IHEEM Facilities Management Compliance Sept 2011

Paul RobertsGuidance Transition Lead

IHEEM – Facilities Management ComplianceIHEEM – Facilities Management ComplianceSeptember / October 2011

Estates & Facilities GuidanceEstates & Facilities Guidance

Premises Assurance ModelPremises Assurance Model

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Subject to Parliamentary Approval

DH/ NHS National Provider Reference Group (NPRG)

10 NHS Chief Executives under chairmanship of Mike Deegan

Ian Dalton Department of HealthProvider development within the

new landscape

DH/ NHS Senior Executive Estates & Facilities Reference Group

(Drawn from NPRG Organisations)

Estates & FacilitiesInterface

DH/ NHS Senior Executive Estates & Facilities Reference Group

• HEFMA,IHEEM,FM Network, BIFM• Devolved Economies• Private sector, Others

Provider Interface

Structure for Influencing the design of new landscape

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Subject to Parliamentary Approval

We need to Identify requirements To support the New Landscape

The Department of Health’s role will no longer be to provide guidance on the built environment for providers of services

The Health Technical Memoranda and the Health Building Notes need a new future

Looking forwardLooking forward

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Facilities Management Compliance

• Met with various stakeholders to consider current guidance– Essential– Best practice– Archive

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Essential Best Practice ArchiveHBNs 12% 83% 5%

HTMs 34% 42% 24%

Essential Best Practice ArchiveHBNs 87% 13% 0

HTMs 63% 23% 14%

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01 Decontamination 86% 14% -

02 Medical Gases 86% 14% -

03 Heating & Ventilation 70% 30% -

04 Water systems 58% 42% -

05 Firecode 20% 77% 3%

06 Electrical services 28% 38% 34%

07 Environment & Sustainability 10% 34% 54%

08 Specialist suite 15% 77% 8%

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• Green – 31 documents - ESSENTIAL• Amber – 28 documents – RETAINED (but lower maintenance)• Red – 53 documents – ARCHIVE

• Nothing so far changes the current format

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CURRENCY Archived Over 10 years

5 – 10 years

Under 5 years

Ongoing future need

VALUE 1 2 3 4 5Low value/importance 1 1 2 3 4 5

Desirable not essential

2 2 4 6 8 10

Essential for quality 3 3 6 9 12 15

Required for regulatory reasons

4 4 8 12 16 20

Required for registration purposes

5 5 10 15 20 25

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• Looking forward:– Who needs to use guidance in the future?– What are their needs for guidance– What level of information is required?– Who will produce it?– How will it be disseminated?– How will it be updated?

• We don’t have all the answers … yet

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Who needs to use guidance in the futureWho needs to use guidance in the future• Regulators• Commissioners• Providers of NHS services (including Any Qualified

Provider)What are the needs and what level of informationWhat are the needs and what level of information• Current guidance not written for regulators or

commissioners (although they use it)• Some publications are regarded as too prescriptive

“Tell us what we need to comply with, Tell us what we need to comply with, but not how to do itbut not how to do it”

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Who will produce it?Who will produce it?• DH role will most likely be to commission guidance

(depends of current functions being retained)• Co-produced between NHS, industry, professional

bodies & learned institutions and othersHow will it be disseminated?How will it be disseminated?• Space for Health (SfH) current option• Currently only guidance on SfH is supported by DH

(other versions may be available but not up to date)How will it be updated?How will it be updated?• An area where we don’t have the answer yet• Anticipate this will evolve as future roles &

responsibilities become clearer

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Everything we do is ratified by the SEFR Group• Identified 2 options – there may be others

– CFPP – Choice Framework for local Policies & Procedures

– Functional guidance• Working group set up to report to SEFRG comprising

DH, SEFR and CQC to identify guidance• Both options will be tested in coming months• By March 2012 we expect to know the new format• Other options may be considered as they arise

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Part 1 - CFPP basics.

• Choice Framework for local Policy and Procedures.

• Open approach which is thought to comply with the “Big Society” policy direction.

• Preserves all that is valued in the established HTMs.

• Provides clear links to clinical requirements.


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Aims and Objectives.For the CFPP programmes in decontamination.

• To accommodate the policies of the new coalition Government.

• To allow the guidance documentation to be better supported by clearly stated policy.

• To open out the guidance production and support services to a wider group.

• To support the work of commissioners.• To work with Health Standards from NICE.• To ensure long-term sustainability of the guidance

programme. • To retain the information and value of what has gone

before. The HTM engineering information remains.


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CFPP.Structure of the guidance publication.

The guidance document CFPP is provided with 4 major sections:•An introduction providing scene setting and an explanation of current English Policy. (Part 1).•A guidance section written specifically for use by care commissioners & quality inspectorates. (Part 2).•A further guidance / evidence section constructed for care providers and their supporting services. (Part 3).•A technical section based on EN/ISO/BSi standards intended to aid engineers involved in provision, validation and testing of devices used. (Part 4).


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What does this mean?

• There is a local choice agenda in terms of the measures pursued.

• Minimum standards (called “attainments”) are set out within the choice framework as Essential Quality Requirements (EQR) as first seen in HTM 01-05.

• The EQR attainments will be the subject of Local Self Audit (LSA) reported, when appropriate to the Quality Inspectorates (CQC).

• Commissioners are also likely to look for the choices made in local policy.

• Guidance will contain information to assist in the formation of local policies.


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Who is being advised and involved?• The established guidance is orientated towards health

and social care providers.• The future guidance will retain the information needed

by providers but will be primarily focused on Commissioners and the judgments made in the purchase of care.

• The Quality Inspectorates will be extensively consulted in the drafting of guidance but will also be advised by the packages produced.

• The LSA programmes are intrinsically linked to the guidance and often analysed by using models themselves based on a breakdown of the recommendations.


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Who is producing the CFPPs?• In England the Department will remain responsible for policy

and will integrate this content to a new framework structure.• The framework will provide for choice and functions

essentially on a risk control basis.• Directive guidance to support the polices will also be

incorporated to the framework and in-turn is supported by clinical and technical information where appropriate. This is being produced by a wide range of professional, learned and commercial bodies.

• The use of international standards such as those from CEN, ISO and BSi will continue largely unchanged.


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Who is producing the CFPPs? (2)• Working Group on

Decontamination Research* and other learned groups bring the evidence base in a digested form to support informed choice making.

• In each case a Steering Group will be established to oversee the preparation of the guidance and provide governance.

• Other groups, outside the DH framework, are being formed by learned and professional bodies. These include the “Decontamination taskforce.”**

* Chair Don Jeffries**AfPP, IDSc, IHEEM.


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How are the local choices made?

• On the basis of evidence and professional advice contained within or referenced by the CFPP.

• Must ensure that the EQR and associated risk considerations are met or exceeded.

• With a view to economic considerations.• To suit local circumstances particularly in terms of the

nature of the institution and the clinical services provided.

• Often by consultation between providers and care commissioners.

• Lead by appropriate local expertise such as infection control groups.


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How is the guidance validated?

• Contributions will be brought to the Steering Group for evaluation and constructive critique.

• Where possible practical piloting of key policy and guidance material is seen as appropriate.

• As well as being evidence based - guidance should also be demonstratively practical.

• Risk and safety assessments are needed - as a general rule a change in approach, protocols or technology should not result in risk increase in respect of staff or the public.


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How do people develop excellence?• EQR provides a baseline but should not itself be the limit of

aims or aspirations.• A higher level of attainment is provided within the evidence

based guidance. Business Planning towards the higher standard will frequently be recommended to commissioners as a point in evaluation of providers. (The use of the new protein detection techniques is an example of the higher attainment within BP for CFPP 01-01).

• Initial work with learned and professional bodies suggests they will promote Best Practice attainment with their members.

• Pressures from Commissioner and the Quality Inspectorate in the competitive provider market.


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Summary on CFPP - Part 1.• This new initiative will appear first in guidance on the

decontamination of acute unit surgical instruments or endoscopes.

• The new Governments’ policies calling for an emphasis on outcomes rather than process related targets are encompassed.

• The new approach provides a clear distinction between what is regulatory and / or National Policy and what is guidance in the sense of advice to professionals.

• Much of the technical component to guidance and some specialist clinical advice will be provided by learned and professional bodies working within the framework.

• The user will have a broad spectrum of choice within which to formulate local policy.


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Functional guidanceFunctional guidance• Could be applied to both HBN and HTM series• Identify a range of functional requirements necessary

to deliver the relevant topic area to ensure safe, suitable premises for delivering a high quality service

• Compliance with the functional requirements would be what the regulator looks for

• Additional supporting guidance would be provided on how to meet the FR but alternative options providing an equivalent or better standard could be used

• Result would be a more streamlined set of guidance which allows local choice

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Application example 1: Electrical guidance (HTM 06-01)• Functional requirements• FR 1: All providers of NHS services are required to have an electrical

supply connected to the public electrical supply (PES), which is provided and operated by the distribution network operator (DNO).

• FR 2: Supply voltages should be:– Large healthcare premises (floor area over 8500m2) – 11kV– Medium size healthcare premises (floor area 5500 – 8500m2) –

11kV/400V– Premises less than 5500m2, primary care premises, stores etc. – 400 V

TP&N– GP & Dental premises, small off-site clinics – 230V SP&N

• FR 3: Large healthcare premise should be supplied by a dual PES with either an automatic or a manual change over system.

• FR 4: There should be resilience of the internally distributed system.• Methodology for delivering functional requirements• Outline as an example, how the functional requirements could be met using

some, but not necessarily all, the information contained in the HTM 06 series of guidance.

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Application example 3: Day Surgery (HBN 10-02)• Functional requirements• FR 1: Provide facilities to support clinical and diagnostic

invasive procedures within a dedicated day surgery unit located within an acute hospital, treatment centre or independent sector provider premises from which NHS service are delivered.

• FR 2: The design should facilitate uninterrupted patient flow through the department.

• Methodology for delivering functional requirements• Best practice from the current HBN, combined with

research evidence and shared knowledge from the wider NHS should be used to deliver the functional requirements.

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• Proposed CFPP 05 (Firecode for the future)• CFPP 05: Part A – Management• Policy• Regulatory Framework (Fire Safety Order)• Functional requirements (compliance with Approved Document B of the Building Regulations)• Arrangements (strategy, reporting incidents, training etc.)

• CFPP 05: Part B – Practical implementation• Relevant elements of HTM (e.g. means of escape, travel distance, lighting etc.)• Fire detection and alarm systems (including reducing UwFS)• Patient categorisation• Fire fighting

• CFPP 05: Part C – Technical section / Engineering services

• Sprinklers / automatic fire suppression• Fire engineering• Atria• Retail / Commercial

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• The following elements would be left out of future guidance due to being adequately covered elsewhere by non-specific healthcare guidance from other sources:

• Significant content from 05-03: C - Textiles & furnishings

• 05-03: E – Escape bed lifts• 05-03: F - Arson• 05-03: G - Laboratories• 05-03: H (to be combined with Fire detection & alarm)

reducing unwanted fire signals• Some content of 05-03: K – Fire risk assessment• 05-03: L – Fire statistics

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●The Premises Assurance Model (PAM) is a tool that allows trusts to better understand the efficiency, effectiveness and safety with which they manage their estate and how that links to patient experience. At a high level it is based on two types of analysis: – qualitative, self-assessment evaluation; and – quantitative analysis.

• ●The model allows the user to: – see its own results on self-assessment questions (SAQs) in

scorecards; – compare its quantitative results to other trusts, years and the

national average; and – see the average scores in its SHA and other SHAs

• ●The quantitative analysis currently contains three years of data: – 2007-08, 2008-09, and 2009-10


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Premises Assurance Model (PAM)Premises Assurance Model (PAM)PAM will continue to be the DH supported tool for

providing assurance regarding the safety and suitability of premises from which NHS care is delivered

• Latest version released July 2011• Built on current DH published guidance and

information from ERIC, PEAT, National In-Patient survey results and Hospital Episode Statistics

• Future versions will relate to new guidance as it becomes available and new metrics may be developed for the ERIC collection

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Setting the sceneAssuring your future

The role of premises assurance in the future healthcare landscape

NHS Premises Assurance Model

A management tool, providing nationally consistent approach to evaluating healthcare premises performance against a set of national indicators:

• Assurance on the premises in which healthcare is delivered;

• Driving premises-related quality and performance improvements throughout the system;

• Greater understanding of the vital role that NHS premises play in the delivery of improved clinical outcomes


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Setting the sceneAssuring your future

The role of premises assurance in the future healthcare landscape

NHS Premises Assurance ModelGiving healthcare providers the opportunity to:

• Identify improvements in efficiency;

• Assure commissioners of high-quality, safe and fit-for-purpose premises;

• Identify and assess performance against peer organisations, spreading innovation and best practice;

• Raise the profile of estates issues at board level;

• Avoid onerous bureaucratic requirements for evidencing quality and safety of premises.

• A source of information which commissioners and providers can use to inform Patients and the Public helping with real CHOICE;

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Assuring your futureWho uses the PAM?

• PAM is intended for Local Healthcare use only. The DH will not collect data.

• Users of the PAM can includeTrust BoardsNHS CommissionersThe CQC have agreed that the NHS PAM can be used as evidence as part of their Regulatory regime.

QIPP PAM supports the QIPP process and should be used in QIPP plans in relation to the estate.

Monitor The Assurance process supports the roles of the Monitor in respect of their financial/economic efficiency NICE


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Assuring your futureDevelopment of the PAM

• Release NHS Acute sector model only April 2010. The model had combined Self Assessment Questions (SAQs) and Metrics Sections.

• Development of the Universal Model released July 2011. Self Assessment Questions (SAQs) and Metrics sections separated. SAQs are intended for all NHS Providers while the Metrics are for the NHS Acute sector only.

• Future Development of the PAMContinue to Develop the Universal ModelCreate GP and Dental Practice Version


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Data Envelopment Analyses

• DEA only gives relative efficiencies - efficiencies relative to the data considered. It does not, and cannot, give you absolute efficiencies.

• PAM has not used any new information, the tool has merely taken data on inputs and outputs and presented it in a particular way.


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Is the data robust?

• The calculations are based on the annual ERIC collections. The submissions are signed off by trusts as being accurate.

• The clinical activity statistics are again submitted by trusts and collected by the NHS IC. PAM does not use the raw data, this being cleaned by the North East PHO and analysed into Health Resource Groups.

• Frontier Economics further analyse the HRGs and reduce the groupings down to 12, split between in-patient and outpatient activity


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To obtain a copy of the model please visit the DH Website on

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_128702

Any queries please contact the Pam helpdesk on

[email protected]

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CONCLUSIONCONCLUSION

• The role of the Department is changing• With it, the role and structure of guidance is changing• The Department will no longer produce guidance

directly, but will work with providers, learned & professional bodies and industry to ensure healthcare specific guidance is available in the future

• HBNs and HTMs currently published as PDFs are now being published as integrated web-based documents

• Future guidance will underpin standards and help providers meet regulatory duties

• The PAM will help provide assurance that premises meet effectiveness, safety, efficiency requirements

• Together they form key components for achieving FACILITIES MANAGEMENT COMPLIANCEFACILITIES MANAGEMENT COMPLIANCEG

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Thank youThank youAny Questions?

Documents

IHEEM Facilities Management Compliance Sept 2011