The management of facilities and estates is a critical aspect of NHS organisations' operations. However, a decade of underinvestment coupled with challenges such as the pandemic and an aging population have left estate teams playing catch up instead of making proactive improvements.
Infrastructure problems have contributed to a maintenance backlog to the tune of £11.6bn. More worryingly, these same issues are causing more than 100 care disruptions every week.
In 2013 the Government introduced the Premises Assurance Model (PAM)
These problems have been recognised by the NHS Confederation, a membership organisation that represents and advocates for the entire healthcare system in England, Wales, and Northern Ireland.
In a recent report, one of its recommendations to the Government was to “develop a new long-term capital strategy that is more than just about fixing roofs – it is about investing in the entire NHS infrastructure, including its buildings, medical equipment, IT and digital tools.”
This sounds great but will take years to action if it does happen at all. So what can NHS estate teams do in the meantime to become more efficient?
Premises Assurance Model
In 2013 the Government introduced the Premises Assurance Model (PAM), a framework designed to support effective estate and facilities management. It provides a basis for NHS organisations to demonstrate to various stakeholders that their premises are safe and suitable for healthcare provision.
The model includes self-assessment questions grouped into five areas: Safety, Patient Experience, Efficiency, Effectiveness, and Organisational Governance.
A significant gap often exists between the knowledge levels of directors and facility managers on the ground when it comes to PAM implementation
By using PAM, NHS trusts can prioritise investment decisions effectively, measure compliance with legislation and guidance, and ensure robust systems are in place. The model is regularly updated to incorporate feedback, changes in policy, technology, and regulations to enhance its usefulness for trusts.
PAM was no doubt created with the best of intentions, but I and my colleagues have observed various challenges hindering the successful implementation of PAM within NHS Trusts.
Disconnect between stakeholders
A significant gap often exists between the knowledge levels of directors and facility managers on the ground when it comes to PAM implementation.
During meetings with NHS FM and estates teams, I have often witnessed a lack of awareness and understanding of the model. This knowledge gap hampers effective implementation and inhibits the ability of these teams to leverage the benefits of PAM.
One of the major obstacles faced by some NHS estate teams is the absence of centralised systems for estate data management
Furthermore, a lack of understanding about the specific data that needs to be reported, and more importantly, why it matters, further complicates the implementation process.
This lack of clarity makes it challenging for estate teams to allocate resources effectively, measure performance accurately, and make data-driven decisions.
Scattergun reporting
One of the major obstacles faced by some NHS estate teams is the absence of centralised systems for estate data management.
This makes it incredibly difficult to report accurate data each year. The reliance on disconnected spreadsheets, outdated systems, and manual processes results in inefficiencies, repeated data entry, and potential errors.
One of the big trends that I’m hearing from my NHS clients is the utilisation of space since the pandemic
This can even boil down to how different assets are named – one FM might use “bathroom” while another uses “toilet”, which means that the data is not showing a complete picture.
As a consequence, valuable time, effort, and resources are wasted.
Wasted space
One of the big trends that I’m hearing from my NHS clients is the utilisation of space since the pandemic.
There are now more remote calls and meetings, in addition to non-clinical staff working remotely, which has freed up space. Waiting areas are also often less busy as more appointments are booked online.
A better understanding of space utilisation can make for much stronger strategic decision-making
Any free space can typically be used to improve the patient experience and hospital capacity. Last year the National health Executive reported that the NHS could create space for 10,000 extra beds by storing patient records offsite.
A better understanding of space utilisation can make for much stronger strategic decision-making. PAM can help with this when it’s properly completed.
Actionable steps for NHS estate teams
It is crucial to raise awareness among all relevant stakeholders within NHS Trusts to ensure successful implementation of PAM.
This process can include tailored training sessions, informational campaigns, and workshops to empower directors and FM teams with the necessary knowledge and understanding of PAM's objectives, requirements and benefits.
Investing in FM software solutions can centralise and streamline data management and reporting processes.
These solutions provide real-time access to critical information, enhance collaboration among teams, and enable accurate reporting. Our QFM Space software allows users to create a matrix, pre-populate fields with existing data, determine costs and risks, and create a backlog.
With the many challenges facing the NHS not likely to disappear anytime soon, proactive estate management fuelled by data will be a vital tool for FMs
Having one central system to manage this data helps to prevent the duplication of tasks or manual, disjointed approaches that can often cause inefficiencies.
Furthermore, integration into CAFM software allows any resulting maintenance tasks to be allocated, completed and reported on, creating a fail-safe end-to-end solution for NHS trusts.
Train your teams on how to use your software and build a comprehensive understanding among FMs regarding the data that needs to be reported and the significance behind it. Choose a system that is as intuitive as possible, or people simply won’t use it.
Conclusion
Rather than viewing PAM reporting as an annual tick box exercise, take the opportunity to analyse and act on the data and insights that have been collected for the submission.
I’ve seen trusts employ FM software and realise a big ROI from just a few changes to areas such as asset management or space utilisation.
With the many challenges facing the NHS not likely to disappear anytime soon, proactive estate management fuelled by data will be a vital tool for FMs.
