Guidance on the organisation of assessments

The PLACE programme offers a non-technical view of the buildings and non-clinical services provided across all NHS trusts, voluntary, independent, and private healthcare providers. It is based on a visual assessment, not relying on the application of any technical or scientific tools. PLACE should be undertaken from a patient’s perspective, focusing on what matters to them, and only patient areas should be assessed. Assessors will need to exercise a degree of judgement.

Each organisation should have a PLACE programme lead appointed or identified. This individual, with the support of others, is responsible for ensuring the overall delivery of the PLACE programme and for ensuring that the results are submitted to NHS England and that they meet inclusion criteria for completed assessments (found in PLACE summary information). 

All question and section scores submitted within PLACE will contribute to one or more of the 6 relevant PLACE domains:

• cleanliness
• condition, appearance and maintenance
• food and hydration
• privacy, dignity and wellbeing – supportive environments
• dementia – friendly environments
• disability – supportive environments

PLACE is designed to cover all sectors of healthcare including acute, community, mental health and learning disabilities.

All organisations and sites are eligible for inclusion in the programme regardless of size or bed numbers. However, the intention is to restrict inclusion of very small units which clearly do not meet the definition of a hospital.

Therefore, where a unit has fewer than 10 beds, organisations will need to determine, based on their knowledge of the unit and the services provided, whether it could reasonably be classed as a hospital. For example, a 9-bedded unit called ‘XXX Regional Eye Hospital’ would meet the definition of a hospital, but a community-based home where assessment and treatment are not carried out would not. Any unit with 10 or more beds should be included in the assessment programme.

For large sites/organisations, a minimum of 25% of wards or 10, whichever is the greater, should be assessed:

For non-ward areas a minimum of 25% should be included in the assessment. For specific areas such as outpatient departments this will be relatively simple but for less specific areas assessing teams will need to apply a degree of discretion in deciding precisely how much to assess.

In all cases the area assessed should:

• be sufficient to allow the PLACE team to make informed judgements about those parts of the site/organisation it does not visit
• where possible, focus on areas of the site/organisation not included in recent PLACE assessments so that over time all areas will be assessed
• include all buildings/wings of different ages and conditions

Final decisions on which wards or areas of the site/organisation to be assessed should not be made until the day of the assessment and should be a joint decision by all members of the team. Although the staff will have an important role to play in ensuring that the wards or areas chosen are reflective of the range of services and, where appropriate, the buildings and wings that make up the site/organisation.

Additionally, the site/ward staff will have a knowledge of the geography and specifics of their area which should be taken into consideration when planning the schedule and division of work for the visit.

Scores should be based on the conditions seen at the time of the assessment. It is the site’s/organisation’s responsibility to always provide a clean environment, and therefore no allowance should be made for such things as the weather, building works or the next scheduled cleaning, except for those items that are subject to scheduled but infrequent cleaning/maintenance. This includes items such as external windows, ceilings and high-level areas which will have schedules ranging from weekly to quarterly as opposed to a daily cleaning schedule.

The assessment should not be made against how well a site/organisation is doing with what it has, but how well it is doing against the defined criteria and guidance. No allowance should be made for shortcomings that are the product of infrastructural obstacles (such as age or design).

Something being ‘as good as it can be in the circumstances’ is not sufficient reason to award a high score. If there are investment or management implications for the organisation as a result, this is a matter for the organisation to address.

The PLACE assessment applies to all NHS trusts, voluntary, independent, and private healthcare providers. Where there are recognised differences/special considerations that should be considered, these are reflected in the detailed guidance. Other than this, no allowances should be made for the challenges that may face specific units. Such difficulties are not an excuse for less-than-acceptable standards, even if this means that the highest scores cannot be achieved.

Over- or under-scoring benefits no-one as it presents a false picture of the standards being provided. If organisations are to be able to continuously improve, they need to understand their current position.

All assessments will be delivered through self-assessment. The programme opening and closing dates will be advised by NHS England from the [email protected] mailbox.

Organisations will be expected to complete their assessment(s) and submit their data within the opening and closing dates of the collection. It is for the organisation to decide how and when within that period they organise and undertake their assessment(s).

All reports will be submitted through the Estates and Facilities Management information system (EFM) website.

Once the programme dates have been confirmed by NHS England, organisations will be able to organise site assessment dates and put together their teams of patient and staff assessors.

PLACE is intended to be as unannounced as possible to ensure that a true reflection of the site/ area is viewed and to avoid any reactionary issue resolution prior to arrival which might impact the scores.

It is acknowledged that PLACE being completely unannounced is unlikely to be possible in many cases, particularly in mental health and learning disabilities sites, and where ward management/staff needs to provide facilities and support for the visit. However, organisations should give as little notice as possible and should limit the number of staff aware of the full assessment dates to prevent any unintended prior notice.

Organisations should be as flexible as possible in their arrangements so that a diverse range of people have the opportunity to be involved. Other than the requirements around numbers, organisations can choose precisely how their assessments are undertaken, including:

• undertaking the assessment over more than one day: larger sites/organisations may find this particularly useful as it would mean a less intensive process. It may also allow more patient representatives to be involved over the period of the assessment
• splitting assessing teams into several teams: this would allow more of the site/organisation to be seen while at the same time reducing the burden on any individual(s) as well as being less disruptive
• undertaking the assessment during the evening or at weekends (it is reasonable for assessments to continue up to 7pm at night). Patient mealtimes should be protected as far as is possible

It is strongly advisable to begin early engagement with the relevant patient user groups and organisations that you plan to work with to keep them well informed and updated.

Depending on your organisation’s processes for patient/staff assessor training, this might also be a good opportunity to arrange training/update sessions with those organisations/individuals.

It is also good practice to engage early on with staff internal to your organisation that may be required to lead or participate in assessments. You may also want to arrange to meet with those likely to lead teams or assessments to plan and to discuss key updates and changes.

This is also an opportunity to engage with the wider organisation (including relevant contractors) on the upcoming programme through internal and external communication and engagement. Although it is appropriate to share the upcoming programme, specific site assessment dates should not be shared in advance other than with those who it is essential to know.

Engagement with the clinical services who are being assessed is a proactive way to dispel common misunderstandings about the process, help them to understand its value and to help ensure the visit runs smoothly. Guidance for services has been produced separately to support with this.

To support a smooth and well-coordinated PLACE assessment programme it is advisable to undertake the following actions well in advance of commencement:

• review your organisation’s PLACE contact list and update NHS England’s Workforce and Estates Statistics team via [email protected] as required. This will help ensure communication from the centre is shared in an appropriate and timely fashion
• review your organisation’s list of PLACE qualifying sites and update NHS England as required
• review and update key information such as ward and bed numbers which are required to setup site assessments on the system

The following are actions which it is advisable to complete as soon as possible after the PLACE assessment programme dates have been released:

• share relevant PLACE forms and supporting documentation with assessors and stakeholders in advance of the programme so that any questions, queries, or areas of concern can be raised
• consider any site or ward/area specific information you may require for completing key data areas such as the site information section or the organisational questions
• identify or review staff within the sites/wards/areas who should be included in communications relating to PLACE
• enlist the help/support of an independent reviewer, if using one
• pre-book a signoff meeting with whoever is responsible for final submission of PLACE data well in advance of the final submission date

As part of the preparation for the PLACE collection, consideration should be given to using PLACE mobile, which significantly reduces the time taken for administration of the collection. It eliminates the need to enter data from the written assessment forms onto the EFM collection portal, as results are instead input directly during the assessment via mobile devices (such as laptops, tablets or phones).

There is no need for a mobile or Wi-Fi signal as results are stored on the device and can be submitted to EFM once a signal is available. Results should still be reviewed by the assessment team before data is submitted. Further guidance on PLACE mobile is available via the EFM portal (in the “documents” section within the PLACE module).

The assessment applies equally to all healthcare premises and providers. However, in some care environments special considerations need to be applied to reflect the very different ways in which care is organised and delivered. This is particularly the case in mental health and learning disabilities.

Some people stay in mental health or learning disability units for long periods, and the unit effectively becomes their home for that time. The surroundings should reflect this, and the unit should aim to provide an environment that is appropriate to their care but in which individuals feel comfortable and that supports their therapeutic and personal wellbeing. Patient assessors should, as far as possible, reflect the patient population.

Maintaining the environment for care in such settings can also deliver additional challenges, including in many cases the design of buildings/areas and the need to care for people with challenging behaviours. Assessments within these areas should be expected to meet the same standards but certain aspects of the criteria may not be appropriate or may need to be delivered in a different way. Examples of this include handrails not being present where they pose a high ligature risk and Wi-Fi being available only in designated areas.

Where there are specific circumstances that require different guidelines, as far as is possible, this is reflected in the assessment and accompanying guidance. Any additional areas of concern should be discussed and agreed at a team level, likely with information provided by management from the area being assessed.

The precise membership of an assessment team is for local determination, subject to certain requirements (see ‘Patient representation’ below).

A member of the staff should be appointed as the PLACE assessment lead/manager with responsibility for all administrative matters before, during and after the assessment. 

PLACE teams will consist of patient and staff assessors. Either before or at the beginning of the assessment, someone should be identified as the PLACE/team leader for each of the teams participating. The PLACE/team leader may be either a staff or a patient assessor but whoever is nominated, it should be an agreed decision by all members of the team. It is crucial the leader has the full support of other team members as they have a vital role in managing the process and resolving any disputes or disagreements. Should teams split into smaller sub-teams, each sub-team must have a PLACE/team leader.

Final scores are recorded and submitted via the EFM system. Where this is done using PLACE mobile, it should be recorded by a staff member with an EFM account but must abide by patient assessors’ joint decision. If using paper forms to be later transcribed into the system, then the form should be completed by a patient assessor (in agreement with others). 

As well as covering PLACE specific information, any briefing sessions provided on the day of assessment should also include housekeeping (including fire evacuation information, facilities and hand hygiene protocols), break and refreshment information and information on areas not to be assessed (such as safety reasons or closed for project works).

Organisations should have an appropriate mix of staff representation to ensure that they get a comprehensive and balanced view and so that areas of specialist knowledge are considered. A peer review approach should be taken whereby staff should not be assessing the specific ward/area where they work.

Organisations should consider including representation from the following (an individual staff assessor may cover several roles):

• an executive director/director (for example, of estates, nursing, or director of infection prevention and control)
• a representative of the organisation’s estates team
• a hotel services manager/domestic manager
• a catering manager/nutritional lead for the organisation
• a senior nurse
• a member of the infection prevention and control team
• a dementia lead/nurse

Whilst it is valuable to have as many of these areas of expertise covered within assessment teams it is also important to balance this with the size of the team. Particularly in smaller units/wards, teams which are too large can be disruptive and may not be appropriate for some settings. You should ensure that the team size is of the correct level whilst ensuring compliance with the relevant minimum assessor numbers.

A crucial component of the assessment process is the involvement of patient assessors. This term covers all people whose experience of the site/organisation would be as a user rather than as a provider, and so encompasses relatives, carers, friends, patient advocates, volunteers, trust/organisation membership and governors. Organisations can determine locally how patient representation will be made up. However, the entire representation should not be drawn from the board of governors and representation should be balanced.

Existing or recent staff members (that is, who have left the organisation within the previous 2 years), or anyone otherwise connected to the organisation in an official capacity, should not be asked to act as patient assessors on any of the organisation’s sites, even where they may otherwise meet the definition of ‘patient’. However, they may act as a patient assessor for another organisation. 

The number of patient representatives on each team must always be at least equal to the number of staff assessors and as a minimum each team should always have at least 2 patient representatives. When teams break into sub-teams this balance and minimum number must be maintained.

Where, for instance, a patient assessor does not attend and the team is unbalanced, a staff assessor should either be released from participating or should be withdrawn from all aspects of the scoring process. There is no maximum number of patient representatives allowed in a PLACE team.

Where an additional member of staff (for example the ward manager/sister on duty) accompanies the assessing team for their ward or area, this is for observation purposes only and they should not join the team or take part in the scoring.

The exact number of patient representatives you need depends on how you want to organise your assessment. For example, you could use smaller teams or one large one. This also allows the involvement of a wider range of patient assessors, including those who might not be physically fit enough to assess a whole site.

Additional guidance on the recruitment and preparation of patient assessors is available. It is best practice for organisations to:

• provide all patient assessors with feedback post PLACE assessment
• give patients, carers, the public and staff the opportunity to feed into the prioritisation of the PLACE feedback
• formally present the PLACE results and action plan to the Board that includes include timescales and an indication of resources required 
• provide feedback to patient assessors to demonstrate the valuable contribution patient assessors have made to the assessments and the benefits of improvements. Give examples of where their contribution has made a positive difference for patients (such as replacement of chairs in a waiting area or additional options on a menu)
• progress updates from action plan with mid-year reviews (an action plan template will be available with PLACE documentation)
• share completed organisation question forms (food and facilities) with patient assessors 
• enlist support from an independent reviewer

The organisational questions within PLACE covering food and facilities, are to be answered by staff. It is the responsibility of the organisation to determine the required facts to record a score, they do not need to be observed by the assessment team. These questions do not need to be completed on the day of the assessment.

Within the assessment format, there is a patient assessment summary sheet, which is for completion solely by patient assessors. It will be a matter for the patient assessors to decide whether they wish staff to be present at this time. Patient assessors will decide whether they want to complete individual forms or they may wish to complete a consolidated form together.

Patient assessors may choose to complete more than one patient assessment summary sheet (for example, if the assessment has taken place over more than one day, with different assessing teams, both teams may wish to complete a form based on the areas they assessed).

Staff must enter data on to the system exactly as agreed by the patient part of the team regardless of whether they agree/ observed the same things. It is acceptable for staff to challenge patient assessors and discuss their scoring and comments, however, the patient assessors will have the final say. 

PLACE is not a patient survey and PLACE assessors are required, as a team, to reach joint decisions based on what they see on the day of the assessment, considering the guidance provided.

Team members may talk to patients if the patients clearly wish to do so. However, assessors should avoid allowing their judgements on, for example, cleanliness matters to be unduly influenced by individual’s comments since these may be subjective and personal. Assessment teams should use patient feedback to help them come to their own conclusions and they should ask the right types of questions.

In any event, care and consideration should be exercised when approaching patients, and the advice of ward or other staff sought before doing so.

Independent review in the context of PLACE assessments means that an individual with good experience of PLACE attends an assessment at another organisation to observe the process and ensure it is conducted in accordance with the published advice, guidelines and recommendations.

Independent reviewers (validators) do not normally formally take part in the assessment and would not count as either a staff or patient assessor.

Organisations are responsible for arranging their own independent reviewers. The use of independent review is considered best practice, however it is not mandatory. NHS England maintains a list of current independent reviewers, which is available on request at [email protected].

All items included in the assessment framework and present in the area being assessed must be included. However, the notion of sampling is well established, and it is not necessary to look at every item in every area to determine the score to be awarded.

Where there is only one of a specific item (for example, a floor), it should be assessed in full. However, where there are multiples of the same item (for example, beds or over-bed tables), assessing teams should assess enough of each to be able to reach a reasonable judgement on the likely condition of all those items not seen. This should be determined by the assessors at the time, and should follow the simple rule 'Have we seen enough to judge?’

Where the items present a mix of pass, qualified pass and fail, the team will need to assess as many items as necessary until they feel they have seen enough to decide on a score.

Many questions within PLACE require the selection of one of three scoring options, Pass, Qualified Pass and Fail. The Not Applicable (N/A) option should only be selected where the item is not in the area being assessed. For example, if there are no toys on a particular ward, N/A should be selected.

Below are the criteria for each of the selections.

Where a Pass is not appropriate, the team must decide to apply a Qualified Pass or Fail score.

It is not possible to quantify the exact point at which a qualified pass becomes a fail.

Those undertaking the assessment need to exercise judgement; as a guide, to score as a qualified pass, no more than 20% of the items would not meet the guidance descriptions. Teams will therefore need, through discussion, to agree which score to apply where it is obvious that a pass is not appropriate. For example, a small amount of fluff on a floor should not be marked as a fail, but fluff under every bed and/or in every corner would be a fail. Similarly, a small amount of spilled liquid would not be a fail, but any bodily substance fluid (such as blood, faeces or urine) on any surface would constitute a fail regardless of the quantity or frequency. Scores allocated should be based on a fair reflection of the range seen.

Where separate teams assess different areas of the site/organisation, the scores should be agreed by each team. It is recommended that:

• each team score as they go: final scores for each ward or area should be agreed at the end of the assessment of that ward/area before moving to the next. (Note: this does not apply to internal (communal) or external areas, where a single score reflecting all similar areas seen is still required – see below)
• no member of the team should assess any area alone, so that any faults or shortfalls are agreed by at least 2 people
• other areas – for example corridors, lifts, public toilets – can be aggregated for the purpose of agreeing a final score. The score awarded should reflect the standards found across all those seen – this will inevitably require teams to exercise a degree of judgement

There are many questions within PLACE which have Yes/No options or are multiple choice. To ensure accurate scoring, it is essential that N/A is selected only where the item/ area being assessed meets the criteria outlined in the guidance to select that option. In some circumstances the guidance specifically advises the selection of Yes or No to reduce the number of N/A responses. PLACE/team leads should take ownership of ensuring the correct response is provided. Please contact the Workforce and Estates Statistics team at NHS England if there is any doubt by emailing [email protected]. 

When assessing the food provision, teams are asked to score based on a pre-determined list of options (good, acceptable or poor).

One of the most common scoring challenges for teams is differentiating between what is a ‘Cleanliness’ issue and what is a ‘Condition’ issue. If it is the opinion of the team that something could not be removed by normal cleaning processes, then it is ‘Condition’. Where it could be removed through normal cleaning processes then it is ‘Cleanliness’. The key thing is to ensure that you do not mark both sections down for the same thing.

It is the responsibility of each PLACE/team lead to manage the scoring process appropriately to ensure that all parts of the assessment are given enough time for discussion and completion. The PLACE/team lead should ensure that all voices are heard and that all aspects have had sufficient and fair discussion time. They should also be responsible for trying to resolve any disagreements. Where a consensus scoring agreement cannot be reached the lower score should generally be selected and a note made of the lack of consensus.

Teams should only score what they observe (and taste). The PLACE process is about practice and not policy, there should be no speculation on what might happen on another day or time.

Guidance on scoring is included in the assessment forms.

A separate relevant assessment form must be completed for each ward/ area, outpatient area (except where all outpatient areas are served by a single reception/waiting area, where a single form may be completed) and emergency department or minor injuries unit.

A single assessment form for internal (communal) and external areas should be completed, with the scores being agreed by the assessors to reflect the totality of areas seen (for example corridors) or a specific team being asked to assess those areas alone. A communal area form may not be relevant for single ward sites (such as independent rehabilitation/community units) where no internal areas are shared. However, if there are waiting areas, corridors or lifts, a communal area form should be completed.

A ward food assessment form should be completed for each food service provision sampled, in line with the minimum number of assessments required (see Food and hydration assessment section). Food items should be scored individually, including side dishes and desserts (such as chicken curry, carrots, plain rice, apple crumble). It is best practice to sample the maximum number of items if available, to promote consistency in scoring.

The Organisational questions forms need to be completed for each site, although as noted earlier in this guidance this does not need to happen on the day of the assessment.

To make the process easier, the forms may be completed by exception during the assessment (that is, do not record a pass, only entering a mark on the form where a qualified pass, fail or not applicable response needs to be recorded). If using PLACE mobile to record scores, all responses will need to be recorded.

Each organisation must decide for itself the levels of service (for example, choice) it wishes to provide, but these decisions will inevitably be reflected in the outcome of the assessment. Clear criteria allow organisations to plan service developments, but do not compel them to do so.

Those questions which are for answer by the assessing team can only be answered through observation, tasting and occasionally asking patients.

The food assessment form outlines the minimum and maximum number of food items that should be sampled on each relevant ward. It is important that this is complied with to provide a fair reflection of what is tasted. It is recommended that organisations score the maximum number of items to ensure consistency of scoring. 

Teams should base their scoring on what is observed and said rather than relying on statements of policy or assertions of what usually happens. If something does not happen on the day of the assessment, this must be reflected in the assessment regardless of what policies or practices may be in place.

In order that assessors can observe and accurately reflect their experience on the day, organisations should make every effort to ensure assessors can do the following:

• undertake the assessment on the ward, from the same food as provided to patients. The practice of sampling food in a separate area with food specifically provided to assessors is not acceptable
• if possible, assess both the lunchtime and evening meal services to obtain a rounded view and to improve the accuracy of the assessment. It is recognised that this may not be feasible in small units; however, in large hospitals or sites where there are multiple sub-buildings it should be possible to ensure that different mealtimes are assessed
• taste food at the end of the patient meal service to ensure that temperatures have been maintained at an acceptable level for the last patient to be served. Assessors should take into account any time delay between final service and their sampling
• wherever possible, taste all meals on offer rather than only a selection. Not everyone in the team must try everything, but at least 2 people should taste any single item, so the score is not based on a single individuals’ view. Items tried only by one person should not be scored
• watch how food is served to check for the care taken in presentation
• observe how staff are involved in the meal service and how they provide help for those patients who require it

At no stage of the food assessment should team members watch patients eat or in any other way disturb them while they are eating. Any questions should not be asked until their meal is finished.

It is also important that assessors, as far as possible, overcome their own likes and dislikes and remain objective. Where an individual has a particular dislike for specific foods, they should avoid assessing them. This can be an issue with spicy foods, where personal tolerance for example, levels of heat, can widely vary. Additionally, it can be challenging where salt is reduced based on a process of ‘adding to own taste’ for health reasons. In these instances, it may be helpful to seek the views of patients.

The food assessment should also, where appropriate, be undertaken on more than one ward/area, and the organisation of the assessment day should take this into account. The total number of wards/areas where food is assessed is for organisations to determine, but should follow the following minimums:

Where for any reason the food delivery model varies between wards/areas, assessing teams should try to ensure that each type is assessed, though this may not always be practical/possible.

Where patient food is bought or cooked by the patients, there is no need to undertake an assessment of food service. In this situation, organisations should select the ‘self- catering’ option. However, this option should only be selected where all patients are provided with food this way. Where there is a mix of self-catering and other in an organisation, assessment should be undertaken for services provided by the site/organisation.

In some circumstances it may be deemed inappropriate to assess the food service, for instance in eating disorders units, in this case approval to not assess should be sought from NHS England. If there are other circumstances where it is not clear whether an assessment should be undertaken then contact NHS England for advice at [email protected]. 

The dementia assessment should be completed for all sites/ward/departments except where the organisation can confidently state that patients with dementia will not be present in the department/area being assessed. Examples of such departments/areas include:

• maternity services
• paediatric/ children’s services
• some mental health and learning disability settings
• young people/ adolescent services

However, organisations should assume that unless such persons are specifically excluded in line with the above, the assessment should be undertaken bearing in mind that a diagnosis of dementia may not have been made.

Many organisations continue to undertake PLACE-Lite assessments across qualifying sites throughout the year, either covering all assessment aspects or certain areas of the criteria. Although this is not a specific requirement it is advisable to undertake PLACE-Lite visits to sites in advance of the formal assessment programme. This is to ensure ongoing standards and to review action progress and resolutions from the previous year’s programme if required.

Prior to the commencement of the years PLACE programme, you should have reviewed any action plans from the previous year to ensure that all relevant actions have been completed or an update position can be provided to assessment teams if requested.

Please refer to the PLACE-Lite guidance for more information.

The PLACE process should not interfere with patient care or disrupt service delivery. To a certain degree the presence of an assessment team will cause unavoidable challenges in many settings, but its impact should be minimised as much as possible. Assessment teams should ensure that they always help to maintain the confidentiality and privacy of the patients.

Discussions between PLACE team members should be of a discreet nature and either permission should be sought before entering bedrooms or a site/ ward staff chaperone should make this decision.

Any team member who has concerns about the conduct of an assessment and is not able to resolve such concerns with the lead assessor or PLACE lead may contact [email protected] to express any concerns. In such cases, NHS England reserves the right to require a fresh assessment.

PLACE scores and results are published by NHS England on a date advised in advance. 

Prior to this release date all scores (provisional or validated) are classed as “Pre-release information” under the Pre-release Access to Official Statistics Order and as such are restricted, and therefore should not be shared externally to your organisation. Internal sharing must be controlled to reduce any risk of the information getting into the public domain before finalisation. Full details of your responsibilities with respect to pre-release data can be found in the “EFM Terms and Conditions” document, which you can download within the PLACE module of the EFM system (user account required).

The results of the assessments are used by the Care Quality Commission, in their intelligent monitoring to support regulation of services to ensure they meet fundamental standards of quality and safety. Other organisations such as NHS Choices use PLACE data on food and cleanliness on their My NHS pages to rate services nationally. The results are published annually by NHS England. 

The PLACE process requires organisations to respond formally to their assessments and develop a plan for improvement. Results should be shared across the organisation, and it is recommended these are also published on external websites as well as internal intranets. Action plans should be developed for PLACE to help address issues and areas for improvement.

It is also recommended that organisations share PLACE scores and updates as appropriate with patient assessors and relevant patient organisations.

It is up to individual organisations to determine timeframes for rectifying issues identified during PLACE and this should take into consideration the severity of the issue and what is a reasonable response. Often timeframes for rectification will correlate with existing internal processes (such as maintenance actions linked to normal response times for maintenance jobs). It is important to acknowledge that more complex and widespread actions will take longer to rectify and may be part of a wider organisational plan.