In six and a half years as Director and Head of Profession, NHS Estates, at NHS England, Simon Corben has faced some considerable challenges and a pretty full in-tray. To date his agenda has included directing the central NHSE Estates & Facilities team and the national EFM workforce in their rapid response to COVID-19, guiding the EFM workforce in delivering on Lord Carter’s Productivity programme, working with the New Hospital Programme team on England’s biggest hospital building programme yet, and revitalising the NHS standards and guidance programme. HEJ editor, Jonathan Baillie, recently met up with him.
Simon Corben became Director and Head of Profession, NHS Estates, at NHS England, in April 2017, after 14 years in the private sector, where he advised the NHS, and grew and managed a team of property and clinical planning consultants and analysts. Immediately before joining the NHS he spent six years as Business Development Director and Sector Leader for Health at Capita Property and Infrastructure. He has an MSc Degree in Construction Project Management from London South Bank University, and – when we spoke by ‘Teams’ in midNovember – he explained that while his professional and educational background is centered around this field, he has become considerably more well-versed in engineering and facilities management as his career has progressed.
One of the first things I wanted to discuss was the current healthcare estate backlog, which (based on the latest ERIC returns), sits at over £10 bn. I asked how big a task addressing this is for the healthcare EFM workforce across England. He replied: “Its massive, and indeed the figure is so big now that people really can’t get their heads around it. We’ve thus spent significant time changing the narrative, shifting to a far more focused view around the impact of infrastructure failure, over and above simply ensuring that we’re meeting our obligations under the Health and Care Act in key areas such as fire, electrical, and water safety, and a clean, fit-for-purpose environment. The infrastructure failure we’re seeing can significantly disrupt our clinical services. Our stakeholders understand that, and articulating this is a really important message. You’ll now hear me talk considerably more about this than about backlog maintenance per se.”
Burst pipes and electrical burn-outs
Simon Corben acknowledged that while RAAC concrete was among the more high-profile current issues for England’s EFM workforce, Estates and Facilities teams were often faced with more immediate, unexpected scenarios requiring a rapid response – for instance pipes bursting and leaking into ward or theatre, which could see clinical services interrupted, with significant disruption to the hospital concerned. He said: “In the past two years we have had over 12,000 recorded incidents where infrastructure failure has stopped clinical services. We now have tools to enable logging of incidents, and to collect data on such events in the ERIC returns.
“I’m really fortunate,” he added, “to have an amazing workforce that rolls up its sleeves and sorts problems out. It’s phenomenal how they’re able to do it so quickly. What we need to get better at is not hiding this work, but instead celebrating and quantifying it. Otherwise, EFM teams do the work, and then don’t want to talk about it. I believe we should be showcasing the brilliant work NHS EFM teams do – because that will result in greater levels of investment.”
With the New Hospital Programme now often in the news, I asked about the major gains – alongside the clinical and patient benefits to the communities impacted – in terms of learnings for future hospital design and construction. Simon Corben said: “The Programme is unprecedented in size and scale – to know that we’re putting this level of investment into this number of hospitals, within the timescale we are. There’s thus a huge opportunity for us to learn, replicate some of the learning across the wider NHS, and really look at how we respond to the current operating model within the estate. This is not an opportunity we’ve had yet to this level, and at this pace, so we’re working closely with the NHP team. When they have good ideas, we look at them, and if we think they’re repeatable, we’ll definitely embrace them.”
I asked: “The New Hospital Programme must be a great opportunity for the supply chain to engage with the Programme team and the central NHSE Estates and Facilities team, and for suppliers to innovate?” Simon Corben replied: “The NHS supply chain is intrinsic to the NHS’s successful operation; it employs 40% of our staff, and it’s vital that they’re included in these conversations.”
Opportunities for external suppliers
He continued: “Our external suppliers and contractors also, of course, have an unprecedented opportunity. ProCure23 has been fantastic in that, and the relationships we had through it stood us on fantastic ground when we faced the challenges we had through COVID and the Nightingales. We simply wouldn’t have been able to accomplish what we did without the framework, and the associated relationships and levels of trust.”
Returning to the NHP team and its work, I asked Simon Corben how the Hospital 2.0 concept had come about. He replied: “We’ve all been massive supporters of the standardisation aspects. We have the Repeatable Rooms in P22, and the ProCure framework, while the construction industry has moved a huge amount on Modern Methods of Construction. I think Hospital 2.0 is more about that, plus the process of taking Trusts and the supply chain through that. The NHP team has definitely embraced this, and developed it as a team.”
Another element of Hospital 2.0 is how to get new-build and refurbishment schemes approved more quickly via the planning process. I asked how much of a challenge this would be. He replied: “If you have repetition, and standard forms of contract, plus really clear, unambiguous projects coming forward, they’re pretty straightforward to approve. We see that, and in the last 5-6 years we’ve seen tremendous amounts of capital go through the system – through other programmes – to good effect. For example, the mental health dormitory eradication programme; the urgent emergency care schemes, and the RAAC programme, where we’ve deployed significant capital at pace. However, with significant-sized business cases, Government does need to look over them, which takes time, as does external town planning.”
I asked, nevertheless, if he felt there was scope to further streamline the process. He said: “My experience is that it’s not necessarily the individual schemes causing delays; rather it’s the conversations around development control plans, and more strategic conversations with the planners about what you want to do on your site, to ensure no surprises coming forward. There will obviously be circumstances where planning becomes really tricky, but if you’re in those conversations as an organisation consistently with the planners – both at Trust and ICS level – then you’ve got a better chance of going through that process in a fairly smooth and coherent manner.”
The mental healthcare estate
Switching focus – but still on the NHS estate across England, I asked Simon Corben if he thought there was sufficient focus on the mental health estate. He replied: “In the last four years we’ve deployed £550 m into eradicating mental health dormitories across England – a really successful programme. It’s been a huge programme of significant change, but we still have much to do in this area – as we do around community and primary care.” Simon Corben explained the under the programme, 1,370 dormitory beds had been eradicated, in 33 separate schemes, since 2020.
I next asked how well he thought NHS Trusts across England were faring with their Green Plans. Simon Corben said: “I think everybody is embracing these, and from an Estates standpoint, it’s surely a bit of a win-win? Replace you boiler plant, for example, and not only are you reducing your backlog lability, but also your utility bills, and providing something with a far lower carbon footprint. We’ve been really successful in the PSDS (Public Sector Decarbonisation Scheme) funding around this, because of the plans these Trusts have. In all we’ve secured over £830 m of additional funding, which we are deploying into the system through the PSDS fund, and – as you know – we’ve set the standard for the Net Zero new builds with our NHS Net Zero Building Standard.” Simon Corben conceded that the PSDS fund had been ‘a challenging programme, due to the way that the application works’. “However,” he added, “we’ve been really successful – by being on top of our game when it comes Net Zero.”
I wondered how much pressure the clinical backlog – especially post-COVID, and so-called ‘bed blocking’, were putting on Estates and Facilities teams in terms of utilisation of buildings, etc? Simon Corben responded: “As estates professionals we have to be there to support the programme of recovery – for example by turning beds around as quickly as we can, with porters attending to patients quickly, and by providing high quality food to our staff and patients. Our systems need to be fully operational. We have a major support role in hospitals, so we need to make sure we maintain the momentum and motivation among our workforce to continue doing that. COVID hit the NHS, and we then went full steam into recovery mode. It’s been really difficult for the EFM community and across the NHS, but everyone has stepped up.”
On a different note, I asked Simon Corben what impact he thinks the new Integrated Care Systems (ICSs) will have on the running and operation of the healthcare estate? He said: “I think they’ll have a holistic portfolio view of the assets, and will look to ensure better asset utilisation, and care being provided where we think it should be. We also hope the workforce can be effectively deployed across ICSs, and are keen to become more far corporate in managing our assets, harnessing a ‘Core, Flex and Tail’ approach.”
The ‘Core’ element, Simon Corben explained, is ‘the highly technical estate that we need to own, maintain, and invest in’, and the ‘Flex’, the estate that is ‘transient and flexible, where services can be moved in and out, and where ownership is not a priority’. He added: “The ‘Tail’ is the estate surplus to requirements that we can either redeploy or dispose of.”
I asked him whether he thought healthcare estates and healthcare engineering personnel’s vital role in keeping healthcare facilities running smoothly and safely was finally gaining the recognition it deserves – particularly among Trusts’ senior management teams and Boards.
Changing the narrative
He replied: “I think, fortunately, that there’s never been such a focus on estates and facilities, the condition of our healthcare buildings, and what the EFM community does. We’ve also changed the narrative of pushing problems under the carpet.
People are calling out that we can’t operate in these environments, and need to influence change. Bulding conditionwise, everybody is aware of the need for investment, while as far as the EFM workforce is concerned, in high pressure situations our staff have shown they really come to the fore. COVID really shone a light on the profession, and how well staff performed in such a challenging situation. I will forever be immensely proud of what the Estates and Facilities community did, and continues to do, but for others not normally so close to the sector, Estates personnel’s dedication shone a true light on the value of their work.”
I wondered what Simon Corben thought the key factors behind the growing estates maintenance backlog, and the poor condition of some healthcare buildings, were. He replied: “I don’t think people have properly appreciated the need to maintain assets to ensure they last the required timespan. Equally, we’re still operating in buildings well past their ‘sell by date’, so that becomes difficult. We are now putting considerable focus into ensuring that when business cases come forward, the lifecycle cost is protected.”
Without limitless funds, I imagined the key was to focus on the buildings with the highest risk ratings. Simon Corben said his team is ‘trying to put a little bit more science behind this’. He added: “I was delighted when the Health Secretary last summer called the NHP ‘a rolling programme’. We have to ensure that the next wave of hospitals to be rebuilt comes forward, and that investment is apportioned in a way that ensures that the Trusts with the built assets most in need of renewal are prioritised.”
Attracting new recruits
As IHEEM is aware, the sector’s ageing profile, and ensuring effective succession planning, are pressing issues, so I asked Simon Corben what particular ‘selling points’ of a career in healthcare estates management / healthcare engineering he would highlight most when seeking ‘new blood’. He said: “Well, I’ve spoken at a couple of schools in exactly this space, as has Fiona Daly (National Deputy Director of Estates), and other members of my team. When I discuss estates and facilities I’m always able to show students so many different options they can have in a career in the field. We offer a really exciting and progressive safe start, and need to emphasise this. Our NHS Chef competition has been hugely successful, and the National EFM Day has proven a real opportunity to showcase EFM teams work, so I’m hugely grateful to IHEEM and the other engineering bodies for initiating and supporting it. There is a great career in estates and facilities, and it appeals to a broad range of people.
I wondered what he felt IHEEM had most notably contributed to the drive to attract more EFM professionals. He said: “The Institute has done a great job – for example in the Faraday Challenge programme and others. I think what we need to do, however, is to put such initiatives on steroids. We’ve run the NHS Estates and Facilities Apprenticeship Challenge in the last two years – the aim is to create 1000 apprenticeship starts in a given year. That has been huge, but we need to scale all this up. People like IHEEM and HEFMA need to be in schools, showcasing the worlds of estates and facilities.”
My next question related to the impact of the pandemic, and the many ways it had prompted a re-think in healthcare facilities’ running and operation. I asked Simon Corben in what areas of EFM activity he felt the greatest impact on evolving practice had been. He said: “I think we now recognise, more than ever, the importance of resilience, and of highly technical services like medical gases and ventilation, alongside those of portering, cleaning, and catering, and of quality environments. We also understand the need for good communication. Our clinical colleagues, meanwhile, have learned the importance of medical gases and ventilation, and both ‘sides’ now recognise the vital importance of good and close ongoing dialogue between EFM teams and clinicians.”
Innovation
Healthcare generally, and indeed healthcare engineering and estate management, have been major beneficiaries of innovations in new technology, in almost every facet of their activities; indeed developments such as AI and increasing ‘digitalisation’ will surely transform care delivery. I wondered how impressed Simon Corben has been with the level of innovation and imagination he has seen from suppliers to the sector. He replied: “At October’s Healthcare Estates 2023, I had a good look around the exhibition, and there are some amazing things people are developing to improve the way we deliver care. Where we need to improve is showcasing some of these products and technologies, so others learn about them, and I recognise it can still be really hard for suppliers to get their products seen by potential buyers. There are great opportunities to highlight their products and expertise at places like Healthcare Estates and HEFMA’s annual event. It’s something I’d like to help with.”
“On ‘digital’,” Simon Corben added, “we’re working with a number of our FM suppliers and consultancies and developing digital twins, and you’ll see a lot more happen here over the next 12 months, which I’m really quite excited about – with my team really driving that operational digitalisation of the estate.”
With one of the most noticeable impacts of COVID-19 being increasing use in primary care of e-consulting, the past 3-4 years have seen considerable continuing debate about the opportunities for more care to be delivered remotely using ‘telehealth’ technology. I asked Simon Corben if he envisaged this escalating significantly in the short to medium term, and about the potential impact on the estate. He answered: “I think it needs to happen – because we simply don’t have the space in our facilities for it not to. When you look at the ageing demographic we’ll see in the next 10-20 years, pushing care out in the community is central to our strategic thinking. Equally, that is what the ICSs are doing within their Estate Strategies – looking at that ‘left shift’, as per the NHS Long Term Plan. I’d like to see more community diagnostic centres integrated into a wider community offering, as opposed to separate individual buildings.”
Simon Corben explained that he and his team have an initiative called the Cavell Programme, which is about these ‘integrated care hubs’, and that the team is currently writing a programme business case for this. He said: “It will be a significant part of our campaign going into the next Spending Review – examining how we can scale integrated care hubs across the communities – via a combination of new-build, refurbishment, and utilisation of existing estate.” Adding that the Virtual Ward programme was ‘going really well’, he said that the next key focus here would be on ‘the FM package we can put around it’.
I wondered how important to the sector he felt learning from international best practice was.” He replied: “We did a lot of sharing through COVID in really impressive ways. Our EFM technica standards programme, for example, considers experience in other countries. Many, of course, still look to the UK for FM advice around healthcare, but I’ve had opportunities to see what goes on elsewhere in Europe. I think the key is to continually learn – whether from Europe, or the rest of the world, about how we can do things a little differently.”
Importance of knowledge-sharing
We often hear that NHS Trusts operate in ‘silos’, so I asked Simon Corben whether he feels there is sufficient sharing of knowledge, experience, and expertise, among NHS Trust healthcare EFM teams and their counterparts in other Trusts. He said: “My impression is that EFM professionals are sharing ideas. We’ve been delighted with the development of the NHS Estates Team Collaboration Hub. We now have over 2,500 members – having started with 25, with a constant flow of questions and answers – from the north-east of the country to the southwest – on anything from cleaning and car parking to engineering. The webinars we have run have also proven a great way of sharing knowledge. We can still go further though, and we’re currently working to make the Collaboration Hub something even more intuitive, and accessible on a handheld device, so people out at the coalface can stay up to date.”
Moving to technical guidance, I wondered how updates to the HTMs and HBN documents were progressing. Simon Corben said: “At the outset it was really tricky to get that programme moving again. However, we have just let the next generation of standards, and are starting to see some documents being published. Of course everyone wants the new standards tomorrow, but you have to go through a proper consultation process first.”
I wondered what he felt had been the greatest challenges for he and his team since the pandemic. He said: “We’ve had a lot of capital come our way in the past two years. Getting back on our feet and deploying this effectively has been a challenge. We’ve continued with the Productivity Programme, and will have hit the Lord Carter targets this year, and are on track to exceed them – a testament to the work of our teams. By the end of 2023/24, Estates teams will have delivered productivity savings of £1.375 bn against a Carter target of £1.275 bn. In addition, Estates teams have reduced non-clinical space in NHS buildings by 26.1% – from 44% in 2015/2016 to 32.6% in 2021/2022. Much of this space has been converted into core clinical space.”
Simon Corben continued: “We also reinitiated the HBN and HTM programme, and have mandated the Premises Assurance Model since COVID. It’s also been about keeping the profession ‘revved up’ and buoyant, and knowing they are valued. Keeping ourselves in the limelight as a community is very important.”
I wondered what achievements he was most proud of, and if he had identified any particular goals over the short to medium term. He said: “In terms of my proudest moments over the past six years I’d say the response to COVID and Grenfell, NHS Chef, the raising of the workforce’s profile, and the instigation of the New Hospital Programme. The hard work and commitment of the EFM workforce have been extraordinary. I’m so proud of my team and our community, and having steered us through those situations. I’m also proud that we are increasingly drumming the drum for the EFM community. I think we now have far more influence at the top table. While there’s still work to be done, Estates and Facilities is a very important part of the conversation now, and we are starting to see more capital coming into the system.”
Productivity targets
He continued: “We’re also still hitting our productivity targets. There’s a lot that has made me very proud, but I couldn’t have done it without my team. Looking ahead, I really want to cement in long-term capital planning principles, and widen our reach in terms of EFM services across geographic areas. This, in turn, leads to the workforce agenda and recruiting people. I also want us to be more corporate in our approach to managing our assets.” Simon Corben explained that this came back to the ‘Core, Flex, and Tail’ approach he had earlier highlighted.
He said: “It’s about being more rigorous in how we move and utilise our assets. My other goal,” he added, “is to have a ‘digital wrapper’ around all of this. We now have a really straightforward new capital reporting tool we’re rolling out that we want the entire NHS to put their capital programmes through in terms of monitoring cost and programme. It will allow us, ICSs, regions, and the national EFM team, to have clear oversight on progress with projects. We’ve signed the contracts, and are currently rolling it out across ICSs on a number of schemes. We will do this internally for two years before deploying it out into the system. We also have the SHAPE portal – our asset management platform, which is being used by all the ICSs in the development of their Estates Strategies. We then have the operational work we discussed earlier.”
‘Some long days’
I asked – with all this going on – how pressured Simon Corben finds his role. He said: “There can be huge pressure. I work long hours and travel a lot, but I’m driven by the fact that we’re incrementally making changes, and I really enjoy the job; it’s fascinating.”
One of the new ‘spare time’ activities he has got involved with in the past year is mountaineering, although he was already a keen skier. He explained: “In March 2023 I took on a challenge for The Brain Tumour Charity, during which a group of us climbed the equivalent height of Everest over four days in the Swiss Alps. It was tough, but also a wonderful experience to meet different people from all sorts of backgrounds. I enjoy ski-touring, but to go through that monotony and the degree of physical exercise for 10 hours a day for four days with little sleep in between – albeit with some fantastic guides spurring us on, was quite something. The son of a great friend has a brain tumour, which is how I got involved. Our team raised £250,000. I raised £20,000 myself through support from the community, for which I’ll forever be grateful. Getting to the end was quite a moment.”