7.0 Forward Look to 2013 and 2014
7.1 Innovation and Collaborative Working
It is widely recognised that the demands for healthcare and the circumstances in which it will be delivered will be radically different in future years. From advances in technology through to changes in clinical practice and greater collaborative working, the need for innovation has never been greater.
Assets and facilities services can be a key enabler for achieving NHSScotland's Quality Ambitions and for delivering the Scottish Government's "20:20 Vision" for sustainable high quality in health including a healthcare system where there is integrated health and social care.
Advances in technology are driving changes in healthcare that are likely to significantly impact on the NHSScotland's asset base. These technologies are enabling care pathways to be developed which deliver more care outside of hospitals and therefore there is likely to be less reliance in the future on buildings to deliver services. Hence, it is essential that the asset base is closely aligned with these changes in service delivery models. This will include the need to carefully examine the balance of investment needs across the different types of assets going forward if the NHS is to maximise the potential benefits of the new technologies and the innovative and collaborative working. The performance improvement scenarios shown earlier in this report are the basis for further work on the development of a financial model for evaluating alternative investment proposals.
7.2 Delivering improvements in quality at lower cost
It is clear that demographic trends and global pressures on health spending will not allow increases to quality that increase costs. The Scottish Government is working with Boards to identify opportunities to deliver improvements in quality at lower cost.
The NHSScotland Efficiency and Productivity Framework is clear that conventional approaches to efficiency will be insufficient to deliver the depth and duration of efficiency savings required over the next three to four years. The purpose of the Efficiency and Productivity Framework is to give real focus to identifying a range of changes which will support Boards to achieve this alongside the Quality Strategy and to support Boards to redesign services bringing together all of the dimensions of quality, including value for money. The State of NHSScotland's Assets and Facilities Report is part of this initiative to identify changes that support Boards to deliver improvements in quality and reduce costs by providing an annual high level assessment of the progress that NHSScotland is making on improving the performance management of assets and facilities services. The focus for improving performance is expected to be on estate rationalisation, space utilisation and benchmarking.
The case studies included in this report demonstrate that some Boards are at the forefront of the initiatives on innovative and collaborative working and delivering improvements in quality at lower costs. The inclusion of these case studies in this report is aimed at enabling Estates and Facilities Teams within Boards to identify, share and spread good practice and act on opportunities to improve performance.
7.3 Future State of the NHSScotland Assets and Facilities Reports
The development of the 2013 and 2014 State of NHSScotland Assets and Facilities Reports will see work on:
- Further improving the quality and consistency of the information on assets and facilities, particularly in respect of the wider range of assets (vehicles, medical equipment and IM&T) introduced in this year's report. This will include the implementation of further measures to improve the alignment of the ISD Cost Book with the operational assets and facilities information systems such as EAMS and eMART.
- Further development of the Asset and Facilities Performance Framework as a key tool for monitoring performance at national, Board and local levels. This will include further work on the setting of performance targets with particular focus on ensuring that they are realistic and achievable within available resources. It will also include the development of KPIs for vehicles, medical equipment and IM&T assets which are similar to those for property and facilities services and provide a balanced approach to measuring quality, efficiency and risk.
- The work on developing a more formal approach to capital planning and prioritisation using a robust set of criteria to develop an affordable list of capital priorities should demonstrate measurable improvement in asset performance over time. From a financial perspective it should be able to increase the effectiveness of investment and reduce the expenditure that is required to meet performance or increase the performance for the same level of expenditure. This annual report and in particular the Performance Framework provide an ongoing opportunity to demonstrate improved investment decision-making.
- Development of guidance and training for Boards on the development of strategies for vehicles, medical equipment and IM&T assets that address the key questions that this report need to answer:
- What are the risks that NHSScotland face in relation to these assets?
- What investment is needed in these assets?
- What opportunities are there for changing the balance of investment between the different assets types?
- Establishing a library of best practice case studies with the aim of drawing on the outcomes from these studies to provide an evidence base for informing decisions on future investment in assets and for modelling the potential for future performance improvement.
- Alignment of the 2013 report with the work and outcomes of the NHSScotland Soft FM Review. This review will deliver a report on soft facilities services identifying improvement opportunities relating to:
- Utilising relevant technological innovations from across the world to improve service effectiveness and efficiency,
- Synergies and efficiencies that can be achieved by joining up service delivery across Health Board boundaries, regions, pan Scotland or delivered in conjunction with other public bodies,
- Ensuring that best practice is identified and as far as is practical is put into operation across as much of NHSScotland as it would be practical to do so,
- Applying new evidence based practice to Soft FM and to stop historical practices which have evolved over time with limited or no basis in evidence,
- Identifying opportunities to generate income for NHSScotland through improved retail delivery and careful marketing of spare (contingency) production capacity,
- Assessing the advantages / disadvantages from contracting out work to other public sector providers.
The work on these future State of Assets and Facilities Reports provides an opportunity to identify and find solutions to some of the issues and barriers to improving performance that have been identified to date. These future reports will focus on demonstrating success, and ensuring that important seeds are sown for the delivery of longer term benefits, performance and efficiency improvements in the assets and facilities services across NHSScotland.
Email: James H White