This paper discusses the application of the balanced score-card (BSC) concept as a widely used management framework for optimal measurement of organisational performance within NHS facilities directorates and discusses the fundamental points to cover in its implementation. Thereby, the paper identifies this framework as a strategic measurement and management system for facilities management. BSC formulation within NHS estates and facilities is described as a case study based on a facilities directorate situated in the north west of England, and discussion covers its implementation procedures, evaluation standards and reporting process. The paper further establishes the conceptual framework for performance management for the facilities directorate, as well as consistent techniques useful in undertaking the performance management administration and system oversight functions.