Without well-maintained buildings, clinical services cannot be delivered safely and effectively and a poor environment becomes an inhibitor to patient recovery.

NHS buildings continue to deteriorate at an alarming rate, and the issue of backlog maintenance spiralling out of control due to lack of funding has long been in the headlines. In October 2017, The Guardian published that the “crumbling state of hospitals is putting staff and patients at risk and could lead to health and safety prosecutions.”

There have also been stories of at least one NHS Trust being put in to special measures by NHS Improvement, partly because buildings are unsafe, poorly maintained, not fit-for-purpose and falling in to disrepair.

Since 2013/14, Trusts have been transferring capital budgets to revenue budgets to deal with day-to-day financial pressures, drastically reducing funds intended for long-term investments such as new buildings, maintenance and equipment. In 2017, The Health Foundation stated that “£1.2bn was transferred from capital to day-to-day spending this year” and “capital spending in the NHS has fallen by more than 20% in real terms over the last three years”.

The Carter Review of NHS Productivity published in February 2016 provided recommendations for achieving £1bn of efficiency savings from hospital estates and facilities. However this money would not be prioritised to go back into the estate but rather into the support of patient services. The Naylor Report on NHS Property and Estates published in March 2017 stated that “without investment in the NHS estate the [NHS England] Five Year Forward View (5YFV) cannot be delivered, the NHS estate will remain unfit for purpose and will continue to deteriorate”.  

Trusts' estate and facilities departments are doing what they can but they have a proportionately reducing pot of money, as demand for clinical services continues to increase. Many Trusts are turning to the private sector for investment and strategic planning to help them do more with less. 

Traditionally, capital schemes had been delivered via Private Finance Initiatives (PFI) or Public Private Partnerships (PPP), but these have fallen out of favour in recent times due to their perceived inflexibility and high annual unitary charges. Ryhurst developed the Strategic Estate Partnership (SEP) model in 2010 as a response to these criticisms and reflecting feedback from the NHS which had highlighted a lack of value for money options for the delivery of capital schemes.

The SEP model is becoming increasingly popular within the NHS. It looks at an NHS estate holistically and strategically and can be used as a vehicle to deliver not only capital schemes, but also as a way of realising estates and facilities efficiencies.

A SEP can be used to eradicate backlog maintenance through the implementation of managed lifecycle maintenance, funded from efficiency gains delivered through an outsourced Hard FM service.

Ryhurst is able to introduce Trusts to a range of specialist maintenance contractors to forward fund the delivery of work to the most critical backlog items, reducing the Trust’s risk exposure. Trusts are also able to further reduce their liability and risk through a third party managed service agreement for all or some plant, assets and equipment.

Testing the market to provide a Trust with the right provider for their requirements, Ryhurst will ensure a wide remit Hard FM service that lowers costs, improves the quality of the environment and increases service quality.

This approach can significantly reduce or avoid the re-accrual of backlog maintenance, enabling the Trust to spread the cost of eliminating backlog maintenance liabilities by realising efficiencies provided in Hard FM.

The SEP model is completely flexible, and does not have to be used as the vehicle to take forward projects. It’s a 50:50 joint venture, meaning that decisions within the SEP are agreed on an equal basis between the partners. The SEP provides the capacity and range of capabilities by introducing the right skills at the right time and ensures value for money by testing the market for each specific project.

Ryhurst is in partnership with Lancashire Care NHS Foundation Trust, Cheshire & Wirral Partnership NHS Foundation Trust, the Isle of Wight NHS Trust, North West Anglia NHS Foundation Trust, and has recently been selected as preferred bidder for Whittington Health NHS Trust. The following savings and achievements are examples of successes realised through our SEPs:

  • £5 million revenue savings on Hard and Soft FM whilst increasing quality of services provided through outsourcing
  • Up to 50% reduction in consultancy costs on capital projects
  • Saved over £20m capital costs by renegotiating the ProCure21+ project, The Harbour
  • Improved usage of existing corporate and clinical facilities by 39% through a space utilisation programme
  • £300k per annum savings through market testing of a PFI FM contract
  • Managed the procurement and development of a large mental health unit for children and young adults, and through savings, enabled the inclusion of a four bed specialist unit as an addition to the project scope
  • Won four projects awards for various schemes delivered through the SEP including: Design, Project of the Year, Service User Engagement, and Large Commercial Building  

Find out more about SEPs and the success of our joint ventures to date here.