Martin Read and Bradford Keen report on the pressures healthcare estates and facilities managers face with evolving skills requirements in a dynamic environment.
07 October 2019 | Martin Read and Bradford Keen
Tight finances, more demand for services, a bigger and ageing population, staff shortages and rising public and political expectations - facilities service provision in the NHS needs to cope with a lot, says Preston Gan, business services and performance, directorate of facilities and eHealth at NHS Grampian in Scotland.
Senior-level FMs need a mix of skills that simply wasn't required 10 to 20 years ago, says Paul Featherstone, executive director of estates and facilities at Tameside and Glossop Integrated Care NHS Foundation Trust. Key among these are the soft skills necessary to manage and maintain relationships within EFM teams and beyond.
Naturally, the technical competencies necessary to deal with more complex compliance concerns are a staple. But healthcare FMs in 2019 also need the business acumen and corporate awareness necessary to engage properly at senior levels and understand the broader drivers for the average hospital or NHS trust.
"There are a lot of organisations whose senior FMs don't have that blend of skills and awareness," Featherstone suggests. More education and people development is required. "To do the job as effectively as you can within the current environment, you need a blend of skills."
Recruiter Peter Forshaw agrees that the sector's FMs have "a very wide remit". People management, says Forshaw, "is particularly important in healthcare, where unionisation is far more prevalent than in other sectors. This often requires the kind of diplomatic approach that many FMs may not be used to or capable of".
Union disputes, strikes, staff restructuring or even contagion outbreaks: these FMs require "a high level of professional composure that FMs in other
sectors may not".
To diplomacy, add decisiveness. Budget management is "an important weapon in a healthcare FM's arsenal. It is often the job of the FM to find cost savings wherever they can, and this often requires a cut-throat approach when it comes to areas such as contract negotiations and staff restructuring. Not everyone has the stomach for that", he says.
A blend of skills
Although senior FMs might need a better blend of skills, Gary Lupton, executive director of estates and facilities at Medway Hospital Foundation Trust, says the sector benefits from excellent long-serving facilities staff, in particular "some very highly skilled people who really do understand how to work with 40-year-old boiler sets".
Lupton favours addressing the looming shortfall through a new generation introduced through apprenticeships.
Fiona Daly, who works for NHS Improvement as its sustainability and estates and FM workforce lead, is focused on these and similar issues. Daly is tasked with transforming the estates and FM workforce, encouraging young people, introducing effective succession planning and improving collaboration. Issues of gender equality and diversity were highlighted in a recent workforce survey, as were entry points into the profession.
"Many of our workers came in through vocational avenues or apprenticeships," says Daly. "That's fine, but I also think we need more graduates. Every other NHS department has management grads circulating through it, but we don't. We need more."
A broader concern is demographics. "Seventy-four per cent of the workforce is over 40 years of age, with 34 per cent being over 56," Daly says. "We also have 2,000 people over 65 who are coming back after retirement to keep things going. But we don't have the people coming in at the other end to replace them.
"The sector has been underinvested in and training budgets have reduced over time," says Daly. "We haven't invested in our core programme for leadership in a while, yet the skills we're asking people to have are changing."
Daly says NHS Improvement has worked hard to bring estates and FM up the corporate agenda to show how critical the built environment is to providing excellent patient care. She points to initiatives such as the new Healthcare Facilities MSc programme - the first of its kind in the UK, and offered either full-time or in modular form through UCL's Bartlett Real Estate institute.
For now, says Featherstone, what is often an issue is a lack of qualified candidates. Responses to adverts for well-paid jobs requiring certain qualifications and experience are often poor, with candidates misperceiving their ability to do a demanding job. "In fact, they don't have the capability or experience," says Featherstone. "There's something missing in the system at the moment, which makes it really difficult to get the right people."
John Carey, director of estates, facilities and capital planning at Medway NHS and Social Care Partnership Trust, wants better contract management skills. About two years ago Medway began outsourcing its maintenance and catering functions. "It was the right thing to do, and we have got a better product at a better value," he says, "but it introduced something my people hadn't had to do previously, which is manage those contracts. Developing skills on specifications, contract management, the application of contract conditions - that's a whole new area for some mental health organisations."
Nick Fox, a senior FM working in healthcare, says better contract management ties in with his notion that FMs from outside healthcare FM can bring much-needed commercial nous.
"From an operational perspective, when you work for service providers you live a very busy, hectic, pressured life - that's quite common," he says. These FMs can emphasise better processes and standard reporting in healthcare, for example.
Resilience and stress management
Daly believes that FM staff in healthcare need to be strong of mind in often trying circumstances.
"The fact that we are all contactable 24/7 and can check on everything all of the time - it means we need to look at mental health in our profession. FMs working in healthcare are in a particularly stressful FM role. When you know that there's somebody on the end of a piece of kit who could be affected negatively if you or your team don't do their jobs, that can only result in a toll on their mental health.
"Personal resilience is a real issue. They're faced with risks every day, literally keeping things switched on. And that can be quite wearing after a period of time. Our people take on a lot of risk because they care about doing the right thing. We tend to have people with common-sense values, but they're being constantly pushed, which affects their personal resilience and wellbeing."
Martin Burholt, managing director of international FM and UK communities for Interserve, puts a high value on FMs able to demonstrate such resilience. "From my experience, if you are resilient enough in management and skilled enough to be successful in this environment, you can literally survive and flourish in any arena."
Such strength of character can soon lead to professional progress on the supply side.
"Healthcare is a great part of an FM's learning portfolio," says Burholt. "I've got the example of someone who was a partnership director on a very large university account campus who is now running the largest healthcare FM contract in the company.
"At management level it's about how you use your resources wisely, how you understand your customer and recognise the dynamics."
For in-house healthcare FMs, the requirement is to ensure that the skills match the responsibilities.
"We have people looking after disposal and acquisitions or outsourced FM contracts with values that are eye-watering," says Daly - "and they've got no contract management skills. We've clearly got to work on that."
It is also about considering skills requirements as yet unknown. "Five years ago we probably would not have thought we need data analysts in our teams," says Daly, "but we do now. We also need to take people whose jobs are being automated and train them in the skills we need now. One of the biggest challenges we're facing is how we reskill people."
Automation is a pressing issue. Daly says: "We're looking to trial an AI energy manager. It's a world first, and it will allow our energy managers to get way from mundane data crunching to instead use their brains, work across larger geographical areas and develop their own capabilities - but there's a behavioural and cultural barrier we need to overcome if we're to stop people thinking automation automatically means the end of their jobs."
Ultimately, whatever the skill demands, the vocational component of providing for the NHS should not be underestimated.
Martin Steele, chief operating officer of NHS Property Services, notes the "emotional attachment" his organisation's staff have to the NHS.
"They know why they're here and what they're here to achieve. It's part of our purpose, which is helping the NHS to transform to enable excellent patient care. Everyone gets it. We see people joining us and, invariably, they are happy and feel good about joining our organisation." Those who have joined from other providers show "a massive sense of pride of being part of an NHS team, when they put the NHS badge on it makes a huge difference to them".
The overall picture is of a sector and a skills requirement in a state of significant flux.
What's needed, suggests Lupton, is for the NHS to learn from what banking did 20 years ago; introduce change management directors tasked with supporting people through change programmes. While resources at the NHS are limited, more time needs to be invested in communicating with staff about the benefits of change.
"Staff have felt they are simply being told to change after working in a certain way for a long time. And they're just not comfortable with that," says Lupton.
The time is now to improve workforce development
"There is no other environment where estates and facilities professionals are provided with such a breath of opportunity and the potential to make such a positive difference," claims Paul Featherstone, who has been in the sector for almost three decades.It's why I was originally attracted to the sector, and it remains a privilege to play a part."
Focusing on in-house requirements, Featherstone would like to see better succession planning and the development of "our own experts" through the nurturing of "appropriately qualified people with appropriate levels of resources".
He also believe recruitment and retention in the sector need to be better, as does performance monitoring of both in-house and contracted teams.
Last month, the IWFM, healthcare estates directors and other interested healthcare sector parties met in Manchester to help devise a sector-wide strategy to improve workforce development. "We're all sort of fishing in the same pond for expertise and we're all struggling to recruit the appropriate people," says Featherstone.
Those already in healthcare FM could find themselves "typecast" because of its specialist nature, suggests recruiter Peter Forshaw. But healthcare FMs' skills are transferable to other sectors.
"They can often develop knowledge of numerous business functions that aren't sector-specific," Forshaw says, such as health and safety, finance, security, building management and soft services.