Annual State of the NHSScotland Assets and Facilities Report for 2012

Annex G

Facilities Shared Services Review

Introduction

In order to improve the quality and efficiency of services the Scottish Government's Quality and Efficiency Support Team (QuEST) is working with NHS Boards to provide a national approach to the efficiency and productivity agenda. Shared services is one of seven work streams within this portfolio of work.

The sharing of services by public sector organisations is increasingly recognised as an effective method of improving the quality and efficiency of services while reducing costs. Implemented well, the work has significant transformational potential: simplified and standardised service delivery, improved customer service, strengthened governance arrangements and opportunities to share good practice between comparable organisations.

A robust and formally constituted governance structure has been established within NHS Scotland and is tasked with delivering the high level objectives set out in the Efficiency and Productivity Framework. The Shared Services Programme Board is responsible to the NHS Efficiency and Productivity Portfolio Board of the Scottish Government for shared services across all aspects of non-clinical support service.

The Facilities Shared Services Programme Board forms part of this governance structure and is tasked with, improving the quality and efficiency of services delivered to patients and other customers, improved governance, resilience and sustainability of services.

Traditionally, services have been structured and managed by Boards in the geographic areas for which they are responsible. This has not always resulted in the most efficient use of time and resources.

While there are a number of good examples of Boards sharing services or facilities with other Boards or public sector organisations. The decision to co-locate or share resources is generally an operational decision which takes advantage of local circumstances and the need to deliver services more effectively and will only involve the service partners directly involved in a particular service.

The development of a more strategic approach to the delivery of shared services is crucial to optimising the revenue benefits and avoidance of inefficient capital and revenue spend.

Work Streams

Identified by Health Facilities Scotland, through the Strategic Facilities Group, and ratified by the Facilities Shared Services Programme Board, an initial five areas of opportunity have been identified. These work streams are led by senior managers with significant experience in service delivery, supported by the Boards, QuEST and where appropriate the Scottish Futures Trust.

Utilising the existing advisory structures which support the Strategic Facilities Group the following areas of activity will be scrutinised and recommendations made to the service regarding the opportunities which exist to improve the quality and increase the efficiency the service.

PPP/PFI

The operational management of PPP/PFI contracts has been inconsistent. There are currently 26 contracts managed by 9 NHS Boards.

With support from The Scottish Futures Trust all contracts are being reviewed and current management arrangements assessed. All those involved in the management of PPP/PFI will be engaged in the process of review both at Board and national level in order to extract the maximum benefit from sharing best practice.

Contracts for facilities services as part of the PPP/PFI arrangements have developed over time and there is a need to examine early (first generation) contracts and establish a more consistent and strategic approach to their management.

Working with colleagues in National Procurement, The Scottish Futures Trust and those delivering the contracts on behalf of the Boards, maximise the benefit of existing and future contracts for the purchase of goods and services used by the PPP/PFI providers.

Capital Planning and Hard Facilities Management Manpower Review

The effective management of capital and revenue expenditure is vital to the long term delivery of high quality, effective and efficient clinical services. The management of capital and revenue budgets and projects has been the responsibility of each Health Board.

With the changing profile of capital and revenue funding there is potential for there to be inconsistencies in the distribution of staff, skills and the allocation of capital and revenue resources.

There will therefore be a review of the staff and skills available across the service and an examination of the synergies which exist within and across the service. The hub Territory Partnership Boards, Scottish Futures Trust and all relevant bodies will be involved in this process.

The estates function relies upon the technical knowledge and expertise of highly skilled and experienced staff. The age profile of this group of staff indicates a large proportion of staff with specialist skills will leave the service over the next 5/10 years. A close examination of the skill set necessary to deliver a safe, quality service that is available now and in the short, medium and long term will be carried out. Opportunities to share services and skills across the existing Board and public sector organisations will be explored and recommendations made on how to deliver services into the future.

Sterile Services

The provision of sterile instruments, on time and to the required standard is essential to the delivery of a safe, high quality service while meeting waiting time commitments.

The production of sterile instruments is governed by legislation and it is necessary to ensure the decontamination equipment and the environment used to process the equipment meets the necessary standards. This requires significant capital and revenue investment.

It is important that there is capacity in the system to meet all of the demands of the clinical service by optimising the available resource. By using the principles of simplifying processes, to make them more efficient, standardising, to remove inconsistency and sharing, to increase efficiency, sterile services will be reviewed and recommendations made regarding the strategic direction of the service.

Transport

The procurement and management of the NHSScotland vehicle fleet is undertaken in a variety of ways across NHSScotland with no consistent specification or standard being set.

Data regarding the size and condition of the fleet, whether owned or leased, will be undertaken and a clear direction for the future procurement and management of this asset established. The availability of depots and workshops across the public sector will be examined and the shared use of these facilities considered.

Standard specifications and quantities of vehicles will be established to enable effective replacement of vehicles through a national procurement process. To maximise public sector benefit, common specifications can be shared with other agencies to increase the quantum of spend in this area.

Waste Management

Contracts for the uplift and processing of all significant waste arising from NHSScotland have been established, the majority on a national basis. However the Waste Scotland Regulations 2012 will fundamentally change the way in which waste is segregated, uplifted and processed with the aim being to remove the need to landfill waste.

The Waste Management Steering Group, working with Zero Waste Scotland, Scottish Government, the waste industry, local authorities and the service will develop strategies, including reverse logistics, source segregation etc to maximise the benefit of existing and yet to be developed services to ensure NHSScotland meets its obligations under the legislative framework and sustainability agenda set by the Scottish Government.

Soft Facilities Management Services

There is currently being undertaken a review of soft facilities management services including catering and laundry. There may be areas of these services which will lend themselves to the adoption of shared services across NHSScotland or the wider public sector.