This section of the report reviews asset and facilities services performance across NHSScotland with the aim of gaining an insight into where opportunities lie for improving performance.
4.1 The National Asset and Facilities Performance Framework
The National Asset and Facilities Performance Framework provides an essential link between asset and facilities services performance and patient needs as defined in the NHSScotland Quality Strategy's three Quality Ambitions. Since introducing the Performance Framework in the 2011 State of the NHSScotland Estate Report further work has been undertaken to align the Framework with the outcome measures for the Quality Strategy developed by the NHSScotland Quality Measures Technical Group. The diagram below shows the relationship between the Quality Strategy and the National Asset and Facilities Services Performance Framework.
The Framework provides targets for improvement in asset and facilities services performance by 2020 and uses 23 key performance indicators to monitor year on year progress towards the achievement of these targets.
The National Asset and Facilities Performance Framework for 2012 is shown overleaf.
A separate Performance Framework has been now been developed for office accommodation and data to populate this will be collected and included in the 2013 State of the NHSScotland Assets and Facilities Report.
|NHSScotland National Asset & Facilities Performance Framework|
|Quality Ambition||Performance Measure||KPI No||Key Performance Indicator||2020 Performance Target||Current 2012 Performance|
|Patient Centred||Quality of physical environment||1||Percentage of properties categorised as either A or B for Physical Condition facet of estate appraisals||90%||71%|
|2||Percentage of properties categorised as either A or B for Quality facet of estate appraisals||90%||61%|
|Patient opinion of healthcare accommodation||3||Positive response to Patient Questionnaire on patient rating of hospital environment||95%||83%|
|Patient needs are accommodated in modern, well designed facilities||4||Percentage of properties less than 50 years old||70%||73%|
|PAMS reflective of service needs and patient preferences||5||PAMS Quality Checklist Overall Score (max score 100)||95||60|
|Safe||Statutory compliance status of property asset base||6||Overall percentage compliance score from SCART||95%||68%|
|Backlog maintenance expenditure requirement||7||Cost per square metre for backlog maintenance||£100||£215|
|Level of risk associated with outstanding backlog maintenance requirement||8||Significant and high risk backlog maintenance as percentage of total backlog expenditure requirement||10%||45%|
|Effective & Efficient||Estate Functionally suitability||9||Percentage of properties categorised as either A or B for Functional Suitability facet of estate appraisal||90%||65%|
|Estate Utilisation(from Property Appraisals)||10||Percentage of properties categorised as 'Fully Utilised' for space utilisation facet of estate appraisals||90%||75%|
|Estate Utilisation (from Cost Book)||11||Building Volume 100 cu.m per Consumer Week (from Cost Book)||0.10||0.11|
|Cleaning||12||Cleaning Costs £ per 100 cu.m (from Cost Book)||893||992|
|Property maintenance||13||Property maintenance costs £ per 100 cu.m (from Cost Book)||846||965|
|PFI - Facilities Management||14||PFI - Facilities Management Costs £ per 100 cu.m (from Cost Book)||775||861|
|Energy consumption||15||Energy Costs £ per 100 cu.m (from Cost Book)||551||612|
|Rent & rates||16||Rent & Rates Costs £ per 100 cu.m (from Cost Book)||459||511|
|Catering||17||Catering Cost £ per consumer week (from Cost Book)||68||77|
|Portering||18||Portering Costs £ per consumer week (from Cost Book)||40||45|
|Laundry & Linen||19||Laundry & Linen Cost £ per consumer week (from Cost Book)||27||33|
|Waste||20||Waste Cost £ per consumer week (from Cost Book)||7||10|
|Vehicles||21||To be confirmed||0||0|
|Medical Equipment||22||To be confirmed||0||0|
|IM&T infrastructure and equipment||23||To be confirmed||0||0|
(1) The "Current Performance 2012" for KPI Nos 12 to 20 inclusive is based on the 2011 Cost Book information
(2) KPI No 15 - Energy costs have increased significantly in recent years and are projected to increase further through to 2020. These price increases are beyond the control of NHSS Boards, therefore it will be necessary to adjust this KPI each year to take account of energy price rises.
4.1.1 Change in Framework KPIs - 2011 to 2012
A key objective of this report is to monitor year on year change in asset and facilities services performance to ensure that NHSScotland is progressing towards achievement of the 2020 targets in the National Asset Performance Framework. The table below shows the performance change between 2011 and 2012.
Note: KPI No 15 for 2011 has been adjusted to take account of the increase in energy prices over the year which is out of the control of Boards. This adjustment enables year on year comparison of energy consumption rather than energy cost. Annex C of this report proposes additional KPIs which enable energy consumption to be measured rather than energy cost.
4.1.2 Review of Performance Framework KPIs
The table on the previous page shows that performance change between 2011 and 2012 has been mixed with 11 of the KPIs showing improved performance and 8 showing deterioration in performance.
Notwithstanding the continued issues on information quality, the results from the review of changes between 2011 and 2012 on the Performance Framework KPIs raise a number of issues that Boards need to address:
- The improvements in property condition, age and functional suitability appear to be inconsistent with the deterioration in performance in the quality facet KPI (No 2). However, this is likely to be primarily as a result of significant re-appraisal of the condition of property assets, including verification of historical data over the last year. The process of re-appraisal and verification of property information is ongoing and further improvements in the quality and consistency of information are expected as the EAMS system becomes fully operational over the next year.
- The 12% reduction in the overall SCART score (KPI No 6) is most likely due to a change in methodology over the year. Last year's figure was computed centrally whereas this year Board's have produced the scores and therefore, more accurately reflecting local issues.
- Both KPIs relating to estate utilisation (Nos 10 and 11) indicate deterioration in performance. This is concerning since many of the asset ownership and facilities services costs are primarily driven by estate size. Given the continuing trends in clinical practice, particularly less hospitalisation and increasing care at home, the overall size of the estate can be expected to reduce but the information available from the Cost Book does not show evidence of this expected trend. Furthermore, as shown earlier in this report the acute hospital estate has increased in size over the last decade. Boards will need to rigorously examine the current performance in relation to space utilisation since any space that is not fully utilised represents an opportunity to make better use of assets and improve efficiency.
- PFI - Facilities Management (FM) costs (KPI No 14) show an increase between 2011 and 2012 of 7%. However, interrogation of these PFI costs suggest that the information submitted to the Cost Book may not have been collated in a consistent way and further work is needed to be confident that these costs represent only the Facilities Management element of the total PFI unitary charge. Furthermore, it is also evident that the various PFI contracts held by NHS Boards provide different ranges of FM services and therefore, the PFI costs may not be directly comparable. Over the next year Health Facilities Scotland working closely with the Scottish Futures Trust will undertake a detailed examination of current PPP/PFI contracts and their management. Best practice will be identified and shared. Annex E provides details of the review of PFI contracts.
- Portering and Laundry and Linen costs (KPI Nos 18 and 19) show increased unit costs over the year and by amounts in excess of inflation. A Review of Soft FM Services is currently being undertaken. The review is expected to identify opportunities for improving the efficiency of these services. Annex H provides more detail on the Soft FM Review.
- Waste costs (KPI No 20) appear to have risen sharply (25%). However, this is the first time that Waste has been reported in the Performance Framework and this result has most likely arisen as a result of the terminology and definitions used in the Cost Book no longer reflecting current waste practice. Furthermore, the data in the Cost Book is not consistent with that reported in eMART. Accordingly, recommendations will be made to update the 2012 Cost Book waste parameters in line with the Health Facilities Scotland Waste Management Steering Group report of September 2011. This will result in a common set of waste data reporting parameters and their appropriate descriptors, i.e. standardised definitions and calculation methods to allow comparable data on waste to be collected and presented in a consistent way. It should also be recognised that there has been some price and demand volatility in relation to waste in recent years which is outside of the control of Boards. Annex D provides a detailed commentary on a number of topical issues relating to Waste.
- Both the Cost Book and eMART show reductions in year on year energy consumption. However, energy prices are expected to continue to rise and are beyond the control of Boards. Therefore, there is a need for Boards to continue the good work that has resulted in the year on year reductions in energy consumption and to continue to rigorously pursue further reductions in order to mitigate the impact on NHSScotland of a potential doubling of future energy cost over the period to 2020. Annex C of this report provides a detailed review of NHSScotland's energy performance .
- Improved performance on physical condition (KPI No 1), building age (KPI No 4), functional suitability (KPI No 9) and backlog (KPI Nos 7 and 8) are evidence of the Board's focus over the last year on reducing backlog, re-appraisal and rationalisation of the estate. Case Studies Nos 5, 6 and 7 provide good examples of this approach. The review of the PAMS submitted by Boards this year show a continuation of this emphasis on rationalisation of the estate and reducing backlog which should further improve these KPIs.
4.1.3 Performance variation across Boards and hospital sites
Whilst the Performance Framework provides a useful national "picture" of performance on a range of asset and facilities management services, it does potentially mask variation in performance across Boards. Further analysis of the Performance Framework KPIs at Board level reveals very significant variation across Boards as shown in the Chart below.
Note: The "Total Asset and Facilities Costs" shown in this chart relates to the £637 million expenditure on property and facilities services described in Section 3.1 of this report
Similarly, Board level analysis potentially masks variation in performance across individual hospital sites within Boards. This is demonstrated in the chart below which shows that whilst the Board level performance may be similar to the national average, there is considerable variation across the hospitals within the Board.
This variation in performance at both Board and hospital level is evident in all the Framework KPIs and is where the potential lies for improving efficiency once geography, demographics and local circumstances are taken into account. This potential is examined in further detail in Section 6 of this Report.
4.2 Property and Asset Management Strategies (PAMS)
The Performance Framework includes an overall score for PAMS quality (KPI No 5). This results from a detailed review of each Board's PAMS. It is important that Boards are able to describe, in a consistent way, how well the totality of their existing property and assets is performing against ongoing policy objectives both now and in the longer term. A Property and Asset Management Strategy (PAMS) is the key strategic document for demonstrating how each NHS Board is performing in meeting this requirement.
The Scottish Government's "Policy for Property and Asset Management in NHSScotland" requires all NHSScotland bodies to have a Property and Asset Management Strategy which is reviewed and approved annually by its Board. Health Facilities Scotland has provided comprehensive guidance and training to support Boards in developing their PAMS.
One of the key aims for a PAMS is that as it is implemented it will fuel continuous improvement in the condition and performance of the asset base in supporting the delivery of healthcare services. The State of NHSScotland's Assets and Facilities Report provides an opportunity to review and compare each Board's PAMS.
4.2.1 Review of PAMS submitted in 2012.
The PAMS that were submitted in March 2012 show that the main focus over the next few years is to complete the current major investments plans and then to refocus on reducing backlog and improving the utilisation of existing property assets. This should result in substantial improvement in overall property performance of the estate. Generally, the PAMS show that Boards are increasingly linking their PAMS with service strategies - an essential requirement if investment in assets is to support the delivery of the Scottish Government's vision for the future.
A review of the quality and comprehensiveness of each submitted PAMS was carried out using the PAMS checklist introduced in the 2011 State of the Estate Report and the results from this are shown overleaf. This checklist is based on the Scottish Government's "Policy for Property and Asset Management" and the Health Facilities Scotland guidance for developing a PAMS. Whilst there has been improvement in a number of PAMS, there remains potential for further improvement. Currently, there is considerable variation in PAMS quality across Boards. The Scottish Government and Health Facilities Scotland have recently provided extensive feedback to Boards on their 2012 PAMS through individual Board reports and interviews. This feedback was aimed at supporting Boards to improve their PAMS for next year.
Email: James H White