As an estates professional, do you have a list of priority jobs and actions? So, arriving in the office on Monday morning with every intention of dealing with them in order, what happens? Stuff happens — and by the end of the day, the list is untouched, while plenty of other tasks have taken its place.
Another question — Do you and your team/colleagues have a clear ‘strapline’ that guides you every day? Something simple which opens into the aspirations for the long term?
In every walk of life, there are only two types of tasks — maintenance and new work. In the NHS, the interminable waves of stuff that come at us are almost always maintenance or, more simply, firefighting. This scenario may be an oversimplification but is to be found in most organisations, not just healthcare.
Can SEMAP help?
Simply put — yes! SEMAP stands for the Strategic Estates Management Advisory Platform — and note the word ‘strategic’, which defines what we do.
Picking up the theme of this year’s Healthcare Estates conference, SEMAP is predominantly about prevention — with a little cure here and there.
From the outset, SEMAP recognised that there is a lack of practical everyday guidance for estates professionals looking to address strategic estates management issues. Our response has been to establish a number of working groups, aiming to provide a source of helpful advice as well as asking some difficult questions about the strategic status quo. Outlined here is what SEMAP is currently progressing.
PFI — friend or foe?
Many NHS bodies have been dealing with PFI for a couple of decades or more, and these contracts are coming to a close over the next few years, with the majority reaching expiry by 2035. How prepared is the NHS for the hand-back of these assets? There are a multitude of issues ranging from establishing condition, maintenance records, staffing, budget reallocation and many others.
As per National Infrastructure Service Transformation Authority (NISTA) PFI Centre of Excellence expiry guidance, Expiry Health Checks start seven years ahead of handback, yet it is never too early to start the handback process, and in particular ensuring that the concession the Trust or Board is about to inherit, is operationally compliant.
For this reason, working with partners WSP and Citation, SEMAP developed a digitised PFI question set that enables Trusts and Boards to understand the condition of their PFI asset, and importantly, ensure that what they receive from their PFI Project Co. is actually an asset rather than a liability.
The question set, which asks NHS Trusts/Boards to RAG rate their compliance against key evaluation criteria, aligns with the categories required to set up a robust asset management system, and, taken a step further, could be developed into a system that complies with ISO 55000. Categories include:
- Strategy and planning.
- Asset management decision-making.
- Lifecycle delivery.
- Organisation and people.
- Risk and review.
We have been working with IHEEM members on messaging the question set to Trusts and Boards, underlining the importance of the question set acting as:
- an early warning mechanism for any operational compliance issues and support to answer the NISTA Expiry Health Checks.
- guardrails for day-to-day management of contract and awareness to deliver the best possible healthcare facility beyond the concession period.
- support to the ongoing lifecycle, contract management and base data for the NISTA asset condition playbook.
It is hoped that we can learn from the experiences of these PFIs as the prospect of son-of-PFI is being discussed as a means of funding future projects and filling the hole in NHS capital availability. For further information and a demo of the PFI question set, please contact Nigel Lea at Citation: nigellea@citation.co.uk.
Aside from handback — which always seems so far off, until it isn’t — ensuring that private capital is visibly fairer to both parties than in the past is crucial.
Going digital
The digital transformation agenda has ballooned over the last few years and is set to become a major element of working practices across the board. It’s a huge agenda that cannot be ignored, and one in which the NHS is struggling to keep up with even the most basic elements of digitisation.
SEMAP has a specialist working group tackling the impact and future of digital systems. It aims to develop and expand the knowledge and application of data and digital tools in health estates management, and educate the sector on the benefits of digital based management decision making. This work is about changing the mindsets of ‘off the shelf digital tools’, and to bring about a recognition of how digitisation can facilitate delivery of the functions that we all need to deliver, and how to begin this critical journey.
We recognise that the capabilities and starting points vary monumentally between organisations. Our intended outputs include a guidance document on the development of digitisation and development of a best practice toolkit that will initiate and accelerate the digital transformation journey of client organisations.
Joined up working
A new capital project lands on your desk. In all probability, the project will have one or more of the following characteristics:
- An unrealistically short timetable.
- A less than expected budget with no workings out explaining how it was calculated.
- No comprehensive brief.
There is a large piece of work which SEMAP has in its sights — but is a way off yet — to work with colleagues in the service who generate these kinds of problems, and to explore a more joined up way of working.
So, SEMAP is currently progressing several strands on the capital projects front.
Healthcare planning
For pretty much every capital scheme, you will need a Healthcare Planner — and fast. Resist the temptation to start designing stuff, particularly in a 3D model as everyone will think ‘job done’.
Find out who the key stakeholders are and get them together as soon as possible with a Healthcare Planner who will interrogate the assumptions, and dig into the service need and clinical model. What comes out the other end of this process could be radically different from where you started.
SEMAP has recognised that healthcare planners come in all shapes and sizes, and there is no recognised qualification or registration system. In response, we have developed a course in healthcare planning with 10 comprehensive modules. We are currently seeking recognised accreditation for these modules. We are also in the process of finishing a guidance document that covers the complexities and scope of healthcare planning all in one all-inclusive document — another first in this critical area.
We have high hopes to run a short course called an ‘introduction to healthcare planning’ later this year. This will cover the rudiments of healthcare planning in an accessible way, and will serve anyone involved in capital healthcare estates development, as well as budding healthcare planners keen to gain a full understanding of the breadth, depth and importance of the role.
Capital planning — process and pitfalls
SEMAP Estates Capital Development Group has identified a variety of ‘wicked problems’ — handling the public estates’ maintenance backlog, Net Zero, distributional issues, supporting service productivity, system not just facility orientation (after the change in status of ICSs), and widening the perspective of what counts as benefits for a new capital project. You’ll be familiar with all these; they may be wicked but they’re not a counsel of despair, each can be addressed.
Unsurprisingly, as capital projects are funded by the public purse via central funding — adjudicated by the Treasury and DHSC — there are a range of rules and guidelines to be followed. Treasury has ‘books’ of various hues for various purposes, but the Green Book on capital appraisal is the most relevant here. Government has indicated it is open to shifting the interpretation of what have hitherto seemed like rigid rules. SEMAP plans to contribute to the rethink.