A model approach to identifying priorities

Achartered engineer who began his NHS career as a maintenance electrician before going on to head up estates and facilities functions within the acute sector, and subsequently, in 2004, joining the Department of Health’s Estates and Facilities Division, Peter Sellars is today responsible for managing the DH’s “physical environment” policy initiatives, which include P21+, NHS Gateway Review, Physical Environment Sustainability, Premises Assurance, and NHS Informatics. Having “been there and faced the many challenges” of running a large hospital estate himself, he made clear early in our discussion his belief that, especially today, given the unprecedented media and public spotlight on issues such as minimising hospital-acquired infection rates, the NHS should “fully recognise the impact that a clean, safe, well-run, and well-maintained healthcare environment can have on patient-centred care, supporting recovery, and thus improving future wellbeing”. He said: “Patients deserve to receive services that meet both high NHS standards and their expectations, and this also includes the physical environment from which these services are delivered. The Premises Assurance Model is, in my opinion, an excellent starting point for commissioners and providers to demonstrate how their healthcare environments contribute to healthcare delivery and improved patient outcomes on the one hand, but also, on a wider scale, how these environments could support a public health agenda focusing on empowering patients and the public with real choice and supporting healthier options and decision-making (see Fig. 1). “By means of the Model,” he continued, “commissioners and providers will be able to assemble a body of environmental evidence in one place for strategic, informed decision-making, and improving how public healthcare assets contribute to the wider environment of the country, supporting long-term health and wellbeing choices.” The “challenge of getting estates issues onto a typical Board’s radar” was, Peter Sellars believed, reason enough alone for the introduction of the new Premises Assurance Model, but it would also, he explained, provide NHS Trust boards for the first time with “important productivity and quality information”, along with peer comparison, integrated with their “core business objectives of providing high quality healthcare in a challenging environment”. NHS PAM’s key objectives would furthermore, he believed, accord strongly with the drive for greater efficiency being demanded from estates and facilities teams as part of wider NHS efforts to manage within the challenging financial climate over forthcoming years. Despite the need for savings, there would, he believed, be no let-up in the ongoing pressure on EFM teams to further improve the patient care environment “to respond to the everincreasing demands which new treatments, medicines, and technology, bring”. This would mean estates personnel not only “working smarter”, for example via more efficient and productive use of space, but equally bringing to their boards’ attention instances where the care environment is falling short of NHS standards.

Bringing the data together

While there had, in recent years, been many different systems in place for collating and analysing data on the condition and functionality of the NHS estate, Peter Sellars said he believed that, prior to the NHS PAM’s introduction, none had properly brought together all the data in a coherent, cohesive form. He said: “NHS Trust boards now have available the means for a nationally consistent approach to examining performance and delivering assurance developed by the NHS to reduce central bureaucracy, and be operationally fit-for-purpose as a high quality frontline management information tool. The NHS PAM is about demonstrating to NHS Trust boards, via solid, documented evidence, key areas for improvement action where clinical and management frontline teams should focus efforts to ensure that patient care and safety do not suffer in the future. “Now, for the first time, an estates manager can download a computer model which, via the answering of a number of simple questions about the key systems, procedures, and processes, they already have in place, will provide them with a highly accurate snapshot not just of the general condition of the facilities across their estate, but equally of how the ‘state’ of those buildings, and their team’s efficiency and ‘cost-effectiveness’ in running and maintaining them, compare with those of their peers.” The NHS developed the Model, supported by the Department of Health, Peter Sellars went on to explain, working closely with a wide range of different NHS staff, not only to identify the elements that estates, clinical, nursing, and other key players felt should be included, but also, more recently, by “testing” it with a number of NHS Trusts (including Foundation Trusts), and subsequently fine-tuning it to reflect the considerable feedback received. He went on to say he felt there was “every indication that the need for substantial public sector productivity improvement and public sector savings over the next 3-5 years will see immense pressure on the NHS to reduce its costs by whatever means possible”, and that this will “undoubtedly necessitate greater overall productivity and efficiency”. Given the drive for reinvestment of efficiency gains back into frontline services to continually drive up productivity, he said it would be “important not to ignore the physical environment’s contribution”, and to “maintain the standards and quality that a more informed public now expect”. “This efficiency drive makes good sense, but how will any commissioner and provider team be able to really optimise the productivity of their operations without a sound platform of accurate, up-to-date, and comprehensive information on which to base any action?” he asked. “This is what the NHS PAM starts to provide.