asset management in the nhs
DESCRIPTION
a review of the importance of asset management by Strategic Healthcare PlanningTRANSCRIPT
DISCUSSION DOCUMENT S T R A T E G I CHEALTHCAREP L A N N I N G
Estate Asset Management in the NHS Lessons learned in the UK Date January 2014
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Content 1.0 Introduction ...................................................................................... 3 2.0 Background ...................................................................................... 4 2.1 Assessment methodology ................................................................................... 4
3.0 The Estate Asset Management Process .......................................... 6 3.1.1 Where are we now? ................................................................................................................... 6 3.1.2 Where do we want to be? .......................................................................................................... 6 3.1.3 How do we get there? ................................................................................................................ 7 4.0 SHP has 20 years experience in the management of healthcare estate. ...................................................................................................... 8 4.1 Data Review ....................................................................................................... 9 4.2 Physical Survey .................................................................................................. 9 4.3 Developing a database ..................................................................................... 10 5.0 Recommendation ........................................................................... 11
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1.0 Introduction Management of assets should form part of an integral process of an organisations strategic
service planning determined by the interaction of service need, asset availability and
performance, available finance, and availability of skilled healthcare professionals.
The stock of physical assets represents a valuable resource equally as important as the resources
of finance and manpower. This is indicated in the UK by the growing recognition that there is a
need for more effective and cohesive management of assets which was reinforced by the British
Standards Institute PAS 55 – a publicly available specification for optimal management of
physical assets which has been adopted and applied in most industries, in public and private
sectors and different regulatory regimes, cultures and environments, and is becoming a world-
wide specification for whole life cycle management of physical assets.
The NHS has historically segregated asset management within separate departments and
organisations with the key leads being the estates and facilities functions and a focus therefore on
buildings and utilities. This in turn led to prioritisation of work predominantly according to
condition rather than lowest whole life cost solutions for delivering improved and sustainable
models of care. NHS organisations are recognising this short fall and adopting the principles of
asset management in how they plan and allocate capital to deliver strategic service objectives.
They recognise the competing demands for maintenance and improvement of:
• Estate – facilities and utilities
• Medical Equipment
• Information technology
And the inter-relationship between each in developing long term solutions that optimise
flexibility and efficiency.
The Estate element represents the most significant asset in terms of both size and value and
experience has shown that creative manipulation of the estate in the context of service planning,
can substantially reduce the revenue burden, but only if the nature of the estate and its future
potential are properly understood.
SHP has provided support to many NHS organisations in identifying and auditing this element,
it’s potential to support strategic service objectives and detailed programmes of work to effect
appropriate change and development.
This paper seeks to identify processes and lessons learnt from supporting the NHS in improving
its estate asset that may be of value to health services in Portugal.
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2.0 Background The NHS estate covers 6.9 million hectares and is
valued at almost £40bn (2011-12). This makes it
the single largest property holder in the public
sector and potentially able to cover the City of
London ten times over. For this reason if no
other, it has a major role in delivering
Government initiatives and legislation. The
annual running cost of the NHS estate is £7
billion annually and with current Government
austerity measures and a need to save £20 billion
across the service without reducing safety or
quality; the estate and facilities assets are significant in achieving this.
The NHS Constitution contains two pledges that relate to the premises in which healthcare is
delivered:
a) Services are provided in a clean and safe environment that is fit for purpose, based on
national best practice; and
b) Continuous improvement in the quality of services that users receive, identifying and
sharing best practice in quality of care and treatment.
The NHS estate is therefore an important enabler of high quality health services as well as a
potential source of risk to patients, staff and visitors in terms of safety. The Boards of NHS
organisations are responsible for ensuring these commitments and an assessment system has
been developed to provide a consistent national basis that can be made available to other
stakeholders such as commissioners, regulators and the public.
2.1 Assessment methodology The systems used in the NHS provide individual organisations with a way of assessing their
estate and have the advantage of providing a diagnosis that is based on comparing chosen
dimensions of an organisation’s use of the estate with those of other relevant NHS organisations.
It is a tool that allows greater insight into the efficiency, effectiveness and safety with which they
manage their estate and includes some patient experience measures. At a high level it is based on
two types of analysis.
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§ Qualitative, self-assessment of effectiveness, safety and patient experience – Self Assessment Questions (SAQs);
§ Quantitative, non-parametric benchmarking (using Data Envelopment Analysis, DEA) of the efficiency of estate use - Metrics
The methodology covers both estates (the physical fabric of buildings) and facilities (the services
that are directly linked to the estate i.e. energy, water, cleaning etc.).
The SAQs give an overview of the systems, procedures and on- going actions that organisations
should be undertaking. The Metrics show the results of those actions, in terms of benchmarked
metrics that allow comparisons against peers. By comparing the SAQs (inputs) to Metrics
(outputs), an NHS organisation can determine where they are doing well and where action is
needed to make improvements. Action plans can then be developed and implemented if required.
The assessed profile provides a guide to the character and complexity of the healthcare estate and
facilities, and can be used as a prompt for further enquiry and to stimulate better-informed
dialogue as to how the premises can be more efficiently used, more effectively managed, and
make a contribution to the overall strategic objectives of the healthcare provided.
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3.0 The Estate Asset Management Process
This process aims to provide a vision for the estate that can be flexible enough to respond to
future service requirements, supports maintenance and improvement to existing services,
increases efficiency and effectiveness and improves patient care – an Estate Strategy.
It asks three basic questions in relation to an organisations estate:
§ Where are we now?
§ Where do we want to be?
§ How do we get there?
3.1 Where are we now? This element is aimed at developing a comprehensive analysis of the current condition and
performance of the estate using six facets. It develops a baseline against which the development
of strategy can be measured.
The six facets are:
§ Facet 1: Physical Condition – identifies all elements of the estate depending on operational safety and deterioration – also called backlog maintenance
§ Facet 2: Statutory Compliance – assessment of compliance of facilities with standards and guidance
§ Facet 3: Environmental Management - assessment of the organisations ‘sustainability’ performance including energy (including carbon footprint), water, transport, waste, procurement
§ Facet 4: Space Utilisation – identifies how much and how often rooms are used
§ Facet 5: Functional Suitability – assesses the internal space relationships, support facilities and location/adjacency of clinical areas
§ Facet 6: Quality – identifies the levels of patient amenity and comfort offered in each area including aspects of aesthetic design
3.2 Where do we want to be? This stage considers the long-term aims of the organisation, requirements of national and local
service strategies/policies and short-term service issues. It aims to develop an understanding of
what service changes are required and the impact these would have on the estate. It also aims to
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set targets for improving the condition and performance of the estate and for ensuring that the
estate more closely matches the service need for the foreseeable future.
3.3 How do we get there? This final stage of the process involves developing options to enable the organisation to achieve
its objectives that identifies and prioritises the capital investment that will be needed to deliver
the required changes and modernisation of services including:
§ the estate that is to be retained; the degree of modification (extension, change of use, reduction) envisaged;
§ the need for additional land and property and the functional units to be provided and the availability for disposal of unwanted existing land and property;
§ the potential for re-use of assets (equipment, plant) currently used in unwanted facilities;
§ the timing for delivery of retained, refurbished, re-usable, extended or newly-created land, property and other assets and the availability for disposal of unwanted assets;
§ the resources to sustain the resultant estate.
This can also include
production of a ‘development
control plan’ to control ad hoc
expansion of the estate over
time and will input into the
organisations capital
investment/business case
process along side medical
equipment and information
technology developments.
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4.0 SHP has 20 years experience in the management of healthcare estate.
The methodology and process described above has been used by SHP throughout the UK to help
health organisations ensure:
§ Land and property is used efficiently, effectively and strategically to support organisations plans;
§ Maintenance of appropriate quality healthcare facilities in the right location that support the provision of effective healthcare.
Since the introduction of this methodology in the NHS in 1984, SHP staff has undertaken
assessments of over 3,000,000 m2 of assets, the most recent of which covered the totality of the
healthcare estate of Leicestershire.
We have helped organisations to put innovation and productivity at the heart of healthcare
delivery by elucidating efficient care models with clinical staff and combining this with our
assessment of the estate to deliver effective change as depicted below:
The range of benefits to a healthcare provider and the wider health economy in having a formal
estate evaluation are:
§ an assurance that clinical services will be delivered from safe, appropriate environments
§ a means of ensuring that estate capital investments are linked to service strategies
§ a plan for change in which progress can be measured
§ a strategic context in which detailed business cases for all capital investment can be developed and evaluated
Delivering change
Efficiency driven models
of care
ExploiGng underused Estate
Estate evaluaGon
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§ a means by which the healthcare procurement body can identify capital investment projects which will require formal approval and relate to wider community developments/plans
§ a clear strategy to ensure environmentally sustainable development
§ a process that ensures property assets are effectively managed, risks are controlled and investment properly targeted.
4.1 Data Review To support the estate evaluation, it is essential to have:
§ A clinical service strategy
§ Up-to-date drawings of the buildings, showing room layouts with room numbers.
§ Records of the buildings age and any past upgrading schemes.
§ Appropriate maintenance records for major plant to providing information on abnormal plant deterioration.
§ Statistical information on bed numbers, patient contacts, and sessions held etc.
§ Statistical information on energy, waste, water and transport performance
4.2 Physical Survey The process of collecting data for the appraisal of the current estate should be approached
pragmatically based upon informed and experienced observation. It will constitute a snapshot in
time and, therefore, needs to be completed within a tight timescale.
Surveying should be carried out by more than one person, as this will allow assessments to be
compared and discussed, and will lessen the subjectivity of the exercise. In order to ensure
consistency it is advisable, wherever possible, for the same people to conduct appraisals across all
the sites involved. For example, a single panel of people could undertake assessments of
functional suitability, space utilisation and quality at a single visit comprising: an
estates/facilities manager or architect with a general/clinical departmental manager to survey
these three facets in order to give a multi-disciplinary viewpoint. However, it should be noted
that a team of more than three will be cumbersome and may not be welcomed by departments.
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A standard form for each facet should be used to ensure that data is collected across each
building and department in the same way. It is useful to have a “notes sheet” for each building on
which more specific issues can be recorded, to be followed up later.
Ultimately the aim should be to collect the data electronically, using a hand-held terminal to
input data as the surveying takes place. This can be downloaded later into the database and can
populate drawings in a CAD system.
4.3 Developing a database It is particularly important that the results from the appraisal are presented in a clear and concise
way. This can be achieved by using a computerised database, which allows large amounts of data
to be stored and easily handled. The system used should have outputs in the form of statistical
diagrams, scale drawings, spreadsheets, reports or a combination of these. It should be capable of
extensive interrogation and the more flexible it is the better.
The database should be capable of presenting different levels of aggregation of data, for example:
§ by floor level;
§ by organisations whole estate;
§ by site;
§ by individual building;
§ by department;
§ by building age/value.
It can be useful to be able to present data on a care group or clinical department basis, but this
may be difficult where several functions share a site or building.
A presentation of the cost implications of the appraisal is very important – in other words, what
will it cost to bring the estate up to an acceptable condition?
It is often useful to be able to look back in order to establish whether the situation has got worse
over the past decade. It can also be useful to look forward and estimate the requirement for
expenditure on assets to keep them in an acceptable condition over the next 5–10 years.
Examples of data outputs are given in ‘Developing an estate strategy’. This can be used to inform
the capital investment programme for the organisation.
One of the best ways of sharing data is to apply it to site and floor plans through the graphical
interface capability of a CAD package. Most CAD packages are complex and require a powerful
computer with specialised equipment to make them effective for the user. There are specialised
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software packages on the market that provide integration between data files and plans/maps;
most require significant investment to set up and specialised operation to keep the record
updated. Specialised software packages also require specialised training and dedicated staff
resources to keep them updated.
Consideration should also be given to the use of aerial/localised photographs to illustrate
particular areas of concern.
In presenting the results you should attempt to provide both a cost and a risk assessment from
your data. You need to indicate within each facet where the most serious risks lie and what
investment needs to be made to put them right. It will not necessarily be the case that buildings
in a seriously poor condition, where action must be taken to minimise risk, are those where the
cost is highest.
5.0 Recommendation This document has been prepared to introduce the importance of effective estate asset
management to those organisations that currently have no processes in place.
Such organisations are invited to consider the potential benefits that can be derived in the use of
the proposed methodology and to determine the extent to which Strategic Healthcare Planning is
able to assist
The following link will provide an indication of those projects that
have been undertaken by SHP and of the depth of experience the
company has.
http://issuu.com/j.clarke/docs/es_v2.3_pages
For those interested parties who reside in Portugal and who require
further information, an initial approach should be made to;
Pedro Lenz Marcos (351) 917 221 866
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John B Clarke Strategic Healthcare Planning LLP January 2014