ESTATE MAINTENANCE
steeped in the culture of evidence-based medicine. Departments that are able to argue a clear case for the cause and effect of action or inaction on patients stand a significantly greater chance of attracting capital funding than those who provide circumstantial evidence at best. However, there are clear actions that can be taken by Estates professionals to start to respond to this question.
Reporting The current NPSA reporting tool captures some data on the impact of estate-related patient harm. This is predominantly direct impact, not the true effect of estate on patient outcomes. However, it is possible to quantify the time, cost, and effort taken to rectify incidents when they occur. This information will start to give the profession evidence on the impact of underinvestment on the Trust’s infrastructure, and will also start to provide greater anecdotal evidence on the magnitude of the disruption caused to the patient pathway.
Research In 2020/21 The National Institute of Healthcare Research (NIHR) granted £1.2 bn in funding for research in the NHS, none of which was directed at estates infrastructure research; nor has there been any over the last five years.15
This is
despite there being significant evidence through the work on evidence-based design that the environment in which we deliver healthcare has a strong effect on the outcome of patients. This research needs to be expanded into the live hospital setting, so as to greater understand the impact and importance of the role that ‘Estates’ plays in the delivery of high- quality healthcare provision. The work that the NHS estates
professionals do is foundational to providing high quality infrastructure for the delivery of safe clinical services. However, this is proving harder to deliver year on year, with costs spiralling, and capital becoming ever restricted. The response by the profession must one of clear irrefutable evidence.
References 1 Davies N, Atkins G, Guerin B, Sodhi S. How fit were public services for coronavirus? CIPFA / Institute for Government. August 2020.
2 NHS England / NRLS Reports. Organisation patient safety incident reports. 23 and 29 September 2021.
https://tinyurl.com/muutbf9z
3 NHS Digital. Estates Returns Information Collection Summary page and dataset for ERIC 2019/20. NHS Digital. 2021. https://
tinyurl.com/45zcdcs9
4 NHS Estates. A risk-based methodology for establishing and managing backlog. London: The Stationery Office; 2004.
54 Health Estate Journal September 2022
Protocols/Policy/Procedure/ Guideline Availability/Adequacy, 68%
Screening/Prevention/ Routine Check-up, 12%
Diagnosis/ Assessment, 21%
Organisational Teams/People, 9%
Human Resource/Staff Availability, 22%
Bed/Service Availability/ Adequacy, 1%
Matching of workload management, 1%
Behaviour, 1%
Bloods/blood products, 0% Nutrition, 1%
Oxygen/ gas vapour, 0%
Healthcare-associated infection, 1%
Non-classified, 28% Patient accident, 1%
Monitoring, 5%
Supply/Ordering, 5% Storage, 1%
Administration, 16%
Presentation/Packaging, 2% Delivery, 1%
Preparation/Dispensing, 8% Prescribing, 62% Chart 3: Classification of patient harm literature by WHO classification
5 Kraindler J, Gershlick B, Charlesworth A. Failing to capitalise: Capital spending in the NHS. The Health Foundation, March 2019.
6 Hall R. Warning over potential roof collapses at NHS England hospitals. The Guardian [Internet]. 16 August 2021.
https://tinyurl.com/mvccb8n4
7 Slips, trip and falls in hospital. National Patient Safety Agency, 2007. https://
tinyurl.com/mrydrn5
8 Braithwaite J. Changing how we think about healthcare improvement. BMJ, 2018; 361:k2014
https://tinyurl.com/44kfdxej
9 Dickerman K, Barach P, Pentecost R 3rd. We shape our buildings, then they kill us: Why health-care buildings contribute to the error pandemic. World Hosp Health Serv. 2008; 44(2):15–23.
10 Reason J. Human error: models and management. BMJ 2000; 320: 18; 320 (7237): 768–770.
11 Ulrich R. Evidence-Based Design for Patient Safety. The Environment for Care – An NHS ESTATES SYMPOSIUM, pp. 14-18, 29, 35-36. April 2004.
12 Kohn LT, Corrigan JM, Donaldson MS. To Err Is Human: Building a Safer Health System. Institute of Medicine. National Academies Press; 2000. 312 p.
13 World Health Organization. The conceptual framework for the international classification for patient safety. 15 January 2009
https://tinyurl.com/4banywc8
14 Scopus preview – Scopus – Welcome to Scopus Preview.
https://www.scopus. com/home.uri
15 FOI Request to the National Institute for Health Research; response received on 20/07/2022.
David Jones
David Jones is the director of Estates, Facilities and Capital Development at the University Hospital of Southampton. Previously the director of Estates and Facilities at Brighton University Hospital Trust and, prior to that, director of Estates, Facilities and Capital at Western Sussex NHS Trust, he has worked in senior positions across the NHS for 14 years. A Fellow of IHEEM, with an MBA from the University of Surrey, he is currently working towards a PhD. in the Faculty of Social Sciences at the University of Southampton. His research is focused on understanding the causal relationship between backlog maintenance and patient outcomes within the acute sector of NHS England.
Medication/ IV Fluids, 27%
Resource/ Organisational Management, 24%
Clinical Process Procedure, 31%
Procedure/Treatment/ Intervention, 38%
General Care/ Management,
10% Tests/ Investigations, 16%
Specimens/ results, 2%
Detention/ Restraint, 1%
Non-Classified, 1% Clinical/Administration, 4%
Documentation, 7% Infrastructure/Buildings 0% Medical device, 3%
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