Karl Cundill, Joint Managing Director at LitmusFM, has shared his thoughts on the growing number of NHS facilities repairs, with Trusts reporting the work required to tackle the problem costing hundreds of millions of pounds. With an overwhelming list of urgencies to tackle, Karl discusses how Facilities Managers within NHS Trusts, get control of the building upgrades and tackle them with the budget available.

“The condition of NHS facilities and buildings has been making headlines recently. In February, Health Secretary Victoria Atkins went head-to-head with BBC presenter Sally Nugent on how much money NHS Trusts need to improve their hospital buildings.

“In many cases this can reach into the hundreds of millions of pounds. Oxford University Hospitals (OUH) NHS Foundation Trust, which includes the John Radcliffe Hospital, the Churchill Hospital and the Nuffield Orthopaedic Centre, has been revealed to have one of the biggest maintenance backlogs of hospital building repairs in England, requiring £237million to tackle the problem. A spokesperson, who until recently spent 16 years working at the county’s hospitals, was quoted as saying she had dealt with ‘ceilings falling down, mould everywhere, plants growing through windows,’ and cracks in windows and doors which ‘let in vermin and cockroaches.’

“The sheer size and scale of maintaining NHS buildings and facilities – which often span across multiple buildings – can feel overwhelming. The number of improvements needed are vast and ever- evolving. For many Facilities Managers, the answers are not easy or obvious, budgets are often limited, yet many of the issues are all deemed as a ‘priority’. How can Facilities Managers gain some control over the situation, and put plans in place that will bring them out the other side?

“Part of the story is in having the right approach and the right people in place. Some of the NHS Trusts we work with aren’t necessarily operating in old buildings; sometimes they are relatively new having been built in the last 10-15 years. However, the right approach hasn’t been in place from the start; not only financially, but management and resource-wise. Traditionally, Trusts would have an in-house estates team comprising of Mechanical and Electrical Engineers, Joiners and Decorators but many of these have left due to outsourcing or have retired and not been replaced, as the NHS simply cannot afford to do so. With the lack of skilled people, comes skills and knowledge gaps and the ability to spot the issues before they happen.

“Another element is focussed on the ‘engines’ of the facilities; the areas patients don’t see – for example, infrastructure such as boiler plant rooms and heating systems. Money is allocated to new wards, which look great, but there remains an underlying issue that behind-the-scenes the infrastructure is ageing, with some of these assets and systems dating back to the 60s or 70s, with no programme in place for their upgrade or replacement. The ‘sticking plaster’ approach will only work for so long, before cracks begin to show.

“NHS Trusts need to start by really getting to grips with understanding what assets they have, their condition and age. This will inform them of how much residual life remains in their assets and which assets are the key priorities that need to be replaced – and equally which can be replaced further down the line.

“This work needs to encompass a whole-life approach and align to the overall estates’ strategy. For example, if Trusts have plans to mothball or demolish specific areas of the facilities in 5-10 years’ time, there is no point in investing or refurbishing those areas. Key buildings that are being retained need a Forward Maintenance Register (FMR), that cover the next 5, 10, 15, 20-year period, which identifies the priorities, budget and when the upgrades can happen. Development of a detailed FMR will ensure Trusts can spot if there are any issues with how a piece of equipment is working, catch it early and avoid the need for any call outs or equipment break downs, which can be costly.

“More to the point, NHS Trusts need to ensure their assets adhere with current UK compliance standards and legislation to ensure the environment remains safe for everyone. If an accident occurred due to assets that haven’t been maintained correctly, it could potentially result in catastrophic injuries and legal claims.

“The whole-life approach is also useful for NHS Trusts looking to make sustainability improvements to their facilities and will ensure a far better overall outcome. Instead of implementing one-off, short-term solutions – such as installing LED lighting – the upgrades can be done in a holistic way, and wrapped into the estate planning so they can be implemented as and when different parts of the relevant facilities are upgraded.

“Ultimately, this comes down to two key factors: budget and knowledge. Budgets are what they are, and NHS Trusts can’t magic money out of nowhere. But with a proper lifecycle strategy in place, Facilities Managers will have a firm grip on the cost challenges, be able to plan the upgrades that are possible and, equally, have the knowledge to fight for additional budget for other planned upgrades.”

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