NHSScotland assets and facilities 2015: annual report

Annex A: Case Studies

This annex of the report has been used since the first edition of SAFR in 2011 to highlight and share innovative solutions and best practice 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. The following table provides a reference summary of previously published best practices, with information on which SAFR report can be referenced for further details.

It is envisaged that this section will continue to 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. Further examples of new case studies are provided after the following summary table. These have been selected for their potential for making a difference and which could be easily replicated more widely across NHSScotland.

Summary of Case Studies Published in SAFR since 2011:

NHS Board	Best Practice	Benefits	SAFR Year
Strategic & Service Planning
NHS National Services Scotland	NSS were the first NHS Board in Scotland to use scenario planning to develop a PAMS that was agile and flexible to long term change.	The process provided a valuable insight into how future change could impact on the need for property and assets, and the decisions that the organisation is likely to face in the future in relation to these assets.	SAFR 2013
NHS Highland	The redesign of rehabilitation services across two inpatient sites in Fort William focussed on the patient journey using LEAN methodology and the need to centralise inpatient activity at the Belford Hospital and outpatient activity at the Health Centre.	This project has resulted in a vastly improved patient experience, improved conditions for staff, and reduced bed days. It also enabled a ward facility to become surplus to needs and freed for disposal	SAFR 2013
NHS Grampian	Following a thorough engagement and consultation process involving the public, the local population agreed that the existing Maud Hospital facility was no longer required, and they would be better placed with more community based services	The service redesign ensured that people had the opportunity to remain longer at home rather than occupying local hospital beds, and it also demonstrated a community approach to integration of services.	SAFR 2012
NHS Greater Glasgow & Clyde	The Board's Acute Service Review ( ASR) aimed to modernise services across the City by renewing its acute healthcare facilities in tandem with a redesign of patient service delivery. The new Queen Elizabeth University Hospital was a pivotal phase of this strategy.	Enables modern healthcare to be provided in fit for purpose buildings and clinical environments, with resulting improvements to the patient experience and the working environment for staff.	SAFR 2011
NHS Fife	Following on from extensive public consultation, there was an identified need to change in-patient mental health services from three to two geographic locations.	This resulted in the re-provision of clinical service accommodation with modern, design award winning facilities which enabled the provision of care facilities which encourage social activity and interaction from within patient focussed, innovative and sustainable building environments.	SAFR 2011
Asset Management
NHS Highland	NHS Highland have introduced an Enterprise Asset Management System to control the maintenance of its estate, integrating the functions of purchasing, maintenance, asset history, and contract maintenance.	It enables information to be available which can optimise future maintenance and replacement planning and enable condition based monitoring and reliability centred maintenance to be carried out. It is also improving planned to reactive maintenance workload ratios.	SAFR 2013
NHS Lanarkshire	NHS Lanarkshire's property investment and estates rationalisation plan involved a programme of replacing outdated service accommodation, centralising its corporate office function, and review all existing lease arrangements.	Better use was made of existing buildings and old facilities were replaced with more functionally suitable and better quality accommodation. The four year programme achieved a net floor space reduction of 9%, annual lease savings of circa £300k and a reduction in backlog of circa £12m.	SAFR 2012
NHS National Services Scotland	The refurbishment of a 1970's office building in the centre of Glasgow was the enabler towards the relocation of 415 NSS staff from 5 leased office properties across central Glasgow to a surplus Government building at Meridian Court.	It re-used surplus office space with a long lease, transformed a tired and non-functioning 1970's building, introduced a new working environment for staff which enable more flexible working, and reduced overall space needs.	SAFR 2012
Facilities Management Services
NHS Forth Valley	Automated Guided Vehicles ( AGV's) were incorporated into the new Forth Valley Royal Hospital in order to separate out staff and patient flows from visitor and FM services.	The intention was that this would reduce opportunities for cross infection, improve the hospital environment, enhance the patient experience, and promote a calmer, more therapeutic atmosphere. Also, by keeping patient flow separate from visitor and FM traffic, patients can be moved between wards or to theatre in a more controlled environment.	SAFR 2011
Energy & Environmental Management
NHS Grampian	A new energy centre was commissioned to serve the current and future energy requirements of the Foresterhill Health Campus whilst also taking advantage of modern and more efficient CHP plant, biomass boiler and three dual fuel boilers.	This award winning project was designed to provide a 16% reduction in CO 2 emissions and a 39% reduction in energy costs.	SAFR 2012
NHS Greater Glasgow & Clyde	Glasgow undertook a review of its central laundry facilities in 2009 with the intention of developing more efficient processes for the recycling of the trade effluent and creating a sustainable use of both water and gas energy resources.	It has managed to achieve 70% water and 95% heat recovery from introducing these new processes, with an expected pay back of less than 3 years.	SAFR 2011
NHS Tayside	Ninewells in Dundee implemented an ongoing programme of investment in energy efficient lighting schemes to reduce energy waste and improve the building environment.	The scheme has contributed significantly to energy, carbon and financial savings, as well as enhancing comfort levels for patients and staff. The schemes are expected to have a payback of between 7 to 10 years.	SAFR 2011
NHS Ayrshire & Arran	A wide range of environmental, sustainable and renewable technologies were integrated into the new Girvan Community Hospital in order to minimise its environmental impact and reduce future revenue consequences without compromising on quality or functional suitability.	It was estimated that the building performance would lead to a reduction of 3% of NHS Ayrshire & Arran's current CO 2 emissions and was also expected to receive income from the installed wind turbine.	SAFR 2011
NHS Lothian	Installation of electrical supply voltage optimiser technology to reduce electricity and operating costs by reducing incoming power to more accurately match the electrical loading of the equipment on site thus reducing the carbon foot print.	Savings in electrical energy consumption were expected to be between 9 - 12%.	SAFR 2011
Office based Strategies
NHS National Services Scotland	Since 2011, NSS has embarked on a programme of further consolidating and rationalising its office estate with a specific focus on improving space utilisation, reducing recurring revenue costs, and creating agile and flexible working environments for staff.	The recurring revenue savings as a consequence of implementing the NSS programme of office consolidation and rationalisation from 2012 through to 2016 is projected to be £2.6m - a 25% saving over that period.	SAFR 2014
NHS National Services Scotland	NSS implemented a programme of mainly office based property rationalisation to support its strategic model of property provision since the year 2000	Improved building performance, improved quality of working environment, flexible working spaces, shared use of accommodation, and reduced revenue costs.	SAFR 2011
NHS Lothian	In 2010, NHS Lothian undertook a Clinical Accommodation Release Strategy ( CARS) to create additional clinical accommodation on hospital sites currently used for office accommodation purposes.	Valuable clinical accommodation was freed up with resources directed towards front line service delivery. It also enabled better efficiency, improved working environment, and reduced energy consumption.	SAFR 2011
IM&T & eHealth
NHS Lothian	NHS Lothian was one of the first Boards to introduce a single 'cradle to grave' electronic patient records system in Scotland incorporating 'Fairwarning Privacy Surveillence Solution'. This covered approximately 850,000 patients and 1.3m records. Part of this initiative was to encrypt all 4000 laptops and USB devices in order to prevent data loss.	This was part of the drive to prevent security breaches and data loss, and thus be able to provide assurance to patients that their data was in safe hands.	SAFR 2013
NHS Forth Valley	NHS Forth Valley was one of the leading NHS Boards in introducing electronic bed management into the hospital ward environment through its eWard system.	It provides medicines reconciliation on admission and discharge which improves patient safety and streamlines patient discharge medication and thus minimising delays to discharge. The bed management module improves the management of hospital capacity and discharge planning, thus removing the need for 'floor walking'.	SAFR 2012
Other Assets
NHS Lothian	NHS Lothian expanded a pilot study in 2012 to create a centralised transport hub to coordinate all inpatient transport needs.	This resulted in all transport resources being used more efficiently and there is now stricter control over the booking of private ambulances.	SAFR 2014
Resource Efficient Scotland and the Scottish Futures Trust ( SFT)	These two organisations are jointly delivering a project to work with various public sector organisations in Scotland who are in the process of decommissioning buildings, to understand the options available for re-use and redeployment of mobile assets.	Anticipated benefits include improved data on volume, tonnage and cost of the disposal of mobile assets within the public sector, and to enable better decisions to be made on the potential for re-use or redeployment of these assets rather than disposal.	SAFR 2014

Best Practice Case Study 1

Using Frameworks Scotland 2 for NHS Lanarkshire's Backlog Maintenance and Statutory Compliance Works Programme

A collaborative working relationship has been established through Frameworks Scotland 2 between NHS Lanarkshire, Graham Construction, and Currie & Brown. This approach brings benefits through the use of two new initiatives under Frameworks Scotland 2, the Lead Advisor role (comprising combined Project Manager, Joint Cost Advisor and NEC3 Supervisor services) and the new flexible Overarching Scheme Contract.

The objective of this works programme is to address backlog maintenance and statutory compliance risks across NHS Lanarkshire with a rolling programme of approximately £5m per annum. The programme uses a series of work task orders ( WTOs) across the asset base. The work task orders are identified through ongoing condition surveys and strategic risk workshops.

The project team works collaboratively to develop and refine work task order briefs, design options, preferred options and construction proposals to produce solutions for each of the WTOs. The team is required to demonstrate value for money both in procurement and in fee allocations. Each of the WTOs is being delivered within a live clinical environment and the team must take into account the requirement for critical business continuity to be maintained throughout the delivery of the works.

The range of WTOs being delivered is diverse and relates to clinical priorities as well as Estates Asset Management System priorities. This therefore includes a variety of WTOs including roof repairs, treatment of Japanese knotweed, ligature reduction works, electrical testing, and fire safety works.

There is flexibility within the contract for selection of the most appropriate New Engineering Contract NEC3 Option (lump sum, target cost or in certain circumstances cost reimbursable) on each of the development and construction WTO stages. This is particularly beneficial to the programme, with the team developing the most appropriate contract strategy.

Working on backlog maintenance within a live hospital or other facilitates poses particular challenges to be managed such as: management of multiple stakeholders; safety of patients, staff and visitors; continuity of service - clinical and support; fire safety and security; control of infection; and effective management of resources to align with a fluctuating workload.

The team has developed a track record of delivering multiple WTOs under single contract and using NEC3. The joined up team approach has ensured a collaborative and high performing project process, evidenced by the implementation of BS11000, Collaborative Business Relationships.

Benefits realised include:

• Long term strategic approach with defined project team objectives
• Optimum working across the joint project team ensuring ability to respond and deliver quickly
• Clear, simplified process and administration with more effective use of resources
• Continuous improvement from lessons learnt e.g. reducing programme timescales and driving best value in design and procurement
• Minimal impact on stakeholders and improved user confidence in the process

The key principles adopted by the project team include:

• Flexibility in terms of the provision of resources to meet project types, scale, and volume.
• Clear structure of working as one joined up team to optimise use of available resources and expertise. This provides clarity of roles and best value in delivery.
• Scalability in service response to either increase or decrease resources deployed in a seamless manner to meet NHS requirements. This ensures that knowledge, expertise and lessons learnt are built up and utilised as effectively as possible.

Best Practice Case Study 2

NHS Grampian: Carbon Energy Fund ( CEF) Project

NHS Grampian has the third highest energy-consuming hospital in Scotland (Aberdeen Royal Infirmary) and has a number of hospital sites with energy consumption well in excess of the Scottish national average (including Aberdeen Maternity Hospital and Dr Gray's Hospital). The Boards financial plan identifies the priorities for investment for the next five years and beyond and although it includes some small scale investment in replacement energy infrastructure there is no scope using NHS capital to progress the significant investment in energy infrastructure required to achieve a significant reduction in carbon emissions.

A revenue based funding scheme was therefore developed which included:

• Installation of an energy link (heat and power) between Foresterhill and Royal Cornhill Hospital sites;
• A new main High Voltage incomer substation and modifications to the High Voltage network at Foresterhill;
• A SCADA (Supervisory Control and Data Acquisition) system for Foresterhill, Royal Cornhill Hospital and Dr Gray's Hospital;
• Modifications to the Central Decontamination Unit ( CDU) and Laundry steam/condensate return system at Foresterhill;
• Novation of the existing comprehensive maintenance contract for the Combined heat and Power Plant at Foresterhill to Vital Energi;
• Installation of LED replacement lighting in specific locations across the Foresterhill site and Royal Cornhill Hospital.
• A new heat link, new plate heat exchangers and modifications to condensate system at Aberdeen Dental School;
• Specific meter upgrades;

The project will also address targeted backlog maintenance through :-

• The decommissioning and demolition of the East Boilerhouse at Foresterhill;
• The installation of replacement gas boilers at Dr Gray's Hospital;
• Replacement chiller units at Foresterhill

On practical completion, the initiatives will deliver a reduction in overall GHG emissions of approximately 6,062 tCO ₂e per annum (roughly 16% of overall emissions across the NHS Grampian estate).

Best Practice Case Study 3

NHS Forth Valley: Inventory tracking of mobile medical devices

Keeping track of a large inventory of mobile medical devices in a busy hospital environment can be demanding and time-consuming. NHS Forth Valley uses a frequency identification ( RFID) Discovery Asset Tracking system from Harland Simon to automatically track 2,500 devices around their main hospital site, including infusion pumps, syringe drivers, monitors and scanners. This helps minimise time spent looking for equipment, improves utilisation levels and reduces the requirement to purchase new devices.

The main drivers for introducing RFID Asset Tracking for mobile medical devices at NHS Forth Valley were:

• Problems keeping track of a large number of movable medical devices
• A lot of nursing and technician time was wasted trying to locate equipment
• Poor equipment utilisation meant that more devices than necessary were in circulation
• Budget constraints meant purchasing additional equipment was not an option
• Staff were often keeping supplies of equipment locally which exacerbated some of the other issues

Key benefits of the system include:

• Improved equipment utilisation reduces capital expenditure for new and replacement equipment.
• Locate assets quickly minimises the time technicians spend looking for equipment so more time is being spent carrying out vital tasks.
• An RFID read range of up to 20 meters means that devices can be detected through barriers like walls or curtains.
• It has the ability to identify where surplus equipment is in circulation.
• Tracking beds with RFID will reduce bed hire costs by reducing the overall number of additional rental beds required and also by ensuring beds are used for their appropriate purpose.
• Introducing passive RFID tags to all mobile medical devices will improve inventory management and save significant time when carrying out a full audit of all medical devices every 12 months.

Best Practice Case Study 4

NHS Borders: Income generation from Laundry Services

The Linen Services Department at Borders General Hospital opened on the 1 ^st July 1988 and continues to provide an efficient, cost effective service to all users. This department is purpose built and in addition to the core healthcare service is also open to staff, the public, local businesses and hotels. A collection and delivery service is provided throughout the Scottish Borders including premises in Northumberland.

The linen services department provides a comprehensive linen service to all NHS Borders premises, non NHS external customers and to the general public through the onsite shop. Average production per week for NHS linen is approximately 45,000 pieces.

In order to maximise laundry production and efficiency, non NHS work was introduced and an external laundry and dry cleaning services offered to all NHS employees and the general public together with the contracted Linen Hire customers.

The service provides a comprehensive provision and laundering of linen to external customers, mostly Hotels, B&Bs and Guest Houses, providing bedding, table linen and chefs wear. There is now in excess of 100 contracted customers and the average production per week for income generation and Linen hire is approximately 10,000 pieces.

During 2014-2015 the Linen Service Department processed 472,253 items of non NHS linen (93 customers) and generated £314,416 worth of income.

NHS Borders also provides a dry cleaning service which is available for patients and the general public. In the first 6 months of 2015 the dry cleaning department generated an income of £12,500.

NHS Borders also provides a comprehensive staff uniform laundry service. The sewing room staff stocks the automated uniform dispensing system on a daily basis ensuring staff have access to clean uniforms.

Other services provided by the sewing room staff include measuring, ordering and making window and bed curtains, repairing theatre and bed linen and labelling patients clothing. A professional alteration services is also available to NHS staff and the general public providing further income generation.