NHS Scotland assets and facilities 2016: annual report

3.0 Planned future investment in assets

NHS Boards are planning investments in their assets over the next 5+ years of circa £3.3bn (based on NHS Boards' 5+ year investment plans presented in their PAMS). While major parts of this programme of investments are subject to funding availability and approval, it does represent a significant opportunity to further improve the condition and performance of these assets. It will also further enhance the important supporting role that assets play in the delivery of quality healthcare delivery and NHSScotland's 2020 Vision. This investment will also enable the disposal of older properties which are expected to generate receipts of over £180m over the same period (subject to economic and market conditions).

This investment covers all asset types (property, medical equipment, IM&T, and fleet) and will be achieved through a combination of capital and revenue based investment. The following chart provides a breakdown of this investment.

NHSScotland's 5 Year Asset Investment Programme of £3.3bn

3.1 Investment in Major Hospital & Infrastructure Projects

Investment in 'Major Hospital & Infrastructure Projects' accounts for 62% of the overall planned future investment described above and includes the key strategic investments planned by each NHS Board. They will be funded mainly though NHS Board capital or NPD / hub revenue based funding. The following chart provides a breakdown of the £2.0bn of investment associated with these major hospital and infrastructure projects.

Total Investment in Major Hospital and Infrastructure Projects (£2.0bn)

Note: while all major projects have been included in the above chart only those which are over 1% of the total investment have been listed, for clarity of presentation reasons only. Also, as the business case process for planning the new Monklands project is at an early stage, an element of these projected costs may fall out of the current 5 year investment programme.

3.2 Investment in Primary and Community Care

In addition to the £2.0bn of investment on the major hospital & infrastructure projects / programmes) described above (which includes some primary and community care hospital projects, a further £250 million is being planned for new primary & community care projects. This investment is key in delivering the emerging Health and Social Care Integration agenda and shifting the balance of care from hospitals to local facilities and people's homes.

3.3 Income receipts from asset disposals

A direct consequence of investment in new facilities can often be a surplus of older accommodation no longer required for operational purposes. Boards have identified in their PAMS planned disposals of these surplus properties which they report an income value of circa £185m over the next 5+ years. Scottish Futures Trust is actively supporting NHS Boards to maximise the potential of income receipts from these disposals.

The programme of anticipated income receipts per NHS Board over the next 5+ years are listed in the following table, but these are subject to change dependent upon economic and market conditions at the time of sale.

NHS Board	Anticipated Future Income Receipts from Disposals (£m)
NHS Greater Glasgow & Clyde	25
NHS Lothian	72
NHS Tayside	16
NHS Grampian	27
NHS Fife	6
NHS Ayrshire & Arran	2
NHS Lanarkshire	12
NHS Highland	3
NHS Forth Valley	12
NHS Dumfries & Galloway	3
NHS National Services Scotland	5
Others	2
TOTAL:	185

3.4 Investment required on vehicle assets

As described earlier in this report, many of the NHSScotland vehicles are leased and, therefore, the replacement cost of these vehicles is effectively included within the annual leasing costs. However, substantial vehicle assets remain owned, particularly those of the Scottish Ambulance Service, NHS National Services Scotland, NHS Tayside, NHS Fife, and NHS Borders. The current 5 year investment plan for vehicle assets, which is taken from NHS Boards' own investment plans and includes the Scottish Ambulance Service's vehicle replacement programme, is an average of circa £16m per annum. Earlier analysis of age profile suggests that there isn't currently a backlog of investment need for these assets but funding levels will need to be maintained to continue to support this position.

3.5 Investment required on medical equipment assets

In relation to its overall £1 bn replacement value, during 2015/16 a total of over £65m was invested in medical equipment. This would theoretically result in complete replacement of all existing equipment within 15 years. However, a general planning rule is that most equipment should be replaced within a 10 - 15 year cycle; hence, the current investment level seems to be set at a minimum level with limited scope for investment in additional equipment. Note that rapid technological developments in some equipment, including high cost radiotherapy, imaging and endoscopy equipment; which together account for approximately 40% of the total value of medical equipment, reduces the effective lifespan of this equipment to 7 to 10 years.

The speed of change in technology over the last 10 years has added further pressure to upgrade equipment more regularly and to meet the additional cost of this technologically enabled equipment. There are also specific peaks in investment requirements often associated with earlier equipping programmes for new hospitals.

Some of the risks and issues associated with using medical equipment beyond its recommended lifespan include:

• Equipment failure leading to service withdrawal or unavailability.
• Failure to meet diagnostic & treatment standards expected for NHSScotland.
• The potential harm to patients of using sub-standard equipment.
• Increasing reliability problems disrupting service provision.
• Increasing cost of maintenance and parts replacements
• Removal of manufacturers support for older equipment.

Accordingly, future investment in medical investment would need to increase by up to 50% if it was to achieve an ideal position of a full replacement cycle of 10 years.

Further information is available in Annex C on medical equipment assets.

3.6 Investment required on IM&T assets

NHS Boards are reporting planned expenditure on IM&T projects of circa £100 million over the next 5 years, which is similar to that reported in last year's SAFR. Further IM&T investment is also incorporated into some of the major investment projects associated with the refurbishment and replacement of property assets.

This expenditure is part of the overall eHealth Finance Strategy and, in addition, the Scottish Government's eHealth Division retained funds may also be used to contribute to refresh activities in relation to infrastructure.

Careful management will be required to ensure that a build-up of infrastructure (network cabling, servers, etc.) backlog does not arise due to the increasing use of end user IM&T equipment, as well as the relatively short life of desktop and mobile equipment devices, which have the potential to outgrow the capacity of the infrastructure. This investment will also need to fund any additional investment in technology.

3.7 Summary of asset investment plans

The combined asset investment plans of circa £565 million per annum are shown in the chart below. Although presented as a single investment amount, in practice some of the capital requirement will be funded through revenue schemes such as NPD, hub and leasing arrangement.

Combined Future Asset Investment Requirements

In addition to the investment requirements identified above there is expected to be further investment required to implement the recommendations of the Shared Services and Soft FM reviews, and any environmental improvement investment projects.