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Ian Burden of Capita Health Partners, on behalf of BIFM, looks at how effective use of technology in facilities management can bring tangible benefits to the NHS.
The perennial issue for the facilities manager within the health sector is to ensure that buildings remain fit for purpose, cost effective and correctly located for the delivery of health services to patients. However, this also needs to be done against the backdrop of making £22 billion of savings and complying with new reviews and reports giving guidance on improving services. Perhaps the result will see more use of technology.
The NHS Five Year Forward View has provided an opportunity for the NHS to bring major changes to the way services are delivered with a strong sense of direction towards some recommended models. When combined with the findings of Lord Carter’s February 2016 review, the NHS has a good basis for facilities managers and estates teams in the NHS to start to develop and revise their individual estate strategies.
In June 2015 the Department of Health asked every Clinical Commissioning Group in England to develop a Local Estate Strategy. The development of these strategies, aligned with initiatives including the Vanguard and One Public Estate, attempts to ensure that the NHS estate is mapped and provides the framework for future adaptation in a meaningful and organised manner. But what are some of the problems that have been overcome and what is being achieved?
An overview of the estate is one where the system has become slightly divided, where providers and primary care occupy, acquire and dispose of their individual estates in a fragmented way alongside new bodies such as NHS Property Services and Community Health Partnerships. This does not provide the whole system solution which could deliver major savings which comes from a more central view of the estate as a whole. Having the opportunity to consider county and city wide strategies provides the opportunity to look at the regional estate in its totality, inside which the providers and primary care estate sit and where a more co-ordinated approach to the estate and investment in the estate can be taken.
Looking at the estate from the commissioning viewpoint, it is apparent that the disparate estates have competing agendas and abilities and, whilst there was a good level of information in some instances, many property decisions were being made on the basis of limited, or no property data. This has meant that in some instances where funds have been used to maintain poorer quality accommodation, with no awareness that a partner organisation may have a fit for purpose building nearby which is under-utilised.
Only through the comparison of data and mapping of the estate on Public Health England’s ‘SHAPE’ system, has it been possible to appreciate not only the extent of the estate, but its location and, through the use of dashboards, the lack of some information. The comparison of the dashboards is helping to identify where properties are replicated and, when combined with demographic and needs modelling, helps to target sites which can be rationalised and declared surplus, whilst also identifying the sites which will form the core estate for years to come.
As facilities managers will know, the result of a well formed strategy will help to underpin the decision making process on where and when investment is needed. This will be the case with the Local Estate Strategies where the integration of health and social care can more easily be brought together through the shared use of accommodation, very much in line with the One Public Estate. The strategies will help identify where the NHS could potentially release properties for the construction of new housing to help not only create savings and income for the NHS, but to help relieve the pressure on finding new housing sites – a long standing theme but with the potential to now start delivering a solution.
However, one of the enablers for many of these changes comes not from the properties themselves, but the ways in which they need to be utilised by staff and patients – the implementation of technology. The ability of staff and patients to interact in new and different ways from those currently, will be a fundamental change to the way in which health services can be delivered. This is a theme within the Five Year Forward View and is very clearly the way in which the sector will start to move in the coming years. This will affect the ways in which the estates will need to change and become more flexible, with a deeper understanding of the ways in which patients will be able to access services remotely and with staff working through flexible and mobile agile working models.
So how will buildings have to change to ensure that they remain fit for purpose, cost effective and correctly located for the delivery of health services to patients?
The Local Estate Strategies will provide the support and framework for the delivery of the efficient estate, but facility managers will have to ensure that their own strategies fall in to line as well. If the drive is to deliver more services through a technologically enabled service delivery plan, whether this is from patients accessing services or staff seeing patients in a wider range of locations, the facilities manager will need to start identifying the impact of delivering more technology enabled buildings. This does not only mean that buildings will need to have enhanced access to robust data cabling and a wireless systems at a basic level, it will also mean that the way in which the services are actually being delivered will force a change in the ways in which buildings need to be configured. There will be a greater dependency on being able to drop in to administration spaces, increased use of larger meeting rooms to provide team meetings and potentially a greater need for individual spaces to allow for video conferencing, with an improved and more accessible use of technology providing a robust and achievable solution than in the past.
With the drive to integrate social care services with health organisations, access arrangements to sites will form a key issue for the practical day to day use of buildings. From a security perspective, information contained on central systems will be covered by the host organisation, whereas the need to provide physical access to a number of partner organisations who can drop in and use flexible workspace will create a dilemma on how physical equipment and virtual access is made secure. Facilities are going to have to be far more accessible and ready to deal with a wider range of scenario’s including the use of accommodation to see patients, have team meetings and allow access to partner organisations. This will require a robust management solution to ensure that arrangements for accessing services is ‘open’ and yet still restrictive enough to protect staff and patients. Buildings will need to provide efficient accommodation which can not only provide optimal use of the space, but also ensures that sustainable and fit for purpose facilities are well maintained and supported.
The increase in utilisation of buildings from a number of organisations who may drop in, rather than specifically lease rooms, will need close monitoring and a clear pricing structure unless the commissioning bodies (NHS and partner organisations) are prepared to accept that the open use of facilities makes it difficult to easily allocate budgets required to maintain buildings. However, the biggest cost could be the initial installation and maintenance of the technology that will be required to maintain the shared access – this will mean that facilities managers will need to ensure that when considering their own estate strategies, the cost of providing the IT systems is identified at an early stage for funding purposes.
The role of facilities managers
A particular skill of facilities managers is to identify where and when resources will be required. The location of the estate, mapped against the Local Estate Strategies, may already be decided but the use of non-core facilities will require an informed approach in identifying and securing drop in accommodation and short leases in a range of properties.
The alignment of health and social care, alongside working with the One Public Estate may see a greater utilisation of properties including schools, libraries and other community facilities (enabled by mobile technology) and whilst these will be provided by other organisations, the NHS facilities manager will still need to be aware of where their services are located and need support.
In summary, the NHS is still making the drive to make the efficiencies which the government requires, but the greater direction from guidance documents, such as the Five Year Forward View and the Carter Review, alongside the new CCG Local Estate Strategies, is providing NHS facilities managers with an interesting set of new challenges, albeit with a better sense of direction. Facilities managers are well placed to take advantage of this opportunity due to their ability to look at a wide range of disparate issues and introduce a sustainable solution.
The British Institute of Facilities Management (BIFM) is the professional body for facilities management (FM). Founded in 1993, it promotes excellence in facilities management for the benefit of practitioners, the economy and society. It supports and represents over 16,000 members around the world.