Enhancing estates and facilities information

It was interesting to receive feedback after the article in the last edition that looked at the English Functional Suitability figures. This was written after the BBC approached us to comment on the figures released from the Department of Health that are extracted from the ERIC returns. Interest ranged from plain old general curiosity to specific queries about how we use and interpret information to help health providers understand their estates and facilities issues. As with any such conversations it is inevitable that people get round to asking why:

•    Why does the government require this information?
•    Why do they keep changing the data set?
•    Why isn’t there any trend information?
•    Why doesn’t anyone link the estate costs to actual use?
•    Why can’t we get a UK set of figures?
•    Why isn’t this of any real use?
    
I cannot answer all these questions definitively but have a view on them all, as you would expect. Government requires the information so that they can monitor the effectiveness of the NHS estate and have some overview of the cost and value for money of the service provision. They keep changing the dataset as the political drivers keep changing and so the Civil Service has to answer the parliamentary questions. This obviously impacts on the trend information available but through the HFC Benchmarking Club we have been producing trend information for our subscribers for over 20 years and continue to do so year on year with at least ten years information in our annual report.

Successful initiatives
It has been very encouraging to see more and more NHS bodies looking at their Estates and Facilities information alongside other key information and producing meaningful business based informatics. This then allows and supports more business based decision making at board level. One of the more obvious moves from this has been the recognition that hospital space is relatively expensive and so it makes sense to move services that do not have to be in the hospital away to cheaper and probably more appropriate accommodation.
    
My local PCT has set their facilities management team up in offices in the community rather than on a hospital site and their home care delivery service is run from an industrial unit rather than a hospital base. At the University College London Hospitals NHS Trust they have established a delivery pathway that sees all deliveries made to one of three hubs out by the M25 and then dedicated mixed deliveries in eco vehicles to the relevant hospitals. This has reduced problems with large lorries accessing central London sites to make part load deliveries and contributes to the greening of the Trust through its long term carbon commitments.
    
Such initiatives are often seen as innovative within the NHS, and indeed they are, but in reality this is only picking up on what industry has been doing for some time. However, the impact of such change can only be seen and proven if the business cases are supported by accurate and relevant estates and facilities information used alongside an understanding of the business processes involved. There are many other areas where the health service can become more efficient and the recent NAO report of the procurement processes for consumables highlighted some classic examples that make for good media but appeared to be thin on the actual savings that can realistically be achieved.

Driving efficiency
17 types of A4 sounds extreme but even in our little office we have 4 different weights and finishes of A4 paper in use, each for a specific purpose. Our fliers and information sheets would be useless on the 90gsm paper we use for letters and invoicing and similarly it would be very wasteful to print routine correspondence on a 160 gsm glossy paper. Any organisation like a large Acute NHS service provider that produces its own publicity material, temporary internal notices, and disease or treatment sheets as folders will of course need to carry a reasonable range of different papers relevant to their needs. Of course this then leads to the question of the relevance of an NHS service provider running its own internal printing department when there are plenty of good, reliable and cost effective commercial providers of this service. The same applies to car parking – why are we using NHS employed staff to manage car parks? The answer is simple – the decision was made that this is a cost effective and efficient way to handle this side of the management of our premises. The proof of the decision is in the effectiveness of the service provided and this requires ongoing monitoring.

The big picture
The thorny issue of getting a UK wide set of figures is a very difficult one to answer. When I first joined the NHS it was NHS UK and although different District and Area Health Authorities worked in different ways the whole was provided under a single set of guidance and standards. Since devolution we now have four governing bodies each with their own view and political need to express their independence. As an Englishman it would be remise of me not to point out that England is the only one of the four countries in the UK that does not have its own government; but that is an issue for a completely different forum. At present English figures are published through an open access web site but as far as I am aware no one in the UK Government offices compiles a UK data set relating to the performance of the whole of the NHS throughout the UK.
    
Some of us compile what we can from the open access information and our own data sets and that really leads us on to the last of the questions – why isn’t this of any real use?

What’s the use?
As an ex NHS Trust Information Manager it greatly upsets me when I hear this question voiced. National statistics are of real use; they help define and drive the national level decisions that form the framework for the delivery of healthcare to the nation. Sometimes it might feel like the politicians make decisions that aren’t based on the figures but at least with the figures there a level of accountability is provided. One of the problems is that if locally people don’t believe that the statutory returns are important and have value then the reliability of the figures comes into question.         

The bottom line is the statutory figures are only a high level summary of the information that should be being used for day to day management and strategic decision making at the local level. The recent QIPP exercise has shown how the SHAs in England use the figures and several of the squeals heard around the West Midlands really proved that the Trusts had not been taking care with the accuracy of the information they provided.

Benchmarking
Roy Lilley has recently written a very challenging article about QIPP and within this he noted that: “Benchmarking is another waste of time,” and likened it to “driving looking in the rear view mirror.” Whilst I have a great deal of respect for Roy and his, often, outspoken views I do feel that he is taking a very lopsided view here. Yes – of course we have to look forward as we plan the business of healthcare for the future but when driving it is actually very important to know what is going on all around you. My one daughter failed her driving test on one occasion for “failing to be aware of the surrounding environment.” In other words she didn’t use her mirrors and side view enough so her awareness was limited. Likewise at work we need to have a wide view and not a blinkered one.
    
Benchmarking has a variety of functions and one of the problems, which Roy highlights in his article, is that it is often used only to produce league tables; you know where you are in the table and put lots of effort into improving the position. Sight of the service provision is actually lost in the light of the number in the list. Where benchmarking is just used in this way it really is a waste of time but once the information is used to inform the current position and provide trend analysis you have a solid understanding of how your organisation is performing now and in which direction it is facing.
    
Returning to the driving analogy, you cannot plan a journey unless you know where you are. As change is then made using the benchmarking information, or management information as it should perhaps more correctly be known, you can actively monitor progress and the impact of the changes made and see if the movement is in the right direction. Yes it is useful to know what your performance is like relative to others but not in a league table; use the information to tease out who does what better, or more effectively, and then see if this better practice can be applied to your own set up.

Better decision making
Enhancing estates and facilities information is not about adding to it, or making it more complicated; it is about using it to inform and drive business decision making. After all, the estate and the facilities are there to enable the healthcare provision that is the primary objective of our organisations, so it is pointless just looking at this in isolation.
    
A little thought to end on: If the government wants to see a ten per cent increase in front line services then surely we have to accept that there is going to be a commensurate increase in the wear and tear and utilities costs on the premises these services are provided in. I am still trying to get my mind round how that can be achieved, whilst maintaining current standards to ensure a clean and safe environment, with a 45 per cent decrease in what has been called “back office costs.” This is the reality of the challenge facing the estates and facilities teams and their management boards around the country.

For more information:
Web: www.hfc.org.uk