop sufficiently stretching plans, should not be granted access to capital funding either through grants, loans or private finance until they have agreed plans to improve performance against benchmarks.

At a minimum, the Department of Health (DH) and HM Treasury (HMT) should provide robust assurances to STPs that any sale receipts from locally owned assets will not be recovered centrally provided the disposal is in agreement with STP plans. This report recommends that HMT should provide additional funding to incentivise land disposals through a "2 for 1 offer" in which public funds match disposal receipts.

NHSE and NHSI should provide guidance on the relative roles of providers and STPs with respect of estate matters.

NHSE and the NHS Property Board should ensure primary care facilities meet the vision of the 5YFV. This should consider linking payments to the quality of facilities and greater use of fit for purpose standards. The NHS Property Board should support GPs to meet these standards, taking advantage of private sector investment.

Land vacated by the NHS should be prioritised for the development of residential homes for NHS staff, where there is a need. The NHS Property Board should support this.

Urgent action should be taken to accelerate the delivery of a large number of small scale and low risk developments to deliver housing.

All national bodies should work together, sharing intelligence, to develop a robust capital investment plan for the NHS by summer 2017. This should maximise value for money and make a strong case for securing both the public and private investment the NHS needs.

Substantial capital investment is needed to deliver service transformation in well evidenced STP plans. We envisage that the total capital required by these plans is likely to be around £10bn, in the medium term, which could be met by contributions from three sources; property disposals, private capital (for primary care) and from HMT.

Establish the NHS Property Board in shadow form immediately (involving key staff from NHS PS and CHP) and substantively by April 2018. It should consider if the functions and residual assets it inherits from the abolition of Primary Care Trusts (PCTs) should be divested back to providers. In the interim NHS PS and CHP should focus on addressing their well-documented operational challenges.

The NHS Property Board should urgently bring together and expand the current strategic resources into a new national strategic planning and delivery unit to support local areas and strengthen capacity to deliver major projects.

The NHS Property Board should be the primary voice to the system on estate matters and should work with national bodies to ensure that the system receives clear and consistent messages about the importance of developing a modern fit for purpose estate, releasing land and addressing backlog maintenance.

The NHS Property Board should produce improved guidance on estates planning and disposals for the NHS, covering the scope of estates planning, accessing private sector expertise, models for affordable housing for NHS staff and partnerships with both housing associations and developers.

The NHS Property Board should produce improved guidance on building standards so they support the Five Year Forward View (5YFV) and deliver value for money. This should gather evidence on the most appropriate estate models through the vanguards programme and should prioritise new guidance on primary care facilities.

The NHS Property Board should improve transparency and intelligent use of data. This should include extending the minimum estates dataset to cover all NHS funded care, improving the quality of existing data collections and taking ownership for the future development of the benchmarking developed as part of this review.

The NHS Property Board, in partnership with other national bodies, should review processes to ensure they are proportionate and effective. It should particularly consider the business case process, which is often seen as cumbersome, and a block to estates development.

STPs should develop affordable estates and infrastructure plans, with an associated capital strategy, to deliver the 5YFV and address backlog maintenance. These plans should be supported by robust business cases. The new NHS Property Board should support the development of these plans.