Beyond buildings

Chris Hodgson, Eric Fehily and Sarah Clarke reveal the complex nature of estates and facilities management.

When Fortis catches up with Eric Fehily, Associate Director of Estates at Essex Partnership University NHS Foundation Trust, he is in the middle of a seven-and-a-half-hour drive from Essex to Manchester for a conference. This type of on-the-go meeting is not uncommon for him and a typical day for Eric and others in similar roles sees them wear many different hats. Whether heading up teams as diverse as engineering and catering, boosting staff engagement and welfare, project managing, analysing financial strategy, strategic estate planning or keeping on top of government healthcare legislation, to say the role of head of estates is diverse is an understatement.

“I don’t think people understand the amount of complexity in the job,” explains Eric. “You’ve got a multitude of stakeholders you have to manage and work with. One minute you’re a quantity surveyor, the next you’re an architect, then you’re sorting out bed pans. The following day, you could be ordering beds for new wards, doing appraisals for staff, joining health and safety committees, report writing – it’s everything you can imagine.

“It’s very challenging at times and it’s very rewarding at times.”

A complex role

“I don’t think people understand the scale of it and how it has such a huge impact on patient experience and outcomes. We can’t deliver services without buildings and we need the therapeutic environment to be right to support recovery,” says Sarah Clarke, Head of Strategic Estates and Capital Investment at Tees, Esk and Wear Valleys NHS Trust. “People automatically think working in estates is about the physical construction and maintenance of buildings, but theirs is also our side – we do all the planning – and then there’s all the housekeepers, the food deliveries and the porters.”

Sarah began her career in the NHS 25 years ago as a Health Promotion Officer before moving into planning management.

“I never thought buildings were my thing, to be honest, but the more I looked into it, I realised the buildings are an enabler for all our clinical service provision. It’s core to everything we do. My role is more strategic than some of the traditional estates roles, which links well with my planning background. It’s interesting exploring how we can best align our estate to clinical strategy and population health need, taking account of demand and capacity and patient feedback. I enjoy working in partnership with other agencies, such as local councils, identifying opportunities for place-based service delivery, co-location or estates efficiencies.”

Similar to Eric, Sarah’s role involves meeting with multiple stakeholders. A typical day starts with a team huddle, followed by meetings with finance colleagues “reviewing our capital forecast to see how we’re progressing, discussing mitigations if there is variation from the plan, and considering pipeline projects we could potentially bring forward or realign to ensure best use of limited capital funds as a Trust and at system level” before meeting with clinical colleagues. “Topics can include community transformation, long-term bed trajectories, use of assistive technology, health and safety works or office space.”

Following these discussions, it’s time to start writing business cases, which Sarah advises to approach as “telling the story. I actually quite enjoy writing them as it’s an opportunity to share all the thinking and hard work that a multi-disciplinary project team has done to get to that point.”

Eric started his NHS career as an Estates Officer on the drawing board, working in the projects office of district health authority. “This was before CAD, mobile phones and any tech gadgets that we have now to improve our work efficiency!” he remembers. After working his way up to become Senior Projects Manager in various London, Hertfordshire and Oxfordshire NHS Trusts, he also worked as Project Director in the Royal National Orthopaedic Hospital in Stanmore and London, before moving into an Estates and Facilities Director role. He now works in a Mental Health Trust in Essex and says: “There is no such thing as an average day for me. My diary is usually full of meetings where estates are an important part of the topic. I try to speak to as many people as possible to support the health and wellbeing agenda, and spent time writing assurance and executive team reports on compliance.”

Having started his career as an electrician working in industrial control systems, Chris Hodgson became a technical officer in defence and now works as Director of Estates and Facilities at the East Sussex Healthcare NHS Trust. “I joined the NHS as an electrical engineer at 26 and worked my way through the ranks, taking degrees and MBAs to get my current role in 2004. I’ve worked in the public and private sectors; I used to build and deliver PFI hospitals in a former life.”

Although Chris concedes his engineering background has helped, he says the key to success in the role is having the right skill set and attitude.

“You need intellectual and time flexibility to be able to deal with the complexity of the estates. I have 700 in my team working across a variety of services that are in-house, and I need to keep abreast of it all. It’s a big estate – 130,000 square metres – and some of it’s old, some of it’s new. It’s such a complex mix and you need to have a grip on that daily operational and strategic breadth.”

Effective reporting: alert, advise and assure

One of the areas Eric identifies as crucial to an estates role is the need to communicate with various teams: “I prepare reports for clinicians and board execs alike. I’ve worked in various different Trusts around the country and it’s interesting to see how different Trusts and executive teams have different views on estates and how much information they want. Some Trusts are really interested in having a monthly report on compliance and resilience – they want to know the risks they’re running and about staff morale. Some Trusts don’t get any reports – they leave the estates team to sort themselves out.”

In Eric’s view, the executive team needs to know as much as possible.

“The estates team needs to provide that information in a very coherent way, being open and transparent about risks and compliance. Many of my reports are based on three things: alert, advise and assure. We alert them to any problems we have. We advise them what we’re doing about it. And then we assure them by the actions we’ve taken. That’s the three things that each Trust board should have.

“In Essex, we produce a 40-page performance report every month that goes to the exec team, so they can see how we’re moving forward (or not).”

Meeting patient needs

Obviously, the raison d’être of any estates team is to enable the provision of healthcare to the population. For Eric, going from one or two albeit large buildings for an acute setting to 140 sites across all of Essex was quite daunting. “And there is so much variation between them. We’ve got women’s and children’s units, specialist units, men-only units – a variety of different patients who need different environments. It’s very specialised in mental health, and health and safety and compliance are really tough because the patients are high-risk. There’s quite a lot to manage and you need a strong compliance team.”

Sarah acknowledges similar challenges with patient diversity. “All patient groups have different needs in terms of the operational environment. We’re experiencing more acuity within our patient groups, which requires quite specialist environments that can limit flexibility. We also must ensure our environments support people with complex neurodiverse needs – having a broad understanding of some of the clinical presentations and the implications for the estate is quite complex.”

Sarah’s region incorporates Teesside, Durham, Darlington, North Yorkshire, York and Selby, which includes some affluent areas, pockets of concentrated deprivation, densely populated and remote and rural areas.

“We were asking: ‘How can we deliver person-centred services where people are and where they go? Do we need to start delivering services out of community halls, for example?’ The challenge we then have is the building itself as it won’t have our usual specification for things like acoustics or infection prevention and control. But the Trust is doing a lot of community mental health transformation, changing the way people are supported in their local communities. In Hartlepool, the council has converted a library into a community hub and one of our mental health access teams works out of there now. Responding to those challenges and meeting population need the best we can is going to be a continuous issue.”

Chris has been working on several significant capital programmes to improve elective capacity and address the Trust’s backlog, but is highly experienced in acute environments and advises: “It’s so important to remember the voice of the patient. Our design is focused on the size, Health Technical Memoranda (HTMs), Health Building Notes (HBNs), what the clinical requirements are – and it can be really easy to forget the voice of the patient in this.”

And it’s not just about patient needs: “Covid-19 really woke us up – we didn’t always provide facilities for our staff as we are so clinically focused. The NHS is thinking more about its staff, which is a good thing to have come out of the pandemic.”

Challenge(s) accepted

Due to their slightly different roles, Sarah and Eric identify different key challenges, with finance being an unsurprising common theme.

“The first of my three biggest challenges is responding to the clinical strategy, because it’s constantly evolving,” explains Sarah. “We’re currently working on a Trust-wide estates masterplan to better and more efficiently align the estate to Trust strategy and the clinical vision. We have identified core elements for investment, where we need to do further options appraisal and identify which buildings we would like to vacate – although, even when we want to rationalise, enabling investment is often required.

“The second biggest challenge is quantifying and level-loading the impact of hybrid working so we can maximise space and financial efficiencies.

“The third is obviously finance; both capital funding and revenue to support development, building running costs and depreciation. The lack of multi-year financial settlements makes planning difficult, especially when we have long lead-in times for procurement and delivery of schemes.”

Eric echoes the financial difficulties, but against a backdrop of the NHS’s net zero carbon ambitions. “How do you get to net zero with no money? Of my 140 buildings in Essex, some are over 100 years old. How do I make that net zero? Some boilers are 30-to-40-years-old. Insulation values are very poor in lots of the old properties, and you can’t just clad the outside or get more insulation. It’s much more complicated. We can’t offset, we must actually make them net zero, so there needs to be a lot of thinking about how you address these issues and how you move them forward. The New Hospital Programme will help, but it won’t replace a lot of the hospitals.”

Net zero is also at the front of Chris’ mind. “In this role, you can’t neglect the short-term pressures and you’ve got to be able to react to them, but you mustn’t let your long-term strategic direction go. We’ve got a net zero strategy to think of and keep aligned to – it would be too easy to make short-term decisions that would negatively impact this. You need to take the long-term view.”

Another area Eric finds a challenge, which is also linked to finances, is staff retention. The private sector pays far more than the NHS. “The trainees – electricians, mechanical plumbers, etc. – go straight to where the money is. They don’t look at the NHS. If you’re trying to meet all these compliance standards and retain staff, having your budget cut every year is not a great way to do that. If we had – and kept – the right teams, we wouldn’t have to use contractors as much and we’d save money that way.”
One way Eric and his team are combatting this issue is to bring in apprentices and show them there is a career future within the NHS. “We grow and teach them to become our own. I’ve developed several apprentices who’ve gone on to become Directors of Estates and Facilities because they kept moving up the ladder. You can get qualified, experienced staff to stick with you. It’s our job to make the job attractive, meaningful and interesting for them to stay on.”

Digital advancements and AI also need to be factored in, but the future is far from clear, as Chris explains: “We know change is coming, but we don’t know what that change looks like. All our infrastructure needs to be digitally enabled. We’re starting to prepare for AI, yet we still don’t fully know what that will look like – we’re almost waiting on the next advancements in AI.

“It’s also about having more flexible spaces – we don’t have enough in the NHS.”

Words of wisdom

As far as advice goes, Chris reflects on his lessons learnt in the role (see box), while Eric shares three mantras for work and for life: “Stay calm and keep going; if it’s worth doing, then do it well; measure twice and cut once.”

For Sarah, it’s all about teamwork. “I’ve always been taught that a team is only ever as strong as the weakest relationship in it. Working as closely as possible and developing good relationships with clinical colleagues is essential in what we do. Estates are just an enabler to the clinical services, so understand the clinical agenda and vision.”

What does an NHS estates and facilities team actually do?

Broadly speaking, these teams are responsible for the turnaround and management of buildings within the NHS. They work with clinicians to understand what is required, with finance teams to understand what is affordable and with design teams to bring the two together.

Within this, they have to comply with statutory Health Technical Memoranda (HTMs), which give comprehensive advice and guidance on the design, installation and operation of specialised building and engineering technology used in the delivery of healthcare.

Once built, estates and facilities teams manage the maintenance of the buildings, including IT, HR, finance, catering, waste management, health and safety, etc. and any refurbishment – all while reporting back to the executive team about what’s going on.

Lessons learnt

Chris Hodgson, Director of Estates and Facilities at the East Sussex Healthcare NHS Trust, shares what he has learnt from 20 years in the role.

You need to listen to your staff and your patients. It’s too easy to forget them, especially when you sit behind the scenes, as my team often does.
It’s important to get out there, network and talk to others. We might think we have all the answers, but it’s actually about finding the right one; the right solution.
Learn from each other. I love my job – estates and facilities is a fantastic career – but we must remember to learn from each other. The NHS is not good at sharing, so you need to share what’s worked and what hasn’t. We can all learn from each other in the NHS.

This article was taken from the January 2024 edition of FORTIS magazine.

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This article was written for the January 2024 edition of FORTIS magazine; a forum for the NHS to share ideas, innovations and case studies. To read the publication in full and access digital copies, visit FORTIS magazine. FORTIS magazine is free for NHS change-makers and leaders and is available as a print or digital copy. FORTIS magazine is managed and owned by Health Spaces Ltd.

Beyond buildings – Estates and facilities management