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Addressing the Maintenance Backlog in NHS Estates and Across the Public Sector

The NHS has one of the largest property portfolios of any organisation in the world. In England alone, it owns more than 130,000 buildings with a combined floor space of approximately 42 billion sq ft. The maintenance backlog is a growing problem for all public service organisations. In the NHS, it’s estimated that there is a £5 billion shortfall in maintenance spending across trusts and primary care sites. These facilities are continuing to age and new challenges have been created by the emergence of digital technology. The maintenance and estate issues that are plagued by the NHS are not unique to the organisation as many buildings across the public estate are facing similar challenges.

Estates Strategies across Government & the NHS

The NHS Estates Strategy is the centrepiece of NHS England’s approach to facilities management and the operation of the estate. The strategy outlines the role of the NHS in the delivery of its buildings and infrastructure, and how the different partners work together. The strategy, which is implemented across England, is a response to the challenges posed to the NHS by the rising number of people, the ageing population, and the growth in digital technology. The government recently announced their 2022-2030 property strategy which looks at how to create a more efficient, effective, and sustainable public estate. The strategy outlined three missions including: transforming places and services, a smaller, better and greener public estate and improving professional excellence and insight. Both strategies are designed to support an NHS and public estate that is fit for the future, and to be the blueprint for how organisations will operate their estate.

Smart Building Frameworks

Smart Buildings refer to buildings that are designed, built, operated and connected in order to reduce the cost of operations, minimise the risk of disruption, and lower carbon emissions. NHS England has been working with the Department of Health and Social Care, the NHS Trust Development Authority, NHS Improvement, the Health and Safety Executive and others to develop the NHS Smart Building Framework. This is a set of objectives that will be used to drive forward the transformation of the health estate into smarter buildings that will deliver these benefits. The framework will be used to assess and award buildings that are designed to meet the highest standards in terms of performance, health, safety and sustainability. These will then be used as a model for the transformation of the health estate. The framework includes a set of 25 health, safety, and sustainability outcomes for buildings, 10 service delivery objectives, and five design and construction objectives. Smart Buildings are not only being trialled at the NHS but across the public sector, the Crown Commercial Service, a strategic partner at Smart 2022, has dedicated Smart solutions frameworks to help organisations make the transition.

Sustainable Design and Facilities Management

Sustainable design and construction – as well as operation, maintenance, and decommissioning – is at the heart of the NHS estates strategy. It is important, as this will ensure that assets are fit for the future with a longer lifecycle, as well as reduce the energy required to provide the same level of services. Healthcare facilities are complex and interdependent environments, and they need to be designed and managed according to the specific needs of the healthcare setting.

However, it is important to understand that sustainable design is not merely an aesthetic choice. Sustainable design practices are a means of reducing costs and improving efficiency and performance, whilst also reducing the environmental impact of NHS facilities. The adoption of sustainable design and building practices can be expected to have a significant impact on the maintenance backlog, as well as future performance, operations, and sustainability of NHS facilities.

Digitalisation in Facilities Management

Whilst sustainable design will directly impact upon the maintenance backlog, the emergence of digital technology heralds a new wave of challenges and opportunities in NHS Facilities Management. As the NHS has already committed to reducing the amount of CO2 produced by its activities, it is therefore developing strategies and targets of how it will reduce the amount of electricity it uses. One of the key methods to reduce the amount of electricity being used is by increasing the energy efficiency of the buildings that house vital equipment and assets. For example, the rise of smart meters in electrical infrastructure has created new opportunities to improve energy efficiency. As a large institution, the NHS is uniquely positioned to demonstrate leadership on this issue. It can show the rest of the world how to reduce the amount of CO2 produced by electricity and set an example of how important it is to reduce our dependence on fossil fuels.

Another conversation that spans across the entire public sector is the use of PropTech and how this can aid with property performance to reduce costs and reach sustainability targets. It can help with analysis for smarter decisions and modernising property management. This engaging conversation at Smart 2022 will feature Christopher King of NHS Property Services, to share not only what the NHS is doing, but understand what else is available and already utilised across other sectors.

CAD/CIM - Computer Aided Design and Computer Aided Manufacturing are essential tools for developing and managing the design process of a building. It allows engineers to design the building in a virtual environment and identify and address any potential issues with the building before construction begins. This will ensure that the finished building will be fit for purpose and meet the specific requirements of the health service with regards to design, functionality, and energy efficiency. BIM - Building Information Modelling is another key tool for managing and maintaining the estate. BIM can be used to manage all aspects of the design, supply chain, construction, commissioning, and lifecycle of the building. It will also enable better collaboration, as all the stakeholders can share the same information about the building online and use the tools available to check and amend the information.

The adoption of digital technology in NHS facilities and across the public sector will require careful management, as the integration of innovative technologies can be challenging, and responsible interoperability is essential. However, the adoption of digital technology in facilities management offers a significant opportunity to improve efficiency, reduce costs and create better working environments for staff.

NHS Estates Workforce and Facilities 10-Year Action Plan

In addition to managing the backlog of maintenance work, the NHS and other public sector organisations also have a significant challenge in recruiting enough staff to manage the high-level operational requirements of the estate. This is particularly true in relation to facilities management. NHS England recently published a 10-year plan to accelerate the transformation of the facilities management function across the health estate. The 10-year plan aims to increase the number of facilities managers in the NHS from 10,000 to 25,000. This will be achieved through a combination of recruiting new staff, changing working practices and increasing productivity.

The NHS estates strategy is designed to address the challenges posed to the NHS by the rising number of people, the ageing population, and the growth in digital technology. The NHS Long Term Plan sets out its strategy for managing and investing in the health estate over the next 10 to 15 years. The NHS is not alone in feeling the pressures in estate and facilities management, asset and estate managers across the entire public sector are facing challenging goals and pressures to meet targets and decrease backlogs. 

Learn more about the NHS Estate at the National NHS Estates Conference on 19th April 2023 at etc.venues St. Paul's. This pivotal strategy and networking conference offers a leading platform to discuss how to transform NHS estates to better meet the financial, operational and clinical demands of staff and patients. Complimentary tickets are available to the NHS and public sector, find out more here

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