The "Annual State of NHSScotland Assets and Facilities Report for 2013" is the national strategic report on asset and facilities management for the Scottish Government and NHS Boards' and Special NHS Boards' use. Its purpose is to review asset and facilities management performance, highlight areas of best practice, set target areas for improvement and monitor performance against the targets. This is the third year that the report has been published.
The report will form part of the Scottish Government's formal performance review and investment planning process. It will inform the annual reviews of the Local Delivery plans (LDPs) through review of capital planning and infrastructure investment proposals. NHS Boards will be asked to use the performance framework set out in the report to demonstrate that assets are used efficiently, safely and support health care improvement. It will form the basis for setting target areas for improvement to be monitored by Scottish Government in partnership with Boards throughout the year. It will guide Capital Investment Group (CIG) investment approval decisions along with the Boards' annually updated and approved Property and Asset Management Strategies (PAMS).
The main body of the report provides key information and performance analysis on the full range of assets and facilities services covered by the scope of the report. More detailed information and analysis is provided in the Annexes to the report.
The first report in 2011 focused primarily on NHSScotland property and estate issues. In 2012 the scope of the report was extended to cover all NHSScotland owned and leased physical assets (property, vehicles, medical equipment, and IM&T). In addition, from 2012 the report has examined a range of facilities management services that are closely linked to asset ownership. This widening of the scope of the report is aimed at increasing the understanding of the opportunities for changing the balance of future investment between the different assets types. This is particularly important given the emerging landscape of new health & social care pathways which are increasingly being developed to deliver care outside of hospital environments.
The strategic agenda for healthcare services in Scotland is set by The Healthcare Quality Strategy for NHSScotland. This is the overarching strategic context for the direction, development and delivery of all healthcare services for the years to come both in terms of securing improvement in the quality of healthcare services, and in achieving the necessary efficiencies.
The Asset Management Policy for NHSScotland [CEL 35 (2010)] establishes the policy environment and key performance indicators for asset management. It makes mandatory the use of the national asset management system to collect data and the requirement to submit annually updated asset management strategies to the Scottish Government. The policy establishes a robust framework against which the planning, delivery, management and disposal of property and other assets is undertaken and assessed. The policy seeks to establish asset management excellence in NHSScotland.
Over the last two years Scottish Government has carried out a number of key pieces of work which have set out the approach to improving quality in healthcare, a governance structure to align national work around the approach, the 2020 vision for what the healthcare system will look like in the future, and the strategic priority areas to deliver the vision for achieving sustainable quality in healthcare across Scotland. This work confirms the Scottish Government's commitment to providing care in a home or community setting with a focus on prevention and self-management and where hospital treatment is required for day case treatment to be the norm. This 2020 vision will have a significant impact on the type and distribution of assets and prioritisation of investment in the future.
The Quality Unit has worked with Cabinet Secretary and the NHS boards to develop a route map to the 2020 vision for health and social care which identifies 12 priority areas for action in the three domains of the triple aim; quality of care, the health of the population and value and financial sustainability. It has been agreed that these form the basis for business planning, prioritisation, positioning and integration of all national work.
1.4.1 The 2020 Capital and Facilities Change Management Plan
The Annual State of NHSScotland Asset and Facilities Report for 2012 identified the need to consider capital investment and facilities management in the context of the quality strategy, health and social care integration and the drive to realise the "2020 Vision". Following discussion with Directors of Facilities and the Quality Unit it has now been agreed that this work should be developed as "The 2020 Capital and Facilities Change Management Plan". This work will aim to ensure:
- Clarity on the shape, size and distribution of a leaner acute estate.
- Support for the rationalisation of any estate that is no longer required under the 2020 vision.
- The right balance of investment across asset types - currently 80% property 20% others.
- An understanding of the extent of regional shared services that will be publicly acceptable given likely closures, staff changes etc.
- The impact of health & social care integration on all premises, including ownership & change that may be required to existing staff and facilities contracts
- The role of wider stakeholder groups and their contribution to the 2020 vision, including the private sector, third sector, etc.
The development of the 2020 Capital and Facilities Change Management Plan will be undertaken in partnership with all stakeholders to ensure that it reflects national priorities and local need, supporting quality ambitions whilst taking cognisance of issues relating to sustainability.
1.4.2 The Facilities and Shared Services Review
The Facilities and Shared Services Programme, established in 2011/12, is examining opportunities to improve efficiency and effectiveness through the development of strategic partnerships between Health Boards and, where appropriate, other public sector organisations. The areas of activity being examined are:
- Capital Planning/Project Management and Hard Facilities Management.
- Operational Management of PPP/PFI Contracts
- Decontamination of Medical Devices
- Waste Management.
All outcomes from these work streams will be considered by the Facilities and Shared Services Programme Board before being passed to the Efficiency Portfolio Board for approval.
1.4.3 Capital Planning and Prioritisation
As with other areas of Government spend, capital resources for physical health assets is under pressure for the foreseeable future which is driving a more formal approach to capital planning and prioritisation at NHS Board and national level. A Capital Planning and Prioritisation Short Life Working Group, which forms parts of the above Facilities and Shared Services Programme, has been established to take forward long term capital planning and prioritisation work to address capital constraints and fragmentation issues identified in previous State of NHSScotland Assets and Facilities Reports. Successful delivery of the Group's work will result in clarity and direction on:
- The current state of capital planning process at board, regional and national level, capital planning roles and functions for Boards, HFS, SFT, Hub and SG,
- Current skill levels and staff turnover for capital planning
- An understanding of the NHS Scotland Capital Programme by project type & distribution and skills and staff numbers required to deliver programme
- Staff numbers and skills required to deliver the current PAMS, Capital Plans, LDPs, and the hubco and NPD project pipelines
- An understanding of the implications of policy changes, for example 2020 vision and community planning partnerships, which may have implications for the numbers and distribution of NHS capital planning staff
- The most appropriate model for delivering capital planning and asset management (disposals) services following an option appraisal exercise i.e. delivered locally / regionally / nationally.
1.5 Procurement Efficiencies
The Scottish Government and Health Facilities Scotland has recently procured a new framework (Frameworks Scotland 2) for use by NHSScotland bodies to deliver cost and time efficiencies for publicly funded health and social care projects across Scotland. Frameworks Scotland 2 will reflect a strategic and flexible partnering approach to the procurement of publicly funded construction work and complements other procurement initiatives for the delivery of health, social care and other facilities in Scotland. It is expected to have a project "pipeline" of approximately £110m per year.
Frameworks Scotland 2 will provide a route for the procurement of publicly funded construction, repair and maintenance projects in respect of health, social care and other facilities. It will sit alongside alternative procurement routes available, namely hub and NPD projects. The hub initiative is led by the Scottish Futures Trust on behalf of the Scottish Government and has been implemented across five geographical territories across Scotland. In each territory, the participating public bodies have joined with a private partner to form a new joint venture company known as a hubCo that will deliver a diverse pipeline of projects. Across Scotland the total value of projects is expected to be worth more than £1.4bn over the next ten years. Hub will typically be utilised for community services in particular primary care projects and health and social care projects involving multiple public sector organisations. NPD will be used to procure large projects which will be privately financed. The principal focus of the work under Frameworks Scotland 2 is anticipated to be around the acute sector, and will include both refurbishment and new build work along with programmes of backlog maintenance and risk reduction work. It is anticipated that the majority of the work will be projects or programmes of work with construction costs in excess of £1 million.
1.6 Information Quality and Consistency
NHS Boards and Special NHS Boards are responsible for providing and maintaining information about the assets that they own and lease including ensuring that this information is accurate and up to date. They are supported and facilitated in this by Health Facilities Scotland and together they continually work to improve the quality of data so that it assists better quality analysis and performance monitoring. During the last couple of years NHS Boards have focused on updating and verifying their records on estate assets as part of the development and implementation of the new Estate and Assets Management System (EAMS). Similarly, information on energy and waste has been updated as part of an initiative to revise and update the Environmental Monitoring and Reporting Tool (eMART). This report makes extensive use of the information and data provided by Boards to the ISD Cost Book, EAMS and eMART. In addition, the report uses information specifically provided by Boards for this report using standardised information proforma.
In the 2011 and 2012 State of NHSScotland Assets and Facilities Reports, a number of issues in relation to the general quality and consistency of information of different information sources were identified. Since then a number of actions have been taken to improve the data:
- Short Life Working Groups were formed to examine the data collection proformas for vehicles and medical equipment which resulted in revised proforma being used for collection of data on these assets for this year's report
- Since the 2012 Assets and Facilities Report was published a comprehensive survey of overall IM&T expenditure by Scottish Government eHealth Division and Boards was completed in April 2013. Significant effort was put into validating the data for this report and there is a high level of confidence in the quality and consistency of this data. Therefore, it has been used as the source of data for IM&T expenditure used for this report
- Changes to the definitions and measurements of assets and facilities inputs to the ISD Cost Book have been implemented and were incorporated into the ISD Cost Book published in November 2012 and used to inform this 2013 Report
- EAMS is now used by the majority of Boards to hold and interrogate information on the estate condition and performance. This has led to a general improvement in the consistency of data presented by Boards in their PAMS and proformas
- Boards have generally been systematically reviewing their estate information, particularly in relation to backlog costs and risk, and this has resulted in an updated and more accurate picture of the current situation
- Additional property appraisal surveys have been completed over the last year resulting in more accurate condition and performance information for many of the hospital sites.
- Comparative analysis exercises have been undertaken to assess the degree of alignment between the various information sources. This has shown that, at national and Board level, the main property metrics (area and cost) are broadly comparable.
As a result of the above, most Boards are now reporting improved confidence in the quality and consistency of the property information that they submit for use in this report and in the National Asset Performance Framework.
However, the widening of the scope of the report in 2012 to cover vehicles, medical equipment and IM&T for the first time identified further issues on information quality and this remains a concern for these asset groups. The information systems for these assets are generally less well developed than those for property assets and this inevitably limits the conclusions that can be drawn from the analysis of performance in relation to these assets. Short-life working groups were set up in 2012/13 for medical equipment and fleet and these will continue into 2013/14 aimed at further improving and validating information received from NHS Boards for these asset groups. In reality, it is likely to take a number of years to bring the quality and consistency of the data for these asset groups up to the confidence level currently achieved for property assets.
Similarly, some of the information at hospital level provided by Boards to the ISD Cost Book remains of concern in terms of both its accuracy and consistency with other information sources. Particular concerns relating to individual Boards have been detailed in reports provided to Boards and were discussed at the interviews with each Board in June 2013. Boards have agreed to review their processes for ensuring consistency between the information submitted to the ISD Cost Book and other information sources and this will be monitored over the next year.
Email: Gillian McCallum