Annual State of NHSScotland Assets and Facilities Report for 2014

Annex A

Case Studies

This annex of the report provides short summaries of a number of best practice case studies covering different aspects of managing assets and facilities services in NHSScotland.

The case studies are aimed at promoting and learning from good practice, and to provide the reader with information on actions being taken elsewhere in NHSScotland to deliver improvements in the performance, efficiency and sustainability of assets and facilities services. It is envisaged that this will continue be a key feature of this annual State of NHSScotland Assets and Facilities Report, aimed at helping NHSScotland to develop capability and capacity to deliver high performing, efficient and sustainable assets and facilities services. They have been selected because they are innovative and should have a significant impact on performance. Also, they should be easily replicated more widely across NHSScotland.

Best Practice Case Study 1

NSS Office Consolidation and Rationalisation Programme

NSS is one of 22 NHS Scotland Health Boards and is accountable to the Scottish Government. NSS's purpose is to "support Scotland's health" and it achieves this by maximising the health and financial impact of its services, reflecting the organisation's desire to not only benefit the health of the people of Scotland but also ensure value for money, avoid cost and seek additional savings where required. Positioned at the heart of the health service, NSS provides national strategic support services and expert advice to all of NHSScotland. NSS also plays an active and crucial role in the delivery of effective healthcare to patients and the public. NSS works closely with partner organisations, especially local NHS Boards.

In the context of seeking to reduce cost, maintain or improve services and provide good and modern accommodation for staff, NSS has delivered key results in terms of:

• Its own office property portfolio
• Sharing its estate and estate services with other NHS Scotland Health Boards
• Tangibly contributing to the wider public sector agenda on smarter offices

In accordance with the Scottish Government Health and Social Care Directorate's "Policy for Property and Asset Management in NHSScotland" CEL 35(2010), NSS has a Property and Asset Management Strategy (PAMS) in place which is reviewed, updated and approved annually by the NSS Board. The PAMS is an integral part of NSS's corporate planning process and plays a major role in supporting, enabling and facilitating change and modernisation of NSS services.

The strategic objectives of the NSS PAMS are as follows:

To drive change towards a more productive asset base that:

• Facilitates improved service delivery and user experience to customers and promotes partnership working with stakeholders;
• Is clinically suitable, effective, supports improved quality of healthcare and meets or exceeds user expectations;
• Is safe and secure, fully compliant with all applicable statutory and regulatory requirements, minimises risk and promotes safety for people who use our services, our staff and visitors;
• Is "fit for purpose" and sufficiently agile to respond to the inevitable uncertainty around organisational and functional change over the long term;
• Enables optimum solutions through co-location, integration and shared resources across service streams and with our partners in service delivery;
• Represents good "Value for Money" and is demonstrably affordable in terms of capital and revenue investment;
• Disinvests from assets with high operating costs, backlog maintenance or short remaining life where these do not meet future service requirements;
• Is environmentally sustainable, moving towards a "carbon neutral" asset base;
• Improves asset performance against all key performance indicators.

Between 2003 and 2011 NSS successfully completed a significant number of property acquisitions and disposals across Scotland (primarily in Edinburgh, Glasgow and Aberdeen) aimed at consolidating and modernising its portfolio of office accommodation. This resulted in the replacement of most of NSS's stock of old, inflexible and dilapidated office accommodation with modern, fit for purpose facilities which were best able to meet business needs going forward.

Since 2011, NSS has embarked on a programme of further consolidating and rationalising its office estate with a specific focus on:

• improving space utilisation and driving out inefficiencies
• reducing recurring revenue costs
• providing well designed space that supports changing working practices and new technology and enables the introduction of agile working
• achieving synergies from sharing accommodation and support services with other NHS Scotland Health Boards

In order to support this programme, NSS, supported by Scottish Government, has been proactive in identifying opportunities to optimise the utilisation of office accommodation in Edinburgh and Glasgow by generating co-location opportunities with other Special Health Boards, thereby both reducing accommodation costs overall and also achieving best value in terms of shared facilities and services.

As a consequence Scottish Ambulance Service successfully relocated its headquarters functions to Gyle Square, Edinburgh between December 2011 and March 2012. Subsequently, Healthcare Improvement Scotland also relocated their Edinburgh based operations from Elliott House to Gyle Square in September 2012, and during February and March 2014 NHS Health Scotland relocated their Edinburgh based operations from Woodburn House and Thistle Street to Gyle Square. This now means that the Edinburgh based operations of 4 Special Health Boards are now co-located in what has become a Special Health Board "hub" at Gyle Square. In addition, NHS Health Scotland co-located with NSS in Glasgow through a relocation of their Glasgow based operations to remaining surplus Scottish Government space in Meridian Court in March 2013.

The following table illustrates the changes in the NSS's office estate from FY12 to the present date and through to FY16 when the current programme of office consolidation and rationalisation will be completed and further initiatives will be required:

NSS Office Accommodation		FY12	FY14	FY16	FY12 v FY16
					+/-	% +/-
Space (m² NIA)	Total	27,366	24,418	20,320	(7,046)	(25.7%)
	% of total estate	38.4%	35.8%	31.9%	(6.5%)	(16.9%)
	per person	11.95	10.84	9.19	(2.76)	(23.1%)
Cost of space (Recurring Revenue)	Total	£10.38m	£9.18m	£7.74m	(£2.64m)	(25.4%)
	% of total estate	69.7%	65.4%	60.9%	(8.8%)	(12.6%)
	per person	£4,470	£4,074	£3,500	(£970)	(21.7%)

The following table illustrates the recurring revenue savings as a consequence of implementing the NSS programme of office consolidation and rationalisation since 2012 to the present date and then forward over the next ten years to 2024:

NSS Office Estate Cost Analysis
FY12 to FY24

From a FY Baseline of £10.38m per annum the total cumulative savings (Baseline plus inflation v Actual) over the 13 year period amount to more than £48.4m which is broken down as follows:

FY12 - FY14: £ 2.7m

FY15 - FY19: £18.8m

FY20 - FY24: £26.9m

Total: £48.4m

As part of the development of the first NHS Scotland "State of the Estate Report" in 2011, a framework of property key performance indicators (KPIs) was introduced which links property performance with the delivery of the NHS Scotland Quality Ambitions. Subsequently NSS played a leading role in developing the framework to ensure relevance to NHS Scotland's office estate. The work undertaken to implement the NSS PAMS will continue to enable NSS to achieve (and some cases exceed) the National Asset Performance Framework targets in relation to office accommodation in future years.

NSS is also playing a leading role in developing and delivering the NHS Scotland "Smarter Offices Programme" in conjunction with Scottish Futures Trust. The programme is focused on the corporate office portfolios of Health Boards and Special Health Boards and its key objectives are to:

• Improve the utilisation of office accommodation across NHS corporate office facilities by identifying opportunities for consolidation and rationalisation, increased agile working and shared use of space with other public sector partners
• Identify appropriate Key Performance Indicators (KPIs) for monitoring and benchmarking of performance through the national performance framework
• Use the national performance framework to improve the utilisation of NHS office accommodation through benchmarking and comparison with best practice and industry standards
• Review of asset management strategies and provide challenge to improve performance
• Agree target areas for improvement with each Board
• Identify areas of best practice within each Board and develop plans for rollout
• Develop investment and savings plans

Best Practice Case Study 2
NHS Lothian - Creation of a Centralised Transport Hub

Background

It was recognised that there was no consistency in the approach to arranging inpatient transport. A pilot study was undertaken In January 2012, on the RIE site where all wards were instructed to arrange all inpatient transport through the RIE Discharge Lounge. This resulted in all transport resources being used more efficiently and there is stricter control over the booking of private ambulances.

The Business Challenge

NHS Lothian faced the following challenges:

• Practices for arranging transport required improved governance arrangements, were unsustainable and incurred unnecessary cost.
• The requirement for a more rigorous patient needs assessment which ensured that appropriate transport was available for those patients who need it.
• The number of ways requests were being made and the need of inpatient transport requests from all sites to be channelled through a central transport hub.
• A lack of governance covering usage of private ambulance providers by NHS Lothian
• The need to better utilise the existing SAS resource, volunteer cars and in-house vehicles and to stop using all private ambulance providers as soon as possible

The Solution

Following a pilot study undertaken at the Royal Infirmary of Edinburgh, where all requests for transport was directed through the Discharge Planning Lounge, it was agreed to extend the pilot study to explore the option to expand the principle of a central point of contact and to develop a centralised Transport Hub site through which transport requests for all sites across UHD would be channelled. The Hub operates between 0800 and 1900, Monday - Friday and between 0900 and 1600 at weekends.

The staffing of the Hub is shared between the SAS and NHS Lothian. The full-time SAS dispatcher post will continue between 0900 and 1700, Monday to Friday. The staffing levels were based on estimated demand, using 7,500 as the monthly average number of discharges and transfers across UHD as a starting point. An assessment of the potential activity through the Hub was made using the most accurate data available. The staffing requirement is monitored and will be revised once accurate activity data available and until the demand could be validated, the posts were offered as temporary contracts.

Best Practice Case Study 3
Project Brief: Re-use and Redeployment of Decommissioned Assets

Background

Resource Efficient Scotland and the Scottish Futures Trust (SFT) are jointly delivering a project to work with various public sector organisations in Scotland in the process of decommissioning buildings, to understand the options available for re-use and redeployment of mobile assets for the following key product groups - furniture, textiles and small electrical equipment - and to create tools and supporting guidance for the development of a register of mobile assets within an organisation.

Key Stakeholders

• Scottish Futures Trust (delivery partner)
• Zero Waste Scotland Circular Economy Team
• Health Facilities Scotland (Decommissioning Unit)
• Up to five pilot decommissioning sites (to be confirmed)
• Local private/third sector organisations (asset disposal)
• Scottish Public Bodies

Anticipated Outputs

• Bespoke software to support mobile asset surveys
• Mobile Asset Register tools and supporting guidance, including methodologies
• Pilot Mobile Asset Registers for up to five decommissioning sites

Anticipated Benefits

• Improved data on volume and tonnage of mobile assets within public sector organisations.
• Improved data on the 'true' costs and carbon impact of choosing reuse, redeployment or recycling for disposal of mobile assets
• Provision of data to aid the development of the business case for repair services and re-use hubs in Scotland
• Influence public procurement processes to stimulate demand for recycled, remanufactured, refurbished and re-used products

Best Practice Case Study 4
NHS Ayrshire & Arran - Girvan Community Hospital

Since its completion, Girvan Community Hospital has picked up a number of awards including the "Building Better Healthcare Award for Best Sustainable Design", and "Health Facilities Scotland Award for Energy and Environment". More recently, and according to a recent article published on the Renewable Energy Systems in Hospitals website, Girvan Community Hospital is one of the most sustainable hospitals in the world producing two thirds of its energy from renewable sources. Renewable heat and hot water is generated from a 700kW biomass boiler, and electricity is generated from a 100kW wind turbine. Other energy saving features include utilising natural lighting combined with internal automated lighting controls, variable speed motors and pumps and natural ventilation.

Sustainable design was embedded from the start of the building process which ensured that the use of renewable materials in its construction together with the use of renewable energy technologies to lower the buildings total carbon emissions and ensure sustainability goals are being upheld through to the finished product. Both medical teams and community members alike played a large role in putting forward ideas for the new hospital. The result of which has set the standard to which all new hospitals within the NHS Scotland should be built.

The biomass boiler supplies the hospital with 92% of its total heat, combined with the wind turbine which produces 25% of the hospital's electrical demand. This gives a total renewable energy use of 66%. The renewable technologies implemented have reduced the carbon emissions of the hospital by 50%. This equates to a saving of around £1.6 million over a 20 year service life.

Future plans for this hospital and other healthcare sites include the installation of LED lighting, solar PV panels, and air to water heat pumps, which all have the potential to further reduce the hospitals carbon emissions and energy use, with a target goal of becoming the first carbon neutral hospital, where its utilities will be cost neutral.

As part of NHS Ayrshire and Arran's commitment to reducing their energy and carbon emissions, they have also recently won a national award for the best renewable project of the year in the Public Sector for the Arran War Memorial Hospital bio mass boiler project. This accolade was received at the 2014 Heating & Ventilation News awards ceremony in London. The hospital has moved from using oil as the primary source for heating, to a wood chip biomass boiler. The wood is sourced sustainably from the island and is maintained by teams on the island too, making the project fully sustainable.