Annual State of NHSScotland Assets and Facilities Report for 2013

Annex G: Strategic Review of Soft Facilities Management Services

Introduction

Facilities Management (FM) is a multidisciplinary range of services, in conjunction with Estates, which combine NHS assets, staff resources and activities in order to support clinical services, maintain a safe environment and add value to the patient experience. Within NHS Scotland, Soft Facilities Management encompasses the following services;

• Catering
• Laundry & Linen
• Domestic
• Portering & Security
• Transport
• Retail

Soft FM services across NHS Scotland are now large and complex, comprising a mix of in-house departments and teams, specialist contractors and consortia. Staff members require a range of skills and knowledge with training and professional qualifications, often co-ordinated by NHS Education for Scotland and supported by FM institutes or associations.

Soft FM services can have a significant impact on patient experience, and like clinical services, face the same challenges of improving productivity whilst maintaining and improving the quality of service.

NHS Scotland Strategic Context

The Healthcare Quality Strategy for NHS Scotland (May 2010) identifies how NHS Scotland contributes to the wider purpose of the Scottish Government, developing three Quality ambitions presented in Figure 1.

Figure 1 - NHS Scotland Quality Ambitions

The Scottish Government's 20-20 Vision - Achieving Sustainable Quality in Scotland's Healthcare (September 2011) is clear, "that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting". This strategic narrative builds on the Quality Strategy acknowledging that whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions.

Within the public sector financial context, the Scottish Government Efficiency and Productivity: Framework for SR10 (February 2011) outlines the need to continuously improve the quality of services and simultaneously improve productivity. The Quality and Efficiency Support Team (QuEST) is working with NHS Boards to provide a national approach to the efficiency and productivity agenda. Estates and Facilities Management is identified under the Shared Services Workstream within the Efficiency and Productivity Portfolio.

With the background set out above, the State of the NHS Scotland Estate 2011 (February 2012) identified the need for, "a full and comprehensive NHS Scotland wide strategic review of the basic systems and processes within Soft FM to ensure they remain effective and efficient".

The Strategic Review of Soft FM

The Programme will complete a strategic review of Soft FM services across NHS Scotland, including an assessment and prioritisation of potential service improvement opportunities by the spring of 2014.

The services that will be covered as part of this review include;

• Catering
• Laundry & Linen
• Domestic
• Portering & Security
• Retail

Transport will not be included in the Strategic Review of Soft FM as it is within the scope of the Facilities Shared Services Programme, although some areas of transport and logistics may be considered.

The Strategic Review will be presented to the NHS Scotland Efficiency Portfolio Board and the Chief Executives' Group in order to consider, approve and prioritise potential service improvement opportunities for project initiation by the summer of 2014.

Progress

A brainstorming event for the Strategic Review was held in January 2013 which gave NHS facilities staff from across NHS Scotland the opportunity to take an active role in the Strategic Direction for Soft FM services, challenge current thinking and suggest service improvements/efficiencies to any service covered by the review.

From the event, over 150 proposals and ideas were generated which were then categorised into short (up to 18 months), medium (18 months to 4 years) and long term (over 4 years) timescales under the appropriate service. These proposals were assessed by members of the relevant NHS Health Facilities Scotland Technical Advisory Groups before a subgroup of the Health Facilities Scotland Strategic Facilities Group shortlisted 25 of the proposals and ideas that would be assessed as part of the Strategic Review. The other proposals and ideas were assessed as either; hold and revisit later, refer to the appropriate Technical Advisory Group for progression or not to be taken forward as part of the Soft FM Review.

Current work being undertaken as part of the Soft FM Review

Catering Services Review

A review of the catering provision to patient and non-patient is being undertaken to identify the actual cost of both of these services and detail potential efficiencies or improved income opportunities.

Each Health Board will receive a report highlighting their complete catering operation and findings from these reviews will be utilised in the Strategic Review of Soft Facilities. This review across NHS Scotland is anticipated to be completed by the autumn of 2013.

NHS Greater Glasgow & Clyde has undertaken significant work to reduce subsidies on non-patient catering commencing in 2009/10. They have converted a sizable subsidy to a small surplus situation as at March 2013. This has involved close working with Partnership colleagues to review the non-patient catering service provided. Greater Glasgow and Clyde have also introduced 11 Aroma outlets (see retail section below) across their health board's area.

An initial assessment indicates that 10 Health Boards have strategic plans for their catering services, with 4 Boards considering new catering facilities, 8 considering upgrades and 3 planning new food production system changes.

Laundry / Linen Services

A data gathering process, which commenced in the spring of 2013, has collected cost, production and income data in a universal way so that actual costs of processing items can be identified and compared across NHS Scotland. This should allow the identification of the production laundries which operate on a more efficient basis and highlight best practice for nationwide rollout.

An initial assessment indicates that 6 Health Board have a Laundry Strategy or contract in place, 5 Boards have recently considered regionalising or sharing services within the last 12 months and 6 have capital commitments for Laundry Production sites over the next 3 years.

NHS Fife has recently replaced major elements of laundry equipment which has significantly improved production, product finish, energy efficiency and carbon performance.

Domestic Services

Health Board returns have indicated that 5 Health Boards have recently or are considering major change to Domestic Services and 6 Boards are considering the introduction or trialling of new cleaning technologies.

Portering

Recent Board responses have indicated that at least 2 Health Boards are considering the introduction of a tracking and automated dispatch system to improve internal operations and maximise the efficiency of the portering service. NHS Fife has recently approved, and is now tendering for the procurement of such a system. 4 Boards are also planning significant portering service changes and the introduction of new technologies.

Retail

NHS Scotland has introduced branded coffee/dining outlets across a number of high footfall sites to maximise potential income and reduce subsidies for non-patient catering. The Aroma brand was launched in 2009 and is now operating in 15 units across NHS Scotland. Additionally 9 Scottish Health Boards and a number of NHS England sites are considering the introduction of the Aroma brand to maximise income from these locations.

Next Steps

Service specific review groups will be formed and tasked to complete a baseline of current service provision by analysing existing FMS Benchmarking Returns, Cost Book analysis and other relevant sources of information.

Assessments of service improvement opportunities will also be completed by service specific review groups utilising existing evidence bases and stakeholder engagement.

The prioritisation of service improvement opportunities identified in the review will be completed by ranking according to financial and non-financial scoring criteria. This ranking will then support the consideration, approval and prioritisation of projects for initiation by the Assets and Facilities Management Programme Board, Efficiency Portfolio Board and Chief Executives' Group.

Following approval from the Chief Executives' Group, the programme will initiate service-specific projects in order to deliver the opportunities and benefits prioritised in the Strategic Review.