NHS Scotland assets and facilities 2016: annual report

Annex A: Review of NHSScotland's Property Assets

This Annex provides a detailed analysis of property, vehicles, medical equipment and IM&T asset performance which supports the summarised information provided in the main body of the report.

The responsibility for the management of NHSScotland's assets rests with 14 NHS Boards and 8 Special NHS Boards.

The information presented in this annex combines information from all 22 NHS Boards and Special NHS Boards, however, some charts and tables split the analysis between the 16 Boards with in-patient accommodation (labelled NHS Boards), i.e. all 14 NHS Boards plus the NHS National Waiting Times Centre - Golden Jubilee and the State Hospitals Board for Scotland, and the 6 remaining Special NHS Boards.

It should be noted that all information presented in this section is broadly based on April 2016 information, unless otherwise stated.

Asset Value

NHSScotland owns physical assets that are worth circa £6.2bn. Most of these assets relate to the estate (land and buildings) which are estimated to be worth £5.6bn. Other significant fixed assets which are owned are vehicles, medical equipment and information management and technology ( IM&T) assets. An estimate of the Net Book Value of these owned assets is shown in the chart below.

Net Book Value of NHSScotland Assets (Total £6.2 billion)

Taken from information returned by each NHS Board

The NHS also has assets which it does not own including buildings, vehicles, medical equipment and IM&T. These assets are estimated to be worth a further £1.4 bn, the majority of which are hospitals and health centres managed under Public Private Partnership ( PPP) agreements. Also, the majority of cars used by NHSScotland staff are leased, with staff paying for their own non-business element of these leased vehicles.

In addition to the NHSScotland owned and leased property assets, there are numerous smaller properties used to provide a range of community and family health services provided by GPs, Pharmacists, Dentists and Opticians, many of which are owned or leased by these independent practitioners themselves and paid for indirectly by the NHS through a range of charging and re-imbursement mechanisms.

Estate Size

The NHSScotland estate comprises circa 4.4m. sq.m of building floor area encompassing buildings ranging in size from 40 sq.m to 200,000 sq.m. The majority of this is the hospital estate of the 14 NHS Boards and 2 Special NHS Boards ( NHS National Waiting Times Centre and the State Hospitals Board). The 2015 ISD Cost Book records this hospital estate as 216 hospitals with a total building area of 3.67m sq.m.

The other property types that account for the further 0.8m sq. m. includes health centres & clinics, day centres, offices, residential accommodation, and industrial / storage units.

The table that follows shows an analysis of the hospital estate by type of hospital in terms number of sites and building area.

	Acute	Long Stay	Mental Health	Psychiatric & Learning Disabilities	Community	Other	Total
Number of Hospitals	38	45	33	12	67	21	216
Hopsital Area (million sq.m)	2.44	0.27	0.46	0.04	0.23	0.23	3.67
Percentage of total area (rounded)	67%	7%	12%	1%	6%	7%	100%

The above table shows that whilst community hospitals are the most numerous (67) they only represent 6% of the total hospital estate in terms of building area i.e. a large number of small hospitals. In contrast, the 38 acute hospitals account for 67% of the total hospital estate in terms of building area.

The total number of hospitals included in this analysis has reduced by four since last year, mainly due to the reclassification / exclusion of some day hospitals from reported cost information. It should also be recognised that a number of the hospitals included in the broad categorisation of "Long Stay Hospitals" includes hospitals with acute long stay beds, psychiatric long stay beds and psychiatric day hospitals. These hospitals may also have other types of beds which are not classified as "long stay".

Providing services more locally is an integral part of the 2020 Vision and this is expected to have an impact on the size and distribution of the hospital estate. Subsequent changes in the hospital estate will continue to be monitored as part of SAFR in future years.

The current distribution of the hospital estate (by numbers of hospitals and by area sq.m) across the Boards is shown in the tables that follow.

	Distribution of hospitals (numbers) across the NHS Boards
Board	Acute	Long Stay	Mental Health	Psychiatric & LD	Community	Other	Total
NHS Greater Glasgow	8	6	8	1	0	5	28
NHS Grampian	4	1	3	1	17	2	28
NHS Tayside	3	3	4	2	8	5	25
NHS Highland	4	4	2	0	14	2	26
NHS Lothian	4	12	2	2	2	2	24
NHS Dumfries & Galloway	2	3	2	2	6	2	17
NHS Lanarkshire	3	5	2	1	4	0	15
NHS Borders	1	6	2	0	4	2	15
NHS Fife	2	1	3	1	4	0	11
NHS Ayrshire & Arran	3	3	1	1	3	0	11
NHS Forth Valley	1	1	3	1	3	0	9
NHS Western Isles	1	0	0	0	2	0	3
State Hospital	0	0	1	0	0	0	1
Golden Jubilee	0	0	0	0	0	1	1
NHS Orkney	1	0	0	0	0	0	1
NHS Shetland	1	0	0	0	0	0	1
							216

 

Distribution of hospital estate by area (sq.m)
Board	Total area (million sq.m.)	Percentage of NHSScotland Total Area (rounded)
NHS Greater Glasgow	1.07	29%
NHS Lothian	0.56	15%
NHS Tayside	0.43	12%
NHS Grampian	0.33	9%
NHS Fife	0.25	7%
NHS Lanarkshire	0.21	6%
NHS Ayrshire & Arran	0.21	6%
NHS Highland	0.22	6%
NHS Forth Valley	0.15	4%
NHS Dumfries & Galloway	0.07	2%
NHS Borders	0.06	2%
Golden Jubilee	0.06	2%
State Hospital	0.02	1%
NHS Western Isles	0.02	1%
NHS Orkney	0.01	0.2%
NHS Shetland	0.01	0.2%
	3.67	100%

Estate Tenure

The majority of the NHSScotland estate is owned (80%) but for some NHS Boards PPP/ PFI (including NPD and Hub) and leased property is a significant proportion of their estate, as shown in the charts that follow.

2016 Estate Tenure

Tenure profile above includes all 22 NHS Boards and Special NHS Boards, where information is available

2016 Tenure Comparison - NHS Boards

The majority of office accommodation occupied by Special NHS Boards is leased.

2016 Tenure Comparison - Special Health Boards

Estate Age

NHSScotland occupies approximately 824,000 sq.m (19% of the total) of relatively new / modern accommodation (i.e. less than 10 years old), which is an increase of 153,000 sq.m since 2011, and is evidence of the significant capital investment in property assets over recent years. There does, however, remain scope for improvement and further investment or disposal in the estate in order to move away from old, poor quality and functionally unsuitable properties. The following charts show the range of property ages for the NHS Boards, which indicates that 23% of the estate remains over 50 years old (note that some older properties are refurbished to modern standards rather than replaced).

2016 Estate Age Profile

Age profile above includes all 22 NHS Boards and Special NHS Boards

2016 Age Profile Comparison - NHS Boards

2016 Age Profile Comparison - Special Health Boards

Estate Condition

The Boards report that 70% of their estate is in good physical condition (category A or B) with 26% requiring investment to improve its condition (category C) and 4% being unsatisfactory and requiring major investment or replacement (category D).

2016 Estate Physical Condition Profile

The proportion of the estate in good physical condition of 70% is higher than the 66% reported in the 2015 SAFR. Boards advise that this is as a result of the rationalisation of parts of the NHSScotland estate following completion of associated property replacement projects.

The two charts that follow highlight the variance in condition across the NHS Boards.

2016 Physical Condition Comparison - NHS Boards

Physical Condition Comparison - Special Health Boards

Further to the above Board level analysis, it is now possible through the Estate Asset Management System ( EAMS) to report on estate KPIs such as physical condition and backlog maintenance at hospital level. Analysis of this information is being used by NHS Boards to link their property improvement needs and their strategic & service plans for improvement included within their PAMS.

NHS Boards which have buildings assessed as category D - "unsatisfactory" have indicated that they have plans in place to either dispose, replace, or improve these buildings over the next 5-10 years.

Estate Utilisation

Accommodation space has a direct relationship with cost. The aim, therefore, is to hold only that space which is needed to support the delivery and support of effective and efficient service delivery. Analysis of the information contained within each NHS Board's Property and Asset Management Strategy shows that approximately 83% of the NHSScotland estate is fully utilised although some under utilisation and some overcrowding is evident as shown in the chart below.

This profile has improved from that reported in the 2015 SAFR when the percentage fully utilised was 81%.

2016 Estate Utilisation

The following charts highlight that space utilisation can vary across the NHS Boards.

2016 Space Utilisation Comparison - NHS Boards

2016 Space Utilisation Comparison - Special Health Boards

The under utilisation of accommodation across NHS Highland and NHS Orkney reflects the challenges faced from such a geographically diverse area and the need to maintain and provide critical healthcare facilities in locations with relatively low population masses.

Estate functional suitability

The estate also plays an important role in supporting the effective delivery of services. Poor functional suitability often results in inefficient working practices, increased staffing levels and poor clinical outcomes. Approximately 69% of the NHSScotland estate is functionally suitable but, as shown in the charts that follow, this can vary significantly across NHS Boards.

This profile shows a slight 3% decrease in the area of the estate in categories A & B compared to that reported in 2015. Boards have advised that this is as a result of the annual re-assessment of buildings for functional suitability.

2016 Estate Functional Suitability Profile

2016 Functional Suitability Comparison - NHS Boards

2016 Functional Suitability Comparison - Special Health Boards

Performance Improvement of Property Assets

The following chart provides a comparative overview of performance improvement in property assets between 2015 and 2016.

Performance Improvement of Property Assets between 2015 and 2016 for all NHS Boards

Note: green bars above the horizontal indicate a positive improvement whereas a red bar below the horizontal indicates a performance reduction.
The backlog analysis excludes inflation for comparative purposes.
The PAMS Quality assessments take place every two years hence the reason this has not been shown this year.

The above chart highlights performance improvement for physical condition, utilisation and backlog per square metre across these property based KPIs. These positive results reflect the good progress made by NHS Boards in improving the state of NHSScotland's estate. However, the quality and functional suitability has reduced as the estate continues to age. The SCART score has also reduced significantly and this is due to the transition to the new SCART 2 review process which Boards have found more onerous than previously.