Asset management and maintenance
HTM 04-01. A rolling programme of replacement will eventually deliver savings, but replacements are heavily loaded with upfront costs to cover the capital cost and the essential regime of pre- and post-commission testing. It is often a hard sell stakeholders. Adding to the facilities management team’s workload is debate about where responsibility for these older properties lies. For instance, what if a mental health partnership Trust is using a building being leased to it by the acute hospital Trust? For me the answer is simple: the buck stops with the people delivering the care. Simply doing the minimum towards compliance will not suffice, and will certainly not manage the risk. For a Trust’s estates and facilities team, a few outbuildings can prove more time- consuming than the PFI hospital that is its ‘jewel in the crown’.
Implementing a remediation strategy If there are infrastructure issues that cannot be addressed by inspection and cleaning, they need to be identified, a remediation strategy put in place, and a budget negotiated. The work involved in specifying and replacing the best part of 1,000 TMVs, for instance, is almost certainly not in a healthcare provider client’s original plans when it begins delivering outpatient health services from the building; the organisation had originally expected tenders for operational servicing, not advice for capital replacements.
This is hopefully an extreme example, and the buildings usually have a long enough foreseeable working life to justify the costs. There may be older buildings that are effectively in run-off as Trusts
Unless in regular use, water outlets can present a significant infection control risk for healthcare estates teams.
optimise the way services are delivered. They may be converted to flats long before the useful life of any new equipment that was to be installed would have delivered a return-on-investment or passed its useful lifespan. So, there is a clear incentive to avoid capital expenditure, and managing such facilities needs special care, planning, and realistic costing.
No ‘slack’ in HTMs Health Technical Memoranda, of course, cut no slack. The way to avoid emergency remedial work via good management comes down to the usual mantra: a
schematic asset register is the foundation of good risk management and auditing. It is, after all, a legal requirement to have it, and it means that investigative trace- and-access work is completed and documented ahead of any emergency or positive test result. Such compliance would, for example, enable water treatment professionals to confirm the cause of a Legionella or Pseudomonas outbreak, and where it might have spread to, more quickly and cost-effectively.
Positive danger
It has been our experience that older buildings do return a higher proportion of Legionella-positive results, a trend that can quickly be reversed when the infrastructure and prevention regime is reviewed. While the buildings may be used for outpatient clinics, the outcome will still mean both major disruption and significant expenditure. Another common Achilles heel is hidden – literally – in hospital ventilation systems. There are rarely enough inspection hatches, just about every different type of fire damper will have been installed at some stage over the years, and it is extremely doubtful that there will be a central record. Indeed, while Legionella grabs the headlines, ventilation systems are also a key concern in older buildings. While there may not be a need, in many areas, to meet the specific ventilation requirements applicable in treatment areas and operating theatres, ageing ventilation equipment could prove a major headache. There does not necessarily need to be a particular incident; simply failing to keep the right inspection and maintenance records can set alarm bells ringing, trigger emergency measures, and even see potentially costly closures.
Older buildings, often used for outpatients’ clinics, present the same business risks as newer, flagship buildings. Closure or interruption can compromise the Trust’s ability to keep treatment paths on schedule and meet referral targets.
48 Health Estate Journal September 2016
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