Review of Estate Assets and Performance
This Annex provides a detailed analysis of property asset performance which supports the summarised information and analysis provided in the main body of the report. The information presented in this annex within the pie charts combines information from all 22 NHS Boards and Special NHS Boards, whereas the subsequent charts and tables split the analysis between the 16 Boards with in-patient accommodation (labelled NHS Boards), i.e. all 14 NHS Boards plus 2 Special NHS Boards (NHS National Waiting Times Centre - Golden Jubilee and the State Hospitals Board for Scotland), and the 6 remaining Special NHS Boards.
NHSScotland occupies approximately 930,000 sq.m (21% of the total) of relatively new / modern accommodation (i.e. less than 10 years old), which is an increase of 240,000sq.m since 2011, and is evidence of the significant capital investment in property assets over recent years. There does, however, remain substantial scope for improvement and further investment, or disposal, in the estate in order to move away from old, poor quality and functionally unsuitable properties. The following charts show the range of property ages for the NHS Boards, which indicates that 25% of the estate remains over 50 years old.
2014 Estate Age Profile
Age profile above includes all 22 NHS Boards and Special NHS Boards
2014 Age Profile Comparison - NHS Boards
2014 Age Profile Comparison - Special Health Boards
The majority of the NHSScotland estate is owned (78%) but for some NHS Boards PPP/PFI and leased property is a significant proportion of their estate, as shown in the two charts that follow.
2014 Estate Tenure
Tenure profile above includes all 22 NHS Boards and Special NHS Boards, where information is available
2014 Tenure Comparison - NHS Boards
2014 Tenure Comparison - Special Health Boards
Analysis of the information contained within each NHS Board's Property and Asset Management Strategy (PAMS) shows that approximately 59% of the NHSScotland estate is in good physical condition (category A or B) but, as shown in the three charts that follow, this can vary significantly across the NHS Boards.
2014 Estate Physical Condition Profile
2014 Physical Condition Comparison - NHS Boards
Physical Condition Comparison - Special Health Boards
Further to the above Board level analysis, it is now possible, through the Estate Asset Management System (EAMS), to report on estate KPI's such as physical condition and backlog maintenance at hospital level. Analysis of this information enables links to be made between property improvement needs and the strategic plans for improvement included within the appropriate NHS Board's PAMS.
Backlog maintenance costs
Backlog maintenance costs arise from maintenance that has built up over a number of years and is now giving rise to poor condition and performance. These backlog maintenance costs have been identified as those required to bring the estate back to Condition Ranking B (satisfactory). It is an on-going challenge for the NHS to balance investment between that which is focussed on service improvement and development, and that which is necessary to ensure existing properties do not cause harm or undue disruption to service delivery.
An analysis of the distribution of backlog across NHS Boards is shown in the chart below. It identifies a backlog maintenance cost of £797m, which is a £213m reduction since 2011.
Backlog Maintenance Comparison - NHSScotland Total is £797m
Note: the above chart includes all 22 NHS Boards and Special NHS Boards but those whose backlog is below 1% have not been separately identified for clarity of presentation reasons only.
By the very nature of a mixed use and mixed aged estate, backlog maintenance will always be present in such a large and diverse estate. The emphasis should, therefore, always be on ensuring that the level of backlog maintenance does not unduly increase the risk of building or engineering service failure to an extent that it could have a detrimental impact on each NHS Board's ability to function effectively, efficiently and safely.
NHSScotland managers are focussed on mitigation strategies for backlog to ensure that high and significant risk backlog is prioritised, based on the risk it poses, for investment within the finite resources made available to them.
The two key strategies for reducing backlog maintenance are either to invest directly in the rectification of backlog or to rationalise the estate to remove those properties with high levels of backlog maintenance. For the current stock of modern buildings future backlog can be avoided by ensuring the right levels of expenditure on both operational and cyclical lifecycle maintenance.
The following chart identifies the profile of low, moderate, significant and high risk backlog for each NHS Board.
2014 Backlog Maintenance Risk Profile - NHS Boards
2014 Backlog Maintenance Risk Profile - Special Health Boards
The earlier pie chart expressed the total amount of Backlog Maintenance Cost across the NHSScotland estate, whereas the following chart shows backlog maintenance expenditure requirement per unit of total building floor area for each NHS Board.
2014 Backlog Maintenance per sq.m - NHS Boards
It should also be recognised that around 21% of the current backlog maintenance expenditure requirement is in buildings which are classified as "non-clinical" and will have little impact on the patient's healthcare experience. An analysis of this by NHS Board is shown in the chart below.
2014 Proportion of Backlog Maintenance between Clinical & Non-clinical Spaces - NHS Boards
Note: not all NHS Boards have provided a split between Clinical and Non-clinical therefore the real 'Average Split' is likely to be even lower.
Approximately 37% of the total backlog maintenance expenditure identified is high or significant risk clinical space. This includes some property identified for disposal.
NHS Boards are already targeting high and significant risk clinical backlog maintenance through planned maintenance and re-provision plans outlined in their PAMS. Overall, Scottish Government budgeting levels should be sufficient to reduce existing high and significant clinical backlog maintenance levels for retained property to manageable levels over the next five years.
For lower risk backlog maintenance and non clinical space, Scottish Government will work with NHS Boards to develop detailed long term plans for rationalisation and disposal of surplus, unsuitable, poor quality properties, and life cycle planned maintenance plans for retained property. These will be updated annually as part of the PAMS update and reviewed more formally through the LDP process.
Accommodation space has a direct relationship with cost. The aim, therefore, is to hold only that space which is needed to support the delivery and support of effective and efficient service delivery. Analysis of the information contained within each NHS Board's Property and Asset Management Strategy shows that approximately 77% of the NHSScotland estate is fully utilised but, as shown in the charts that follow, this can vary significantly across the NHS Boards.
2014 Estate Utilisation
2014 Space Utilisation Comparison - NHS Boards
2014 Space Utilisation Comparison - Special Health Boards
The under utilisation of accommodation across NHS Highland and NHS Orkney reflects the challenges faced from such a geographically diverse area and the need to maintain and provide critical healthcare facilities in locations with relatively low population masses.
The estate also plays an important role in supporting the effective delivery of services. Poor functional suitability often results in inefficient working practices, increased staffing levels and poor clinical outcomes. Approximately 65% of the NHSScotland estate is functionally suitable but, as shown in the charts that follow, this can vary significantly across NHS Boards
2014 Estate Functional Suitability Profile
2014 Functional Suitability Comparison - NHS Boards
2014 Functional Suitability Comparison - Special Health Boards
Patient Satisfaction Survey Results relevant to Premises
Better Together is Scotland's patient experience programme, using the public's experiences of NHSScotland to improve health services. One of the key elements it is currently focussed on is the Inpatients Patient Experience Survey 2012. This asked a range of questions about people's experiences of staying overnight in a Scottish hospital and included a particular question that was relevant to the condition and performance of the hospital estate, namely "Q.13 Overall, how would you rate the hospital environment?" The following chart shows the results of the response to this question for each NHS Board:
Positive Patient Option on Hospital Environment (2014)
Note: No data is available for the State Hospital Board
The results are generally positive across all NHS Boards, however, it needs to be recognised that these results are based on only one question and, therefore, should not be taken as indicating overall patient satisfaction in NHSScotland premises.
Performance Improvement of Property Assets
The following chart provides a comparative overview of performance improvement in property assets between 2013 and 2014.
Performance Improvement of Property Assets between 2013 & 2014 for all NHS Boards
Note: green bars above the horizontal indicate a positive improvement whereas a red bar below the horizontal indicates a performance reduction
The above chart highlights performance improvement in several key indicators; such as patient rating, age of properties, PAMS Quality, SCART Score and backlog maintenance per sq.m. The main focus for NHS Boards over this year has been estate rationalisation and reduction in backlog maintenance and these positive results reflect the good progress made on these initiatives. 2013-14 has also seen a significant re-appraisal of the condition and performance of property assets, including verification of existing data. This has had an impact on the above results and can explain some of the further variation in performance results between 2013 and 2014.
Email: Gillian McCallum