Is multi-million pound backlog a reality?

This article has beeen written in response to the current economic climate, coupled with the lack of understanding within the NHS relating to the limitations inherent within the national NHS guidance for assessing backlog maintenance. The combined effects will be significant for a Trust’s patient safety and business impact assessments, and could potentially have a major impact on its cash flow, estates and clinical strategy, and the maintenance specification for its infrastructure. An outline case study is presented from a large acute site with a reported £12 million backlog problem. When modern risk assessment techniques were employed, with the correct interpretations, the patient safety/business impactassessed risk was identified to be approximately a £0.5 m issue.

Background

The base document used throughout the NHS for assessing backlog maintenance needs is a risk-based methodology for establishing and maintaining backlog,1 which is well-presented, and clearly explains the approach to employ. The methodology recommended has stood the test of time, and proven to be an extremely valuable managerial tool, both locally and nationally. However there is a fundamental flaw in the way that most Trust senior managers have been presenting this information, and thus the interpretations applied to the data. The guidance recommends a detailed survey across a range of building and engineering infrastructure elements by competent people/companies. However, when this detailed data is analysed, it is apparent that it is only a high-level assessment. This initial survey should be followed by much more locally focused and detailed analysis into those areas suspected of generating significant and high levels of assessed risk, employing advanced risk assessment techniques accepted as best practice throughout industry and the academic world for many years. The result will then be an accurate picture with respect to time in relation to the assessed patient safety and business impact. This additional work should entail detailed assessment of each element/ sub-element, and in some cases sub/sub/ elements, as to the likely cause of its failure, the possibility of repair, impact of failure to the department being served considering the initial failure characteristics, and mean time to repair. This must be undertaken for the current building condition and (just as importantly) for, say, 10 years into the future. The data should then be converted into the national “5 x 5 criticality” grid-type design that senior managers would recognise, but with one major difference.