Part 11: Shared Services: Soft Facilities Management
ABOUT THE PROGRAMME
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The Shared Services Programme is part of NHSScotland's long-standing commitment to the people of Scotland to ensure that our quality services are good value for money.
The purpose of the Strategic Review of Soft Facilities Management is to take stock of how facilities management (FM) is being delivered across NHSScotland in different NHS Board areas. It will also look to find out if there are better ways that the NHS can provide these services.
The State of the NHSScotland Estate (2012) identified the need for 'a full and comprehensive NHSScotland wide strategic review of the basic systems and processes within Soft FM to ensure they remain effective and efficient. In particular there is a need to assess the potential for utilising relevant technological innovations to improve service effectiveness and efficiency'.
Review all soft facilities management services across NHSScotland to see how the current service works and look at options to improve patient safety, efficiency and user satisfaction. The specific objectives are:
- The programme will complete a strategic review of soft FM services across NHSScotland, including an assessment and prioritisation of potential service improvement opportunities.
- The Strategic Review will be presented to the NHSScotland Efficiency Portfolio Board and the Chief Executives' Group in order to consider, approve, and prioritise the potential service improvement opportunities for project initiation.
- Linen and laundry
service improvement opportunities
Introduction of a range of standard meal delivery systems
Introduction of standard patient menus
Introduction of a standard meal ordering and stock control system
Introduction of NHS-run bakeries and Aroma cafe
Re-provision of catering production units
Introduction of policies for the standarisations of linen, theatre drapes, blinds, curtains and bed screens
Introduction of a national contract for purchase, repair and maintainence of laundry equipment
Re-provision of laundry production units
Introduction of standardised floor cleaning equpment and material
Recommendation of how the Portering role should adapt in order to support changing clinical serives
Introduction of a standardised tracking system
Re-provision of mailroom services
Introduction of standardised private sector lease return rates
Introduction of NHS-run retail outlets
Catering reviews for each NHS Board are currently being completed by a catering expert, who has worked within the NHS environment in a number of locations. The reviews are identifying current service levels and costs for both patient catering and non-patient catering. These reviews are being conducted on a Board-by-Board rolling programme and will also identify cost savings and efficiencies.
Catering reviews have now been completed in all NHS Boards with the exception of NHS Greater Glasgow and Clyde, NHS Forth Valley, The State Hospital, National Waiting Times Centre Board and NHS National Services Scotland. Although there is significant variation in the cost of patient meals, food and labour, across NHSScotland, the initial findings have also shown a high standard in the quality of food and service.
After the first few catering reviews had taken place, it became clear that the services have been looking for a support tool to aid the efficient running of departments. Funding was approved for the initial two pilots of a Catering Information System - one in NHS Borders and one in NHS Fife. These pilots have now been running for several months and are already showing an impact in service improvements and efficiency gains, such as reduction in food waste and stock holding.
Features of the system include:
- An easy to use management tool that allows full analysis of all catering data
- Bespoke to each site
- Focuses on improving quality while reducing cost
- Mentoring and support for catering managers
- Prioritisation of the national service improvement opportunities across NHSScotland Catering, Domestic, Laundry, Portering and Retail services. Following approval, these prioritised opportunities will be progressed as part of the Programme during 2014-15.
- Further rollout of the Catering Information System and associated patient ordering system across NHSScotland
Programme Case Study
Catering Information System
Background and context
The Strategic Review of Soft Facilities Management (FM) Programme was initiated in November 2012 as part of the Facilities Shared Services Workstream within the Efficiency and Productivity Portfolio and encompasses the following services:
- Linen and Laundry
As part of the first phase during 2013-14, the Programme set out to assess the current service provision across NHSScotland and evaluate potential service improvement opportunities which would identify the priority projects for the second phase of the Programme.
Board-specific catering reviews were conducted as part of the programme during 2013-14. Emerging findings from some of the early reviews indicated that a number of services were operating below their potential because of significant inefficiencies and wastage. This was partly driven by the lack of access Catering Managers have to timely and accurate service data which would allow them to make informed decisions and take appropriate management action in order to drive out waste and reduce costs whilst improving the quality and consistency of services.
Within NHS Fife there was a generic IT system with limited ability but no dedicated catering
IT system in place to capture all of the below items:
- Meal production numbers
- Production wastage and costs
- Stock control management
- Retail pricing, sales and margins
There was also a substantial non-patient subsidy.
To test the implementation of a Catering Information System (CIS) which would provide timely service data to the catering management in order to support cost and waste reduction decisions without negatively affecting the patient experience and quality of service.
A bespoke Excel-based CIS was introduced to Queen Margaret Hospital (QMH) in Dunfermline. This enabled the local Catering Management Team to have instant access to review data including:
- Stock holding and consumption
- Meal production numbers for QMH
- Purchasing data
- Non-patient retail operations
- Production wastage
The data produced by the CIS allowed the Catering Team to review all aspects of production/purchasing and stock holding, and also to review retail items that offered the best margin and produce a profit and loss account for non-patient catering.
A more efficient and productive catering service at QMH helps the service to be more consistent in meeting patient meal needs and requirements.
"We introduced the Catering Information System at Queen Margaret Hospital, Dunfermline in September 2013. We use the system daily to track all our revenues, costs and wastage. With all information being linked and stored together it is very user friendly and gives you up to date information at the touch of a button. With our wastage being recorded we can show a significant drop in our overall waste which is easily monitored and recorded" Saffron Moir, Assistant Catering Manager, NHS Fife.
Within the production kitchen at QMH timely information for production has encouraged competition between cooks to aim for "spot-on" production.
The CIS has helped to decrease the management, storekeeper and clerical time and effort involved in stock management.
Efficiency savings and productive gains
A total of £40,000 was saved within a year following an investment of £10,400 in the pilot system - a return on investment of 4:1. This specifically includes:
- A reduction in waste of £5,000
- Gross profit margin increase of £10,000
- Resource release saving of £20,000
- Service demand production accuracy - saving of £5,000
Moving the system from Excel to a web-based format and linking it to an existing Health Facilities Scotland platform will support benchmarking and further embed the use of the system into NHSScotland catering management practices.
Sustaining the use of the system and ensuring the full range of the applications and reports are used by catering management requires training, mentoring and support in collecting and entering data, running reports and analysing the results in order to take corrective action.
In the course of 2013-14 the pilot was also extended to NHS Borders, NHS Lanarkshire, NHS Tayside, NHS Shetland and NHS Orkney, with these NHS Boards now spreading the use of system and beginning to realise associated benefits.
The Catering Information System project, to be taken forward as part of the Programme and subject to tendering and funding, will encompass the move from Excel to a web-based platform and further development in Bedside Electronic Patient Meal Ordering.
NHS Board Case Study
Improving Efficiency and Reducing Cost in Laundry Services
Background and context
NHS Orkney has an ongoing requirement to make efficiency savings, with all departments contributing to achieving the NHS Board's savings target. Within the estates and facilities department there was an awareness of the national review of soft services and the need for all NHS Boards to explore opportunities for new ways of working, using partnership arrangements where appropriate to improve quality and reduce cost.
A review of NHS Orkney's performance against benchmarking data highlighted that laundry costs were much in excess of national averages (more than double at one stage at £1.46 per item). It was recognised that there were issues with the remoteness of Orkney and travel challenges which meant a partnership solution would not be ideal. However, there was a need to ensure learning and best practice from other NHS Board areas was used to support the roll out of improvements in the laundry operations which brought the cost per item in line with national averages.
To reduce laundry costs per item to in line with national averages by March 2014.
The national benchmarking strategy was used as a means of understanding exactly how much we were spending to process each and every individual item of laundry. When labour, utilities, high cost of oil and steam generation etc were all considered the per item cost was in excess of £1 against an approximate cost of £0.50 per item nationally.
We then considered the soft services review, consulted with the national soft services lead and obtained advice from the assistant director at Health Facilities Scotland and concluded that biggest single expenditure in the laundry was the processing of staff uniforms, resulting in 33 per cent of the annual laundry throughput.
In line with national trends we created a business case outlining the expenditure and the efficiencies that could be made. The business case also highlighted the risks and mitigation that would be required to manage these risks as well as any remaining residual risk. Through the Corporate Management Team and Area Partnership Forum we were able to outline the existing pattern of expenditure and the case for reviewing the practice of laundering of staff uniforms.
Assurances were given to laundry staff that there would not be any redundancies as a result of the change however they may be offered the opportunity to evolve into other roles.
The process was supported by a significant piece of internal communications work which outlined the rationale for the change to staff and gave them the opportunity to contribute to discussions. The change in practice was perceived as the removal of staff benefit by some but was in general widely accepted as an appropriate way forward, particularly in light of the current financial climate and practice elsewhere.
In addition to ceasing to launder staff uniforms it was recommended within the business case that the use of sleep knit sheets be introduced within the Balfour Hospital. This was supported on the basis that the change would enable the achievement of laundry efficiencies as well as lowering carbon emissions, water usage, transportation and movement by porters and wear and tear on machinery.
The project has evidenced a number of successes - in the majority financial and linked to a reduction in carbon emissions, however it has also displayed fundamental success in introducing changes in line with national trends in a remote and rural location.
In relation to the introduction of sleep knit sheets, staff feedback has confirmed that the material is easier to handle and more efficient in terms of manual handling. Feedback from patients has also been very favourable.
With regards to the laundering of staff uniforms, this change has been implemented fully and is now contributing to a much reduced per item laundry cost as outlined below.
Efficiency savings and productive gains
Through the implementation of sleep knit we have seen a reduction in the amount of porter time associated with the moving and handling of bedding as well as a reduction in the capacity of work for the laundry staff and storage space at a ward level. We have also been able to remove inefficiencies associated with the folding of sheets, putting them into a trolley, moving the trolley, unloading the sheets, and using as needed. We have also been able to reduce the number of loads going through the laundry as more of the sleep knit sheets go in a machine than the older, bulkier bedding.
With regards to the laundering of staff uniforms we have been able to reduce the volume of activity in the laundry by 33 per cent per annum as a result of ceasing this practice. This coupled with our move to sleep knit sheets has reduced our price per item laundered to £0.37.
No issues foreseen - both practices are readily sustained within existing operations.
From a NHS Orkney perspective, the importance of understanding existing practice and being able to benchmark appropriately with others to highlight areas for challenge has been recognised through this project. Having the soft service review and strategy to inform our thinking was extremely helpful in this regard.
Communication with all stakeholders, securing the support of relevant committees and ensuring there was robust evidence to support the rationale for change was central to the success of this improvement project. Additionally, having strong project leadership with a clear vision and aim was fundamental along with a willingness to challenge the status quo in order to achieve improvements.