This annex of the report provides short summaries of a number of best practice case studies covering different aspects of managing assets and facilities services in NHSScotland. In addition to the benefits to participating Boards, there are outputs from these case studies that are of value to a wider audience in NHSScotland. The case studies are aimed at promoting the sharing of good practice and provide the reader with information on actions being taken elsewhere in NHSScotland to deliver improvements in the performance, efficiency and sustainability of assets and facilities services. It is envisaged that this will be a key feature of this annual State of NHSScotland Assets and Facilities Report, aimed at helping NHSScotland to develop capability and capacity to deliver high performing, efficient and sustainable assets and facilities services. They have been selected because they are innovative and should have a significant impact on performance. Also, they should be easily replicated more widely across NHSScotland.
Best Practice Case Study 1
NHS 24 - Telehealth and Online Services
NHS 24 unscheduled care service provides round the clock access to health information and support to the people of Scotland. During the out of hours period, NHS 24 is one of the main 'gateways' into NHSScotland unscheduled care services for the whole of the country. This activity operates via the telephony platform with complex call routing in operation to try to ensure that callers, where possible, are answered at their nearest regional centre. However, all operatives have access to a sophisticated, on-line, national Knowledge Management System which gives all staff the same access to local information, wherever they are in Scotland. The kind of information they need access to is pharmacy locations/opening hours, where the closest A&E is etc.
Over the last few years, we have improved our web access and online facilities by updating NHS24.com and introducing NHSInform.com. Both of these sites contain helpful information for self-care, including the 'body map' system for helping users to indentifying possible ailments. They also offer an on line enquiries function so that people can send their health queries in by e-mail, if this is their preferred communication style, and are responded to in the same way. All online enquires are vetted for appropriateness with any query that appears linked to a person being symptomatic is contacted by a clinician for reasons of patient safety.
NHSInform.com, in particular, contains current health information to support the prevention of ill health, early detection activities and various zones for self-help, such as health screening programmes and mental health wellbeing.
There are a number of 'additional services' in pilot phase with partner boards including:
Patient Reminder Service - In an effort for the NHS Boards to improve clinic efficiency and cut down on "Did not attends" (DNAs), NHS 24 is providing a reminder service for several clinics. Using a software system which is able to calculate propensity to DNA using patient demographics, we can target those most likely, calling them a week in advance of their appointment to confirm or cancel. Early results are very positive delivering a reduction in DNAs and fuller utilisation of clinic appointments.
MSK - A telephone pre-screening service for musculoskeletal conditions to reduce the numbers of patients unnecessarily referred for physiotherapy and to promote appropriate self-care.
Best Practice Case Study 2
NHS Grampian - Foresterhill Energy Centre
NHS Grampian's new Energy Centre was commissioned to serve the current and future energy requirements of the Foresterhill Health Campus. This was in response to:
- failing and insecure current energy production facilities, with boiler plant nearing the end of its economic life and high associated labour costs;
- increased energy requirements associated with recent and future developments at the Foresterhill Health Campus, including new clinical services and additional medical teaching and research facilities for the University of Aberdeen;
- steep increases in energy costs;
- NHS Grampian, NHSScotland, Scottish Government and UK Government policies and drivers relating to energy consumption and greenhouse gas emissions.
Following detailed assessment of potential options, it was decided to replace the existing boiler house with a new energy centre comprising more efficient plant on a brownfield site. The new plant includes a gas turbine Combined Heat and Power (CHP) plant, a biomass boiler and three dual fuel boilers. These will provide all heat, and around 90% at peak loads of the electricity requirement of the Foresterhill Health Campus.
The steam plant comprises:
- one gas turbine CHP unit providing base load steam demand and 5.3MW of on-site power generation
- one 1.5MW biomass steam boiler fuelled on locally sourced wood chip to meet the higher winter steam demand
- two 8.5MW and 1 x 6.5MW dual fuel (gas/oil) steam boilers to meet peak demand.
The steam plant configuration was designed with N+1 redundancy to provide security of supply with a 1MVA standby generator providing 'black start' capability and a gas booster set providing 2000m3/hr at 18 bar pressure.
The entire plant is housed in a single building with integral woodchip delivery and storage using fully automated flatbed 'walking-floor' trailers. The plant is designed to provide a 16% reduction in CO2 emissions (9830 tonnes/annum) and a 39% reduction in energy costs (£2.95M at 2010 prices).
Air dispersion modelling was undertaken to determine the minimum height of the flue stack required to ensure there was no increase in levels of air pollutant concentrations (NOx, CO, PM10 and PM2.5 particulates) at local sensitive receptors.
The project achieved Building Research Establishment Environmental Assessment Method (BREEAM) Excellent status, and has recently won the Industrial Category in the annual BREEAM Awards.
Best Practice Case Study 3
Scottish Ambulance Service - Working Together for Better Patient Care
The Scottish Ambulance Service 5 year Strategy 'Working Together for Better Patient Care' is aligned with the Scottish Government's Quality Strategy and has five key work streams. These are examining how clinical care can be provided more locally to patients, especially in rural areas - some of which can be achieved through eHealth proposals and investment in technology infrastructure.
Therefore, the eHealth Strategy is one of these key work streams. This has 2 key areas of significance; Telehealth, whereby decision support can be accessed through professional to professional lines involving clinicians within NHS Boards supporting Scottish Ambulance Service staff in diagnosis and treatment. Thus enabling patients in unscheduled care situations to either stay in their own home or remain within a community hospital setting. This benefits the patient and also assists NHS Boards in terms of reduction in in-patient and A&E attendances.
The Scottish Ambulance Service is also working in partnership with NHS24 to introduce a single clinical triage system that will utilise the most up to date clinical evidence to effectively triage patients, again, with unscheduled care requirements.
This system, due to be implemented in the summer of 2013, has the potential to be used in A&E Departments and GP surgeries and will direct patients to definitive care efficiently and effectively. This will also lead to more care delivered at home and a reduction in A&E attendances.
Where possible, the Scottish Ambulance Service co-locates its premises with other NHS bodies as part of its PAMS. As well as making effective use of NHS estate, this also has the benefits of closer working between NHS staff. This leads to the development of multidisciplinary teams, including Scottish Ambulance Service staff, which can provide anticipatory care and health checks to patients in their communities.
One of the key HEAT[i] targets for the Scottish Ambulance Service is the achievement of an 8 minutes response to Category A Emergency patients for 75% of the population. To ensure this target is achieved, ambulance station locations in particular areas need to be sited to best effect to enable to HEATtarget to be achieved. So whilst, co-locations, hub initiatives etc may make financial sense, if the property is not correctly sited for the HEAT target, Scottish Ambulance Service cannot enter into these proposals.
The Scottish Ambulance Service, in terms of all assets, Property, Vehicles, IM&T, ensure that these are aligned with Working Together for Better Patient Care and the Quality Strategy. Each has a different timescale, however, are all flexible enough to accommodate changes to the way healthcare is delivered right across Scotland. The strategy has elements that can benefit the wider NHS and are structured to deliver services as efficiently and effectively as possible.
i. HEAT Targets are NHSScotland's targets for performance in the areas of Health Improvement, Efficiency, Access and Treatment
Best Practice Case Study 4
NHS Forth Valley - Investment in eHealth
NHS Forth Valley is one of the leading NHS Boards to introduce eHealth into the hospital ward environment. This initiative has achieved significant benefits to patient safety, patient care, improved access to information, and significant financial savings through improved efficiencies.
NHS Forth Valley has introduced electronic Bed Management through its eWARD system which now covers all its hospital inpatients. The system also includes a Nurse Handover facility, Hospital at Night clinician handover facility, District Nursing Discharge letters, and patient discharge medication management.
Medicines reconciliation on admission and discharge is one of the most valued facilities provided by eWARD, both for patient safety and streamlining the patient discharge medication process, minimising delays to discharge.
Further efficiencies through electronic communication were realised by the development of supporting technologies between Acute and Primary Care.
While eWARD had been in use for some time, it did not record patient beds and staff interacted with it infrequently, resulting in significant delays in updating the location of the patient on the system. With the introduction of the Bed Management module, dedicated touch screen computers and availability from every eWard computer, visibility and access to this information has improved. The resulting improvement in system update times improved the accuracy of information available for the management of hospital capacity and discharge planning which was previously gathered through a team of Patient Flow Co-ordinators (Bed Managers) walking to each ward on a 24/7 basis.
Accurate information and remote access to patient flow/demand management has meant that floor walking was no longer required, leading to an annual recurring saving of £130k.
Further benefits/efficiencies achieved include standardisation of ward information and processes, reduced duplication in recording patient location information, and availability of 'at a glance' patient status for visiting clinical staff; all synergistic objectives of the Releasing Time to Care initiative.
NHS Forth Valley's work on the eWard Bed Management facility has been nationally recognised, winning the NHSScotland Event 2011 Infrastructure Poster prize. This year, it has been short listed for the HSJ Efficiency Awards 2012 with its award submission "Using Electronic Ward Maps to manage Patient Flow" in the Efficiency in Information Technology category.
Best Practice Case Study 5
NHS Grampian - Whinhill Medical Practice
Whinhill Medical Practice opened its doors to patients on 8 December 2010. This development was completed as part of NHS Framework Scotland and was the first project in Scotland to be delivered under this programme.
The two-storey, modern and bright facility is a multi-agency centre, providing six GP consulting rooms, social services and community nursing offices, as well as a police station with its own entrance. This environment promotes collaborative and partnership working and brought together the merged Belmont and Ferryhill Medical Practices as Whinhill Medical Practice, and a local community policing team for the West End.
Whinhill Medical Practice provides a range of General Medical Services to patients registered at the practice. This includes the management of long term conditions, routine immunisation of children, annual flu immunisation programme, health screening programmes, Diabetes clinic and a Nurse-led Minor Illness Clinic.
The aim of the Whinhill Police Office is to take local policing closer to you and achieve this through higher visibility and easier accessibility as this new modern station has brought the local policing team for the West End area together under one roof.
The ethos of partnership working was promoted from the outset, not only between NHS Grampian, Aberdeen City Council and Grampian Police as public sector bodies, but also the Principal Supply Chain Partner (PSCP), led by Scottish Firm Morrison Construction.
This partnership working also involved staff and service users by gathering their views and ideas during a series of team workshops led by Architects Halliday Fraser Munro and keeping local residents up to date with activities using newsletters and an open day in the local community centre.
As part of NHS Framework Scotland Programme and more specifically the Whinhill Medical Practice project, the key criteria set out by NHS Grampian was to attain a BREEAM Excellent rating for the new Facility. Morrison Construction as the PSCP set out at a very early stage in the gateway process that the only way to achieve the "Excellent" rating was through partnership and collaborative working with the entire team.
Whinhill Medical Practice achieved the BREEAM Excellent rating for the Design and Procurement Stage on 14 December 2011. The Final Post Construction Assessment is ongoing and there is confidence the BREEAM Excellent rating will be re-confirmed in the very near future.
The project was also completed earlier than the scheduled programme and below the target cost value.
Best Practice Case Study 6
NHS Lanarkshire - Estate Rationalisation
NHS Lanarkshire's property investment and estates rationalisation plan has resulted in a significant improvement in its overall estate performance KPIs, including a net floor space reduction of 9%, annual lease savings of circa £300k, and a reduction in backlog maintenance of circa £12m.
An outcome from NHS Lanarkshire Property Strategy 2009-13 was a need to rationalise parts of its estate. This was advanced through 3 main activities:
1. NHS Lanarkshire's Service Strategy
This identified a need for investment in new buildings to replace ageing premises with poor functionality, poor physical condition and high maintenance costs.
It also involved removal of surplus property from the estate portfolio.
2. NHS Lanarkshire's Office Accommodation Review
This identified the opportunity to centralise its executive management team, senior managers and some corporate functions on a single site. This would bring a range of efficiencies and improved management performance from making better use of existing buildings and utilising more modern facilities.
3. Review of all Lease Arrangements
The aim was to ensure that at the earliest break clause the opportunity to provide services in alternative existing premises was taken.
A four year programme of works was undertaken with an overall investment of circa £85m. This resulted in:
- The construction of 4 new Community Health Centres at Carluke, Coatbridge, Bellshill, and Airdrie;
- Refurbishment of 2 Health Centres in East Kilbride and Hamilton;
- Refurbishment of 2 Buildings to establish the new Board HQ in Bothwell.
- Replacement of 2 mental health inpatient facilities at Hamilton and Coatbridge.
As a result of the above, 10 buildings were declared surplus to requirements and were scheduled for disposal. An initial programme of demolition of 8 buildings has been completed. Of the final 2 buildings, one is scheduled for demolition in August 2012 and the second is being marketed for sale. The remaining land has been declared surplus and is being managed for disposal by NHS Lanarkshire's Property Strategy Group.
The relocation of staff and services from these sites was successfully achieved through the implementation of the estates rationalisation plan, developed and carried out following extensive consultation and planning with service user groups.
The outcome of this programme has been a significant improvement in property performance KPIs, thus ensuring that its property assets continue to meet modern service needs, as well as public and patient quality expectations.
Best Practice Case Study 7
NHS Grampian - Reprovision of services, Maud
NHS Grampian made available a capital grant of £2.15m to Maud Village Trust for the construction of the Old Mart Community Resource Centre. This allowed the decommissioning of Maud Hospital and the re-provision of more community-based services for the Central Buchan population.
Through a thorough engagement and consultation with the public , the local population recognised they did not require a local hospital to deliver future services. This project demonstrated a community approach to integration of services involving the NHS and Local Authority, Third sector and crucially the population.
The service redesign ensured that people had the opportunity to live at home living more fulfilled lives with greater independence rather than occupying a local hospital bed.
The facility is managed by Maud Village Trust and a partnership agreement is in place between Maude Village Trust and NHS Grampian. A management committee with representation from both organisations meets quarterly to deal with maintenance and budgetary issues relating to the building. Day-to-day management is via The Centre Manager, employed by Maude Village Trust. There is also an occupancy agreement in place with Aberdeenshire Council for local authority staff based there.
The Old Mart Community Resource Centre is truly a community resource and provides the following for health and community care:
- Base for Older People's Team - Health and Social Work
- Base for Mental Health Team
- GP consulting room - used by Mintlaw Group Practice and visiting consultants
- Range of therapies - Physiotherapy, Podiatry, OT etc
- Base for Health Visiting Team
- Treatment rooms /gym - e.g. falls prevention classes, ante-natal classes, health promotion events etc
- Assessment kitchen
- Community meeting facility
The original intention was to provide day hospital/service and out-patient facilities, but these have not been progressed. The gym facility run by MVT is well resourced and popular with the local community.
The remainder of the complex, the former mart site, has been developed by the Trust and provides:
- Base for Buchan Dial-a-Bus
- Play area
- Community crèche
- Units - for use by businesses/meeting facilities
These facilities complement services being provided within centre.
It was the intention to provide 6 GP beds at Culsh Nursing Home in New Deer, however, that was not progressed. Demand has been met from within Fraserburgh Hospital as the emphasis has been on reducing length of stay and more capacity has been created.
Best Practice Case Study 8
NHS Grampian: Health and Care Framework
NHS Grampian has developed a Health and Care Framework of guidance and tools to support its development of a detailed picture of how health and healthcare will be developed in Grampian.
The NHS Board embarked upon a number of Pathways Projects as part of the Health and Care Framework development. Two of these pathways centred on geographical areas - Forres and Inverurie. The work carried out in each area differed in their approach but had may common elements. The work was conducted with a range of stakeholders using both NHS staff and independent consultants.
Throughout the engagement work was guided by both NHS Corporate communication staff and Scottish Health Council to ensure conformity with Inform, Engage and Consult responsibilities. In broad terms the approach taken in each area comprised of the following:
- Needs analysis
- Public engagement
- Clinical engagement
- Partner engagement
- Option generation
- Data analysis and benchmarking
- Cost projections
- Use of structured questionnaires
- Community council
- Meeting with public reps
- Meetings with GPs
- SMT, OMT, HCCSP, OPSOG, HMD
- Practice Participation Group for Inverurie
- Working Group
- Local Authority Officers and Councillors
- Third Sector
- Friends of Hospital
- Scottish Health Council
- Integrated Resource Framework
- PAS Admission Data
- Local Medical Knowledge
- HEAT data
- Health Profile (Health Intelligence)
- Practice Profile
The Health and Care Framework is not a single plan or strategy. The framework aims to provide direction, initiatives and actions that will continue to evolve. It is also the framework within which NHS Grampian and its partners will make difficult decisions about the allocation of resources, Grampian services, facilities and corporate strategies. In addition, it is the framework within which Community Health Partnerships and acute services will make detailed changes to services, and how public health and health improvement will achieve long terms aims in relation to the health of the population as a whole.
Best Practice Case Study 9
NHS National Services Scotland - Meridian Court Refurbishment
In June 2011 NHS National Services Scotland (NSS) relocated 415 staff from 5 leased office properties across central Glasgow to Meridian Court, a surplus Scottish Government building close to Glasgow's Central Station.
The move to Meridian Court presented NSS with a range of unique challenges and opportunities in terms of:
- Re-use of surplus Scottish Government office space with a long lease that might otherwise have remained empty in the prevailing difficult commercial climate;
- Transformation of a tired and non-functioning 1970's building where many of the building services, fixtures and fittings were approaching or beyond their useful life and the layout required significant reconfiguration to meet modern office standards;
- Designing a new working environment to meet the needs of different NSS functions moving from multiple sites to a single building solution;
- Introduction of green technologies e.g. chilled beam, energy efficient lighting systems etc.;
- Developing and incorporating new design principles within the fit-out which focused on flexible workspaces to support more collaborative and dynamic work styles;
- Cost constraints demanding creative solutions to meet the need to reduce space while continuing to meet NSS operational needs and staff aspirations.
NSS has delivered a contemporary working environment that has surprised and delighted its staff who have successfully transitioned to a shared open-plan working environment (where even senior managers and medical consultants do not have dedicated cellular office space).
The open-plan workspace on the upper floors of the building is supported by informal meeting and break-out zones for non-confidential meetings and discussions, touchdown and hot-desking facilities for visiting colleagues, quiet rooms for individual concentrative work and formal meeting rooms equipped with video conferencing and presentation technology. The reception, conference rooms, touchdown and Aroma café on the ground floor provide business and amenity facilities for staff and visitors alike and serve to enhance the NSS corporate identity.
The efficient design and use of space at Meridian Court is reflected in an overall space standard of 10.3 sq.m. NIA per person. By 2014 space utilisation within the building will be further improved following implementation of NSS plans to further consolidate and rationalise its office accommodation in Glasgow. Enabled by a move from 1:1 desking to a shared desking model NSS plan to increase occupancy to a total of 456 staff at a space standard of 9.4 sq.m. NIA per person.
NSS has breathed new life into a potentially redundant building and delivered a working environment that provides efficient modern in design and is flexible enough to respond to future strategic and operational requirements.
In March 2012 the success of this project was recognised when Meridian Court was short-listed for the British Council of Offices (BCO) Regional Awards in the refurbished/recycled workplace category.
Email: James H White