3500 ESTATE MAINTENANCE 3000 £3.5 bn £3.0 bn
£2.5 bn 3500
3.5 3.0 2.5
£2.0 bn 3000
2.0
£1.5 bn 2500
£1.0 bn 2000
£0.5 bn 1500
1000 500 0 1.5 1.0 0.5 0.0 £0
Cost to eradicate high risk backlog
Cost to eradicate
1000
significant risk backlog
Remaining backlog 500
contributory factors that the estate has on harm or near-miss incidents. What is not known is to what level the NHS infrastructure has played a part in the harm caused to patients in the remaining 21.3 m cases recorded by the NPSA over the two decades. In other words, is there a latent impact on patients due to the state of the infrastructure? Environmental factors such as poor surface finishes, leaks above ceiling voids, or even failing ventilation plant, may be primary causes of some hospital-acquired infections. However, all too often attention is drawn to the primary caregiver and hand hygiene techniques as a simpler cause/effect explanation.8
0 Latent
cause impact is noted within the academic literature,9,10
and has been greatly explored
in sectors such as the airline industry and the nuclear power sector. It has also been
Cost to eradicate
moderate risk backlog
0 2 4 6 8
1500 2000
10 12 14 16 18
Cost to eradicate low risk backlog
Eradicated backlog Chart 1: Impact of HIP Programme on Backlog Maintenance.
10 12 14 16 18
explored in the context of new hospital design within healthcare.11
have been no peer-reviewed works on the effects of NHS estate below condition B on patient outcomes. This is surprising given the magnitude of research that has been undertaken in the wider field of patient harm.
0 2 4 6 8
Seminal US report In 2000, the Institute of Medicine in the U.S. published To Err Is Human.12
This
seminal book highlighted that as many as 98,000 people in the United States of America die in any given year from unintended harm while under the care of the clinical profession. This seminal report spawned thousands of academic papers, conference notes, and books on the subject of patient harm and its many
2500
18% 16% 14% 12% 10% 8% 6%
0% 2% 4%
10 12 14 16 18
0 2 4 6 8
2015 to
2024
2005 to
1995 to
Remaining buildings
1985 to
2014 2004 1994
1975 to
1984
1965 to
1974
1955 to
1964
1948 to
1954 Removed / refurbished buildings Chart 2: Impact of HIP Programme on Age Profile of the Estate. However, there
subsets. Chart 3 uses the World Health Organization classifications and sub- classifications to graphically categorise the papers reviewed during a literature review search on ‘patient harm’ in SCOPUS.13,14 Of 2,708 papers classified, only 0.148% (n=4) of all the papers were related to infrastructure or buildings. This is in comparison to the 5.3% of all NRLS reports citing work and environmental factors as a direct contributing factor to patient incidents. What was common with the four papers classified as infrastructure, and with the majority of other papers on patient harm, is that they focus on the how, when, and where of the primary cause-effect relationship, not why the incident occurred in the first place. It is through understanding why an incident happened, and what influenced the causes of the incident in the first place, that true understanding and change can happen.
Lack of clarity The lack of clarity on the impact of estates-related issues makes it difficult to comprehensively argue for funds to rectify the backlog position. The current model of capital funding is via the Department of Health & Social Care (DHSC), which allocates the Capital Department Expenditure Limit (CDEL) to each of the 44 ICS systems within England. They in turn distribute the funding to the Trusts based on a mix of depreciation, income, and identified clinical priorities for the region.5
The methodology by which
Research needs to be expanded into the ‘live’ hospital setting, to help understand the importance of the role that ‘Estates’ plays in the delivery of high-quality provision.
the ICS and member Trusts allocate the funding is on a case-by-case basis. There is very little ring-fencing of funds, and, as such, most Estates Departments in Trusts have to ‘bid’ each year for funds to tackle backlog maintenance. This is alongside clinical departments who are
September 2022 Health Estate Journal 53
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