‘The next generation of assurance tools’

There remains a considerable focus on governance and assurance within NHS estates, with demands for Trust EFM teams to demonstrate compliance to their Boards, with an expanding agenda that also now sees environmental and sustainability issues to the fore, as well as the challenge, for some, of looming PFI handbacks, to contend with. In the light of this, the PAM model for 2024 been extended, with more areas covered in this year’s Trust submission than ever before. However, it can be argued that PAM only goes ‘skin deep’, and does not offer the deeper dive at a more technical level to provide assurance that estates and facilities are safe, effective, and of a high quality. With the continuing financial challenges facing the sector, the need to balance risk is greater than ever, with no blank cheques being handed out.

Against this backdrop, the partnership formed in 2023 between leading compliance software specialist, Quiqsolutions, and IHEEM – the independent professional engineering institute that promotes best practice guidance and development within the sector, was a significant step towards raising the awareness of quality and governance, as well as highlighting that the sector was lagging behind in its adoption of digital solutions in QA and compliance. Completing PAM submissions every year has become mandatory for all NHS Trusts, but there is still a long way to go in embedding governance and assurance processes that delve more deeply to give a truly accurate picture.  

Underwriting compliance standards

Over the past 12 months Quiqsolutions and IHEEM’s Technical Platforms have been working to develop the next generation of assurance tools and to develop standardised audit and pre-audit templates across the key estates technical areas such as Ventilation, Water, Decontamination, Electrical, and Medical Gases. With content underwritten by IHEEM – including an ongoing review and approval process, there is peace of mind for Trusts that the content is current, in line with the latest best practice, and fit for purpose. In addition, the Quiqcare self-assessment tool is now available, enabling Trusts to evidence compliance and run reports. Action plans can be developed to capture any issues requiring improvement, and alerts and reminders ensure nothing gets missed.

IHEEM now provides free access to the digital audits for all IHEEM-accredited AEs, including licences to use the software, and dashboards showing the audit history across all locations where they have used the tool. AEs can also access evidence and action plans for Trusts using the PAM / HTM self-assessment tool in the technical areas they are working in. Free training and access to ongoing helpdesk support is also included, with easy access to IHEEM for input on content updates. The challenge now is to encourage a new way of thinking, and to persuade AEs who are used to operating in a certain way to now adopt technology and the benefits that this will bring. 

A Trust’s view

Trusts are starting to embrace the Quiqcare system, and a number of them are investing. Liam Casey, Associate Director of Estates, Facilities and Capital Development at Sheffield Health & Social Care (SHSC), said:  “Along with other Trusts, we had found completing our annual PAM returns using the spreadsheet provided by NHS England to be a time-consuming process, with challenges in managing inputs across multiple departments, and maintaining version control. With the advent of products such as Quiqsolutions’ Quiqcare platform, this process has been transformed for us, enabling the team to work on a year-round picture of compliance rather than focusing on an annual event. The ability to assign tasks and create action plans means that issues uncovered during self-assessment are made more visible, and greatly increases the likelihood of them being addressed in a timely and efficient manner.

“SHSC is really seeing the benefits of this approach,” he continued, “and we are now going deeper by adding the new Quiqsolutions / IHEEM tool to run alongside PAM. This tool asks detailed self-assessment questions regarding HTM compliance, and we are now able to ensure that we identify gaps, implement action plans to address them, continuously monitor, and provide the assurance we need across all the hard FM technical areas that it covers, in a robust and transparent way. We look forward to working with our AEs to join more of the dots, and align our priorities with the findings from their audits, which will all be on the same platform.

“A number of other NHS Trusts are going down the same road, and we are collaborating with IHEEM to continue to develop the content in line with best practice and new legislation. It is good to hear that new areas are being proposed, and we see this expanding exponentially in future years.”

Steve Goddard IEng, FIHEEM, runs MGPS Services, which provides a professional and independent training and medical gas consultancy service. He shared his expertise and knowledge to help develop the IHEEM-approved AE Audit for medical gases and pipeline services, and has embraced the system. He said: “Digital is the only way forward, and having a consistent approach to audits will provide certainty for Trusts and AEs that all of the key questions are being asked and answered. I am now using the Quiqcare tool, and find it a really useful tool for requesting information in advance of an audit, and for carrying out the audit itself. I have been able to feed back suggestions for consideration, and this approach will help develop the system going forwards.

“I would encourage Trusts and AEs to take a look for themselves, and with the option for Trusts to take responsibility for their own compliance by completing PAM and the new HTM toolkit, this will help shine a light on issues in estates, and ultimately lead to a safer system as action plans are implemented and can be reported on.”

The future

So what might the future hold? By collecting data in a standardised format it will be possible to compare compliance across multiple locations. There are opportunities using digital tools to carry out ongoing self-assessment at hospital or unit level, as well as across the entire Trust. This could give a much clearer picture of compliance for the Trust, but by comparing common data, this leads to opportunities for comparing performance at ICB, regional, or even national level. 

In a similar project (iQAAPS) involving aseptic pharmacy units in Trusts and health Boards across England and Wales, the NHS has now implemented a consistent approach to auditing, and is using data collected monthly to assist in planning and resource allocation. They now have a real-time picture that has addressed a pressing need for visibility of quality assurance in pharmacy services. 

There are already new areas being considered by IHEEM for inclusion on the Quiqcare platform. In conjunction with WSP, a multidisciplinary engineering and strategic advisory practice with strong healthcare expertise, work is under way in the area of PFI asset management. With 150 healthcare PFIs being handed back over the next 17 years, having a structured approach to asset management is imperative to ensure that the PFI facilities being absorbed back into the NHS estates of Trusts and Boards continue to operate for as long as required. 

Commenting on this, Anisha Mayor, WSP’s Director and Head of Healthcare, said: “This self-assessment tool is the first step in the process to becoming ISO 55001-accredited. Designed to cover all aspects of asset management, this PFI question set tool covers strategy and planning, decision-making processes, lifecycle, asset knowledge, staffing, and assessing levels of risk.” 

“By having responses and evidence at their fingertips, Trusts’ and Boards’ SROs and Estates teams are able to review easily their maturity and readiness for making sure the PFI asset they are handed back is actually an asset, and not a liability.” 

Adoption

Quiqsolutions and IHEEM are trying to encourage adoption by delivering affordable solutions for Trusts and AEs. IHEEM AEs have exclusive access to the digital audits, and it is hoped that other AEs will seek IHEEM accreditation so that they can have access themselves in future. The more AEs who use it, the greater the likelihood of acceptance within the system as a whole, and as data starts to become more available, this is likely to prick the interest of NHS England and other stakeholders like the CQC and HSE. It is hoped that the combination of a proven software provider and IHEEM will be compelling, and – coupled with a low implementation and licence cost for Trusts – this will be something that can only grow in future.

IHEEM and Quiqsolutions are jointly promoting the tool at this month’s Healthcare Estates 2024 conference in Manchester, and at other regional events throughout the year, and it is likely there will be more adopters as word gets around.  

Pete Sellars, CEO of IHEEM, said: “I am immensely proud of this new governance toolkit that we have produced in partnership with Quiqsolutions. It is the culmination of a lot of hard work and significant input by many of our Platform and branch members. I want to thank everyone who contributed and gave their time and expertise to this programme.”