CIAMS

CIAMS stands for Commissioners Investment & Asset Management Strategy. It is one of the recommended vehicles through which information about the health estate to be gathered and assimilated with commissioning strategies and service planning to establish an overall management framework for health care provision. The principles are illustrated in the following diagram (reflecting the CHP guidance):

From an estates perspective CIAMS is addressed in two phases :

Understanding your estate (estate information audits) and the planning function
Implementation (of the management plans)

The development of a CIAMS is a new approach to estate strategy, which builds on existing practice and promotes a complete alignment between a PCT’s commissioning strategy and its plans for the future of primary and community care estate. It is wider than was initially envisaged in the ‘Transforming Community Services’ annex as it now seeks to include all estate from which primary and community services are delivered. The purpose behind this change is to ensure that PCTs take into account all sites from which services can or are being delivered, whether directly owned by the PCT or not.

A template form has been designed and is available through the Community Health Partnerships site (link below) to assist PCTs with baseline information gathering. This document (spreadsheet format) identifies fields of information needed about the health care premises used by the PCT (whether within their ownership or not, and whether occupied or not). The standard form provides a ‘high-level’ view, to support strategic planning decisions. The tactical and operational details (data) about the buildings and facilities in use will need to be gathered from other sources, including :

ERIC reports (Estates Return Information Collection)
ESTATECODE – 6 Facet Surveys of facilities and spaces
- Condition
- Utilisation
- Suitability
- Statutory (and standards) compliance – including FIRECODE and DDA
- Energy performance
- Quality
Estate Property Terrier documentation
Building Maintenance Systems output
Investment / Business case documentation (including CIM requirements)
SSDPs where available (Strategic Service Development Plans)

Phase 1 : Understanding Your Estate and the Planning Function

This is the interpretation of the service outputs from the commissioning strategy and the mapping of these to the current estates provision. Any “gap” will be identified together with an assessment of the options to close it. The ultimate end product will be a CIAMS.

Developing a comprehensive Estates Audit (using toolkit provided in document)
- focused on ensuring that Commissioners have a complete picture of the quality, use, location and cost of the estate from which they commission primary and community healthcare services
- the process takes Commissioners through a series of questions about their estates
- the output is the production of a strategic document (‘CIAMS Output Spreadsheet’) - providing the Commissioners with a visual assessment of the level of detail and knowledge held about the estate from which it commissions
- No prescribed format for information and the Estates Audit itself – left to discretion of each PCT

The example CIAMS spreadsheet format

To augment the estate elements, there are a series of checklists and guidance to assist the (services) and capability planning activitites.

For more information
Link

Phase 2 - Implementation of the CIAMS

This involves the development of plans and strategies to ‘close the gap’ and seamlessly integrate commissioning with infrastructure management and investment, so that health care services (delivery) plans are continually renewed.

The Process (toolkit) should be applied to each property from which primary and community services are provided, confirming:

Base Line Information
Fitness for purpose
Finance

CIAMS Data Validity Index

Accepting that information may not be complete, but enabling CIAMS process to be progressed, a data validity index is assigned to each entry:
- Level 1 : likely to require further validation
- Level 2 : some supporting evidence; more detailed evidence may be required
- Level 3 : fully supported / validated

For more information
Link

CIAMS Information Requirements - overview

Note some of the items below are single line entries in the CIAMS spreadsheet – or are not detailed at all - hence no detail regarding completeness of information can be provided using the spreadsheet alone

Base Line Information

Property list – including status
- PCT owned, PCT leased, GP 3rd party, Other 3rd party
- Status (including related legal documentation) – Freehold, Lease and Licences, Town Planning
Location details (geographical)
- Address, premises specific post code, grid reference, co-ordinates
Services provided and service provider
- Commissioned services, provider, days/times of provision
Statutory compliance (owned and leased – if 3rd party, duty of care elements to be reported upon)
- Elements to include (drawing from 6 facet survey if possible)
  - Firecode – Annual Statement of Fire Safety
  - Asbestos Register
  - Legionella checks and risk assessments
  - HASAW Act 1974
  - DDA compliance
  - Reduced CO2 emissions – UK Govt targets
- Documented building maintenance programme
- Cost of compliance
  - Static, rising or falling
Premises utilisation
- Premises utilisation assessment (if available)
- Indication of percentage of rooms occupied within premises opening hours:
  - A - >75%
  - B – 50-75%
  - C - <50%

Fitness for purpose (Property suitability)

Physical condition
- Assessment in last 2 years
- Mechanism/tools employed – e.g. 6 facet survey
- General assessment (use Estatecode definitions where possible)
  - Needs no work
  - Needs minor work
  - Needs major work
  - Not fit for purpose
Functionality
- Confirmation of current functionality
  - Flexible
  - Functional
  - Restrictive
  - Not fit for purpose
  - Enhanced benefits (future potential for enhanced services or site development)
Environmental
- Assessment made (audit completed) of building’s environmental impact?
  - Good corporate citizen assessment
  - BREEAM for Health (B4H)
  - Aedet
  - SMARTWaste (SWMP)
  - Energy Performance Certificates
- Building’s current environmental status
  - Good, average, poor
- Costs associated with maintaining or improving environmental impact in relation to building’s ability to deliver long-term health care services
  - Low, reasonable, high
Quality (of the building with respect to patient experience)
- Patient experience survey(s) completed?
- List of key findings confirmed and action plan implemented?
- Level of actions (challenges) related to the building with respect to patient experience
  - Minimal, reasonable, extensive

Financial Information

Financial information (capital) (references – ERIC data, Capital Investment Manual, IFRS and Estatecode – May 07)
Capital value of (owned) assets
Capital investment required for (owned) assets – next 2 years
- Capital works
- Risk based backlog maintenance
- Statutory compliance
Agreed capital investment programme
Financial information (revenue)
- Full revenue running costs (budget / actual)
  - Incl. FM, utilities, capital charges, business rates
- Leased buildings – reimbursments – incl. clinical waste, water and sewerage, business rates

For more information :

Community Health Partnerships – Publications relating to Transforming Community Services

Department of Health – Estates and Facilities Management – ERIC Reports

NHS – Primary Care Commissioning – Premises documentation and guidance

Department of Health – Knowledge and Information Portal

Primary and Social Care Premises – Planning and Design Guidance – Strategic Service Development Plan