Maintaining Critical Assets in the NHS

In an increasingly litigious environment, the NHS is looking hard at its asset estate and working to improve its planned proactive and reactive maintenance activity to minimise risk. Wrightington, Wigan and Leigh NHS Foundation Trust has invested in Real Asset Management’s fixed asset register to create a single asset view across its Finance, Medical Electronics and Estates departments.

This consolidated source of asset information, that includes in-depth maintenance history and highly-effective maintenance management, is enabling the Trust to improve its asset management and efficiently allocate resources to the highest priority devices through automated Adjusted Equipment Management Ratings.  In addition, in depth analysis into the total cost of ownership is enabling the Trust to optimise asset value.

Critically, the Trust has passed its most recent NHS Litigation Authority audit and has streamlined its asset management processes, from capital asset reconciliation to the use of mobile maintenance, to significantly reduce its manual overhead and deliver a quantifiable return on investment.

Managing Risk Exposure

Wrightington, Wigan and Leigh NHS Foundation Trust is a major acute trust serving the people of Wigan and Leigh. Innovative and forward thinking, the trust is dedicated to providing the best possible healthcare for the local population in the Wigan Borough and surrounding areas. The Trust aims to continuously provide safe quality care to all patients. Over £220 million is spent each year on a diverse range of reputable general and specialist acute services. The Trust has three hospital sites, a state-of-the-art outpatients centre and offices located at Buckingham Row in Wigan town centre.

“The Trust recognised it needed to introduce systems to allow it to improve its asset management to a standard that was appropriate to the NHS Litigation Authority’s guidance”, says Winstone Gondwe, Medical Equipment Manager.

Wrightington, Wigan and Leigh NHS Foundation Trust needed to put in place a system that provides not only a comprehensive list of assets, from X-ray machines to infusion pumps and beds, but which also includes a full maintenance history behind each asset to provide the Trust with immediate access to asset performance information should any litigation arise.  “Every asset must be maintained in line with clearly defined safety guidelines,” says Gondwe. “Without detailed, auditable, proactive preventative and reactive maintenance information, the Trust cannot demonstrate that the equipment has been correctly maintained.”

Improving Asset Insight

One of the main problems facing the Trust was the lack of a good asset register and maintenance management system within the Medical Electronics department. While the Trust’s Finance department has been using a fixed asset register from Real Asset Management (RAM) for six years to successfully manage capital depreciation, the Medical Electronics department’s attempts to deploy a different maintenance and facilities management solution had, left users still reliant on spreadsheets.

With around 11,000 live assets at any one time, all requiring planned preventative and reactive maintenance, a manual spreadsheet-based approach was clearly inadequate. While there were clear operational benefits to be gained from creating a single consolidated asset register across the Trust by extending the use of RAM’s fixed asset register to the Medical Electronics department, a key consideration was the functionality of the maintenance management technology.

One of the key benefits is that RAM provides up to 100 user-definable fields against every asset record, enabling the Trust to implement a system that reflects existing information models and terminology. In addition, the Trust was keen to explore the benefits of mobile maintenance using PDAs. Job work orders can be automatically uploaded onto the PDA and the engineers can update the job status directly onto the device. Even if they are working on one of the remote sites without access to the Trust’s wireless network, the system will automatically synchronize as soon as they are back in range, updating the RAM database.

“Providing the Trust’s 6 medical engineers with job work orders on a PDA rather than on paper significantly streamlines the maintenance process,” says Gondwe.  “In the past, support staff have had to manually re-key information concerning more than 70 jobs each day. The mobile solution completely removes that overhead.”  He continues, “With the huge emphasis on cost cutting across the NHS, RAM provides the ability to drive down back office costs whilst improving the quality of service delivery.”

Maintaining Asset Value

Indeed, the Trust is now analysing the information held within the asset register to derive further financial benefits. Using the full financial history held within the RAM database to analyse the cost of maintenance of assets – based on parts, labour and frequency of both planned preventative maintenance (PPM) and reactive jobs – the Trust can compare the cost/value of assets from different suppliers to make better purchasing decisions. “The total cost of ownership of assets is a key consideration to ensure the Trust optimises its return on investment,” says Gondwe.

Critically, the Trust now has a system that delivers the information required to pass the NHS Litigation Authority audits. It also has a platform to more effectively allocate maintenance resources to further mitigate operational risk.  And this is key: in the current economic climate, the NHS simply does not have the resources to undertake every maintenance requirement. It is therefore critical that maintenance resources are directed at the most high risk areas – whether the asset is high priority or it is the only one in a specific location and its failure could impact on the performance of an entire ward or department.

RAM’s system takes into account a number of factors, including the statutory PPM schedules, asset priority, asset location and number – to automatically create the Adjusted Equipment Management Rating (AEMR), which is based on an international risk model. “The automated production of the AEMR is enabling Wrightington, Wigan and Leigh NHS Foundation Trust to confidently allocate resources to the most critical assets,” says Gondwe.

Single Asset View

One of the key benefits to the Trust of the adoption of a single asset register from RAM is the ability to automate the reconciliation of capitalised fixed assets. Traditionally the reconciliation of the 5-10% of assets within the Medical Electronics and Estates departments that exceed the £5,000 capital depreciation threshold has been a highly time-consuming, manual process.

“Assets are regularly moved, scrapped or sold. In the past, that information was provided to Finance on paper, requiring the Finance team to manually identify the asset and update the system. Now any movements of assets on the capital register are automatically updated,” says Gondwe.  The Trust estimates that around two man days a month have been redeployed as a result of this single asset database. 

In addition, the Trust’s Estates department is also investing in RAM, enabling the Trust to create a single source of all asset data for the first time. “Within 12 to 18 months Wrightington, Wigan and Leigh NHS Foundation Trust’s asset management system will be completely paperless. There will be no need to transfer paper-based information between the Estates and Medical Electronics department departments and Finance; while the use of mobile maintenance will remove all paper-based job work orders,” says Gondwe.

Critically, the Trust has significantly reduced its operational risk. Gondwe concludes, “Not only has the Trust passed its latest NHS Litigation Authority audit but RAM provides the platform for achieving PAS55 compliance, supporting the drive towards optimising asset value and improving risk management and corporate governance through effective risk assessment and a clear audit trail.”