The pandemic has put enormous strain on the NHS. At the height of the crisis, the virus stretched hospital capacity close to breaking point and caused significant disruption to routine appointments. Recent figures show that 388,000 people have waited more than a year for non-urgent surgeries.
To limit this disruption as much as possible, NHS Property Services (NHS PS) has had to make dynamic use of its portfolio by converting unused space and adopting a more flexible approach to managing its buildings. Adrian Powell, head of property development at NHS PS has said that lack of “face-to-face contact and the ability to be mobile and visit sites” has been particularly challenging “for properties that needed extra capacity during the crisis”.
The need to adapt
Build and engineering teams have provided crucial support through this period. Last April, Integral partnered with the NHS and Kier Construction to create a Nightingale hospital in Bristol, one of seven in the UK commissioned to help the NHS cope with the surge in COVID-19 cases. In parts of the portfolio where the NHS had identified spare capacity, the Integral Projects team also helped build special “COVID wards”. The organisation designed and delivered a ward in Brentwood Community Hospital in approximately six weeks, increasing the bed capacity from 30 to 120.
It’s just one way that FM services providers working across critical infrastructure, such as healthcare, education and supermarkets, adapted to a fast-changing new reality. While these organisations were shielded from broader economic upheaval, teams had to adopt new ways of working quickly and remain focused despite the difficult environment they were operating in.
These findings tally with the experience of Phil Byrne, head of public accounts for Integral, who says the real challenge in the healthcare sector wasn’t a lack of demand, but the need to become more flexible. “The buildings we maintain were still being used – maybe more – so the challenge for us has been to adapt to the virus, protect our people, and work around the new pressures on the services we were delivering.”
Added flexibility has meant early starts, late nights and weekend working to get access for essential maintenance. “Where there were COVID-19 outbreaks, we were able to leverage our cleaning teams to do deep cleans and fogging to get areas back up and running as quickly as possible,” adds Byrne.
Post-pandemic challenges
As restrictions lift in the summer, healthcare organisations will need to work closely with engineering teams to establish post-pandemic repairs programmes. Byrne says that one of the most significant challenges moving forward will be the historical backlog maintenance issue within the NHS.
A recent report by NHS Digital revealed a substantial deterioration in the NHS estate despite a £1 billion injection in capital spending. The cost of bringing deteriorating assets back to suitable working condition (the maintenance backlog) totalled £9.6 billion in 2019/20, a figure that is “roughly equivalent to the annual cost of running the entire NHS estate”. What’s more, at least half of outstanding capital maintenance has been categorised as ‘high’ or a ‘significant risk’.
The government has included hospitals in its pledge to ‘build back better’ after the pandemic. It has already confirmed a series of major investments in NHS infrastructure since August 2020, including £850 million to upgrade 20 hospitals. Following a recent Spending Review, a further £1.2 billion has been ring-fenced for new hospitals and upgrades in 2021/22.
Despite the positive short-term outlook, the NHS will most likely continue to grapple with financial constraints. The data from NHS Digital, for example, revealed that the maintenance backlog grew by five times the amount that NHS trusts invested in addressing it in the last financial year.
Byrne explains: “The backlog isn’t as significant an issue in the parts of the NHS estate that Integral looks after, but we will be in buildings within NHS Trusts that have to deal with constraints elsewhere.”
Embracing technology
Since 2013, NHS PS has embarked on a space optimisation programme, including the sale or lease of unused parts of the portfolio and the more efficient use of partially occupied spaces. To date, the initiative has raised more than £380 million through the disposal of unwanted assets and saved approximately 4,600 tonnes of CO2.
Technology can play a crucial role by capturing the data that makes this progress possible. According to Simon Taylor, the head of optimisation for NHS PS: “By gathering occupancy data, combined with local knowledge and technological inputs, we can then better assess how space is being used – a key step to optimising space.”
Similarly, sensor technology that monitors and measures asset performance could also help the healthcare sector tackle its maintenance backlog issue while creating significant energy savings. By equipping assets with these sensors, engineering teams can perform predictive maintenance, build a detailed picture of assets’ lifecycle and make informed decisions about future capital spending.
However, the shift to a tech-forward mindset will not be easy. Byrne says that the public sector’s risk-averse and steady nature makes it reluctant to stand at the forefront of technology. It is also hard to incentivise NHS trusts to embrace efficiency-driving technology when they are in the middle of a 25-year PFI.
But the responsibility doesn’t rest solely on the healthcare customers. Byrne says it’s down to Integral to take organisations on that journey: “I think it’s something we need to push more as we come out of the pandemic to identify where there are opportunities for us to further support the NHS with the challenges they face.”
