High-level estates personnel from England, Scotland, Wales and Northern Ireland discussed some of the key challenges facing healthcare estates teams at a seminar, “The top five issues from a national perspective”, staged before the 2009 IHEEM AGM in London. Jonathan Baillie reports.
Opening speaker and IHEEM president Rob Smith, director of Gateway Review, Estates and Facilities Division, at the Department of Health, said that, while public perceptions of the NHS were currently the highest he had ever experienced, today’s estates professionals faced “huge challenges”, with hospitals increasingly judged not just on clinical standards, but equally on the environment within which care is delivered. Payment by results, and growing choice of treatment location, only fuelled such pressures, all at a time when capital investment was being “smashed” and revenue “seeing a downturn”. He elaborated: “From 2011, I believe we may see annual revenue growth of just 0.7%, compared with the 5-6% growth we’re used to. This will mean estates teams delivering improvements though innovation. However it will also mean us standing our ground and telling boards that patient safety will suffer if budgets are pared beyond a certain point.” Estates professionals were also “being challenged by ever tougher environmental targets”. For instance English NHS organisations must reduce carbon emissions by 80% by 2050. Sustainability was also a major theme for Paul Kingsmore, director of Health Facilities Scotland (HFS). In future he believed that, during the planned performance review of every Scottish health board, Scottish Health Minister Nicola Sturgeon would “sit down with CEOs and ask boards upfront” specifically about their progress towards meeting carbon reduction targets.
Asset management focus
With standards of asset management in Scotland “historically poor” all health boards would also be subject to closer scrutiny, “all tied in with a new performance management scheme”. He said: “While a lot of eyes have been on clinical, catering and cleaning standards to date, in future we can expect a stronger focus on how well we deliver our estates service more widely.” While Scotland had “led the way” on decontamination, too many such facilities were not meeting the latest standards, an especially worrying trend with some experts predicting another wave of variant CJD could surface soon. The HCAI agenda was also “driving substantial change” in estates and facilities activities. Around 9% of those patients currently entering Scottish hospitals were still dying; “in many cases, entirely preventable deaths”. Neil Davies, director of Welsh Health Estates (WHE), said his biggest challenge was “making the Welsh healthcare estate world-class by 2015”, an “extremely tough target” given that backlog estate maintenance in Wales currently lagged “some considerable way behind England, Scotland and Northern Ireland”. Echoing many of his counterparts’ comments, he said another issue for estates personnel was that, with increasing migration of services to the primary care sector, the equipment left in large acute hospitals was becoming “increasingly hi-tech”, requiring high levels of engineering expertise to maintain it. Growth in such equipment’s use would also almost inevitably lead to increased energy use, “directly counter to government policy”.
Streamlined services
More positively, the current reorganisation of the Welsh healthcare system “should help streamline services and enhance healthcare delivery”. He was also encouraged that the Welsh healthcare estates sector had retained “a good core of engineering expertise”. He was still not clear how the current “economic crisis” would affect Wales, although some estimates suggested a £500 m reduction in spending over the next five years. Other challenges included rationalisation of smaller hospitals, and the need to deliver more complex commissioning and procurement. In future estates personnel would also, he believed, see more emphasis on demonstrating the physical benefits of capital spending. With an ageing estate there would also be increasing focus on health & safety, effective risk management, and governance arrangements, plus greater onus on estates professionals to make themselves heard at board level. Neil Davies said the Welsh Assembly Government had a statutory obligation to promote sustainability, which was “filtering down to estates departments”, not only in terms of mounting pressure to cut energy consumption, but equally to recruit local personnel and use locally sourced materials.
Continuing funding need
The final speaker, Gordon McKeown, former head of estates at the Belfast Royal Hospitals Trust, said he feared both nursing and estates personnel “might feel intimidated” about raising estates-related concerns because of the “bullying culture” in some healthcare organisations. Nevertheless, like his counterparts, he stressed the “fundamental need” for senior estates personnel to “continue to take the lead in flagging up the importance of continued funding for estates improvements to ensure patients receive the high standard of care they expect in buildings that are genuinely fit for purpose”. Despite, or indeed because of, the tough economic times, he believed such individuals had “an unprecedented opportunity to make a difference to the overall patient experience”.
