FACILITIES MANAGEMENT


When NHS and private sector FM partnerships work well, they can deliver real value for both organisations. When they do not work well, the consequences are significant: disputes, patient safety, legal and reputational risk, and operational disruption.


staff started treating him differently. They were less relaxed around him. They joked about him working for ‘the other side’. This tribal dynamic creates real friction. It breeds distrust and cynicism. People working for the public sector start to assume that the only goal for the FM management team is to maximise profit. You just need to watch the conversations around contract variations to witness it. The distrust becomes the lens through which every interaction is viewed. And in extreme cases, where relationships have completely broken down, people can almost get a kind of satisfaction from bashing the FM provider. That is not a healthy place for anyone.


The people problem When people talk about business partnerships, they talk about shared vision, clear deliverables, and well-defined roles and responsibilities. Time gets spent on the contract to make sure everyone understands the allocation of risk. This is all important business stuff that looks good on a slide deck and will comfort the executives. But contracts can have the right governance structure,


the right commercial model, clear measurable outcomes, and even shared values, and yet still end up in dispute within a year. I have seen it happen. The organisations spent so much time on strategic matters that they forgot the success of the partnership would ultimately be determined by how well two individuals at an operational level got along. If those key individuals do not get on, cannot trust each


James Saunders


James Saunders is the founder of Partnerships Working, which helps the NHS and private sector work more effectively together. He has over 20 years’ experience 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. He has also worked directly for NHS Trusts, giving him a perspective from both sides of the outsourcing relationship.


other, or have fundamentally different values, then the contract is doomed from the start. This is why a change in key individuals can have such a big impact on the relationship and the perceived performance of the contract. I have seen contracts go from exemplar to distressed in a matter of months because of a change in customer or account manager The impact of people is not limited to management.


Consider a more operational example: Agatha had worked on a ward for over five years. The whole ward team knew her and liked her. If there were cleaning issues, the ward manager would have a chat with Agatha and it would be sorted. No fuss, no bother. Then Agatha had to take three months off due to a family issue. Anne was the new cleaner. She had just started with the business and had little experience in healthcare cleaning. She was thrown in at the deep end with neither training nor support. Things did not go well. Anne did not know any of the ward staff, and they did not know her. The ward had not even been told that Agatha was no longer around. When there was an issue with the cleaning, the ward manager felt uncomfortable raising it with Anne. She worked for another organisation – he had no relationship with her. In the space of four weeks, the ward went from being


74 Health Estate Journal May 2026


exemplary for cleanliness to – quite literally – a complete mess. That is the impact a single change in people can have when nobody invests in the transition.


What good looks like It is not all doom and gloom. There are excellent examples of outsourced FM partnerships working well, and the common threads are always the same: there are strong relationships between the key people on both side, people are working together to achieve a common goal, and both organisations are playing to their strengths. Here is an example of when outsourcing can work. A hospital lost mains power and was running on the


backup generator. The Trust estates team were relatively new and inexperienced. They were worried about the impact on patients and staff. The service provider stepped up. An experienced engineer arrived on site, supported by a central team who had dealt with this exact issue before. A responsive and agile supply chain was put in place, and the Trust focused on its strengths: managing comms to staff and patients, mobilising additional support, and keeping the focus on patient safety. The engineer found the issue within an hour and identified the part that needed replacing. Because it had been flagged as a critical spare, the part was delivered to site within four hours. The hospital was back on mains power by the end of the day. That is what a good partnership looks like. Each


organisation doing what they are good at. But none of that would have happened without the right people and the right relationships. The engineer on site had a strong working relationship with the Trust estates team. They trusted each other. The private sector brought specialist skills, buying power, and the ability to make decisions quickly. The NHS Trust set the priorities, managed communications, and kept the focus on patient outcomes. It worked because the people made it work.


Practical recommendations So how can you get these partnerships to actually work in practice? It is not easy, but certain things work consistently. Invest in relationships before they are needed. Do not wait until there is a problem to find out whether people can work together. When there is a change in key personnel on either side, time and effort need to go in from day one. Getting people to meet outside of work, away from the office environment, uncovers things that a formal meeting room never will. Be honest about how the relationship is going. Ask your counterpart to score it out of ten. Avoid ‘why’ questions like ‘why are you doing that?’ – they come across as accusations. Instead, explain how the current working relationship is making you feel. It sounds simple, but it takes courage, and most people do not do it until things have already gone wrong. Understand how the other person works. Personality


profiling tools like Myers-Briggs or DISC can be genuinely useful here. Understanding how someone prefers to communicate, what their priorities are, and what matters to them is not soft fluffy nonsense – it is practical information that can save months of friction. Treat people as individuals. Do not assume that because someone wears a particular uniform, they must be a particular type of person. There are fantastic individuals working in FM on both sides. A cleaning manager’s goals will be very different to the goals of their CEO. Get to know people and ignore the badge. However, always remember the importance of tribe. Consider keeping staff in the same uniforms, attending the


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