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The Impact on the NHS from the Economic Downturn We shape our buildings; thereafter they shape us Healthy citizens are the greatest asset any country can have . Winston Churchill. NHS Facilities Management. What do Trust Boards need Strategy Leadership Assurance. The NHS Challenges Ahead.

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The Impact on the NHS from the Economic Downturn

We shape our buildings; thereafter they shape us Healthy citizens are the greatest asset any country can have.

Winston Churchill

nhs facilities management
NHS Facilities Management

What do Trust Boards need

  • Strategy
  • Leadership
  • Assurance
the nhs challenges ahead
The NHS Challenges Ahead
  • Rights or Targets
  • Darzi
  • Rising Demand
  • The Market
  • Regulation
  • Productivity
  • Public concern
  • Politics
government spending
Government Spending
  • TARGET 40%
  • ACTUAL 55%
  • BANK Bailout 80%
  • PFI 85%
Treasury U-turn on PFI takes pressure off DH capital budgetExperts had warned that the amount of NHS assets due to come on to balance sheets would bring the DH dangerously close to breaching the Treasury’s strict limits on departmental annual capital spending, resulting in squeeze on the NHS capital pot.
the challenges for nhs the funding crunch
PSBR at its highest ever level

NHS funded by taxation

Comprehensive spending review: up-to 2011 budget settlement above inflation

Productivity gains required in future years

£2.6Bn paid back to HMT and capital halved

65% of NHS costs on staff

The Challenges for NHS “The Funding Crunch”
the challenge
Trusts will have to deliver between £15 billion and £20 billion in efficiency savings over three years from 2011 to 2014, David Nicholson, the NHS chief executive, told health service finance directors in a speech delivered behind closed doors.

The operational framework calls for better use of underused and therefore surplus estate. With the opportunity to save £3Bn of investment

This will require new ways of working and ownership of the estate. The DH estimate saving up to £100 million per annum.

The Challenge
global population ageing
Under 5.0%

5.0% to 12.4%

12.5% to 20%

Above 20%

Global Population Ageing

Percent of Population Age 60+:2020

national population ageing
Significant growth in “young elderly” before 2020

Significant growth in “old elderly” after 2020

National Population Ageing

Age Groups as a Percentage of the Total Population

65 - 74 yrs

0 - 14 yrs

75+ yrs

production and productivity
The scale of this challenge is underlined further by increasing levels of demand and low and declining levels of NHS productivity.

The demand on the health service is set to increase as the result of an ageing population and a higher incidence of chronic disease.

And although NHS outputs (operations, patients treated etc) have been increasing since 2000, NHS inputs (money) have been increasing at a faster rate and hence productivity in the service has fallen.

Future productivity gains will be essential if the NHS is to cope in a period of austerity.

Production and Productivity
future developments for nhs fm
Assurance to the Board

The Corporate Manslaughter and Corporate Homicide Act 2007 (CMCHA) came into effect on 6th April 2008.

The Health and Safety Offences Act 228 came into effect on 16th January 2009

The Regulatory Reform Act (Fire Safety) came into law on 1st October 2006

Quality and Regulation

Value for money

Future Developments for NHS Fm
in numbers
47,709 The additional full time equivalent “infrastructure support” staff employed in the NHS between 1998 and 2008

£200m The approximate value of a 0.5 per cent cut in prices paid for hospital activity

£1bn The annual saving the Treasury says can be made through shortened hospital stays and extending the tariff

7.4 per cent The real terms growth in NHS funds between 2002 and 2008

2.3 per cent The Institute for Fiscal Studies predicted real terms cut for government departments from 2011-12 onwards

In numbers
sweating fixed assets increasing income reducing costs
Bring in extra revenue: Productivity increase and efficiency gains

Reduce cost: supply chain management in a recession

Reduce operational expenditure: Spend where income generated management

Improve and protect revenues: Knowledge management and best practice

Sweating Fixed AssetsIncreasing income, reducing costs
future developments for nhs fm offer strategic value
New Ideas for creating Value

Next Generation of FM performance criteria

An updated methodology for a Asset Strategy and Investment Plan

Systems and protocols for Assurance

Innovation to deliver accommodation solutions in a changing NHS

Knowledge Managment

Future Developments for NHS FmOffer Strategic Value
the balancing act
Trusts need to manage a range of difficult balancing acts between NHS values, commercial activity and pursuing the bottom line while keeping the patient first

Matching demand to clinical productivity and programmed admissions are probably the greatest opportunity gains.

FM directors need to have a handle on their operations like they have never had before. The concept of service-line management and Space utilisation

The next three years requires an even greater focus on quality, safety and leadership.

The Balancing Act
going into the unknown
A politician needs the ability to foretell what is going to happen tomorrow, next week, next month, and next year. And to have the ability afterwards to explain why it didn't happen. Winston ChurchillGoing into the Unknown