October’s Healthcare Estates 2024 conference in Manchester saw some topical, thought-provoking, and insightful conference presentations from NHS leaders, academics, and industry experts, with the broad-ranging content touching on some of the biggest challenges and opportunities for the healthcare engineering and estates and facilities management community, and the associated professionals working in the design and construction of, and supply to, such buildings.
The Day One opening keynote session, on one of the key conference themes — Governance, Assurance & Compliance — was chaired by IHEEM CEO, Pete Sellars, who told delegates: “IHEEM is an engineering institute, but until today we’ve never had a keynote session actually dealing with the focus of engineering. For this opening keynote we have three fantastic speakers — Dr Hilary Leevers, Chief Executive of EngineeringUK, Professor John Chudley, Chair of the Engineering Council, and Simon Corben, head of Profession for NHS Estates & Facilities at NHS England.”
Close working with IHEEM over the past year
Dr Leevers, the first to speak, explained that EngineeringUK — a not-for-profit organisation which works to ‘drive change so more young people choose engineering and technology’ — had been working closely with IHEEM over the last year, and said it was ‘an absolute pleasure’ to be able to present at the event. She said: “I’m going to focus on the engineering workforce — an absolutely necessary part of what you all do.” Dr Leevers explained that she would cover four key elements — Understanding the (‘wider engineering’) workforce needs, ‘What’s happening in skills policy — particularly with a new government’, ‘What EngineeringUK does to help with the skills agenda’, and ‘How you can get involved’.
“To contextualise the challenges you may well be facing in recruiting engineers or technologists,” she told delegates, “this is something all areas of the engineering sector are currently seeing. Demand for engineers is certainly growing. Looking towards 2030-2035, there are hundreds of thousands of new roles that will need filling, most being driven by Net Zero, but also via the renewal of infrastructure, and the move to digitisation and automation.” Currently, she explained, around 6.3 million people work in the UK’s ‘engineering and technology footprint’, accounting for 19% of the workforce, but 25% of all job advertisements relate to the field. Dr Leevers said: “EngineeringUK is a member organisation, and many of our members are facing considerable recruitment challenges — so if you’re experiencing this, you’re not alone. You’re not going to be able to compete with each other to address this, so we are seeking a massive collaborative effort to grow the talent pool that everyone can recruit from.”
Moving to key policy developments, Dr Leevers said: “We now have a new, mission-driven government, with five major missions — NHS ‘Fit for the future’ being the fifth — a huge opportunity. However, I’d also draw your attention to the first two — sustained economic growth, and achieving clean energy, which will both drive huge demand for engineering and technology skills.
Pay attention to the sector
“As a sector,” she continued, “we’re absolutely telling government: ‘We in engineering underpin the success of these missions. You must ensure that we have the right workforce in place.’ ” This created a good opportunity, ‘which actually the government had recognised’. Dr Leevers’ next slide, headed ‘The emergent workforce planning system’, showed some of the key Government departments and other bodies — such as the Migration Advisory Committee and the Labour Market Advisory Board, involved in current and future workforce policy and planning strategy. She said: “Things are still evolving, but we’re in quite an interesting position, with the need for a coherent workforce strategy being properly embraced.” This had been ‘flagged’ in the current government’s manifesto. The speaker elaborated: “There’s a definite desire to reduce our continuing reliance on immigration. I love to see positive recruitment from overseas. It’s very enriching, but we’ve now become quite dependent on it in some areas, leading the Government to ask the Home Office to look at these and work with others to develop workforce plans.”
While a number were expected to emerge, Dr Leevers said, ‘the only two we know about’ are for Engineering and IT and Telecommunications. She said: “I think this will all be happening within the next nine months. We would expect an output from that, but they will be drawing on insights from the Industrial Strategy Council, the Department for Work & Pensions, the Labour Market Advisory Board, and from Skills England — a new Department for Education body that is absorbing the Institute for Apprenticeships and Technical Education. We also have 15-20 different Skills Task Forces across government departments all feeding in.”
Dr Leevers hoped ‘something really positive’ would result — including ‘looping in the devolved nations’, and thinking about the graduate and ‘more technical’ pathways to create these workforce plans. She felt this was ‘a really great opportunity’ for organisations like EngineeringUK and IHEEM to ‘get involved and have their voices heard’.
Next explaining ‘what EngineeringUK does to contribute to growing the workforce’, she said: “We aim to enable, inspire, and inform more young people from all backgrounds to choose engineering and technology careers and, like IHEEM, have a special emphasis on careers that will enable us to achieve Net Zero and improve sustainability.”
Research into workforce needs
The speaker said EngineeringUK also ‘does a lot of work around the wider workforce’, but that its activities ‘tend to focus on young people’. She explained: “We do a lot of research into workforce needs, and the workforce’s current composition.” Earlier in the year, Engineering UK had highlighted some of the challenges around diversity. Of the current overall engineering footprint, women make up just 15.7% of the workforce, with a number of minority groups also underrepresented. Dr Leevers explained: “So, we not only create all this data, but also look at the numbers of young people on pathways in (to engineering) to see how we’re progressing, and where the risks are, and evaluate activities to see which interventions can make a real difference here.”
All this information is drawn from insights from across the membership. “Just last week,” Dr Leevers explained, “we published a report on STEM careers education, using it as an opportunity to make recommendations at a time when there’s considerable thought about education policy. Last year, we produced a report with Lord Willetts and Lord Knight on how to increase the numbers of young people on Level 2 and Level 3 apprenticeships. That is where most of the last decade’s decline in apprenticeships has been.”
Dr Leevers added: “We work with over 300 organisations with an interest in increasing the number of young people on these pathways who are doing outreach or other activities to support this themselves, to take what used to be a very fragmented, and slightly competitive, area of work, and enable people to collaborate swiftly. This is a really important aspect of our activity, alongside our own activities to reach young people.”
The EngineeringUK speaker said one of the organisation’s ‘collaborative vehicles’ was neon — a platform for teachers to find the activities that best meet their needs, which can search effectively by geography, but also by age, content, and such like. Organisations providing such outreach activities can list them free of charge, while neon is also free for schools to use. Hilary Leevers said Engineering UK also hosted ‘a huge amount’ of careers resources and case studies of career stories on the platform. She said: “We also have the Tomorrow’s Engineers Code,” (described as ‘a community of more than 300 like-minded organisations committed to increasing the number and diversity of young people entering engineering and technology careers, by designing, delivering, supporting, or funding, STEM outreach activities’).
Pledging their commitment
The speaker explained: “The organisations involved pledge to work together to improve the collective impact of all our endeavours, and we support members of the Code — again free to join — through webinars and resources, and help them network. We might, for example, have webinars on how to target new activities more effectively — so it’s about reaching the groups less likely to have gone into engineering and technology, and talking about environmental sustainability in a way that doesn’t alarm children. We know that climate change is very worrying, so must frame the associated career opportunities young engineers have so they feel empowered and more positive. We take anyone at any point on that journey. You could even just be thinking about increasing your involvement in working with young people, and we’d welcome you as a signatory.”
EngineeringUK also has a new ‘schools-facing’ brand, ‘EUK Education’. Hilary Leevers’ next slide showed some of the events which reflect the type of activities and work EngineeringUK wishes to do with school-age children — such as the Tomorrow’s Engineers Week, its Climate Schools programme, and the now well-established The Big Bang (science) Fair. She said: “Our focus is on 11-14-year-olds — a key age group, but we support people working across all ages.” Last year, through these various initiatives, EngineeringUK had worked with over 120,000 young people — a number the speaker said it planned to increase in the coming year.
Dr Leevers told delegates: “I want to say a bit about our Big Bang programme, and its three components — the first being the Big Bang national competition, where we identify the UK young scientist, engineer, and technologist of the year, and the students undertake really practical hands-on activities. This is very important — because they have gone through a period of quantifiable decline in practical work at schools.”
Those keen to participate can get involved by being a judge, or volunteering to support local schools by telling them about the competition, while the second ‘component’ is the Big Bang Fair, attended by 20,000 young people over three days, ‘with amazing STEM interactive exhibitors, and a real opportunity for attendees to talk one to one with apprentices or recent graduates who they can really relate to’. Hilary Leevers said: “We target very carefully young people from groups underrepresented in the workforce to maximise our impact. We also have a whole load of ‘Big Bang at School’ events occurring more locally.”
The EngineeringUK speaker said those keen to get involved could find and talk to her, or email her, to find out more. Asking delegates to ‘think about what more you could do for young people’, she added: “For instance, of huge benefit to budding young engineers are offers of work experience, the industrial placements that accompany T Levels, and offering apprenticeships, as indeed are amplifying and participating in the work that others are doing.”
In concluding, she told the conference: “You’re in a very inspiring area for young people. They like to follow their interests, and to be paid well and have job security — knowing they are in areas of high employment, but they also want social purpose and to make a difference, for example towards the Net Zero goals, and I see all these opportunities here. So, do feel confident in selling your wares, and please sign up to the Code if it’s something that’s appropriate for you.”
Having thanked the audience for listening, she handed back to Pete Sellars — who thanked her, and introduced the session’s second speaker, Professor John Chudley, Chair of the Engineering Council, who he explained would be discussing the importance of professional registration and the international agenda, and the organisation’s Five Year Vision.
Professional registration, and the routes to it
Professor Chudley said that while he would indeed discuss professional registration, he was as keen to emphasise the importance of valuing all routes to it. He said: “We tend to talk about degrees, and accredited degrees, but I think we have lost sight of valuing all routes, i.e. apprenticeships, etc., and going through with experiential learning.” His message was that the Engineering Council ‘does not prescribe, but values all routes’.
Moving to his own motivation for becoming an engineer, the Professor showed a slide of him on a motocross bike in his younger days. He said: “It’s not just an excuse to show myself on a motocross bike aged 17, but this is really about the challenge for EngineeringUK in getting young people interested in engineering; the things we used to do are being lost, and engineering is getting hidden behind other things without realising it.” He continued: “I did an engineering apprenticeship, rather than the standard route to becoming a Chartered Engineer, but the only reason I got into engineering was that I wanted to make that bike lighter.
“Before speaking to you all today,” he added, “I wondered how I could link my motocross riding days back to the conference and being here with IHEEM.” To do this, he showed slides of two of his own knee X-rays side by side pre- and post-falling off the bike. He said: “How exciting is the engineering in those X-rays — the material, the additive, and manufacturing etc. involved; the cross-sector work of engineering. The technology is phenomenal, and we must get that message out.”
Focusing next on the Engineering Council’s key functions, Prof. Chudley explained that as the UK regulatory body for the engineering profession, it holds the national registers of nearly 223,000 Engineering Technicians, Incorporated Engineers, Chartered Engineers, and Information and Communications Technology Technicians. He said: “It’s important to say that it’s under license through the PEIs — the Professional Engineering Institutions — that you can become professionally registered. We thus license the 39 PEIs to register on our behalf. It’s thus vital that we work together, but many people have never heard of the Engineering Council, because it sits behind the PEIs. However, I think registration is extremely important for the industry — from the point of view of competence etc., in allowing us — for the public benefit — to ensure that things are safe and regulated for the environment we work in.”
Registrant numbers currently ‘flat-lining’
Professor Chudley acknowledged that the number of professional registrants was currently ‘flat-lining’ — and said the Engineering Council feels there should be many more. He told delegates: “I think we need to look at the register, and work with the PEIs to see how we can best address this. What I now want to pick up on — via this slide — is the last bullet point — i.e. that the route to assessment for all titles has evolved, and that it’s about valuing all the routes. What’s really exciting is the individual route becoming more popular than the standard one for all titles except Chartered Engineer.”
This, the Professor explained, meant that while the route to Chartered Engineer still required an MEng (Master of Engineering) or equivalent degree, the pathways to EngTech and Incorporated Engineer were now valuing other routes, i.e. such as apprenticeships. He said: “A degree is now not the be-all-and-end-all. Nor is an apprenticeship ‘a failed A level’ route, but rather one worth celebrating in the way you can progress.” He continued: “You could question what degrees will look like in the future? Will they exist?, or Will we go down a micro-credential route? Will young people in industry demand things that are constantly changing to suit the environment they’re working in, rather than an arbitrary three or four-year degree completed 20 years ago, but that is still recognised as giving you the knowledge and understanding for what you’re doing now?”
The age profile
Looking at the current age profile of professional engineering registrants, Prof. Chudley said it was good to see a rise in those aged 30-49. “However,” he said, “we need a big increase in those aged 18 to 24; it’s currently only 0.6%. Why aren’t all the apprentices being registered as EngTech when they’ve done their Level 3 apprenticeship? It should almost be automatic, and then that percentage would increase, and it would get people thinking of engineering as a profession to be celebrated, not just a job.”
Nor, the Professor argued, was the proportion of women on the register high enough, although it was rising. He told the conference: “What’s pleasing is that if the new registrants by gender keep increasing, the total registrants by gender will also keep increasing. I’m putting it there, not really to celebrate, but as going in the right direction. We still need to work on this — with EngineeringUK, in getting young females interested in engineering and exciting them about it — by highlighting the technology involved, and the broad range of available roles.”
Discussing the total number of registrants registered by IHEEM, Prof. Chudley said: “We will be working on this together, and I think these figures just reflect where the register is currently — so, 618 in 2023, compared with 768 in 2018. However, the good news is about the number of apprentices and graduates. You have to sell this story early in a career, not later on. It must be embedded. If we look at the new final stage titles awarded, IHEEM is increasing on that. There is, however, still a long way to go.”
Role in higher apprenticeships
He continued: “I used to be a director for the National Apprenticeship Service, and in 2011 was instrumental in introducing higher apprenticeships. I refuse to call them degree apprenticeships, because it makes it about the degree, not the competency element. They’re higher apprenticeships that the degree happens to be a part of, which is key. So here I think it’s important — and I hope this is what happens in the future — that it should be a ‘step on, step off’ approach.”
He continued: “If you look at this in green, going up the left (of the slide), it is really not the knowledge and understanding element, but the professional body approval of a standard and review of competence and commitment that are probably more important, and we’ve lost that balance. What we really want is to allow individuals to step on and step off. We don’t help with our register, in that you can become EngTech at Level 3 — in ‘old school’ that would have been a technician apprentice, but basically, you then have to get to a Level 6, i.e., a Bachelor’s degree level equivalent, to become an Incorporated Engineer. That’s too big a jump, and, if anything, too close to Chartered Engineer,” Prof. Chudley explained. “If you start looking at the outcomes of various documents of the different streams, for Incorporated and Chartered Engineer, they are too close. We must look at that.”
The speaker explained that, consequently, the Engineering Council is undertaking a registration review with engineering professionals that will involve industry and all the PEIs, which would go out for consultation later in 2024. The Professor said: “It’s to look at early career commitment derived from a statement of ethical principles.” He continued: “We always talk about ‘early career’, but unfortunately, when people discuss this, they tend to be to talking about the graduate training schemes, not the apprenticeships. We need that early career commitment for the 16-year-old going in to do the Level 2 or Level 3.”
As regards progression through the register, Prof. Chudley explained that a more sequential route, with ‘extra steps’, was being mooted. While ‘early days’ for the proposals — which he acknowledged ‘might get turned down’, he would be delighted, ‘maybe next year or the year after’, to come back and discuss the work the Engineering Council had done — working with IHEEM and the NHS — to ‘make this more valued’ among the individuals impacted.
Touching on ‘parallel pathways for technicians and engineers with transferability’, the speaker said that on talking to somebody prior to presenting, they had said to him: ‘You’ve got a technician route. It’s EngTech.’ “In fact,” he said, “EngTech is where you are coming out at Level 3 — equivalent after an apprenticeship. It’s not really a technician pathway. What we want to do is value those technicians alongside Incorporated and Chartered Engineers; thinking about the opportunities this brings for professional recognition among your peers — communicating your competence and commitment.”
The Professor said that ‘through outreach’ the Engineering Council is keen to hold facilitated roundtables of key stakeholder groups — from ‘early career’ right through to employers, government departments, and agencies. He added: “We’re taking it back to basics, and asking: ‘Is it fit for purpose?’ We want to empower influencers to engage. We will also be issuing an open access questionnaire.” He urged all — when the questionnaire came out via IHEEM — to complete it. He said: “It will give you the opportunity to steer the future of professional registration, and how it’s valued within your sector — and that’s all about the integrity of the register.”
Adhering to its ‘public benefit’ requirement
He continued: “We can make the register so difficult to get onto that we have one person on it; the integrity would be fantastic, but that’s not the point. We need to double, treble, and even quadruple its integrity — ensuring that every registered individual has demonstrated their competence and commitment against the relevant standard — to ensure we adhere to our public benefit requirement.”
Showing his final two slides, Prof. Chudley said: “People ask ‘Why register?’ Everyone has a different story. Please look at our website — all the stories are on there, but look at the example of Charlotte there first. She is registered as an EngTech, and cites having been promoted within her company, the range of associated benefits, a pay rise, and having more responsibility as an employee.”
He continued: “We also have an IHEEM-registered individual, Adam, who sees professional registration as ‘a way of making the next step in your career’. Then we go on to Chartered. One Chartered Engineer says on the Engineering Council website: ‘Being a CEng assures our clients that we work according to ethical and professional standards.’ These are the reasons why individuals do it. That’s why you should be professionally registered through IHEEM for your sector and the wider public’s benefit — having confidence in everything the health sector does from an engineering perspective.”
Increase in IHEEM membership
This concluded Professor Chudley’s presentation, and here Pete Sellars told the audience: “Our IHEEM membership has increased by 30% over the last five years, so there’s something about the need to get people professionally accredited.” He then introduced the session’s third and final speaker, Simon Corben, Director and Head of Profession, NHS Estates and Facilities, at NHS England, who he said would be looking at engineering in terms of corporate governance assurance for the NHS on patient safety.
Simon Corben began: “The theme of this year’s IHEEM conference and exhibition is ‘Embracing the Challenges’, and we certainly have plenty of them within the NHS. However,” he continued, “before getting into these, we have structures here at Manchester Central representing quite outstanding engineering. If anyone follows the America’s Cup sailing, meanwhile, you’ll see that simply by installing a foil on the side of the boat, they take a 70-foot boat from 15 kilometres/hour to 85 kilometres/hour — the most extraordinary piece of engineering. That’s what engineering is at its heart, but it’s also about keeping the show on the road. The engineers we have within the NHS estate are either at that high end — dealing with the medical equipment, the intensive care units etc., or the many other personnel keeping us and our patients safe, and it is quite outstanding the work you all do here.”
Attracting more engineers
Simon Corben explained that there are currently around 120,000 people working within Estates & Facilities across the NHS in England — a mix of private suppliers and directly employed NHS staff. The latter make up about 94,000 of that 120,000, but only 3000 of those are registered as engineers. Simon Corben said: “I think the number is actually far higher, and we need to celebrate that, but it’s not a huge number considering the amount of responsibility you and your teams take on board daily.
“In terms of the diversity of the workforce,” he conceded, “currently just 11% of the estates and facilities management workforce is made up of black, Asian, and minority ethnic groups, and only 27% are female over Band Four. There’s thus a significant amount of work we need to do in this area; a lot of it is around engineering.”
Focusing on how NHS England can improve on this — in terms of its equality goals, Simon Corben explained that it will be looking to publish a document ‘which will really start to think about how we can set some targets across the NHS workforce to improve where we are currently today’.
In 2023-2024, he explained, approximately 800 estates and facilities staff had accessed apprenticeships. He said: “We’re seeing a number of school leaders get up to Master and Degree level; there is really something we can do for everyone.” Over the past year, Simon Corben explained, the NHSE Estates & Facilities team had undertaken ‘a huge amount of work’ around the Schools Outreach Programme. He said: “It’s been extremely rewarding visiting colleges and seeing young adults doing those apprenticeships, and really looking for a career in estates and facilities, and particularly engineering. We’re engaging with about 4000 young people through the programme.”
The outreach was ‘crucial’ in inspiring the next generation of engineers and healthcare professionals. He said: “We’re excited that, in the past year, 30 young people have been undertaking T level placements in NHS engineering teams. We’re looking to expand that to see how we can bring further opportunities into this sector. Tomorrow, another NHSE speaker, Fiona Daly (the Director of Sustainability and Workforce, and National Deputy Director of Estates at NHS England — see pages 29-34) will talk more on the ‘workforce’ theme.”
Assurance and compliance
Continuing his presentation, he said: “On assurance and compliance, the Premises Assurance Model (‘PAM’) is going really well, with the returns at the highest level yet. However, it’s really important that PAM isn’t misunderstood as a case of ‘everything is fine’ when you see a returns score of 98%. That doesn’t necessarily mean the estate we’re working in is at its finest. We need to better articulate the fact that while our PAM scores are up in the 90s, this doesn’t often mean our estate is compliant.”
Simon Corben said he felt the PLACE (Patient-Led Assessments of the Care Environment) assessments were ‘a really good mirror for those that understand them’, and ‘another good reflection on how the estate is working, and how, as organisations, we are looking after the patient environment’. He said: “Currently Cleanliness is up at 98.1%, and Appearance and Maintenance at 95% — so again, really good scores, but these doesn’t necessarily reflect the difficulties we’re going through to achieve those scores. Again, a huge hat off to all involved.
“The final thing I want to talk about,” Simon Corben explained, “is the insight I have had for the past two years as a Non-Executive Director at East Kent Hospitals University NHS Foundation Trust — particularly about the need to articulate the message to the Board about the issues you all face daily. You need to recognise that some Board personnel don’t understand the language we speak within Estates & Facilities, and thus using tools like PAM gives us an opportunity to develop that narrative, and be able to teach Non-Executive Directors how and where the problems are. My suggestion is to team up with an NED on your board. If you’re not on the Board, this can be done through the Executives, but nurture them and let them understand some of the challenges you face, but also some of the opportunities you can bring to a challenging environment. Explain the impact that a ‘good’ or ‘bad’ environment has both on patient care, and the reactive maintenance you and your teams must undertake. One Trust I met recently said they undertake 2000 reactive maintenance tasks in a single month; that’s the condition of the estate we’re dealing with in some cases.”
Simon Corben concluded: “I think engineering in healthcare has never been so important — not only because of the innovation we want to see driving through, and the technology we’re seeing coming in, but also in terms of keeping the show on the road. A great example was the phenomenal work everyone did through COVID to keep us and our patients safe. So, it’s really important we come together, and I’m delighted to be here today to work with Hilary, John, and Pete to see how we really bring through and foster the next generation of engineers within the healthcare estate.”
Here Pete Sellars thanked all three speakers, and invited questions.