• NHS England/Improvement aims to better trusts’ scrutiny of their estates and facilities services
  • Self-assessment against checklist to become mandatory
  • CQC discussing using estates data as part of inspections

Trusts will be forced to demonstrate the safety and efficiency of their estates and facilities services under new plans drawn up by NHS England and Improvement.

The regulator wants to increase board-level assurance over trusts’ ability to manage their estates and facilities services properly, and it plans to make providers contractually obliged to do so.

It comes amid a growing backlog maintenance bill,  which now stands at more than £6.5bn — of which more than half, £3.4bn, is considered “high” or “critical” risk.

To increase trusts’ compliance with estates and facilities requirements, NHSE/I chiefs are planning to include the NHS Premises Assurance Model in the NHS Standard Contract.

The Premises Assurance Model is, effectively, a large checklist which trusts self-assess against to ensure they are complying with a range of legal requirements related to estates and facilities management.

Examples include how the trust manages, and complies with policies related to, issues like clinical waste, food hygiene, cleaning, and the safety of fire, water and electricity systems.

Although trusts are expected to monitor compliance against the PAM, it has never been mandatory — and HSJ understands some providers have never used the PAM.

Fully self-assessing against the PAM can take several months and requires input from trusts’ estates, IT, contract management and HR departments.

However, including the PAM into the NHS Standard Contract means non-compliant trusts could miss out on providing NHS-commissioned services.

A ‘voice’ for the estates workforce

Speaking at the annual conference of the Institute of Healthcare Engineering and Estate Management earlier this month, NHSE/I’s estates lead Simon Corben said mandating the NHS PAM through the Standard Contract would “promote assurance” and the estates workforce’s “voice” to the executive board.

An NHSI spokeswoman later told HSJ  proposals for the use of NHS PAM via the new NHS Standard Contract for 2020-21 would be “considered and consulted on in the usual way”. 

Additionally, Mr Corben revealed NHSE/I is in discussion with the Care Quality Commission over increasing the watchdog’s use of PAM when gathering data on trusts during inspections. The CQC has the power to ask for a trust’s PAM assessment, but does not always do so.

HSJ asked NHSE/I when a decision would be made on the CQC using PAM, but had not received a response at the time of publication.

A CQC spokeswoman said: “We welcome efforts to support improvement of premises and we will consider how to use information from the scheme where it has been applied by a provider, but the specifics are yet to be determined.”

‘An important step’

NHSE/I’s decision to make the PAM mandatory through the Standard Contract was welcomed by both IHEEM and the Health Estates and Facilities Management Association.

HEFMA chair Jonathan Stewart told HSJ the decision was “quite significant” and described it as “an important step” for the NHS.

He said: “This is the first time it’s [PAM] been explicitly mandated and I would say it’s way overdue.

“It’s a huge piece of work,” he said, adding trusts with a large and/or diverse property portfolio — for example, mental health and community trusts — may have the biggest job to self-assess against the PAM.

The current PAM checklist was published in 2016, but an updated version is expected in the next few months.

According to the current PAM guidance, the NHS operates more than 1,200 hospitals as well as nearly 3,000 other treatment facilities.

The NHS’ occupied floor area is 24.3 million square miles, which is equivalent to nearly 3,500 football pitches.

HSJ Strategic Estates Forum

The HSJ Strategic Estates Forum, now in its 3rd year, takes place in London on 12 March 2020. This is a high level strategic forum that brings together estates directors, sustainability and transformation partnership estates leads and trust board leaders responsible for the estates function who are developing strategic plans for their organisations and local health economies. The focus of the forum is on issues such as availability of and access to capital, tackling backlog maintenance, utilisation of the estate and role of technology in infrastructure development. The forum builds on the Naylor Report and highly anticipated 2019 spending review.

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