Estate performance and facilities functions

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There are a number of standard tools used across the NHS to support the effective performance management of the estate. This allows for a common set of measures that enables both more effective performance management and benchmarking with peers. Over the past five years, the trust has made considerable progress in improving the performance of its estate.

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Like all NHS trusts, KMPT uses the NHS Estates Return Information Collection (ERIC)/Model Hospital information returns systems, which relate to the costs of providing, maintaining and servicing the NHS estate. This also includes information on the costs of providing certain patient-focussed services such as food and laundry. In addition, the collection includes a number of non-financial aspects of building operation, such as information in relation to fire safety and an organisation’s progress in meeting carbon reduction targets.

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Over the past two years, the ERIC system has begun to be superseded by the Model Hospital information system, which uses the ERIC reporting process to produce and, since last year, publish comparative benchmarking information for all NHS trusts. There have been some interesting technological advances, particularly the use of apps on mobile phones, which are capable, through using dashboard data capture, of bringing comparative benchmarking all the way down to between - and across - individual wards/teams. These will be explored with trust clinical technology and information colleagues.

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KMPT also employs the Patient Led Assessment of the Care Environment (PLACE) process, which applies to NHS in-patient facilities and is carried out by specialist audit teams, independent of the clinical and facilities operational teams, and which have both patient and professional representation. Some of this focuses on the quality of estates and facilities services as they impact on the patient experience. PLACE looks at how well facilities meet standards on privacy and dignity, cleanliness, quality of meals, “dementia friendly” care environments, and aspects of estates performance that affect patient care.

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A final source of information on performance of the estate is gleaned through the periodic update of what is known as the “6 Facet Survey”. Developed for the NHS and used across the public sector, this review focuses on 6 dimensions of building condition and performance, and for KMPT was last updated in 2018. Set out below are some of the current key outcomes for KMPT estate from these various performance systems.

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The first full Model Hospital data set for community and mental health trusts was published in 2018. It illustrates where KMPT sits on the chief estate and facilities dimensions in comparison to other trusts (MH data includes all trusts, whether acute, mental health, community or specialist, much of which cannot be sensibly benchmarked). By isolating for comparison a cohort of comparable trusts, the information is more useful. The overall benchmark of KMPT estates and facilities costs per m2 is illustrated in Figure 1 below, as well as that of five “cohort” comparator trusts, and shows the trust in the highest performing quartile in the country.

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The key messages for KMPT to be drawn from the Model Hospital data are:

• Although there continue to be some inaccuracies in Model Hospital data - some inherited from the ERIC system, some to do with the definitions used for some categories, some with data challenges and all amplified by the comparison with other trusts where the same problems will have a different mix - the benchmark information does provide a useful starting point for investigating estates and facilities performance and cost
• KMPT benchmarks positively with other trusts on food, utilities, maintenance costs and hotel services. KMPT does less well on the amount of non-clinical space it has (39.6 per cent against the Carter Review’s 30 per cent target), the amount of empty space (13.9 per cent against 2.5 per cent) and the amount of under-utilised space across the trust, assessed at 9.9 per cent. The benchmarking shows that KMPT is in the poorest performing quartile for all three of these measures.

Estates and facilities cost - national distribution

The image is a bar chart which gives every trust in the country a bar and arranges them in order of the cost per meter squared to maintain their estate. This bar chart shows KMPT at the top end of the chart, with our estate costing less than most other trusts. We are in the top quarter nationally on this measure.

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In response to these findings, the trust’s estates department is in the process of:

• Reviewing the data collation and submission processes to ensure accuracy of the resulting findings
• Continuing to improve the utilisation of space. Much of the negative benchmarking above relates to older, poor building stock targeted for disposal where a large amount of space is not used at all, or poorly (for example, St Martins West, which is being vacated for disposal, and Canada House, which is also earmarked for disposal as part of the Medway Hub development with the local council). Achieving the Carter targets on empty and under-utilised space will have direct cost improvement/efficiency benefits and these are factored into the team’s cost improvement plans. The estates team will aim to achieve the Carter targets on all three of the utilisation and vacancy areas by April 2020
• Reviewing opportunities for cost improvement in cleaning services. The MH data suggests that KMPT’s cleaning costs are £45 per m2, against a national median of £36 per m2, a 25% difference. The estates team will be aiming to reach the median figure by April 2020.

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The trust’s PLACE results have seen a steady improvement over the past two years. The chart below in Figure 2 provides the trust’s overall results in the five categories used by PLACE. From this, it can be seen that the trust is at, or near, the national average in its scoring and that the trend is in the right direction in all areas except food/catering. This information has been understood for some time and helped drive the trust’s decision to outsource the catering operation to its new provider partner, ISS. It is anticipated that scores will improve for 2019.

Figure 2 - Trust place results

Year	Cleanliness	Food	Privacy, dignity and wellbeing	Condition appearance and maintenance	Dementia
Overall trust scores 2018	99.43%	87.03%	88.41%	94.51%	86.94%
Overall trust scores 2017	98.99%	87.68%	85.68%	92.85%	81.05%
National average	98.64%	91.04%	90.42%	95.24%	87.34%

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During 2017-2018 the trust invested in updating its 6 Facet Survey information. This information gives the estates team a clear picture of the main problem areas where, if the building is retained, significant investment is likely to be required. Thus, the annual capital investment plan can be informed by this information, as is the identification of transformation/disposal opportunities.

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KMPT has made significant improvements to its fire safety systems in recent years, and will continue to do so. The Grenfell tragedy led to an urgent review of fire systems across the public sector, a review which showed KMPT systems to be robust. The trust’s approach to fire safety is one of continuous improvement, so there will be no let-up in the drive to greater safety for our patients and staff. Improved and more accessible training packages, a relentless focus on audit activity and fire risk assessments and use of innovation, such as installation of fire “misting” systems (which release controlled
amounts of water in mist form from specially-designed sprinklers) for minimising collateral damage in the event of a fire will keep the trust on top of this critical agenda. Strong team leadership, and robust governance arrangements, ensuring Board level sight of fire issues, is a feature of the trust’s fire operations.

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Finally, on the question of performance, the CQC reviews estate matters as part of its inspection processes. For the most recent CQC visit, a relatively small number of estates issues were identified, only one of which was categorised as a “must do”. This related to acute inpatient wards in terms of fire (this issue being largely related to the problem of patients smoking in bedrooms), flooding (on the day of the inspection at one site there was a problem with a couple of en-suite bathrooms) and the ongoing problem of ligature reduction (primarily in those wards where upgrades are scheduled but not yet
complete).

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Overall, KMPT can be proud of what has been achieved to date with the performance of its estate, but there is more to do. The trust is gradually shedding the worst of the accommodation inherited when it was formed in 2006, has a major programme of upgrades agreed and scheduled, is continuing to explore surplus property disposal opportunities arising from its estates transformation programme so capital can be reinvested in improvements, and is driving forward efforts to improve space utilisation and reduce costs.