With the NHS under severe financial pressure, should we welcome plans to raise capital by selling off inefficiently used land and buildings owned by the health service? Experts debate the issue in The BMJ today.
Earlier this year, Sir Robert Naylor, national adviser on NHS property and estates, recommended that wasted NHS land and property ("estate") should be sold to fund essential backlog maintenance of existing buildings and deliver plans for a modern health service.
His review concluded that around an extra £10bn was needed to repair hospital buildings and replace essential medical equipment to improve patient care. Wasted land could be used to provide land for thousands of affordable new homes, particularly for NHS staff. The government appears to support the review and the investment required.
This is absolutely not privatisation or a "fire sale" but a reinvestment of wasted assets to improve patient care, stresses Naylor.
"Now is the time to rebuild the NHS to be fit for the future," he writes. "Significant service reconfigurations and new buildings are required to maximise value, led by local sustainability and transformation partnerships (STPs), with public support, engagement, and consultation through STP plans."
"As someone who has dedicated my working life to the NHS, I consider this a generational opportunity to sustain a fit for purpose, cost effective NHS estate, which can only be good news for patients and remain the envy of the world," he concludes.
But Kailash Chand, a GP in Manchester, worries that services could be threatened and that public consultation is lacking.
He casts doubt on this method of funding for what are obvious shortfalls in the health budget and he's concerned about the longer term strategy which should involve making maximum use of the NHS estates. A quick, short term fix could prove costly in the long run, he says.
He acknowledges that it should be acceptable to reinvest unused assets in health services, but says "we need urgently to take an honest look at the pressures facing the NHS, and guarantee any plans to transform care are evidence based and open to scrutiny."
He also points out that many trusts and foundation trusts "are deep in deficit, the STPs require the closure of services and the sale of infrastructure to produce savings which the BMA estimates at £26bn, with financial penalties for failure."
More broadly, "we should discuss why patients and doctors don't have the properly funded health service they deserve – with care, not cost cutting, at its core," he says.
"We should be standing firm against these changes before they are made and demanding that there is transparency, accountability, and a thorough evidence based assessment made of public service alternatives to this proposed dispersal of public assets into private hands," he concludes.