Trust establishes a subsidiary company to review and remodel the existing services, resulting in significant savings and improved patient care experience

Gateshead Health NHS Foundation Trust (“the Trust”), also known as Queen Elizabeth Gateshead (QE), is based in the North East of England. Today the QE is rated as one of the best performing middle sized acute Trusts in the country. Our project came about following the Trusts recognising of a huge financial challenge over the next few years, our aim was to create a first of its kind multi-faceted, flexible vehicle to deliver value for money

Support and Procurement

Service to maximise efficiencies and economies and take advantage of the trading benefits of being a separate legal company, to benefit our Trust. We needed a solution to the financial pressures that would not only be able to drive out efficiencies but also could generate income from outside Gateshead Foundation Trust and that could compete in the commercial world. Fundamental was also the need to Reengineer the way Estates and Facilities services were delivered to our patients, whilst efficiency and cost savings were extremely important, it was also just as important to drive though Improvements in our patient journey and experience though our support services. The formation of this subsidiary company of the Trust, known as QE Facilities Limited (QEF) is undoubtedly the most significant achievement.

We have created a model referred to as the (Gateshead Model) that is at the forefront of service delivery, which brings together the very best commercial benefits of a private outsourced service with the ethos and culture of a quality In-house service. This Hybrid model represents a new way of delivering quality and cost effective services for the NHS. Like with any first, the most significant achievement has been the very creation of the subsidiary company. With no blue print or tried and tested model to work from, QEF which is now delivering those tangible benefits back to the NHS though the QE and to an increasing number of Trusts up and down the country, is an outstanding achievement. We are Proud to say that QEF has been established on the solid foundations of the NHS and bring together a team of multi-talented experts. The creation of QEF as a Arm’s length Separate legal entity which is governed by;-

•QEF Board

•Articles of Association

•Separate systems, policies and procedures

•Separate terms and conditions of employment

•Separate governance arrangements QEF has now a proven track record in achieving our original aim and is delivering real and tangible financial benefits flexible, proactive range of high quality and an ever expanding range of Estates and Facilities services, delivered on the lines of a commercial organisation and well as delivering improvements in our patents experience.

In terms of our significant achievements undoubtable the very creation of the wholly owned subsidiary company QEF was the most successful element of the project. However as part of that Achievement has allowed our Estates and Facilities services to grow, expand and reengineer to create a single multi skilled workforce which is delivering tangible financial benefits and a flexibility high quality service delivery that would not have been possible under traditional self-delivered services. At the launch of QEF the only service the organisation transferred in was the Estates service, in the 18 months to this point, and due to the success of our model our current portfolio [Spread] has expanded to the following service lines;-

•Estates Maintenance

•Estates & Property Management

•Capital Design & Feasibility Service

•Grounds & Garden Services

•Catering

•Energy & Utility Services

•Cleaning

•Portering

•Central Sterile Supplies Department (CSSD)

•Security

•Linen Services

•Telecoms

•Procurement Services

•Managed Equipment & Consumables Services

•Electronics & Medical Engineering Services

•General Facilities Service

•Outpatient Prescription Service

•Pathology Courier Service

•Transport Service

•Specialist VAT advise

•Financial services

•IT procurement

•Patent transport service

•Consultancy service

The Estates department took the opportunity to review and remodel the existing services provided, and made significant changes with the existing workforce in the following areas ;-

•Multi skilled work force

•24/ 7 twin shift cover

•Removal on call service

•On line call logging

•Mobile device job allocation

•Re assessing working practises

•Cross skilling and specialist training

•Bringing contracted services back “in house “

•Environmental Zone champion’s

•Review and overhaul of Planned preventative maintenance

•Condition proactive maintenance

•Modern techniques such as thermal imaging of electrical installations

•The successful employment of trade apprentices

All of the above are monitored via a new library of transparent operating procedures and over 120 KPI’s have contributed to a significant reduction in maintenance costs in the region of £5,500,000. This has also lead to improvements and a better more efficient, responsive and dedicated workforce that is able to offer its employees a wider variety of work, greater job satisfaction, security and increased career prospects. As a measure of our achievements we are proud to boast that QEF has delivered around £10,000,000 of cost reductions to Gateshead Health NHS Foundation Trust in the 18 months the company has been operating with a forecast of saving to have increased to £42,000,000 by 2021.

One of the projects that QEF were heavily involved in was the building and commissioning of a new £32 million Emergency Care Centre at the QE, the design of which is revolutionary in its self in that it brings together all services and a patient flow that ensures our emergency care patients can access all their individual requirements at hand, in a very modern and flowing process. So successful is the design that it recently won the national award for infrastructure at the Royal institution of chartered surveyor’s national finals [RICS Awards}.

With judges commenting, “This design sets a new blue print for the NHS and is an outstanding project”. QEF’s matra is being Professional, Passionate and Proud of what we do in delivering high quality, cost efficient services. This mantra runs through all aspects of service delivery, training branding and staff recruitment. We believe that our subsidiary model will revolutionise the way Estates and Facilities services are delivered in the NHS for the foreseeable future.

Challenges

1.Funding gaps

Our primary challenge was to solve the significant funding gap at Gateshead Health NHS Foundation Trust, by creating something unique, that could provide high quality support services at low cost and that could generate new external funding opportunities, and so had to be able to compete on a commercial footing. The Estates and Facilities costs were already benchmarked at the lower quantum against comparator Trusts using Eric data. The project is the first of its kind (as far as we are aware) and so there were many challenges along the way in creating something entirely new, with no references or guidance templates. Further challenges were thrown out in creating this HighBryid subsidiary company in a risk adverse institution such as the NHS, meant winning over the hearts and minds of both the senior Directors and many others within the Trust along with the 400 employees who were TUPE transferring in to the company.

2.Historical Estates and Facilities Services.

From the outset a major problem to solve was the inherent inefficiencies of traditionally resources Estates and Facilities services. We knew that traditional methods of delivering estates and facilities services, were traditionally costly, or presented a lack of control and governance, and mainly lead to finance seeping out of the organization. We needed to create something revolutionary.

3.Lord Carter and CARE initatives.

One of the elements that our project needed to action was the challenges and actions thrown out to the NHS Estates and Facilities teams by the Lord Carter report; this coincided with a number of care initiatives which again required to be addressed. We had to create something that simultaneously focused on cost reductions and efficiencies also ensured Estates and facilities services were delivered to the highest standards, and that are constantly being challenged to deliver service excellence.

4. Climate Change Act 2008.

We faced further challenges to create something that would deliver opportunities and flexibility to meet the Climate Change Act, in terms of the targets the government set to reduce Carbon Reduction by 2019, whilst under considerable financial and budgetary restraints

Actions

1.Creating a separate but wholly owned legal entity, which works for both Gateshead NHS foundation Trust and externally on a commercial income generation schemes.

2.Creating a new muti-skilled Estates and Facilities services operating as a commercial organisation.

3.Transfer of significant levels of assets to the new organization.

4.The creation and mobilsation of a whole new library of service specifications and KPI’s.

5. TUPE transfer of 400 staff and changing employee’s cultures and encouraging all staff to embrace the new company ethos; Proud, Passionate and Professional.

Results

1.Cost saving and efficiency

As a direct result of the establishment of QEF savings by the end of 2016/17 will equate to over £5.6 million and has delivered around £10,000,000 of cost reductions to Gateshead Health NHS Foundation Trust in the 18 months the company has been operating. Over the first 5 year period the forecast savings are estimated to equate to £34,000,000 revenue and £7,638,000 of capital, our projection is that savings on the group costs will have risen to over £42 million by 2021. The average annual savings are in the order of around 3% of the Trusts annual Turnover.

Turnover as risen shapely to £32,000,000. QE Facilities are currently working with 11 other Trusts, with a number being much larger than our own. What these figures nicely evidence is our statement regarding the revolutionary implications to the NHS as an organisation. Even if we only draw a comparative of savings for each of the 11 Trusts with no additional Trusts added, there is a potential for the NHS to save as a minimum over £462 million by 2021 if these Trusts replicate our achievements. Whatever the savings turn out to be it can be directly attributed to our project innovation.

2.Patent facing service excellence

Whilst we believe the cost and efficiency savings element of our achievement is significant achievement this has not been at the detriment of our service delivery to our patients. Indeed in creating QEF this has allowed our management team to target underperforming areas moving then to the point where we are now constantly achieving all contracted KPI’s, so much so that in pursuit of service excellence QEF are proactively introducing stretch targets to all service streams. We believe that nothing measures QEF’s Estates and Facilities services like our patients feedback themselves.

Just such feedback is given via Patient Led Assessment of the Care Environment (PLACE) which has been undertaken in 2016. It is therefore marked that all Estates and Facilities services were scored higher than the NHS national average. The aim of PLACE assessment is to provide a snapshot of how an organisation is performing against the range of non-clinical activities highlighted which impact on the patient experience of care. The inspection process was completed over 3 days in March 2016; audits were completed at agreed dates and times enabling assessment throughout the working day.

In summing up the assessment reads “Queen Elizabeth Hospital The Hospital consists of buildings of various ages which have been integrated together to give the overall effect of a modern operation. The standard of cleanliness is high throughout the entire Hospital, also the state of repair and signage has improved in the last 12 months. The steps taken by the QEF & the Trust to implement “Dementia requirements” are to be applauded in view of the current financial situation. Finally staff have a sense of pride and ownership in the hospital which comes through at all levels’.

3.Lord Carter and Care Initiatives

The challenge thrown by out by the Lord Carter report and CARE initiatives is around the patient experiences and the role our Estates and Facilities teams and services had to play in achieving these standards. One of the projects that QEF were heavily involved in was the building and commissioning of a new £35 million Emergency Care Centre at the QE, the design of which is revolutionary in its self in that it brings together all services and a patient flow that ensures our emergency care patients can access all their individual requirements at hand, in a very modern and flowing process.

So successful is the design that it recently won the national award for infrastructure at the Royal Institute of Chartered Surveyor’s [RICS] National Finals. This £32 million Accident & Emergency Care Centre was described by RICS judges as an outstanding project, not only in terms of the architecture and facilities provided, but also in how it brings together all the medical facilities required to treat patients during an emergency into a single bright modern new building.

The exemplar Building heralds a new era in medical design with the latest wireless technologies to streamline patient flow. RICS judges said it will greatly benefit the Gateshead community and surrounding areas for generations to come. The new Emergency Care Centre building not only has a unique design and facilities, but it completely changes the way patients are cared for during an emergency by bringing together a wide range of services including:

•Accident and Emergency

•A walk in centre

•GP services

•Medical & Surgical assessment

•Urgent children’s services

This state-of-the-art facility, which was officially opened by Brendan Foster CBE in August, has also been designed in a completely different way to most existing hospitals. The layout has been chosen because it specifically reflects what people say they want from a modern NHS hospital, which includes single occupancy rooms with en suite bathrooms for all patients in our short stay wards. David Brooks Wilson - FRICS FCIS FCT FCIM “This award recognises exceptional infrastructure projects that have impacted and enhanced the lives of millions of people living around them. The schemes reviewed showed evidence of public consultation detailed planning, Innovation and improvement not only in construction but in contributing to maintaining essential services and improving the quality of the environment” With judges also commenting that “This outstanding design sets a new blue print for the NHS”.

4.Carbon Reduction

Our energy and environment team have also achieved Go Smarter Gold Award for providing a wide range of new travel options for employees and regularly promoting sustainable ways of travelling. QEF’s plan in Gateshead has been such a success that the NHS Trust has reduced single occupancy car journeys by more than 10% over the last 6 years with many more people now choosing to car share, walk or use public transport. QEF is forging ahead with its pioneering work to cut carbon emissions across the Gateshead Trust with new equipment – and is saving thousands of pounds in the process.

A new biodiesel CHP (Combined Heat & Power unit) is now supplying carbon-neutral electricity and heat to the QE’s emergency care centre. Not only will it save an estimated £100,000 in energy costs but the building will be running with carbon emissions that are 68% lower than the current government standards for new buildings. QE Gateshead is also working towards a series of other green initiatives that will not only help reduce carbon emissions, but will also actively help to save money. A second biofuel CHP is planned for the emergency care centre, and a CHP is planned for the pathology centre. Other achievements in improving sustainability in 2014/2015 include:

•Gas consumption across the trust fell 13.5% even though the actual size of the hospital increased by 14%. This is estimated to save £200,000

•Ageing pipework was removed and replaced with new, high-efficiency steam systems, which is projected to save costs of £200,0006

•New electric Vehicle charging points have been installed across the Queen Elizabeth Hospital site Cost-saving and environmentally-friendly measure that will not only cut the amount of carbon we, as a Trust, produce, but will also save us money. Becoming greener will have a positive knock on effect for patients, in that the money we are saving will be invested back into patient care in Gateshead. Under the Climate Change Act 2008, every NHS organisation is required to reduce carbon emissions. Gateshead Health NHS Foundation Trust met the first target of 10% reduction by 2015 four years ahead of deadline. The next targets for QEF is to assit GHNT in striving towards 34% reduction by 2020 followed by 50% by 2025 and 80% by 2050.

5.Taking away the headaches for the Trust.

The creations of QEF has allowed us the flexibility to take away some of the previous headaches for our Trust. Such measurable success has been recorded within Patient transport services where we have not only reduced the cost by around £50k annually but we are able to speed up patent waiting time from our discharge lounge and introduce added value by cross services cooperation with our catering team providing a home care provisions pack of basic essentials for our most vulnerable patients returning to an empty home or who may be on their own. Within our Endoscopy decontamination, QEF have transferred the service to create operating efficiency as this this department have been integrated with QEF’s existing CSSD and medical Instruments teams to ensure that not only can we ensure the limited endoscopes are readily available, but we can control both the acquisition of new and where there is an issue with availability work with other local Trusts to provide a contingency plan.

Another of our recent facilities projects has been to install Omnicell cabinets for the storage tracking and electronic ordering of medications has been deployed across our wards. This allows us to proactively manage stock and the control of drugs at ward level, it provides us with valuable Management Information and will shortly be part of a fully automated procurement process, which currently is a manual task taking up valuable support services and medical resources affording further efficiency savings. A further major facilities project was the re-engineering of specialist pathology transport, resulting in a costs saving coming out of the efficiencies of introducing a bespoke trackable timed collection and deliver service, allowing the pathology lab to rosta staff around the critical times of the day. Feedback for this service from the community GP’s has been excellent.

Value

1.Achieve significant savings for the Trust.

As a direct result of the establishment of (QEF) savings by the end of 2016/17 will equate to over £5.6 million and has delivered around £10,000,000 of cost reductions to Gateshead Health NHS Foundation Trust in the 18 months the company has been operating. Over the first 5 year period the forecast savings are estimated to equate to £34,000,000 revenue and £7,638,000 of capital, our projection is that savings on the group costs will have risen to over £42 million by 2021. The average annual savings are in the order of around 3% of the Trusts annual Turnover. Turnover as risen shapely to £32,000,000.

2.Patient experience.

Our Patients Lead Assessment of Care and Environment [PLACE] survey have recorded higher satisfaction rates (on average 3.5% above the national average) above the national averages in all services, for food, organizational food, ward food cleanliness and maintenance. Service are delivered against a library of detailed, robust and transparent specifications. QEF Continual improvement program introducing ‘stretch targets’ to push our service standards upwards.

3.Revolutionary.

Our project provides the blue print as the example model for the way all NHS can improve the value of its support services, and fundamentally sets the platform for the NHS organisation to generate many 100’s of Millions of pounds in savings and efficiency going forward. Further example of our revolutionary project, is the new build Emergency Care Centre and the Queen Elizabeth Hospital, where the revolutionary design sets a new blue print for the NHS.

4.Energy and sustainability targets. QEF assisted Gateshead Health NHS Foundation Trust in achieving its carbon reduction targets 4 years ahead of schedule.

In detail

Ambition: To meet the increasing significant financial pressures on Gateshead NHS Foundation Trust whilst delivering high quality value for money Estates and Facilities services, which met a range of directives and overarching principles of patient care quality initiatives.

Outcome: To create new subsidiary company which allows our parent organisation to focus on its core clinical services, yet provides a focus for its Procurement and Financial services to deliver the flexibility and tangible financial efficiencies and savings, while still maintaining extremely high standards of service to the key stakeholders. Through the creation of this vehicle we have been able to drive though a whole range of efficiencies and reduce operating costs significantly while service level measures are now above NHS national averages. QEF is delivering significant savings and service line efficiencies to the Trust whilst maintaining high quality and flexible support services.

We have been able generate high quality services and achieve some significant targets and achievements along the way, this will continue long in to the future. Our business development strategy engages with many Trusts throughout the NHS to create their own version of our project. Once QEF have supported these Trusts and inspired each of them to go on and generate their own savings and efficiencies’ at the levels we have been able to through their own subsidiary companies the precedent our project will have set is for the potential for the whole NHS to save 10’s if not 100’s of Millions of pounds over the next 10 years.

Spread: The ‘spread’ of the operating model through the QE from the original single Estates service to the current portfolio of 24 services and into other NHS organisations throughout the country is actively being pursued and the Company is working on a consultancy basis with in excess of 11 NHS Trusts on the local implementation of the QEF ‘model company’. Our business development strategy is to continue to work with other Trusts to asset them create their own version of the Gateshead support services model, for the overarching benefit of the NHS as a whole.

This is a big claim. However we genuinely believe our innovative project will revolutionise the way NHS Estates and Facilities services are delivered for the foreseeable future and that our project, this is backed up by the fact and figures, from not only what has been achieved in Gateshead however in working with the 11 other Trusts we are currently engaged with.

Involvement: From concept to implementation and operational reality the engagement of the workforce, key stakeholders and service customers has been essential to ensure a smooth transition. Regular briefings, communications, publications have been used to ensure all parties are aware and up to date with developments and have had the opportunity to express their views and make comment. QEF reports Operational and Financial Governance into the Trust on a monthly basis, with QEF operational management meetings and team briefing held throughout the month. A Staff Partnership Forum has been formally established to provide a ‘voice’ for staff in the ongoing operation of the business and its future development.

Customer feedback is important and a variety of key performance indicators have been developed and are reviewed regularly with clients to ensure standards are maintained. We have launched our new QEF Web site (www.qefacilities.co.uk) to maintain, update and create a vehicle to increase our commercial presence. For the first time our Procurement teams have launched and are seeking further opportunities via social media. QEF have an active business development department to seek out further commercial opportunities. We believe the facts and more importantly the figures to support our submission speak for themselves. However, to further evidence our achievements we would extend a welcome to meet with the GHNF Trust Chief executive Mr Ian Renwick and QEF Managing Director Mr Peter Harding, along with our patents or customers.