FACILITIES MANAGEMENT
Making NHS and private FM partnerships work
NHS & FM commercial advisor James Saunders examines common pitfalls in NHS outsourcing relationships and offers practical recommendations to avoid them.
“It’s appalling that the private sector is profiteering from the NHS. We could do it cheaper and better ourselves!”
“The NHS should focus on patient care and recognise the private sector can provide FM services better and cheaper. Nothing wrong with making a profit.”
These statements are not a million miles from things I hear regularly, on both sides of the table. The outsourcing debate in NHS FM tends to be binary: outsourcing is terrible, and in-house is good. Or vice versa. Having spent over twenty years delivering FM
services to the NHS, working across operations, business development, procurement, commercial, and finance for some of the largest private FM companies in the UK, as well as working directly for NHS Trusts, I have sat on both sides of this debate. My view is that there is no right or wrong answer. The in-house model can be great or terrible. But equally, the outsourced model can be the same. The right model is determined by several factors, including: n What problems are the Trust trying to solve? n What are their priorities? n What internal strengths and competencies do they have?
n What is the political landscape? n What is the Trust’s experience of outsourcing?
If a Trust does decide to outsource, the biggest predictor of success is how the partnership is set up and, more importantly, how the people involved choose to make it work. When NHS and private sector FM partnerships work well, they can deliver real value for both organisations and better outcomes for patients. When they do not work well, the consequences are significant: disputes, patient safety, legal and reputational risk, and operational disruption.
The elephant in the room There is something we need to acknowledge before we move on – specifically that the primary goal for a public sector organisation is fundamentally different to the private sector. The NHS exists to deliver patient care and spend public money wisely, whereas a primary objective of a large, publicly traded FM company is to generate a return for its shareholders. These different primary goals and
May 2026 Health Estate Journal 73
the concept of a private company making a profit from the NHS can create friction and tension if not managed correctly. The NHS has a non-pay bill of around £39bn each
year. Much of that money will be spent with suppliers, all of whom will be making some profit. Nobody seems to mind when a pharmaceutical company or an IT provider makes a margin from the NHS, but with FM it becomes different. It becomes emotive. Why? I would argue that this is because of the people: the cleaners, porters, engineers, security guards, food assistants. At some point, many of them worked directly for the NHS Trust. Same uniform, same ID badge, same team as the nurses and doctors. They were part of the same tribe. When the FM service gets outsourced, those people now work for the private sector, and that shift creates problems that most people underestimate.
Tribal thinking
Humans are innately tribal. We need to belong to groups, and our employer is naturally one of the tribes we belong to. We spend over a third of our lives at work, so this is hardly surprising. Something changes when you change tribe. For example, when you go from working for the public sector to working for the private sector I saw this play out on a first-generation outsourcing
contract. Dave was head of works at a prison in London.
He had worked directly for the prison service for ten years. Everyone respected him. Then the FM services were outsourced and Dave was ‘TUPE’d’ over to the private sector provider. New uniform, new tools, new IT equipment. The same person – except the rest of the prison
Same person – different tribe.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80
