Asset Management Plan

Transcription

1 Asset Management Plan 2016 to 2026 NHS Grampian s response to Scottish Government s CEL 35(2010) Status 02/06/16 Approved Author G Legge Reviewed G Donald Sponsor A Gray Version16.3 June 2016

2 NHS Scotland 20:20 Vision Our vision is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting. We will have a healthcare system where we have integrated health and social care, a focus on prevention, anticipation and supported self-management. When hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm. Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission. The Asset Management Plan is also available in large print and other formats and languages, upon request. Please call NHS Grampian Corporate Communications on (01224) or (01224)

3 Contents Page Implementation Plan 85 Executive Summary 1 Introduction 4 Where are we now? 7 o o How we will implement the plan Governance o o o o o Progress over the last year Property Condition and Performance Medical Equipment - Condition and Performance Facilities and Support Services Condition and Performance ICT Equipment Condition and Performance Where do we want to be? 37 o o o o Challenges that will influence our plan Partnership Working Healthfit Vision Clinical Service Strategy Strategic benefits and investments that are necessary How do we get there? 70 o Our investment plan for the next 5 years o Our investment priorities for years 5 to 10 Appendices A Performance Framework B Prioritisation and Risk C Performance of the Board s Property Estate D Medical Equipment E ICT Infrastructure F Proposed Impact of Local Plans G NHS Grampian Geographic Areas (Maps) H Primary Care Premises Plan Glossary Contents

4 Executive Summary Context Changes are taking place both within Grampian and across the country to make sure that NHSScotland is in the best possible shape to meet future health needs and improve people s wellbeing. There are a number of national and local policies and initiatives aimed at making NHSScotland more effective and efficient such as Better Health, Better Care: Action Plan, the NHSS Quality Strategy, the Efficiency and Productivity Framework and Achieving Sustainable Quality in Scotland s Healthcare A 20:20 Vision and the emerging NHS Scotland Clinical Strategy. The developing strategy for NHS Grampian is built around four healthcare delivery themes; Prevention; Self-Management of long term Conditions; Planned Routine and Urgent care in the right Place and Time; Unscheduled care in the Right Place and Time. We have continued to develop a system for monitoring and prioritising all current and future capital and revenue projects through the SCIM process. This has been achieved through the development of Strategic Assessments and the use of the Capital Planning System. All future planned investments will be directly linked to the NHS Grampian Clinical Strategy Investing in our infrastructure NHS Grampian covers a geographic area of over 8,700 sq.km., and provides services to a population of over 584,000 from 26 hospitals, 27 health centres 22 clinics and 5 separate dental units along with 2 hub procured health centres and the health Village with a net book value of 453m. There are also over 20,000 individual items of medical equipment, ICT, vehicles and other equipment with a net book value of over 50m. We have a current backlog of 138m which is the second highest of the 22 Health Boards in Scotland and an annual capital allocation of 12.71m. Progress in the last 12 months In the previous 12 months we have: Through the use of our capital allocation, asset sales receipts and endowment funds we have continued with the backlog investment programme focused on reducing High and Very High Risk in clinical areas, particularly at Aberdeen Royal Infirmary. Since 2012, we have reduced backlog maintenance by 55m equating to a 28% reduction from the 193m base point. Invested 7.7m in new medical equipment, including a Robot for Theatres and Endoscopy equipment for the Health Village. Both these investments have brought significant clinical benefit to our patients. Page 1

5 Through an extremely charitable donation from the Wood Group Foundation we have been able to plan for a multistorey car park on the Foresterhill campus for exclusive use by patients and visitors. It will provide a net additional 1000 spaces and will be adjacent to the front door of ARI Phase1. To support this significant programme of investment, the Board agreed to set aside revenue funding over the next three years to ensure the programme is suitably resourced. Priorities for further investment Through investment in IT infrastructure Windows 7 rollout and replacement of older PCs was completed. Storage and networking capacity and further development of core patient management applications was progressed in preparation of the move to an Electronic Patient Record System EPR). Confirmed five year investment programme Looking forward our five year investment programme will continue to be focused on Commissioning of new health facilities including the Baird Family Hospital and ANCHOR Centre, the Inverurie Health Centre and Community Midwife Unit, replacement Foresterhill Health Centre and a new Denburn Health Centre, the latter supported significantly by the use of developer contributions. Progressing with the development of a new Diagnostic and Treatment Centre on the Foresterhill site after the announcement of Scottish Government funding of 40m and a 19m capitalised value for Health Centre investment in the North of Aberdeen City using the hubco model. Continuing with our backlog maintenance programme, medical equipment replacement and ICT investment. Whilst acknowledging the announcements around the Diagnostic Centre and primary care investment, the Board is facing an immediate and significant challenge in relation to the following key areas: Medical Equipment At present there are 1,572 assets fully written down with a replacement cost of 44m. Based on our forecast projections, and taking account of future investment, it is likely that the replacement cost of fully written down medical equipment in use will increase to over 100m by Within the context of our 10 year plan, we are developing a detailed equipment replacement strategy informed by a comprehensive assessment of risk. Whilst equipment can be used and maintained beyond the depreciated life, a planned replacement medical equipment programme cannot be adequately sustained within the Board s current level of capital allocation, particularly given the corresponding requirements to address statutory and backlog maintenance. We have committed 3m in 2016/17, 3m in 2017/18 rising to 6m in each of the following three years for essential equipment replacement. This will however not enable replacement of medical and ICT equipment at the rate required to reduce the risk to an acceptable level. Page 2

6 Community and Primary Care Premises Based on the Local Development Plans for Aberdeen City, Aberdeenshire and Moray the number of new housing units is anticipated to increase by over 40,000 by 2023, with the potential for an increase in patient population of between 80,000 and 100,000. Our GP premises strategy identified a need for investment in additional infrastructure in excess of 100m to meet the demands that these new and emerging communities will place on our primary and community based services. We will be submitting further strategic cases for revenue funding through the hub model and continue to advocate for Developer Contributions where appropriate to support proportionate development needs. We welcome and recognise the support and close working relationships we have with colleagues in the Scottish Government, Scottish Futures Trust (SFT) and Health Facilities Scotland (HFS). We will continue to develop our Asset Management Plan and supporting strategic assessments to support cases for further capital funding in line with the priorities set out in our Clinical Strategy. In addition agreement to undertake further rationalisation will be essential to ensure sustainability, whilst allowing NHS Grampian to support the population in Grampian through our principles of Caring, Listening and Improving ; achieving the NHS Grampian Healthfit Vision and developing Clinical Services Strategy; and that of the National 2020 Vision. Acute Sector Infrastructure Together with an ageing estate, and a growth in demand for services, this 10 year asset plan has identified the need for priority investment in a number of key areas within our acute sector infrastructure MRI capacity; laboratory and medical equipment accommodation; replacement laundry and CDU facility; and new mortuary accommodation. Furthermore the full replacement of the theatre block and remaining inpatient capacity requires to be addressed within 15 years. The backlog programme provides capability to extend life of the estate, but investment in this area without new replacement buildings in itself is not sufficient. Page 3

7 Introduction The 2016/17 Asset Management Plan reflects our Healthfit Vision and is very much informed by our developing Clinical Services Strategy. It is entirely consistant with Chief Executive Letter CEL35(2010): setting out our future investment priorities and our financial planning assumptions, along with how performance, management and utilisation of the Boards entire asset base will be monitored. The AMP is reveiwed annually and is one of a coherent suite of supporting and enabling plans demonstrating how NHS Grampian will successfully deliver Scotland s health policies. It covers all assets, and includes vehicles, equipment, information and communication technology and property. Aims of the Asset Management Plan The aims of this Asset Management Plan are to support the requirements of the National 20:20 Vision and the world leading desires of the Healthcare Quality Strategy for NHSScotland. It will also support the delivery of the developing NHS Grampian Clinical Strategy, as described within the Healthfit Vision NHS Grampian s strategy for future delivery of healthcare services in Grampian. It will also: Demonstrate the appropriate governance and management structure to effectively manage the Boards assets. Identify all the issues that are driving the need for change and ensure all assets are used in such a way as to support the existing and future requirements of the service and the change required. Manage all assets within NHS Grampian, by maintaining, enhancing, replacing or disposing of; ensuring the plan takes us towards the national ambitions of care which is person centred, safe and effective. Provide/maintain an appropriate number of quality affordable assets complementing and supporting the high quality services which meet the population needs and are financially sustainable over the long term. Address backlog maintenance and essential equipment replacement where there is a high, significant or moderate risk likely to impact on the Board s ability to deliver current and future services. The Plan covers the period 2016 to 2026, with detailed investment proposals covering the next five financial years, considering a range of scenarios and sensitivity analysis building in flexibility and agility into our longer term plans covering the 5 to 10 year period and beyond. Developing the Plan The Plan involves wide consultation with many key members of staff responsible for modernisation, service delivery, finance, facilities, medical staff and asset management as well as our many stakeholders including Aberdeen University. The Plan is led by the Head of Property and Asset Management and his team but involves information, direction and management from the Board and Senior Management to ensure it reflects the Page 4

8 requirements of the NHSScotland 20:20 Vision and NHS Grampians developing Clinical Strategy which underpins our Healthfit vision. This year NHS Grampian has been developing a Clinical Strategy to underpin our Healthfit Vision and meet the needs of the population of Grampian and the North of Scotland. We have continued to develop a system for monitoring and prioritising all current and future capital and revenue projects through the SCIM process. This has been achieved through the development of Strategic Assessments and the use of the Capital Planning System. By developing Strategic Assessments through a workshop process with Stakeholder and Public representation we are ensuring that our development plans are open and transparent and outline the need for change, describe early thoughts on any potential investment proposal and allow a methodology of prioritising all projects against the NHS Grampian Clinical Strategy and the national 2020 vision. The development of the AMP also encompasses ongoing dialogue with the three Local Authorities in developing the Structure Plan and Local Development Plans: the principle of securing Developer Contributions under Section 75 of the Town and County Planning (Scotland) Act 1997, as amended by the Planning etc. (Scotland) Act 2006 : and continued discussions in the provision of joint projects. The Plan was approved by the Asset Management Group (AMG) prior to recommendation for approval at the full public board meeting held in June Commitment to the Plan NHS Grampian prioritises available capital and revenue funding including proceeds from the ambitious asset disposal programme to carry out the day to day activities required of us, to enhance our asset base and improve the healthcare environment ensuring it is safe, effective and responsive to their needs. The following pages evidence where we are now with regard to our asset base, identifies the issues driving the need for change and explains the investment that has occurred in the last year since the previous AMP. It also describes new investment bringing forward major projects, including the Baird family Hospital and Anchor Unit on the Foresterhill site, and funding for General Practices in existing and emerging communities. It also demonstrates the move of activity to community settings; partnership working with Local Authorities including the impact of the new Integration Joint Boards (IJB s); the importance of the Voluntary Sector; and the importance that technology has for a Board covering a large rural area. Thereafter, it describes where we want to be and how the Board s assets contribute towards achieving our strategic outcomes, influencing discussions, affordability, patient care and the ongoing modernisation agenda. This will range from developing home and community based solutions with a consequential impact on inpatient hospital care, and how technology assists in delivering the outcomes described in the Grampian Clinical Strategy. Page 5

9 We also consider NHS Grampians prioritised investment needs against available finance and how the retained asset base can best be used to improve the Board s performance, reduce backlog maintenance, and positively contribute to the health of the people in Grampian. Finally, we describe how NHS Grampian, will implement this plan within the funding available to it and demonstrate how all available resources will be utilised to meet the programme of prioritised investment described within this AMP. Whilst acknowledging the significant funding that has been made available for major infrastructure investments at Aberdeen Royal Infirmary and in new Primary Care Premises the existing and projected core capital formula funding cannot fully address: property maintenance backlog and statutory compliance; essential equipment replacement and provide the required level of resilience and functionality within our IT networks and supporting infrastructure. Page 6

10 Where are we now? NHS Grampian s progress over the last year In the last 12 months NHS Grampian has been developing an ambitious Clinical Strategy that underpins our Healthfit Vision, the aim of the strategy is to ensure NHS Grampian continues to work collaboratively with patients, the public and our partners to improve health and clinical outcomes for the population of the north and north east of Scotland. The proposed strategy not only sets out NHS Grampian's priorities, but also aims to outline the shared intent of the newly created Health and Social Care Partnerships (HSCP s) of which there are three in Grampian and alignment with the recently published National Clinical Strategy. This plan underpins that developing strategy through widespread consultation of all stakeholders and the development of Strategic Assessments for all proposed areas of investment. In terms of action taken forward in the last 12 months we would highlight the following: Provision of high quality specialist acute care Replacement Maternity Hospital and Cancer Centre -The Scottish Government have approved the Initial Agreement for NHS Grampian to commence with the 156m development (inclusive of VAT and equipment). This will provide a new hospital which will provide maternity, gynaecology, breast screening and breast surgery services to be known as the Baird Family Hospital (item1 on fig1 overleaf) and a new centre to provide out-patient and daypatient investigation and treatment services for patients with cancer and blood disorders. The centre will be known as the ANCHOR Centre and will include pharmacy, research and teaching facilities (item 2 on fig1). Multi-storey car park Foresterhill NHS Grampian was exceptionally pleased to have been offered a donation from the Wood Foundation to design, procure and construct a multi storey car park on the Foresterhill campus for exclusive use by patients and visitors. It will provide circa an additional 1000 parking spaces (item4 fig1). NHS Grampian had the ambition to be the first Board in Scotland to implement robotic surgery focusing initially on Urology Radical Prostatectomy. Robotic surgery has been utilised in many health organisations globally to improve outcomes for patients as well as long term financial benefits to service providers. Aberdeen Royal Infirmary has become the first hospital in NHS Scotland to use an O-Arm scanner. This sophisticated machine generates high-resolution 3D images of patients' spine, bone and soft tissue structures, improves the speed and accuracy of operations, removes the need for repeated X-rays, reduces the extent of incisions, and improves recovery time. Therapeutic Roof Garden at Aberdeen Royal Infirmary opened in January 2016, the green space which was funded entirely by charitable donations provides a floodlit rooftop garden primarily for patients to reflect and heal. Page 7

11 Provision of community based health care The Masterplanning of Inverurie Hospital site including a new Health Centre has continued to be developed; this will enhance primary care services in an area of high population growth. The development will provide a Health Centre, Community Maternity Unit (CMU) along with a Community Dental suite, Diagnostic and Treatment suite, X-ray suite and improved car parking. This will establish a new model of service, bringing together and integrating a range of health and social care services to create a Care Hub. The design, specification, business case and local community consultation have all been progressed in the last year with the aim of work on site commencing autumn 2016, and being operational in This project will be delivered through the hub Design Build Finance and Maintain (DBFM) procurement and is bundled with the Foresterhill Health Centre. The design and planning of Foresterhill Health Centre has continued enabling NHS Grampian to free up the site required for the Baird Family Hospital (item1 fig1). The new facility will accommodate 2 GP practice s, speech and language therapy, podiatry, dietetics, a health and social care integrated team and a retail pharmacy and will be located at item3 on fig1 Fig1 Foresterhill Site Development Page 8

12 With the government announcement of 19m to be invested in general practice premises to the north of Aberdeen City, the Board has established a Project Board to fully consider the needs of the communities in the corridors of Bucksburn and Blackburn; Dyce and Newmachar; and Balmedie and Ellon Completion of work at Northfield Medical Centre with the provision of a new temporary building (planning consent for up to 5 years) to expand the accommodation allowing the existing services to continue in the short to medium term. from a significant reduction in carbon emissions from this investment as well as improvements to infrastructure estimated at c 15.m over the 25 year life of the contract. The project to replace the heating plant at Woodend Hospital with more efficient gas fired boilers has progressed. The scheme will reduce operating costs, reduce carbon emissions and ensure future service delivery and will become operational in September Third party and independent sectors Currently on site at Cullen Medical Centre carrying out a refurbishment of the premises which is due for completion in July Sustainability and Carbon Reduction The Carbon Energy Fund (CEF) contract with Vital Energi was signed on the 29th December 2015, the programme includes :- replacement of boiler plant at Dr Gray s, provision of a steam & condensate link from the Energy Centre to the Foresterhill Laundry which will allow the closure and removal of East End Boilerhouse, provide energy links from the Energy Centre to Royal Cornhill Hospital, Dental School, Dental Institute and further proposed developments, provision of a new Foresterhill High Voltage (HV) intake substation and improvements to the existing HV infrastructure, replacement of a large number of chiller units at ARI and extensive lighting replacement at RCH and ARI. NHS Grampian will benefit The new Crimmond Medical Centre, being constructed by a local benefactor and operated as a charitable trust commenced on site in 2013 and once complete will allow the existing medical practice to relocate to a new purpose built building. This model is attractive to NHS Grampian as it allows community ownership and provides modern fit for purpose facilities and space at no additional cost. We need to secure integrated working between health and social care, and more effective working with other agencies and with the Third and Independent Sectors. NHSScotland 20:20 Vision Charlie House NHS Grampian have approved the proposal to grant a concessionary lease to Grampian Children s Respite Care for an area of land within the Woodend Hospital Site from which they intend to provide a centre for children s respite care. The project known as Page 9

13 Charlie House will provide a home from home environment where children will be fully cared for in a safe, supportive and stimulating setting with or without their families. Addressing backlog and statutory compliance issues A major backlog programme at Aberdeen Royal Infirmary has been under way in the East End 2 and Phase 2 blocks to reduce overall backlog within inpatient areas of the hospital and the relocation of the Eye Out Patient Department to Phase 1 at ARI. The East End 2 project was completed and operational in September Stage1 of Phase 2 works was completed in November 2015 with Stage 2 in progress with a completion date of June The programme provides a safer and more appropriate environment for our patients, staff and visitors, and continues to reduce our backlog maintenance requirements. The works have so far completed approx. 50% of the programmed 15m targeted reduction. o Aberdeen Royal Infirmary, Kitchen o Woodend Hospital, Boilerhouse o ARI, Laundry o ARI, Mortuary Woolmanhill Hospital, Aberdeen - the relocation of the remaining services of Ear Nose and Throat and pathology stores will be complete during 2016 allowing NHS Grampian to progress with the sale of this listed building site which was built in It has substantial backlog maintenance and is no longer suitable for modern health care provision. After marketing a preferred bidder has been identified. Fire Precaution works a planned programme of fire precaution works has continued with projects at:- o Royal Cornhill Hospital, Corgarff ward o Woodend Hospital, General Block o Woodend Hospital, South Block o ARI, Ward 205 Asbestos Over 195k of encapsulation, remediation and removal of asbestos contaminated areas at:- Page 10

14 Investment in essential equipment Developing systems and process around the Management of Medical Equipment, including the development of a Global Medical Equipment Register using the Real Asset Management system (RAM) to record, plan and monitor Medical equipment usage has been focused on this year. A primary element of our investment programme is the replacement of essential equipment and critical assets. We have had significant engagement with clinical services this year in order to assess and prioritise available funding to target at essential equipment that is critical to continued service delivery and the acquisition of equipment that enables NHS Grampian to achieve key organisation goals. Due to the aging profile of our medical equipment many of the equipment purchases this year have been due to actual or imminent critical equipment failure. During 2015/16 we also committed 2.8m of capital expenditure on strategic health investments establishment of the first robotic and minimally invasive surgery service in Scotland and a new endoscopy service at Aberdeen Health and Social Care Village. Both of these developments are having positive impacts on patient outcomes and access to high quality care. Equipment purchased this year includes:- ENT Scopes Video Laryngoscopes A Number of Ultrasound Scanners Patient Monitors Stacks with Video Bronchoscopes Lower GI Diagnostic Endoscopic Equipment CJD equipment Surgical Drills Cardiac heater Cooler Units Nerve monitor NSD MISEQ Tourniquets Atrial Lifts Ventilator Colonoscope Osmometer Radiology Workstations Spinal Operating Table Real time PCR system Transfer Monitor & Ventilator Maternity Birthing Beds Audiology Hearing Aid Calibration Patient Beds Ophthalmic Biometry Instruments HD Laparoscope Stack Renal Chairs Endoscopic Ultrasound Endoscope Page 11

15 IT investment supports changes in working practices Investment in IT infrastructure creates the foundation for a move towards the NHS Grampian s Healthfit Vision, by enabling more services at home or in local communities, including: The installation of wireless technology within all GP practices (including the remote rural branch surgeries) llowing community nursing teams to access the network (in these premises) where 3G is not yet widely available. consultation details whilst away from the practice e.g. fig 2. The rollout of Windows 7 operating system to all NHS Grampian PC s including the purchase of 1700 new PC s to replace outdated machines concluded in March A Guest Wi-Fi solution enables members of the public to access the internet from wireless networks whether Acute, Community or GP premises. This is greatly enhancing NHS Grampian s No Delays initiative, enabling patients to manage their own symptoms and treatments with bespoke advice and videos. New IP telephony for all main office accommodation was completed in 2015, allowing flexibility for staff to work at any desk and login to their own telephone extension. This supports our progress towards a smarter office initiative described in the office accommodation section of this document. Vision 360 the procurement of the Vision 360 software provides general practices and nursing teams with secure, remote access to patient's clinical data including medical history, therapy and test results. It allows GP s and nursing teams to view, record and edit patient Fig 2. Visual representation of Vision 360 Wardview - The purchase of the Wardview software application provides a presentation display of the TrakCare and other clinical systems to provide a coordinated view of a wards current patient status (length of stay, current medical alerts, status of referrals, consultant etc.) which improves bed management, ward efficiency, patient safety and ultimately reduces average length of stay. Page 12

16 Careview Care View enables the service to receive and discharge patient admissions by utilising the virtual ward facility in TrakCare The patient s home becomes a bed in a virtual ward thus ensuring the same focus of care while reducing hospital admissions and relieving pressure on beds. This is currently being installed in a number of community locations. Screenshots are shown in figs 3 and 4. Purchase of Cisco Guest allows Consultant, GP or Nursing consultations via secure Video conferencing to an IPad, laptop or PC at home. This innovative approach is being trialled by the diabetes service. Investment in IT local and wide area networks (LAN, WAN) and increased central data storage and backup facilities. Fig 3. Sample screen shot of the Care View Fig 4. Care View geographical map view Page 13

17 NHS Grampian Endowment Fund The Endowment Fund is a registered charity and operates in compliance with charity legislation. The fund (over 1,000 separate funds individually restricted for a particular use) is made up of money donated by patients and their families, or from legacies, and interest received on the investment of the Fund. The aims of the Fund are: of a multi-storey car park, an additional MRI scanner at Woodend Hospital and a new renal dialysis facility in Stonehaven. Provision has been made within the financial plan for the revenue running costs of these new facilities which will deliver improved access to key services for patients. Some of the other major investments aproved in the last year include the following: Improvement of the physical and mental health of the Grampian Health Board s population and our staff; Prevention, diagnosis and treatment of illness; Provision of services and facilities in connection to the above; and Research into any matters relating to the causation, prevention, diagnosis or treatment of illness, or any other matters relating to the health services, as the Trustees see fit. Applications are considered against the following criteria The scheme is in line with NHS Grampian s Healthfit vision The scheme is in line with the charitable purposes of the fund The endowment funded elements do not substitute core NHS provision There is demonstrable benefit to patients or the wider population NHS Grampian acknowledge the continued support of donors and community fund-raising which will enable the establishment Key Worker Accommodation an investment of 1.7m to purchase a two-storey apartment block in Maybaird Avenue, comprising six two-bedroom and nine one-bedroom units for key worker accommodation. Peterhead Community Maternity Unit - funding for the refurbishment and reconfiguration of the Maternity Unit at Peterhead Community Hospital. Sandpiper Trust - Wildcat Project project to create a network of trained Cardiac Responders across the north-east of Scotland. Based at 50 locations around the region, they ll be primed to deliver swift, on-the-spot medical care to people who have suffered cardiac arrest. Mortuary an investment of 299k for a scheme to add an extension to the mortuary which will improve the accommodation for visitors including facilities for the viewing and identification of a body, a waiting room and appropriate toilets. Stephen Hospital 60k for aesthetic improvements including flooring and decoration. Page 14

18 Disinvestment and sales Progress has continued with the ambitious disinvestment programme providing much needed additional funding to support our investment needs, consistent with NHS Grampian s Clinical Service Strategy and Healthfit vision with the sale of :- Land Registration: The Scottish Ministers require the transfer from the Sasine Register to the Land Register for all Health Boards to be complete by 31 st May Work is ongoing to meet this requirement. Former Ross Clinic Former Forres Health Centre Upper and Lower Royal Cornhill Hospitals The affordability of our planned works at ARI Phase 2 is dependent upon delivery of the asset disposal programme. To assist in mitigating the risks associated with the uncertainty of timing of asset disposals the programme is being delivered in 3 distinct stages with Board approval requested prior to the commencement of each stage; this ensures each stage of the programme is affordable. The disposal programme requires to deliver net proceeds of circa 16m over the next 3 years, which with Scottish Government agreement will be re-invested in the planned backlog maintenance programme. The disposal programme and delivery of the required actions is monitored by the Board s, Asset Management Group (AMG). Major advances have also made with a number of sales expected to be concluded within 3 years, subject to planning constraints and include: 431 North Deeside Road The Former Maud Hospital Bilbohall (the Firs), Elgin Site at Westburn Road, Aberdeen Page 15

19 Property Condition and Performance Condition and performance of the property portfolio follows the format of Health Facilities Scotland guidance A risk based methodology for Property Appraisal. The emphasis is on providing a consistent approach assessing condition and performance of properties within NHSScotland. NHS Grampian owns and manages a large property portfolio on behalf of the Scottish Ministers, ranging in size and age. Of that estate, 75% (by floor area) is hospital based accommodation. This percentage has decreased from previous years with the demolition of older hospital buildings (RCH and Raeden) and the building of new health and care centres at Forres and Woodside, and the purchase of premises at Inverurie Road, Bucksburn and Cullen Medical Centre. A detailed analysis of the results of the appraisal of condition and performance of the Board s estate is provided in Appendix C and the key summarised messages are as follows: The six facet appraisal of the property portfolio produced results which were not unexpected for such a large and complex estate: 66% of properties are physically satisfactory, 72% are functionally suitable, and 91% of space is fully utilised whereas only 2% is overcrowded. The analysis of six facets and the condition and performance of our properties are included in the following table 1: Very Not Very Satisfactory Facet Satisfactory Satisfactory Unsatisfactory A B C D Physical Condition 12% 54% 29% 5% Functional Suitability 19% 53% 16% 12% Quality 19% 55% 14% 12% Average SCART Score Average Energy Consumption PI Table 1 Analysis of Property Performance 75 GJ/m3 Category Not Used Under Used Fully Used Overcrowded E U F O Space Utilisation 5% 1% 91% 2% The areas identified as Not Used by NHS Grampian are currently awaiting disposal. - increase on previous year, - decrease on previous year The table shows a significant improvement in the condition, functional suitability and quality of our property portfolio over the previous years. This is due to the significant investment NHS Grampian has made to improve the physical environment (including the disinvestment in poor buildings). Like most health boards, NHS Grampian s ability to reduce the level of outstanding backlog maintenance is very challenging given existing capital formula allocation. Page 16

20 The Current Backlog at April 2016 is shown in table 2 below: Table 2 NHSG Backlog Register 1st April 2016 Element Low Medium High V.High Total Physical Condition External Works & Grounds 5,054, , , ,531,712 Structure 721, ,835 1,205,039 6,780,000 8,909,661 External Fabric 11,574,427 1,688, , ,992,504 Roofs 2,032,085 2,392,799 1,509, ,934,822 Drainage 4,754, ,554 1,365, ,423,463 Internal Fabric 9,092,109 1,015,072 2,423, ,530,531 Internal Fixtures & Fitttings 2,461, ,925 18, ,157,796 Hot & Cold Water Systems 2,555, ,967 36, ,455,659 Electrical Installation 5,539,732 3,326,055 3,724,208 1,367,300 13,957,295 Comms - telephone & paging 163, , ,983 Comms - Alarm/Safety 281, , , ,146,178 Heating Systems 2,637,328 2,061,437 1,691, ,390,239 Steam systems 6,905, , , ,808,995 Ventilation & Conditioning 1,697,999 12,745,954 5,178, ,000 19,928,172 Piped Medical Gases 2,997, , , ,660,834 Lifts 163,850 1,247, , ,958,890 Boilers and Calorifiers 177,975 1,513,240 2,095, ,786,235 Fixed Plant & Equip 3,113, , ,678,849 Fuel Storage and Distribution 5,680,007 77,148 21, ,778,625 Energy Conservation 1,260, , , ,421,209 Physical Condition Total 68,865,209 31,393,227 22,152,914 8,453, ,864,650 Statutory Standards Safe Hot Water Temp 291,451 1,286,712 1,879,364 96,050 3,553,577 Legionella 839, , , ,729,907 Asbestos 552,331 4,093, , ,600 5,374,032 Firecode 2,516,220 1,517,997 3,640,083 2,511,838 10,186,136 Health & Safety 1,312, , , ,698 2,047,308 Disabled Access 1,657, ,330 5, ,275,994 Waste Collection Statutory Standards Total 7,169,674 8,217,727 6,444,375 3,335,686 25,167,461 Total Backlog 76,034,882 39,610,954 28,597,290 11,788, ,032,111 This demonstrates an overall backlog improvement of 37.4m from the 2012 baseline of 193.4m, but more significantly it shows a reduction in high or very high risk backlog of 35.8m against our 80% targeted reduction of 61m. We will continue with our programme of targeted expenditure initiatives, asset disposals and site rationalisation to meet this target. If we were however to remove the backlog associated with our surplus properties that are programmed for disposal including demolitions then the Backlog profile would be represented in table 3 below. NHSG Backlog Register 1st April 2016 with surplus property removed Element Low Medium High V.High Total Physical Condition External Works & Grounds 5,264, , , ,758,947 Structure 683, ,717 1,265, ,100,709 External Fabric 10,829,591 1,532, , ,058,738 Roofs 1,897,042 1,656,344 1,591, ,144,860 Drainage 5,004, ,772 1,097, ,348,955 Internal Fabric 7,553,175 1,024, , ,928,513 Internal Fixtures & Fitttings 2,392, , ,948,734 Hot & Cold Water Systems 2,676, ,506 11, ,522,982 Electrical Installation 5,784,172 3,115,367 3,676,244 1,441,134 14,016,917 Comms - telephone & paging 156,281 96, ,679 Comms - Alarm/Safety 265, , , ,730 Heating Systems 2,636,591 2,016,188 1,679, ,331,806 Steam systems 7,278, , , ,213,166 Ventilation & Conditioning 1,736,589 13,413,140 3,582, ,524 19,055,097 Piped Medical Gases 3,158, , , ,843,631 Lifts 95, , , ,734 Boilers and Calorifiers 186,395 1,216, , ,633,120 Fixed Plant & Equip 3,269, , ,819,786 Fuel Storage and Distribution 5,969,778 69,449 22, ,061,856 Energy Conservation 1,265, , , ,458,846 Physical Condition Total 68,103,820 29,752,668 15,849,661 1,763, ,469,808 Statutory Standards Safe Hot Water Temp 244,155 1,249,644 1,906,622 77,416 3,477,837 Legionella 873, , , ,772,845 Asbestos 581,931 3,467,230 36,871 12,204 4,098,236 Firecode 2,083,018 1,502,736 2,885,683 2,562,422 9,033,859 Health & Safety 1,377, , , ,946 2,056,534 Disabled Access 1,510, ,791 5, ,151,941 Waste Collection Statutory Standards Total 6,671,331 7,558,672 5,414,797 2,946,988 22,591,788 Total Backlog 74,775,151 37,311,339 21,264,459 4,710, ,061,595 Table 3 These figures provide a more realistic representation of our Backlog profile due to the fact that we would not be investing in buildings that are to be demolished or sold in the near future. However we should still not become complacent by the progress Page 17

21 made so far as other backlog elements of low and medium risk potentially progress to become high and very high risks in coming years. There remains an obvious disparity between the costs of reducing backlog maintenance and the level of available funding. Quite simply time and cost factors are outpacing availability of resources to invest. Focus of investment - property The proposed investment programme for the next five years reflects the commitment within NHS Grampian to address our backlog maintenance requirement by prioritising available capital and revenue funding together with asset disposal proceeds. Specific objectives that we aim to deliver include: Improvements in functional suitability of the estate which are measured through on-going re-assessment of the functional suitability facet as well as annual review of the AMP to ensure that accommodation meets the operational and service needs of the organisation. Improvements in the quality of the operational estate which are measured through reductions in backlog maintenance costs/risks and by using annual patient perception surveys. Improvements in statutory compliance and risk reduction which are measured through reductions in non-compliance with statutory legislation, incident rates, and an increase in each property s Statutory Compliance and Audit Reporting Tool (SCART) score. Improvements in energy performance (in line with mandatory targets for NHS organisations in Scotland) and in compliance with Corporate Greencode requirements. Reductions in our property footprint and reduction in the revenue cost of the operational estate over time (which can be measured by mapping trends in overall maintenance costs, utilities costs and the Board s income-to-asset value ratio). Projects planned for investment over the next 5 years include; The New Baird Family Hospital and Anchor Centre; Inverurie Care Hub; Foresterhill HC; Diagnostic and Treatment Centre (dependent on SG funding); the introduction of a major trauma centre within ARI (dependent on SG agreement and funding); Backlog Maintenance and further Carbon Reduction Schemes. Planned GMS developments include: Replacement of Denburn HC Land purchase for Ellon HC and potential health and social care facility in Balmedie Bucksburn/Blackburn area health centre(s) Dyce/Newmachar area health centre(s) Portlethen HC extension and Cullen Medical Practice refurbishment Page 18

22 Projects planned for investment beyond the 5 years include Ambulatory Care facility and new Theatre Block and Surgical Wards at Aberdeen Royal Infirmary New Medical Physics and Laboratory Accommodation Replacement mortuary New Health / Community Hubs in areas of population growth Page 19

23 Medical Equipment - Condition and Performance Governance of medical equipment is devolved to three main areas: Radiology, Medical Physics (looking after General Medical Equipment, Radiotherapy Equipment and Nuclear Medicine Equipment), and Laboratories. NHS Grampian has circa 4,000 items of medical equipment capitalised assets with a total net book value of 35.9m. The table below details this information in line with the requirements of the Audit Scotland Report, Better Equipped to Care. It should be noted however that there are also a further circa 13,000 minor equipment items (non-capitalised) with an estimated value of around 15m used throughout our services. Medical Equipment Category Imaging (CT / Ultrasound / MRI / Gamma Cameras) Other X ray (Angio / Dental / Fluoroscopy / General X Ray) Radiotherapy PET Replacement Programme IV systems (Syringe and Volumetric Pumps) Other medical equipment e.g. defibrillators, dialysis machines, endoscopes Cost of Purchase 14.2m 7.3m 6.5m 1.5m 0.6m 75.5m Net Book 6.2m 2.9m 4.5m 0.3m 0.2m 21.8m TOTAL 105.6m 35.9m The devolved medical equipment areas are responsible for the ongoing management and replacement of equipment within their own area, and in a wider sense to provide specialist advice/support to other departments regarding the equipment replacement programme. The replacement of equipment across NHS Grampian is a key element of our Capital Plan, and forms part of the Local Delivery Plan (LDP). A clear strategy for the replacement of equipment that represents highest risk of failure is vital in order to protect patients and operational services. Co-operation exists between each of the devolved areas in order to prioritise our requirements ensuring that available resources are targeted effectively, using a risk managed approach on an annual basis. This process will be managed by a newly formed NHS Grampian Equipment Group, which will be a sub-group of our Asset Management Group. Each medical equipment lead is a member of the group along with senior management. Our annual planning process involves a peer review of all equipment requirements. Key considerations when assessing assets remaining useful life, in addition to the obvious priority given to issues that affect patient safety and clinical benefit, include: Age and intensity of use; Availability of spare parts; Image quality where relevant; maintenance and upgrades; Radiation dose where relevant The work undertaken by the three medical equipment areas include: Page 20

24 Radiology The Clinical Radiology service is responsible for the direct provision of diagnostic equipment and interventional services to patients throughout Grampian, Orkney and Shetland on a 24/7 basis. The department directly manages imaging services located at Aberdeen Royal Infirmary, Royal Aberdeen Children s Hospital, Woodend Hospital, Dr Gray s Hospital, 11 Community Hospitals and the Aberdeen Health Village. The modalities provided include general radiography; dental radiography; fluoroscopy; CT; angiography and interventional radiology, cardiology, mammography; MRI and ultrasound. Approximately 300,000 examinations are performed annually. A five facet appraisal of our Radiology equipment is still ongoing and will continue to be enhanced as we implement a global medical equipment register. We do however know that 79% of Radiology Equipment is in a physically satisfactory condition and functionally suitable for the task required. The analysis of this performance is included in the following table 4: Facet Analysis of Radiology Equipment Performance Very Satisfactory Satisfactory Not Satisfactory Very Unsatisfactory A B C D Condition 37% 42% 13% 8% Modern Standards 37% 42% 13% 8% Functional Suitability 37% 42% 13% 8% Quality 37% 42% 13% 8% Category Under Additional Not Used Fully Used Used Required E U F O Utilisation 0% 0% 100% 0% Table 4 Focus of investment Radiology Over the next five years, investment in radiology will be focused on continuing with timely equipment replacement of the very unsatisfactory equipment (identified above), which will be informed by the development of an NHS Grampian 2020 Imaging Strategy. Plans are in force for the establishment of two new plain film services in community hospitals at Aboyne and Inverurie hospitals and continuing with establishment of the imaging service at the Health Village. Other priorities are a review of in-patient radiology facilities at ARI to include interventional facilities and fluoroscopy services, reviewing options to increase MRI capacity on the ARI site and for Page 21

25 provision within Moray. A PACS refresh will occur during 2016, (current PACS contract expires 2017). General Medical Equipment The General Medical Equipment infrastructure team has a critical role in governing medical equipment requirements for all wards and departments across the organisation. The Medical Equipment and Consumables Commodity Action Group (ME&C-CAG) co-ordinates the review and prioritisation of medical equipment requirements. The group brings together senior clinical and management representation from the organisation, with the operational component provided through NHS Grampian's Medical Electronics Service. Typically the ME&C-CAG will progress replacement of the full range of medical equipment including defibrillators, dialysis, heart/lung machines, IV systems, endoscopes and diagnostic ultrasound scanning and other imaging equipment where this is carried out by medical/clinical staff. There is very close co-operation between the Medical Electronics team, laboratories, the Clinical Radiology service, Estates and ehealth. A five facet appraisal of our General Medical equipment is ongoing and will continue to be enhanced as we implement a global medical equipment register using RAM. This will include the management of data on reusable medical equipment requiring maintenance and support and will fulfil the requirements of CEL 35 (2010). Our current information demonstrates that 90% of Equipment is in a physically satisfactory condition, 95% is functionally suitable for the task required, and an estimated 43% of the equipment is underutilised whereas 10% of equipment is under resourced. The analysis of this performance is included in the following table 5: Facet Analysis of Electronic Equipment Performance Very Satisfactory Satisfactory Not Satisfactory Very Unsatisfactory A B C D Condition 1% 89% 3% 7% Modern Standards 3% 93% 2% 2% Functional Suitability 3% 95% 1% 1% Quality 0% 0% 0% 0% Category Not Used Under Additional Fully Used Used Required E U F O Utilisation 0% 43% 57% 10% Table 5 Utilisation = 110% because 10% is an additional requirement that increasing the utilisation level cannot address Focus of investment General Medical Equipment The Medical Electronics Service procures and maintains equipment management activities for NHS Grampian's General Medical Equipment will introduce a medical equipment library service leading to more efficient use of all mobile medical equipment. It is piloting a radio frequency tracking enabling NHS Grampian to specify future requirements for the tracking of Page 22

26 significant mobile Medical Equipment allowing the introduction of a library. There remains a significant short term investment requirement in a number of areas including re-equipping the main theatres and recovery areas at ARI and Woodend Hospital and ITU area at ARI with replacement patient monitoring equipment. No funding has currently been allocated or is indeed available for this currently. A Patient Monitoring Learning Workshop Improving Patient Care, was targeted at medical staff, nursing staff, medical equipment and planning staff with the aim of sharing knowledge about; improving patient care, new ways of working, what we can do now that we have not been able to do before, to set goals focusing the specification requirements for current and future purchases of medical equipment. By improving data quality in our medical equipment registers, we hope to provide more accurate forecasts of future investment needs. Radiotherapy The radiotherapy equipment replacement program is managed nationally with an annual plan for equipment replacement. In 2013 the first phase of the new radiotherapy facility opened with two new replacement linear accelerators. The second phase went operational in 2014 when Phase 2 with one additional linear accelerator and a complete rebuild of the radiotherapy facility. The three linear accelerators provides improved service efficiency and capacity and better outcomes and experience for staff. Table 6 below shows the current 5 facet condition of our Radiotherapy Equipment and reflects that we have just invested in 3 Linear Accelerators. Analysis of Radiotherapy Equipment Performance Very Not Very Satisfactory Facet Satisfactory Satisfactory Unsatisfactory A B C D Condition 50% 42% 8% 0% Modern Standards 50% 42% 8% 0% Functional Suitability 50% 42% 0% 0% Quality 50% 50% 0% 0% Category Not Used Under Additional Fully Used Used Required E U F O Utilisation 0% 17% 75% 8% Table 6 Utilisation The 17% under Utilisation reflects the additional capacity available with the use of a 3 rd linear accelerator. Focus of investment Radiotherapy Following guidance from Scottish Government the replacement interval for CT simulators has now been set at seven years. As a result a replacement CT Simulator has been purchased to tie in with the move to the new Radiotherapy Centre. The new Anchor Centre will be built adjacent to the Radiotherapy Centre to provide out-patient, day patient investigation and treatment services for patients with cancer or blood and bone marrow disorders. Page 23

27 Nuclear Medicine The department functions well despite being in accommodation that is not functionally suitable for nuclear medicine. A new corridor has been built recently to improve access to the building and alleviate a health and safety issue with patients and staff. The accommodation however limits delivery of a modern effective service. The department does not have accommodation to house a modern standard gamma camera. Consequently it is limited to choosing a system based on available size. A new replacement PET/CT was purchased and commissioned in 2014/15 with funding from the SGHSCD. This has enhanced image quality and reduced radiation doses therefore improving patient outcomes and operational efficiency. The following table 7 shows the current 5 facet condition of our Nuclear Medicine Equipment, this evaluation will be enhanced over the coming years with the development of our Real Asset Management (RAM) database. Analysis of Nuclear Medicine Equipment Performance Very Not Very Satisfactory Facet Satisfactory Satisfactory Unsatisfactory A B C D Condition 50% 50% 0% 0% Modern Standards 50% 50% 0% 0% Functional Suitability 100% 0% 0% 0% Quality 100% 0% 0% 0% Category Not Used Under Used Fully Used Additional Required E U F O Utilisation 0% 0% 100% 0% Table 7 Focus of investment Nuclear Medicine A National agreement has now been reached for all replacement of Nuclear Medicine; based on a rolling programme for all Boards, ensuring that nuclear medicine in Scotland remains at the forefront of technology. In the medium to long term the Nuclear Medicine service will require to be relocated to accommodation on the Foresterhill site more suited to patient access and which is also able to accommodate the latest advances in nuclear medicine technology. A short term alternative could be the incremental consolidation and upgrade of the existing accommodation as described below:- Page 24

28 During Gamma camera replacement ( 750k) - upgrade the old scanning room and the main corridor to a standard that meets infection control guidelines and enables the equipment to be installed ( 50k) and divide the current main scanning room and install the radiation protection measures to enable the SPECT/CT to function correctly ( 70k). These steps could result in a single controlled area, capable of housing the equipment with support and office facilities adjacent to it. Laboratories Department of Health figures state that 70% of all clinical decisions are informed by diagnostic testing. For that, a wellequipped, modern and efficient laboratory service is required. Laboratories hold a Managed Service Contract (MSC) (leased equipment) for major analysers in the departments of Clinical Biochemistry, Haematology and Dr Gray s hospital laboratory. This contract has been extended for a further 2 years and will expire in The contract also includes blood gas analysers within Foresterhill. rental type arrangements. This equipment base is degrading as there is less capital/revenue monies available for timely replacement. Significant investment will be required in laboratory equipment over the next few years to maintain the levels of service expected by the organisation. Many of the analysers and pieces of equipment used have procurement lead-in times of months. Any failures will have a direct effect on our ability to provide essential diagnostic information affecting patient pathways and turnaround times. Laboratory Genetics is a National Services Division (NSD) funded service and receives equipment either from NSD nationally funded initiatives or from NHSG capital. The tables 8 and 9 overleaf show the current 5 facet condition of Labs MSC Equipment and owned equipment. It reflects the fact that the MSC equipment has been replaced in a contracted equipment refresh. The tables also demonstrate the advantages of the MSC over the capital funding of the Labs Assets. Other departments within Laboratories currently have equipment procured via capital/revenue purchases or various leasing/ Page 25

29 Analysis of Labs Owned Equipment Performance Very Not Satisfactory Facet Satisfactory Satisfactory A B C D Condition 0% 50% 50% 0% Modern Very Unsatisfactory Standards 0% 50% 50% 0% Functional Suitability 0% 45% 55% 0% Quality 0% 50% 50% 0% Category Not Used Under Additional Fully Used Used Required E U F O Utilisation 0% 0% 80% 20% Table 8 Focus of investment laboratories After reviewing options given by our current MSC service provider, Laboratories are commencing on the business case to procure a new MSC to start in 2017 to ensure a smooth transition at the expiry of the current contract. Aberdeen University require the Virology and Genetics department to vacate the space currently occupied in the Polworth building (approximately 25-30% of the University Polwarth Building). These moves will necessitate extending the existing lab accommodation within the east end special block. The Project requires the significant movement of administrative and storage space from the Link Building into the Special block allowing movement of Virology and Genetics into the Link Building. This requires significant investment to refurbish areas Analysis of Labs MSC Equipment Performance Very Not Satisfactory Facet Satisfactory Satisfactory A B C D Condition 0% 100% 0% 0% Modern Table 9 Very Unsatisfactory Standards 0% 100% 0% 0% Functional Suitability 0% 100% 0% 0% Quality 0% 100% 0% 0% Category Not Used Under Used Fully Used Additional Required E U F O Utilisation 0% 0% 100% 0% to become fit for purpose laboratory accommodation. Clarity on the timing of the Genetics move is urgently required as the proposed area within the East End Special Block, is prime space being considered for other uses. It is expected that if the East End buildings can be utilised that this would provide a working solution until The aim is to provide a new modern Blood Services Department post The departments of Medical Microbiology, Pathology and Immunology reviewing the MSC model and options which could result in a single directorate wide contract. Page 26

30 The mortuary based at Foresterhill is in poor condition. Short to medium term measures have been put into place to accommodate anticipated demands due to changes in legislation and requirements to improve access for waiting and viewing areas. In the medium to longer term a new mortuary build is required. Partnership options with the local authority around the replacement of the police and public mortuary should be considered. The laboratory Information Management System (LIMS) is approximately 19 years old and requires a replacement. A specification has been drawn up and is now with NSS for verification. This requires to be procured in 2017/18 as it would be unreasonable to carry out this work during the retendering of the MSC. The estimated costs (based on the last major Scottish Heath Board procurement) is estimated to be approximately 1.8M. The timeline and cost implications of the information management system replacement will be considered as part of our forward capital plan. Page 27

31 Medical Equipment Incident data All risks associated with Medical Equipment are captured and monitored at a service level with all incidents, risks and mitigating actions captured within the Risk Management Information System (DATIX). A search of the DATIX system was conducted to identify Medical Equipment related incidents for the period to , from this a total of 531 incidents were identified, these are broken down in the tables below: Incidents by Adverse event and Result Harm Near Miss No Harm Property Total Lack/unavailability of device Failure of a medical device or equipment - decontamination issue(s) Failure of a medical device or equipment - electrical/electronic fault(s) Failure of a medical device or equipment - mechanical/physical fault(s) Failure of a medical device or equipment - user error(s) Failure of a medical device or equipment - wrong or missing part(s) Radiation dose greater than intended - Equipment malfunction Totals: Incidents by Result and Severity Negligible Minor Moderate Major Extreme Total Occurrence resulting in injury, harm or ill-health Near Miss (Occurrence prevented) Occurrence with no injury, harm or ill-health Property damage or loss Totals: For this period there were a total of 34 Adverse Events showing an outcome where Harm is indicated, these were investigated further to identify severity of harm any learning outcomes that should be shared. Adverse event Harm x 9 No Occurrence resulting in injury, harm or illhealth Lack/unavailability of device 9 Failure of a medical device or equipment - x 2 No Occurrence resulting in injury, harm or 2 decontamination issue(s) ill-health x 7 No Occurrence resulting in injury, harm or illhealth, Failure of a medical device or equipment - 8 electrical/electronic fault(s) x 1 injury Occurrence resulting in injury, harm or ill-health x 6 No Occurrence resulting in injury, harm or illhealth, Failure of a medical device or equipment - 8 mechanical/physical fault(s) x 2 injury Occurrence resulting in injury, harm or ill-health Failure of a medical device or equipment - user x 5 Occurrence resulting in injury, harm or illhealth 5 error(s) Failure of a medical device or equipment - wrong or x 2 No Occurrence resulting in injury, harm or illhealth 2 missing part(s) Totals: 34 NHS Grampian requires that all incidents resulting in actual harm or with the significant potential to have done so or is regarded as a near miss is recorded in DATIX, including property damage or loss. This allows local management of the incident by managers who are also responsible for initiating an investigation and escalating or fast-tracking incidents to managers or to topic specialists, as appropriate. Any incident that has a severity of outcome grading of Major or Extreme, involves an accidental death, or is reportable under RIDDOR should have an investigation carried out to identify actions and learning. There were no adverse events rated either Extreme or Major during this period. Page 28

32 Facilities and Support Service assets- Condition and Performance Facilities and support services are responsible for a critical part of infrastructure supporting clinical services incorporating Laundry, Central Decontamination Unit (CDU), transport, property maintenance, cleaning, portering and catering services. The net book value of the Facilities Directorate assets at 1 st March 2016 is 9.6m. Table 10 below summarises this information in line with the analysis requested as part of the LDP financial planning template. Equipment Category Support services vehicles Other vehicles Plant and machinery Other equipment Table 10 Linen Services Cost of Purchase Net Book m 15.4m 5.4m 0.5m 5.8m 3.3m TOTAL 24.1m 9.6m Laundry and CDU are located within the south east of the Foresterhill Health Campus. They share a common building and both rely on the use of steam. The building has significant backlog issues which include asbestos, roof leaks and dated infrastructure. Steam is supplied from the new energy centre and from the older East End boiler house (built 1933). The laundry used high pressure steam from Mile End but investment in gas fired dryers removes some of the dependency on high pressure steam if required. NHSG signed up to the Carbon Energy Fund (CEF) contract in January 2016, which will, with the installation of new steam and condensate, enable the closure of the East End boiler house and demolition of same by the end of The CDU facility can already be supplied solely from the new energy centre. Focus of investment Linen Services A service review has resulted in the older laundry facility at Woodend Hospital closing, allowing NHS Grampian to concentrate all linen processing on the Foresterhill site. Consideration is being given to cladding the existing Asbestos roof on a temporary basis to prolong the life of the building until a permanent home is identified. Decontamination Services The main Decontamination equipment has been invested in and is now at an acceptable standard with a life expectancy in excess of 15 years. However the building condition remains a significant risk to service continuity. Focus of investment decontamination services Previous investment in an additional washer disinfector /dryer at Foresterhill has increased the throughput and improved overall efficiency within the decontamination facility. Within the next five years investment will require to be prioritised to replace a number of autoclaves which will be beyond their economic life. Page 29

33 In the longer term relocation of the Foresterhill CDU closer to the main users of the service at ARI (which accounts for almost 80%) must be considered. Accommodation and funding require to be identified, Catering Services Relocation of the Central Production Unit (CPU) (cook/chill) from Kittybrewster, Aberdeen to Dr Gray s Hospital, Elgin is now complete, concentrating production of food onto three sites (ARI, Royal Cornhill and Dr Gray s). Investment during the last 2 years has brought the CPU and kitchen equipment up to an acceptable standard with a life expectancy in excess of 15 years Focus of investment catering services The focus of investment will continue with timely replacement of end of life catering equipment ensuring the ability to provide quality catering service to our patients. Currently catering to Kincardine Community Hospital is provided by the onsite care home. A regeneration kitchen will be installed at the Kincardine Community Hospital as part of the 2016/17 capital plan. Vehicles Transport is essential in providing services to the community, whether it is moving patients from their home to hospital or delivering essential drugs to those that require them including the transportation of various stores, equipment, catering, mail, phlebotomy and cytology specimens and pharmaceutical deliveries. Clinical waste collection and disposal service is provided to and from GP surgeries, dentists, pharmacies and other healthcare users. Clinical waste is managed in-house and involves collection from over 600 sites equating to 38 tonnes of clinical waste per week. This waste is moved to the transfer station on the Foresterhill site and then uplifted by a third party for disposal. NHS Grampian has 417 vehicles, 350 of which are leased and 67 are owned vehicles, ranging from the large 7.5 tonne delivery lorries to the small 2 seat car (the profile of these can be seen in the tables below. These vehicles are spread across a wide range of users who have very different requirements. Owned Vehicles Type <2 years 2-5 years >5 years Fuel Type old old old Petrol Diesel Cars (pool) Less EV Small vans Large Vans 3.5 Tonne Large Vans 7.5 Tonne Mini Buses up to 18 seats Electric Vehicles Table Total Leased Vehicles Type <2 years 2-5 years >5 years Fuel Type old old old Petrol Diesel Cars (pool) Less EV Small vans Large Vans 3.5 Tonne Large Vans 7.5 Tonne Mini Buses up to 18 seats Electric Vehicles 12* Total Table 12 Table 11 and 12 above demonstrates we have 25% of vehicles over 5 years old. Page 30

34 In addition there are 434 lease cars which are provided to staff who qualify as essential users on the basis that this is the most cost-effective means for NHS Grampian staff to travel. Staff qualifying as an essential user are required to pay for the lease costs associated with all personal use and this is automatically deducted from their monthly salary payments. This is constantly kept under review and opportunities are continually sought to minimise staff travel through use of alternative methods, such as video-conferencing. A high level five facet appraisal of the performance of the commercial vehicles described above are shown in tables 13 and 14 below; Table 13 Analysis of Lease Vehicle Performance Not Satisfactory Satisfactory A B C D Very Satisfactory Very Unsatisfactory Facet Condition 4% 93% 3% 0% Modern Standards 4% 96% 0% 0% Functional Suitability 97% 3% 0% 0% Quality 0% 100% 0% 0% Table 14 Very Satisfactory NHS Grampian carries out a broad range of work with the large commercial fleet (3.5 and 7.5 tonne), these vehicles work 5 days a week with an average of 2500 miles per month. Currently 4 x 7.5 tonne vehicles are 8 years old and costing significant revenue funding to keep them operational. It is a similar picture with the 3.5 tonne vehicles with 6 of them in poor condition. A priority based replacement programme has been agreed for 2016/17 and 2017/18. NHS Grampian has also made use of Government funding to lease 12 Electric vehicles and currently have 4 charging stations across Grampian each capable of charging 2 vehicles at a time. Focus of investment vehicles Analysis of Owned Vehicle Performance Not Satisfactory Satisfactory A B C D Very Unsatisfactory Facet Condition 1% 67% 30% 2% Modern Standards 1% 82% 17% 0% Functional Suitability 1% 79% 20% 0% Quality 1% 61% 36% 2% The efficient utilisation of vehicles is critical and this should be maximised wherever possible. Vehicles that are utilised less than 40% of their maximum will be reviewed and an alternative solution considered. This could be through daily hire or even public transport. Page 31

35 The average cost of a pool car including insurance is 2,428; to hire a similar car would cost per day including insurance. Table 15 below shows current utilisation of the NHSG fleet by mileage. Table 15 Car Small Van Utilisation of Vehicles by Type Large Van 3.5 Tonne Large van 7.5 Tonne Mini Bus Electric Vehicle Total 100% % % % % % Total From the table we can see that there are currently 143 vehicles below the 40% utilisation requirements. 25% of NHS Grampian vehicles have been held on the asset register for a period of over 5 years. This has led to increased costs due to reliability and high maintenance. Current analysis clearly identifies that leased vehicles are a more cost effective solution than holding a depreciating vehicle asset on the asset register and the associated liabilities. Technology is forever changing, particularly in the area of alternative fuels, and by leasing on a 3-5 year period NHS Grampian may also be able to stay up to date with the latest innovations within the fleet market. Page 32

36 ICT Equipment Condition and Performance ehealth/ict encompasses much more than the deployment of computer technology. It requires both hardware and software within a compatible environment, including; desktops, networks, storage, backup systems and resilience built in throughout. It is an essential element in support of modern healthcare and provides advances to both healthcare professionals and patients. The Electronic Patient Record (EPR) is a key enabler of this technology and a critical area for investment for NHS Grampian to ensure that the Healthfit Vision and Clinical Services Strategy are achieved. A considerable amount of work has already been done to implement an EPR in NHS Grampian, this includes: Within Acute Services 75%-80% of individual patient information is held electronically. Over the past 5 years NHS Grampian has consolidated much of its patient management from 4 separate IT systems onto 1 system; PMS Trakcare. This has also included Lab and Radiology order requests, bed management, waiting times management, and evetting of referrals. It is used across all Acute, Community, Maternity and Mental Health services. Access to information from the SCI Store (medical data) has increased from 680 in 2007 to over 5 million in Trackcare has in excess of 11,000 registered users and includes staff who previously did not have access to an IT system. More information is available during unscheduled attendances so clinicians can make better decisions. Placement to speciality can be more accurate which leads to better care and shorter stays. Good progress has been made in the development of the EPR but requires further momentum over the next 5 years to ensure the EPR fully supports the themes identified in the emerging clinical strategy as well as improving patient safety and clinical efficiency. The Value of NHS Grampian s ICT assets are shown in table 16 below ICT Assets Cost of Purchase Net Book Networks and Cabling 3.9m 1.0m Servers 2.1m 0.7m Communication systems 1.7m 0.7m Other Hardware 7.4m 2.8m Applications/Other IT Systems 16.7m 3.1m Table 16 TOTAL 31.8m 8.3m A very high level five facet appraisal of the performance of this ICT hardware has been carried out; covering three categories; network systems; desktop systems and; server equipment. Page 33

37 Table 17 Analysis of ICT Desktop Performance Very Not Very Satisfactory Facet Satisfactory Satisfactory Unsatisfactory A B C D Condition 33% 30% 26% 11% Modern Standards 36% 31% 22% 11% Functional Suitability 60% 30% 10% 0% Quality 33% 30% 26% 11% Category Not Used Under Used Fully Used Additional Required E U F O Utilisation 0% 22% 73% 4% Table 19 Analysis of ICT Server Performance Very Not Very Satisfactory Facet Satisfactory Satisfactory Unsatisfactory A B C D Condition 16% 53% 8% 22% Modern Standards 16% 49% 8% 27% Functional Suitability 16% 49% 10% 24% Quality 16% 53% 6% 24% Category Not Used Under Used Fully Used Additional Required E U F O Utilisation 0% 11% 89% 0% Table 18 Analysis of ICT Networks Performance Very Not Very Satisfactory Facet Satisfactory Satisfactory Unsatisfactory A B C D Condition 60% 24% 9% 7% Modern Standards 67% 31% 2% 0% Functional Suitability 62% 29% 9% 0% Quality 64% 24% 4% 7% Category Not Used Under Used Fully Used Additional Required E U F O Utilisation 0% 22% 73% 4% Page 34

38 The preceding tables 17,18 and 19 reflect an improvement from previous years with the investment in new servers including the upgrade of software to Microsoft server 2012, the installation of new wireless technology in NHS Grampian properties and the purchase of 1700 new PC s or laptops which has allowed NHS Grampian to upgrade to Windows 7. Although 1.2m has been invested since 2014 in the purchase of 1,700 new devices, desktop performance remains low. NHS Grampian owns a total of 11,000 PCs and laptops. This recent investment represents a replacement of only 15% of the overall estate. The typical desktop PC/laptop lifecycle is 5 years; to achieve this, a recurring 1.5m investment is required to refresh 20% of the desktop estate annually. In absence of the level of funding required to achieve this, the desktop estate has been allowed to age. The current age of desktop equipment ranges from 1 to 9 years. Focus of investment - ICT As indicated above considerable progress has been made in the development of the EPR in NHS Grampian. It is important, however, to summarise the key issues which have an influence on the development of priorities for the future. These are summarised below: Vulnerability of Paper Records A programme to radically reduce paper record storage in our buildings forms part of the agreement with the Information Commissioner to reduce the risk associated with these paper records; whilst at the same time making more efficient use of our building and facilitates a move towards Smarter Working Dual Paper and Electronic Record Use - Whilst 75%-80% of acute services patient information is held electronically there continues to be a paper record for every patient in the system. This results in inefficiency with resources employed in the maintenance of both paper and electronic systems. Community Nursing and Health Visiting - The absence of an electronic information system for community nursing and health visiting means that staff cannot efficiently plan their case work or interface with other systems. Allied Health Professionals - Like community nursing and health visiting the availability of electronic systems for AHPs is at a very low level. Child Health Services - The increasing integration of the approach to child health required by the Children Act requires the development of information systems and records which can facilitate a high level of information sharing between professionals. Mental Health Services - The rollout of document scanning to support Mental Health clinicians requires to be completed and Mental health services requirements are required to be included in the development of the EPR within Trakcare. Information Sharing - As indicated above a key challenge is the ability to which information can be shared between clinicians and agencies involved in the delivery of health and social care. The vision for the EPR states that clinicians should have systems that provide the information they need to make their contribution to the patient's care within the context of the wider health and social care team. This could be done by the use of paper based systems but it would be cumbersome, expensive and could not be available in real time. Page 35

39 Given the current progress on the implementation of the EPR and the key challenges it is necessary to set out the proposed priorities for further development towards a comprehensive clinical information system, this is currently being considered along with a programme of works. The Trakcare infrastructure (servers, storage etc.) will also be at end of life and require replacement by July This requires an investment of around 1.2m with a 6 month lead time to ensure a managed change over to minimise disruption to services. Funding has been identified to meet this requriement. There is also a requirement for an investment of around 1m in increased data storage and key backup systems in 2017/18 for NHS Grampian to maintain existing services. This will be assessed as part of our planning for future years.. Page 36

40 Where do we want to be? Changes are taking place both within Grampian and across the country to make sure that NHSScotland is in the best possible shape to meet future health needs and improve people s wellbeing. There are a number of national and local policies and initiatives aimed at making NHSScotland more effective and efficient such as Better Health, Better Care: Action Plan, the NHSS Quality Strategy, the Efficiency and Productivity Framework and Achieving Sustainable Quality in Scotland s Healthcare A 20:20 Vision and the emerging NHS Scotland Clinical Strategy. Healthfit Vision The NHS Grampian Healthfit Vision was approved by the NHS Grampian Board in October 2011 and sets out the ambition for modernising health services across Grampian. It brings together significant information and advice which has been provided by managed clinical networks (MCNs), pathfinder projects, the clinical advisory structure and the management structure. This information and advice, together with the National 20:20 Vision, the Quality Ambitions described in NHS Scotland s Quality Strategy and the emerging NHS Scotland Clinical strategy clarify the overarching principles that guide the development of our strategic vision and the service and infrastructure scenarios that we believe are required to meet future health need. The changes in the demography of the Grampian population are predicted to have a significant impact on all public services, particularly health. These include: Over the next 20 years the population in Grampian is predicted to grow by 87,000 to 672,000. Under current allowances this equates to a requirement of 58 additional GP S that will require appropriate accommodation. Over the next 20 years the population aged will rise by 39% and those over 85 by 123%. By 2034 there are likely to be 35,000 people in Grampian living with diabetes, one third higher than the current 27,000. Nationally, the number of people with dementia is likely to rise by 75% and the number of people living with cancer could rise by 28% in Page 37

41 Grampian Clinical Strategy emerging themes NHS Grampian is currently developing its clinical strategy through wide engagement with clinicians, managers and the public across the north east of Scotland. The clinical strategy will be published later on this year and will take its place alongside the strategic plans of the new Health and Social Care Partnerships (HSCPs) of Moray, Aberdeenshire and Aberdeen City which have already been approved by the relevant Integration Joint Boards (IJBs). The engagement to date has identified that prevention, self-management, elective care and unscheduled care, are key themes. The aim of the Grampian clinical strategy is to ensure NHS Grampian continues to work collaboratively with patients, public and our partners to improve health and clinical outcomes for the population of the north east of Scotland and beyond. Grampian has an excellent track record of innovation, leading in service delivery and, importantly, improving care, health and patient outcomes. However we have a number of significant challenges in relation to the increasing age of the population, people living with multiple long term conditions, workforce availability, funding and geography as described later. The clinical strategy sets out NHS Grampian's priorities and outlines the shared intent of health and social care partners in the north east of Scotland and beyond. The strategy supports priorities from the emerging Health and Social Care Partnerships and the recently published National Clinical Strategy. The developing strategy is built around four healthcare delivery themes; Prevention; Self-Management of long term Conditions; Planned Routine and Urgent care in the right Place and Time; Unscheduled care in the Right Place and Time. These four strategic themes should not be seen as separate. They are interlinked and change in one theme will have an impact on the other. The more we do to prevent illness the less requirement there will be for planned care and unscheduled care. Increased self-management will reduce planned care and unscheduled care, and if our planned care services are more accessible it is less likely that people will require unscheduled care. The aim is to achieve the right balance of change and improvement across all four strategic themes. Prevention NHS Grampian will have a healthcare environment purposefully shaped to promote the health and wellbeing of those who work in them, and those who visit them whether as patient, carer or visitor. To enable this: Making Every Opportunity Count will be widely implemented across NHS settings A pilot staff health and wellbeing programme will be trialled Generic health coaches will be piloted in a clinical setting and lessons will be learned about whether to expand their provision Page 38

42 Strategic Asset Impact We will digitise health promotion advice onto the No Delays platform. NHS Health Scotland s Place Standard will be trialled to inform planned developments at Foresterhill or another NHS site and the healthcare retail standard will be achieved across NHS setting Increase access for those with greatest need to preventive clinical services Self-Management of Long Term Conditions NHS Grampian will ensure people who are living with long term health conditions are supported, minimising their risk of complications and premature mortality, optimising their sense of health and wellbeing, and maximising their ability to live the life of their choosing. Supporting self-management is a fundamental component of the move to develop person-centred health and social care services. Very little of learning to live with a health condition actually happens on healthcare premises. Yet finding answers to what it means to be living with a health condition often multiple health conditions, finding ways to cope with associated uncertainties and anxiety, increasing self-confidence and self-belief, and finding constructive ways to overcome health-related obstacles to everyday functioning are vital to developing an increased sense of being able to self-manage. Integrated Joint Boards and NHS Grampian will support communities to develop and strengthen a wide range of resources for people to draw on to support their own health. This will be achieved by: Collaborative communication, agenda setting and decisionmaking skills will be part of all health and social care professionals annual appraisals and personal learning and development plans. Training will be available to support this. Organisational development and service improvement programmes will include a focus on the provision of collaborative, person-centred services mindful that many will be living with multiple complex long term conditions. The participation of those who use services in helping design, develop, improve and deliver services is a fundamental part of the Community Empowerment (Act) Scotland The opportunities for HSCPs and NHS Grampian to co-create services with third sector and civil society groups will be grasped. Alongside formal systems of social prescribing, new trial roles such as health coaches and community link workers will be developed and coordinated, to help bridge the gap between healthcare services and their users local communities and these will be evaluated. HSCPs and NHS Grampian will play an active role in Community Planning Partnership, helping to build healthier and stronger communities and supporting research and evaluation to better understand self-management of long term conditions. Page 39

43 IJBs and NHS Grampian will work with Voluntary Organisations experienced in developing peer-led support and education programmes and buddying schemes to incorporate these into clinical services pathways, ensuring suitability for people with multiple conditions: individual and better connect clinicians to improve the continuity of care. Patients will be assessed and treated in the right place, at the right time, and by the right person. The main components of the programme to change and improve planned care include: Strategic Asset Impact A wide range of resources will be provided to give professionals additional support to help people to self-manage including: traditional and digital information and education for people and their carers self-monitoring resources virtual consultations via digital communication technologies tele-health devices and telephone services. Planned Routine and Urgent care in the Right Place and Time Planned care is the name given to those diagnostic and treatment services which are not carried out in an emergency. The services can be delivered routinely or on an urgent basis within community, primary and secondary care settings by a wide range of health care professionals e.g. pharmacists, GPs, nurses, physiotherapists and consultants. NHS Grampian will ensure a wide range of treatment and care is provided to patients on this planned basis i.e. non-emergency; to support patients to make decisions about their treatment; to make treatment and care more accessible in a wider range of locations closer to home; improve the efficiency of care; reduce the need for multiple attendances which add no value to the Diagnostic and Treatment Services: The Scottish Government has earmarked capital funding for NHS Grampian to develop Diagnostic Treatment facilities. The intention of this funding is to ensure that sufficient capacity is available to meet the needs of the increased elderly population for planned care over the next 10 years and beyond. NHS Grampian and the HSCPs for Aberdeen City, Aberdeenshire and Moray will work together during 2016/17 to review all aspects of planned care to develop an agreed way forward for the north east of Scotland. It is through this process that a specification for diagnostic and treatment facilities will be prepared in The aim will be to bring new diagnostic and treatment facilities into use by Modernising Primary Care: NHSG will enhance the support provided for a wide range of improvements and innovations that are being taken forward across Grampian in both planned care and unscheduled care. This change includes the implementation of different workforce models, developing new ways of working with acute services, and developing new relationships with patients and partner organisations in communities. Patient Pathway Development: A more coordinated approach to pathway development is being planned to ensure that clearer agreements are in place between primary Page 40

44 care and hospital based clinicians in relation to the referral and treatment of patients. This will not only contribute to ensuring that care is provided in the right place and at the right time, but also improve efficiency in terms of patient time and staff time. Doing outpatient integration together (DOIT): This is a national programme aimed at transforming the delivery of outpatient services. The programme focuses on; reducing reliance on traditional outpatient appointments by use of improved communication and processes e.g., electronic advice referral, e-triage; developing alternatives to face to face appointments; Actively managing return activity patient initiated returns and working collaboratively across Scotland to test and share new ways of working including developing the clinical workforce in the context of ensuring that consultants do what only a consultant can do Enhanced recovery: This includes the implementation of evidence based practice to optimise patient recovery from surgical procedures and minimise length of hospital stay. This is only partially implemented in Grampian and full roll out is dependent on creating the time for clinical teams to be appropriately supported to realign current practice. Deep community engagement: This process is being taken forward as part of the modernising primary care initiative. A Community enterprise has been engaged to develop innovative ways of engaging local communities associated with practice populations. The aim is to maximise the potential of patients to self-manage, connect with local communities and develop capacity to support community health and wellbeing. Strategic Asset Impact Orthopaedic Quality Drive: This is focused on the development of pathways to manage musculoskeletal (MSK) conditions to ensure patients are seen at the right time and by the right clinician. This work involves collaboration of all the disciplines involved in MSK pathways to both develop the pathway and ensure they are fully implemented. There is a significant amount of co-ordinated work being undertaken to create a planned care system that meets the predicted needs of our population. Our future asset requirements and investment programme will be determined through joint planning and coordination of community, primary care and hospital based professionals, and the work being undertaken on a regional basis. Maximising Theatre Utilisation: Operating theatres are an important part of the pathway of planned care for many patients and it is important that they are used as efficiently and effectively as possible. A programme of work to improve utilisation is underway and this will be linked to the work on the diagnostic and treatment centre. Page 41

45 Unscheduled Care (USC) in the Right Place and Time Unscheduled Care is defined as care which cannot reasonably be foreseen or planned in advance of contact with the relevant healthcare professional, or is care which, unavoidably, is delivered out with core working period e.g. overnight/weekends. As this demand can occur at any time, services must be available 24 hours a day to respond as appropriate. The scope of unscheduled care is therefore extremely broad and includes primary care and community services including GPs, social care, nursing, pharmacists, opticians, dentists secondary care hospital services and specialist major trauma services. NHS Grampian will ensure that treatment and care will be provided as close to home as possible by a team of professionals who will be provided with advice to support decision making on treatment and transfer to the right service if required. The pathway of care for USC will be organised by the HSCPs with the emphasis on ensuring that any stay in hospital is appropriate to the care needs of individuals. The focus for improvement will include: The Scottish Government 6 Essentials Actions approach will be implemented in a coordinated way across the health and social care settings. Improve the movement and transfer of patients to the right place at the right time by working closely with the Scottish Ambulance Service. Targeting delayed discharges as part of focusing on patient flow Further extend the clinical decision support service to improve the level of care that can be provided locally, convert unscheduled care to planned care wherever possible and ensure quick access to specialist care when required. Develop the workforce to ensure that skills and experience are applied effectively e.g. by employing more advanced practitioners, physician associates etc. Strategic Asset Impact We will develop innovative approaches to out of hours care through the development of primary care. We will also contribute to the development of a network of major trauma care for the north of Scotland and establish a major trauma centre in Aberdeen to be the hub of the network, as part of the national trauma network. Acute services and HSCPs work closely to better manage flow through the system. This will focus on clear, agreed and shared pathways reducing delays so that patients receive the right care at the right time in the right place improving the patient experience and the quality of the care received. Page 42

46 Grampian Clinical Strategy enabling change The four Healthcare delivery themes will be supported by the following key elements: Continuous Improvement A Quality Improvement Hub will provide the focus, context and support for the improvements required at organisation and service level by providing direction to deliver improvements on agreed priorities and support to test, spread and implement improvements at both small and large scale. It will utilise the expertise of Hub members to build organisational improvement capacity to effect step change and actions set out in our implementation plans and it will enable clinical and administrative data to be readily available which will be linked to support improvement, performance and assurance at all levels. Information Sharing Across the System Information sharing agreements will be developed with the Health and Social Care Partnerships and Councils in Moray, Aberdeenshire and Aberdeen City to enable the appropriate sharing of information to improve treatment and care outcomes. A key element of this will be the implementation of the electronic patient record (EPR) which will improve the management of care across the health and social care system. Collaborative Working & Networking Around the Individual & Communities Systems and processes which bring acute services and Health and Social Care Partnerships together will be strengthened to co-ordinate care across the system, develop effective patient pathways, improve access to services for communities and support the implementation of the nine health and social care outcomes. Services which are provided across the north east of Scotland will be encouraged to work effectively as networks of care and there will be closer working with NHS Boards in the north of Scotland to ensure that a range of tertiary services are developed and maintained to provide good access for people in the north east and north of Scotland. Promoting Staff Health and Wellbeing NHS Grampian will actively promote and support staff health and wellbeing by working with staff to improve the environment for the provision of services and care, identifying and addressing causes of injury or ill-health. It will also promote healthier lifestyles and support staff in their own self-management and by collaboratively working with staff will address the impact of health on the capacity of the individual to work. Page 43

47 Maximising Innovation A culture of innovation will be promoted to stimulate and support staff to be innovative in meeting the challenges facing health and social care. This will include the establishment of an Innovation Hub to provide a focus for innovation to support health and social care integration and the development of innovation partnerships with other public service organisations and industry. Work will be done in partnership with the Scottish Government as part of the Innovation Year 2016 and provide a foundation for future innovation. Digital health technologies will continue to be developed and implemented, such as No Delays to encourage people to improve their own health and self-manage their own conditions. Acute setting bed numbers are likely to remain broadly similar to existing provision. A piece of work is currently in development confirming that there is unlikely to be any further reduction with the possibility of marginal increase. Management of an increasing population will be achieved through efficiency programmes to improve system flow. Older people services have largely been transferred to community settings and this will continue. Again review of the ageing population in Grampian is an ongoing feature of local planning and this is confirming a decentralised model of care. Similar to older people services, mental health services are already largely embedded in community settings and deviation from this model is highly unlikely in the emerging health and social care context. As well as ageing, the Grampian population is undergoing significant growth with new settlements/communities emerging across the region. Again this is a consideration for the planning and prioritisation of primary and community based health and adult social care services. Strategic Asset Impact Our Healthfit Vision and Clinical Strategy puts the application of technology at the forefront of a new sustainable model of patient care. The way to do this is to improve the availability of electronically held patient information which, subject to the application of good practice, can be exchanged efficiently between clinicians and carers. This requires the development and implementation of a comprehensive electronic patient record an EPR Page 44

48 Developing our workforce A capable, flexible and sustainable workforce will be developed with the necessary skills to deliver care and support across the health and care system, including the Third Sector and non-paid carers. A key focus will be on modernising the workforce, developing and extending new roles including physician associates and improving the attractiveness of support roles. Our workforce of the future will be organised in an integrated way, focusing on the needs of the individual rather than the desires of the professional. Whilst managing growth and demand, healthcare professionals will be more accessible to the public and to each other. The particular matters that will influence our future strategy regarding workforce will include: The number of staff working in Scotland s NHS is reported as reaching an all-time high. However this is not yet the case in Grampian. In some specialties it is difficult to recruit skilled medical staff to sustain services. There have also been challenges with recruitment to low-skilled labour, although this may improve with changes in the north east oil and gas economy. An ageing population with a growing burden of chronic disease has implications for staff numbers, skill mix and competencies. Importantly the creation of the new Integration Joint Boards covering all adult health and social care services will result in one of the most significant changes in the configuration and delivery of health and social care for some time. This will require staff to have a mix of health & social care competencies. Increased investment in technology will mean that the skills staff require will need to be supported by investment in assets which will support a technologically adept system of care delivery. Key worker accommodation - The Grampian area has been unique in the Scottish economy largely due to the buoyancy of the Oil and Gas sectors, more recently that economy has fallen away. The net impact on public services such as NHS Grampian is the affordability of housing whether to purchase or lease and despite the downturn this remains an issue. This has had a significant effect on recruitment and retention of staff. In response to this NHS Grampian has identified a site at Foresterhill to provide key worker accommodation which would be operated by a Registered Social Landlord providing accommodation at mid-market rentals primarily for key workers in the public sector. This site is likely to provide c100 residential units based on short assured tenancies. In addition we are working with the Scottish Government, Aberdeen City Council and the private sector to identify affordable housing options for staff. A key challenge is the appropriate use of the Strategic Housing Investment Plan (SHIP) grant monies and how the qualifying criteria can be revised to accommodate those classified as key workers, this includes household income caps and length of tenure. If through the use of the SHIP funds the qualifying criteria cannot be more flexible then alternative solutions will require to be identified. Other options under consideration are; Page 45

49 extending the staff home (Woodend); former Craiginches Prison; former Summerfield Academy site; Smithfield Court; and through site sales buying affordable housing units through the use of endowment funds. Consistent with the Healthfit vision our workforce requiring an office will be working differently in the future. The use of technology and an effective ICT network along with the previously mentioned IP telephone will facilitate this. Office based costs must be reduced allowing redirection of funds into frontline healthcare, once a sustainable technology and ICT network is funded. Strategic Asset Impact Technology will be used to bring people closer together, more staff will be working flexibly, not require a permanent base or office, with links to wider support facilitated by enhanced use of IT and tele-links. Integrated team working will become increasingly vital to successful delivery of the Healthfit vision. Supporting teams to come together to work in a different, integrated way will require active encouragement and support. Teams will be empowered to actively remove barriers to delivering person-centred care, to develop core behaviours and skills to enable better and more streamlined delivery of service. Page 46

50 Partnership working In terms of partnership working we have a strong level of engagement with our partners in the North East which extends beyond an awareness of the Local Development Plans and respective asset management plans. This commitment to partnership working is reflected in a number of ways: Regional Working North Territory Programme Board (TPB): the TPB comprises 16 public sector participants and is responsible for the Strategic Leadership of the hub programme, ensuring there is a coordinated approach to planning future accommodation needs across all participants. hub has delivered Aberdeen Health Village (NHS Grampian working in partnership with Aberdeen City Council and Grampian Police) and concluded a bundle of health centre projects specifically Forres and Woodside (including Tain and working in partnership with NHS Highland and with support from The Moray, Aberdeen City and The Highland Councils). North of Scotland Planning Group: is a collaboration of six NHS Boards NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland, NHS Tayside and NHS Western Isles, delivering significant benefits to patients in the North of Scotland through collaborative working often for patient groups where services need a critical mass greater than available in any one Board. NHS Highland: the hub process has enabled greater joint working between NHS Grampian and colleagues in NHS Highland delivering the Health Centre at Tain, which was completed in April The Capital Planning and Hard FM working group has been considering regional working and have identified NHS Grampian and NHS Highland as a pilot for further development, wishing to build upon the joint working established through hub. Significant progress towards a regional solution has been made. North East Scotland Joint Public Sector Group: continues to meet and co-ordinate asset management plans to ensure the opportunities of joint working through co-location and integration remain very much at the forefront of all asset investment. NESTRANS: The Regional Transport Partnership, Nestrans continues to invest in active travel networks and to lead on Behaviour Change initiatives in the Grampian region through the Getabout partnership. A programme of events has been carried out and marketing initiatives conducted to promote active and sustainable travel in Aberdeen City & Shire. NHS Grampian are represented on the NESTRANS Board. Health Transport Action Plan (HTAP): For a number of years, NHS Grampian has worked collaboratively to produce and deliver on a range of Health and Transport initiatives through a partnership with Aberdeen City, Aberdeenshire and Moray Councils; Scottish Ambulance Service and Nestrans. A Steering Group coordinating the work and supported by a fulltime member of staff funded by Nestrans and NHS Grampian has overseen a refresh of the HTAP and established two subgroups to develop initiatives under the headings of Access to Health & Social Care and Transport & Public Health. THInC (Transport to Health Information Centre): One initiative delivered by HTAP provides an information centre handling enquiries relating to travel, to and from healthcare Page 47

51 appointments. Initially operating out of Elgin, the centre is now based within Aberdeenshire Council. A database of all public transport, community transport and third sector transport providers in the region has been compiled, along with other voluntary schemes. Callers can be directed to appropriate transport through an understanding of available options, eligibility criteria and travellers needs. Community Planning Partners Within Grampian relationships are well developed with our Community Planning Partners (CPP s). In the last year, we have held meetings with the 3 local authorities to identify joint capital investment priorities and participate in future infrastructure requirements for services resulting from development sites supported through the Local Development Plan process. This has led to further detailed discussions with: The Moray Council regarding joint development of a vision for the area, based on the concept of our Healthfit Vision. This includes the process of identifying opportunities of joint working and developing proposals which may be linked in part to the Moray Local Development Plan and include Developer Contributions to meet the needs of the Moray population. The Integrated Joint Board of Moray will have the opportunity to co-locate staff and specifically vacate the Spynie site in Elgin in readiness for disposal. Aberdeenshire Council regarding joint service developments around Inverurie, Banff, Fraserburgh, Peterhead, Ellon, Banchory and Balmedie as well as the sharing of accommodation. Aberdeen City Council regarding the joint marketing of shared surplus assets, potential for future joint developments and the sharing of accommodation. Local Authority Development Planning As a key agency NHS Grampian continues to engage with it s four Planning Authorities to ensure infrastructure requirements are identified to support service delivery in local areas. This engagement has allowed NHS Grampian to be one of the first Health Boards in Scotland to ensure health is supported in terms of Developer Obligations to support the delivery of infrastructure as a consequence of patient growth due to house building. In the Grampian Board area supplementary guidance in most of the Local Development Plans now recognize health as one of the services that may require support from Developers Contributions along with a methodology of what contributions and/or provision of land for infrastructure will be sought. In terms of potential Developers Obligations funding and land could amount to 80m. To date NHS Grampian have secured contributions of circa 8m plus land through legal agreements. Page 48

52 Aberdeen City and Shire Strategic Development Plan The Aberdeen City and Shire Strategic Development plan identifies strategic growth areas which will be the main focus for development in the area up to The new plan was approved by Scottish Ministers and came into force on 28 March Local Development Plan (LDP) The Local Development Plans for Aberdeen City and Shire support the delivery of the Strategic Development Plan with a target of 70,000 housing units over the next 20 years. To meet the strategic development 50% of the planned housing will be delivered in Aberdeen City with the balance delivered within the main commuting routes in Aberdeenshire. The Moray Council has published strategic housing land requirements for the period 2013 to 2025 and aims to ensure that a five year effective housing land supply is maintained. The Moray LDP was formally adopted on 31 st July The Cairngorms National Park includes areas within Aberdeenshire and Moray and form part of NHS Grampian s service area. It sets out policies and proposals for development and use of land for the next 5-10 years, and gives the basis for the assessment of all planning applications made across the Cairngorms National Park. For more detailed analysis see Appendix F Community Empowerment Bill The Community Empowerment Act gives community organisations a right to ask to take over control of public land or buildings. An asset transfer request has to be made by a community transfer body to a relevant authority. The community transfer body can make a request about any land or buildings which the relevant authority owns, or rents from someone else. They can ask to buy or rent the land or buildings or have other legal rights, for example to occupy or use the land. The relevant authority must listen to what the community transfer body wants to do with the land or building. If a community transfer body wants to buy land or a building through asset transfer, they must become a company, a Scottish Charitable Incorporated Organisation (SCIO) or a Community Benefit Society. The Act says all relevant authorities must make a list of all the land and buildings they own or rent, and let everyone see it. The law on asset transfer is not yet finished. Strategic Asset Impact We will continue to progress discussions with all partners in Grampian and the North of Scotland around engagement in developing joint asset plans, assessing the impact of all future residential developments and continuing to seek developer contributions for Health Care Infrastructure where appropriate. Page 49

53 Strategic benefits and investment that is necessary NHS Grampian will move in the agreed strategic direction as described in our Clinical Strategy, putting a renewed emphasis on Prevention and Self-Management as well as Planned Routine and Unscheduled Care. We will also endeavour to improve: management and performance of all buildings, equipment and infrastructure as per the performance framework over the next 10 years. There is, however, limited funding available and consequently all investment needs will require careful scrutiny based on greatest risk and with reference to the Local Development Plan process to identify and secure developer contributions wherever appropriate. In terms of our plans for the period of the AMP, we would highlight the following strategic benefits across key service areas: Acute and Mental Health Foresterhill Health Campus The Foresterhill Health Campus is still in need of much development to fulfil the Foresterhill Development Framework (approved in 2008 and updated 2014). It has rightly formed the spine to redevelopment of the site over the last 6 years in terms of planning, design, style and quality of the built environment. Considerable progress has been made with the completion of a range of strategic developments including the Suttie Centre, Aberdeen Dental School and Hospital, new Radiotherapy Centre which will form part of the new Anchor Cancer Centre, two new minimal invasive operating theatres to accommodate robotics and the Emergency Care Centre. In addition, significant reconfiguration works (ARP) are currently underway in the inpatient areas of ARI, which is planned for completion 2017/18, to ensure that they are fit for purpose for the next years. Funding has been identified by the Scottish Government to allow the development of the Baird Family Hospital and Anchor Centre within the Foresterhill Campus in Aberdeen. The enabling works for this project also requires the replacement of the Foresterhill Health Centre and the relocation of the Eye Outpatient Clinic. These projects will be delivered by capital expenditure and expected for completion in The Scottish Government have also announced 40m funding for the provision of a new Diagnostic and Treatment Centre NHS Grampian aim to carry out a detailed planning exercise over the next 9-12 months to develop the strategy for elective care in the North of Scotland with the aim of producing a specification for this new centre as part of that process. NHS Grampian are also looking to contribute to the development of a network of major trauma care for the north of Scotland and establish a major trauma centre, which will be the hub of the network, within the newly developed Emergency Care Centre. NHS Grampian is developing a new multi storey car park on the Foresterhill campus after being offered a donation from the Wood Foundation. The car park will provide circa an additional 1000 parking spaces for exclusive use by patients and visitors. Page 50

54 The next stage of the strategic development of the campus will require investment in, Phase 1 and East End of ARI for Ambulatory Care, New Laboratory Building (referenced above), New Mortuary, a solution for Nuclear Medicine, accommodation for Medical Physics and the relocation of CDU and Laundry. All of the foregoing requires funding to be identified. To plan for the next stages a major service planning exercise has been carried out and was reported to the AMG in March This included participation from clinicians, heads of service and other key stakeholders. The exercise demonstrated more detailed analysis is now required to demonstrate the proposals for the next stages of reconfiguration are feasible and will provide a good level of fit for the predicted levels of activity (clinical, educational and research) and changing service delivery models that are emerging. Other Acute and Mental Health developments under consideration are: Relocation of the Learning Disability in-patient service into the Royal Cornhill Hospital. This would increase safety for patients and staff whilst guaranteeing a quick response to emergency calls and improved access to on-call staff during anti-social hours. There is a requirement to carry out refurbishment works to all Mental Health and Learning Disability ward areas across Grampian to enable the patient environmental improvements, HAI targets, significant self-harm risk management concerns and wider health & safety issues which were revealed by workplace inspections. These works would significantly improve the quality and safety of our patients, staff and visitors experience. Of the 7 Child Development Teams (CDT) 5 are currently accommodated in unsuitable accommodation. A business case is required to be developed to establish the most appropriate development programme to suit the needs of the service. The potential of a hotel being created on the Foresterhill site which may include a patient hotel element, for those patients not requiring a hospital bed. Community Hospitals Many changes have affected community hospitals with this likely to continue as health and social care services integrate and focus on different care models including, prevention, self-care and care at home. The immediate future investment will be around the following: Provision of a new healthcare facility within the existing Inverurie Hospital site incorporating a Health Centre, Community Maternity Unit (CMU), Community Dental suite, Diagnostic and Treatment suite and an X-ray suite. These new facilities have been established based on a new service model which will bring together a range of health and social care services to create a Care Hub. Page 51

55 As part of the new development at Inverurie hospital, NHS Grampian has relocated the Dementia Assessment unit to co-locate with Aberdeenshire Council Services at Bennachie View, Inverurie. This has provided the capability on the hospital site to deliver the new Care Hub facilities and services. The detailed future configuration of Community Hospitals will be the subject of comprehensive community planning work undertaken jointly by the NHS, Local Authorities and the third sector using the existing Community Planning Structures. Primary Care The NHS Grampian Primary Care Premises Plan sets out the strategic investment needs of each of the HSCP s in line with NHS Grampian s Healthfit Vision, and includes General Practice, Dental Practice, Pharmacy and Optometry. The key overall priorities and investment need is assessed by this group. The Primary Care Premises Plan was approved by the AMG in May 2014 (updated May 2015) and is included in appendix H. NHS Grampian currently own 27 Health Centres, 22 clinics and 5 separate dental units along with 2 Hub procured Health Centres and the Health Village. In addition, there are a - 71 GP (owned or leased) premises, 70 dental premises, 121 pharmacies and 52 ophthalmic premises. The Primary Care Premises Group awards grants (that meet set criteria) for a range of needs allowing some premises to be extended, improved and comply with the needs of legislative/hai requirements. Pharmacy There are National Plans (e.g. Prescription for Excellence) to increase the role of community pharmacists in the provision of health services, this is further explored in the Clinical Services Strategy. These may include but not limited to; prescribing; lifestyle support; administering vaccines and management of prescriptions. These changes will increase the need for consultations with patients and space to carry them out. Pharmacies will require to ensure they have the capacity and layout to cope with this increased workload over the next 10 years and that their premises meet the high standards expected of a healthcare environment. Many pharmacies are keen to offer integrated/shared premises within local communities and certainly co-location of GP and Pharmacy services would encourage closer working relationships as per British Medical Association and Royal Pharmaceutical Society recommendations. Properly designed consulting rooms in pharmacies could allow GP consultations from pharmacy premises to become an acceptable option of service delivery, particularly in rural areas where separate accommodation is not viable. NHS Grampian are currently looking at this option within the Aberdeenshire and Moray area. This could also include nurse dressing clinics being offered from these same pharmacies. To enable some of these opportunities there will also be a need to improve IT connectivity to many of the Pharmacies as described in NHS Grampian s requirement for an EPR, this Page 52

56 move to share electronic records could significantly improve patient safety. Optometry Over the next 10 years, premises developments are largely dependent on independent practitioners. National developments in care and treatment will influence internal premises redesigns. It is hoped that the implementation of the EPR can mean that Optometrists can have access to hospital Ophthalmology notes through SCI Store and the Emergency Care Summary (ECS), which can lead to two major improvements: safer comanagement of patients, sometimes with Independent Prescribing qualified Optometrists and also fewer re-referrals of patients who have been seen by Hospital Eye Service and discharged. The aging demographics in Grampian, as in the whole of Scotland, have led to increased demand for wet Age-Related Macular Degeneration (ARMD) treatment. To assist with this demand, there has been a two-fold response by NHS Grampian. Firstly with more Ophthalmologists in the Eye Out-Patient Department, there is now capacity for more clinics to run in peripheral hospitals. Secondly, these peripheral clinics commission local Optometrists who can also help with follow-up appointments in their own practices. Improving technology has also meant that virtual meetings can feed back results from the community Optometrist to the treating Consultant. In the past few years the General Ophthalmic Services contract has incorporated Ocular Coherence Tomography (OCT) as an examination prior to referral of ARMD, allowing accurate diagnosis and appropriate urgency of referral for this condition. This has been aided by the addition of funding to Optometry practices to install OCT machines. Financial assistance for scanners has also assisted appropriate referrals for visual field plots by scanning results from suspect glaucoma patients. Currently there is a spread of 60 practices throughout Grampian (see map 1 overleaf). Although each practice has its own patient base, this is fluid as there is no registration of patients. The Eye Health Network is a successful model of care for those needing unscheduled appointments for eye emergencies. The spread of practices means that patients can attend locally and if an appointment is not available, the practice can find the patient a home at a nearby practice. Over the next 10 years, as the population age rises, there will be more need for eye care and related age conditions e.g. macula problems. In some areas of Grampian e.g. Alford, Laurencekirk, Insch, Mintlaw, Keith and Fochabers, there is limited or no access to optometry practices. There is future potential to incorporate Optometry rooms within future community builds as in a hub (both in the new build sites and the emerging community sites (see map). This could assist with keeping and treating patients in the community by the community Optometrists running virtual glaucoma and macula clinics; results can be forwarded to the hospital eye service. Tele health links installed in these rooms would also aid this type of consultation. In the auspices of Modernising Primary Care agenda, GMS could also utilise these Optometry hub facilities by directing patients accordingly, both for General Ophthalmic and Enhanced Services. Page 53

57 Through NHS Grampian Premises funding, many of Grampian community Optometry practices have been made more compliant with the Equality Act 2010 e.g. wheelchair ramps. assured courses for dental nurses and dental technicians now also makes Grampian a more stable environment for NHS dental services and high quality care. NHS Grampian is developing a dental locality planning model based on the needs of small localities of about 20,000 people. This system will be used to monitor service availability and target access initiatives where required. General Practice Recently projects have been completed through the hub initiative at Woodside Fountain Health Centre (Aug 2014) and Forres Health and Care Centre (Sept 14); and plans are well advanced for replacement facilities for Inverurie and Foresterhill health centre under the hub revenue funded model and Denburn Health Centres as a hub capital scheme. Map 1 Dental Dental Services have improved significantly in Grampian over the last 5 to 10 years through our modernisation agenda firmly supported by the SGHSCD. Presently there are 120 modern dental practices in Grampian identified as fit for purpose through our rigorous practice inspection process. This enables sufficient capacity for dental services to offer comprehensive care to all. The development of the Aberdeen Dental School with new dentists graduating annually in Aberdeen made a contribution to 25 new practices opening since The introduction of quality There has already been considerable change to the requirements of GP premises while we attempt to move the balance of care to our local communities. Larger integrated premises are required for, prevention and self-management information or clinics, increased diagnostic and treatment services, training and community nursing teams. The increasing development of intermediate care facilities is changing the demands on general practice. Increasingly integration and coproduction is used to describe how we will all work in the near future, and this may provide opportunities to make investment decisions which provide greater value for money for all parties. Page 54

58 The NHS Grampian Primary Care Premises Plan pulls together many dimensions and sets the strategic context within each of NHS Grampian s HSCPs in line with our vision, highlights current plans within our GP services and sets out key overall priorities as assessed by the Primary Care Premises Group. Further to the announcement of 19m to be invested in General Practices the Board has been considering how best to use this funding along with Developer Contributions and new primary care funding to ensure maximum benefit for the patients. Focus for this work has been concentrated on the corridors of Dyce and Newmachar; Bucksburn and Blackburn; and the community of Balmedie. The next emerging bundle of projects which NHS Grampian will be seeking funding support from the Scottish Government will include Banchory, Ellon and Danestone all of these practices now have sites identified and all provide funding through developer contributions. Work has also progressed with strategic planning (stakeholder workshops) around a future development at Keith and short to medium term solutions for Northfield and Portlethen Medical Practices through GMS grants. Listed below are the priorities identified by each of NHS Grampians Integration Joint Boards for the next 10 years, these will however continue to be assessed and prioritised on an annual basis in line with this AMP. Bucksburn/Dyce Medical Practices (Aberdeen) (part of 19m bundle) Banchory Medical Practice (Aberdeenshire) (emerging Bundle) Ellon Medical Practice (Aberdeenshire) (emerging Bundle) Northfield/ Mastrick Medical Practice (Aberdeen) (temp solution, portacabins) Keith Medical Practice (Moray) (strategic planning stage) Danestone Medical Practice (Aberdeen) (emerging Bundle) Kincorth Medical Practice (Aberdeen) Torry Medical Practice (Aberdeen) Fochabers Medical Practice (Moray) Whilst we have achieved much of our earlier priorities, the pressures of the National 2020 vision coupled with the the significant growth of population in this area, is focusing attention on the need to identify solutions and investment to cope with the services the required to support new and emerging populations. Page 55

59 Office Accommodation The NHS Scotland Asset and Facilities Management Programme Board, supported by Scottish Government, have set up a programme of activity for all office accommodation to ensure best use is made of resources, identify savings and efficiencies. Within this programme is the development of new ways of working. NHS Grampian has made a commitment to improve the utilisation of its office accommodation across the office portfolio by identifying opportunities for consolidation and rationalisation, increased agile working and shared use of space with other public sector partners. NHS Grampian are currently working alongside our local authority partners in a number of ways (a) learning from their recent experiences of implementing Smarter Working; (b) implementing these same principles throughout NHS Grampian where appropriate; and (c) co-location of office accommodation with the introduction of Health and Social Care Integration incorporating the Smarter Working principles. Worksmart culture workshops have taken place in many of our health and social care offices along with the local authority Worksmart teams. This has allowed us to co-locate Health and Social Care staff which in turn optimises the use of office space, improved communication between services which will improve patient outcomes. The success of the initiative is being measured by: Improved communication for Health and Social Care Staff which leads to improved patient outcomes; A reduction in running costs and our office accommodation footprint; A reduction in energy and water consumption as well as reduced waste and carbon emissions; An overall improvement in the space utilisation of our office accommodation; NHS Grampian has invested in sensors to gather comprehensive information on desk and office utilisation which is informing our implementation of the Worksmart programme. It has already highlighted a 60% underutilisation of desk space in some of our offices areas. A summary of the main office accommodation within NHS Grampian is set out in table 20 below. Description Floors GIA m² Table 20 Usable Area Desk No.s Staff Desk Ratio Per 10 Staff Floor Ratio Per m² Person Revenue Costs Costs Per m2 Costs Per Person Ashgrove House , ,148 Foresterhill House , ,953 Foresterhill Lea , ,450 Spynie , ,887 Summerfield House , ,420 Westholme , , Union Street , ,890 Total 891 2,421,648 Page 56

60 A number of case studies are also taking place at Summerfield House, Westholme and Spynie. These studies have been implemented to demonstrate good practice, the investment required for medium and long term gain and the cultural change required to ensure success. Where are we going? NHS Grampian will continue to maximise utilisation of office space in order to provide more flexible working styles to employees and reduce costs. This will include ensuring we have the appropriate furniture, appropriate IT infrastructure, appropriate HR support for flexible working options, depersonalised desks, de-cluttering and limited storage (as highlighted in the case studies) which will create a flexible modern environment for everyone, anywhere. Worksmart is about achieving the best utilisation of office space reducing costs and providing more flexible working styles to employees. It is also about a cultural change where work is thought of as being something you do and not somewhere you go not to focus on the place but focus on the task. How will we achieve the change required? style of working has already demonstrated a significant change in the culture of the HSCP, the ability to work from different locations, its travel patterns, use of technologies and use of space. NHS Grampian, supported by the Scottish Futures Trust, will continue with our cultural change programme of introducing alternative work styles. The initiative will be rolled out initially in our larger offices and then throughout NHS Grampian including clinical areas. ICT infrastructure is laying the foundation for this change programme to commence:- Wireless installation in all offices, community hospitals and in all GP premises including branch surgeries which was completed in the summer of Implementation of Microsoft Direct Access which is allowing access to the NHS Intranet Network with an NHS PC/Laptop from any internet point, testing has completed and is currently being rolled out to those staff requiring access. NHS Grampian is targeting a desk ratio of 7 desks for 10 staff located in all office locations. Plans are in place to move the remaining 9 staff from 181 Union Street to alternative accommodation in 2016/17, freeing up the revenue associated with running the building. Aberdeenshire HSCP has introduced Worksmart which had already been adopted by Aberdeenshire Council. This flexible The replacement of the N3 contract, which ended last year, with the Scottish Wide Area Network (SWAN) introduces greater speed, bandwidth and improved links with our other public sector colleagues. The NSS replacement of all N3 circuits within a 12 month timescale lays the foundation for this improved access to other public sector agencies. Page 57

61 ICT transformation project replaces the Microsoft XP operating system on all PC s and laptops and the upgrade of NHS Grampian domain which is based on Windows 2003 to Server 2012 will be a major foundation builder. This work was completed in March This required the replacement of all older PC s and laptops. IP telephony for all main office accommodation was completed in 2015, allowing flexibility for staff to work at any desk and login to their own telephone extension. In order for NHS Grampian to remain viable and sustainable, we must move forward with Worksmart in line with the NHS Grampian Healthfit vision, the IJB strategies and the NHS Grampian Clinical Strategy. This is will ensure a balanced and consistent approach for our office staff in implementing Health and Social Care Integration. Page 58

62 Essential equipment and ICT replacement programme As at 31 st March 2016 NHS Grampian s equipment and ICT assets had a net book value of 50m (gross cost before accumulated depreciation of 152m). At this date 1,572 individual assets were fully written down of which 350 are older than 10 years see table 21 below. Assets fully written down as at 1 April 2013 Assets fully written down as at 1 April 2018 Assets fully written down as at 1 April 2023 Assets fully written down as at 1 April 2026 Table 21 Cost When Additional No Purchased of assets 44m 1,572 58m 1,560 46m 1,091 4m m 4,360 Assuming no investment in essential equipment and ICT, by 2026 there would be 4,360 items fully written down with a replacement cost of 152m plus inflationary uplifts. Equipment A primary element of the investment programme is replacement of essential equipment and critical assets. Clinical services have been fully engaged in order to assess and prioritise available funding for essential equipment replacement. With an ageing estate, together with a growth in demand for services, our asset plan has identified the need for priority investment in a number of key areas within our acute sector infrastructure MRI capacity; laboratory and medical equipment accommodation; replacement laundry and CDU facility; and new mortuary accommodation. Within the ten year plan, we are developing a detailed equipment replacement strategy, informed by a comprehensive assessment of risk. 3m is earmarked in 2016/17, 3m in 2017/18 rising to 6m in each of the following three years for essential equipment targeted at those areas of highest risk. Further funding will be required however to meet future essential equipment replacement requirements. ICT The implementation of the EPR is not just about information systems. Implementation requires wide scale redesign to ensure that working practices of clinical staff are transformed to ensure maximum benefit can be achieved. Implementation will also include redesigning support staff and systems in heath records and health IT, as the use of paper based records reduces and electronic information becomes the sole source of clinical information. The priority areas for development in the EPR programme are summarised below: Acute Services - move towards the elimination of paper based records by increasing the level of digitally generated information at source and supporting changing practice to make electronic record usage routine Page 59

63 Mental Health Services - significant workflow redesign is required to improve management of waiting lists, complete the rollout of scanning into the CCube document management system, link CCube to Trakcare so that information can be viewed within Trakcare (as per SCI Store). devices, network traffic and storage etc. ehealth resilience is required to be a significant part of the EPR implementation programme. Improvement will also be targeted as follows: Maternity Services - extend Badgernet to Community Midwifery and provide interface to GP records, work to provide a paper free maternity record which conforms to the National Scottish Women s Hand Held Maternity Record (SWHMR). General Practice - exploit the potential to use Vision 360 to support mobile working within GP practices and the reconfiguration of services within HSCPs. Provision of additional ICT roaming features to users to overcome the inflexibility of a wired network in difficult or remote locations. Installation of IP telephony to complement and replace traditional analogue telephone systems. Fundamental review and upgrade of ICT estate to a common supported platform with increased security to enhance protection. Community Nursing - develop and configure the Community Vision system to support the work of community nurses, health visitors and school nurses etc, Allied Health Professionals - extend use of PMS Trakcare to those AHPs not covered by the AHP Advanced Practice Musculoskeletal (MSK) project. The move to the EPR being the sole record is a significant change with no contingency plans based on paper records. Therefore the resilience of ehealth Services, server infrastructure and network resilience needs to be reviewed and enhanced. There will also be a requirement for additional support from both ehealth ICT Services and PMS Application Support as a consequence of the increased use of services, Clinical Decision Support will bring together a wide range of clinicians to support professionals at the first point of contact with patients requiring unscheduled care. This service when developed has the potential to provide support to other NHS bodies, public sector partners such as local authorities, prisons and police, and could extend to commercial partners within the oil and gas sector. No Delays aims to transform the relationship that patients have with services and clinicians in planned care. No Delays will provide patients and GPs with information, support and involvement in the care of a range of conditions by using video and tailor-made websites for patients called patient postcards. We are currently piloting and evaluating the No Delays concept at 13 GP practices throughout NHS Page 60

64 Grampian. The success of the project longer term will be dependent upon investment in our ICT infrastructure. Table 22 on the following page sets out the proposed programme for change in relation to the development of the EPR and the resource requirements. If we are to realise our ambitions to unlock the potential of ICT to support developments such as clinical decision support and No Delays - further investment beyond that in our current plan will be required. Page 61

65 Key Action Description Expected Outcome Patient Management System EPR Trakcare will be the prime patient record with users A transition programme of work will be agreed with to support able to update a patient record from work or home. the move from paper records to electronic. Maternity EPR Community Vision/Child Health AHP Rollout Digital Dictation/Speech Recognition Patient ecommunication Patient Management System Infrastructure ARI Records Library Risk Reduction Table 22 The Maternity EPR will join Acute staff with Community staff onto the same EPR, with links to GP systems to provide summaries of patient contacts. To be developed for Health Visitors, School Nurses, Community Nurses and District Nursing and will contain a scheduling and caseload tool and a clinical recording system. This system is absolute critical if we are to meet our GIRFEC responsibilities. This will complete the rollout of Trakcare to all AHPs in Grampian. This will permit standardisation on methods of interacting with the EPR recording notes to be converted to text and navigating through forms etc. This solution allows correspondence with patients, such as appointment letters, clinical instructions and clinic letters, can, optionally, be done online or printed centrally reducing cost. The PMS Infrastructure is at end of its useful life and requires replacement. From a resilience point of view we will continue with the failover/failsafe approach to minimise the risk of unscheduled downtime and review any additional requirement e.g. storage (SAN) that the move away from paper based systems brings. Two major floods in the ARI subbasement in the past year have damaged 8,500 paper records beyond repair and as NHS Grampian has a duty of care to patient information the decision has been taken to move inactive records offsite and to clear the bottom shelves of filing. In advance of the Baird Hospital opening the EPR in Badgernet should be available for all Maternity staff with summary information updating GP systems automatically. Community based nursing staff will have a IT system that will support NHS Grampians Children and Young Person s Act responsibilities. e.g Child Plan. All AHPs will have access to and use Trakcare as their core IT system. This will assist with the desire to create and record information in PMS Trakcare without having to transcribe from paper. Patient Correspondence will be sent electronically, either for posting from a centralised location or to be viewed on line. A resilient EPR infrastructure, appropriately supported and maintained, including OOH support for applications. Over time with the development of the EPR the requirement to recall file rom offsite storage will reduce. Page 62

66 Targets for improvement Backlog reduction The targets for our property portfolio (Table 23) below have been developed on the following assumptions: Surplus properties identified for disposal will have been sold or demolished by April 2021 thus removing the associated backlog. Programmed new builds such as the Baird Family Hospital and Primary Care Projects will provide high quality buildings that score A s on the 6 facet performances. By 31st March 2021, a further reduction in backlog of 7m (significant and high risk) as a result of further rationalisation of the estate. Targets for Improvement in Property Condition and Performance Table 23 Facet Previous Performance 2011/12 Previous Performance 2013/14 Condition / Performance of NHS Grampian s Property Portfolio Previous Performance for 2015/16 Current Performance for 2016/17 Target Performance for 2020/21 Physical Condition (Appraisal ranking A or B) 41% 48% 52% 66% 85% Functional Suitability (Appraisal ranking A or B) 64% 66% 69% 72% 85% Quality (Appraisal ranking A or B) 70% 69% 70% 74% 90% Space Utilisation (% fully utilised) 80% 89% 90% 91% 93% Average SCART Score Average Energy Consumption PI (GJ/100m 3 ) Backlog Maintenance (High &Very High risk items) 77m 69m 67m m Page 63

67 Sustainability and Carbon Reduction Environmental Sustainability In January 2012, the Scottish Government Health and Social Care Directorate published A Sustainable Development Strategy for NHS Scotland, alongside CEL 2 (2012); A Policy on Sustainable Development for NHS Scotland. The documents have shared objectives, which are, to improve the sustainability of NHS Scotland s activities, primarily in the context of estates, property and asset management, in addition to contributing to the Scottish Government s overall purpose and wider strategic objectives. The role which sustainability plays within NHS Scotland continues to increase, and is necessary in the planning and delivery of modern health and social care facilities and services. Therefore the role of getting it right, has many direct and indirect implications for the NHS: Improved healthcare outcomes for patients, staff and communities; Financial and resource efficiency, Both legal and mandatory policy compliance, with consequent reputational benefits or risks. NHS Grampian has produced a Sustainable Development Action Plan (SDAP) which sets out a clear route map for NHS Grampian s contribution towards meeting the Government s sustainability targets, aims and objectives and how they are being integrated into the core business. There are a number of key national drivers for embedding sustainability and climate change activities across NHS Grampian, these include: Climate Change (Scotland) Act This places a duty on public bodies to contribute to carbon emission reductions and climate change adaptation and to act sustainably in exercising its functions. Climate Ready Scotland: Scottish Climate Change Adaptation Programme. This sets out Scottish Ministers objectives in relation to adaptation to climate change. Scotland s Zero Waste Plan (2010): This sets an overall 7% reduction target for all waste by With the 2025 targets aiming for a 15% reduction in all waste, 70% recycling and no more than 5% waste to landfill. The Waste (Scotland) Regulations 2012: These introduced mandatory source-segregation of recyclates (2014) and mandatory source-segregation of food waste for recovery (2016 for hospitals). This was further strengthened by a ban on the disposal of food waste to public drains or sewers (2016) and on biodegradable municipal waste to landfill (2021). The Procurement Reform (Scotland) Act 2014: This places a Sustainable Procurement Duty on contracting authorities to improve the economic, social, and environmental wellbeing of the authority s area Page 64

68 The Nature Conservation (Scotland) Act 2004: This places a duty on public bodies to conserve biodiversity. For NHS Grampian this means improving greenspace quality, linked to ministerial priorities to reduce prominent healthcare conditions (heart disease, obesity, etc.) through active use of Scotland s outdoor environment, including the healthcare estate. The Wildlife and Natural Environment (Scotland) Act This requires NHS Boards to publish details of their biodiversity actions from 2015 and then every 3 years. Public Bodies Duties Climate Change Reporting. The Scottish Government has introduced mandatory climate change reporting for all major player public bodies, which includes NHS Grampian. EU Energy Performance of Buildings Directive (EPBD). This requires all public buildings in the EU over a particular size to display a valid Energy Performance Certificate (EPC). Scottish Building Standards and BREEAM. The Scottish Building Standards have recently been revised to improve the energy and carbon performance of new and refurbished buildings with further changes expected to be triennially. While the scale of new-build is relatively small in comparison to the existing estate, this will still have a marked impact on the overall sustainability and climate change performance. Linked to the above, all new NHS Scotland buildings over 2 million must achieve a minimum BREEAM standard of Excellent and refurbishments must achieve Very Good. Over and above these NHS Grampian also has other local drivers for sustainability across Grampian which include: Recognition of the important role of a high quality environment in supporting health and wellbeing; NHS Grampian s own sustainability targets and objectives; Participation in the EU Emissions Trading Scheme (EU ETS) and the Carbon Reduction Commitment (CRC) Energy Efficiency Scheme; Rising costs of energy, fuel and waste management, including landfill costs; Depletion of finite resources, scarce materials and health care supply risks; Need to conserve resources, increase efficiency and support Scottish Government ambitions for a more circular economy; and The Duty of Best Value in public services to demonstrate a contribution to sustainable development. NHS Grampian is currently in the process of setting up a Carbon Management and Sustainability Group (CMSG) which plans to meet on quarterly basis. The aim of this group is to both drive and monitor progress on actions contained within the SDAP. A non-executive Board member has also been appointed as the Sustainability Champion for NHSG. The Board employs a head of sustainability compliance and risk, who has the responsibility for co-ordinating the CMSG, including progress on actions, reporting internally and to Health Facilities Scotland and Scottish Government, preparing and implementing the Boards Waste Management Action Plan, Carbon Management Plan and Page 65

69 Adaptation Action Plan, whilst ensuring that carbon reduction targets are met. Sustainability is embedded throughout the NHS Grampian in a number of ways which are summarised below: Use of the Good Corporate Citizen Assessment Model (GCCAM) to foster cross-organisational engagement and assessment. Regular sustainability performance reviews by managers and the Board. Consideration of potential climate change and sustainability impacts and /or benefits of all projects, tenders and contracts. Daily procedural duties that all staff must adhere to such as IT switch off office temperature policy, waste recycling etc. NHSG also plans to develop a local communication strategy that involves a range of activities that support national and local initiatives information about this will be circulated to staff via, the intranet and the newsletter. The Good Corporate Citizen Assessment Model (GCCAM) is a web-based toolkit designed to facilitate the integration of sustainability aims and objectives into the daily delivery of healthcare services. It encourages a Board-wide selfassessment of sustainability against key criteria, the result of which forms the basis of the NHS Grampian SDAP. Good Corporate Citizenship means following the five principles of the UK Sustainable Development Strategy: Living within environmental limits. Ensuring a strong healthy and just society. Achieving a sustainable economy. Using sound science responsibly. Promoting good governance. There are six key areas for action covered in the GCCAM: 1. Community Engagement - including community consultation and partnership decision making. 2. Procurement - including equipment, food, and sustainable building materials. 3. Buildings - design, refurbishment and construction of NHS Grampian sites. 4. Facilities Management - including building maintenance and land management. 5. Travel - including journeys to, from and between sites by staff and NHS Grampian fleet. 6. Workforce - including staff recruitment, retention and training. Corporate GREENCODE has been developed for NHS Scotland Boards as a Corporate Environmental Management System (EMS) which has been designed to achieve the same standard as ISO Work within this area will continue to be progressed. Page 66

70 Carbon Energy Fund (CEF) NHS Grampian has the third highest energy consuming hospital in Scotland (Aberdeen Royal Infirmary) and has a number of hospital sites with Energy consumption well in excess of the Scottish national average. The Fund is designed to encourage innovation from prospective bidders for the supply, maintenance and energy management of large scale energy investment opportunities within NHS Estates. The third party service provider s costs, in the form of a unitary charge, are covered by contractually guaranteed savings from reduced energy consumption and greenhouse gas (GHG) emissions. Following shortlisting and evaluation Vital Energi were appointed to deliver a series of infrastructure investments aimed at improving the carbon efficiency of three Grampian sites, Foresterhill, Royal Cornhill and Dr Gray s. The contract signed on 29 December serviced from the main CHP plant. This will facilitate the closure and demolition of the east end boiler house. The project is due to complete on 2 January The key project milestones are as follows :- Dr Gray s Boiler Replacement 3 rd August 2015 ARI Chiller replacements 29 th June 2016 Steam & Condensate to Laundry from ARI Energy Centre 15 th July 2016 Energy Link (ARI to Royal Cornhill) 2nd September 2016 Dental School & Institute integration 7 th October 2016 Mile End Boiler House Demolition 14 th October 2016 ARI High Voltage Ring 28 th October 2016 Lighting upgrade ARI and Royal Cornhill - 18 th November 16 Project handover 28 th November 2016 It is anticipated that this project will eliminate 2.6m of backlog risk. An overall reduction in carbon emissions of 16% is anticipated in the life of the contract. NHS Grampian will also benefit from investment in infrastructure estimated at circa 15.6m over the 25 year life of the contract; 10.4m of initial investment with 5.2m lifecycle replacement of lights and chiller units throughout the contract period. A significant component of the contract is the creation of an energy link between Foresterhill and Royal Cornhill Hospital which will also allow all areas of the Foresterhill site to be Page 67

71 Transport NHS Grampian is working in partnership with NSS through the shared services review, investigating and identifying potential options and structures for a northern fleet operation. The review identified opportunities for a more joined up approach across Scotland, with potential to realise better utilisation of vehicles and logistics resources whilst improving the effectiveness and efficiency of day to day operations. Aberdeen Council of Voluntary Organisations. This has enabled a one year pilot to be established providing transport options for those previously unable to access health and social care in Aberdeen with bookings managed by THInC. The pilot was launched on 2nd March In order to achieve the strategic vision of modern and efficient fleet management and logistics functions, the Strategic Facilities Shared Services Programme Board approved the recommendation to create a regional fleet management structure with national support and it was agreed that a detailed implementation plan be produced. The proposed structure could also result in the number of commercial fleet operations being reduced from 22 to 5 territorial operations plus the Scottish Ambulance Service (SAS). It is proposed that a lead from an NHS Board within each region will provide fleet management for the region and will be responsible for ensuring all fleet requirements are met. Within Grampian, THInC have identified gaps in patient transport provision within Aberdeen City. Partners have collaborated with Buchan Community Dial a Bus and successfully secured Change Fund monies, awarded by Page 68

72 Where do we want to be - Conclusion The Board believes that our investment plan should be directed towards: Delivering our Healthfit Vision and developing the Clinical Strategy by responding to new and improved ways of delivering services that require fewer assets as services will increasingly be delivered in people s homes, on an outpatient basis, on a mobile basis and through the use of new technologies such as the EPR and video conferencing. Seeking further innovative solutions to property needs through co-location, integration and shared services/resources across Grampian with all its partners. Improving estate and asset performance on all key performance indicators, including a targeted reduction in significant and high risk backlog maintenance and a continued programme of essential equipment replacement. Disinvesting from buildings with high operating costs, backlog maintenance requirements, or short remaining life where these do not meet future service requirements. Investing and developing new technology that achieves simplification of the existing ICT infrastructure, while simultaneously allowing additional investment. Within the following section of the plan, we set out how our assumed capital allocation will be invested for the next five years and our priorities for the five years beyond. However there remains a high degree of risk associated with the need for further significant investment in the replacement of: Essential medical equipment Upgrading the 15 year old ICT infrastructure The plan aims to reduce backlog maintenance by 68m compared to an overall maintenance requirement in excess of 193m (Restated April 2012 fig), targeting investment at high and significant risk as a priority. Whilst this will improve the performance of our estate, further availability of capital would enable significant issues to be addressed within the major hospital environment and a number of our health centres; essential Medical Equipment and ICT infrastructure which is fundamental in providing the necessary platform to modernise and improve efficiency of clinical care. Page 69

73 How do we get there? The process was approved and managed by the Asset Management Group; Making Service Change Happen Engagement with stakeholders is a key factor in making change happen, whether with respect to Asset Management or the design of new buildings. Encompassing this in our plans Having stakeholder engagement from inception through delivery of our Clinical Strategy and Asset Management Plan will ensure NHS Grampian delivers the appropriate services that best meet the needs of the population of Grampian. The Scottish Capital Investment Manual (SCIM) sets out the requirements for this in detail from Service Planning, Strategic Assessment, Initial Agreement through to Outline and Full Business Cases. Asset Investment Prioritisation The Scottish Capital Investment Manual has provided the template for NHS Grampian to develop its prioritisation and monitoring process of capital and revenue infrastructure projects. SBAR and Strategic Assessment submitted to the AMG for consideration, when approved it will be given a project number and added to the project list. If approved the project will then be prioritised through the decision criteria as follows: o Service Planning will score the Strategic Fit (patient centred) against the National 2020 Vision and Quality Ambitions, our Clinical Strategy and provide a rationale for the score. o Each member of the AMG will score both the service and business need (effective quality of care) and non-financial benefits (health of the population) based on the requirements of the project and provide the rationale for the score. o Property and Asset Development Team with specialist input will score the risk reduction (Safe) against our risk register, backlog maintenance, patient safety, service/business interruption, adverse publicity etc. and provide the rationale for the score. o Finance department will provide the value for money score based on information available at the time, whether capital, revenue, endowments, fund raising etc. and provide the rationale for the score. o Acceptability will be scored by corporate services against political (local and national) and social acceptability and provide the rationale for the score. Page 70

74 All scores will be reviewed (up or down) as more information becomes available through the approval process or if the project is altered for any reason. Acceptability in particular will score higher as a project progresses through the process. The resultant total scores will then be fed into the Capital Planning System to give a prioritised order for all projects. AMG will either reject, request re-submission with further details or give approval to submit an Initial Agreement (I.A.) If the I.A. is given approval AMG will either request that the project proceeds to Outline Business Case (OBC) or Standard Business Case (SBC), projects over 3m will also require Capital Investment Group (CIG) approval. If OBC is approved then AMG will request that the project progresses through to Full Business Case (FBC), projects over 3m will also require CIG approval. All projects will require either SBC or FBC approval by AMG and the Board and in some cases CIG to progress through to an approved and committed project. The table overleaf lists the current NHS Grampian prioritised Investment Requirements. The top 20 projects have a supported Strategic Assessment completed. Page 71

75 NHS Grampian Asset Investment Prioritisation Item Project Type Description Overall score Priority Item Project Type Description P002 Inverurie Hosp and HC site development Development P008-P007 Baird Family Hospital and Anchor Unit Replacement P001 New Denburn Backlog P024 Bucksburn/Dyce Medical Solution Replacement P025 Banchory Medical Practice Replacement P004 Westburn Road site (inc. Foresterhill Court) Sale Overall score Total Score Priority The development of a new Inverurie Health and Care Hub on the Inverurie hospital site that will also replace the existing health centre. The proposed new integrated model of service delivery is fully in line with national and local policies and the strategic direction of NHS Grampian and Aberdeenshire Council in shifting the balance of care and the integration health and social care This will include a new Maternity Hospital and woman's services in one central hub on the Foresterhill site and the provision of a new Cancer Centre adjacent to the new liear accelerators Existing Health Centre requires to be replaced due structural issues with the building New Medical Centres solution is required within the Bucksburn/Dyce community as a result of population growth, aging accommodation and limited space for expansion A new joint Health and Social Care Facility is required within the community P042 Inverurie Hospital Steam Boiler Backlog Replace Steam Boiler Peterhead Community hospital to provide a Community P051 Peterhead CMU Development Midwife Unit (CMU) P040 Multi-Storey Car Park Development Provision of a new Multi-Storey Car Park to be built on the Foresterhill site A replacement/extension to the Health Centre is currently P026 Ellon Health Centre Replacement being discussed with Aberdeenshire Council as a result of population growth and the need to provide local accessible P028 Keith Medical Practice Replacement A replacement to the Health Centre is required as a result of population growth and no space for expansion P016 Learning Disability (Elmwood) Replacement In-patient service to be considered for moving on to the Royal Cornhill Hospital P041 Woodend Hospital Steam Boiler Backlog Replace Steam Boiler P020 Laboratory Information Management System (LIMS) Replacement The existing dated LIMS is in need of replacement The Foresterhill site rationalisation plan identifies Phase 1 as the future location for ambulatory care services in the P009 ARI Reconfiguration Development medium term. Haematology outpatients and day unit and the Upgrade of ARI Pharmacy inc. new robot A new Medical Centre is required within the Foresterhill Site P039 Foresterhill Health Centre Replacement to allow the demolition of the existing building to enable the build of the new Baird family hospital A new Medical Centre is required within the community as a P027 Northfield/Mastrick Medical Practice Replacement result of population growth, aging accommodation and limited space for expansion P003 Woodend South Block P023 Increased imaging and MRI Capacity Development P052 Mental Health and Learning Disability Ward Improvements Backlog P022 IT Solution(s) for Community based Staff Development New provision for Care of the Elderly (non-acute) services in Aberdeen. The Granary building is being considered for the main base and certain day services. An option appraisal to be undertaken for in-patient services. Maidencraig to be relocated to Westview (either redesign or extension). Replacement of hydrotherapy is being considered on a partnership basis with ACC, and long term options for wheelchair services and other services located within the east of the site shall be considered by the Woodend blueprint group. There will also be costs associated with decommissioning a significant part of the site There is a requirement to increase imaging capacity in particular MRI capacity on the ARI site and for a new MRI provision within the Moray area There is a requirement to carry out refurbishment works to all Mental Health and Learning Disability ward areas across Grampian to enable the patient environmental improvements, HAI targets, significant self-harm risk management concerns and wider health & safety issues which were revealed by workplace inspections This is required to assist with Health and Social Care Integration and the Children and Young Persons act e.g. the Child s Plan/named person responsibilities P019 HEPMA A new Hospital Electronic Prescribing and Medicine Development Administration system is required P013 Laboratory Accommodation, ARI Combine a number of clinical laboratory services into shared Blood Sciences accommodation. Also longer term Development requirements to develop Genetics accommodation on the ARI site for period in line with national capital framework There is a requirement to replace the Theatre Ventilation P039 ARI - Theatre Ventilation replacement. Backlog Plant at ARI P018 Mortuary Replacement There is a need to review all mortuary facilities within Grampian to ensure the service meet all demand requirements and comply with modern standards. The mortuary at Foresterhill is accommodated in 1930 s facilities and we also have dated facilities at Woodend, Dr Grays and Spynie P005 Spynie Hospital Sale Relocation At present NHSG of existing utilises services several and websites, sale of site sitting in isolation of each other and containing varying degrees of partial, P021 Patient Portal Development complete and duplicated information. The benefits of a Patient Portal is to allow patients access to safe, trusted P006 Office accommodation for Spynie staff Replacement P029 Danestone Medical Practice Replacement A new Medical Centre is required within the community as a result of a large population growth and very limited space for expansion P015 Ear Nose and Throat (ENT) Replacement A permanent solution is required for the accommodation of ENT facilities with the city of Aberdeen P010 New Surgical Ward and Theatre Block, ARI Replacement There is a requirement to replace the remaining outdated surgical wards and theatre accommodation with high quality accommodation that meets modern standards Consider the expansion of the current cardiac P011 Cardiac Centre, ARI Development accommodation on the Foresterhill site P036 Balmedie, Aberdeenshire Development Existing settlement in Aberdeenshire with no GMS premises Having problems with using the warehouse in the city as an P047 Aberdeen City Equipment store Replacement equipment store - it is failing to meet required standards of cleanliness etc A new Medical Centre is required within the community as a P030 Kincorth Medical Practice Replacement result of a large population growth and very limited space for expansion P017 Foresterhill Laundry and CSSD Replacement The current laundry and CSSD facility is required to move due location, building condition and backlog maintenance costs P035 Newmachar, Aberdeenshire Development Existing settlement in Aberdeenshire with no GMS premises P040 AMH - Interim Works Backlog Refurbishment of Theatre, Firecode works and the Neonatal and Labour ward ventilation requires replacement The General Medical Equipment Department requires to be P012 Medical Physics Accommodation, ARI Replacement relocated to accommodation fit for purpose and more central to its core users An extension to the existing building is required to P032 Torry Medical Practice Development accommodate the large population growth within the Torry area of Aberdeen An extension to the existing building at Kingswells is P033 Victoria Street Medical Practice Replacement required to accommodate patients from the Victoria Street branch when the lease terminates in P043 New dental facilities at Stonehaven Development P031 Fochabers Medical Practice Replacement A new Medical Centre is required within the community as a result of population growth and limited space for expansion New Theatres at Woodend has led to an increase in staff Increased space for Orthopaedics Outpatients P045 Development levels, additional accommodation is required for these staff and office accommodation at Woodend members (space audit required) An extension to the existing building at Portlethen is P034 Portlethen Medical Practice Development required to accommodate the population growth within Portlethen itself and the surrounding area P014 Clinical Research Facility, FHC Work jointly with Aberdeen University in the Foresterhill Development Health Centre The Council have indicated that we shall need to be out of the existing building by December Most of the P048 Healthy Hoose, Aberdeen Replacement residents are going to be relocated in the surrounding area and we shall come under immense pressure to reprovide the service P046 Countesswells, Aberdeen Development Emerging settlement in Aberdeen with no GMS premises P044 New dental facilities at Peterhead Development P037 Blackburn, Aberdeenshire Development Existing settlement in Aberdeenshire with no GMS premises Emerging settlement in Aberdeenshire with no GMS P038 Elsick, Aberdeenshire Development premises Total Score Page 72

76 Our investment programme for the next 5 years The Asset Management Plan sets out the Board s investment priorities to support the delivery of patient care and associated services across Grampian. This is integral to the delivery of the NHS Grampian Healthfit vision, our Clinical Strategy and our the strategic plans of each of the three Integration Joint Boards. The investment programme is focused on actions across four main areas: Our infrastructure programme also includes 15.5m of investment to be financed from charitable donations, a combination of individual philanthropic donations for specific projects such as the new MRI scanner and the Foresterhill car park and new equipment purchases and ward refurbishment through the Board s Endowment Funds. Investment in infrastructure consistent with our strategic health priorities as described earlier including initiatives to reduce carbon emissions; Reduction in high and significant risk backlog maintenance in clinical areas and compliance with statutory requirements; Replacement of essential equipment and ICT infrastructure to enable the Healthfit vision; Disposal of assets declared surplus to requirements. The supporting financial plan incorporates the resources aligned against expenditure areas financed from revenue, capital and through asset sales. We have assumed a formula capital allocation over the five years of the plan consistent with that outlined in the Board s Local Delivery Plan. Page 73

77 Our plans are summarised as follows in table 24: NHS GRAMPIAN SUMMARY INFRASTRUCTURE AND BACKLOG MAINTENANCE PROGRAMME 16/17 17/18 18/19 19/20 20/21 Total 5 Year Plan AVAILABLE FUNDING 000s 000s 000s 000s 000s 000s Core CRL Formula allocation 12,751 12,751 12,751 12,751 12,751 63,755 Allocation Adjustment 7,500 0 (2,500) (2,500) (2,500) 0 Baird & Anchor 2,000 4,000 60,877 71,875 7, ,752 Diagnostic & Treatment Centre ,000 Revenue to capital Capital to revenue (1,000) (1,000) Radiotherapy Equip Prog Additional allocation - backlog maintenance Sub Total Core CRL 21,509 26,901 91,375 92,126 17, ,162 Withdraw al of NBV benefit by SGHSCD (2,630) (2,630) Net CRL 18,879 26,901 91,375 92,126 17, ,532 Non Core CRL CRL Cover est - Inverurie - hub 0 10, ,100 CRL Cover est - Foresterhill - hub 0 7, ,816 CRL Cover est - Other Primary Care - hub , ,000 Sub Total Non Core CRL 0 17,916 19, ,916 Total Gross CRL 18,879 44, ,375 92,126 17, ,448 OTHER FUNDING SOURCES - CAPITAL Estimated Actual NBV benefit on disposal - property 3,394 3, , ,035 Estimated Actual NBV benefit on disposal - equipment Estimated Actual NBV benefit on disposal - hub Sub Debt 0 OTHER FUNDING SOURCES - CHARITABLE CONTRIBUTIONS Endow ments - Phase 2 ari 1, ,594 MRI - Woodend 1, ,257 Endow ments - Mortuary Endow ments - Stroke and Plastic Surgery accommodation Endow ments - Roxburgh House ARI Multi Storey Car Park 10,401 10,401 Endow ment - Equipment ,500 OTHER FUNDING SOURCES - REVENUE Estimated Net Surplus on Disposal of Property 3,203 8,286 2,094 2, ,179 Estimated Net Surplus on Disposal of Equipment Developer Contributions ,325 Estates Maintenance operational budget 1,140 1,140 1,140 1,140 1,140 5,700 Additional Estates Maintenance 0 Non Value added Infrastructure budget ,250 Inverurie Enabling IJB Funding VAT Recovery 0 TOTAL FUNDING AVAILABLE FOR INFRASTRUCTURE AND BAC 42,388 59, ,454 98,441 19, ,534 PLANNED EXPENDITURE HUB Schemes on Balance Sheet (inc New Build Equipping C 0 17,916 19, ,916 Strategic Investment inc New Build 13,891 18,010 84,487 77, ,263 Backlog Maintenance/Statutory Standards 21,415 17,798 2,420 1,200 1,184 44,017 Essential Equipment Replacement 6,571 4,775 9,036 18,855 17,546 56,783 Other ,555 TOTAL GROSS EXPENDITURE 42,388 59, ,454 98,441 19, ,534 SURPLUS (+)/DEFICIT (-) Table 24 Investment in strategic health priorities During the five year period of this local delivery plan, we will progress the new Baird Family Hospital, ANCHOR Cancer Centre and Diagnostic and Treatment Centre for which Capital funding has been allocated. A planned programme of enabling works will commence during 2016/17 and 17/18 which will include the replacement of the Foresterhill Health Centre and the relocation of the Eye Outpatient Centre. Investment in integrated services The plan assumes that we will progress a number of priority primary care developments during the next five years:- Provision of new healthcare facilities within the existing Inverurie Hospital site incorporating a Health Centre, Community Maternity Unit (CMU) along with a Community Dental suite, Diagnostic and Treatment suite and an X-ray suite. This will establish a new model of service. Integrating a range of health and social care services to create a Care Hub. The specification, schedule of accommodation, design, business case and local community consultation have all been progressed in the last year with the aim of reaching financial close by summer 2016 and work on site commencing autumn The project is currently planned for completion in in the first quarter of Since the government announcement of 19m to be invested in General Practices the Board has considered how best to use this funding supported by Developer Page 74

78 Contributions to ensure maximum benefit for patients. Focus for this work will concentrate on the corridors of Dyce and Newmachar; Bucksburn and Blackburn; and the community of Balmedie. Denburn Health Centre the existing health centre requires to be replaced due to structural issues with the building. A site has been identified and a new build will be provided under a hub capital scheme with developer contributions significantly assisting in the provision of the facility. provide a home from home environment where children will be fully cared for in a safe, supportive and stimulating setting. Child Development Teams (CDT) new property leases are required to accommodate 2 of the CDT s within Aberdeen City, there is also a requirement for capital funding to deal with a further 3 teams within Aberdeenshire who are currently accommodated in inadequate accommodation. A business case is being developed to establish the most appropriate development programme. Crimmond Medical Practice will relocate to a new purpose built building provided by a local benefactor which will be run and operated by a charitable trust. The cost of which will be no more than currently paid. Renal services south of Aberdeen City - There are currently no dialysis facilities in the south of Aberdeenshire meaning that patients who require dialysis have to travel to Aberdeen 3 times weekly for between 4 and 6 hours of treatment. The patients, staff and Grampian Kidney Patient Association have chosen Stonehaven as the next site for a satellite haemodialysis unit which will be situated within Kincardine Community Hospital. Charlie House The Scottish Government and NHS Grampian have approved the proposal to grant a concessionary lease to Grampian Children s Respite Care (to provide an area of land within Woodend Hospital Site) to provide a centre for children s respite care. It is expected that the centre, currently known as Charlie House will Establishment of an NHS Grampian cyclotron NHS Grampian are currently working with Aberdeen University to finalise the options for replacement of the existing Cyclotron, which has reached the end of its useful economic life, and is owned and operated by Aberdeen University. The cyclotron is a particle accelerator used to produce radioactive isotopes for medical imaging purposes. Typically it is used to produce Fluorine 18 which is a positron emitter that can then be injected into patients and imaged using a PET scanner. These isotopes have a half-life of up to a few hours so production and imaging are ideally done in the same geographical location and continuity of the diagnostic PET scanning service based at Aberdeen Royal Infirmary, which currently serves all of NHS Grampian, NHS Highland, NHS Orkney and NHS Shetland, is dependent on a sustainable local source of supply. Page 75

79 Reducing carbon emissions The Board is committed to reduce the level of carbon emissions across our property base and all new developments are delivered with integral technology designed to reduce energy use and consequently carbon emission levels. The Carbon Energy Fund (CEF) contract with Vital Energi was signed on the 29th December 2015, the programme includes :- replacement of boiler plant at Dr Gray s, provision of a steam & condensate link from the Energy Centre to the Foresterhill Laundry which will allow the closure and removal of East End Boilerhouse, provide energy links from the Energy Centre to Royal Cornhill Hospital, Dental School, Dental Institute and further proposed developments, provision of a new Foresterhill High Voltage (HV) intake substation and improvements to the existing HV infrastructure, replacement of a large number of chiller units at ARI and extensive lighting replacement at RCH and ARI. NHS Grampian will benefit from a significant reduction in carbon emissions from this investment as well as improvements to infrastructure estimated at c 15.m over the 25 year life of the contract. Reduction in backlog maintenance statutory compliance The Annual State of NHSScotland Assets and Facilities report highlighted, nationally, many of the issues that are the focus of our Asset Management Plan. The report places particular emphasis on the extent of backlog maintenance that the remaining estate requires in order to bring accommodation up to the relevant physical and statutory standards. Accordingly our financial plans allow for substantial resources to be targeted at delivering a demonstrable reduction in high and significant risk backlog maintenance inpatient clinical areas, whilst maintaining an essential equipment replacement programme. The total assessed backlog risk across all NHS Grampian properties at April 2016 was 138m (this excludes backlog associated with surplus properties) of this 26m was high or very high risk. Our programme will continue with targeted expenditure initiatives, asset disposals and site rationalisation resulting in a substantial reduction in backlog maintenance compared to the 193m base point. A major element of this programme was the planned package of works to be undertaken in the East End 2 and Phase 2 blocks at ARI and the relocation of the Eye Out Patient Department to Phase 1 at ARI. The work associated with the East End 2 block (target price 5.452m) is now complete with services operational in their new accommodation September Stage1 of the Phase 2 works was completed in November 2015 with Stage 2 due for completion June Please note that the above values used to quantify backlog maintenance risk are stated net of VAT, fees and other on costs which means that the actual project costs necessary to deliver the required works are often well in excess of these values Page 76

80 In February 2016, the Board approved Stage 3 of the project at a not to be exceeded cost of 10m. This stage will involve the establishment of a new general surgery department and surgical high dependency unit and will be completed during 2016/17. The final stages of the Phase 2 backlog project will be undertaken during 2017/18 and 2018/19. The Project is providing a safer and more appropriate environment for our patients, staff and visitors. available to support the programme over the 9 years 2012/13 to 2020/21 It is assessed that the East End 2 and Phase 2 programmes will contribute 14.72m (net of VAT, fees and other on costs) to the reduction in backlog maintenance. In February 2016, the Board also approved the initial stage of the Phase 1 ARI backlog maintenance project (including relocation of the Eye Out Patient Department and upgrading of the lifts) at a cost not to exceed the identified budget of 6m including all risk and contingency allowances and the replacement of the Aseptic Pharmacy Suite located within Phase 2 of ARI. The overall programme at ARI is underpinned by a complex series of service moves, a decant plan, which is agreed on a stage by stage basis by both clinical leaders and the acute sector management team. The decant plan aims to ensure services are only require to move once prior to occupying their permanent accommodation. The following table 25 from our financial plan summarises the budgeted expenditure on backlog maintenance (inclusive of VAT fees and other on costs) and the sources of funding Page 77

81 NHS Grampian Backlog Programme Table 25 Page 78