Health Service Focus

20.03.17

Developing a robust argument for estates change

2acd2a5Simon Corben, NHS Improvement’s (NHSI’s) director and head of profession for estates and facilities, talks to NHE’s David Stevenson about the plans to drive estates change over the next 12 months.

Last year, Lord Carter’s operational productivity review put forward a number of recommendations to improve efficiency and reduce variation across the NHS estate. Central to his proposals was the need to ensure every acute trust has a strategic estates and facilities plan in place by April this year. 

Speaking to NHE before the looming deadline for plans, Simon Corben, NHSI’s new director and head of profession for estates and facilities, who officially starts at the beginning of April, told us that it is too early to comment on what they will include, but it is likely they will reflect what has been produced in some sustainability and transformation plans (STPs). 

“The STPs are, I think, absolutely in line with the Carter programme. Having worked on some of those myself, reducing costs is a core component. But, more importantly, they were also looking at the care pathways,” he said. 

“I would hope that all the provider trusts and the plans they bring back would be cognisant of the initial estates aspect of the STPs. I would hope that the trusts who report back to my team will reflect the ambition of the STPs.” 

Corben, who has over 20 years’ worth of experience delivering management consultancy to the health sector, added that his team has already arranged follow-up meetings to run through the impending plans with a number of trusts. 

Creating a robust argument

He reflected that his predecessor, Peter Sellars, now president of Institute of Healthcare Engineering and Estate Management (IHEEM), did a “phenomenal job” in setting the agenda for change in estates. This includes plans for trusts to operate with a maximum of 35% non-clinical floor space, and that the amount of unoccupied or underused space should be set at a maximum of 2.5%. 

The key aim of the Estates and Facilities Productivity & Efficiency Project Team is to support those across the acute trust sector to achieve savings of up to £1bn, as well as additional potential savings for new sector organisations – mental health, community, specialist acute and ambulance trusts. 

This will be achieved through reducing the unwarranted variation in costs across the NHS in relation to the operational management of their estate, explained Corben, adding: “The trusts are doing well in moving forward on that, but we still have plenty to go at – about 30-35% of the £1bn opportunity has been identified. It is always easy to do the first bit, but now comes the gritty bit.” 

“What I’m inheriting is a trajectory that everybody understands, everybody feels they are accountable to, and everyone is taking seriously. It is a good thing to come into,” he said. “The challenge that I have got is to really take this forward and deliver what we anticipate to deliver by 2020, and provide consistency across the NHS estate to ensure when we look for capital funding we can back that up with quality data and assurance around the condition and operation of the estate.” 

If we can make a robust argument as to why trust X is running at £200 per square metre and why trust Y is running at £300 per square metre, then we can make a quality case for additional capital to tackle things like backlog maintenance and other transformational change, he explained. 

ThinkstockPhotos-531844679 hospital

However, Corben reflected that, at the moment, he doesn’t “see the argument for articulating change against inefficiency being as robust as it should be. That is an area we need to focus on”. 

His team, which is predominantly based in Leeds, but looking to grow to provide better coverage for the NHS nationally, fits into three components: policy, operational efficiency and commercial. 

Explaining how the three aspects are working together, he said: “As a supplier to the NHS, I have seen the confusion that is out there whether it be in legislation, policy, procurement or operational efficiency. One of my core drives is to put some simplicity into the system. 

“That is a core component of my policy, operational and commercial teams, to ensure we provide the NHS with the toolkit to deliver. The guys on the ground are doing a brilliant job to ensure sites are safe and secure. The condition of the estate is what it is, that won’t change overnight. It may change in a number of years, but it is what it is, and, therefore, it is important that we at NHSI provide trusts with the toolkit and ease of implementation to deliver change and transformation within their organisation.” 

Simplicity, explained Corben, will include the standardisation of documents, and ensuring trusts make the most out of existing frameworks and standards. 

Improving knowledge share

In addition to this work, he wants to improve the knowledge share around estates: “We have the Data Exchange, which is a year old, and I want to make it more intuitive and user-friendly and really use it as our central point of communication and knowledge share.” 

Currently, there are close to 300 registered users, representing all general acute trusts, accessing information via the portal, as well as supporting each other by contributing to the blogs on any emerging issues. 

“I’m a big believer in that you don’t innovate unless you make a few mistakes along the way,” noted Corben, adding that it is important the portal highlights best practice and where things have gone wrong. 

“It is really important that we give the guys on the ground the comfort and air cover to allow them to try doing things differently, if it is going to truly transform the way that we do things,” he said. “Clearly, there will be checks and balances around all of that but it is important that this sharing of ideas is improved. It is definitely there, but I think we can move on from where we are at the moment.” 

He also wants his team to take a more hands-on approach to helping outlier trusts, to bring them in line with those organisations that are doing well.

“The big agenda for me in the next year is to improve the reporting,” noted Corben. “We will look to do that on more of a monthly basis – simplified, but consistent – so it becomes second nature. I also want greater levels of knowledge share and for us, at NHSI, to be more hands-on in helping out some of the trusts that are struggling – looking at areas such as efficiency, their clinical care and the governance that sits within the trusts. 

“Part of the work will be down to technology and understanding what systems we have out there. There is a huge amount of different systems at play in terms of managing, operating and monitoring the estates and FM budget. It is also about engaging the private sector and understanding what they can do, and it is about bringing in a team of internal NHS directors of estates who can share their knowledge of implementing change.” 

Another recommendation by Lord Carter was for trusts to invest in energy-saving schemes such as LED lighting, combined heat and power units, and smart energy management systems, funded through a new Department of Health (DH) ‘invest to save energy efficiency fund’. 

Corben confirmed that the business case has been developed in support of the Energy Efficiency Capital Fund. “This is currently awaiting approval by DH and Treasury,” he revealed, adding: “Clearly, there is a time limit on this and it does need to move fast. My team is chasing regularly to get some form of approval. There is a definite need to progress on that.”

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Comments

Ambrose Kingston   23/03/2017 at 09:04

This is an interesting article. One thing that was not mentioned was Infection Prevention and Control. How important is this in the thinking of Healthcare Estates personnel, with regard to the designing of a Healthcare Environment with surfaces that lend themselves to thorough cleaning and disinfection, rather than containing a plethora of bug traps such as one sees commonly in existing hospitals? Joints, seams, connections of different materials, holes, fissures and rough surfaces are all potential nesting places for pathogens that we can't see, as are dust-collecting areas such as curtain tracks and inaccessible areas. Are designs of smooth, cleanable surfaces something that Healthcare would welcome?

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