Brent disabled advocacy voluntary organisation faces closure as a result of NHS Estates income maximisation

 Nearly a year after I published concerns that Brent Advocacy Concerns would lose its space at the PFI Willesden Health and Care Centre LINK as a result of the NHS Estates policy of gaining market rates for its property LINK the situation has not been resolved, and if anything has worsened. As a small voluntary organisation BAC is unable to afford the market rate plus rent demanded,

Despite 'good intentions' voiced by NHSPS, Brent CCG and Brent CVS to help Brent Advocacy Concerns I understand that Burnley Medical Practice will be relocating to the space that houses  Brent BAC with premises that will be designed for 12,000 patients.  Work is due to start in January 2018.

Brent Advocacy Concerns, a voluntary organisation will have to close or move, but state that 'nobody, including Brent Clinical Commissioning Group, will tell us anything.'

BAC's webpage LINK sets out the benefits of advocacy:

Advocacy is about making sure that you as a disabled person can make your voice heard, especially when dealing with local services and the health and benefits systems.

Advocates are likely to have first-hand knowledge and experience of what you’re going through, and are well-equipped to help you get your point across. They might work with you one-to-one, or link you with a group of similar people; they might be needed for a short time of crisis, or for providing longer-term support.

Everyone’s situation is different, and the aim is always to find the best solution for each individual. We believe that every disabled person has the right to be properly heard, and to have choice and control over their lives.

It would be a shame if the income maximisation policy of NHS Estates and the repercussions of PFI deprive Brent residents of this service.

Brent voluntary organisations face crisis as NHS Estate's Market Rent policy is implemented

The NHS Estates programme is scheduled to be completed by June 2017, according to their website which will mean 6 or 7 Brent voluntary organisations providing back-up health services will be faced with paying market rents from April 2017.

Many will not be able to afford them and will be faced with finding new bases despite the Sustainability and Transformation Plan being based on collaboration enhanced by location in the same premises.

At a previous Scrutiny Meeting, it was reported that The Willesden Centre for Health and Care (with its PFI legacy) was "presenting a particular challenge" but the Brent CCG also reported "that plans were in place" to sort it out.  The CCG agreed to "detail in its commissioning intentions how it will use the Estates strategy to support and enable the voluntary sector" (Agenda item 5, NHS  Estate in Brent, 23/11/16.)

Brent Advocacy Concerns, one of the voluntary organisations affected, has approached Brent Healthwatch and Brent CVS for assistance, so far without success. 

Assurances had been given when I raised the issue previously that assistance would be given to voluntary organisation to enable them to be part of contracted services. access grants to enable them to be able to pay market rents, improve their financial viability or to share sessional space at centres.  So far none of these options have resulted in concrete proposals.

Brent Advocacy Concern meet tomorrow lunchtime with the shadow of closure hanging over them with little information on which to plan their future.

NHS market rent demand threatens the future of Brent Advocacy Concern

I asked to speak at the Brent Health and Wellbeing Board  yesterday on behalf of Brent Advocacy Concern who were at another meeting, as were Cllr Butt, Leader of the Council and Cllr McLennan, Deputy Leader.

Chair Cllr Hirani, who has the discretion to allow speakers, refused my request on the ground that I had not given 24 hours notice.

My request was in response to a request from Brent Advocacy Concern, a 25 year old charity in Brent, who work with people with disabilities.

NHS England, through NHS Estates, are now charging 'market' rents on spaces in their property and this is impacting on many charities and voluntary organisations who work on health issues.  As the STP proposals involve working in 'Hubs' bringing together different services, including voluntary organisations, this is clearly an issue.

You cannot have a policy of working with voluntary organisations and then pricing them out.  This impacts on the whole strategy of prevention and out of hospital care.

Brent Advocacy Concern received a letter from NHS England on January 11th, which had been sent to all Clinical Commissioning Groups, including Brent, about the move towards market rents.

John Healy of BAC wrote to me:

In order to stay in our office we know that we will have to pay 'rent' on the space. We will also be required to pay for 'capital costs'. Then comes the 'services charges'. Followed by the 10% Management fee. And finally  another 5% Management fee towards the overall lease. There may be other charges such as VAT but as a charity we might be exempt.

I cannot make it myself tonight, as I am booked for a council meeting at the same time.
Anyway, we will have been providing services in Brent continuously for over 25 years (we became a registered charity in Jan. 1991) but we will have to close down as soon as the NHS ASKS FOR THE MONEY.  So far they have not told us anything but I am expecting 'the bad news' anytime soon.

Maybe you or someone could ask a question as to what help might be offered to help small charities to stay within NHS properties such as The Willesden Centre for Health & Care.

That was the question I wanted to ask as it clearly affects more than just Brent Advocacy Concern. The organisation contacted Brent Healthwatch after the publication of an article outlining their situation on this blog LINK but received no response.  I spoke to Healthwatch at the meeting and gave them more details and hope that this results in some action, or at least a recognition of the problem.

John Healy added today (Wednesday):

At the last Community &Wellbeing Scrutiny Committee meeting on the 23rd of November, 2016 it was resolved that:-

(1) "Brent CCG together with NHS Property Services Ltd. develop 'a social value' policy detailing how to maximise use of void space in NHS buildings by the voluntary sector" Agenda item 5, 'NHS Estate in Brent'.

A RESOURCE THEY MIGHT FIND USEFUL CAN BE FOUND AT:-

How to keep it local--- A 5 step guide for councillors & commissioners.  It covers The Social Value Act

and it can be obtained from

Locality.org.uk

NHS Estates siphoning of £2 million a year from Brent health and care budget

Willesden Centre for Health and Care

NHS England policy that health organisations should pay market rent for NHS Property means that Brent Clinical Commissioning Group is paying £2 million annually for spaces (voids) that are not being used, Cllr Nerva established at the Community and Wellbeing Scrutiny Committee on Wednesday.

The Willesden Centre, built under the Private Finance Initiative costs £6.5 million a year with a void of £1m and other property voids gives a total of £2m. PFI costs were higher with additional ad hoc charges.

Monks Park is a joint local authority - NHS PFI initiative and the rents have been too high for most user organisations.

It is of course banks and shadowy investment trusts that profit from PFIs. LINK 
 LINK   LINK

Source

Earlier this year, following the release of the Panama Papers it was revealed that Chris Hudson, a property developer and the owner of 100,000 British homes, helped finance the building of the Willesden Centre for Health and Care in a Public Private Partnership deal. He set up the Yarrow foundation in Panama, which records show transferred €85,000 into his personal account and made available €115,000 to buy a Boeing 747 jumbo jet.

The Brent Clinical Commissioning Group (CCG) has to pay the market rent for the spaces whether or not they are occupied.  This is money that could otherwise contribute to the health and care budget.  The CCG is attempting to gather all out of hospital services in one of three centres. Some hospital services were over crowded and could use any spaces released spaces on their sites.

Councillors were told that NHS Estate advisers were experts in their field:

Health estate is a market of its own own. Our advisers are expert at health provision. They may be more expensive than other properties and not economically viable for general office space, but there are benefits of proximity to other health users.

When a councillor asked why the CCG should pay for space it wasn't using Sarah Mansuralli, Chief Operating Officer of the CCG replied, 'You may well ask - but that is the policy.'

Cllr Lesley Jones asked if there was any discretion over voluntary organisations having to pay market rents, giving the example of Brent Carers forced out of the Wembley Centre by higher rents.
Mansuralli said she would like to support voluntary organisations but it was difficult to have space occupied by a voluntary organisation that even with a subsidy would not be able to afford the rent. The CCG could not subsidise fully and also close the financial void.  She was willing to look to see whether some space could be used on a sessional basis, when other users were not using it.

Mansuralli added that Brent CVS were working with voluntary organisations to help them develop the capacity to afford the rents.

The practical impact of this can be seen in the case of Brent Advocacy Concerns LINK who have sent me this email about their situation:

I attended the meeting with our NHS landlords last Tuesday and received a 'fair hearing' but they only told us what we already knew.  That at some point in the future we will be sent the rent and service charges that we will have to pay to stay in our office.  The manager present said that her 'pay scale' did not allow her to make the final decision on our situation.

I just had a phone conversation with a disabled lady from Brent.  She needed face to face advice to help her with filling out her PIP FORMS. She had tried the council first at the Civic Centre in Brent who could not help her and they sent her to Brent CAB, who after a whole morning could not help her either and they gave her our number.  I offered to help her if she could come to our office this afternoon but she wanted an appointment for next week which I could not offer her, as my own health issues might cause me to miss it.  I then told her to try Brent Age UK but she had already tried them without success.

So my question is, where in Brent can she get face to face advice, as she told me she has both physical and mental health issues?

It is clear that voluntary organisations provide an essential service, that in the long term saves the NHS money, but the operation of 'the market' means that they cannot be accommodated in NHS or local authority property due to the monetisation of these estates.

Given these examples the Scrutiny Committee's recommendation that the  'social value' of organisations should be taken into account when filling voids will appear to have little traction.

Cllr Rita Conneely  asked about joint working between the regeneration and planning teams and health.  She was told that the council's strategy and the local development framework explored section 106 opportunities regarding local health care.

Conneely said that some developments had been ear-marked for primary health use and then were not occupied by them. This had been a contractual agreement with developers and so we ended up losing valuable community space.  She was told that the CCG was aware that this had been the case in the past with the primary care estate. These had been small spaces but larger spaces were needed to deliver at scale and thus be sustainable.

Conneely pursued this issue stating that the NHS Estates document had not designated South Kilburn a growth area despite its regeneration. The original idea was that young families would move in but rents were so high that they were not available for starter families.  Sarah Mansuralli answered that plans were made around 'units' and health impact studies for each area using Wembley growth as a model.

The Committee recommended that the needs of South Kilburn as a growth area should be factored into plans.

Cllr Hector raised doubts about the population data that was being used which apparently showed a decline in the population of Willesden and appeared to neglect the fringes of the borough. She was told that GLA data was used but it did not cover everything. Cllr Conneely asked if the CCG was looking at concentrations of older people in particular parts of the borough.  he was told that this was not easy because there was a diversity of population and age groups within single area. There was an annual review of GP surgery provision in terms of population growth.

The Committee Chair, Councillor Ketan Sheth, asked why three hubs had been chosen.  He was told that this was based on existing estates that could be expanded. Sarah Mansurali had spoken with Carolyn Downs, Brent CEO, about why Brent had three when some other boroughs have one, and others have five. There would be a review to see if this was appropriate.

The Committee recommended that much clearer consultation procedures on the use of NHS Estates should be adopted.

Early warning: During the meeting Cllr Hirani, Cabinet lead member for Community Wellbeing, seemed quite happy at the prospect of building on the Vale Farm playing fields when discussing the One Estate (combination of Council and NHS estates) strategy. Watch out!

A 2013 Panorama on PFIs as a scam can be found HERE