The care manager

‘It’s the same old story,’ says Geoff Callan, adviser to NHS Estates and the new chairman of the health facilities management association (Hefma). Referring to the long history of under-funding for non-clinical services in the NHS, he says; ‘The money was not put in to keep plant and buildings functional, the money went to clinical care. Support services and estates had money taken off over the years, and now we feel the effect because buildings are deteriorating. You can’t keep cutting back.’

Part of this maintenance backlog, it is hoped, can be written off as new hospitals emerge due to the private finance initiative. The government has also pledged to blitz one quarter of the backlog by 2004. How long the rest takes is anyone’s guess. But one thing is clear – the days are long gone when the exclusive focus from central government rests on the clinical side of the health service equation, with little or no attention to the non-clinical.

This shift was underlined by the launch of the government’s NHS Plan in July. Part of this directly addresses the question of how to develop and improve the environment within which patients are treated.

Meanwhile, plans to usher in the equivalent of the local government’s ‘best value’ regime for the health service are awaiting final approval from ministers. As in local government, the move will have profound implications – both for the way facilities services are provided and the standards by which service provision is judged.

Reflecting this new focus on the strategic importance of facilities, the NHS Estates has brought support services under its remit, a move for which Callan, together with colleagues from Hefma, has lobbied particularly hard in the last year.

‘We felt NHS Estates should take on facilities management and that NHS Estates and Hefma should work together,’ he says. It’s a move which is increasingly reflected at individual hospital trust level where more and more are combining the role of head of estates and head of support services.

‘Although there are still some that split the role between estates and support services, most trusts are moving towards having a head of facilities,’ says Callan, who is director of facilities at the Milton Keynes General NHS Trust.

Patients are a virtue

Callan clearly welcomes the latest focus on non-clinical services contained in the NHS Plan. ‘The key to all this is the patient,’ he says. ‘If we can provide a nice environment it helps the patient to feel better. If we can provide a safe warm environment for the patient to be treated in, then we are doing the job.’

Among the various strands of the NHS Plan is a ‘hospital clean-up’ initiative backed by extra funding for trusts – all part of the government’s commitment ‘to improving patients’ experiences of the NHS by focusing on their comfort, convenience and dignity,’ said Lord Hunt at the launch of the initiative. ‘This is not just about cleaning floors but about the whole potential experience of patients – where they park their car, whether they find the wards clean, whether there are cigarette butts everywhere, whether there are pictures on the walls and so on’, says Callan.

Callan’s own hospital could easily serve as a blueprint for this section of the NHS Plan. The commitment of the trust to the environment in which its patients find themselves stretches to £40,000 worth of sculpture and paintings adorning corridors and wards (all paid for by private businesses) – a rare and calming sight in an NHS hospital.

‘It’s also about food,’ he says referring to the government’s intention, also announced in the NHS Plan, to encourage the provision of ‘hotel-style’ catering services. ‘It’s about radical changes within the food supply to healthcare. We are talking about the provision of a national menu and a 24-hour service.’

Callan fully expects the private sector to play its part in the transformation: ‘It has to be done in partnership with the private sector. They do some things better than us and we do some things better,’ he says.

We have to think of making ancillary workers more a part of the ward teams through multi-skilling, increasing their profile and possibly pay

But he does admit to concerns over funding: ‘This will be all for the good provided that funding is available. Over the years we’ve all been market tested to death,’ he says. More specifically he is concerned that the injection of cash promised by the government for both the big clean up and for its revolution in catering services (£30 million and £10 million respectively) will not be repeated.

He adds: ‘My worry is that these (payments) are one off. If it means employing additional staff, then there is an added cost, and what of the future?’

Good housekeeping

Despite such concerns, Callan doesn’t believe that throwing money around is the only answer to the challenges faced by managers within the NHS.

Innovations such as multi-skilling, and rethinking the way services are delivered, must also play a role, he argues.

Recruitment and retention of staff is an issue that particularly concerns Callan and his colleagues at Hefma – at all levels. ‘We have to think of making ancillary workers more a part of the ward teams through multi-skilling, increasing their profile and possibly pay,’ he says.

Milton Keynes has already experimented with the creation of ward based housekeepers, managed by ward sisters and functioning as part of the ward team, an idea that is now a key part of government thinking.

Under the six-month pilot study, ancillary workers were allowed to take on some ‘lower level’ nursing roles – supplying water to patients for example. ‘We trained them, and gave them better pay,’ says Callan.

Under the NHS Plan, all hospitals will have to have housekeepers by 2004. ‘It is about front of house and back of house – people have got to be warm and friendly,’ says Callan. ‘You’d be surprised what you can get if you put domestic staff in a new direction.’

If everyone is to gain from such new approaches and ideas, they must be spread around, a goal that Callan particularly wants to fulfil in his new role at Hefma.

‘As the chair of Hefma, I am a great believer in the idea that we should be sharing information. Therefore we want to bring together all the bodies within facilities: Hefma, the Health Facilities Consortium, the Hospital Caterers Association, the Association of Domestic Management and the laundry and linen bodies. If anything is coming out from Leeds (NHS Estates) it goes to Hefma and we want them (the bodies) around the council table.’

While the timing of Callan’s appointment to Hefma coincides with the new focus on non-clinical services, it also coincides with the arrival of the first new hospitals procured under PFI.

When asked whether PFI has been a good thing for facilities in the health sector, Callan says: ‘In theory, PFI is a good thing, with trusts getting new hospitals. In fact he says, it is ‘probably the only way we can move forward.’ But he is concerned that the role of the ‘informed client’ must be retained in the PFI model. A view with which few facilities managers would disagree.