NHSScotland assets and facilities 2015: annual report

2.0 Performance of NHSScotland's Assets

This section of the report provides an overview of the current state of NHSScotland's assets whilst also reviewing asset and facilities services performance. The intention is to gain an insight into the significance of this asset base and also to appreciate where opportunities lie for improving performance.

The data used within this report is based on that currently available and reported at the beginning of the financial year 2015/16 (April 2016). This includes:

• The latest asset performance information provided by NHS Boards in April 2015 covering property, office accommodation, vehicle and medical equipment assets.
• The latest available eHealth IM&T survey information, which was carried out in 2012.
• The latest facilities management costs published within the Scottish Health Service Cost Book (published in December 2014), covering NHS Boards' annual accounts for the reporting period 2013/14.
• The latest PPP/ PFI service charge costs from NHS Board's audited accounts.
• Information from NHSScotland's 2014 patient questionnaire survey which reports every two years.
• NHS Boards' Property & Asset Management Strategies which were submitted in June 2015.

All costs reported in this document include the impact of inflation but exclude the cost of VAT or other on-costs, unless specifically noted.

2.1 The Current Status of NHSScotland's Property Assets

The following provides an overview of the current status of NHSScotland's assets, with some comparative information on annual changes. More detailed information on the current status of property assets can be found in Annex B of this report.

Current status of NHSScotland's property assets
Current Net Book Asset Value (all assets)	2015
Property:	£5.7bn
Other:	£0.6bn
Total:	£6.3bn
Floor Area ('000's sq.m)	2014	2015
Total:	4,512	4,478
Age (% less than 50 years old)	2014	2015
	74%	78%
Condition (Good - category A or B)	2014	2015
	58%	66%
Estate Utilisation (Fully Utilised)	2014	2015
	77%	81%
Functional Suitability (Good - A or B)	2014	2015
	65%	72%
Backlog Maintenance	2014	2015
Including Inflation uplift for 2015	£789m	£898m
Excluding inflation uplift for 2015		£809m

Improvements to the above property performance KPI's is a combination of performance improvement across several NHS Boards; however, a particular impact this year has been the inclusion of the new Queen Elizabeth University Hospital facility and the exclusion of associated non-operational estate which has become surplus to requirements.

2.2 The Current Status of NHSScotland's Vehicle Assets

The following provides an overview of the current status of NHSScotland's vehicle assets, with some comparative information on annual changes. More detailed information on the current status of vehicle assets can be found in Annex C of this report.

Current status of NHSScotland's vehicular assets
Number of Vehicles	2014	2015
Owned*:	1,897	1,932
Leased:	2,178	2,516
Staff Car Scheme:	6,485	5,548
Long term hire:	198	155
Total:	10,758	10,151
Age (% less than 5 years old)	2014	2015
	85%	83%
Mileage (average per vehicle)	2014	2015
Owned:	-	15,800
Leased:	-	9,700
Staff Car Scheme**:	-	4,900
Fuel Type	2014	2015
Petrol:	-	21.9%
Diesel:	-	77.7%
Alternative:	-	0.4%

* 65% of NHSScotland's owned vehicles belong to the Scottish Ambulance Service.

** The Staff Car Scheme does not include staff using their own vehicles for work purposes.

The quality of information returned by NHS Boards on their vehicle assets has improved this year (but with scope for further improvement). This enables more information to be presented on the current state of these assets. For example, mileage and fuel type are presented for the first time and can be used to monitor future changes in vehicle usage based on mileage per vehicle, and any change in fuel use from a reliance on diesel towards use of alternatives such as electric, bio-fuel, low pressure gas, etc.

The age profile of these assets suggest that they are in good condition and well maintained, with some Board's suggesting that vehicles beyond 5 years old are often due to their lower annual mileage enabling an extended life.

2.3 The Current Status of NHSScotland's Medical Equipment Assets

The following provides an overview of the current status of NHSScotland's medical assets, with some comparative information on annual changes. More detailed information can be found in Annex D of this report.

Current status of NHSScotland's medical equipment
Replacement Cost*	2014	2015
Radiotherapy equipment	£61.9m	£66.2m
Imaging equipment	£209.3m	£268.9m
Renal dialysis equipment	£15.0m	£16.0m
Cardiac defibrillators	£19.2m	£19.7m
Flexible endoscopes	£69.5m	£84.2m
Infusion devices	£32.2m	£37.0m
Other high value equipment:	£437.0m	£440.0m
TOTAL:	£844m	£932m
Radiotherapy equipment (linear accelerators & CT simulators)	2014	2015
Number of items:	n/a**	35
Proportion within minimum lifecycle age:	n/a	100%
Imaging equipment	2014	2015
Number of items:	n/a	2,745
Proportion within minimum lifecycle age:	n/a	69%
Cardiac Defibrillators	2014	2015
Number of items:	3,600	3,850
Proportion within minimum lifecycle age:	n/a	85%
Infusion Devices	2014	2015
Number of items:	19,225	20,190
Proportion within minimum lifecycle age:	n/a	76%
Flexible endoscopes	2014	2015
Number of items:	2,870	3,035
Proportion within minimum lifecycle age:	n/a	85%
Renal Dialysis	2014	2015
Number of items:	920	944
Proportion within minimum lifecycle age:	n/a	66%

* estimated cost of replacing all medical equipment, excluding low value medical equipment & leased / privately financed equipment

** n/a - represents comparative data not available in 2014

Medical equipment is a valuable asset both in monetary terms and in the important role it plays in the delivery of quality and safe healthcare across NHSScotland. The annual change in the replacement cost of medical equipment is mainly due to revised cost estimates and more accurate cost information available this year on imaging and flexible endoscopes. Better information this year also makes it possible to report on the proportion of each type of equipment that is within the minimum recommended age before needing to consider its replacement (Proportion within minimum lifecycle age).

The programme of continued investment in medical equipment will ensure that modern standards of available equipment is maintained which will be used to better support person centred & safe care and improved efficiency and effectiveness of service delivery.

2.4 National Asset and Facilities Performance Framework

A key objective of this report is to monitor year on year change in asset and facilities services performance, and the National Asset and Facilities Performance Framework (below) has been used since first introduced in 2011 to provide an essential link between asset and facilities services performance and patient needs, as defined in the NHSScotland Quality Strategy's three Quality Ambitions.

The Framework uses 20 key performance indicators to monitor year on year progress in asset performance towards the achievement of the 2020 Vision targets. It should be noted that the 2020 Performance Targets are (a) provisional and subject to review to reflect funding availability and the outcome of the work on the 2020 Visioning, and (b) based on the qualification that their attainment will not reduce service quality. Broadly, half of the KPIs are based on quality measures and half are based on cost measures.

Annual changes to these KPI's are further explained in the following section.

2.4.1 Changes in National Asset Performance Framework KPIs

The following provides an overview of performance change between 2011 (when the performance framework was first developed) and 2015, along with a short commentary on the changes.

KPI Nos 1 to 10 - Derived from property appraisal information and PAMS provided by Boards

(Note: 'Percentage of properties' indicators are based on floor area, unless otherwise stated).

Physical Condition (percentage of estate area in Category A & B)

Physical Condition

Over that last five years the reported physical condition of the estate has ranged between 58 - 68% being in satisfactory condition (category A & B). A contribution to the improvement this year has been the inclusion of the new Queen Elizabeth University Hospital in Glasgow. Boards advise that the various reasons for changes to this indicator over the last five years includes:

• Delivery of new modern facilities; such as those described in Section 1, which present opportunities to remove from service older buildings in poorer condition.
• A substantial re-examination of the condition of the NHSScotland estate over the last 5 years, which presents a more informed understanding of the condition of the estate and future investment needs.
• The natural aging affect on the condition of buildings.

Over the next 5+ years, NHSScotland's asset investment programme, as outlined in Section 4, will continue to deliver new and modernised estate to replace or improve on outdated accommodation.

Quality (percentage of estate area in Category A & B)

Quality

As might be expected, this facet is showing broad correlation with the physical condition facet, with a small improvement this year. It is further expected to follow similar improvements in the future as investment in facilities is implemented.

Positive Patient Rating of the Hospital Environment

Patient Rating of the Hospital Environment

This is the sole indicator taken from NHSScotland's patient questionnaire survey. The survey is now carried out every two years therefore the performance indicator remains unchanged between 2014 and 2015 at a positive rating of 90% for the patient's opinion on the hospital environment.

Properties less than 50 Years Old

Properties less than 50 Years Old

The proportion of properties less than 50 years old has steadily improved over the last 5 years from just over 63% in 2011 to just under 80% in 2015. This shows the impact of the strategic investment programme implemented over this period including the recently completed Queen Elizabeth University Hospital in Glasgow. As a further impact of this and other projects, over the next few years older parts of the NHSScotland estate will be removed as they are no longer required.

Further potential for future improvement includes:

• NHS Lothian is embarking on several replacement programmes including a new Royal Hospital for Sick Children & DCN, redevelopment of Royal Edinburgh Hospital, and a new East Lothian Community Hospital.
• NHS Orkney and NHS Dumfries & Galloway are preparing plans to replace their existing old hospitals with new facilities.

Many of these new investments will replace old and outdated accommodation.

PAMS Quality Checklist Average Score (max score 100)

PAMS Quality Checklist Average Score (max score 100)

This indicator shows continued general improvement in the quality and content of NHS Boards Property & Asset Management Strategies over the last five years. This reflects a strong focus by Boards over recent years on improving the quality and consistency of their property data and the continued aim of linking property changes to their clinical and service strategies.

Overall SCART score

Overall percentage compliance score from SCART

SCART is a self-assessment tool that indicates general compliance with policies and procedures related to property aspects of statutory compliance. This indicator shows a continued improvement over the last 4 years. The initial assessment in 2011 concentrated on high priority areas, such as inpatient accommodation, whereas the subsequent further assessments from 2012 onwards, which covers circa 88% of NHS Boards' estate, identified a wider range of improvement needs. A new, expanded question set is currently being adopted which may affect the performance results of this KPI next year.

Backlog Cost per sq.m. (excel.inflation)

Backlog Maintenance Cost per sq.m.

This indicator for estate performance has shown a continual improvement (reduction) between 2011 and 2014 but with a levelling off this year. The 2015 KPI also excludes the impact of rebasing backlog costs to reflect inflationary pressures. This enables the 2015 KPI to be compared with previous years on a like for like basis. Section 2.4.3 provides further details on the current status and movement of reported backlog maintenance.

Percentage of High and Significant Risk Backlog

Proportion of Significant & High Risk Backlog Maintenance

The proportion of backlog that is in the category of Significant or High has reduced this year which reflects the important focus on reducing this category of backlog though direct investment and replacement of facilities where this is a particular issue. The results also reflect the work of Boards in introducing better mitigation measures which enables them to review their original risk assessments.

Functional Suitability (percentage of area in Category A & B)

Functional Suitability

There has been an overall improvement in this KPI over the last 5 years, which shows the positive impact that property assets are having on the effectiveness of health & care service delivery. Again, the impact of modern new facilities, such as the new Queen Elizabeth University Hospital, are positively impacting on this KPI.

The strategic investment programme (as indicated in Section 4) should result in further improvements in this KPI.

Space Utilisation (percentage of area fully utilised)

Fully Utilised Space

The area of the estate that is regarded as fully used has improved to 81% this year.

This remains an ongoing focus for Boards as they continue to reconfigure their estate to make the most effective use possible of this complex accommodation. Boards will also need to plan to fully utilise the new accommodation that will come on line over the next 5+ years.

KPI Nos 11 to 20 - Cost Book Derived KPIs

Note: 2015 SAFR Cost Book data is based on financial information for financial year 2013/14

As part of the measures to improve the quality and consistency of data, the unit of measurement for building size was changed from 100 cu.m to sq.m in the 2012 Cost Book. Therefore, comparisons can only be made for the last three years on these KPIs.

Building Area (sq.m) per Consumer Week

Space Utilisation - Building Area per Consumer Week

This indicator has remained relatively stable over the last 3 reporting years but with a slight increase this year as consumer weeks for inpatient activity reducing as Boards shift to more day case activity.

Cleaning Costs £ per sq.m

Cleaning Costs

Higher cleaning standards as a response to increased HAI standards of cleanliness, increased activity and usage of space, and normal inflationary cost pressures have all impacted on this KPI. However, this seems to be offset by efficiency performance improvements which have reduced such increases to below inflation levels.

Property Maintenance £ Costs per sq.m

Property maintenance costs

Property maintenance costs have reduced slightly this year which is mainly as a result of varying revenue spend on backlog maintenance included in the expenditure figures for property maintenance.

PPP Service Charge Cost per sq.m

PPP - Service Charge Costs

This KPI shows only the service charge element of PPP/ PFI operating costs taken from NHS Boards' audited accounts (i.e. not from Cost Book information). It doesn't include interest or recharge payment elements of a unitary charge. It has also been adjusted this year to take account only of the floor area associated with such facilities and not the overall estate. The KPI for 2015 is similar to that reported the previous year.

Energy Costs £ per sq.m

Energy Costs

This KPI shows a slight reduction in energy costs per square metre over the last year which is mainly as a result of reduced energy consumption during a year of generally milder temperatures However, as energy cost changes are outside the direct control of NHSScotland then energy efficiency improvements are the main measure for reducing consumption and thus overall costs. Further information on energy performance is provided in Annex F.

Rates Costs £ per sq.m

Rates Costs

Rates are generally index linked to inflation but the cost per sq.m has reduced this year which may be due to a reduced rates charge across the estate.

Catering Costs £ per Consumer Week

Catering Cost £/consumer week

This KPI shows a steady increase in catering costs per consumer week over the five year reporting period during which time patient choice and food quality have both improved. The cost impact of these improvements in service delivery seems to be offset by efficiency performance improvements as the costs increases are generally lower than inflation over the same period.

A review of catering services was carried out during 2014/15 as part of the Soft FM review programme, details of which can be found in Annex H.

Portering Costs £ per Consumer Week

Portering Costs

Boards explain that their Portering service is being used to carry out additional tasks in order to reduce pressures on front-line staff and the need for additional security staff in some instances. This is a key reason why the cost per consumer week has steadily risen since 2011. A review of Portering can also be found in Annex H, which includes the recommendation to install automated portering task tracking systems in appropriate locations.

Laundry and Linen Costs £ per Consumer Week

Laundry & Linen Costs

Laundry & linen costs have generally remained the same since 2011, despite inflationary pressures. Efficiency measures such as the move from conventional linen to fitted bedding have helped to control any cost increases.

The Soft FM review of Laundry services (see Annex H) has recommended a business case to evaluate the reprovision of Laundry Production Units across NHSScotland.

Waste Costs £ per Consumer Week

Waste Costs

The cost associated with increased regulation on clinical waste and stricter controls over the segregation and disposal of waste have both put pressure on overall waste costs since 2011.

A review of Waste services falls under the Facilities Shared Services Review, with opportunities for future efficiencies described in Annex G.

The scale of the above cost charts has, when convenient to do so, been kept at 0 - 50 to enable comparison of the scale of costs between charts.

As described above, the Strategic Review of Soft Facilities Management Services Programme and the Facilities Shared Services Review are both carrying out strategic reviews of FM services across NHSScotland to identify improvements and efficiencies that can be made to these services and thus make improvements to the above performance KPI's.

It should be noted that a number of the above Cost Book derived KPIs use "consumer weeks" as the denominator in the KPI. It should also be recognised that this is primarily a measure of inpatient activity however it also takes some account for day patient activity. Studies have shown that it is primarily inpatient activity which drives the numerator in each of these KPIs i.e. the two variables in each of these KPIs are highly correlated.

2.4.2 Performance variation across Boards

The Performance Framework is intended to provide a useful "national picture" of performance on a range of asset and facilities management services. The tables that follow compare each Board's performance on each of the 20 KPIs in the Framework. However, it should be recognised that comparisons between NHS Boards should be treated with some caution because:

• The size and scope of each Board's estate has historically developed in different ways over time.
• Increased spending can be a result of an improvement initiative.
• Boards may use different service delivery models to suit local circumstances i.e. number and type of duties carried out by domestic services staff may vary from site to site.
• Smaller Boards will be unable to achieve the economies of scale evident in the larger Boards.
• There are different specifications between Boards in the scope of each service.
• Allocation of costs between services and sites may not be uniform.
• Annual variances in non-recurring expenditure may distort operational KPIs i.e. expenditure on backlog incorporated within annual property maintenance costs.
• The introduction of new initiatives which improve performance take time to implement across NHSScotland.
• Clinical complexity / specialist services vary between hospitals and may drive cost differentials i.e. specialist clinical activity may result in higher clinical waste quantities and costs.
• Differences in pay and supplies costs across geographic areas i.e. some Boards may incur higher cost arising from remote and rural locations.

NHS Board	Properties categorised as either A or B for Physical Condition	Properties categorised as either A or B for Quality	Positive response on patient rating of 'hospital environment'	Percentage of properties less than 50 years old	PAMS Quality Checklist Score (%)	Overall compliance score from SCART	Cost per square metre for backlog maintenance	Percentage of significant and high risk backlog maintenance	Properties categorised as either A or B for Functional Suitability	Properties categorised as 'Fully Utilised' for space utilisation
NHS Greater Glasgow & Clyde	73%	57%	85	86%	72%	73%	246	58%	67%	88%
NHS Lothian	54%	76%	88	65%	83%	84%	97	73%	77%	75%
NHS Tayside	58%	92%	91	69%	69%	76%	138	62%	82%	84%
NHS Grampian	62%	72%	91	63%	84%	59%	338	25%	69%	90%
NHS Fife	79%	71%	84	73%	71%	86%	179	39%	80%	81%
NHS Ayrshire & Arran	48%	82%	89	71%	80%	72%	307	21%	88%	69%
NHS Lanarkshire	80%	73%	80	92%	78%	91%	183	29%	71%	90%
NHS Highland	34%	43%	94	97%	61%	62%	237	29%	28%	40%
NHS Forth Valley	85%	85%	91	91%	75%	70%	81	16%	89%	95%
NHS Dumfries & Galloway	63%	50%	88	69%	80%	71%	526	56%	57%	47%
NHS Borders	98%	67%	89	93%	71%	83%	77	32%	63%	98%
NWTCB - Hospital	94%	93%	99	100%	72%	89%	7	3%	93%	100%
Western Isles	92%	98%	97	88%	75%	95%	25	38%	97%	96%
The State Hospital	100%	100%	-	98%	72%	95%	14	38%	100%	88%
NHS Shetland	61%	68%	91	53%	80%	65%	110	64%	72%	98%
NHS Orkney	24%	75%	90	68%	74%	71%	667	20%	49%	53%
NHS Board Average 2015:	65%	70%	90	77%	75%	78%	206	45%	72%	81%

The size, scope and historical development of each Board's estate influences the 2011 starting performance base indicator and thus continues to impact on Boards' variation from the NHS Board Average.

Backlog in this table includes the cost impact of inflation.

The NHS Board Average 2015 excludes NHS Special Boards

The Patient questionnaire data remains unchanged since 2014 as the national survey now takes place every two years.

NHS Board	Building Area sq.m per Consumer Week	Cleaning Costs £ per sq.m	Property maintenance costs £ per sq.m	PPP Service Charge Costs £ per sq.m	Energy Costs £ per sq.m	Rates Costs £ per sq.m	Catering Cost £ per consumer week	Portering Costs £ per consumer week	Laundry & Linen Cost £ per consumer week	Waste Cost £ per consumer week
NHS Greater Glasgow	3.5	37.6	27.4	57.6	32.5	11.2	83.4	60.7	33.1	12.8
NHS Lothian	3.4	41.8	27.4	177.8	29.1	10.8	89.1	48.9	26.3	8.2
NHS Tayside	4.5	35.8	28.6	70.3	25.2	11.2	81.6	62.4	36.7	10.0
NHS Grampian	3.9	63.1	30.7	33.5	37.7	11.7	78.4	56.8	25.3	15.8
NHS Fife	4.4	34.8	21.2	68.9	17.2	12.5	81.5	49.0	27.4	12.4
NHS Ayrshire & Arran	3.0	42.0	54.7	114.9	24.8	8.3	85.8	62.9	43.7	11.3
NHS Lanarkshire	2.2	45.3	77.5	291.8	30.2	17.9	95.6	32.7	42.7	12.7
NHS Highland	3.5	45.8	35.0	192.5	41.3	17.5	104.2	42.5	26.6	12.6
NHS Forth Valley	3.1	43.8	44.9	186.4	31.6	22.4	87.9	30.1	32.6	10.5
NHS Dumfries & Galloway	3.1	58.8	51.1	32.0	33.5	14.0	105.1	26.6	43.0	16.3
NHS Borders	3.0	47.8	43.8	0.0	28.0	14.5	75.6	28.9	24.1	10.3
Golden Jubilee	7.9	25.9	45.4	0.0	43.4	17.9	85.5	71.6	64.3	44.2
State Hospital	3.5	55.4	34.8	0.0	33.6	24.1	110.5	21.2	8.6	5.5
NHS Western Isles	3.4	46.3	41.8	0.0	48.8	26.1	105.4	34.5	34.2	14.3
NHS Shetland	3.4	74.6	84.9	0.0	63.8	22.2	186.4	100.4	51.1	13.7
NHS Orkney	3.2	61.9	88.6	0.0	66.3	22.7	109.2	49.0	38.9	17.5
NHS Scotland 2014 Cost Book Average	3.50	42.36	34.67	159.4	30.65	12.76	87.23	51.20	32.80	12.06

Comparisons between NHS Boards should be treated with some caution for the reasons outlined at the beginning of this section.

Cost information is sourced from the latest Cost Book data for 2013/14.

PPP Service Charge Costs are derived from Boards annual accounts and their proportion of PPP accommodation. Service charges may incorporate more services for different buildings / Boards

2.4.3 Current status of Backlog Maintenance

The current 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, however, only a singular reference to understanding the current state of the estate and should not be considered in isolation to other important indicators such as the physical condition, age, and functional suitability of available accommodation; as described earlier in the National Asset and Facilities Performance Framework.

The 2015 backlog maintenance expenditure requirement is reported as £898m, which is an increase of just over £100m since 2014. This increase includes a readjustment to the cost base of £90m to account for the impact of inflation on maintenance works costs. It further includes a real term reduction of circa £40m from the majority of NHS Boards' backlog position this year, but this is set against newly identified backlog of circa £50m reported by NHS Greater Glasgow & Clyde following recent surveys being carried out. This position is however expected to improve in future years when backlog associated with identified surplus estate is removed following completion of the new Queen Elizabeth University Hospital.

The following chart provides a breakdown of the current total £898m of backlog maintenance across each NHS Board:

Backlog Maintenance Comparison - NHSScotland Total is £898m

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.

Improved asset management practice introduced since 2010 requires that all identified backlog maintenance is risk assessed so that appropriate mitigation actions can be implemented and maintenance activity can be logically planned and prioritised. This provides the necessary governance arrangements to enable the expected life of property elements to be extended and backlog to be managed in a safe and financially sustainable manner.

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

Backlog Maintenance Risk Profile

The proportion of Significant and High risk backlog maintenance has reduced from 47% reported in 2014 to 44% reported this year. This is mainly attributable to High risk reducing from 12% to 9%. This suggests that NHS Boards' investment & disposal strategies are aligned with the need to reduce these aspects of backlog maintenance.

NHS Boards are continuing to review their current risk assessments to ensure that they appropriately reflect the level of risk to service and business continuity once adequate mitigation actions have been introduced to manage these risks. This has the potential of reducing the current risk profile of outstanding backlog maintenance.

The variation in risk profile across the different NHS boards is highlighted in the following table:

2015 Backlog Maintenance Risk Profile - NHS Boards

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

• Estate rationalisation and disposal of older properties avoiding the need for expenditure on backlog. The scope of planned disposals over the next 5 years is outlined in Section 4.
• Replacing older properties with new facilities and avoiding the need for expenditure on backlog e.g. the estate rationalisation to follow the completion of the Queen Elizabeth University Hospital in Glasgow and further estate rationalisation once the new hospital replacement projects are completed in Dumfries and Orkney.
• Incorporating backlog works within major redevelopment, modernisation and refurbishment projects e.g. improvements to inpatient accommodation at Aberdeen Royal Hospital, Royal Edinburgh Hospital, and Ayrshire Central Hospital.
• Undertaking specific projects to target the high and significant backlog.
• Incorporating backlog work within operational repair and cyclical maintenance.

These strategies have been used to reduce the backlog maintenance expenditure requirement since a total figure of £1,010m was first reported in the 2011 SAFR. The following table provides a summary of the progress that NHS Boards have made in reducing this backlog between 2011 and 2015 (i.e. excluding inflationary cost adjustments and any additional newly reported backlog in that period):

SAFR Reporting Year	Change to backlog costs since originally reported in 2011 SAFR (£m)
2011	1010
2012	911
2013	803
2014	702
2015	655

The table shows that NHSScotland has been able to successfully reduce the backlog maintenance expenditure requirement identified in 2011 by £355m to a total of £655m by 2015. However, as identified earlier, the total backlog expenditure requirement reported by Boards in 2015 is £898 million which takes account of the impact of inflation on maintenance costs as well as additional newly identified backlog over the same period. Hence, the backlog reported by Boards in any one year is a total figure which incorporates both the impact of their investment to reduce the backlog identified in previous years and any new backlog and cost adjustments identified within the year.

It should also be recognised that newly identified backlog in buildings and engineering systems is an inevitable consequence of aging buildings that occurs as a result of:

• Building and engineering elements coming to the end of their operational life, which can vary significantly depending on the element - engineering components and systems can have relatively short operational lives with most requiring replacement within 20 years whereas building elements tend toward longer operational lives of up to 60 years.
• Variations in normal day to day operational usage which can result in shorter than expected operational lives of elements and in some cases unpredicted failure of systems and the need for earlier than expected replacement.

The following chart uses the original backlog figure reported in the 2011 SAFR to track the actual annual change in this backlog (i.e. excluding the impact of newly reported backlog or inflation) up to 2014/15, and then plots future reductions needed to meet the aspirational target of reducing this to below £500m by 2020 and with no outstanding High risk backlog maintenance:

Past and Projected Backlog Maintenance Expenditure Requirement (excluding new backlog and inflation)

* excluding newly reported backlog & inflation

The chart shows that the reductions in this backlog this year (2014/15) is generally in line with that forecast necessary to achieve the aspirational target for 2019/20. However, in future years the growing level of new backlog will also need to be considered

It is recognised that in practice new build and refurbishment / upgrade schemes will inevitably also reduce low and moderate risk backlog when, for instance, this backlog is in the same building/area in which the high and significant risk backlog is present, hence, it is accepted that some reduction in low and moderate risk backlog will continue to take place in parallel with the reductions in high and significant risk backlog and is a practical consequence of undertaking works in buildings.

In summary, whilst this analysis and projections of future backlog provides a high level indication of how backlog might be reduced over the next few years, it needs to be recognised that in practice it is very difficult to accurately project changes in backlog in existing buildings, and timings for estate rationalisation can be influenced by a number of factors including operational priorities and market forces (in relation to disposals).

Future SAFR reports will continue to monitor annually how Boards are actually reducing their overall backlog as well as the risk profile of that backlog.

2.4.4 Asset Performance for Office Accommodation

The NHSScotland Smarter Offices Programme was established in October 2013 with the aim of supporting improved utilisation of office accommodation across the NHS estate by supporting NHS Boards and Special Boards in the development of a strategic approach to their office accommodation. This expected to gain the following benefits:

• Provision of affordable support accommodation to the NHS that is better able to respond to future changes in strategic direction
• Improved quality of working environment which facilitates the retention and recruitment of staff
• Improved availability of staff welfare facilities promoting positive staff morale.
• Flexible, well designed, efficient space that is able to cope with uncertainty around future property needs, support opportunities to change working practices, and introduce new technology
• Supporting Scottish Government environmental sustainability agendas through the appropriate procurement, design and operation of its property assets.
• Maximised opportunities for staff to develop and deploy their knowledge, skills and personal qualities creatively to add value to the organisation.
• More integrated/collaborative working and thereby encourage better use of skills and resources.
• Synergies from shared use of accommodation and support services.

By drawing on wider research undertaken by UK Government, the Programme has developed a set of performance measures covering workplace standards and benchmarks which this report has adopted as the Office Performance Framework. This includes setting a benchmark of 8sq.m. per Whole Time Equivalent ( WTE) (i.e. space per person) for new and refurbished office space and 10sq.m. per WTE for all other office accommodation. It also includes a Desk to WTE of 80% (i.e. desks per person).

The tables below show NHS Boards' position in relation to these benchmarks, as well as the annual change in costs associated with this accommodation type. For territorial health boards there appears some scope for improvement in both of the space KPI benchmarks; with an average space per WTE of 14.5 sq.m. and a desk to WTE of 104%. This is, however, affected by these Boards using older parts of the estate for their main office accommodation which is less flexible for agile working practices yet is more cost effective. Many of the Special Health Boards who are more likely to use modern office accommodation are much closer or better than the KPI benchmark standards. Costs associated with all office accommodation will continue to be monitored to ensure ongoing cost effectiveness.

NHS Board	Space Standard (sq.m NIA)		Desk to WTE/ FTE %	Accommodation Budget Costs inc VAT: 2014/15							Annual Change
	WTE/ FTE	Desks		Rent £ per m2 NIA	Rates £ per m2 NIA	Service Charge £ per m2 NIA	Hard FM £ per m2 NIA	Soft FM £ per m2 NIA	Energy £ per m2 NIA	Total Costs £ per m2 NIA	Total Costs £ per m2 NIA
NHS GG&C	21.6	19.8	109%	29	21	0	29	20	22	120	6
NHS Lothian	12.1	10.8	112%	153	49	21	4	24	16	266	44
NHS Tayside	13.2	12.9	103%	96	15	0	11	25	20	167	-11
NHS Grampian	14.1	13.0	108%	39	43	0	24	16	31	154	-74
NHS Fife	15.4	14.0	110%	8	23	0	5	5	24	66	-3
NHS Ayrshire & Arran	13.6	12.4	110%	32	19	0	9	6	8	73	-13
NHS Lanarkshire	5.5	6.8	81%	0	25	0	26	10	17	78	-21
NHS Highland *	8.8	8.2	107%	123	63	2	8	6	30	232	0
NHS Forth Valley	16.2	15.6	104%	56	28	9	32	14	22	161	18
NHS Dumfries & Galloway	18.4	20.8	88%	15	10	0	14	11	21	71	2
NHS Borders	12.3	10.4	119%	22	31	0	8	10	26	97	18
NHS Western Isles	9.5	9.2	103%	31	67	0	14	74	10	196	-59
NHS Shetland	11.8	11.8	100%	5	18	0	2	8	24	57	-54
NHS Orkney	9.3	8.0	116%	156	66	0	17	15	16	271	-18
NWTC/Golden Jubilee	11.4	9.7	117%	0	25	0	34	68	45	172	68
The State Hospitals Board	47.4	45.2	105%	0	32	0	19	9	24	84	12
NHS BOARD TOTAL / AVERAGE	14.5	13.9	104%	46	27	3	18	15	20	129	-2

NHS Special Board	Space Standard (sq.m NIA)		Desk to WTE/ FTE %	Accommodation Budget Costs inc VAT: 2014/15							Change
				Rent	Rates	Service Charge	Hard FM	Soft FM	Energy	Total Costs	Total Costs
	WTE/ FTE	Desks		per m2 NIA	per m2 NIA	per m2 NIA	per m2 NIA	per m2 NIA	per m2 NIA	per m2 NIA	per m2 NIA
				£	£	£	£	£	£	£	£
NHS National Services Scotland	9.5	9.1	103%	241	76	11	23	28	34	412	24
NHS Education for Scotland	9.6	9.1	106%	195	96	79	0	8	16	394	-1
Healthcare Improvement Scotland	11.1	10.1	110%	246	90	40	21	39	23	458	54
NHS Health Scotland	10.3	10.9	94%	287	92	0	25	29	38	472	15
Scottish Ambulance Service	10.3	12.3	84%	100	55	3	21	17	11	206	-30
NHS 24	7.8	11.1	71%	162	63	21	42	34	58	380	60
SPECIAL NHS BOARD TOTAL/AVERAGE	9.3	9.8	95%	213	77	23	23	26	33	395	25

2.5 Property and Asset Management Strategies ( PAMS)

The Scottish Government's "Policy for Property and Asset Management in NHSScotland" requires all NHSScotland bodies to have a Property and Asset Management Strategy which is reviewed and approved annually by its Board. Health Facilities Scotland has provided comprehensive guidance and training to support Boards in developing their PAMS.

A Property and Asset Management Strategy ( PAMS) is the key strategic document for demonstrating how each NHS Board is performing against ongoing policy objectives both now and in the longer term. The Performance Framework also includes an average score for PAMS quality ( KPI No 5). This results from a detailed review of each Board's PAMS.

2.5.1 Review of PAMS submitted in 2015

The State of NHSScotland Assets and Facilities Report provides an opportunity to review and compare each Board's PAMS to ensure that their strategic plans are aligned with NHSScotland's strategic investment priorities, and that proposed changes to their asset base will deliver tangible benefits to the delivery of health and care services whilst also improving the condition and performance of those assets.

The PAMS that were submitted in June 2015 demonstrate a strong understanding of the current status and performance of Boards' property assets but more could be provided on how this is informing their investment plans. There appears however a clearer appreciation of the importance of service need in driving forward their strategic plans, and also how investment decisions need to involve a wide range of stakeholders. This helps to demonstrate how their strategic investment plans are fully supported by stakeholders whilst continuing to support delivery of the route map towards NHSScotland's 2020 Vision and other strategic plans. More explanation is needed of the current status of associated general practice arrangements to better to inform their primary and community care strategies.

Boards also appear clear on their plans to further rationalise the estate to reduce backlog and are taking action to improve the efficiency and effectiveness of existing property assets. Further information may be necessary on how asset management risks are governed within each Board.

Overall, this year's PAMS have shown a continued improvement in their content and quality which is highlighted in the following chart over the page:

PAMS Quality Checklist Overall Score (Maximum 100)

It should be recognised that this year's review of all NHS Boards' PAMS was based on an extended set of requirements and the scoring criteria was also adjusted. This makes comparisons with previous years' results more difficult. However, there does remain some degree of parity in the overarching assessment of what is expected of a quality strategic document for the planning and investment in a Board's PAMS and thus the comparative chart above has been retained.

The criteria used to assess each Board's PAMS are indicated below:

These criteria were used in the PAMS assessment results shown in the chart below:

Note: NHS Health Scotland and Healthcare Improvement Scotland are not shown in the above table as their position was unchanged in relation to PAMS in 2015.