For the NHS, delivering quality services in well-maintained, secure environments is integral for the safety and comfort of patients.
When private finance initiative (PFI) contracts were introduced, the goal was to ensure that facilities management services, including high-level maintenance and day-to-day building operations, could be outsourced to specialist organisations. Numerous KPIs were set in these contracts, to ensure that these companies delivered services in line with clearly defined goals. Financial deductions were introduced if a company failed to meet the specific outputs that were expected of them in a designated timeframe. These KPIs were an important way for the public sector to hold the organisations they work with to account, to support them in the continued delivery of high-quality services.
NHS Premises Assurance Model
In 2013, NHS Improvement published the NHS Premises Assurance Model (PAM), which supports boards, directors of finance and estates and clinical leaders to make more informed decisions about the development of their estates and facilities services. The model was first introduced to provide assurance that NHS estates were safe, efficient, effective and of high quality. Updated regularly by the Department of Health and Social Care and the NHS, it was initially used as guidance. However, since April 2021 the model has been part of the NHS Constitution, by providing a universal framework to have oversight of estates and facilities management.
By adhering to the model, trusts can demonstrate to patients, commissioners and regulators that robust systems are in place and that all premises used for services are as safe and effective as they can be. As well as helping trusts to prioritise investment decisions for raising standards, it offers them the ability to measure compliance against legislation and guidance across the whole of the NHS. By achieving these standards, it means that buildings can be kept in better condition and hospitals are more likely to get positive reports from the CQC, leading to improved outcomes for staff and patients. If failings are detected, this may negatively impact an organisation’s review.
Trusts are now adopting the latest version of the PAM, but it’s not without its challenges. The existing KPIs in PFI contacts are currently not mapped against the new model, making it more difficult for private firms to deliver accurately and to specification. While the KPIs do focus on safety and attention to detail, they’re not as stringent as the PAM. The current contracts require private firms to meet NHS requirements, which include the PAM, but the differences within the original KPIs leaves room for confusion, error and poorer quality outcomes. While financial penalties might not occur if the KPI in the contract is met, it doesn’t necessarily mean that the work is meeting expectations.
Upgrading performance monitoring
Upgrading performance monitoring tools within PFI contracts will enable NHS organisations to get the most value from their contractors, ultimately delivering better services for patients as well as commissioners.
PAM provides a universal framework to enhance collaboration between the NHS and PFI partners, but companies must upgrade their performance monitoring for this to happen. They will need to undertake a detailed review of existing KPIs to see how they compare to what’s included in the PAM, putting plans in place ahead of delivery dates to make up for any shortfall. All services, policies and procedures will need to be accounted for to make this possible.
As PFI contracts are phased out, the PAM will support trusts in taking control of their own organisations, ensuring strict, standardised governance is in place for both the development and running of facilities. Meanwhile, PFI partners can learn from NHS organisations about best practice, using the experience of leaders to help them to upgrade their own performance monitoring to meet the standards needed.
By working collaboratively, private partners can deliver what they set out to achieve- creating better and safer buildings and services for the public sector.