The NHS operates over 1,200 hospitals as well as nearly 3,000 other treatment facilities, many of which operate 24h hours a day, seven days a week, every week of the year. With an occupied floor area of the NHS is 24.3 million square metres (the equivalent of 3,400 football pitches), it’s safe to say that managing this estate and its related services is a huge challenge, but it’s one that’s crucial to the delivery of safe, efficient, high-quality clinical care.

That’s why in 2013, the NHS issued the Premises Assurance Model (NHS PAM) to function as a useful management tool that allows NHS organisations to better understand how efficiently, effectively, and safely they manage their estate and how that links to patient experience.

Presented in the form of a self-assessment assurance questionnaire, it encompasses the Estates & Facilities management responsibilities that flow from the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulations 12, 15 and 17. Originally only used by Acute Trusts, it was later extended to cover Mental Health and Community Trusts, and discussions are underway regarding how NHS Property Services can also feed information into the process.

The last update was issued in February 2020 following review and revision by the NHS PAM Working Group, and the revisions mainly consisted of updating the Self Assessment Questions (SAQs) and references to reflect changes since it was last issued.

The NHS PAM has two distinct but complimentary parts:

1. Self-assessment questions (SAQs) that support quality and safety compliance
2. Metrics that support the efficiency of the estate and facilities.

The NHS PAM SAQs encompass the five “domains” of Efficiency, Safety, Effectiveness, Patient Experience and Organisational Governance, with Organisational Governance being a strategic domain that brings together the other four and ensures they are reported and acted on appropriately by the Board.

Clear Benefits

According to NHS Improvement, there are several benefits or functions to using the model. Not only does it give NHS Trusts the ability to demonstrate to patients, commissioners and regulators that they have robust systems in place, and the ability to provide assurance that the premises and associated services are safe, but it also helps Trusts prioritise their investment decisions in order to raise standards in the most advantageous way and gives them the ability to measure compliance against legislation and guidance across the whole NHS. But despite its usefulness, use of the NHS PAM wasn’t made mandatory for NHS Trusts and NHS Foundation Trusts until the NHS Standard Contract for 2020-21.

17.9 The Provider must complete the safety and the patient experience domains of the NHS Premises Assurance Model and submit a report to its Governing Body in accordance with the requirements and timescales set out in the NHS Premises Assurance Model, and make a copy available to the Co-ordinating Commissioner on request.
- NHS Trust/FT

NHS trusts are required to complete the NHS PAM annually, which gives boards the oversight needed to manage estates-related risks.

Currently, the NHS PAM is provided as a spreadsheet, however an online submission system is being developed with the intent to launch it in January 2022. Apart from the local Board and CQC use of the NHS PAM, NHS England and NHS Improvement will oversee the online system centrally, and utilise it to provide national analysis of risks and investment requirements.

The NHS has urged Trusts to start the work of preparing for it now, so that they have the systems and organisations in place.

PAM Pain Points

While the benefits are clear, many Trusts find that properly managing their premises assurance model process isn’t without its own set of challenges. For example it’s important to continually and consistently keep up to date with changes to relevant regulations, and many Trusts find that they are still relying on a hodgepodge of disparate systems, spreadsheets, reports and documents for all their required data, making it difficult to draw together all the evidence-related information they need to complete their SAQs.

Similarly, a lack of clear oversight of progress against objectives means that clear action tracking isn’t always as easy or as efficient as it could be. Without a single place for relevant data, teams can lack trust in the data or feel confused as to which actions are relevant to them – a situation that can often lead to duplicated (and thus wasted) effort. This is turn means that Trusts can spend too much of their time, manpower and resources in working towards their desired objectives, when the right tools could help them achieve better, safer and more accurate results more efficiently.

Making it Easier

It’s clear then, that what Trusts ideally need in order to ease their PAM management process is a solution that helps them address those “pain points” as easily and effectively as possible. Such a solution would always be updated with the latest regulations and support all the regulatory requirements for inspection and auditing of their estates and facilities, with consistent updates of the national guidance for regulatory inspection, so that they’re always up to date.

Trusts would also benefit from a solution that gave them a holistic view of their entire PAM process with auditing, built-in action management and fully linked risks.

Because the PAM is currently provided as a spreadsheet, it can be difficult to get a clear view of performance against the self-assessment questions, but the right solution could present those in a visual, colour-coded format that made it quick and easy to see which areas and actions needed attention, and thus helping Trusts to prioritise their efforts and focus precious resources on achieving the right organisational goals.

Finally, the right tool would make it easier to monitor all PAM-related activity at a glance to easily see which teams or individuals had the greatest workload or the most priority objectives to complete, enabling everyone at every level to see which activities were in progress and which were still outstanding.

In short, Trusts need a solution like our new InPhase Oversight PAM app – a fast, easy and cost-effective way to manage their premises assurance model across the Trust and ensure that the estate is safe, high quality and efficient. Designed after listening to our NHS customers, it takes the pain out of pulling together all the required evidence by effortlessly tying everything together with risks and related actions to deliver complete oversight in one place.

Robert Hobbs

Chief Executive Officer

InPhase’s Chief Executive and Founder, Robert has been the visionary leading InPhase to be one of the UK's leading providers of management, governance and assurance solutions, and helping organisations align their actions and goals more easily and efficiently with InPhase's suite of integrated apps.