CWM TAF HEALTH BOARD ANNUAL ESTATE REPORT 2011/12 & 2012/13

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1 CWM TAF HEALTH BOARD ANNUAL ESTATE REPORT 2011/12 & 2012/13 1. Introduction and Key Messages The on-going maintenance and development of the estate is a key enabler for the Health Board in terms of achieving its service strategies and plans. This report highlights the work that has been done in 2011/12 and subsequently through 2012/13 in relation to the estate, and incorporates data and information from the latest national Estates Condition and Performance Report, produced by NWSSP (Facilities Services) for 2011/12. The report for 2012/13 will not be available until Autumn The report includes a review of: the profile of the estate, improvements made and backlog maintenance requirements governance arrangements in relation to statutory and mandatory requirements, and management of risk staffing infrastructure supporting the estate management of costs associated with supporting the estate. Key messages from this report are outlined below: There has been a significant major capital investment in the estate serving the Merthyr and Cynon valleys over the last few years, in line with the previous Estates Strategy for North Glamorgan NHS Trust. These populations now benefit from some of the newest estate in Wales, which has transformed the environments of care. There have been a number of primary care estates developments which have enhanced the ability to provide a modern primary care service. There remains a risk adjusted backlog maintenance cost of 20.8m, which is a reduction from 2010/11 and which will reduce further following the vacation of Aberdare, Mountain Ash and St Tydfil s Hospitals. National performance indicators relating to the condition and usage of the estate for 2011/12 are in the amber category. The national performance indicator for fire safety is in the red category, related in the main to issues at Prince Charles 1

2 Hospital, which continue to be improved through major capital schemes. There was an increase in overall energy efficiency of the estate in 2011/12, but there remains significant room for improvement, particularly in relation to RGH. Energy consumption has increased in 2012/13. The energy management plan is designed to reduce consumption by 7% every year over the next 3 years. Governance structures are in place for the management of the estate, with roles, responsibilities and accountabilities clearly defined. Statutory and mandatory compliance issues are managed well, although there is currently a risk relating to the ability of the estates maintenance team to undertake all statutory and mandatory planned preventative maintenance tasks. An action plan is in place to improve this situation. The number of staff supporting the maintenance function has decreased and there are difficulties relating to high sickness levels and vacancies. However, work is in progress to develop a staffing strategy going forward, in consultation with unions and front line staff. Significant savings were made in 2011/12 and savings schemes were also implemented in 2012/13. Benchmarking work is underway to identify further areas for investigation and action. 2. Current Estate Profile 2.1 Property Profile As at the end of March 2011/12, Cwm Taf Health Board managed 2 District General Hospitals, 7 community hospitals, and 25 health centres and clinics. Within Primary Care, GPs own and manage a large number of premises, many of which the Health Board shares or utilises to some extent. The profile at the end of 2012/13 was significantly reduced, with the sale of a number of properties during this financial year. 2.2 Major Capital Investments The two predecessor Trusts, North Glamorgan NHS Trust and Pontypridd and Rhondda NHS Trust had agreed Estates Strategies, and work has been progressing in line with these plans for a number of years. 2

3 In the Merthyr and Cynon Valleys, there is an on-going major estate modernisation programme, replacing out-dated hospitals and health centres with new, modern facilities fit for the 21 st century. The major elements of this programme through 2011/12 and 2012/13 are outlined below: In 2011/12, Ysbyty Cwm Cynon (YCC) was opened in Mountain Ash, and the old Mountain Ash and Aberdare Hospitals were closed. The 56m scheme to refurbish 12 wards at Prince Charles Hospital (PCH) continued through 2011/12 and was completed in 2012/13. This scheme is designed to address serious fire safety and asbestos issues at the hospital, but also delivers modernised wards, with a much improved environment of care. Work on the 22m project to build a new state of the art Emergency Care Centre at PCH continued through 2011/12 and was completed in May The new Day Surgery Unit at PCH was completed in June 2011, comprising 2 new operating theatres, separate waiting areas for adults and children and 9 bed spaces. Construction work continued through 2011/12 on the 34m scheme to build the Keir Hardie Health Park in Merthyr Tydfil, and the facility was commissioned in October This allowed St Tydfils Hospital and the Hollies and Seymour Berry Health Centres to be vacated. In April 2011, work commenced on the development of the Strategic Outline Case for the refurbishment of ground and first floors at Prince Charles Hospital. Similarly to the ward refurbishment scheme, this is driven by the need to address fire safety and asbestos issues, but provides an excellent opportunity to remodel and modernise many key clinical services. The SOC was submitted in October 2011 and was formally approved in May The more detailed Outline Business Case was submitted in February Primary care improvements The 2 predecessor organisations had detailed Primary Care Estates Strategies in place, and significant work has been undertaken to renew the estate in this area. During 2011/12 and 2012/13 the following progress and improvements have been made: Hirwaun Medical Centre: this is a third party developer scheme, which has replaced an old health centre with a 3

4 purpose built surgery, incorporating community staff and a pharmacy. The centre opened in August Ashgrove Surgery: This town centre practice in Pontypridd had no potential to expand, but secured Welsh Government funding to carry out a substantial remodelling of the surgery to create additional clinical rooms, a new reception facility and administration area and a new record store. Aberdare Primary Care Centre: Progress is continuing to identify a way forward for the GPs and community staff currently located in the health centre. Aberfan clinic: This clinic was significantly remodelled in 2012 through discretionary capital funding to allow for an urgent relocation of GP services. 2.4 Age Profile This programme has been achieved through significant capital investment from the Welsh Government over the last 5 years. It has allowed the Health Board to significantly reduce the age profile of its estate, as demonstrated in the figure below: 26% 30% 0% 1% 16% 0% 0% 11% 9% 10% 16% 48% 24% 9% 2001/ /12 Figure 1: Age profile of the estate in 2001/02 and 2011/12 Further significant improvements will be evident at the end of 2012/13 given the sale and disposal of a number of sites. 4

5 2.5 On-going improvements to the estate The Health Board has used its Discretionary Capital Allocation and additional funds secured through gain share and disposal income to take forward smaller schemes to improve the estate. Schemes are either designed to support service redesign / improvement or to improve the safety / compliance of the estate in line with legislation or guidance. Examples in 2011/12 and 2012/13 include: 2011/12 Refurbishment and expansion of the Central Production Unit, providing the capacity to move to cook freeze service across the organisation Redesign of the Acute Mental health facilities at RGH to support the new service model for centralised acute mental health services Refurbishment of Maerdy ward at YGT to support the relocation of low secure patients previously placed outside the catchment area Significant refurbishment of Pinewood House to ensure the facility met required standards and to increase capacity Refurbishment of WHSCC offices to provide fit for purpose accommodation Schemes to improve fire safety at Prince Charles Hospital following the receipt of two Fire Enforcement Notices in December 2011 On-going work to ensure compliance with Asbestos regulations Work to repair and replace a number of flat roofs at PCH which were leaking and causing operational difficulties for clinical departments. 2012/13 Transfer of Trecynon ward and the crisis team from St Tydfils Hospital to PCH, enabling significant improvements in the model of care Conversion of one of the day surgery theatres to laminar flow, allowing an expansion of capacity for orthopaedic and trauma work, and potentially improving infection rates Improvements to Seren Ward at RGH to facilitate the care of patients with different care needs in more appropriate environments, and to ensure safety for the staff Upgrade of the radiology interventional room at Royal Glamorgan Hospital (RGH) Upgrade of ventilation systems within the HSDU at RGH to ensure compliance with the relevant guidance 5

6 Upgrade of fire alarm systems at RGH to L1 standards, as part of a programmed approach A range of spend to save schemes designed to make the estate more energy efficient. The staff within the Estates department also work on a constant basis to maintain and improve the estate. In 2012/13 there were a total of 66,000 hours worth of work requested via the estates helpdesk and, looking forward to 2013/14, a requirement to undertake 32,000 hours of work for planned maintenance. 2.6 Condition of the Estate Even with all of the capital investment and on-going work from the Estates department, there remains a significant backlog of maintenance work required, as presented in the national 2011/12 Estates Condition and Performance report. The figure below identifies the 2011/12 Risk Adjusted Backlog (RAB) costs and compares them with the figures submitted for 2010/11. The backlog costs are broken down by risk category as these, together with an estimated remaining life of the building are used to calculate the RAB costs. It can be seen that, compared with the previous year, the RAB costs have decreased by almost 7.8m, largely as a result of the refurbishment works at Prince Charles Hospital. Site Name High risk backlog cost Significant risk backlog cost Moderate risk backlog cost Low risk backlog cost Risk adjusted backlog cost Risk adjusted backlog cost Variation in risk adjusted backlog ( ) ( ) ( ) ( ) ( ) ( ) ( ) Aberdare Hospital 3,332, ,752 1,979,507 1,484,632 4,450,162 4,445,581 4,581 Dewi Sant Hospital 38,110 55,953 18, ,702 94, Mountain Ash General Pontypridd & District 2,854, ,900 1,474,069 2,024,511 4,042,599 3,964,672 77,927 46, ,090 10, , , PCH 7,224,452 2,274,632 4,836,701 5,625,833 9,872,746 15,861,315-5,988,569 RGH 0 504, , , , ,524-14,556 St Tydfil's Hospital 155, , , , ,966 2,776,632-1,966,666 Tonteg Hospital 20, , , , ,200 1,088 YCR YGT 10, ,680 46,350 29, , ,903-20,106 CT - Aggregated Site Health Board Totals 207, , , , , , ,634 13,889,045 6,068,507 9,834,999 10,177,032 20,844,558 28,633,188-7,788,630 6

7 The RAB costs will improve in some areas at the end of 2012/13, for reporting purposes, with the disposal / vacating of Aberdare, Mountain Ash and St Tydfils Hospitals. However, a more robust and realistic approach to the assessment of backlog maintenance for the 2012/13 returns will mean that in some areas, costs are likely to increase. The national Estates Condition and Performance report for 2011/12 highlights the Health Board s performance against the national performance indicator relating to overall physical condition as outlined in HBN Estatecode (% achieving physical condition category B or above). Cwm Taf s performance, along with all other Health Boards performance is set out in the figure below (the national target is 90%): 2.6 Utilisation of the Estate The Estates Condition and Performance report highlights Cwm Taf s performance in relation to the functional suitability of its estate, together with space utilisation (this indicator again relates to the % of the estate that reaches category B for functional suitability and space utilisation, as outlined in HBN Estatecode). The figures below set out the performance across Wales for these two performance indicators (targets are 90%): 7

8 Cwm Taf s performance on functional suitability is skewed considerably by the fact that, for 2011/12 Aberdare, Mountain Ash and St Tydfil s Hospitals were part of the returns and they had very low reported functional suitability and space utilisation. Performance in 2012/13 will be significantly improved in some areas as these properties have now been vacated. However, a more robust and realistic assessment of functional suitability for 2012/13 may alter performance in some areas. 8

9 2.7 Energy Performance In 2011/12 hospitals in the Health Board recorded a net energy consumption of 69,830,576 kwh, a decrease of 2.36% on the previous year s figure. The total cost of energy and utilities in 2011/12 was 4.7m, which includes electricity, gas, water, sewerage, oil and other energy areas. Energy performance is measured nationally through an energy performance indicator, which measures kwh/m2 for hospital sites. The Cwm Taf position was a performance of 426 kwh / m2, denoted as an amber performance. Green represents a performance under 401 kwh/m2. The performance in 2011/12 by site is shown in the table below. Whilst the figures show an overall improvement in energy efficiency. However, it should be noted that the Royal Glamorgan Hospital, the largest energy consumer in the Health Board, is now in the red zone with a consumption increase on last year s figures. The Combined Heat and Power (CHP) installations at both Royal Glamorgan and Prince Charles Hospitals did not operate fully in 2011/12 and maximising the use of these is a priority for the Health Board. Hospital Net Hospital Energy Consumption Change on Previous Year Site PI (kwh) (%) (kwh/m 2 ) Aberdare General Hospital 3,835, % 355 Dewi Sant Hospital 2,507, % 280 Mountain Ash General Hospital Pontypridd & District Hospital 898, % , % 335 Prince Charles Hospital* 24,170, % 462 Royal Glamorgan Hospital* 25,841, % 506 St Tydfil's Hospital 4,507, % 342 Tonteg Hospital 684, % 418 Ysbyty Cwm Rhondda 4,300, % 299 Ysbyty George Thomas 2,255, % 420 LHB Totals 69,830, % 426 * Site with CHP installed Key Energy performance: 410 kwh/m 2 or below Energy performance: kwh/m 2 Energy performance: 480 kwh/m 2 and above 9

10 An energy management plan has been developed with the aim of decreasing energy consumption by 7% every year for the next 3 years. Components of the plan include strengthening corporate commitment through introduction of a Lead Director for Energy Management, making energy everyone s business through launch of an energy awareness campaign and investing in a suite of energy reduction schemes (e.g. CHP, LED lighting). 3. Governance Arrangements 3.1 Governance Structures Responsibility for the management of Estates Maintenance moved from the Director of Corporate Services to the Director of Planning and Performance in November 2011, following a report from the Director of Facilities Services (NWSSP). This was designed to align capital and estates functions more closely. Responsibility for Fire Compliance remained with the Director of Corporate Services. During the period of this report, the structures for managing governance have therefore changed. The current structure, introduced at the beginning of 2012/13 is outlined in Appendix 1. A structure is also in place for the management of capital investments which includes responsibility for managing the risks associated with both the major capital schemes and the Discretionary Capital Programme, again outlined in Appendix 1. Clear responsibilities and accountabilities for certain aspects of the estates function are set out in a series of Heath Technical Memoranda (HTM) and include roles for Designated / Responsible Persons, Authorised Engineers (AE), Authorised Persons (AP) and Competent Persons. A full list of the people currently fulfilling the AE and AP roles are attached as Appendix 2. Within Estates, responsibility for governance lies in turn with the Assistant Director of Planning, the Head of Estates and the Head of Compliance / Senior Estates Manager. Two members of staff are employed to support the compliance agenda. The compliance agenda is monitored and audited via the Governance and Performance team who currently sit within the Facilities Directorate. 10

11 3.2 Statutory and mandatory compliance National Statutory and Compliance Performance The national Estates Condition and Performance report for 2011/12 outlines the following performance in relation to 2 measures on statutory compliance: % of estate in condition category B for statutory and safety compliance (excluding fire safety); and % of estate in condition category B for fire safety. 11

12 The poor fire safety performance is related almost entirely to fire safety issues at Prince Charles Hospital. On-going work at Prince Charles Hospital on the ward refurbishment scheme and ground and first floor scheme will significantly improve performance against this measure. The most accurate way of measuring performance against these targets would be to undertake a full condition survey of the estate, as outlined in the HBN 00-08: Estatecode, published by the Department of Health. Unfortunately, full surveys have not been undertaken within Cwm Taf or its predecessor organisations for many years. As a result, performance is assessed via a desk top exercise, which may not reflect accurately the true position. It will be important going forward for condition surveys to begin again, potentially spread over the coming 2 or 3 years. For the 2012/13 returns, a more robust approach is being taken to this work, using capital planning and estates staff Compliance Scorecards Within Wales, as outlined above, there are a series of HTMs which set out the best practice in relation to key aspects of statutory and mandatory compliance: HTM Medical Gas Pipeline system HTM Specialist ventilation in healthcare premises HTM The Control of Legionella HTM Guidance on functional provisions for healthcare premises (fire) HTM Operational provisions (fire) HTM Electrical services supply and distribution HTM Electrical safety guidance for low voltage systems HTM Electrical safety guidance for high voltage systems A series of internal compliance scorecards have been developed, which in essence list all of the standards which need to be complied with, arising from the HTMs and relevant legislation / guidance. Examples might include: Requirement to appoint an Authorising Engineer for High Voltage Requirement to have an up to date Asbestos Management Plan for the organisation Requirement to have an annual verification check undertaken on ventilation systems for specialist areas 12

13 Evidence of compliance against each standard is collected via the Facilities Governance team and an assessment is made as to the risk remaining to the organisation. The following table shows the risks in the various scorecards and improvements from 2011/12 onwards. Estates Governance Scorecard Progress Number of High and Significant Risks Compliance Element Jan- 11 April July Oct Jan- 12 April July Oct Jan- 13 Legionella April Low Voltage High Voltage Asbestos Medical gases Energy Ventilation Decontamination Environmental 1 1 Estates Estates Fire Total The table above shows the significant progress that has been made in reducing identified high risks in these areas. However, whilst some of the reduction relates to actions which have actually brought us into compliance, other reductions relate merely to the correct evidence being supplied to the governance team Compliance with PPM schedules The Estates software system contains details of all Planned and Preventative Maintenance tasks that are required throughout the year. These are divided into those that are of a statutory or mandatory nature (for example, weekly checking of benchtop sterilizers), those that are essential in nature and those that are classed as good housekeeping. 13

14 The system provides a monthly report into how many of these tasks have been completed. The target is for 100% of statutory and mandatory tasks to be complete, 75% of essential and 50% of housekeeping. The performance at the end of March 2012 and as at March 2013 was as outlined below: March 2012 March 2013 Statutory PPM tasks 97.45% 85.6% Mandatory PPM tasks 45.34% 57.8% Essential PPM tasks 60.27% 64.0% Good Housekeeping 59.02% 55.9% Tasks These show that performance remains of concern in relation to statutory and mandatory compliance. The main reason for this during 2012/13 was the high levels of vacancies and sickness which have reduced the hours available to undertake this work. A full action plan has been in place to address these issues. The vacancies are now all filled, although work is continuing in relation to training up the new starters to ensure that they can fulfil the totality of their role. Other actions include the identification of further options to improve the efficiency of the department. One such option currently being explored, and is now agreed, is to move responsibility for the weekly testing of benchtop sterilizers to users. This would release approximately 1 w.t.e. to undertake other duties Specific Statutory and Mandatory issues Outlined below are the key areas of progress that have been made through 2011/12 and 2012/13 and includes areas of remaining work. Further to discussions with NWSSP Facilities Services, the intention in future years is for the Health Board to receive one composite and summary report covering all of these areas which will form part of the Estates Annual Report. Asbestos: The major programme of asbestos removal at Prince Charles Hospital has continued through the ward refurbishment programme, and the Outline Business Case for the refurbishment of the ground and first floors will ensure that 14

15 the remaining asbestos on this site will be removed over the next 5 years. Commissioning of new buildings and disposal or demolition of older buildings has continued to significantly reduce risk associated with asbestos. An Asbestos Surveyor / Compliance officer has been appointed by the Health Board to assist with asbestos management. During the period covered by this report, the Asbestos Management Plan has been updated and has been agreed by the Health and Safety Executive. Continuation of statutory in-house training, as well as Toolbox talks are in place and these regularly update staff on procedures relating to asbestos. Nationally, a report into concerns raised in West Wales has been published, and as a result of the recommendations in this report, a national audit has been undertaken into asbestos management. The Health Board has recently submitted its self assessment and has been informed that it is considered, on the basis of this assessment, that it is meeting its requirements under the Control of Asbestos Regulations Water Safety: Key progress includes the approval of a Legionnella Policy for the organisation. A detailed procedure is currently being finalised. The Legionnella compliance group has been rebranded as the Water Quality group, which covers all water borne pathogens. Instigated procedures to cover issues such as pseudomonas Actions instigated, in collaboration with the service and with Infection Prevention and Control, to deal with 2 instances of high incidence of pseudomonas in SCBUs at RGH and PCH, with issues now resolved. An external assessment is currently being undertaken across all areas of the Health Board which will inform of any actions that need to be taken in relation to Legionnella. It is a requirement to undertake these assessments every two years. Ventilation: During the period of this report, a critical report (undertaken by NWSSP - Facilities Services) was received on the theatre ventilation systems at RGH. A series of urgent actions were taken to address the immediate issues and minimise the risks identified. A long term action plan is being developed which will require capital investment to eliminate risks permanently. 15

16 A large capital scheme was completed in 2012/13 to address ventilation issues within the HSDU at RGH. At PCH interim upgrades have been undertaken on theatre plant, with new systems planned as part of the ground and first floor refurbishment A theatre ventilation group has been established for the Health Board. A ventilation policy is in draft. High Voltage: Work has continued on the development of a policy for the organisation. Appropriate maintenance continues to be carried out by an approved external contractor. Low Voltage: Work has continued on the development of a policy for the organisation, which will now be going through the final approval route. Continuation of the 5 year electrical testing via the capital programme. Replacement of fuse boards at Dewi Sant and RGH hospitals as part of a rolling programme Medical Gases: Work has continued on the development of a policy for the organisation, which will now be going through the final approval route. Infrastructure work undertaken at RGH. New vacuum plant at PCH as part of the ward refurbishment scheme, with upgrading of the liquid oxygen system recommended as part of the ground and first floor scheme. Fire Safety: Enforcement notice on the central core Prince Charles Hospital was removed at the end of June 2011 following completion of works. Significant capital scheme (c 1m) undertaken at PCH to address interim control of fire spread measures in advance of the major capital scheme which will address all fire safety issues on the ground and first floor. Fire enforcement notice on ground and first floor at PCH has been extended to June Capital schemes have been in place to address other aspects of fire safety, including replacement of fire doors across the site and upgrade of fire alarm systems to L1 standard. 16

17 On-going emphasis on fire safety training across the Health Board, with particular emphasis on PCH in line with the increased risks associated with that site. 3.3 Risk Register The Estates Department maintain a comprehensive risk register that is reviewed at each Governance meeting. The Governance team within Facilities are the holders of the register in the sense that they check evidence when risks are to be reduced or removed from the register. The highest current area of risk is the inability to comply fully with statutory and mandatory requirements as outlined above. Other risks can be summarised into the following areas: Inability to replace items of plant or equipment which are nearing the end of their life due to restricted levels of capital funding Inability to upgrade or repair buildings / grounds to current standards due to restricted levels of capital funding Requirement to update processes and procedures internally Management of Health and Safety A number of concerns have been raised internally by the Head of Estates and also by the corporate Health and Safety Department, that some aspects of health and safety management need to be improved. An audit recently undertaken by the Health and Safety Department as part of the national Thematic Audit of Health and Safety has identified weaknesses in relation to developing and updating risk assessments. Work is on-going to develop an action plan to improve this area of governance Audit report During the period of this report, the Internal Auditors have undertaken an audit of the following elements of the estates function: Development of the Estates Strategy Compliance with statutory and mandatory planned preventative maintenance and responsive repairs The Estates structure with regard to governance and performance. 17

18 Overall, the report has been given a high risk classification. The 3 high risks identified in the report were: a lack of a formal Estates Strategy in place for the Health Board a number of areas of weakness around the internal performance balanced scorecard, particularly around the fact that there was no formal mechanism for reporting this data no mechanism in place to identify and monitor statutory and mandatory PPM tasks that are performed by external contractors. A number of actions have been taken to address these areas of weakness: An interim Estates Strategy was agreed by the Executive Board in February 2013, with a final strategy to be completed by October A member of staff has been dedicated to working to resolve the issues relating to monitoring of external contracts. A formal written report is taken to each meeting of the Governance Board relating to performance. 4. Staff Management 4.1 Staff profile At the end of 2011/12 there were 90 staff in post within Estates Maintenance. This included a number of vacancies. A total of 8 VERs were approved during 2011/12. At the end of March 2013, a total of 88 staff were in post. During 2012/13, there have been a significant number of staff leaving. Some have retired, but a number of younger staff have also left as, nationally the Estates Recruitment and Retention premium has been taken away and they have been able to find work of higher pay elsewhere. The structure included 3 senior managers, 4 senior estates officers, 7 supervisors, x tradesmen and 2 apprentices. During 2012/13 one of the senior management posts and one of the electrician posts has been lost as part of the savings programme. Within the capital planning team, there are 17 staff. There are currently no recruitment or retention issues in this group of staff. 18

19 4.2 Sickness Management Sickness levels for the last 12 months are outlined in the table below. Sickness levels have traditionally been high in this group of staff. The majority of the sickness relates to long term sick leave, which is in part due to the age of the workforce, and to the nature of the work involved within estates. The 2 significant falls in sickness rates coincide with the termination of a number of staff who had been on long term sick leave. There are very low levels of sick leave within the capital planning team PDP compliance Completion of PDRs was low in 2011/12, with only 7% of the estates department complete at the end of March However, significant improvements were made during 2012/13 and as at the end of March 2013, 73% of estates staff and 100% of capital planning staff had had their PDP Training There is a significant training requirement for staff within the estates function, due to the statutory and mandatory nature of their work. In particular, there are requirements for Authorised Persons and Competent Persons to complete regular training in each of the 19

20 specialist areas, as laid down in the relevant HTM. Training records are currently being updated and a training programme identified Staffing strategy A number of proposals for changing the staffing structures within estates are being consulted on currently. These include changes to the on-call arrangements, shift patterns and the introduction of more flexible working. Staff are identifying a number of other alternative proposals which will also be considered. In developing a staffing strategy going forward, consideration will also need to be given to the fact that a number of staff have recently lost their national Recruitment and Retention Premium, which is affecting ability to retain staff. A review of management arrangements and structures are also being carried out in capital planning and estates in line with the Health Board s back office review. 5. Financial Performance 5.1 Budget In 2011/12 the Estates Maintenance budget was approximately 9.6m. In that year, the full year effect of the savings made equated to 8.8% of the budget. The majority of the savings came from a significant number of VERs approved. In 2012/13, the current budget was c 9m and included a 6% saving target of 522k and a specific site rationalisation savings target of 144k in relation to the closure of Aberdare, Mountain Ash and St Tydfil s Hospitals. The budget is broken down approximately as 2.5m pay, 2.1m non-pay, 4.6m energy and 200k income. As at March 2013, there was an overspend of 884k, which was attributable in the main to utilities consumption ( 516k, due to exceptionally cold winter) and to a one off issue surrounding leases for Triangle Park ( 200k). 5.2 Savings Plans A savings plan was developed for 2012/13 which totalled 272k. The savings plan included: Workforce reductions and reconfigurations totalling 128k, equivalent to a 4.4% reduction in pay costs in year 20

21 Energy savings schemes, including a number of capital spend to save investments Non pay savings The majority of the specific savings have been realised, but have been masked by a significant increase in energy costs. For 2013/14, a saving plan has been developed with a probability adjusted saving of 269k. This includes: energy savings achieved through energy awareness campaign reduction in the number of leased buildings further non pay savings. 5.3 Benchmarking analysis NWSSP Facilities Services are currently undertaking a benchmarking exercise in relation to estates maintenance costs across Wales. A report is due from them shortly (June 2013), and this will be used to identify any areas for consideration or concern. In addition, the national EFPMS data includes benchmarking analysis of building and engineering costs per square metre of occupied space. The results of this data for 2011/12 are set out in the table below: /m Building and Engineering costs / occupied area This data appears to show that the cost per square metre in Cwm Taf Health Board is higher than a number of other Health Boards across Wales. However, there are caveats to this data in that, in the past, there has been little internal and no external validation of data 21

22 submitted making comparisons potentially difficult. Work is now ongoing with the Director of Finance to both improve the accuracy of our internal data and to compare with data from England. This again will provide some information on areas where further attention is required. 6. Conclusion Significant improvements have been made to the estate in the last 2 years through investment in major capital schemes and through allocation of discretionary capital. However, there remain areas where further funding and work is required to ensure that the estate appropriately supports the organisation s key service objectives and meets all statutory and mandatory requirements. The organisation s Estates Strategy, which will be finalised in October 2013, will set out how these objectives will be delivered within the capital and revenue resources available. 22

23 Appendix 1 Governance Structures for Capital and Estates Matters Corporate Risk Committee Workplace Safety and Health Capital and Estates Governance Board Asbestos Advisory Group Medical Gases Group Ventilation Group Water Safety Group The Ventilation and Water Safety Groups also report up via the Infection Prevention and Control groups to the Clinical Governance Committee. Capital Programme Board Executive Capital Management Group Programme Management Team (Major schemes and disposals) Capital Monitoring Group (Discretionary Capital) Various Project Boards / Teams for each major capital scheme 23

24 Appendix 2 - Schedule of Authorising Engineers, Appointments and Reports to Cwm Taf Health Board Authorising Engineer Role High Voltage Authorising Engineer Simon Russell Appointed by the Health Board Health Board Authorised Persons Prince Charles Peter Howells Neil Normanton Mark Thomas Royal Glamorgan Peter Howells Paul Lewis East Glam Laundry Peter Howells Medical Gases John Tidball Royal Glamorgan Alun Evans Peter Howells Prince Charles AP assessments are pending with Colin Brennan as the contact point Ventilation Kevin Ridge Prince Charles Dave Swetman Neil Normanton Alun Evans Royal Health Technical Memorandum HTM Electrical Safety Guidance for High Voltage Systems HTM Medical Gas Pipeline Systems HTM Specialised Ventilation for Healthcare Premises Reports Tri-annual Reports Royal Glamorgan : Nov 2010 (Next due Nov 2013) Prince Charles: Jan 2012 (Next due Jan 2015) East Glam Laundry :Nov 2010 (Next due Nov 2013) MGPS Inspection Reports Royal Glamorgan Prince Charles MGPS Audit Report Royal Glamorgan: Aug 2012 Site Specific Reports 2012 Royal Glamorgan Hospital Obstetrics theatre Obstetrics room 6 Theatre 10 24

25 Authorising Engineer Role Authorising Engineer Decontamination Graham Stanton Fire Safety Anthony Pitcher Appointed by the Health Board Health Board Authorised Persons Glamorgan Stewart Bayliss Michael Green Health Technical Memorandum n/a HTM Decontamination of Re-usable Medical Devices Mark Swift Brian Sparks Phil Keelan Keith Cotter HTM Management of Healthcare Fire Safety Reports Pacing Theatre SCUBU ITU Operating theatres(report to be issued) Prince Charles Hospital Operating Theatres Prince Charles Hospital Porous Load Sterilizers Validation Report Royal Glamorgan Hospital Porous Load Sterilizers Validation Report Washer Disinfector Validation Report Pathology Laboratory Sterilizers Validation Report Steam Quality Validation Report Prince Charles Hospital Independent Review of Fire Safety: May 2008 Main Kitchen Extract Ducts Fire Risk Assessment: October