CASE STUDY: Maintaining critical assets in the NHS

Wrightington, Wigan and Leigh NHS Foundation Trust invests in Real Asset Management’s fixed asset register, creating a single asset view across its finance, medical electronics and estates departments

In an increasingly litigious environment, the NHS is looking hard at its estate assets and working to improve its planned pro-active and re-active maintenance activity in an effort to minimise risk. In this case study we look at the decision by Wrightington, Wigan and Leigh NHS Foundation Trust to invest in Real Asset Management’s fixed asset register, creating a single asset view across its finance, medical electronics and estates departments.

About the trust

Wrightington, Wigan and Leigh NHS Foundation Trust is a major acute trust serving the people of Wigan and Leigh.

The organisation is dedicated to providing the best healthcare for the local population in the Wigan borough and surrounding areas and spends more than £220m a year on a range of general and specialist acute services. It operates from three hospital sites, a state-of-the-art outpatient centre, and offices located at Buckingham Row in Wigan town centre.

The challenge

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.

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, but the medical electronics department’s attempts to deploy a different maintenance and facilities management solution had left users still reliant on spreadsheets.

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

With around 11,000 live assets at any one time, all requiring planned preventative and re-active maintenance, a manual spreadsheet-based approach was inadequate. And, 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.

“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”, said Winstone Gondwe, the trust's medical equipment manager.

The 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,” said Gondwe. “Without detailed, auditable, pro-active preventative and re-active maintenance information, the trust cannot demonstrate that the equipment has been correctly maintained.”

The solution

One of the key benefits of the system is that it 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 organisation was keen to explore the benefits of mobile maintenance using PDAs. As a result 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 synchronise as soon as they are back in range, updating the RAM database.

Without detailed, auditable, pro-active preventative and re-active maintenance information, the trust cannot demonstrate that the equipment has been correctly maintained

“Providing the trust’s six medical engineers with job work orders on a PDA rather than on paper significantly streamlines the maintenance process,” said 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.

“With the huge emphasis on cost cutting across the NHS, RAM provides the ability to drive down back office costs while improving the quality of service delivery.”

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 database to analyse the cost of maintenance of assets – based on parts, labour and frequency of both planned preventative maintenance (PPM) and re-active 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,” said 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.This is key as in the current economic climate, the NHS does not have the resources to undertake every maintenance job requirement. It is therefore critical 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.

The new 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,” said Gondwe.

The benefits

One of the key benefits of the adoption of a single asset register 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 is a highly time-consuming, manual process.

“Assets are regularly moved, scrapped or sold," said Gondwe. "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."

With the huge emphasis on cost cutting across the NHS, RAM provides the ability to drive down back office costs while improving the quality of service delivery

The trust estimates that around two man days a month have been saved and redeployed as a result of this single asset database.

"Within 12 to 18 months Wrightington, Wigan and Leigh NHS Foundation Trust’s asset management system will be completely paperless," said Gondwe. "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."

In addition, the trust has significantly reduced its operational risk. Gondwe concluded: "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.”

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