We were commissioned by the Associate Director of Estates and Facilities Management at the Southern Health NHS Foundation Trust (SHFT) to undertake a benchmarking exercise of the Trust’s Estates and Facilities Services.
The Trust commissioned the exercise as part of its efforts to provide a common standard and to establish a patient focussed, best practice service. As part of this drive the E&FM services have an important part to play in aligning their activity to deliver the desired clinical outcomes and a safe patient environment.
E&FM is responsible for a wide variety of estates and facilities services, split between its three sections, as follows:
Estates and Capital Management
- Maintenance management (strategic and operational)
- Hard FM Contract Management (pre and post tender)
- Capital programme and capital project management (pre and post tender)
- Minor Works
- E&FM Helpdesk
- E&FM Business continuity
- Resilience and critical incidents
Asset Management and Compliance
- E&FM Statutory and compliance assurance, legionella, asbestos,
- Fire safety, food hygiene safety and nutritional advice, food hygiene training
- Health & Safety, advice and risk management
- Local Security management specialist, management of violence, security.
- E&FM Auditing, performance management and benchmarking
- Asset management, estate rationalisation and legal services (strategic use of estate)
- Estate terrier/system support
- Trust/E&FM business support
Facilities and Environmental Management
- Soft FM management (strategic and operational)
- Day to day site management (SHFT estate)
- Environmental management (sustainability and carbon reduction)
- Soft FM contract management (pre and post tender)
- PEAT/PEAG process lead
- Transport management
E&FM provides in-house estates and facilities services to varying degrees under SLA/contract and via recharge arrangements to the following NHS Trusts and organisations:
- NHS Southampton City (including Solent Community Healthcare) - Majority of Estates and FM services
- Southampton NHS Independent Treatment Centre – Maintenance and Minor Works services
- Southern Health NHS Foundation Trust – Full range of Estates and FM services
- NHS Hampshire – Maintenance and Minor Works services for South West Hampshire as secondary contractor to NHS Portsmouth’s Estates and Facilities Service
- South Central Ambulance Service NHS Trust – Maintenance and Minor Works services
- Lymington New Forest Hospital (PFI) - Maintenance and Minor Works services
In addition, it commissions services and manages the interface agreements from the following NHS Trusts:
- Hampshire Hospitals NHS Foundation Trust - Maintenance services for North Hampshire and Maintenance and some facilities services for Mid Hampshire
- NHS Portsmouth City - Maintenance and some facilities services to support the MH/LD service provision in South East Hampshire and Estates and Facilities services as part of the SLA NHS Hampshire has with NHS Portsmouth City to support the ICS service provision.
- Surrey PCT - some cleaning and catering services
Terms of Reference
The Trust required us to undertake the following:
- an initial benchmarking exercise to identify relative performance against other, comparable peer organisations and potential commercial outsourcing providers in order to determine the potential for cost improvement or income generation;
- thereafter work with key senior personnel to validate the benchmarks, confirm the scale and potential for cost improvement in order to establish a cost improvement strategy;
- Finally, to confirm our research findings and strategy in a short report and present to the project sponsor and/or project board.
Our Transformation Team provided a list of basic information that we required from the Trust, so that we could understand the Estates & Facilities Services in question.
In addition, our Transformation Team met with the Heads of the three Estates & Facilities Management sections in order to ensure we had a clear understanding of the service provision. These meetings helped to ensure that any benchmarking of costs was undertaken on a like-for-like basis and that full account is taken of any operational differences in the services. Additionally, meetings were held with the Trust’s Finance department and the E&FM Directorate Accountant to ensure that the all of the costs relating to E&F services were included within the scope of the review and that they were correctly allocated to services and properties.
In order to establish a solid baseline for the analysis, the review team sought to ensure that all costs relating to E&FM were included within the scope of the review. SHFT posed a number of problems in this regard, as the costs of some of the E&FM services sit within the E&FM Directorate, whilst others sit within the Clinical Directorates of the Trust. Additionally, significant levels of expenditure are contained within Service Level Agreements (SLAs) that needed to be reallocated to specific properties in order to establish the total E&FM service costs.
The review team therefore adopted an approach based on the analysis of the actual expenditure for the 2011/12 financial year, using a download from the Trust’s Ledger, which enabled us to extract all of the E&FM cost centres as well as all of the costs relating to account codes which could be considered to be connected with E&FM. These account codes included pay codes for Ancillary graded staff as well as non-pay account codes concerned with cleaning, catering, engineering and building materials, utilities, etc. This analysis also identified a number of lines relating to “services received” from other organisations, these were further investigated to establish whether they related to E&FM and where they did (for example, Linen) these were also included in the analysis. The costs of rent, rates, minor works and phones were excluded from the analysis.
In this way, the review team were aiming to ensure that all of the costs relating to the day-to-day provision of soft and hard FM services were included within the analysis.
Having established a baseline for the totality of the E&FM service costs, a number of significant lines in relation to SLAs were then further broken down and reallocated to specific properties where possible.
Finally, a number of key performance metrics were developed for each service and property based on the square meterage and bed information provided by the Trust.
We undertook a focused benchmarking exercise, using comparative data from:
- Our own benchmarking database consisting of 80 Trust wide reviews (Financial Recovery Plans)
- 390 Market testing exercises
- 270 Technical Evaluations
- 865 Service Reviews
- Over 200 assignments of working with commercial service providers in bidding for NHS and Public Sector contracts and a number of value testing reviews
Our database covers most clinical and non-clinical services and functions. In total our database covers over 140 NHS Trusts including many Mental Health & Community Health Service Trusts.
We conducted semi-structured interviews with the key service managers of those services that form the scope of this review in order that we gain a good understanding of the services being provided. It is vitally important that any comparative analysis is based on like for like comparisons as it is not unusual for the range of service provision to vary significantly from Trust to Trust. Establishing a good understanding of the services in question is therefore imperative if the resultant analysis is to be meaningful. It should be noted that in the time available the validation of the services has been undertaken at a headline level, it has not been possible to assess the detail of each service at each site, which may be more appropriate once this initial analysis has focused attention on any areas where costs appear comparatively high.
Having established a suitable understanding of the service provision at the Trust, the levels of service being provided, the costs and quality of these services, our Team then undertook comparisons of this performance with that of other Trusts.
Report & Findings
On completion of our investigations, our Transformation Team developed a report, which presented our research evidence, findings and recommendations to the Trust.
Our report presented the findings of an analysis of the Southern Health NHS Foundation Trust’s Estates and Facilities Management costs.
The analysis showed that, overall, the Trust’s E&FM costs appeared below the average of other NHS Trusts providing similar services with similar property profiles.
It was particularly noticeable that those services directly provided and managed by the Estates & Facilities Management team appeared to have lower costs than those provided by third party organisations via SLA arrangements and those provided and managed by other directorates within SHFT. There were a few exceptions to this statement, but overall the observation remains valid in the vast majority of occasions.