NHS England is encouraging local trusts to capitalise on banks of land and under-used property to raise money, or provide additional services.
This strikes me as half a good idea. Yes, the NHS should not be hoarding enormously valuable land and real estate that could be put to better use.
But the initiative should not be slanted towards an ever-greater expansion of the NHS. It should instead be focused on inviting the private sector to unlock the value stored up in the land and property.
To illustrate the point, here are two potential outcomes:
Option 1: an NHS hospital, frustrated at its inability to discharge elderly patients quickly into independent care homes, decides to convert a hospital outbuilding into its own care home.
Option 2: an NHS trust sells off the same hospital outbuilding to an independent care home operator who converts it into a nursing home and runs it for profit.
Option 1 has obvious attractions, but must be avoided. It is often stated that the cost of an elderly person blocking an NHS bed is £4000 per week. I take this figure with a pinch of salt, because it is used as a stick to beat central government for more money, but there is no doubt that the cost to taxpayers of keeping older people in hospitals is up to four times more expensive than keeping them in privately run nursing homes.
Option 2 is by far the better choice. A privately run care home might cost the taxpayer £1000 per week for a resident with complex needs. With the right level of nursing care, the resident will be kept safe and comfortable in an environment that they would definitely choose over a hospital ward.
It is highly likely that the resident would, given the choice, choose to die in the care home. Care home owners that I speak to say that the overwhelming majority of residents have do not resuscitate orders in place, and plead to be allowed to die in the familiar surroundings of their care homes. They do not want to be in hospital.
So option 2 is better for residents, better for the taxpayers and better for care home operators that can make a profit from providing an appropriate service.
Which is why I will be so dismayed when – mark my words – the NHS plumps for option 1.