What’s happening in healthcare?

Julian Fris, director at FM consultancy Neller Davies, shares his insight into FM’s changing role in the healthcare sector.

To what extent would you say the themes listed above are consistent with your experience of FM in the healthcare sector? 

FM can play an integral role in the patient experience – whether it’s through the controlling of environments, maintaining buildings to high standards so they are safe and clean, or even through the role it can play in helping patients recover through the food they consume. 

FM can be the difference in offering better, faster and more comprehensive clinical outcomes. The pandemic period has shown how vital FM is to the whole operation as the way organisations have innovated in how they clean, serve and maintain their services have been quite remarkable. 

Being able to break through ‘ordinary’ or statutory procurement processes has actually been vital for innovation. 

We’ve seen so much of this over the course of the last 18 months or so. Innovation has accelerated as a direct consequence of the challenges we’ve faced through the pandemic.

What are some other common themes that you see in FM contracts in the healthcare sector?

As with much of the economy, there are some major themes that the sector is tackling. These centre on patient welfare, cost, sustainability, net zero carbon, hygiene, infection control, nutrition and hydration, food waste and ‘bed blocking’, and patient stays.

These are all significant and FM touches each of these areas. 

There is much that the healthcare sector is grappling with, and not all as a direct consequence of the pandemic. These are historical issues at play that need attention. FM is the engine that drives hospitals to deliver excellent patient care, any weaknesses in the system are clearly going to manifest themselves with poorer outcomes.

What are some of the unique pressures or challenges for FM in healthcare?

The estate itself is a very mixed bag with a number of legacy buildings that are difficult to manage. This is probably the most significant challenge facing the sector at the moment. Clearly, FM is a key component of this. 

The maintenance backlog of nearly £10 billion shows that the whole system is on a knife-edge with old and dilapidated buildings and assets. The government has responded by pledging the construction of 40 new hospitals but the lead time may be too long to relieve the risk pressure today and not all trusts may benefit. Perversely, the pandemic may have lowered some pressures with lower activity levels, but sites are trying to get back to normal but may be struggling with failing facilities.

The recent independent review of hospital food commissioned by the DHSC suggested that the annual cost of hospital food waste is £230 million or 39 per cent of the total food budget. Whilst it is difficult to achieve zero waste, this figure can be significantly reduced, with savings being reinvested into FM services. We also see too many dedicated FM staff being used where better technology and processes could improve productivity and efficiency.

Technology is also a challenge in the sector on a number of levels. Whilst appropriate tech exists, the sheer effort of implementing is a challenge, either getting through impenetrable firewalls to staff actually prepared to use the systems. 

The outcome is that contractors, in particular, struggle to deliver state-of-the-art and economic FM solutions but invariably are left with the financial and& performance risk of being unable to deliver through no fault of their own.

There are also knowledge gaps that need to be addressed and the investment in expertise needs to be considered to enable better use of technology that could be available to offer more efficiency.

People issues in the wider economy do touch healthcare to some degree, however, in my experience, the sector seems better at looking after its people than many others. Whilst payment of staff compared with the rest of the FM community may be a consideration, terms and conditions are generally good, particularly at entry levels. So retention isn’t as challenging as you see in commercial sector contracts and sites. The bigger challenge is attracting more senior positions and critical skill sets such as authorising engineers, head chefs and housekeeping managers.

How do you think FM services in the healthcare sector are likely to evolve over the next few years and in what ways will they be consistent with or different from FM service delivery in other sectors?

With the reforming of the Public Contracts Regulations, we will hopefully see the loosening of some of the shackles placed under procurement departments and organisations. 

The debate has raged for years in healthcare as to whether FM is a core service or not. In the commercial sector, it is seen as non-core, however, hospitals are different. FM plays a vital role in patient care and can be the difference between better/faster recovery versus having a detrimental impact on the patient journey.

Clearly, given where we are societally, cost is going to be a continued issue especially as our healthcare spend is lower than other developed countries like the US, Germany, France, Ireland, and Australia.

An issue fix for some organisations may be to take money and funds out of facilities management and look at reactive rather than proactive maintenance, for example. This may plug some short-term financial gaps, but condition-based maintenance is not ideal in the long term and this largely explains the current problem.

The future, however, shouldn’t be about cost, but more value, productivity and collaboration.

The good news is that we are seeing more ‘vested’ collaborative contracting-based solutions being considered, with great examples already coming from US, Canada, and Scandinavia. Sharing risk and reward is now being seen as an integral part of the success of any organisation. 

I actually think we will see more cross-collaboration between FMs and FM companies from the commercial sector and healthcare. There are collective lessons to be learned from specialists across each sector. 

I also see how social value offered will drive decision-making for the foreseeable future. The wider impact on outcomes achieved through FM delivery will be key factors for healthcare organisations. 

An abridged version of this Q&A appears in the November-December 2021 edition of Facilitate, which showcased the winners of 2021 IWFM Impact Awards.