Annual State of NHSScotland Assets and Facilities Report for 2014

Annex F

Facilities and Shared Services Review

Background

In 2011 the Strategic Facilities Group of Health Facilities Scotland identified a number of areas where there could be opportunities to improve the quality of services and potentially create efficiencies by the more effective exchange of good practice and potentially sharing services across the traditional NHS Board boundaries.

The initial areas of activity which were considered by the programme were:

• Capital Planning and Hard Facilities Management.
• Operational Management of PPP/PFI Contracts
• Decontamination of reusable Medical Devices
• Transport.
• Waste Management.

Governance and Engagement

NHS Board staff are fully engaged in the provision of data and review of services. The Governance structure was altered during 2014 and the Review of Soft Facilities Management and the Hard Facilities Shared Services Programme were brought into a single structure. Under the Chairmanship of Jeff Ace, Chief Executive, Dumfries and Galloway NHS Board the Facilities Review and Shared Services programme Board (FRSSPB) has been responsible for the Programme.

The professional and technical advisory structures of Health Facilities Scotland's Strategic Facilities Group remain the primary source of advice when examining the current services, examples of best practice and areas of unwarranted variation.

Staff representatives are identified through the Scottish Partnership Forum. Where specialist topics are being considered every effort is made to identify staff representatives with skills and experience in that particular field. Where there are difficulties in identifying appropriate members of staff every effort is made to consult as widely as possible to ensure staff are engaged in the process.

Work Streams

To enable an accurate, or as accurate a baseline as possible to be established a significant data collection exercise has been undertaken. This allows the scope of the exercise to be agreed and the cost and quality improvements which are delivered as a result of changes made to be quantified.

Capital Planning and Hard Facilities Management

Capital Planning

The capital planning process, from initial agreement to hand over of the completed project, was identified as the scope of the exercise. A fully inclusive option appraisal was completed in Spring 2014 and a preferred option, based on a geographical model of service delivery, was identified. This was approved by the FFSSPB. A detailed business case will be developed and presented the FRSSPB in autumn 2014.

Good Practice

Staff from the capital Physical Planning Department in Grampian Health Board continue to support the delivery of some aspects of the NHS Highland capital programme.

Hard Facilities Management

Areas of productive opportunity were examined and a recommendation report was considered by the Facilities Shared Services Programme Board. It identified £400k of productive opportunity.

The next phase of this exercise is examining the range and availability of skills necessary to deliver the operational management of the estate in a safe and effective way.

Operational Management of PPP/PFI Contract

A Business Case has been developed in support of the establishment of a Specialist Support Team to assist Boards to develop and improve PFI/PPP Contract Management skills within the NHS to ensure that Boards "get what they pay for" in term of service quality and quantum, out of their existing PFI/PPP Contracts. The Specialist Support Team will bring expert knowledge of operational contract management by further developing collaborative working with colleagues in Scottish Futures Trust (SFT). Two members of Staff from SFT will work collaboratively within the Team on a 0.5 WTE basis.

A Recommendations Report highlights a number of areas of improvement and possible savings which provides the basis for a prioritised work plan for the Specialist Support Team. The Team have a savings commitment of £2.16 m across Scotland, to be delivered by March 2016, as well as a number of non financial benefits.

The Team are already influencing the future Standard forms for Revenue funded Hub Schemes and NPD Pipeline Projects in the light of operational experience, this aspect of their work is increasingly important as the number of revenue funded schemes increases.

Good Practice

The PFI/PPP Advisory Group is a very active forum for help, advice and collaboration and is facilitating the development of the informed client role by sharing experience and cooperation between Boards with common PFI providers. SFT Colleagues bring lessons learned from their In-depth Reviews and these are proving to be very influential for Board representatives. In term of the savings target NHS Lothian have already reported recurring savings of £0.67m for the Financial Year 2013/2014.

Sterile Services

Endoscopy Decontamination

This activity generally takes place close to the department which undertake the procedure. The practice within these was recently reviewed and a programme of capital investment to upgrade decontamination facilities undertaken and the demand for capital has been estimated. Due to the nature of the service the sharing of decontamination services was not seen as a viable option.

There is effective sharing of information through the Health Facilities Scotland advisory structure.

Local Decontamination

Local decontamination services vary, primarily based on the geography of the area being served and the availability of compliant facilities. Where considered a more cost effective solution, some podiatry service have move to single use instruments. The review of these services has been undertaken and the current arrangements are seen as the most appropriate for each Board. The options for sharing services are extremely limited.

Central Decontamination

Health Boards currently support theatre activity by providing decontamination services across NHS Scotland. The data collected as part of the development of the contingency plan needs to be refined to allow it to be used as a strategic planning tool. This information will be gathered and used to identify any spare capacity in the physical assets used to provide this service. Options will then be developed to assess the suitability of this capacity to support clinical services.

The likely capital investment in this service has been identified and possibilities to utilise existing capacity in the current infrastructure, reducing capital investment and improving services will be explored.

The need for a consistent tracking and traceability system has been identified. Work will continue to reach a solution on this issue.

The contingency plans developed locally by each NHS Board have been shared through this project and noted by the Programme Board.

Good Practice

The gathering of data relating to the likely capital investment will allow more effective allocation of capital.

Transport

Fleet Management

Proposals to develop a national support structure with regional and local management has been developed and approved by the FRSSPB. The business case will be developed in partnership with staff side colleagues and presented for approval by the FRSSPB prior to being submitted for funding.

Logistics

A detailed review of all delivery routes in Scotland has been undertaken and analysed to identify productive opportunities.

Car Leasing

Proposals to adopt a more consistent approach to the development of Lease Car Policies has been presented to the FRSSPB and is being consulted upon.

Waste

Zero Waste Scotland has worked closely with Health Facilities Scotland to scope the issues associated with the implementation of the Waste Scotland Regulation 2011.

The Waste Management Steering Group has identified 5 areas which have the potential to deliver efficiencies, possibly using a shared service model. Further consideration will be made by the National Waste Steering Group

They are:

• Food Waste
• Furniture
• WEEE
• Reverse Logistics
• Administrative processes

A national training programme was introduced to ensure NHS Boards were prepared to adopt the new waste regulations with effect from the 31^st of December 2013.

Process

All outcomes from the work streams will be considered by the Facilities Shared Services Programme Board before being passed to the Efficiency Portfolio Board for approval.