• The AFO is a means by which the local healthcare system can access substantial cost-effective non-NHS funding to bring about the desired equalised modern fit-for-purpose community and primary care estate while still retaining ownership with increased operational flexibility.
   

• The AFO is a specialist locally owned property NHS (providing the leases and tenants) and Local Government (providing PWLB funding) Joint Venture. This combination of strategic and operational overlay across tenants, funders, commissioners, and development sites creates lower investment risk, which is passed on in the form of lower rents. It is also a social return vehicle, so it accepts lower than private sector profits reinvested in the AFO locality.
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• It is incredibly flexible to local needs and desires to match the health system’s planned development and, for instance, can draw down on commercial money markets, utilising a combination of local population investors, mezzanine and senior debt, in addition to core funding, whilst still locking in those lower costs.
   

• The AFO is Investment to Save by accessing lower fund costs and realising through funding Optimise’s (and more) Investment to Save opportunities.
   

• Integrated Care Systems staff time is boosted as they can deal directly with a fully funded AFO estate team working to system-agreed local strategies and operational flexibilities.
   

• Ownership is local and consistent, with more joined-up and extended local collaboration.
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• In many but not all cases, systems would be capable of realising their vision via an AFO. Still, they would benefit from having Optimise to speed up evidence and join those much-needed relationships.
  
  AFO In Action
   

• Health and Care Space Newham (read more here) was the UK’s first AFO, put in motion by IHP and established in 2009 as a JV between East London Foundation Trust and London Borough of Newham. Evidence of the scale of transformation scale is that this one Borough (Place) raised £140m capital to invest in primary care-community assets over ten years and £60m to create affordable keyworker accommodation. The AFO has been profitable and will earn social levels of return (HMT levels). Still, estate affordability was fundamentally changed as rents were reduced 15% below the DV market, underpinning alongside the joint strategy the ability to deliver the actual builds needed for modern healthcare across the Borough via a combination of existing and new core sites.
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• The JV’s Stakeholders Steering Group charged IHP with creating the business case and AFO financial-financing model that was approved by their respective boards and NHSEI, delivering the first operational site (a 24,000-list GP-Community site in an area of high population growth) and a development pipeline with an AFO budget-planning system before passing it over to locally appointed management. Because of opportunities identified within Newham, the resultant improved estate costs are not more than the original poor-quality estate.
  
   

Further AFO content

Coming Soon.