ESTATE MAINTENANCE literature,5
The secondary, latent cause, is noted within the but is not a subject that has been greatly
explored. Environmental factors such as heat and noise caused by failing equipment have the effect of causing distraction, and subsequently harm, to patients,6,7
while,
for instance, poor ventilation increases the likelihood of cross-contamination within hospitals.8
Equally, a
failing environment or plant may be the primary cause of hospital-acquired infection in some instances, when all too often attention is drawn to the primary care giver and hand hygiene techniques as a simpler cause/effect explanation.9 However, it is not currently possible to quantify how many patients are being harmed. While there have been anecdotal reports, such as reports on the internet that 88 people were injured between 2015/16 and 2016/17 in hospital fires,10
or the report on unsuitable buildings causing inefficiency within the NHS,11
David Jones explains: “The studies clearly demonstrate how the Estates department is not only intertwined with the clinical teams, but can be the source of significant impact to both patient and clinical services.”
using CPI inflation data, all else being equal, the cost of £4.30 bn cited in 2014/15 would today cost £5.33 bn, an increase of £1.03 bn.
n Revenue impact: One of the biggest impacts on preventing backlog maintenance increasing is the estates revenue budgets. Many Trusts have seen an erosion of estates budgets over the decade. Trusts have been consistently hit with a 3-8% cost improvement (CIP) target, which has de-prioritised planned maintenance to focus on reactive repairs. An example of this is an Estates department which held a budget of £30 m in 2014, but an average CIP target of 5% would see their budgets almost half over a decade to £17.9 m. However, as an estate ages it requires both more planned maintenance, and more reactive maintenance, to ensure that it is functionally sound.
Patient safety incidents In January 2021, the National Patient Safety team (NPSt) released data stating that clinical service incidents citing work and environmental factors in 2019/20 had doubled since 2011/12,3
amounting to over 115,000 incidents
reported. As an estate infrastructure ages and clinical standards increase, greater funding is required to keep pace with planned maintenance and asset replacement to prevent failure and subsequent patient safety incidents. Patient risk from infrastructure failure can originate from
Crumbling buildings and infrastructure often force wards and beds to close.
two main sources – active and latent. The active source is that of a primary cause/effect relationship, such as environmental factors which cause a patient to trip.4 These incidents have been captured within the 1,311,708 reported infrastructure incidents on the National Reporting and Learning System (NRLS) system since 2003.
there has been no
published work on the effects of NHS estate on patient outcomes. Likewise, there have been no systems put in place to track the impact of incidents on patient outcomes.
Delayed or cancelled treatment In 2022/23, ERIC data cited indicated that more than 2,600 patients in acute hospitals had their treatment delayed or cancelled due to infrastructure issues at their hospital. While some aspects are minimal in terms of their impact (e.g. floods in Outpatients), other issues may amount to months of disruption – such as when waiting for new parts for air-handling units. The harm that this delay in treatment is causing is rarely linked to specific incidents. However, the level of disruption and impact on patients can be noted directly from clinicians. At the end of 2022 the British Medical Association published a survey of all its members,12
which highlighted 11 key findings, including:
n 43% of doctors surveyed told the BMA that the condition of their workplace has a negative impact on patient care.
n 38% of doctors answering the BMA’s 2022 estates and IT survey said the overall physical condition of their workplaces was ‘poor’ or ‘very poor’.
n Crumbling buildings and infrastructure often force wards and beds to close, compounding a wider lack of space across healthcare estates, and contributing to ever-expanding waiting lists.
While the NHS does not collect root cause analysis data on all patient safety incidents, there is sufficient evidence to suggest that there is an ongoing clinical impact on a large cohort of patients due to the level of backlog maintenance.
Academic When looking at patient harm research within the built environment, there is a strong tendency to focus on the design rather than the management of the estate. It has been established that good evidence-based design (EBD) can significantly improve the environment in which patient care is given and, by extension, improve health outcomes. However, the current impact of EBD within the NHS is limited due the lengthy replacement cycle involved in embedding EBD into the NHS. There is a small body of evidence that recognises the importance of the support role that management and maintenance of the built environment plays to clinical services and the patient. There is a general acceptance that maintenance is crucial in healthcare settings, and that the failure of key infrastructure systems – heating, water, ventilation, electrics – could have significant impact on patients.13
of failing infrastructure is hard to assess,14 34 Health Estate Journal October 2024
However, the lack of research into the impact due to the
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