EFM POLICY AND STRATEGY IN WALES
Withybush Hospital in Havefordwest (pictured left) and Nevill Hall Hospital in Abervagenny (right) are two Welsh NHS district hospitals with extensive RAAC present.
over a number of sections – Property, Engineering, Construction Procurement, and Estate Development, with a wide array of sub-specialisms.
Backlog maintenance and RAAC Here we moved to discuss some of the ‘big issues’ for Stuart Douglas and his team, and the wider healthcare EFM/engineering sector, in Wales, beginning with a perennial one – backlog maintenance. He said: “The current backlog figure in Wales is £1.2 bn, excluding RAAC remediation work. We’ve made good progress in ascertaining the presence and condition of RAAC, having begun working with Health Boards in 2019. With the encouragement of Welsh Government, we have pushed them as hard and fast as we can in our advisory role to make this a priority.” He continued: “There are two ‘live’ hospitals in Wales with extensive RAAC at present – Nevill Hall Hospital in Abergavenny, and Withybush Hospital in Haverfordwest. “At Withybush,” Stuart Douglas
explained, “the RAAC is over a two-storey building, and they are fixing Unistrut type supports etc. to stabilise the full area of the impacted structure, in phases. At Nevill Hall Hospital, similar works will be done, but concentrating investment on the areas of estate which will be required for the longer term to reflect the Health Board’s service and estates strategy. However, as applies elsewhere with RAAC, just because people put in straps and braces, doesn’t mean you can then walk away and have another trouble-free 10 years. Facilities will need to be regularly monitored, and hopefully they will last long enough for longer-term solutions to be developed.” I next asked about the wider backlog
issue. Stuart Douglas replied: “It’s widely recognised that this is now a material problem. I watched the backlog figure rise from my arrival in 2018 onwards. EFM colleagues recognised its seriousness, but when it topped £1 bn, that milestone really resonated with people more widely. Having increased from £1 bn to £1.2 bn over the last year, one could envisage it won’t be too long before we hit £2bn, and
24 Health Estate Journal March 2024
it’s going to be a challenge to reverse the trend. There are so many demands on our capital – for new services, expanding existing ones, and new equipment, all soaking up the available resources. We’re now in a position where we develop more estate, but are not shedding it sufficiently quickly, to maintain it with the resources we have available. It’s tough; you can’t easily ask a Health Board not to invest in expanding a service in response to demand because you’ve got to replace the windows in its tower block. They’re being pulled in many directions.” Stuart Douglas said a ‘far-sighted’
measure implemented a few years ago had been the Welsh Government’s creation of an Estate Modernisation Fund of £34 m – that Health Boards could bid for to address fire, mental health, fabric, and environmental issues. He explained: “Then, two and a half years ago – having reflected on the outcome – Welsh Government developed a new arrangement offering £40 m based on a 70/30 split – Health Boards had to come up with £17 m, and could bid for investment again in broadly the same categories. They consequently began making inroads into their existing allocations to prioritise the estate, which is what Welsh Government wanted to see. It’s been highly successful, but in terms of arresting a £1.2 bn problem, it’s not enough – and that’s widely understood. Something must change.” When he presented at last May’s Wales
Regional Conference in Cardiff, Stuart Douglas emphasised the importance of having good, accurate, and up-to-date data on the estate’s condition to identify and address the most serious risks. He said: “The guidance requires organisations to thoroughly review the condition of their estate every five years, with interim reviews to check on condition and identify any emerging issues in between – but not all organisations have been able to do this. At times in the NHS we commission surveys, but don’t get a consistent quality or format of report. We’ve been investigating potential solutions with the other devolved nations and NHSE/I. For
the interests of Wales, we’re going to appraise solutions including recruiting people in house, creating a framework, or collaborating with the other nations to produce a shared resource for use UK- wide. It’d be great to have a standardised approach to recording this data, so we can share it effectively.”
Wales’s EFPMS system Wales’s equivalent of England’s ERIC (Estates Returns Information Collection) system is the EFPMS – the Estates and Facilities Performance Management System. Stuart Douglas said: “It’s been developed from ERIC to suit our needs. We started developing it to introduce decarbonisation measures, but we recognise that in England and Scotland respectively the EFM communities have adopted the PAMS and SAMS methodologies. While we’re all busy in Wales, we’re trying to create an environment where we can constantly look at the performance of the estate; thus instead of a one-year ‘snapshot’, we’ll have a live model, showing condition, highest risks, and a picture of operational compliance. In the coming year we want to appraise what’s on offer and decide what can realistically be adopted. The time has come – especially with an ageing estate – to be able to start being clearer about where the risks are, but also to be able to provide assurance that the issues are being managed correctly.” At May 2023’s IHEEM Wales Regional
Conference, Stuart Douglas mentioned that NWSSP Services had begun working with Welsh Government to produce ‘heatmaps’ of particular sites and regions within the Welsh NHS where estate investment is most needed. He said: “As a service we produce spreadsheets, which I personally find easy to use to visualise particular hotspots. Colleagues elsewhere, however, are not so keen, and need to be able to view more visual representations.” He showed me screenshots of a number of the ‘heatmaps’ so far produced, which illustrate, using different-coloured circles for each Health Board, the sites with the
Nevill Hall photo courtesy of Aneurin Bevan University Health Board
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