Property and Asset Management Strategy Document date: 2nd August 2013

Transcription

1 Property and Asset Management Strategy Document date: 2nd August 2013 (Version 12 Draft) Printed: Tuesday, 27 August 2013

2 Contents 1. Executive Summary Introduction The Property and Asset Management Strategy Process Where Are We Now? Where Do We Want To Be? How Do We Get There? Where are we now? About NHS Lanarkshire NHS Lanarkshire s existing estate Other Independent Contractor Facilities Analysis of NHSL's Property Assets The Current Status of Property Assets NHS Lanarkshire's Other Assets Where do we want to be? NHS Lanarkshire's Strategic Direction and Vision for the Future NHS Lanarkshire's Strategies and Plans to Support the Delivery of 'A Healthier Future' Other Factors Affecting the Need for Change NHS Lanarkshire's Strategic Service Plans and their Impact on Property & Other Assets Property and Asset Management Strategy The Key Focus and Targets for Change How do we get there? Planning for Future Investment & Disinvestment Investment Plan Property and Asset Management Strategy The Way Forward Implementation Plan Managing the Risks Monitoring Performance Contents Page

3 1. Executive Summary This Property & Asset Management Strategy aims to support NHS Lanarkshire's overall strategic vision and the delivery of its strategic plans by identifying and prioritising the improvements and investments necessary to its properties and other assets to support quality healthcare delivery. Two key documents currently set out the future strategic direction and vision for the Board and have shaped the proposals to continue advancing this Property and Asset Management Strategy beyond 2013, and these are: The Scottish Government s 2020 Vision Action Plan issued in 2011 which requires the Board to focus on the following principles: Integrated health & social care. Prevention, anticipation and supported self management. Day care hospital treatment is the norm where treatment in community settings cannot be provided. Highest standards of quality and safety whatever the setting. The person at the centre of all decisions. A focus on getting people back into their home or community as soon as appropriate with minimal risk of re-admission. NHS Lanarkshire's health planning framework 'A Healthier Future: A Framework for NHS Lanarkshire Strategic Health Planning ', which has the strategic aims to: Reduce health inequalities and improve healthy life expectancy Support people to live independently at home through integrated health and social care working Have hospital day case treatment as the norm, avoiding admissions where possible Improve palliative care and supported end of life services Emergent service models are needed that will deliver this strategic vision and health planning framework, hence, NHS Lanarkshire are embarking on a comprehensive review and analysis process across all its acute specialties which is expected to further inform medium to longer term investment plans from 2015 onwards. This will, however, be guided by an initial set of planning assumptions (the so-called 'givens'), which are: There will be an Emergency Department (ED) at Monklands Hospital to complement EDs at Wishaw General and Hairmyres Hospital. This will be designed to be fit for purpose with emergency assessment and treatment facilities. 1

4 Planned for greater use of outpatient and day case services reducing the number of people requiring admission as an in-patient, the net result of which will be more day case beds and fewer in-patient beds. Monklands will be the hub for Lanarkshire cancer services (though with cancer care also provided in other Lanarkshire hospitals and neighbouring NHS Boards); Wishaw General Hospital and Hairmyres Hospital will continue to operate under the existing PFI contracts and will be fully utilised to provide acute clinical services. In the meantime, there are many challenges that the property asset base faces which will need to be addressed in the short term. This includes: Investing in primary care facilities that support the drive towards delivering care closer to home, without affecting longer term changes being considered to the acute and elderly care service models. Investing in existing buildings that will improve the quality of health & social care provision and patient experience. Investing in backlog maintenance to continue the trend towards reducing the associated property related risks. Rationalising the existing building portfolio to ensure the most effective and efficient use of buildings to support service delivery Incorporating all assets into the investment prioritisation and decision making process so that resources can be focussed on greatest need and benefit. This has informed NHS Lanarkshire's current investment and disinvestment plans outlined within this PAMS which, more specifically, will deliver the following: Improve access to healthcare services for local populations through the delivery of new primary care facilities in East Kilbride, Wishaw, and Kilsyth. Develop a preferred option for locating a new Intensive Psychiatric Care Unit in Lanarkshire. Develop an implementation strategy for delivering the Reshaping Care of Older People programme. Continued investment in improving facilities and reducing backlog maintenance risks at Monklands Hospital. Continued delivery of a risk based approach to improvements to existing facilities with outstanding backlog maintenance and Statutory Compliance assessed as 'Significant'. 2

5 The total capital expenditure planned over the next 4 years to deliver these improvements is outlined in Table 1 below: Table 1: NHS Lanarkshire's 4 year Capital Expenditure profile Total Capital Expenditure 2013/ / / / m 14.29m 12.54m 12.54m This excludes the revenue based investment in the new primary care facilities in East Kilbride, Wishaw, and Kilsyth; which have an equivalent investment value of circa 54m and are currently programmed for completion in These investment plans will enable NHS Lanarkshire's property asset base to continue to improve in its condition, functional suitability, performance and reduced risks associated with backlog maintenance, and thus provide appropriate accommodation for the delivery of quality healthcare services. It will also build upon the significant capital investment undertaken in recent years which has modernised and re-shaped major aspects of NHS Lanarkshire's estate to deliver service improvement. This investment has resulted in:- Enhanced patient experience (better quality of physical environment) Improved productivity (new spaces designed for modern services) Increased efficient use of overall space (enabling disposal of surplus assets) Improved underlying building characteristics (condition, functionality, flexibility etc) Increased environmental sustainability The outcome of which can be seen in the Chart1 below which compares 10 property KPI's, as published in the annual 'State of NHSScotland's Asset & Facilities Report (2013)', between NHS Lanarkshire's performance and the average for all NHS Scotland Boards. Chart 1: NHS Lanarkshire's Property Performance Note: green bars above the horizontal axis (0%) indicate a positive improvement on last year whereas a red bar below the horizontal axis (0%) indicates a performance reduction. 3

6 The chart highlights that, overall, NHS Lanarkshire's property assets are in reasonably good condition, which is somewhat supported by its modern PFI based hospital accommodation. Also, the SCART score, which reports on the appropriate statutory compliance policies and procedures being in place across the estate, is one of the highest in NHSScotland. The chart also highlights, however, some of the continuing challenges faced by NHS Lanarkshire, particularly in relation to the overall level of backlog maintenance and outstanding Significant risks. These challenges have been considered when developing priorities for future investment plans and thus it is anticipated that NHS Lanarkshire's properties will continue to improve against these targeted and measured KPI's. Adoption of this PAMS for NHS Lanarkshire will enable the Board to move from the current position to a future position which clearly demonstrates effective investment in its properties and other assets, as well as rationalisation of buildings and land. It also aims to deliver a patient centred, safe and effective property asset based from which NHS Lanarkshire's strategic vision, aims and objectives can be delivered. This will be the second Property Strategy implemented by NHS Lanarkshire since While this PAMS identifies the way forward for the next five years, the successful delivery of the previous Property Strategy ( ) inspires confidence that optimum benefit will be efficiently delivered to service users within NHS Lanarkshire. This will provide person centred, safe and effective solutions, efficiently delivered, with management engaging clear strategic planning and assessment methodology, reinforced by detailed regular update and annual governance review. The achievements of the Property Asset Management Strategy last four years are considered to have delivered a significant improvement to the provision of community health care and to the general improvement to the NHSL Property Asset Base. These achievements are listed below:- Development of a Property Strategy Group representing all areas of NHSL supported by an Acquisitions and Disposals subgroup including representation from the CLO and Valuation Office Agency Rationalisation of service accommodation resulting in a reduction in the gross floor area of the NHSL estate from 282k sq m to 261 sq m. Provision of 7 new primary care healthcare facilities and 3 major primary care refurbishment projects This investment over a four year bundling contract of circa 85m with further partnering projects circa 40m has greatly improved the age profile of the estate, a facet that was not reported upon in the original strategy. Removal of buildings at 13 locations with planned disposal of cleared sites with reduction in backlog maintenance of 12m (outlined in Table 16). Non recurring investment of 20.9m in the Primary Care Estate has significantly reduced the Backlog Maintenance and improved the quality of the patient environment. 4

7 Additionally, investment has addressed high and significant risks in Backlog Maintenance and compliance with Statutory Standards. Termination of 7 leases with staff utilising space identified within NHSL properties resulting in an annual saving of circa 300k Reduction in the risk assessed backlog maintenance total for NHSL from 127m to 58m through rationalisation of the estate; investment in new facilities /refurbishments and utilisation of appropriate assessment processes as described above A programme of investment has taken place at Monklands Hospital to support business continuity and meet statutory compliance across a range of issues. This investment of circa 23m has been delivered by the Monklands Project Board, supported by a project team, with supply chain partners procured through Frameworks Scotland. The Project Board reports to NHSL CIG with separate reports to NHSL Risk Management Steering Group (RMSG). This work continues with new supply chain partners appointed through Frameworks Scotland 2. The report to the NHSL RMSG August 2013, is attached at Appendix 1. 5

8 2. Introduction This document updates the NHSL Property and Asset Management Strategy for the period commencing in 1st April 2013 for the four years period to 31st March The Scottish Government Health Directorate s Property Management Policy CEL 35 (2010) - A Policy For Property And Asset Management In NHS Scotland requires that all NHS Boards have property and asset management strategies that reflect the following policy aims:- To ensure that NHSScotland assets are used efficiently, coherently and strategically to support Scottish Governments plans and priorities and identified clinical strategies and models of care. To provide, maintain and develop a high quality, sustainable asset base that supports and facilitates the provision of high quality health care and better health outcomes. To ensure that the operational performance of assets is appropriately recorded, monitored and reviewed and, where appropriate improved. To ensure an effective asset management approach to risk management and service continuity. To support and facilitate joint asset planning and management with other public sector organisations This Property and Asset Management Strategy is the Board s current vision for realising the potential that its property and other assets have to play in facilitating change & improvement in service delivery and modernising the NHS, and it will develop this strategy during 2012/13 to extend its investment plans into

9 3. The Property and Asset Management Strategy Process The Property and Asset Management Strategy described in this report has been developed using a process that asks three basic questions in relation to the Board s estate: Where are we now? Where do we want to be? How do we get there? 3.1. Where Are We Now? The initial stage of developing the strategy analyses the current condition and performance of the Board s assets under the following facets: Physical condition Compliance with statutory standards Functional Suitability Utilisation Quality Environmental Management The analysis provides a consistent approach to determining the condition and performance of NHS Estate Where Do We Want To Be? This stage considers the improvements necessary in service delivery and the future provision of new models of care to address the requirements of the national and local services and policies. It aims to develop an understanding of what impact these service changes will have on the Board's assets. It also aims to set targets for improving the condition and performance of the estate and for ensuring that all assets closely align with service needs for the foreseeable future How Do We Get There? This final stage of the process involves identifying and prioritising the capital investment projects needed to deliver the Board s challenging programme for change and modernisation of services. In the current economic climate, producing a longer term investment programme is challenging and the Board will need to adapt its thoughts, and subsequent implementation processes, to match the Government reductions in available capital investment. It will also have to sustain its requirement to align the functionality of its portfolio with service needs including service development and improvement. 7

10 4. Where are we now? 4.1. About NHS Lanarkshire NHS Lanarkshire is responsible improving the health of over 563,000 people within its catchment area of responsibility. Its annual Public Health report predicts that this is expected to continue in its gradual rate of increase over the next 20 years. Other key points that NHS Lanarkshire's Public Health report highlighted about its population include: Lanarkshire s population continues to increase and is now at its highest level since Population projections for Lanarkshire indicate that there will be 27,000 more people aged 75 and over by 2031, an increase of 66%. The number of live births in Lanarkshire has increased for the first time in three years. The birth rate remains above the Scottish average. Life expectancy continues to increase in Lanarkshire but is still, on average, a year less than the rest of Scotland. More than half of all deaths in Lanarkshire in 2011 were due to the so-called big killer diseases of cancer, coronary heart disease and stroke. NHS Lanarkshire employs around 12,000 staff over a geographic area of 2,181 square kilometres. Its annual expenditure of circa 970million in 2011/12 was used to provide a wide range of healthcare services to its population, as shown in Chart 2 below: Chart 2: NHS Lanarkshire's Board Expenditure 8

11 4.2. NHS Lanarkshire s Existing Estate NHS Lanarkshire has a relatively large existing estate comprising a geographically and functionally diverse property portfolio providing circa 260,000sq.m of accommodation. There are three district general hospitals within Lanarkshire - Hairmyres, Monklands and Wishaw General Hospitals. Their location is indicated on the following map: Monklands Hospital Hairmyres Hospital Wishaw General Hospital Each of these hospitals has an accident and emergency (A&E) department and provides a range of specialist medical and surgical services. Maternity services are based at Wishaw General Hospital. Primary health care is provided in the community and includes health centres / clinics, community health centres / day hospitals; as well as general practitioners (GPs), dentists, pharmacists, ophthalmists, health visitors and a wide range of allied health professionals. Some of these represent high quality estate that is designed for modern healthcare, including Stonehouse Hospital which is provided via the PPP/PFI initiative, while others do not. Overall, services are provided from approximately 65 different sites with buildings on these sites ranging in size from 15 sq.m to 65,000 sq.m. However, the majority of these buildings are relatively small with 33 buildings less than 1,000 sq.m, as shown in Chart 3 below. 9

12 Chart 3: Analysis of NHSL property portfolio by building size March 2013 NHS Lanarkshire Property Sizes Number of Properties Less than to to to to to to to to Grater than Property area range (sq.m) 2012 Source: NHSL 3i EstateManager The net book value of owned premises is circa 150 million but in addition the Board uses property assets which are the subject of PPP/PFI agreements and commercial leases. Table 2 shows an analysis of the existing property ownership and shows that the PPP/PFI hospitals at Wishaw, Hairmyres and Stonehouse account for over a third of the gross internal area (GIA) occupied by the Board. This is one of the highest proportions for any NHS Board in Scotland. Table 2: An analysis of the existing estate by ownership Area % (GIA) sq.m of Total Area % of Total Area Year March 2012 March 2013 Owned By NHSL 142,712 55% 153,676 59% PPP 95,921 37% 96,216 37% Leased 6,778 3% 11,169 4% Other 11,739 5% 0 0% Total 257, % 261, % 2013 Source: NHSL 3i EstateManager (GIA = Gross Internal Area) 10

13 Table 3 shows an analysis of the existing estate by building type. The ratio of non-hospital space to overall space provides an indication of the extent to which the Board is shifting the balance of care from hospitals into the community which is expected to continue through the implementation of this Property and Asset Management Strategy. The table shows that non-hospital space is relatively low (25%) but this will increase as projects in this Property and Asset Management Strategy are delivered. However, it must be recognised that NHS Lanarkshire whilst retaining 3 District General Hospitals has a higher ratio of hospital areas to Primary Care areas than those Boards with only one or two District General Hospitals. Table 3: An analysis of the existing estate by building type Analysis of Existing Estate Year Area (GIA) sq.m % of Total Area Area (GIA) sq.m March 2012 March 2013 % of Total Area Hospitals 194,768 78% 195,795 75% CHP North - Health Centres, Clinics and Offices 23,806 9% 36,549 14% CHP South - Health Centres, Clinics and Offices 20,059 8% 28,717 11% Other Total: 18,517 5% 0 0% 257, % 261, % 2013 Source: NHSL 3i EstateManager There has been a small increase in overall floor area between 2012 and 2013 but the majority of this has been within the primary and community care sector thus showing evidence of the shift towards care closer to home. Table 4 shows the age profile of the existing estate. The hospital estate has a relatively large proportion of modern facilities which is heavily influenced by its two PPP/PFI hospitals. Overall, only 11% of NHS Lanarkshire's estate is over 50 years old, which presents evidence of a well balanced investment programme on property assets over the last 50 years. The main challenge in coming years will be the increasing investment needs for those properties between 30 and 50 years old, which appears a predominant issue for community healthcare properties. 11

14 Table 4: Age profile of the owned/pfi estate in 2012/13 Age Profile of the Estate Pre 1960's Post 2000 Age (Years Old) Hospitals (Area/m2) CHP North (Area/m2) CHP South (Area/m2) Other (Area/m2) Overall (Area/m2) Overall (%age) Over 50 18,399 3,912 6, ,716 11% ,003 13,865 13, ,540 32% ,245 6,305 4, ,088 46% Up to 10 12,148 12,467 4, ,717 11% 2013 Source: NHSL 3i EstateManager 195,795 36,549 28, % 4.3. Other Independent Contractor Facilities There are a range of independent contractor facilities that provide a supporting role to NHS Lanarkshire in the delivery of health and care services across the locality. This amounts to 104 medical practices, 97 dental practices, 121 pharmacies, and 94 ophthalmic opticians. 12

15 4.4. Analysis of NHSL's Property Assets Since the implementation of CEL35: 2010 analysis is now based on SGHD's Risk based methodology for Property Appraisal. This requires use of risk based methodology for property appraisal and is supported by the 3i Studio EstateManager for data management to produce information on the following facets of property appraisal information: Age Profile (including those funded under PFI/PPP) Physical Condition Backlog Maintenance Functional Suitability Space Utilisation Quality Environmental Performance NHS Lanarkshire has regularly updated its property appraisal information, including detailed physical condition surveys carried out in 2008/09, plus further updates in 2011 for Monklands and Hairmyres hospitals, and most recently in 2012/13 further surveys for the following properties: Victoria Memorial Kilsyth Wester Moffat Coathill House Coathill Hospital Udston Hospital Airbles Centre Cleland Hospital Lockhart Hospital Kello Hospital Lady Home Memorial Hospital Kirklands HQ Information obtained during these surveys has been incorporated in the 3i Estatemanager database and referenced in this document. 13

16 4.5. The Current Status of Property Assets Physical Condition The appraisal of physical condition is based on Property Appraisal Guidance for NHSScotland: A risk based methodology for property appraisal and examines individual building and engineering elements depending on the type of property being appraised and identifies the expenditure required to bring these elements back to a satisfactory condition. The appraisal of physical condition looks at the condition of the individual building and engineering elements of a property to ascertain its overall condition. The results from the appraisal of physical condition are summarised in Table 14. Table 5 also includes the three PFI/PP hospitals at Stonehouse, Hairmyres and Wishaw at condition B reflecting the contractual requirement to maintain each facility at this level for the duration of the contract term. Table 5: The physical condition of the estate Ranking Physical Condition of the Estate A Excellent as New B Satisfactory C Poor Condition D Unacceptable Year 2011/2012 Area sq.m 23, ,322 79,734 0 Percentage of the estate (area) in each 9% 60% 31% 0% category Year 2012/2013 Area sq.m 15, ,743 62,655 9 Percentage of the estate (area) in each category 6% 66% 28% 0% Percentage Change Since 1st Quarter 2011/12-3% +6% -3% 0 The results from this appraisal show that a substantial part (72%) of the estate is in a satisfactory physical condition, reflecting the recently constructed PPP/PFI hospitals and some of the new Primary Care Facilities. It also highlights an improving picture with a 3 percentage point increase between first quarter of 2012/13 to the first quarter of 2013/14. in the proportion of the estate in a satisfactory / excellent condition. However, there still remains issues to be addressed in terms of the physical condition as 28% of the estate is not currently in a satisfactory condition. 14

17 An example of continuing investment needs is at Monklands Hospital where, even following direct investment on this hospital over the last 4 years, there remains the following business continuity risks which need further investment: Non-compliance issues related to theatres & ICU. Fire safety works. Further, ongoing roof works. Further, ongoing non-compliant wash hand basins. Further, ongoing works to the nurse call system. Completion of site traffic management works. External supply pipework for oxygen and nitrous oxide. Ongoing works re laboratory infrastructure compliance. Security doors lock down arrangements. 15

18 Statutory Compliance The appraisal of statutory compliance looks at compliance with all statutory guidance and legislation related to the NHS Lanarkshire estate; including fire, health and safety, and the Equality Act Health Facilities Scotland has developed a Statutory Compliance Audit Risk Tool (SCART), a national audit system used to support Health Boards in assessing current levels of property related statutory compliance. Its premise is to ask a series of questions related to a range of 39 statutory compliance topics and associated management arrangements. The responses to these questions are scored to reflect the level of statutory compliance across each property site within the Board s control. SCART is a dynamic tool and the process of updating SCART remains fluid. This is due to factors such as demolition of redundant sites; occupation of new premises; investment in backlog maintenance; and an ongoing audit / review process. A rolling programme of reviews for individual SCART sites on a biennial basis has commenced in Lanarkshire. SCART is, however, predominantly an audit tool; hence the measure of compliance is to the specific pre-determined questions asked. It does not necessarily cover every aspect of an assurance framework for property related statutory compliance. With that proviso in mind however, it does provide a very strong tool for measuring compliance with the question set that is asked. While the appraisal of statutory compliance provides an indication of the operational performance of property maintenance it does not correlate directly with the extent of works requiring to be undertaken to address non-compliance. Processes are currently in place to review all statutory compliance matters and report to NHS Lanarkshire Board any risks that could have a detrimental impact on the primary objectives of the Board. NHS Lanarkshire has introduced a rolling programme of audits, and ongoing reviews of its systems, driven by prioritised risk assessment. The SCART Manager is working closely with maintenance managers to develop procedures linked to the new question sets within SCART. SCART 1 remains the current reporting tool; however SCART 2 is currently under development by a steering group led by Health Facilities Scotland. The most recent Steering Board meeting took place at HFS on 30 th January 2013 where NHSL was represented by the SCART Manager. An action plan was agreed to move SCART 2 forward to launch and five pilot SCART 2 topics will be added to the existing SCART 1 software within the next few months. It should be noted an average compliance score of 85.69% was achieved in 2012/13, which is one of the highest across all NHS Boards. 16

19 Table 6 lists those properties where a compliance score against the SCART question set of above 89% or below 82% has been recorded indicating the narrowing margin within which NHSL scores lie. This demonstrates a good degree of consistency across compliance in NHSL in 2012/13 although there is room for improvement. Table 6: Property Compliance with SCART Properties with a SCART Percentage score above 89% Score Properties with a SCART Score below 82% Percentage Score Hairmyres Hospital 99.25% Kilsyth HC 81.13% Stonehouse Hospital 97.15% Coathill Hospital 79.67% Wishaw Hospital 91.67% Law House 77.45% Larkhall 90.13% Red Deer Centre 89.76% NHS Laundry 89.60% Table 7 identifies those statutory compliance topics with the best and worst compliance against the SCART question set. These will be the focus of targets for improvement during 2013/14. Table 7: Top and Bottom Quartile Scoring Statutory Compliance Topics Top Quartile Scoring Bottom Quartile Scoring Statutory Compliance Topics Statutory Compliance Topics Personal Protective Equipment at Work Regs Construction Design & Managements Regulations Washer Disinfectors Firecode (Alarm & Detection) Firecode (General) Electricity at Work Regs Electrical Services (Abatement) Working at Heights Confined Spaces Legionella MEPS Display Screen Equipment LOLER (Lifting Equipment) Infection Control Window Security Control of Contractors Manual Handling Slips, Trips and Falls Suicide Risk Decontamination of Equipment 17

20 Backlog Assessment Methodology The investment required to bring the estate up to an acceptable condition is known in the NHS as Backlog Costs since it arises from the backlog of maintenance that has built up over a number of years and is now giving rise to poor condition and performance. The guidance defines backlog costs as the base costs required to rectify the deficiency and bring the element/sub element up to an acceptable condition (Condition A or B). The guidance is also very clear in stating that Backlog Costs should be expressed as works costs (that is, the base cost to undertake the work). Additional costs that are dependent upon the project solution chosen (for example fees, VAT, decanting and temporary services to other areas) should be excluded from backlog costs but included in the overall cost of investment required. As part of the overall appraisal of condition it is also recognised that there is a need to assess the risks associated with the continued deterioration and/or failure of estate assets using the NHSScotland Risk based methodology for Property Appraisal guidance. The risks associated with substandard assets that are assessed as high and significant risks should be addressed as a priority and included as part of estate investment planning process. Some consideration must also be given in the current economic climate to volatile construction indices as the baseline year for costs in the 3i Studio EstateManager database. The consequences of failing to address the poor condition of the estate are clear: Increasing risk of building/engineering systems failure resulting in service interruption. Increased risk to patients - including Hospital Acquired Infection (HAI) Failure to comply with statutory requirements and increased potential litigation Significant disruption to clinical activity Low staff morale & recruitment difficulties Accelerated deterioration increased short term capital investment needed. 18

21 Significant Improvement in Backlog Costs The introduction of the property appraisal guidance and 3i EstateManager has enabled an improved unified understanding in appraising properties and assessing backlog maintenance costs through a consistent risk prioritised approach. The investment needed to bring the estate back to an acceptable condition ( Backlog Costs ) is summarised in the Table 8 and this expenditure has been risk assessed to produce the profile shown. 19 Table 8: Physical Condition Risk profiled backlog / statutory compliance costs Backlog Maintenance/Statutory Costs Total Risk Category millions Baseline Year 2009/10 Low Moderate Significant High % 8% 18% 70% 100% Current Year 2013/14 Low Moderate Significant High % 46% 53.7% 0% 100% The reduction in the backlog cost since the baseline of 2009/10 is due to a number of reasons, including a strategy towards reducing significant and high risk backlog maintenance within NHS Lanarkshire's existing estate, replacement of old properties due to investment in new facilities, and the review and realignment of costs associated with assessments originally carried out in 2004/05 (this included longer term investment costs not currently required from the new, standardised guidance). The risk assessment of the current backlog maintenance works has also resulted in an updated risk profile which shows an overall reduction in the proportion of significant and high risk works. This, once again, is due to updated appraisal information as well as changes and improvements to the estate as a consequence of investment carried out; particularly the investment carried out at Monklands Hospital to reduce its high risk items (progress on this is being monitored by the NHSL Strategic Risk Group). It should be noted that the backlog investment requirement of 57.9 million is based on the existing buildings and their current usage. It will do little to improve the functionality of the properties or to modernise them for future use. There is also a need to understand the disruption to existing operational services that would inevitably be involved in this scale of work and any practical programme for undertaking the work will need to comply with the requirements of HAI Scribe and to allow for decanting space/facilities. In addition, the practical approach to undertaking this scale of work would be to combine it with refurbishing and upgrading departments to bring them up to modern standards. Without such

22 refurbishment, the quality of environment for patients and staff is likely to deteriorate as a result of undertaking the backlog work. It is important to recognise that the real investment/project costs will need to increase to include fees, VAT, builder s preliminaries, and contingencies. Whilst the extent of these additional costs will depend on the solution adopted for executing the work it is none the less likely to result in a substantial percentage increase on the 57.9 million identified above. 20

23 Environmental Management As with Statutory Compliance, the reporting requirements for environmental management have changed from Estatecode through to Risk Based Methodology for Property Appraisal. The information previously reported does, however, remain relevant and, therefore, this section contains a combination of reporting requirements. This facet reviews the success of NHS Lanarkshire in improving its overall management of the environment including energy performance, water consumption, waste management, transport etc. In January 2013, The Scottish Government Health Directorate (SGHD) issued CEL 2 (2012), a Policy on Sustainable Development for NHS Scotland This superceded NHS HDL (2006) 21 An Environmental Management Policy for NHS Scotland. The 2012 revision of the Sustainable Development Strategy for NHS Scotland together with NHS Scotland body-specific Sustainable Development Action Plans will form the framework and provide guidance for implementation of the Policy on Sustainable Development for NHS Scotland They will also assist in addressing some of the wider sustainability challenges raised by use of the Good Corporate Citizenship Assessment Model (GCCAM) [NHS CEL 14 (2010) refers]. NHSL, as the organisation responsible for leading the efforts to improve the health of the people of Lanarkshire, currently has a Sustainability Policy with strategies and initiatives involving a number of projects which relate to sustainable development and climate change and which aim to comply with Scottish Government s CEL 2 (2012). These initiatives include: Carrying out of energy performance surveys to all properties in Ph1 and 2 to comply with the Energy Performance of Buildings Directive (2009/91/EC) i.e. sites with GIA over 500m2. Development of an Environmental Management System (EMS) Corporate Greencode. Adoption of the Good Corporate Citizenship Assessment Model to create an integrated approach to managing corporate environmental, social and economic impacts. Inclusion in the mandatory Carbon Reduction Commitment - Energy Efficiency Scheme, which requires participants to monitor their CO2 emissions based on their energy use in buildings and to buy allowances for each tonne of CO2 they emit. Creation of a Sustainability & Environmental Group to examine, amongst other things, NHSL's use of energy and ways of reducing consumption and emissions. 21

24 Heat Targets NHSL have actions in place to ensure the national CO2 emissions and energy efficiency HEAT targets are met by 2014/15, thus reducing potential Carbon Reduction Commitment Energy Efficiency Scheme legislative / financial burdens. NHSL are currently working with The Carbon Trust and other consultants to develop plans for delivery of short, medium and long term projects to achieve these HEAT targets. Whilst the full project register is still being developed the following highlights some of the proposed projects: Lighting replacement at Law House, Motherwell Health Centre, Newmains Health Centre, Coathill Hospital, Monklands Hospital app 150k Replacement of remaining oil and propane heating systems Beckford St Insulation of draught proofing and insulation at all NHSL sites. NHS Lanarkshire has also been tasked with meeting the national HEAT targets E8-KPM1 and E8- KPM2, a year on year reduction of 3% in its carbon emissions, with a specific aim of achieving a 15% total reduction by the end of 2014/15; as well as a reduction of 1% in efficiency savings. A two-part HEAT Target has been agreed which began in April 2010 and consists of: A 3% year-on-year fossil fuel CO2 emissions reduction target covering all oil, gas, butane and propane usage. This is designed to work towards the total elimination of the use of fossil fuels by 2050 (electricity is not included); and A year-on-year energy efficiency target of 1% on all energy sources based on an overall improvement by 2050 of 33% (or one third) on the comparative performance as at 2009/10. Setting these two targets on a year-on-year basis will ensure a greater portion of the CO 2 emissions reduction and efficiency improvement will be within the early years of implementation. It should be noted that an alternative reporting methodology and targets are under review for action in 2013/14. 22

25 The following Tables 9 and 10 show tracked reductions in CO 2 and Gjoules. Table 9: Progress against the Heat Target - CO 2 reduction in tonnes Target CO 2 Emissions Actual CO 2 Emissions Variance against Target Baseline: / % 2011/ % 2012/ Available July 2013 Available July 2013 Table 10: Progress against the Heat Target Energy efficiency improvement in Gjoules Target Giga Joules Actual Giga Joules Variance against Target Baseline 2007/08: / % 2011/ % 2012/ * Available July 2013 Available July 2013 Carbon Management Programme In April 2008, the Board approved the Carbon Management Programme (CMP) Strategy & Implementation Plan and the target of cutting CO 2 emissions by at least 2% per annum and by 15% by This was superceded in April 2012 when the Board participated in the Carbon Trust Carbon Management revisited programme. Table 11 provides information on the progress on reduction in CO 2 emissions against the Carbon Management Programme baseline. The NHS Lanarkshire Carbon Management Plan commits the organisation to a target of reducing CO x by 10% by 2015/16; this is the equivalent of a reduction in the Board s total annual carbon footprint by 4,041 tco 2 e by the end of financial year 2015/16. Reductions will be achieved through a range of projects including energy and water efficiency measures, awareness raising initiatives and travel projects. Table 11: Progress against the Carbon Emission Reduction Target in tonnes Target CO 2 Emissions Actual CO 2 Emissions Progress against Target Baseline 39,407 39,407 0% 2010/11 38,225 36, % 2011/12 37, % Further figures are expected in July

26 By the end of March 2012, NHSL had reduced its CO2 emissions by 3,811 tonnes against the baseline figure:- Transport - reduction of 166 tonnes against previous year equating to a 10% reduction in fleet fuel consumption and 6% reduction in staff travel. The savings in emissions by category through mileage from business use is mainly due to awareness around car use and departments working towards an annual savings target. Waste - reduction of 68 tonnes against previous year equating to 10% domestic waste reduction and 8% reduction in clinical waste. The largest reduction in emissions by category was through domestic waste; arising from improved segregation of waste streams and increased recycling of paper, cardboard, plastic and aluminium. Although a great deal of progress has been made through investment in various carbon reduction and energy efficiency measures, some of this improvement has been offset by service expansion and increased reliance on electricity to power modern equipment. Continued progress towards the 2014/15 targets will, therefore, be challenging as opportunities for efficiency improvements become increasingly difficult to identify and funding constraints restrict the viability of further improvement projects. 24

27 Functional Suitability The overall aim of the functional suitability appraisal is to assess how well the building supports the current and future (known demand) delivery of services. The appraisal of functional suitability is an important one since functionality can have a major impact on the organisation s ability to deliver effective and efficient services. Poor functional suitability often results in inefficient working practices, increased staffing levels and poor clinical outcomes. Therefore, it is an important component of the organisation s overall performance. The results from the appraisal of functional suitability are shown in Table 12, which show a 9% improvement between 2011/12 and 2012/13 but there is still further scope for improvement as 38% of accommodation remains less than satisfactory This result was influenced by a number of the larger buildings such as Monklands and Hairmyres (retained estate) being appraised as less than satisfactory in terms of building layout, patient flow and privacy and dignity. In particular, the following were identified: Monklands Hospital Imaging the schedule of accommodation is significantly below that of current standards Ward areas these no longer meet current standards in terms of compliance with guidance on single bed provision, storage space and space standards generally. Outpatients this department was not designed for the modern operational model with extended diagnosis and treatment taking place within the department Operating Theatres there are significant issues with the size and layout of the theatre areas, compounded by the issues that require services to be upgraded to current standards. Laboratories that are severely overcrowded. Hairmyres Hospital (retained estate) The existing wards and therapy areas within the retained estate (not part of the PFI development) at Hairmyres Hospital were constructed in the 1990s. This accommodation no longer provides the standards in space and amenity needed to meet current clinical service requirements. NHSL has commissioned studies into the feasibility of altering and extending the existing buildings to meet a proposed schedule of accommodation for an Acute Mental Health facility. This has shown that the existing buildings do not allow for the redevelopment to meet current guidance standards and that a high level of compromise of function would be required if the existing wards and therapy areas were to be utilised. 25

28 Table 12: Results from the appraisal of functional suitability Ranking Functional Suitability A B C D Excellent as New Satisfactory Poor Condition Unacceptable Year 2011/12 Area sq.m 127,204 42,334 44,946 58,508 Percentage of estate (area) in each category 47% 16% 16% 21% Year 2012/13 Area sq.m 120,142 41,828 41,604 57,487 Percentage of estate (area) in each category 46% 16% 16% 22% 26

29 Space Utilisation Space utilisation is a complex and sensitive subject as it touches on territorial issues. The overall aim of this appraisal is to make a broad assessment of how well existing space is being used. The appraisal attempts to answer three main questions: How intensively is the space being used i.e. is it empty, fully used etc? How does usage of the space vary over time? How does the space provision compare to national guidance (where applicable)? The appraisal of space utilisation is an important one since the cost of owning space/property is significant. This expenditure, which includes capital charges, building and engineering maintenance, energy (heat, light & power), cleaning etc., is broadly correlated to space occupied/used. Hence, the aim is to hold only as much space as is needed to support the delivery of effective and efficient services. In addition to the direct costs of space/property ownership there are indirect cost such as those associated with under provision of space that results in inefficient working practices and poor clinical outcomes including issues relating to the control of infection. The results from this appraisal are shown in Table 13. Table 13: Results from the appraisal of space utilisation Space Utilisation E U F O Ranking Empty Under Utilised Fully Utilised Overcrowded Year 2011/12 Area sq.m 0 5, ,051 27,453 Percentage of estate (area) in each category 0 2% 88% 10% Year 2012/13 Area sq.m 0 5, ,726 26,110 Percentage of estate (area) in each category 0% 2% 88% 10% These results shows little change between 2011/12 and 2012/13 and as such that concerns of overcrowding in parts of the estate still need to be addressed. The majority of the estate is, however, considered to be fully utilised (88%) which is an improvement of 14% improvement since the baseline of

30 Quality The appraisal of the quality of the estate is a broad brush examination of the quality of the environment created by each property. The results from this appraisal are shown in Table 14 and show that there is scope for improvement in the quality of environment as only 65% of the estate was appraised as having a Satisfactory or Very Satisfactory ranking. This, however, shows an improvement of 11% overall since Table 14: Results from the appraisal of quality Quality Appraisal A B C D Ranking Very Not Satisfactory Unacceptable Satisfactory Satisfactory Year 2011/12 Area sq.m 127,694 46,018 97,214 2,065 Percentage of estate (area) in each category 47% 17% 35% 1% Year 2012/13 Area sq.m 125,309 44,380 91,372 0 Percentage of estate (area) in each category 48% 17% 35% 0% 28

31 Summary of Condition and Performance of the estate Whilst poor physical condition and functional suitability need to be addressed wherever they occur, a degree of prioritisation is needed to ensure that limited financial resources are focussed on those parts of the accommodation with the biggest problems. In terms of the hospital estate, the following properties have been assessed as being in either (or both) poor physical condition and/or poor functional suitability. That is, the property appraisal has categorised a predominant part of the their accommodation as either C or D for these facets: Hospital accommodation categorised as either C or D for both the facets of physical condition and functional suitability Monklands Hospital Coathill Hospital Parkside Airbles Road Centre Hospital accommodation categorised as either C or D for the facet of functional suitability only Udston Hospital Victoria Memorial Hospital Wester Moffat Hospital Ladyhome Hospital Lockhart Hospital Kello Hospital Hairmyres Hospital (retained estate) These hospitals will need to form part of NHS Lanarkshire's future plans for improvement in its estate, along with the following primary and community care estate. The following two tables (Table 15 and 16) summarise the condition and performance of NHS Lanarkshire's Health Centres, Clinics and Offices. The colour coding of the appraisal categorisation (green = good, yellow = not great, red = poor) enables quick identification of those properties in most need of improvement and thus prioritised investment. The are several properties in need of some improvement, but the ones of particular concern are: Wishaw Resource Network. Croy Clinic. 29

32 Kilsyth Health Centre. Kingshill Medical Practice. Forth Clinic. Alison Lea Medical Centre. Larkhall Health Institute. Table 15: Summary of Condition and Performance of CHP North Facilities (Health Centres, Clinics and Offices) Ref Name GIA sq.m Physical Condition Functional Suitability Quality Space Utilisation Total Backlog Cost ( ) Backlog Cost per /sq.m L014A Bellshill Locality Team 631 C B B F 132, L334C Wishaw Resource Network 1007 C C C O 492, L109C Croy Clinic 289 C C C U 87, L222C Fullwood Clinic 122 B C C U 1, L106C Townhead Clinic 346 B C C O 68, L204B Motherwell Health Centre 3160 C B B F 105, L104B Kildrum Health Centre 976 B B B F 5, L210B Newmains Health Centre 962 B B B F 72, L207B Harthill Health Centre 375 B C C F 36, L106B Condorrat Health Centre 1008 B B B F 172, L107B Coatbridge Health Centre 3844 B C C F 273, L101B Abronhill Health Centre 893 C C C F 135, L203B Wishaw Health Centre 3152 B C C O 903, L105B Kilsyth Health Centre 1130 C C C O 302, L205B Shotts Health Centre 1446 B B B U 105, L103B Cumbernauld Central Health Centre 2813 C B B F 110, L409C Bellshill Health Centre 1525 B A A F 0 0 L414C Buchanan Centre 3278 A A A F 0 0 L319B Airdrie Community Health Centre 7800 A A A F