Annex B: Review of NHSScotland's Property Assets
This Annex provides a detailed analysis of property, vehicles, medical equipment and IM&T asset performance which supports the summarised information provided in the main body of the report.
The responsibility for the management of NHSScotland's assets rests with 14 NHS Boards and 8 Special NHS Boards.
The information presented in this annex combines information from all 22 NHS Boards and Special NHS Boards, however, some 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.
It should be noted that all information presented in this section is broadly based on April 2015 information, unless otherwise stated.
NHSScotland owns physical assets that are worth circa £6.3billion. Most of these assets relate to the estate (land and buildings) which are estimated to be worth £5.7 billion. Other significant fixed assets which are owned are vehicles, medical equipment and information management and technology (IM&T) assets. An estimate of the Net Book Value of these owned assets is shown in the chart below.
Net Book Value of NHSScotland Assets (Total £6.3 billion)
Taken from information returned by each NHS Board
The NHS also has assets which it does not own including buildings, vehicles, medical equipment and IM&T. These assets are estimated to be worth a further £1.5 billion, the majority of which are hospitals and health centres managed under Public Private Partnership ( PPP) agreements. Also, the majority of cars used by NHSScotland staff are leased, with staff paying for their own non-business element of these leased vehicles.
In addition to the NHSScotland owned and leased property assets, there are numerous smaller properties used to provide a range of community and family health services provided by GPs, Pharmacists, Dentists and Opticians, many of which are owned or leased by these independent practitioners themselves and paid for indirectly by the NHS through a range of charging and re-imbursement mechanisms.
The NHSScotland estate comprises circa 4.5 million sq.m of building floor area encompassing buildings ranging in size from 40 sq.m to 200,000 sq.m. The majority of this is the hospital estate of the 14 NHS Boards and 2 Special NHS Boards ( NHS National Waiting Times Centre and the State Hospitals Board). The 2014 ISD Cost Book records this hospital estate as 220 hospitals with a total building area of 3.42 million sq.m. This is broadly similar to that reported in last year's SAFR.
The other property types that account for the further 1.1 million sq. m. includes health centres & clinics, day centres, offices, residential accommodation, and industrial / storage units.
The table that follows shows an analysis of the hospital estate by type of hospital in terms number of sites and building area.
|Acute||Long Stay||Mental Health||Psychiatric & Learning Disabilities||Community||Other||Total|
|Number of Hospitals||38||45||35||13||66||23||220|
|Percentage of total area (rounded)||65%||8%||12%||1%||6%||7%||100%|
The above table shows that whilst community hospitals are the most numerous (66) they only represent 6% of the total hospital estate in terms of building area i.e. a large number of small hospitals. In contrast, the 38 acute hospitals account for 65% of the total hospital estate in terms of building area.
The overall number of hospitals has reduced by eight since last year as they have either closed or are now used for other purposes.
It should also be recognised that a number of the hospitals included in the broad categorisation of "Long Stay Hospitals" includes hospitals with acute long stay beds, psychiatric long stay beds and psychiatric day hospitals. These hospitals may also have other types of beds which are not classified as "long stay".
Providing services more locally is an integral part of the 2020 Vision and this is expected to have an impact on the size and distribution of the hospital estate. Subsequent changes in the hospital estate will continue to be monitored as part of SAFR in future years.
The current distribution of the hospital estate (by numbers of hospitals and by area sq.m) across the Boards is shown in the tables that follow.
|Distribution of hospitals (numbers) across the NHS Boards|
|Board||Acute||Long Stay||Mental Health||Psychiatric & LD||Community||Other||Total|
|NHS Greater Glasgow||8||6||8||1||0||5||28|
|NHS Dumfries & Galloway||2||3||2||2||6||3||18|
|NHS Ayrshire & Arran||3||3||1||1||3||0||11|
|NHS Forth Valley||1||1||3||1||3||0||9|
|NHS Western Isles||1||0||0||0||1||1||3|
|Distribution of hospital estate by area (sq.m)|
|Board||Total area sq.m||Percentage of NHSScotland Total Area (rounded)|
|NHS Greater Glasgow||923,670||27%|
|NHS Ayrshire & Arran||206,092||6%|
|NHS Forth Valley||148,574||4%|
|NHS Dumfries & Galloway||74,656||2%|
|NHS Western Isles||21,360||1%|
The majority of the NHSScotland estate is owned (78%) but for some NHS Boards PPP/ PFI (including NPD and hub) and leased property is a significant proportion of their estate, as shown in the charts that follow.
2015 Estate Tenure
Tenure profile above includes all 22 NHS Boards and Special NHS Boards, where information is available
2015 Tenure Comparison - NHS Boards
The majority of office accommodation occupied by Special NHS Boards is leased.
2015 Tenure Comparison - Special Health boards
NHSScotland occupies approximately 1,087,000 sq.m (23% of the total) of relatively new / modern accommodation (i.e. less than 10 years old), which is an increase of 418,000sq.m since 2011, and is evidence of the significant capital investment in property assets over recent years. There does, however, remain 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 21% of the estate remains over 50 years old (note that some older properties are refurbished to modern standards rather than replaced). This age profile has improved from that reported in the 2014 SAFR report, with the percentage of properties less than 50 years old increasing from 75% to 79%.
2015 Estate Age Profile
Age profile above includes all 22 NHS Boards and Special NHS Boards
2015 Age Profile Comparison - NHS Boards
2015 Age Profile Comparison - Special Health boards
The Board's report that 66% of their estate is in good physical condition (category A or B) with 29% requiring investment to improve its condition (category C) and 5% being unsatisfactory and requiring major investment or replacement (category D).
2015 Estate Physical Condition Profile
The proportion of the estate in good physical condition of 66% is higher than the 59% reported in the 2014 SAFR. Boards advise that this is as a result of new property assets becoming available this year; such as the Queen Elizabeth University Hospital in Glasgow, and the rationalisation of parts of the NHSScotland estate following completion of associated property replacement projects.
The two charts that follow highlight the variance in condition across the NHS Boards.
2015 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 is being used by NHS Boards to link their property improvement needs and their strategic & service plans for improvement included within their PAMS.
NHS Boards which have buildings assessed as category D - "unsatisfactory" have indicated that they have plans in place to either dispose, replace, or improve these buildings over the next 5-10 years.
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 81% of the NHSScotland estate is fully utilised although some under utilisation and some overcrowding is evident as shown in the chart below.
This profile has improved from that reported in the 2014 SAFR when the percentage fully utilised was 77%.
2015 Estate Utilisation
The following charts highlight that space utilisation can vary across the NHS Boards.
2015 Space Utilisation Comparison - NHS Boards
2015 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.
Estate functional suitability
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 72% of the NHSScotland estate is functionally suitable but, as shown in the charts that follow, this can vary significantly across NHS Boards.
This profile shows a significant 7% increase in the area of the estate in categories A & B compared to that reported in 2014. Boards have advised that this is as a result of the annual re-assessment of buildings for functional suitability and the completion of new, modern facilities.
2015 Estate Functional Suitability Profile
2015 Functional Suitability Comparison - NHS Boards
2015 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. This asks 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?" This survey is carried out every two years therefore the following chart showing results of the response to this question remain unchanged from last year:
Positive Patient Opinion on Hospital Environment (2014 - 2015)
Note: No data is available for the State Hospital Board
The results are positive across all NHS Boards, however, it needs to be recognised that these results are based on only one question and, therefore, can 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 2014 and 2015.
Performance Improvement of Property Assets between 2014 and 2015 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 backlog analysis excludes inflation for comparative purposes.
The national inpatient questionnaire survey now takes place every two years hence the reason why Patient Rating remains unchanged this year.
The above chart highlights performance improvement across all the main property based KPI's, except backlog per square meter (which is explained in section 2.4.1 of this report). These positive results reflect the good progress made by NHS Boards in improving the state of NHSScotland's estate. The inclusion of the new Queen Elizabeth University Hospital in Glasgow has also helped to improve this national perspective on property asset performance.
Email: Alan Morrison, Alan.Morrison@scot.gov