The primary issues identified were:

1. Disparate Data Management: The client struggled with a fragmented approach by Project Co to managing compliance data, leading to inconsistencies and inaccuracies in reporting.

2. Maintenance Compliance: There was a notable discrepancy between reported and actual maintenance compliance levels, with internal reports indicating compliance levels of 93-97%, while our sample audit revealed a compliance level of only 65%.

3. Performance Reporting: The client’s performance reporting mechanisms were inadequate, particularly in tracking Quality Failure categories and ensuring Health & Safety compliance.

4. Authorised and Competent Persons: The appointment process for Authorised and Competent Persons was not robust, leading to potential gaps in compliance with Health Technical Memoranda (HTM) requirements.

To address these challenges, our team implemented a comprehensive Life Cycle Management approach focusing on the following key areas:

1. Data Integration and Management:

• Developed a unified portal for real-time data management, ensuring all relevant certificates and service sheets were accessible and up-to-date.
• Implemented a system for monthly compliance reporting, highlighting upcoming inspections and renewals.
• Utilised the ‘plan-do-check-act’ principles to standardize asset identification and maintenance strategies, ensuring a structured and robust approach to data management.

2. Enhanced Audit and Compliance Monitoring:

• Conducted thorough on-site audits and desktop reviews to assess compliance with statutory requirements and the Project Agreement.
• Provided detailed recommendations for resolving high and medium priority non-compliance issues within specified timeframes (3-6 months).
• Applied a systematic approach to asset management, focusing on optimising value and ensuring assets meet safety and performance requirements.

3. Performance Reporting Improvements:

• Established a clear framework for Quality Failure reporting and tracking, ensuring all maintenance activities were accurately documented and reported.
• Introduced a robust process for analysing Failure Events and integrating findings into the performance reports.
• Implemented a life cycle costing approach to maintenance, enabling better decision-making and budget optimization.

4. Strengthening Competency Management:

• Reviewed and revised the appointment process for Authorised and Competent Persons to ensure continuous coverage and compliance with HTM requirements.
• Developed a target operating model to maintain a safe estate, ensuring all roles were filled by suitably trained and qualified individuals.
• Ensured a structured, efficient approach to managing the risks and costs associated with owning assets, supporting continual improvement and ongoing value creation.

Our Life Cycle Management approach, enhanced by best practices, yielded significant improvements in the client’s operational efficiency and compliance levels:

1. Improved Data Accuracy and Accessibility:

• The unified portal streamlined data management, reducing discrepancies and ensuring real-time updates on compliance status.

2. Enhanced Maintenance Compliance:

• The client achieved a more accurate and reliable assessment of their maintenance compliance, aligning reported figures with actual performance.

3. Robust Performance Reporting:

• Performance reports became more transparent and reflective of actual conditions, aiding in better decision-making and resource allocation.

4. Strengthened Competency and Coverage:

• The revised appointment process for Authorised and Competent Persons ensured continuous compliance with HTM requirements.

Summary Outcomes

By incorporating best practices to enhance Life Cycle Management, we helped our client overcome significant challenges in data management, maintenance compliance and performance reporting.
Our comprehensive approach not only improved the PFI providers operational efficiency but also ensured sustained compliance with statutory and contractual requirements. This highlights the importance of an integrated and proactive approach to Life Cycle Management in achieving long-term success and reliability in PFI / PPP operations.

Establishing the accuracy from a Board perspective of the reported levels of backlog maintenance from six sample NHS trusts in the region, and how consistently that was applied across the region.

Representatives from each of the six trusts were asked to provide relevant data and participate in semi-structured interviews. The data requested included facet surveys, asset management strategies, critical infrastructure reviews, lifecycle replacement programs, risk registers, capital programs, and other relevant reports.

1. Data Availability

Only approximately 50% of the requested data was received from the trusts, indicating a lack of readily available and measurable data for effective risk management.

2. Risk Management Practices

• Lack of awareness of the regional healthcare system’s estates strategy among most interviewees.
• Inconsistent understanding of core, flex, and tail properties among the trusts.
• Limited strategic alignment between property disposal and estates strategies.
• Absence of comprehensive estates and facilities (E&F) risk registers in some trusts.
• E&F risk registers were not consistently managed as day-to-day business items.
• Reliance on tribal knowledge and word-of-mouth for risk escalation in some cases.
• Lack of assurance of compliance with relevant health technical memoranda.

3. Critical Infrastructure Risk (CI Risk) Trends

• The CI risk backlog across the six assessed trusts decreased by 9% compared to the previous year, in contrast with the national average increase of 13%.
• The regional healthcare system’s CI risk per square meter was significantly lower than a peer benchmark.
• Concerns were raised about the inclusion of Category 2 PFI equipment as high/significant risk items.
• Lack of strategy alignment between CI risk and green plans (environmental sustainability initiatives).
• Inconsistent approaches to risk and asset management, with no strategic application observed.
• Limited utilization of technical assessments, such as authorizing engineers’ reports, to evaluate risks.
• Lack of evidence that some trust boards were adequately informed about the levels of risk within their organizations.

Best Practices

The case study highlighted two trusts that demonstrated best practices in CI risk management:

1. One trust adopted a strategic asset management approach, involving an independent engineer’s review, assessment of existing asset registers and risk registers, and a focus on investing in assets for compliance, clinical capacity, and future decarbonization aspirations.

2. Another trust conducted a comprehensive assessment of its portfolio, utilizing various data sources (facet surveys, asset registers, questionnaires, and authorizing engineers’ reports) to establish a risk-based methodology for managing backlog, compliance, and risk considerations.

Recommendations

The case study proposed several recommendations for improving CI risk management practices across the healthcare system:

1. Adopt a common risk management methodology and cultural reset for consistent backlog assessment and management.

2. Develop an overall asset management approach to inform future capital plans.

3. Integrate CI risk strategy with property disposal strategies and green plans.

4. Implement and maintain E&F risk registers across all trusts.

5. Mandate the adoption of relevant health technical memoranda and utilize authorizing engineers’ reports for risk prioritization.

6. Ensure a common understanding and application of risk-based methodologies, potentially through training.

7. Implement accurate and relevant cost profiling for backlog maintenance calculations through continuous assessment processes.

By addressing these recommendations, the healthcare system could enhance its CI risk management practices, improve data availability, and foster a more strategic and consistent approach to managing critical infrastructure risks across its constituent trusts.