Community mental health services are at the heart of the NHS Long Term Plan. And a key objective is the development of new and integrated models of primary and community mental care to support people with severe psychiatric illnesses. To meet this challenge, service providers are being supported to move their core community mental health teams towards new place-based, multidisciplinary services across health and social care, aligned with primary care networks.

FINDING SPACE

This model of care is led by clinicians, commissioners, practitioners, managers, and service users. But, clearly, the estate plays a key role in its successful implementation. Moving towards a new and modernised community estate, while also integrating mental health, physical health, and social care, is not straightforward, though. The first step is getting a clear understanding of space requirements. Do clinical leaders know how many consulting rooms, clinic rooms, and group rooms each of their services need? Then, equipped with a clear brief of the space and locational requirements, the first place to look is within existing health estates. Making full use of existing estate, especially good-quality estate, should be the priority, and the adoption of agile working principles is essential to making this work. By speaking with the relevant ICS estates lead you can establish a systemwide view of possible opportunities within the existing health estate. You then need to attend your Local Estates Forum and communicate the requirement to local health and social care partners.

A CHANGE OF USE

If there is no appropriate space within the existing health estate, there are alternatives. Amendments to the Town and Country Planning (Use Classes) Order 1987 mean offices can now be converted to health clinics without requiring a Change of Use application. But, when considering the conversion of an office to a community mental health clinic, it is important to get a clear understanding of constraints. Is the office multi-tenanted? If so, can the clinical teams share an entrance with the other tenants, or is a separate entrance required? Does the office offer an opportunity to consolidate multiple clinical teams at scale, with clinical on the lower floors and workspace on the upper floors? Do any of the clinical teams require access to a pool car parked onsite? What are the opening hours of the office, and do they align with the operating hours of the services? And, in what condition is the office being let? It is also vital to consider public transport links here.

SHOPPING FOR HEALTH

Finding suitable properties on the high street can be challenging. Often high street retail units have a single frontage, making it difficult to bring natural light into the property once subdivided. And retail units with flatted residential units above often suffer from leaks coming in through the ceiling from the flats, which can lead to frequent and costly repairs. Retail isn’t all bad, though. If you can find a unit which lends itself well to being reconfigured as a health clinic, the occupational costs are often competitive with offices, and they are usually centrally located with good transport links. The ideal lease length for these arrangements is a 5-10-year term with break options linked to the service contract throughout the term, depending on the level of flexibility required. Meanwhile schools should be considered for Child and Adolescent Mental Health Services (CAMHS) as these create a brilliant opportunity to co-locate services in age-appropriate facilities. Engaging with your local authority is your first point of contact in this case. But be aware though that a Change of Use application will be required in this case and that will take a minimum of eight weeks, often longer.

BEWARE OF THE PITFALLS

Across all property types, there are several other pitfalls to be aware of:

• Fit-out and lease-end dilapidation reinstatement costs: The capital departmental expenditure limit limits the amount of capital that can be spent by an NHS trust in any financial year, so trusts will need to ask whether the landlord will undertake fitout works on their behalf. This could then be paid for in the form of a lease premium, which accountants may be able to treat as revenue spread over the lease term. Or the landlord may undertake the works in exchange for a higher headline rent

• Revenue funding: Is the space for new, or expanded, clinical services? Do they have an allowance for premises costs? This is often underestimated as part of the tender process, and therefore underfunded

• Ongoing maintenance: If you, as the tenant, are responsible for repairs and maintenance, will your inhouse facilities management teams be able to take this on? If the property is an outlier geographically, will a third-party FM team need to be procured?

• External mechanical plant and duct routes: Is air conditioning required for the storage of medication, or within a clinic room. If so, where will the duct be routed and the mechanical plant be located, and what permissions might be required? This can be a particular challenge in high street retail locations where the unit might be sandwiched by properties under different ownership

• What is the lead time for bringing IT network connectivity into the building? Is there a line already serving the building, or will your provider have to bring one in? Engage your IT team as early in the process as possible, ideally as soon as a potential site is identified.