Emergence of the ‘Integrator’ model

Over the past four decades the delivery of estates and facilities management services to NHS Trusts has evolved considerably, with a number of different models now used in today’s market. Here, Colin Kenton, MD, FM services, at KBR, a ‘global provider of differentiated professional services and technologies across the asset and programme lifecycle’, looks back at this changing scene, and discusses an emerging ‘Estates Integrator’ model. As he explains, its basis is the concept of an external ‘Intelligent Client Unit’, independent of client and supplier, which can provide impartial advice on everything from supplier performance to how to get the most out of buildings and other ‘assets’.

Looking back 40 years, the delivery of estates and facilities management across the NHS was a largely in-house affair. Hospitals, GP practices, health centres, and laboratories, directly employed cleaners, porters, maintenance engineers, handymen, and catering staff, with FM teams only turning to contractors for specialist work such as lift or airconditioning maintenance. As the NHS has faced increased demands, however, delivery models have changed. 

In the early 1980s, the concept of competitive tendering was introduced into some hospitals for cleaning, catering, and other ancillary non-medical services, with these contracts often won by small, local businesses. This model then continued to evolve, and during the early 1990s the NHS and Community Care Act introduced an internal market into the provision of healthcare, and made the state an ‘enabler’, rather than a ‘supplier’, of services, which encouraged further outsourcing. The Private Finance Initiative followed in 1992, extending NHS outsourcing into a much wider market, which saw the funding, design, construction, and running of a new generation of healthcare buildings. At the time this was seen as a partnership between the Government and the private sector. This also brought about another change, as the consortia investing in the PFI initiatives often included larger service-providers, and there was a move away from the smaller suppliers. Since the 1980s the NHS has witnessed a major increase in the contracting out of both clinical and administrative services, and in the last 10-15 years a handful of large facilities management companies have majored on healthcare provision and brought new expertise and strategic planning to the sector.