1.0 Delivering NHSScotland's 2020 Vision
This is the fifth year that the State of NHSScotland's Assets & Facilities Report ( SAFR) has been published. Its purpose continues to be that of reviewing asset & facilities management performance, highlighting areas of best practice, identifying priorities for investment and improvement, and monitoring progress against such priorities. This introduction to SAFR 2015 looks back at some of the achievements made over the last 5 years to review how effective asset management and investment planning has been in supporting the delivery of NHSScotland's 2020 Vision, and how it will continue to meet this aspiration into the future for a highest quality NHS for Scotland.
1.2 Strategic Background
The strategic agenda for asset management and investment planning has been guided over the last 5 years by the introduction of The Healthcare Quality Strategy for NHSScotland and the Asset Management Policy introduced by CEL35 (2010).
The Healthcare Quality Strategy sets out the overarching strategic context for the direction, development and delivery of all healthcare services for 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 establishes the policy environment and key performance indicators for asset management; seeking to establish asset management excellence across NHSScotland in support of the Healthcare Quality Strategy.
The 2020 Vision for Health & Social Care in Scotland, and accompanying Route Map for delivery, further set out the framework from which NHSScotland's assets and facilities might respond in supporting the need for continued improvement in health and social care services.
This strategic background therefore sets the context and narrative upon which improvements in the planning, delivery, management and disposal of NHSScotland's properties and others assets has been achieved over the last 5 years, and also prepares the framework from which further efficiencies and performance improvement can be achieved.
1.3 NHSScotland's Strategic Investment Programme
Getting the right assets and facilities services in place is central to delivering the triple aim of Scottish Government's 2020 Vision for improving the quality of care, health of the population, and the value & sustainability of resources across Scotland. Supporting these aims has required significant change and investment across acute, mental health, primary and community care sectors of the health and care system.
Queen Elizabeth University Hospital
For example, investment in the hospital estate has delivered two of the largest acute hospital facilities ever built within NHSScotland; namely the Forth Valley Royal Hospital which became fully operational in July 2011, and the recently opened Queen Elizabeth University Hospital in Glasgow. Between them, an overall investment of circa £1billion has delivered 300,000 sq.m. of the very highest standard of healthcare facilities for Scotland's patients, visitors and staff.
Forth Valley Royal Hospital
A further equivalent investment of £340m is currently being planned to deliver two more hospital replacement facilities in Dumfries and Orkney. These new properties will facilitate enhanced models of service delivery designed to improve quality of care and patient experience within modern, fit-for-purpose accommodation.
The new Acute Services Facility for Dumfries will accommodate some 350 in-patient beds, with an internal floor space of approx 66,500sq.m. Due for completion in 3rd quarter 2017.
Most recently, a new initiative was announced in October 2015 to develop a network of new elective treatment centres across Scotland that would enable people to be treated more quickly for planned surgery whilst also easing the pressure off unplanned and emergency treatment. £200m of investment has been allocated to this initiative to extend services at the Golden Jubilee Hospital in Clydebank and develop new elective treatment centres at St John's Hospital in Livingston, Edinburgh Royal Infirmary, Ninewells Hospital in Dundee, Raigmore Hospital in Inverness, and Aberdeen Royal Infirmary.
While these and other hospital developments will transform the acute hospital estate and facilitate the delivery of safe, effective and person centred acute healthcare services for Scotland, there are also a wide range of no less significant projects that have been, and will continue to be, delivered across the country which will help to deliver each of the 2020 Vision's priorities for improvement (highlighted in bold), as described below:
Improving the way unscheduled and emergency care is delivered has been driven by the requirement to ensure patients are provided with the care they need as soon as possible and, in practical terms, adjustments to patient flow in and out of accident and emergency departments will help to facilitate this. This has been at the forefront of plans for all new hospital developments; both those delivered and those in the planning or construction stages. In addition, NHS Ayrshire & Arran's redesign of 'front door' services at Ayr and Crosshouse hospitals; as well as the £100m Emergency Care Centre (The Matthew Hay building) built on the Aberdeen Royal Infirmary site in 2012, are further examples of investment focussed on improving the delivery of unscheduled and emergency care.
The new Matthew Hay building was completed in 2012 and brings emergency and unscheduled care services in Aberdeen under one roof and provides 350 inpatient beds to replace ageing accommodation at Aberdeen Royal infirmary.
Greater integration between adult health and social care has been a key part of the Scottish Government's commitment to public service reform in Scotland, and an indication of how Boards are considering new models of affordable and sustainable care is inherent within the proposed new Stirling Care Village currently in the latter stages of planning with delivery anticipated in the next couple of years.
Plans are being developed to create an innovative new care village on the Stirling Community Hospital site. This would transform the way services are delivered by bringing a wide range of health, social care, and GP services together on the one site; with training and education opportunities for the current and future workforce an important part of the partnership vision.
Expanding the role of primary care is at the heart of the 2020 Vision and has been supported over the last 5 years through a comprehensive and wide reaching investment programme. The innovative hub procurement initiative and Frameworks Scotland 2 have been the main delivery routes for this work. Examples of projects either delivered, in construction, or in development within each of the five 'hub territories' include:
North Scotland hub territory:
- Aberdeen Community Health & Care Village
- Faithlie Dental Centre
- Forres Medical Centre
- Tain Health Centre
- Woodside Fountain Health Centre
- Inverurie Community Health & Social Care Facility
- Foresterhill Health Centre
- St. Brendan's Health Centre, Hospital & Care Home
South West Scotland hub territory:
- Dalbeattie and Dunscore
- Houldsworth(Wishaw) Medical Centre
- Hunter Health Centre, East Kilbride
- Kilsyth Health Centre
The new Kilsyth Community Health Centre was officially opened on 24th November 2015 and brings together a host of primary, mental health and community care services to create an integrated primary care service.
West Scotland hub territory:
- The Shields Centre
- Maryhill Health and Care Centre
- Eastwood Health and Care Centre
- Gorbals Health and Care Centre
- Woodside Health and Care Centre
The new Possilpark Health & Care Centre was procured using Frameworks Scotland and opened on 24th February 2014 to deliver a range of primary and community care services. The building was also shortlisted for the Scottish Design Award 2015.
East Central Scotland hub territory:
South East Scotland hub territory:
- Tranent Health Centre, East Lothian
- Gullane Day Centre and Surgery, East Lothian
- Lauder Health Centre
- Wester Hailes Healthy Living Centre
- Muirhouse, Firhill & Blackburn Health Centres
- Roxburgh Street Health Centre, Galashiels
An example of improvements made to safety in the healthcare environment is the attention given to reducing backlog maintenance within existing buildings. Over the last 5 years good practice asset management techniques have been introduced to improve the identification, risk management, and investment planning of works to reduce backlog maintenance. This has resulted in the reduction of circa £350m in the backlog initially identified in 2010, but also the identification of £200m of new backlog over the same period. These improved asset management techniques will ensure that appropriate investments decisions continue to be made between the need for service improvement and the need for continued assurance of safety in the healthcare environment.
A property's ability to enhance patient experience from a person centred health and care system is evidenced by the most recent national inpatient patient experience survey which reported, " considerable improvements in patients' rating of the overall ward and hospital environment. This improvement was seen across a number of NHS Boards and in some areas the rises were considerable". The average score for this indicator has steadily increased from 83% to a significant 89% over the last 5 years.
The accommodation used to support the treatment of people with mental health illnesses continues to be transformed across Scotland. For example, important investments in 2012 led to the opening of new facilities for the high secure State Hospital in South Lanarkshire and the Midpark acute mental health facility in Dumfries. Further investments of over £100m are also being planned for the new Woodland View / North Ayrshire Integrated Mental Health and Community Hospital facility, and a new adult mental health and IPCU facility as part of the Royal Edinburgh Campus redevelopment. These are expected to be available in 2016/17.
New State Hospital facility
A focus on early years services is another priority highlighted within the 2020 Vision Route Map and a combined investment of circa £320m in support of this initiative is being planned for the new Baird Family Hospital on the Aberdeen Royal Infirmary site, and a new Children's Hospital (plus Department of Clinical Neurosciences) which is currently being re-provided on the Royal Infirmary of Edinburgh site, due for completion around Autumn 2017.
New Children's Hospital, Edinburgh
NHSScotland's strategic investment programme is also focussed on improving service access and outcomes through, for example, the early detection and treatment of cancer. This includes a new £20m+ radiotherapy facility at the Lanarkshire Beatson satellite centre for the West of Scotland and a £30m construction project for a new Cancer Centre (the Anchor Unit) on the Foresterhill site in Aberdeen, which will link to the newly constructed radiotherapy building containing three new linear accelerators.
NHS Grampian have also been instrumental in working with a local charity to enable their development of a Maggie's Centre on the Foresterhill Health Campus in Aberdeen which offers a charity based support to people with cancer and their families and friends.
The five existing cancer centres in Scotland are also supported by a national equipment replacement programme which oversees the replacement of radiotherapy equipment with leading edge technology to deliver the best available treatment for all cancer patients across Scotland.
Furthermore, new processing / production units aimed at increasing efficiency and productivity are also currently being delivered by the Scottish National Blood Transfusion Service - SNBTS (£35m+) and NHS Tayside's (£25m+) Pharmaceutical Specials Service projects. The SNBTS facility will enable the service to make a step change in the future sustainability of service delivery, respond to an increasing demand for this service, and expand its scope of delivery to new cellular therapies. Once delivered, both projects will ensure that compliant NHS facilities are available for safe, efficient and effective delivery of these important support services.
Examples of innovation include improvements in medical equipment assets, such as the full digitalisation of breast screening equipment to enhance the speed and accuracy of diagnosis. In addition, NHS Grampian is the first NHS Board in Scotland to introduce a Robotic-Assisted Surgical System for minimally invasive procedures for prostate cancer. This technology will be available to clinically appropriate patients from across Scotland and the benefits to patients include reduction in recovery time and their stay in hospital, and a quicker return to good health.
Further examples of best practice and innovative approaches to asset management are described in Annex A.
Each of the above projects provides a sample of the positive impact that NHSScotland's strategic investment programme and other initiatives have had on NHSScotland's 2020 Vision over the last 5 years and how it will continue to do so in the future. Further information on planned investments which will continue with this focus over the next 5 years is outlined in Section 4 of this report.
1.4 Delivering Value and Financial Sustainability for NHSScotland
Value and financial sustainability has been a key driver for change, improvement and where necessary investment in asset and facilities management across NHSScotland, with initiatives of note including:
- A review of the workforce needed to plan and deliver NHSScotland's future strategic investment programme is ongoing with an emerging strategy recommending the formation of regional / geographic groupings of capital planning teams and resources. Proposals are currently being developed for submission to the Shared Services Portfolio Board in early 2016. Annex G provides a further update on the current status of this review.
- The Facilities and Shared Services Programme has been 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 Revenue Financed (including PPP/ PFI) Contracts
- Decontamination of Medical Devices
- Waste Management.
Annex G also provides an update on the current status of this whole review.
- A collaborative framework; Frameworks Scotland 2, has been created as a model of best practice to optimise project outcomes including delivery of cost and time efficiencies for publicly funded health and social care projects across Scotland. In the first two years of a six year programme there are projects with a total construction value of over £200m at various stages of delivery under Frameworks Scotland 2.
- A further procurement initiative available to the NHS, as well as other public bodies, is the hub initiative led by the Scottish Futures Trust on behalf of the Scottish Government. This has been implemented across five geographical territories across Scotland and has been one on the main delivery routes for the investment programme in primary and community care facilities.
- NHS Boards have been working on the procurement of two major energy infrastructure projects at NHS Tayside and NHS Grampian. These two projects will see circa £28.5 million invested across 6 sites resulting in energy/ GHG savings of circa £4.6million per annum and c 20,000 tCO2e.
- Since 2011, NHS National Services Scotland has embarked on a programme of consolidation and rationalisation of its office estate with a specific focus on improving asset utilisation and reducing costs whilst also providing modern accommodation capable of introducing a more agile workforce arrangement. This efficiency programme has already been able to achieve over £5m of efficiency savings in its office occupancy costs over a three year period.
1.5 Delivering Better Asset Management for NHSScotland
Since the current Asset Management Policy for NHSScotland was first introduced in 2010 through CEL35 (2010), NHS Boards have improved their approach to asset management, their performance management of those assets, and their appreciation of how their assets need to be aligned to NHSScotland's strategic investment priorities.
For example, as part of the drive towards better intelligence on NHSScotland's property assets, NHS Boards report that 4.4 million sq.m. of accommodation (94%) has been surveyed over the last 5 years through a combination of Scottish Government sponsored surveys and Boards' own assessments. This makes available a significant amount of better information and data on these assets which can be used to make more informed investment decisions in support of service driven opportunities for improvement and change.
Furthermore, improvements to NHSScotland's property asset performance over the last 5 years include:
- Over 700,000 square metres of old accommodation (over 50 years old) has been removed from the estate and, where appropriate, replaced with new, modern facilities.
- An additional 300,000 square metres of NHSScotland estate is now functionally suitable to support effective health and care service delivery.
- The effective utilisation of accommodation has improved to over 80% which reduces the financial impact of this resource and improves its effectiveness.
- Backlog maintenance has reduced by over £110m; however the full reduction achieved over the last 5 years is closer to £350m if the impact of inflation and newly identified backlog were to be excluded.
- The quality and complexity of strategic planning by NHS Boards as evidenced within their Property & Asset Management Strategies is markedly more transparent and improved from the corresponding position 5 years ago.
- Revenue cost increases associated with property asset ownership and use have remained lower than general inflation between the 2010/11 and 2013/14 reporting periods, despite increased service scope and other cost pressures.
Email: Alan Morrison, Alan.Morrison@scot.gov