Healthcare quality and efficiency support team: annual report 2013

Estates and Facilities

NHS Borders: Hawick Inpatient Facilities

Background/Context

Within the community of Hawick, NHS Borders worked across two inpatient facilities. A review was carried out to establish patients' needs and requirements for their care.

Problem

The two sites were within a mile of each other, and one of the buildings required major refurbishment to ensure it was fit for purpose; this would have incurred significant financial input. Working across two sites was not an efficient way of providing inpatient care.

Aim

The aim of this project was to consolidate the two buildings as appropriate whilst ensuring quality services for all current and future patients. Another aim was to provide enhanced community based services more efficiently.

Action Taken

During 2012-13 facilities within the dementia inpatient setting in Hawick were redesigned to allow services to be provided in a community setting. In addition, acute inpatient services were reconfigured to allow for inpatient care to be consolidated on one site.

Results

This has resulted in a reduction in the amount of resource tied up in buildings. In addition, it has enabled dementia services, which are provided on a community basis, to be involved with an increased number of clients thereby helping to tackle the increased demand for services. Feedback from patients, relatives and support groups is very positive about this model of care for this client group.

This redesign has allowed NHS Borders to enhance the quality of its community based services within this area and realise efficiencies through buildings.

Efficiency Savings and Productive Gains

This review has delivered a number of efficiency gains including:

• reducing the resource tied up in buildings
• benefits of economies of scale of providing inpatient facilities on fewer sites
• better utilisation of remaining inpatient facilities
• opportunities for reviewing skill mix across staff
• increased activity
• improved quality of care for dementia services
• recurring savings of £700,000

Sustainability

This will allow community and inpatient services to continue to be developed and delivered.

Lessons Learned

This has enabled NHS Borders to consider similar models across other sites.

NHS 24: Facilities Management Contract

Background/Context

A report was written proposing options for consideration for the delivery of facilities management (FM) services to NHS 24 properties from June 2012 (to align with the current BT FM contract extension which ended on May 31, 2012).

An analysis of the new strategic front-line application (SFLA) contract scope confirmed that it did not extend to facilities management services and therefore a facilities management contract from May 31, 2012 was a requirement in any case for at least two NHS 24 properties; Norseman House and Riverside House.

Problem

FM services comprise:

• facilities management (provision of advice, guidance and contract performance reporting)
• maintenance services (statutory/planned/reactive mechanical/engineering/fabric and minor works)
• building cleaning (offices/washroom/prestige/periodic e.g. carpet cleaning/upholstery)
• catering (food and drink vending/hospitality)
• office services (pest control/waste management/interior plants/ reception, etc.)
• security
• helpdesk

The services outlined above are in a large part essential and practical to support the smooth and effective delivery of core NHS 24 front-line and non-front-line services and to ensure NHS 24 complies with its health, safety and welfare obligations.

The problem for NHS 24 was that this was no longer going to be included in the Board's infrastructure contract with BT and therefore an exercise had to take place to ensure these services were provided and at best value.

Aim

An analysis of current service provision concluded that the current service did not provide best value.

Proposed options which could offer better value than the current arrangements, with financial benefits of around 100,000 per year (over 15 per cent year on year saving), were developed for appraisal.

An option appraisal scoring matrix was developed in line with Scottish Government Health and Social Care Directorates guidelines to enable NHS 24 to assess and score the non-financial benefits against each option.

A short life Facilities Management Option Appraisal Group, consisting of support service team managers from each site and a finance representative, met to undertake the option appraisal and thereafter make recommendations to the NHS 24 Executive Team on the preferred option.

Action Taken

The current service provision was analysed in terms of what is currently provided, the strengths and weaknesses of this and the overall cost. Based on this, a list of options for consideration was generated.

These options were:

• current service with re-tender (i.e. a strategic/operational model with same specification and lease arrangements)
• in-house (direct employ with revise specification e.g. improve cleaning productivity)
• outsource (revise specification e.g. improve cleaning productivity and full FM package for all sites/outsource some lease services e.g. cleaning)
• joint NHS Board partnership

An option appraisal process was followed. This involved establishing a 'weighted scoring method' for this exercise.

It involved the following steps:

• identification of all the non-monetary factors relevant to the project
• weighting the factors
• scoring the options to reflect how each option performs against each factor
• calculate the weighted scores
• test and interpret the results

Results

By applying the scoring matrix above the following scores were collated:

• Option 1 - 237.5
• Option 2 - 248.75
• Option 3 - 407.5
• Option 4 - 260

As a result the preferred option is Option 3 - outsource with revised specification as one packaged facilities management contract for all NHS 24 sites.

Efficiency Savings and Productive Gains

Each of the options evaluated is anticipated to provide savings ranging from 9.5 per cent to 16 per cent when compared to the current cost of the combined facilities management services.

The preferred option, while not the cheapest, is anticipated to deliver cost savings of around 15 per cent per year.

Sustainability

The FM Framework Agreement used provides NHS 24 with access to a model contract and detailed specification covering the services required (and can be adapted to suit our needs). The contract period is for three years with an option to extend for a further two years commencing from June 1, 2012. The procurement process meets the Scottish Government's sustainable procurement standards.

Lessons Learned

It is important to follow advice received from the Government Procurement Service (formerly Buying Solutions) and with the agreement of the Director of Finance and Technology, the FM contract was procured by accessing the Government Procurement Service FM Framework agreement.

A thorough procurement process needs to be undertaken following Framework guidelines and Scottish Government Procurement best practice including a robust and clear procurement and evaluation process and option appraisal.

Workforce implications, such as TUPE, need to be carefully considered.

Healthcare Improvement Scotland: Accommodation Rationalisation

Background/Context

Healthcare Improvement Scotland (HIS) was primarily based in two sites in Edinburgh and Glasgow. Both of these were commercially leased premises with impending lease breaks, January/March 2011 for Glasgow and September 2012 for Edinburgh. It was accordingly identified that an opportunity for both rationalisation and cost savings was evident.

Problem

In order to comply with Scottish Government guidance the driver was to move either, or both, office bases out of the commercial rented sector into NHS/Scottish Government estate whilst also achieving cash efficiency savings where possible. Success would, of course, be largely dependent on identifying suitable alternative accommodation at an acceptable cost within the timescale.

Aim

The clear aim was to solve the problem outlined above. Could suitable alternative accommodation be identified within the time constraints of the lease breaks, could the physical move(s) be accomplished within those timeframes, were the outcomes deliverable within existing budget frameworks and to what extent could cash efficiency savings be derived from the result?

Action Taken

The first critical timing related to the Glasgow base (Delta House) where the lease break was to occur in January/March 2011. The first action was to commission an option appraisal in June 2009 to consider the project options, carry out a financial appraisal and make recommendations. These were adopted by the Board and the appropriate representations were subsequently made to the Scottish Government. However, this gave rise to a significant timing difference as the preferred option involved moving to alternative commercial accommodation due to the lack of suitable NHS/Scottish Government estate being available. In the event a short term solution to assure business continuity was employed that involved extending the lease on Delta House with break points in March 2012 and 2016. This effectively provided a respite for a further 12 months.

This gave rise to two further critical timing points, March 2012 in respect of Delta House and September 2012 for Elliott House in Edinburgh. In response a comprehensive office accommodation option appraisal was prepared covering both sites. This was adopted by the Board on June 29, 2011 and submitted to the Scottish Government for approval. The recommendations involved relocating the Edinburgh base from Elliott House to Gyle Square which is held on a long lease and forms part of the NHSScotland estate and remaining in Delta House, Glasgow after rationalising the space requirement and renegotiating the lease costs.

Results

The move in Edinburgh achieved the objective of both relocating into NHS/Scottish Government estate and producing cash efficiency savings. In addition the organisation is now accommodated in a modern facility with a space design tailored to meet its needs.

In Glasgow unfortunately no suitable NHS/Scottish Government estate was available but occupation of Delta House was reduced from six floors to five and significant cost reductions were delivered.

Efficiency Savings and Productive Gains

In Edinburgh the annual lease costs of the Memorandum of Terms of Occupation (MOTO) were negotiated to provide for an annual reduction of £95,452 (part year 2012-13, £49,426), a value that continues during the term of occupation.

In Glasgow the savings result from reducing the number of floors occupied by one, freezing the level of service charge until March 2016 and negotiating a rent and service charge reduction of 50 per cent in the first two years. This produces savings of £332,848 in 2012-13 and £312,714 in 2013-14. The savings from the floor reduction of £149,043 per annum will continue for the remaining period of occupation.

In terms of productivity the purpose built nature of the design layout in Gyle Square can be expected to enhance productivity; the accommodation is located on one floor rather than the four at Elliott House and is of an open plan nature thereby promoting easier and more effective communication and interaction.

In addition, HIS was the subject of a comprehensive organisational restructuring and is committed to continue to embrace the concept of generic working for staff wherever possible and to reviewing and improving work processes and business practices wherever possible.

Sustainability

The premises at Gyle Square, Edinburgh are the subject of a MOTO that runs from September 24, 2012 to June 14, 2029.

The premises at Delta House, Glasgow are commercial leasehold expiring in March 2021 but with a lease break in March 2016. It is anticipated that a further option appraisal will be carried out prior to 2016 to consider afresh the possibility of relocating this office into NHS/Scottish Government estate.

Lessons Learned

This has proved to be a fruitful area from which both cash efficiencies and productivity savings can be realised.

Timing is crucial and the reality is that the process is likely to take significantly longer than might be originally anticipated. It is very important to identify at an early stage the critical points in the timeline as failure to meet any of these deadlines can have serious implications for the process as a whole.

There is a need to satisfy the requirements and aspirations of a variety of different interested parties beyond the Board itself. These include the Scottish Government, staff, Central Legal Office, possible commercial landlords and external agencies.

It is important to take expert advice where appropriate. This will generally mean the involvement of the Central Legal Office and might take the form of property consultants in relation to the option appraisal.