Annual State of the NHSScotland Assets and Facilities Report for 2012

2.0 NHSScotland's Assets

The responsibility for the management of NHSScotland's assets rests with 14 NHS Boards and 8 Special NHS Boards.

Special NHS Boards
NHS Education for Scotland	NHS Health Scotland
NHS National Services Scotland[1]	NHS National Waiting Times Centre (Golden Jubilee)
Healthcare Improvement Scotland	NHS 24
Scottish Ambulance Service	The State Hospitals Board for Scotland

NHSScotland owns physical assets that are worth circa £5 billion. Most of these assets relate to the estate (land and buildings) which are estimated to be worth circa £4.6 billion. Other significant fixed assets which are owned are vehicles, medical equipment and information management and technology (IM&T). An analysis of the Net Book Value of these owned assets is shown in the chart below.

The NHS also leases assets which it does not own including buildings, vehicles, medical equipment and IM&T. These leased assets are estimated to be worth a further £1.5 billion, the majority of which are hospitals and health centres leased under Public Private Partnerships (PPPs) agreements. The majority of cars used by NHSScotland staff are also leased with staff paying for their own non business element and costs of these leased vehicles.

In addition to the NHSScotland owned and leased property assets, there are numerous smaller properties used to provide a range of community and family health services provided by GPs, Pharmacists, Dentists and Opticians, many of which are owned or leased by the practitioners themselves and paid for indirectly by the NHS through a range of charging and re-imbursement mechanisms.

2.1 Estate Assets

The NHSScotland estate comprises circa 4.4 million sq.m of building floor area encompassing over 1,800 buildings ranging in size from 40 sq.m to 200,000 sq.m. The majority (97%) of this comprises the hospital estate of the 14 NHS Boards and 2 Special NHS Boards (NHS National Waiting Times Centre and the State Hospitals Board). The chart below shows an analysis of hospital estate by hospital type.

The chart overleaf shows an analysis of the current NHSScotland hospital estate by building type and compares this to 2002.

Data Source :ISD Cost Book

It is interesting to note that whilst the overall size of the estate has reduced by 13% since 2002 this reduction has been almost entirely in the non-acute estate with virtually no change in the acute hospital estate. The reduction in Long Stay, Mental Health and Psychiatric and Learning Disability Hospitals is in line with expectations given the general policy of reducing institutional care for these specialities. Furthermore, significant disposals of long stay sites have been undertaken over the last decade as a result of reduced hospitalisation and inpatient lengths of stay. These reductions in the non-acute hospital estate mean that over the last decade the acute hospital estate has increased from 55% to 64% of the overall hospital estate. However, it needs to be recognised that over this 10 year period, the space provision and quality of accommodation for acute care has risen considerably driven by:

• Patient's expectations in terms of privacy and dignity and the general quality of patient environment and care ie increased space provision (bed spacing), single rooms with en-suite wc/bathrooms.
• Increasing use of medical equipment both at the bedside and in diagnostic/treatment rooms and departments.

In addition to the hospital estate, the six Special NHS Boards (excluding the National Waiting Times Centre and the State Hospitals Board) have a combined estate of approximately 145,000 sq.m comprising offices and purpose designed accommodation for specialist services such as blood processing and testing, warehousing and garaging.

2.1.1 Estate Tenure

The majority of the NHSScotland estate is owned but PPP/PFI and leased properties are also significant as shown in the chart that follows.

Nearly all of the office accommodation occupied by the Special NHS Boards is leased.

2.1.2 Estate Age Profile

The chart below shows the age profile of the NHSScotland Estate. It shows that even though there has been substantial capital investment over recent years, 26% of the estate is currently over 50 years old and a further 29% is over 30 years old.

This estate age profile compares favourably with that reported in the 2011 State of the Estate Report as the percentage of properties less than 50 years old has increased from 63% to 73%. This improvement reflects the significant capital investment over recent years and the estate rationalisation undertaken by Boards.

2.1.3 Estate Condition

Approximately 70% of the NHS Boards' estate is in good physical condition (category A or B) with 27% requiring investment to improve its condition (category C) and 3% being unsatisfactory and requiring major investment or replacement (category D).

NHS Boards which have buildings assessed as category D - "unsatisfactory" have indicated that they have plans in place to either dispose or replace these buildings over the next 10 years.

2.1.4 Estate Utilisation

The majority (75%) of the estate is fully utilised although some under utilisation and some overcrowding is evident as shown in the chart below.

2.1.5 Estate Functional Suitability

The majority of the estate (66%) is functionally suitable for its current use (categories A and B) but 28% (category C) requires investment to improve its functional suitability and 6% (category D) requires major investment or replacement to achieve satisfactory functionality.

2.1.6 Estate Backlog

NHSScotland's estate backlog maintenance expenditure requirement is the base cost required to bring those parts of the existing estate which are currently not in satisfactory condition, back to Condition B (satisfactory). It is an on-going challenge for the NHS to balance investment between that which is focussed on service improvement and development, and that which is necessary to maintain buildings in a good condition and ensure that they are safe, reliable and fit for purpose.

An analysis of the backlog expenditure requirement across NHS Boards is shown in the chart that follows and identifies a base backlog maintenance expenditure requirement of £948 million, which is a £62 million reduction since 2011.

Note: the above chart includes all 22 NHS Boards and Special NHS Boards but those whose backlog is below 1% have not been separately identified for clarity of presentation reasons only.

The total backlog in the estate has been risk assessed and the results of this are shown in the chart that follows.

A significant amount of this backlog cost (£175 million) is in buildings which NHS Boards are planning to dispose of in the next ten years. It should also be recognised that around 20% of the current backlog maintenance expenditure requirement is in buildings which are classified as "non-clinical" and will have little impact on the patient's healthcare experience.

Although backlog is identified as expenditure requirement, in practice is likely to be addressed by a combination of:

• Estate rationalisation and disposal of older properties avoiding the need for expenditure on backlog
• Replacing older properties with new facilities and avoiding the need for expenditure on backlog
• Incorporating backlog works within major modernisation and refurbishment projects
• Undertaking specific projects to target the high and significant backlog
• Incorporating backlog work within operational repair and cyclical maintenance

Therefore, whilst the base backlog expenditure requirement is useful for monitoring "year on year" change in backlog it does necessarily represent cash requirement in terms of capital or revenue since it can be addressed through the different "non cash" approaches shown above. Section 5 of this report, Future Investment Requirements, describes how Boards are proposing to address backlog in the future.

Annex B of this report provides further information on the detailed analysis of estate condition and performance (including backlog) which has been undertaken to provide the information in this section of the report.

2.2 Vehicle Assets

NHSScotland's vehicle assets comprise approximately 11,000 different vehicles. An analysis of the vehicle assets by type is shown in the chart that follows.

The distribution of these vehicle assets across the Boards is shown in the chart that follows.

The vehicle age profile is shown below and shows that around a third of the vehicles are less than two years old but 26% are over 5 years old.

2.3 Medical Equipment Assets

NHSScotland's medical equipment assets comprise a large number of individual items including numerous small items. For this year's report the focus has been on high value equipment. However, it is recognised that the numerous small items of equipment are essential for the delivery of service and further work is needed to identify investment requirements and performance measures for these items.

There are 525 individual items of medical equipment with a replacement value of over £150,000. The chart below shows an analysis of these high value assets by equipment type.

Excludes 6 Special NHS Boards

The distribution of the high value medical equipment assets across the NHS Boards is shown in the chart that follows.

No information available for NHS Greater Glasgow and Clyde

The medical equipment age profile is shown below and shows that 32% is over 7 years old and likely to be approaching the end of its operational life.

2.4 IM&T Assets

IM&T assets consist of infrastructure (cabling networks, servers etc.) and desktop and mobile equipment. There are approximately 41,000 separate infrastructure items and 97,000 individual items of equipment (desktop and mobile devices). The following chart provides an analysis by equipment/system type.

Excludes 6 Special NHS Boards

The distribution of these IM&T assets across the Boards is shown in the chart below.

The age profiles for the IM&T equipment and infrastructure are shown separately in the charts below.