ESTATE AND ASSET MANAGEMENT
Asset management and the opportunity for the NHS
Greg Markham BEng (Hons), CEng, FIHEEM, MIET, MIWFM, Estates & Assets director at Serco Health, and an IHEEM Past-President, argues for a more structured approach to healthcare asset management across the NHS, and reports on IHEEM’s plans to create a Framework, and associated tools and training, to provide the NHS (and all healthcare estate providers) with ‘a standard, repeatable, structured approach to managing the asset base’.
I’ve had a long career to date in healthcare engineering, initially within the NHS, and then across in the PFI service-provider sector, and while both operate healthcare facilities, and much is common between them, one key difference between the two approaches centres around the management of assets. Having been involved with PFI schemes from the early days, the journey has been an enlightening one; it was referred to as ‘Lifecycle’ as opposed to Asset Management, but I soon grew to understand the fundamental principles of risk, condition, and whole-life costs. Indeed I can recall, on my first PFI scheme, being in the enviable position of explaining why I hadn’t spent the full Lifecycle fund in Year 3, a stark contrast to the NHS approach of ‘We know you need £X capital, but this is all we can afford; spend it wisely.’, and the annual round of reporting an ever-growing backlog of maintenance. It may be approaching 20 years since I left the NHS, but from what I see of the ERIC returns, the backlog maintenance bill has continued to balloon, with current reported levels of £9 bn+.
The service’s third-largest expenditure The NHS needs to understand that the ‘Built Estate’ is the third largest expenditure, after ‘People’ and ‘Medicines’, and should be managed and invested in appropriately. After all, the NHS has central People Development plans, and NICE looking after the strategic approach to medicines and treatments for the NHS, so why isn’t there a focussed Asset Management Plan, or framework, for such a significant cost base, and a key enabler to delivering patient care?
You may recall that we recently canvassed opinion from the membership of both IHEEM and HefmA, and a big ‘thank you’ to all who took the time to respond; there were many of you from across the NHS, PFI, and outsourced NHS providers. I believe the results of the survey reflect my concerns, with key highlights as follows:
46 Health Estate Journal September 2021
Greg Markham is a highly experienced healthcare
engineer and EFM professional, who has taken the lead on the new Asset Management Working Group.
AM recognised as important, but with gaps in knowledge and understanding
Service Provider (non-PFI) PFI Provider
NHS Trust (in house) NHS SubCo
0 5 13 20 26 11 27 25 40 Percentage
n Not recognised, considered irrelevant, or unimportant n Not considered vital, but there is some interest or engagement n Recognised as vital for Estates management
Figure 1a: Perceived value of asset management.
Service Provider (non-PFI) PFI Provider
NHS Trust (in house) NHS SubCo
0 5 13 20 26 11 23 38 40 Percentage
n ‘Innocent’ – not widely used or recognised n Inconsistent – some champions, different approaches, different understanding n Developing – systematic programme to develop capability n Mature – common understanding at all levels
Figure 1b: How would you describe the level of knowledge and understanding of asset management in your organisation?
n Asset management is seen as a key requirement, although knowledge and capability were accepted as variable.
n Systematic management of asset- related risk was significantly higher in PFI providers; in fact more than double than within NHS Trusts. This was a similar picture in terms of financial justification of asset replacement, with rates of around half in NHS Trusts compared with other entities.
n The survey also indicated higher rates of risk evaluation in respect of maintenance than within NHS Trusts, and a similarly higher proportion of PFI providers utilising SFG 20 as a maintenance standard.
n Training rates on asset management are very low, and those who have completed the training are concerned about the lack of tools available to implement their learning.
32 56 50 25 60 80 42 33 23 25 100 60 89 68 63 80 100 74
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 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88
