Creating an estate for a ‘critical consumer’

The conference facilitator Simon Fanshawe, a writer, broadcaster, consultant and non-executive director in both the public and private sectors, opened proceedings by highlighting the size of the challenge facing today’s estates and facilities managers, who he said faced the “very difficult task of ensuring a safer, cleaner, better maintained and more comfortable care environment than perhaps ever before” at a time when daily newspaper headlines were constantly trumpeting the current, and predicted, impact of the credit crunch on public services. In one of the three subsequent opening keynotes, HefmA national chair Kevin Oxley acknowledged that all the messages currently emanating from the Department of Health were about reducing spending, including, presumably, on key estates and facilities activities. However whereas previously this might have meant EFM units cutting back on areas of soft FM such as cleaning and catering, today’s much greater patient power, and the ever higher regulatory standards under which healthcare facilities must now operate, would “make it very difficult indeed” for estates managers to take such steps today. He told the conference: “I had dinner recently with Monitor’s executive chairman, Bill Moyes, who admitted that Monitor is very concerned about the impact of the current financial regime on the quality of the patient environment.” Given that capital budgets would “almost inevitably shrink”, but that high patient care standards would remain the NHS’s overriding priority, Kevin Oxley said Trusts generally, and estates and facilities managers particularly, would need to find ways to improve the quality of hospital buildings and services that did not involve significant spending, particularly via “further reductions in waste”, and improved efficiency. With an estimated 20% of the current NHS estate under-utilised, the service would also need to reduce its footprint, requiring EFM departments to think strategically about optimal building use, and about when, and how best, to dispose of surplus stock. Discussing the impact on estates strategies of the need to make high quality healthcare available to a wider populace was, appropriately (since the event was organised by HefmA’s London branch), a London-based speaker whose remit in advising the capital’s Mayor Boris Johnson on policy issues covers not only healthcare, but equally activities including transport infrastructure, land planning, and education.

Empowering indviduals

Beginning by discussing the difficulties faced by some of society’s most disadvantaged individuals in accessing healthcare, Alex Bax, the London Mayor’s senior policy advisor, used the analogy of a man rolling a large boulder up a hill, with the task further complicated both by wider issues such as poor education and employment prospects, and by lifestyle factors such as smoking and lack of exercise. While he said the health service and Government had a significant role to play in impressing upon individuals their own responsibility for health, it was also vital to empower the widest possible cross-section of society to have more control over their own healthcare. Critical to achieving this was availability of well- equipped, accessible healthcare facilities, a “basic right” much harder to enjoy in some parts of London than others, due, for example, to the significant variance in GP surgery numbers in different boroughs. While there were “no easy answers” to what might constitute the optimal UK healthcare estates model for the next decade, with debate “very much unresolved” on the merits of moving more care from today’s large acute facilities to community “polyclinics”, and centralising treatment of diseases like heart disease, there were already, he argued, many ways that improvements and modifications to existing healthcare buildings and grounds could positively impact on health. He explained: “One key way, which need not cost much, is to make cities more ‘friendly’ for walking and cycling, something that applies equally to the healthcare estate.” With many green spaces within hospital grounds currently under-utilised, the Greater London Authority (GLA) speaker said that, in many cases, it should not be difficult to turn green spaces into therapeutic areas, whether simply for patients to relax in, or to participate in activities like gardening, with its proven therapeutic benefits. With GLA research revealing that, in some London boroughs, 14-17% of 4-5 year-old children are already obese, he also questioned the need to continue using lifts in many hospitals, with it being ”far better to encourage people, where possible, to take the steps”.