The NHS estate is ageing when the health service most needs efficiency for patient flow. Yet with the total costs of maintaining and running the NHS estate reaching £11.1 billion in 2022 – an 8.8% increase since 2020/21 – how can you make improvements with your current capacity? Read more to see four suggestions for meeting your PAM aims.
As an EFM leader, one of the most challenging aspects of your role is achieving the assurance and peace of mind that your department remains consistently compliant.
You need to maintain your estate according to the PAM1 (Premises Assurance Model), ensuring compliance across:
- Efficiency
- Safety
- Patient experience & flow
- Effectiveness
However, achieving that compliance as the NHS estate ages is ever more challenging.
For example, The National Audit Office found in 2020 that 14% of the estate pre-dated the formation of the NHS in 19482. An old estate and infrastructure that caused 5,348 clinical service incidents in 2021/222.
The NHS estate is ageing when the health service most needs efficiency. The elective backlog of seven million patients is at an all-time high3, only adding pressure on assets, facilities and people to perform.
A Director of Facilities outlines the importance of an efficient EFM team: “If the lights don't go on, then nothing can happen here, and the clinical teams cannot do their job”.4
Their comment depicts an almost symbiotic relationship between teams. One cannot function effectively without the other, and they must work together to ensure the hospital runs efficiently to allow patient flow.
Furthermore, the costs of maintaining the estate to even current standards are increasing:
- The total costs of maintaining and running the NHS estate were £11.1 billion in 2022. This is an 8.8% increase since 2020/215.
- The total energy usage from all energy sources across the NHS estate was 11.7 billion kWh in 2022. This is a 2.6% increase since 2020/215.
So further efficiencies need to be found within your current capacity, but how can you achieve them?
There are several solutions your Trust could implement to improve compliance and assurance across its estate, of which The Government Sourcing Playbook suggests outsourcing could be one6.
Below are the top four things you should consider as your Trust seeks ways to build a compliant estate that supports its PAM aims.
How could your Trust improve efficiency?
In the long-term plan, NHS England sets out a goal of achieving at least 1.1% increases in efficiency and productivity over each of the next five years7.
The Strategic Framework8 for the efficient management of NHS estates suggests some of the best ways to increase efficiency in your estate is through:
- Collaboration: Improving the cooperation between non-clinical and clinical teams improves communication across a Trust, leading to cultural change8.
- Environment: Improving signposting throughout your Trust to ensure patients and clinicians can find where they need to be quicker.
- Energy-use: Invest in more energy-efficient systems to reduce running costs and contribute to net-zero aims.
- Innovation: Invest in new technologies to promote innovative property solutions that make a real difference in patient care8.
- Data: Collect and analyse data about your estate to discover where you can find further efficiencies.
- Outsource: collaborative working and procurement can help with efficiencies, pool expertise, improve productivity, provide resilience and reduce carbon emissions from the activities provided8.
What could an outsourcer do to support your efficiency?
One of the biggest challenges within the NHS estate is moving people around it.
Portering is a critical component of flow within your Trust because your porters work to move patients, supplies and waste materials around your organisation. So if your porters are held up, most other aspects of your Trust will be too.
Therefore, consider whether your Trust has the right data about your portering teams to ensure they work as efficiently as possible.
Sodexo Health & Care has already succeeded in using new technology to improve the productivity of portering within the North Devon District Hospital9, which has helped them to edge closer to their net-zero targets while maintaining an excellent patient experience.
Our Portzo system is an innovative portering management solution that uses a Wi-Fi-based, real-time location system to improve the efficiency of the portering service and provide data for optimisation. Portzo digitalises the whole process, enabling staff to request a porter electronically on any Trust computer or tablet, with tasks automatically allocated to the nearest porter9.
By the end of the first three months, Portzo enabled North Devon District Hospital to see:
- 26.1% increase in completed tasks against the previous year
- 14% improvement in task response time
- 9% increase in average completed tasks per hour9
At Sodexo, we can use data like this across all portering tasks, including security, waste, linen management, window cleaning and pest control, to improve efficiency and support your Trust to enhance flow.
How could your Trust improve safety to drive efficiency?
Making your staff safer reduces the likelihood of workplace incidents and keeps your workforce more consistent and reliable, improving efficiency.
One of the most significant health & safety challenges within Trusts is whether they can strictly implement and adhere to best practices.
So how can you boost that capacity within the limits of your current people and assets?
You could consider:
- Diversifying the skill sets of your existing talent through training and graduate schemes.
- Linking skill sets with other Trusts to build a professional family to share information and resources.
- Collecting and adequately analysing health & safety data to find trends that might impact compliance and budget.
- How to best learn from health and safety issues and improve your practices, so understanding the rules and adherence to them becomes a core part of your workforce’s approach to their tasks.
How could a partner best support your health & safety?
As Sodexo has increased the amount of support provided to the healthcare sector, our philosophy has been to ingrain health & safety into everything. As part of this focus we empower our teams to prioritise their wellbeing.
When our colleagues are empowered they start:
- Listening to what they need to do in a safe and compliant manor
- Challenging existing procedures, thereby working more effectively and safely
- Focusing on the task at hand - becoming more productive.
As a result, fewer risks follow. Often accidents and incidents happen because not enough emphasis is placed on safety. Delivering information differently, such as communicating more dynamically in a more thought-provoking way, increases its importance within our teams.
This focus on health & safety has become ‘the way we do things’ and is now part of our company culture. Our employees receive task specific training, developed in conjunction with H&S leaders that teams can easily understand and implement in their working practices. This ensures key steps become automatic, rather than being considered ‘extra’ steps to completion.
Our recently formed ‘Safety Heroes’ scheme helps highlight incidents where our colleagues have used initiative to ensure safety. Recent examples include:
- Identifying a discrepancy with new allergen labels from a supplier
- Calling for advice when someone was trying to work outside the HACCP
- Consistently conducting excellent food safety investigations10
Alongside our Safety Heroes scheme, we also have ‘Safety Standing’ where teams within our organisation will stop for 15 minutes, providing time for colleagues to discuss and share their safety pledge for the year.
Additionally we have our ‘3 checks for safety’, which coupled with our ‘7 Safety Nets’, ensures that staff prepare appropriately, speak up and will not do a task if they believe it unsafe. Both the 3 Checks and 7 Safety Nets are designed to be easy to remember, which helps staff to comply with health and safety regulations.
We are committed to working with clients to understand why staff believe tasks may be unsafe, then supporting them to implement any necessary changes.
Sodexo also works to improve the safety of patients and teams directly. For example, Protecta+ offers a range of innovative equipment and technologies designed to minimise staff and patient infections from hospitals.
With Protecta+, we use things like:
- State-of-the-art robotic cleaning
- Advanced IT systems to create data-driven efficiencies
- Specialist training and certification
- Working with Trusts to develop an on-site academy
In the United States, Sodexo has been actively expanding the Protecta+ programme and has fully implemented it at 67 hospitals. As a result, these hospitals saw a 40% decrease in C. diff SIR11.
How could your Trust support effectiveness?
Does your Trust have the resources to ensure the ongoing maintenance of facilities that will not disrupt the efficacy of your staff or the patient experience?
There is a massive issue with backlog maintenance across the NHS. At the end of 2021, the estimated cost of the estate backlog stood at £9.2 billion12.
With such a huge amount of outstanding essential work to estate fabric and fixed assets it is inevitable that this can lead to clinical service failures, which in turn can lead to delays in treatment and patient flow.
The challenges are two-fold: a lack of physical resources to perform the maintenance and expertise to target activity and ensure best use of resource. Both are ultimately impacted by the financial and staffing challenges the NHS currently faces.
To properly manage the suitability of your buildings and the performance of your assets, you could consider:
- The whole-life costing of assets where possible. Making targeted investment decisions around asset performance to inform asset replacement.
- Whether you can collect data regarding critical assets that could provide information on what needs servicing and when, to guard against disruptive failures.
- Focussing maintenance around criticality of use and likelihood of failure to ensure regular maintenance is targeted for the most important assets.
- How much management bandwidth you have to assess, maintain and replace assets using internal resource vs outsourcing.
How could an outsourcer best support your effectiveness?
We recognise how difficult it might be to maintain an accurate list of assets or sufficient data on your estate. This challenge means you may have little reference as to the best place to invest money to maximise efficiency.
Sodexo can support you with hard FM and clinical technology management data.
Hard FM
Where Trusts make investments in a new estate or extensive refurbishment the Government Soft Landings process13 is a project requirement which brings a need for expertise and experience in Building Information Modelling (BIM)14. At Sodexo we have tried and tested capability and can help your Trust with things like interface between the Trust and the project designers / contractors on the journey from a built facility to an operational facility. Our experience with Operational BIM models, digital twins and the integration of Computerised Maintenance Management Systems (CMMS) will ensure a best in class operational FM model.
Clinical technology management
Sodexo’s clinical technology management service, MTS Health, provides data on every clinical asset within your organisation. It gives you a hierarchy of what needs fixing, where and when those items need fixing and which assets should be replaced.
Our inventory management ensures the regular capture of clinical equipment assets, either through RFID (Radio-frequency Identification) or by barcoding assets, and supports you with:
- Equipment condition surveys
- Standardisation of equipment
- Hospital-wide tagging of all clinical technology
- RFID GS1 solutions
- Database creation and maintenance
These audit and inventory services enable you to make critical clinical decisions based on robust insight founded on data gathered from over 20 whole-hospital asset audits.
Healthcare Procurement and Risk Management
MTS can also help your Trust with procurement: managing risk and improving outcomes through supplier selections and OEM contract management.
As a supplier and technology agnostic service, our clinical technology advisory solution provides the best recommendations for your organisation.
Working in partnership with your finance, procurement, clinical and technical stakeholders we assess the capabilities and performance of the market service providers.
Capital project equipping
MTS loans Trust Equipment Advisors to many of the National Hospital Programme Schemes, so it can also support you with business case planning for SOC, OBCs and FBC approvals.
Our system has been the market leader in planning, programming and equipping for new and refurbished hospital builds providing project management and technical skills to oversee the commissioning of assets.
By supporting your estate with equipment and asset management, procurement, risk management and capital project equipping, Sodexo’s MTS Health helps you to optimise clinical outcomes and ensure excellent patient care.
How could your Trust improve patient experience and flow?
93% of inpatients believe they are more likely to get better quicker and leave the hospital sooner if they have had a positive experience15.
While your clinical staff may glean face-to-face insights into how best to improve the patient experience, you'll need macro-level data from across your Trust to bring about the most effective, wide-reaching improvements.
However, to collect this data, you could consider whether:
- You have the resources to implement the systems needed to collect it
- You can train existing staff to use these systems
- This data collection needs to be done by your clinical team or non-clinical staff
- You have the procedures in place to act on feedback from data.
How could an outsourcer best support your patient experience and flow?
The latest digital data tools and technologies, such as Sodexo's Experiencia, enable healthcare providers to collect much richer unstructured data (for example, patient interviews) and structured data (for example, ranking services from 1-5)16.
For providers, platforms like Experiencia deliver the gold dust in knowing 'why' patients feel the way they do.
For example, inpatient feedback such as – “The ward feels clean in the mornings after the cleaning round. And the cleaners are so friendly and always have a smile. But it’s so busy that by the time lunch has passed, it just doesn’t feel so clean to me anymore” – you can then make changes such as adjusting cleaning times and increasing communication to let patients understand what’s happening16.
Hence, data collection through portering, health & safety, asset management and inpatient feedback supports the work between clinical and non-clinical teams. By asking, “are we still doing the right thing”, looking objectively at data and seeing where to make improvements, teams can come together to understand the collective challenge better and improve the patient experience.
If you understand why something works, you can learn from it, share it, and repeat it. And if you know why something doesn't work, with the proper support and capacity, you can implement the changes to make it better16.
Sodexo Health & Care
1. NHS England. (2022) Premises Assurance Model (PAM). London, NHS England. https://www.england.nhs.uk/wp-content/uploads/2022/07/B1763-Premises-Assurance-Model-NHS-PAM-V004.pdf
2. Barron, J. (2022) Crumbling buildings and creaking systems: does the NHS invest enough in capital? London, NHS Confederation. https://www.nhsconfed.org/articles/crumbling-buildings-and-creaking-systems-nhs-capital-investment
3. Morris, L. (2022) Elective waiting list hits seven million for first time ever. London, National Health Executive. https://www.nationalhealthexecutive.com/articles/elective-waiting-list-hits-seven-million-first-time-ever
4. Sodexo Health & Care. Teamwork in Healthcare - Case Study. London, Sodexo Health & Care.
5. NHS Digital. (2022) Estates Returns Information Collection. London, NHS Digital. https://digital.nhs.uk/data-and-information/publications/statistical/estates-returns-information-collection/england-2021-22
6. HM Government. (2022) The Sourcing Playbook. London, The Cabinet Office. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/987353/The_Sourcing_Playbook.pdf
7. NHS. (2022) Test 2: The NHS will achieve cash-releasing productivity growth of at least 1.1% per year. London, NHS. https://www.longtermplan.nhs.uk/online-version/chapter-6-taxpayers-investment-will-be-used-to-maximum-effect/test-2-the-nhs-will-achieve-cash-releasing-productivity-growth-of-at-least-1-1-per-year/
8. Department of Health. (2022) Strategic framework for the efficient management of healthcare estates and facilities. London, Cabinet Office. https://www.england.nhs.uk/wp-content/uploads/2021/05/HBN_08_Part_A.pdf
9. Sodexo Health & Care. (2021) Improving Portering Services at North District Hospital. London, Sodexo Health & Care.
10. Sodexo Health & Care. (2022) HSEQ Update Meeting - presentation. London, Sodexo Health & Care
11. Hossfelt, B. (2021) Reducing Healthcare: Associated Infections with Protecta ̈ Ð An Updated Analysis of Data. United States of America: Sodexo Health & Care.
12. The King's Fund. (2022) Latest on the NHS Estate. London, The King's Fund. https://www.kingsfund.org.uk/blog/2021/10/latest-nhs-estate
13. UK BIM Framework. Government Soft Landings Report: https://ukbimframework.org/wp-content/uploads/2019/11/GSL_Report_PrintVersion.pdf
14. GOV UK. (2022) The Building Safety Act. London, The Cabinet Office. https://www.gov.uk/guidance/the-building-safety-act
15. Sodexo Health & Care. (2021) YouGov research for Sodexo Health & Care. London, Sodexo Health & Care.
16. Sodexo Health & Care. (2021) The Power of Patient Feedback. London, Sodexo Health & Care.