Hospital trusts turn to outsourcing

Citation

(1998), "Hospital trusts turn to outsourcing", Facilities, Vol. 16 No. 1/2. https://doi.org/10.1108/f.1998.06916aab.005

Hospital trusts turn to outsourcing

Hospital trusts turn to outsourcing

Sound management is the backbone of any successful property-owning business. Yet there are massive property portfolios which are still inefficiently managed, or not managed at all! And many of these important assets are in the public sector, where under-funding has been the major culprit in the never-ending saga of neglect. During the last decade, Countrywide Property Management has found itself troubleshooting for Government quangos and some of the newly privatised public services, as they come to terms with the need to make their property assets work ­ in terms of both occupancy and rental levels, but also to know what they have, and where, and its current state of repair. They also need an answer to the question, can we do better by rationalising?

Among those who have turned toCountrywide Property Management are various Hospital Trusts and Operations Director, Mike Moody, believes that his company is the leading expert in this particular sector, managing and advising generally on around 10,000 units, ranging from single rooms and flats to family houses.

"There are problems which are unique to hospitals in that the BMA, for example, lays down very specific criteria for doctors' accommodation. The requirement for a large number of people to be resident on site in order to provide essential patient care, combined with the continuing turnover of staff on short-term contracts, can cause serious logistical headaches."

Much of the accommodation is in Victorian blocks, some of which would barely survive health and safety checks. "Historically, nursing and other jobs in health care have been regarded as vocations, which don't command all the trappings of other careers, so their accommodation requirements were low priorities. That mood is changing because Trusts are competing for the best people, and it is also recognised that property is a worthwhile asset which can, at the very least, pay for itself. But only if the roller-coaster of neglect comes to an end."

All in all something of a dilemma for incoming Trust managers! With money tight, they are faced with finding a cost-effective solution for maximising their assets without diverting money from patient care.

Six years ago, the Mid-Essex Hospital Trust in Essex decided on "outsourcing" their accommodation management, and the tender was won by Countrywide. This formed a template for measuring properties of other Trusts, mainly located in East Anglia and the Home Counties, with the latest instruction coming from Waltham Forest Health Care NHS Trust, commencing in March this year.

"We were able to support our tenders with statistical evidence of our successful management elsewhere. Combined with our knowledge and understanding of the unique problems, this undoubtedly played a significant part in our appointment."

The most common problems encountered include poor, or laborious, record-keeping, owing to under-resourcing in terms of professional staff and computer equipment, so it was not always known who was in which accommodation. A lack of tenancy agreements was a potential legal minefield, and rents had to be brought into line with the prevailing market, if rents were being paid at all. In more than one instance, we even discovered people who had left the hospital's employment still "living on site ­ rent free!" They also found people in occupation for whom a Trust was not mandated to provide accommodation. And there was the question of Council Tax payments, and whether the costs for provision of utilities was recovered.

Mr Moody also found that neglect of building fabric had led to some vandalism, and abuse of furniture and fittings, while, in some instances, non-hospital staff were using the grounds as a free car park. Keys were lost, meaning locks had to be replaced at considerable expense. "We had to help to change the culture associated with these institutions. Making people more responsible for their surroundings."

Employing their own watchwords of "firm but fair", in each case they set about identifying who was in residence, "by the simple expedient of putting notes under doors, with the promise that, if we didn't receive a response within three days, we'd use our pass keys to gain access."

With computer equipment installed, rents were analysed, and increases phased in alongside the shorthold tenancy agreements. Armed with schedules of accommodation/ occupation, up-dated daily, and files for each unit, setting out condition and repairs, Moody's teams were then able to recommend rationalisation, including disposing of some houses off-site, upgrading existing accommodation, and making vacant blocks, where hospital facilities were being run down prior to closure, "available to other emergency services, the ambulance and fire services, for example, as temporary accommodation."

Where not already in place, parking restrictions were implemented, with clamping enforced. And Countrywide Property Management have experienced full-time staff to man the Accommodation Offices every day, with an out-of-hours help line ­ "by making people accountable, as well as approachable, there is an avenue for complaints, which has helped enormously."

Registered letters and parcels are held by these offices until the addressee signs for them, post is delivered rather than left in pigeon-holes (unfortunately, this practice had been abused) and checks are made to ensure that the terms of cleaning contracts are adhered to. Inventories and inspections are carried out, and rents are collected, either by the company, or directly by Payroll, with whom there is constant liaison.

Another improvement means that "on-call" accommodation is allocated to departments, in a single area, with digital door locks to the rooms ­ "doctors are notorious for losing keys!" This means that the same group of doctors will be using the same room, "so they can leave a few personal belongings there, if they wish." The system has "freed up more of the general accommodation, because we don't have to find temporary on-call rooms when doctors don't hand in their keys!"

Information packs are issued to new members of staff, including a site plan and the names of people to contact, as well as a list of what they are required to supply for themselves (i.e. bedding, electrical goods and the standard to which they are to comply).

"With the improved environment, and better communication, the residents are also accountable. They are now quick to complain about other people making a mess, and there has been a visible improvement in their general housekeeping standards because we are prepared to impose fines to cover replacement and extra cleaning. Without exception, they were co-operative and pleased to see someone looking after their interests."

Once the standards are set, and being adhered to, "we can invest in smartening up the premises, making them more comfortable." At Broomfield, the high standards are proving so attractive that medical staff, and other specialists, want to return when they have fulfilled other rotational training requirements ­ "obviously, the Trust's training is very good, but having good accommodation is an important part of the equation, especially nowadays when about 60 per cent of doctors want to bring their families with them. Just a few years ago this was only 20 per cent. So competition for the best people is stronger than ever."

With the closure of Black Notley Hospital at Braintree, and a new Burns and Plastics Unit coming on stream at the main campus in Chelmsford this year, Countrywide Property Management have the challenge of squeezing a quart into a pint pot ­ "non-essential staff will be vacating some of the accommodation, and we're refurbishing some of the multiple-occupancy houses into family units, and will possibly be converting two hostels for family occupation."

Overall, "we are meeting our income targets, and generally raising living standards, as well as the asset value, for the Trusts." This is reflected in occupancy levels which have risen to 95 per cent, and are never less than 80 per cent ­ "the discrepancy is usually due to improvement works which may take accommodation out of circulation temporarily." And all new tenants are interviewed, "so there can be no misunderstandings about our joint responsibilities."

Having the same systems in place at each site means that staff can overlap during holidays ­ "we're there to provide a service to the residents as well as the Trusts, and we ensure that we meet that obligation efficiently and effectively. We sympathise with their problems and understand the youthful exuberance of people in stressful jobs. And we also acknowledge the operational necessity of providing good, comfortable accommodation, which is cost-effective."

Although on-site management is most cost-effective for 300 units plus, "we are developing systems for satellite management of properties within a ten to 15 mile radius of a centre. This means that the benefits can be extended to neighbouring Trusts which do not have large property portfolios."