Speaking immediately following the morning’ first keynote, given remotely by Judith Paget, Director General for Health and Social Services and NHS Wales CEO, on 7 May, Stuart Douglas told the conference the key areas he would be like to explore would be tools for management — with ‘the estate-sensitive subject of surveys and risk management’, space utilisation and rationalisation, decarbonisation and Net Zero, and ‘probably a little bit of good news at the end’. Beginning with ‘tools for management of the estate’, he said that ‘across Wales and probably the rest of the UK’, there was ‘a wide and varied approach’ to managing the estate. While some organisations still used manual systems supported by a range of databases, spreadsheets, and work process calls, others had adopted ‘more modern, active’, computer-aided CAFM systems, which, by comparison, would enhance efficiency and quality, and give assurance of compliance across the estate. He said: “For our Health Boards to have any assurance of adhering to modern standards of estates and facilities management, we need to adopt the latter across the board.”
The situation in England
Looking at ‘the situation in England’, Stuart Douglas said NHS Wales SSP had appreciated having sight of the recently issued NHSE draft Estatecode, HBN 00-08, with its minimum asset data requirements, and the associated data management systems which should be adopted. He explained: “The minimum dataset they’re saying we should all have comprises up-to-date drawings of the estate and engineering services in CAD format, a current asset register, updated within the last two years, testing and inspection records, risk registers, and risk assessments and Safe Systems of Work for each asset.” It was also implicit — he said — that six-facet survey data be included. He said he was ‘really encouraged’ that colleague Health Boards and Trusts across Wales were ‘ahead of the game’, and exploring things like the introduction of 3D imaging of their estate via, for example, the Matterport tool.
The speaker noted that systems for operating estate were categorised in the draft Estatecode as comprising Computer Aided Facilities Management, computerised maintenance management, and integrated workplace management, with ‘quite an overlap across the three’.
“Effectively,” Stuart Douglas said, “it’s about creating a systematic method of recording and managing our approach to the estate. We should have systems whereby Estates staff come to work and are prompted to address requests for work, planned maintenance schemes, testing and servicing regimes, validation, actions and jobs, and discharge of specified actions. Up the chain you then have the assurance that the work is done. We’re still appraising the Estatecode draft to see how it might be applied in Wales, but I think it highly likely some formal direction will emerge on the adoption of robust CAFM-type systems, and/or minimum estates and FM datasets.”
On surveys and risk management, Stuart Douglas explained that NHS Wales SSP SES has worked with NHS colleagues and Welsh Government to appraise the options for improvement with six-facet survey information, ‘irrespective of whether this leads to a national funded survey programme’. He added: “We’re delighted that health organisations agree that we need to work more closely to review and define definitions and collaborate to improve our alignment on risk reporting. All of us recognise this, and are committed to making it work.”
The ‘retained 6 facets’
Looking at ‘the retained six facets’, he said: “The feedback we’ve had is that quality and environmental management really need to be substantially revisited if they are to be retained. The remaining facets — of physical condition, statutory and fire compliance, space utilisation, and functional suitability — remain absolutely key measures, Stuart Douglas continued. “We need to ensure that surveys are both current and competent, and to be smart in the way we concentrate the attention of those that assist us in completing the survey function. The Estatecode draft highlights the function of lifecycle analysis — pointing toward lifespans and risks for building and engineering components, particularly as they reach the end of their designed life. At the onset of any survey commission, those of us who own and are responsible for the estate should review our portfolio with surveyors, and point them toward areas where we can determine that components are reaching the end of their designed lives.”
The speaker stressed that this not only applied to roofs, windows, ‘or anything else’, but as much to engineering and the wider site infrastructure — ‘looking across the piece’. He added: “Working with previous bid documents kindly provided by Health Boards, we are now chairing a study into the development of a core bid template for adoption across Wales, to provide consistency with future procurements, however funded.”
Moving to space utilisation and rationalisation, Stuart Douglas said NHS Wales SSP SES had picked up on this in previous years, but given that deficits in Wales had reached over £183 m in 2023-2024, the organisation had ‘no choice’ but to look hard at the space it occupies. He commented: “We occupy over two million square metres of space, and if our EFPMS data (equivalent to ERIC in England), is accurate, then around 100,000 square metres of this is unutilised — that’s 15 football pitches. Last year’s EFPMS returns show costs, on average, of £870 m2 for every square metre we operate from. So,” he continued, “those will be costs comprising backlog and general day-to-day maintenance, utilities costs, waste costs, and our soft FM costs. So, with 5% of our floor space, we have the potential to reduce backlog by £66 m, and create a revenue saving of £21 m.”
Underutilised space
Looking beyond this, the speaker said he wished to touch briefly on underutilised space — ‘a material proportion of the estate’, and something likely to be prime clinical space. He said: “Use of the Occupeye tool has been incredibly helpful for healthcare organisations in identifying administrative areas for improving efficiency, but we really can go further. Health Boards could consider use of planning and booking tools for clinical and non-clinical space as a means of proactively planning and tracking use.” Business cases for capital investment in new or refurbished accommodation, should, he said, demonstrate how the facility and all the related facilities will be utilised efficiently, ‘hopefully forcing the hand of health organisations to rationalise and divest themselves of spare accommodation’. “I do appreciate that it’s not so easy to close down space,” Stuart Douglas told delegates. “We are at critical point where we have to face this one together. Space resource planning and tracking should be as embedded as planning the use of our staff’s time, but this would represent quite a significant cultural shift. We need to utilise our six-facet data capture to help inform our management processes.”
On decarbonisation and the Net Zero standard, the speaker said that since declaration of a climate emergency in 2019, and the ensuing NHS Wales Decarbonisation Strategic Delivery Plan published in 2021, health organisations across Wales had made great progress in developing their own decarbonisation action plans. He said: “NHS England adopted the Net Zero Standard for new and major refurbishment in 2023 as part of its framework — and we’ve seen it calibrate the adoption threshold of that of schemes valued at £25 m and above.” This removed the ‘disproportionate costs’ of following this standard which smaller schemes were found to attract. Stuart Douglas explained: “In Wales, we’re likely to adopt a similar type of threshold, albeit with a graduated approach, to ensure that smaller schemes will still follow the intent of the document, and what is considered to be good environmental practices. Working through project teams, we are keen to assist in planning for compliance.”
Early engagement with NHS Wales SSP SES would, he said, provide a good opportunity to identify instances where pragmatism should apply. “While rules of thumb for the modern, low-carbon plant space are not as established as they might be,” he told delegates, “we need again to step back and ask the question of proportion. Finally,” he said, “it’s been encouraging to hear of healthcare organisations making good progress with their decarbonisation action plans, numerous PV arrays, EV charging facilities, and being able to gain access to frameworks which enable faster engagement with the market, and faster deliverables.”
Consultation on hydrogen
Here he explained that Welsh Government currently has a consultation process under way on the use of hydrogen, and encouraged all present to engage with it. He said: “Its focus is on how hydrogen is produced, stored, transported, and used; its role in decarbonisation, industry, and meeting our Net Zero targets.” The deadline for responses to the consultation was 16 May. “Hydrogen is an emergent technology,” Stuart Douglas noted, “and could well provide strong competition to EVs charged from the grid, and as an alternative for heating fuel. Engaging with this process will only serve to maximise the choices we have in managing the estate going forward.”
As his presentation neared its close, he said: “Finally, just coming forward with a few notable instances in the last year, I was pleased that following the loss of UK-wide EpiMS database, our colleagues within Shared Services and DHCW worked rapidly to develop a tailored version, which is now tested and available to all NHS Wales organisations. Doing that within a year was a great achievement, and we’re relieved that health organisations will have the opportunity to use that tool.”
He continued: “The introduction of the Building for Wales training has been a major improvement, and a big step forward for us. I have the opportunity today to stress that that is for us to learn together; it’s not a ‘chalk and talk’ type of approach, where we have people talking to very informed people about how to manage schemes, but about us all just getting in a room together — health organisations across the piece, and in many cases with our private sector partners, to learn and keep sharpening our skills in this area.
“One thing as an aside,” he continued, “is that just going through the schedules of services that we have for the framework is really valuable, just as a reminder of the things we are going to be doing, and the times that we need to be doing them in. I’m hopeful that joint learning events will now be a constant feature of the support service we provide. So, in my closing comments, friends, there are certainly many challenges on the horizon. Hopefully this provides a helpful pointer towards some of the mountains to climb in NHS Wales. Reflecting on my seven plus years now in NHS Wales, I’m convinced we have the people and the will to pioneer the estate for tomorrow. I do wish you all an enjoyable conference, and thank you for your time this morning.”