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Taking the Bull by the Horns…..

Taking the Bull by the Horns…..

After years of warning about skills and labour shortages, HEFMA’s leadership has joined forces with IHEEM with the aim of creating a high-quality apprenticeship scheme for estates and facilities in the NHS. Jane Renton finds out all about this new initiative in an exclusive interview with Jonathan Stewart, National Chair of HEFMA and Ian Hinitt, President of IHEEM.


Leadership is about courage and wisdom – recognising what needs to be done.  It is also about action, not just words. This is why HEFMA has joined forces with colleagues in IHEEM (The institute of Healthcare Engineering and Estate Management) as part of a critical endeavour to develop an accredited national apprenticeship training scheme that will ensure a continuous supply of qualified, multi-disciplinary skilled estates and facilities employees for the NHS.


At the time of going to press, a draft partnership agreement outlining the two organisations’ combined objectives for the scheme was being developed by Jonathan and Ian to formalise the proposal with the executive councils of both organisations.


“We are collaborating more closely than ever before. But this is not about the associations themselves, but rather us acting as a focus and a pressure group to safeguard the vital support services that our members provide to the NHS,” explains Jonathan.


Skill and labour shortages on the estates and facilities management side of the NHS have been long-standing issues, but are now reaching critical levels as an ageing staff demographic increasingly approaches retirement. Allied to this is under-investment in the right level of training and development to ensure a steady stream of new talent into the healthcare industry. 


As IHEEM’s President points out, the NHS as Britain’s largest employer has a corporate and economic duty to train and develop people to deal with all the technological breakthroughs needed to transform patient care in the twenty-first century.


“Not to do that could be tantamount to deskilling. We need to create a balanced workforce that is capable of dealing with routine and sometimes basic tasks as well as the more sophisticated high-tech jobs that will also be increasingly required,” says Ian.


Coming up with a plan

To date the apprenticeship levy has not produced the sort of high level schemes within healthcare that the government envisaged. The most recent figures for apprenticeship completion showed just shy of 4,000 healthcare apprenticeships between March and October 2017. Only 11 of those involved training in healthcare facilities, compared to 200 in business administration and 70 in accountancy. 


The unveiling of HEFMA and IHEEM’s joint national apprenticeship initiative is aimed at improving those ratios. It follows the recent publication of the NHS’s Long Term Plan in early January, as well as the appointment of Julian Hartley, the current Chief Executive of Leeds Teaching Hospitals NHS Trust, to lead the new workforce implementation plan for the NHS. Somewhat worryingly, it seems he has just two months in which to complete his Herculean task, which is to set in motion a remedy for the significant skill and labour imbalances that have dogged the NHS for many years.


While one of the key aims of the Long Term Plan is to create a sustainable balance between supply and demand across all groups, the plan predominantly focuses on staff shortages on the clinical front, where the ever-present threat of litigation has prompted Trusts to prioritise training and development in this area to the detriment of virtually everything else. 


There is little if anything in the Long Term Plan that relates directly to the support services, let alone jobs within estates and facilities. Part of the Workforce Implementation Plan, due to be published later this year, involves the establishment of a new NHS Chief People Officer, as well as an NHS National Medical Director and other chief professions officers, including a Chief Midwifery Officer. It remains to be seen whether there will be a Chief People Officer for Estates and Facilities, which will have a crucial role to play in transforming the NHS estate and its related services.


The scale of the problem

Emma Bolton, Regional Estates and Facilities Lead (North) at NHSI is currently involved in mapping the scale of skills and job shortages within estates and facilities, but the scale of the problem is self-evident to anyone who walks into almost any healthcare organisations. Jonathan himself recalls recently walking into a legal training forum aimed at aspiring directors and seeing the scale of the problem clearly reflected yet again. 


“I attended a training event recently for senior level estates and facilities staff. I don’t think there were many attendees there much below the age of 50 and there were only two women out of a group of 35 people. Unfortunately, this is consistent with many meetings and events I attend and it is clearly not representative of the demographics of our potential workforce.”


It is a decades-long problem that perhaps owes its roots to the undermining of many of the healthcare support services apprenticeship schemes that used to flourish in the seventies. At the other end of the scale many of those in senior positions have either retired or are coming up for retirement. Their posts are either not being filled, particularly at assistant director level, or cannot be filled because of a shortage of suitably qualified people to fill those vacancies. Such problems are particularly pronounced in the engineering and hard FM areas of the NHS. As a result, management are increasingly resorting in many Trusts to reliance on expensive interim staffing and consultancy appointments because of difficulties in finding sufficiently skilled people to fill vacant posts. One senior NHS engineer complained of estates managers and engineers being expected to act as the ‘authorised person’ for as many as five different specialisations, something that is considered neither practical nor safe.


“My perspective is that most Trusts are now at bare minimum staffing levels, no slack and no ability to cover gaps,” complains one senior estates manager, who is critical of the way in which the Model Hospital framework continues to drive down costs. 


“Model Hospital does not consider or measure service levels and quality. While finance directors like vacancies, they support cost improvement, directors of estates and facilities recognise only too well that this does not support compliance and patient safety.” 


It seems that pay is also becoming a big issue, particularly when it comes to recruitment in the various trades.  


“Trades employees do not appear to want to work in the NHS, and our experience suggests whether we like it or not, pay is a predominant issue,” the same manager concludes, adding that thousands of pounds are spent on training staff only to see them leave for the private sector.


“It is a ticking time-bomb. Whereas some Trusts have been proactive in addressing labour and skill shortages in these areas, those initiatives have not been replicated on a national scale. We need to provide more opportunities for people from different backgrounds and ethnicities to find a rewarding career here,” asserts Jonathan. 


This could be done through training to upgrade the existing skills of those working at more basic entry levels. 


“We need to upskill those who are semi-qualified and in some cases we are doing that, but generally not in a way that is necessarily in accordance with the high-risk requirements demanded by today’s more complex technology,” says Ian.


While both Jonathan and Ian benefited from high quality engineering apprenticeships in their formative years, many of those schemes were abolished during the Thatcher years and have never really been reinstated.


“We don’t necessarily want to dwell on past history, but we would like to see the reinstatement of similarly high quality schemes that we enjoyed as apprentices, although a multi-disciplinary approach would be more appropriate now than might have been the case in the past,” says Ian.


Wider collaboration

Both men have been active in seeking appropriate partners for their apprenticeship initiative: “We know that NHSI understands and supports what we are doing,” says Jonathan. 


Other professional groups within estates and facilities, such as the Hospital Caterers Association and the Association of Healthcare Cleaning Professionals (both existing partners of HEFMA), may wish to be involved. IHEEM and HEFMA have also been in regular contact with Eastwood Park, the former NHS national training centre for healthcare engineering in Gloucestershire, but now an independent provider of healthcare training services. It has expressed a wish to provide professional educational support to the initiative and it is likely that it could also become a formal partner to the planned national apprenticeship programme. 


The idea is to produce a national curriculum not dissimilar in scale and scope to the old Industry Training Boards where there is a nationally accepted standard for transferable skills across all FM disciplines.


It is still early days, however, and there are a number of significant hurdles to overcome, principally to do with funding. 


“Ultimately the NHS will need to collaborate with us and support the scheme because neither HEFMA nor IHEEM can do this on our own. But the will and leadership is there,” says Jonathan.


Creating excitement

Any successful apprenticeship scheme will also increasingly rely on better promotion of newly-created career paths within the NHS. Ian is keen to see the health service replicate some of the excitement generated by the Royal Academy of Engineering’s recent social media campaign #ThisIsEngineering aimed at attracting young people from more diverse backgrounds into the industry. The accompanying videos feature young men and women working in a variety of engineering jobs, ranging from blockbuster films to disaster relief. The NHS needs to generate a similar level of excitement, rather than one of a Cinderella service within the NHS that has been repeatedly robbed of resources as part of a wider fight to prop up the frontline.


The Royal Academy of Engineering’s series of videos have been viewed more than 16 million times by teenagers on social media. A before and after survey of some 1,200 young people showed a 41% increase in those who said they would now consider an engineering career as a result of the campaign. 


“It is not just about the numbers, but getting more diversity into our sector. We seem to have a much greater issue with gender imbalances in healthcare FM services compared to other disciplines. Even the construction industry is doing better in this regard,” says Jonathan.


As both men conclude, investment in young people and a more diverse workforce is critical. It makes people feel important, that they matter. It makes them loyal, something the NHS is discovering cannot always be taken for granted.