Staff across NHS Estates and Facilities Management (EFM) teams know the problem too well: there’s simply not enough time. In the first round of my Delphi study, participants identified barriers to knowledge sharing across Trusts, and lack of time emerged as the single biggest constraint. It’s not just about busyness, it’s about the maths of work and workforce.
More than three-quarters of respondents agreed that EFM departments lack appropriate staffing numbers. Heads of EFM, who carry responsibility for recruitment and retention, voiced this concern most strongly. Recruitment challenges were repeatedly cited as the root cause, with one Director describing the situation as “a continued challenge, hampered by AfC [Agenda for Change]”, highlighting how NHS pay scales leave Trusts struggling to compete with private sector salaries.
This chart shows widespread agreement across all EFM job levels that recruitment challenges and inadequate staffing are major barriers, with Heads of EFM showing the strongest consensus at 91% for both issues.
COVID-19 laid bare the vulnerabilities created by chronic understaffing. One Trust saw up to 30% of EFM staff shielding or self-isolating, exposing the critical shortage of skilled Authorised Persons (APs). As one participant explained: "there aren't enough APs [...] with days in sickness, particularly during COVID, we were really struggling".
The human cost became starkly apparent. An AP described being "one of only two medical gas APs at the time", while a Head of Estates echoed the sentiment: "everybody is massively busy and understaffed". Staff found themselves working "12-hour shifts through the night, making sure the VIE could cope with the demand". Even Directors stepped into operational roles to fill critical gaps.
These operational challenges align with HSIB findings that described a situation where critical patient safety alerts went unidentified because "one of the Trust's authorised persons was on leave awaiting a planned operation and the other had been admitted to hospital with COVID-19".
Beyond operational disruption, staffing shortages took a severe toll on staff wellbeing. One AP captured the emotional exhaustion: "COVID has been difficult. [...] you start to feel burnout". EFM teams faced physical strain from wearing extensive personal protective equipment - "gowns, goggles, FFP3 masks, and gloves" - while working on the wards. Another described the shock of facing death in the course of engineering duties: “We had to change an oxygen terminal next to a COVID patient in need of oxygen… death isn’t part of our job… for us, it wasn’t expected.”
Think of hospital estates work as an equation:
Right now, that balance is breaking. Budget cuts and workforce demographics mean Y is steadily shrinking. At the same time, post-Grenfell compliance pressures and increasingly complex engineering challenges - net zero targets, climate change impacts, and the demands of an ageing population - are pushing X ever higher. The result? Z grows disproportionately larger, leaving staff overstretched, exactly as reported in the Delphi study and witnessed across the case studies.
For staff to meet this crisis, they need help managing the ever-increasing Z. Recruitment remains essential, but it is not enough on its own. NHS Trusts need tools that can give existing teams more capacity by cutting wasted effort, streamlining processes, and putting critical knowledge instantly in their hands.
This is where INNEX comes in: designed to ease the pressure on an overstretched workforce by helping them manage the rising workload with efficiency and clarity. When every minute matters, support systems like this are not optional - they are essential for keeping hospitals resilient and staff protected from burnout.
Want to dig into the details? Read the full thesis here.