Repair & maintenance: Facing the challenges of Covid-19 in the healthcare sector

Some care operators have been impacted more than others. We have seen the first care home in Kettering close as a result of safety concerns around COVID. Likewise, the Scottish Inspectorate have taken over running one privately-run care home. To control the spread of the virus, many more residents and staff have at one point or another been isolated due to having symptoms or confirmed COVID cases, and most homes banned visitors from mid-March.

The immediate challenge for Kevin and the FM team was deciding what maintenance services were continued in the homes; which services had to stop, and at what point can operations get back to normal, albeit no one is sure what the new normal will be.

As you would expect, urgent services including reactive call outs on heating, hot water, security, patient care equipment, fire alarms etc, were all protected. In addition, statutory inspections and planned maintenance have continued where possible. However, several challenges have made these services more difficult to implement, including:

• Organising safe access into the homes, agreeing dynamic risk assessments, agreeing the appropriate level of PPE and not being able to gain access to quarantine areas
• Contacting and organising access with the homes at times when key home staff are either self-isolating or sick with the virus
• Having the right contractor and the right operative available due to either self-isolating, being ill or suspending operations by furloughing staff

Background of Care UK and the home care sector

There are currently 473,000 care home beds operating in 2019, up 0.9 percent from 2014. Together the ‘Big Five’ health and social care providers, of which Care UK is one, operate 62,000 beds, around 13 percent of the total stock. For Care UK, this amounts to 117 homes and 7,882 total beds.

Within Care UK’s facilities management model all contract management and procurement is retained in house. Before the pandemic, around 4,000 work orders were raised each month and were passed to an established list of pre-vetted contractors.

Currently, there has been a drop of around 75 percent to 1,000 work orders a month since the beginning of the lockdown. The property team, who have a planned program of decorating work across the homes, have paused this activity but are planning to restart work as soon as it is safe to do so.

Lessons learnt from the COVID-19 pandemic

While this is still an ongoing challenge and new lessons are being learnt on a day to day basis, there are some key learnings that have been made so far:

• Having an in-house helpdesk with the ability and technology to work from home has been invaluable and speed taken to mobilise has been impressive
• Stopping non-essential maintenance work was easy. However, it has been incredibly difficult agreeing with the stakeholders how and when this work should recommence.
• Clear and timely communication with the homes and the supply chain has been key
• Using one system to raise and track all work orders is invaluable. This ensures outstanding work per home/per contractor can be managed efficiently
• Plant rooms that segregate contractors from other building users need to be external if access restrictions become the norm
• Dynamic risk assessments and method statements need to consider infection control on every job going forward, not just during COVID-19

The new ways of working for care homes

In terms of what the new normal will look like, it is likely that the whole sector will have a phased approach in lifting access restrictions. As care homes contain many vulnerable residents this won’t be at the same timescales as the general population. Rather than a sudden switch to the green light on restarting paused work and new work orders, the industry will adopt a more cautious phased approach.

Health and safety measures and in particular risk assessments will become even more important and will need to consider infection control more than they have before.

Inevitably, there will be much more stringent infection control procedures in place across care homes. Initially, this will mean:

• Ongoing temperature checks,
• Restricted access to parts of the home and for
• PPE including face masks (type II R)
• Greater hand washing and sanitisation
• The requirement for contractors to change clothing/overalls between jobs
  
  

Ideally, there will be complete separation of contractors from staff and residents. Where possible, this will mean confining contractors to unoccupied wings or floors of buildings.

The future for health care maintenance

For many businesses coming out of this period, cash flow will be a major challenge. Over the past 2 months, in care homes at least £6 million per week has been lost in fees. This will mean that the funds available will need to be focussed on frontline services and it will be the job of the FM team to allocate the moneys where it is most needed.

It is difficult to make concrete predictions of what the future of the care sector will look like post-coronavirus. However, Kevin was able to outline some of his expectations:

• It will be harder to attract residents into care homes as there will be an unfair but understandable view that they are not safe places to be in. This is not the case but, with the news of so many deaths within care homes, it will take time to overturn these apprehensions. The condition of the environment, including finishes, décor and furniture, will all help give a positive impression, which may in turn increase maintenance activity. However, FM teams may be expected to deliver more with less funding as pressure increases to invest money elsewhere within the business.
• There will be a backlog of work and combined with the pressure on budgets, there is an expectation it will take 2 to 3 years to get back to normal spend levels on building and fabric maintenance
• Longer term, by 2040, the age dependency ratio (the number out of 1,000 people of working age requiring support) is expected to increase from 282 to 368. This will increase demand for bed spaces and in turn money spent across the industry should increase significantly.
• Maintenance work will always be required. Expenditure on repairs and maintenance will also have to increase to reflect the condition of either old building stock or newer leasehold stock that comes with repairing obligations.
  
  

From a wider property team point of view, the care sector will be looking to the construction sector to help with innovation on how to future-proof homes in the event of another pandemic, such as products like Dulux Trade Sterishield with finishes that help prevent the spread of viruses.