Keeping the NHS cogs turning

Healthcare is never far from the media spotlight; fears over A&E capacity, waiting lists, administration issues and lack of funding serves to generate unwelcomed publicity. Regardless of the headlines though, the business of providing critical healthcare services to the people living, working and holidaying in UK continues 24/7.
    
On the front line, rightly taking the glory, are the clinical staff, but look behind them and there is an army of managers, administrators and technicians providing the critical systems maintenance, asset management, logistical and material support necessary that enables effective clinical care to be delivered where it is needed most.  
    
Facilities management (or FM) is a core element of the support services. Often part of an estate and property service department, almost always outsourced, the facilities management team cater for anything and everything in and around a hospital from the surrounding landscapes and car parks, the cleaning of the wards, provision of porter service and the physical maintenance of the actual hospital buildings and M&E equipment themselves.

IN THE MIDDLE OF IT ALL
This puts facilities management right in the middle of what is regarded as a complex environment. As individuals they are the silent heroes. Their role is to be diligent, customer service focussed and unseen. But if they get it wrong then, as an economic sector – the big outsource organisations – they instantly become a target. Cleaners, maintenance teams and engineers, often the unseen workers within a hospital, are an easy target, highlighting the noise and disruption in hospital wards and the dilapidation of the built fabric. This means there is no room for failure: 99.9 per cent is not good enough, service providers must through their expertise maintain an operational environment that is continuously running at 100 per cent. It means that FM is at the heart of UK healthcare, at the front line of service accountability and doing a critical job for our society as a whole – there is no place to hide.
    
That is one of the reasons why BIFM highlights the best organisations servicing our healthcare facilities. For example, VINCI Facilities recently won the FM excellence in a major project award for its work at St Helens and Whiston on Merseyside.

BUILDING TOGETHER
For the project at St Helen’s and Knowsley Teaching Hospitals NHS Trust, the company had a head start, as the FM team were involved from the outset of a scheme to create two new hospitals in 2002. Through PFI funding, the Trust appointed a New Hospitals Consortium; work began in 2004 with VINCI Construction (UK) responsible for the design and build of both hospitals, whilst VINCI Facilities provided hard FM services for interim and steady periods.
    
The two sister organisations worked together to embed FM into the building design. The brief was to plan, design, project manage and deliver comprehensive maintenance services to two modern hospitals – Whiston, an 80,000m2 acute general hospital, and St Helen’s, a 20,000m2 day treatment centre. There are 956 beds across the two sites.  

The first six-year ‘interim’ stage of the project required the company to develop solutions to 24/7/365 hard FM requirements that conformed to current legislation from the outset, while meeting complex patient, staff and visitor needs. These encompass the building fabric, mechanical and electrical (such as medical gasses, fire systems services), clinical and other waste removal, grounds and pest control.
    
Experience of working on PFI hospital builds at Princess Royal University Hospital, High Wycombe and Amersham Hospitals, helped inform decisions about products best suited to the environment, such as prefabricated bathroom pods and vinyl skirting boards. It also provided the teams with an insight into design elements that would benefit this project, such as incorporating segregated FM routes and zonal FM hubs.

ENERGY EFFICIENCY

Increasing sustainability was a key consideration, with long-lasting, energy‑efficient and minimal maintenance choices made for ventilation, lighting, heating and air-conditioning. Energy monitoring is achieved through 400 electrical meters feeding data to the VINCI Facilities’ in-house Technology Centre and regularly assessed to develop improvement strategies. In April 2013, further emphasis was placed on energy management with the launch of an innovative ‘emissions gain share’: where losses and gains in consumption are shared. The financial stakes serve to ensure both parties’ fulfil commitment to the goals.

A STRONG CULTURE
At the heart of successful facilities management in healthcare is a strong culture. Because it is ever present, FM helps to bind together the care provided by hospitals. Almost all of the non‑clinical employees are employed by an FM contractor in the NHS. When it is done well, facilities management in the NHS is not just a critical support service that backs up clinical and administrative staff in hospitals and healthcare centres across the UK – it plays a major role in adding value to the patient experience.
    
It is crucial to make sure that across the FM team there is a strong, robust and consistent system of behaviours and values. Healthcare is comparable to retail, where the customer is king and the experience of the retail consumer is paramount. No matter what their role or task, cleaning, catering, checking and fixing fire extinguishers, portable appliance testing, planned maintenance or critical plant maintenance, FM teams must put the needs of the patient and their relatives above everything else.
    
That means establishing a climate of collaboration and open communication  essential to ensure all user-groups at St Helen’s and Whiston – among them 42 Trust staff TUPED over to the VINCI team – could have their input. Focus groups were set-up to facilitate idea sharing, learning and risk management and a core FM group assessed the needs of hospital staff, patients and the community, and developed appropriate solutions. For example, discussions with patients led to the understanding that FM workers should minimise their presence on wards to protect the privacy and dignity of patients.
    
This approach is crucial to long term success and as part of the monitoring and control process VINCI set up to help improve performance, a centralised help desk was introduced. VINCI invested £300,000 developing a bespoke computer-aided facility management (CAFM) system to provide open book monitoring of response and rectification times against targets, with staff able to produce status reports on the move on personal digital assistants. It acts as the central hub of all FM activities and receives an average of 2,800 calls per month along with calls logged via a web based portal. Clinical staff are actively encouraged to log calls via the online helpdesk, which automatically feeds a job request to a pre programmed resource. This approach has been successful, with over 50 per cent of work requests processed via the web. The helpdesk function is exemplary in its resilience to increases in work volumes, with 98 per cent of calls answered within four seconds, and at peak times, within 15 seconds.
    
The scope of the ‘steady state’ 35-year FM contract, which started in January 2013, includes life cycle replacement programmes, ensuring a safe environment, providing logistical access for delivery of all FM services and asset and property management. And it is going well. Aside from the BIFM award, for the proof the formula is achieving its goals, look no further than the results of the new PLACE (Patient‑led Assessments of the Care Environment) surveys. This put Whiston top in the country in the acute care category, and St Helen’s third.

PUTTING THE PATIENT FIRST
A good facilities management service provider makes every effort to appreciate what is required to run a healthcare facility efficiently and effectively and to put the patient first  Nothing is taken for granted. This is critical to how the public judge our hospitals. Many people working within the NHS are not actually directly employed but, work for the various facilities management companies employed to deliver non-clinical and therefore, non-core services. But to the patients and their relatives receiving care and experiencing the non-clinical services it is all a core service. This means it is crucial that no matter how small it might appear, all of the non-clinical issues that arise within a hospital must be dealt with quickly and efficiently – because if they are not, then the end users’ experience of the whole healthcare environment is judged accordingly.
    
BIFM believes that FM service providers are making a positive difference to the healthcare environment. Consequently, FM is having a positive effect upon our society as a whole. But a lot more can be done right across the NHS if healthcare professionals and leading players and consultants in facilities management work even more closely together. If the two sectors work as a team, then the most important person, the patient, the end‑user will have the best possible experience, at a time when they are most vulnerable, during their stay in one of the country’s hospitals.

FURTHER INFORMATION
www.bifm.org.uk