Infrastructure Investment Plan 2015: progress report 2017

Health

The strategic agenda for healthcare services in Scotland is set by The Healthcare Quality Strategy for NHSScotland. This is the overarching strategic context for the direction, development and delivery of all healthcare services for years to come both in terms of securing improvement in the quality of healthcare services, and in achieving the necessary efficiencies. Getting the right assets and facilities services in place will be central to achieving the “2020 Vision” and supporting delivery of the new ‘National Clinical Strategy for Scotland’ and the ‘Health and Social Care Delivery Plan’. These are anticipated to require change to be made to the type and distribution of assets and facilities services, as well as the way in which we prioritise investment in the future.

The new National Clinical Strategy and the Health and Social Care Delivery Plan are expected to generate plans to transform how health and care services are delivered in the future. In response, Regional Boards have been formed across the North, East, and West regions of Scotland to look at local, regional and national service reform and infrastructure investment needs to create a new, long term vision for NHSScotland.

We have also established the NHS National Infrastructure Board which is to provide strategic leadership and expertise in driving forward a National Strategy for infrastructure change, as well as providing national oversight on the continued safe and effective operation of the retained estate.

The Board will develop a National Infrastructure Strategy in support of emerging national clinical service plans and emerging regional plans to form a nationally prioritised programme of infrastructure change. It will also provide oversight, influence and challenge on how this is implemented across Regional Boards, NHS Boards and Integrated Joint Boards through their strategic service plans, Local Delivery Plans, Property and Asset Management Strategies, and individual business case submissions.

In this time of transformational change in healthcare provision, successful delivery of the National Clinical Strategy and Health and Social Care Delivery Plan will depend in part, on the provision of a health and care estate, and supporting services which are capable of adapting to, and encouraging new models of care delivery. The initiatives described above are thus expected to form the necessary framework from which these changes can take place.

The effective acquisition, maintenance and disposal of these assets is a fundamental responsibility of management in supporting the efficient delivery of clinical and support services. The ultimate aim is to deliver the highest quality healthcare services to people in Scotland and through this to ensure that NHSScotland is recognised by the people of Scotland as amongst the best in the world. The strategy clearly sets out the way in which NHSScotland will work with its partners across the public and third sectors, and with patients, carers and the public to deliver health improvement, tackle health inequality and improve the quality of health care.

In order to deliver the highest quality, best value healthcare services for every person in Scotland, we need to maximise the existing NHS estate and 'future proof' new developments to allow for service redesign and technological advances. The settings in which healthcare is being provided are changing, becoming more local, with large acute settings focusing on specialised care. The focus of our healthcare strategy is on outcomes, community-based services and the facilitation and support of joint planning and delivery of services, through programmes such as hub.

Crucially, the infrastructure programme supports the implementation of the three quality ambitions in the strategy, which are that healthcare will be:

• patient-centred, respecting individual needs and values;
• safe, ensuring no avoidable injury or harm and an appropriate, clean and safe environment at all times; and
• effective, with the most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit.

Key infrastructure priorities:

• New diagnostic and treatment centres - The centres will allow people to be treated more quickly for planned surgery and the facilities will help the NHS meet increasing demand from a growing elderly population, taking pressure off unplanned and emergency treatment, reducing the use of the private sector and allowing the delivery in full, and on a sustainable basis, Scottish Government guarantees on inpatient/day case waiting times.

• New-build community health centres and improvements and reconfiguration in existing community facilities - In order to achieve the Scottish Government's policy of shifting care out of hospitals and into local communities, we need to build the capacity to enable general practice to provide this care. Integration of health and social care is the Scottish Government's ambitious programme of reform to improve services for people who use health and social care services, and requires fit-for-purpose accommodation.

• Effective management of the existing estate to address backlog maintenance, ensure statutory compliance and ensure that these are safe, fit-for-purpose and efficient – NHS Scotland's currently identified estate 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 an ongoing challenge for the NHS to balance investment between that which is focussed on service improvement and development, and that which is necessary to maintain buildings in a good condition and ensure that they are safe, reliable and fit for purpose.

• Completion of the delivery of the £1.15 billion pipeline of revenue-financed infrastructure investment - Over £500 million of the initial £750 million pipeline is now either complete or under construction. The focus will now be on achieving financial close on the remaining projects and developing the projects in the £400 million extension of the pipeline, including the Baird Family Hospital and ANCHOR Centre in Aberdeen which will now be capital funded and the completion of the programme of investment at the Royal Edinburgh Hospital.

Progress

Recent investments have ranged from large acute hospitals to smaller primary care premises. In all cases projects have been rigorously assessed for value for money and to ensure that they contributed to improvements in the quality of the estate and service delivery. Projects included the following:

Dumfries and Galloway Royal Infirmary
The £275 million replacement hospital in Dumfries which opened in December 2017 will become a catalyst for the delivery of fundamental improvements in the way that healthcare is delivered in the region and bring major benefits to a population with significant demographic and geographic challenges. The new 344 bed hospital will enable new models of care to be delivered through the introduction of single rooms, a combined theatre and 23 hour surgery area, and an integrated emergency care centre and assessment unit. The whole hospital is designed to provide patients with an enhanced level of care and treatment and, where necessary, be seen, diagnosed, and a treatment plan established, without using mainstream hospital beds.

The Jack Copland Centre
The new Jack Copland Centre which completed construction in 2017, brings together on a single site a range of Scottish National Blood Transfusion Services which create a facility capable of delivering a first rate service in the processing, testing, supply, research and development of blood and human donor tissues and cells. The new Centre will be adaptable to increasing and changing demands for the service, and is designed to improve regulatory standards, costs and operational efficiencies. It will also provide a modern, vibrant environment for staff to work within. Blood donations from across Scotland will now be sent to this new facility for processing, testing and manufacturing before being transported to where they are needed for patients.

Balfour Hospital, Orkney
We are developing a New Hospital and Healthcare Facilities for NHS Orkney to replace the existing Balfour Hospital in Kirkwall. Currently in construction and due for completion in Spring 2019, the new facilities will deliver a Rural General Hospital providing a range of accessible healthcare services from one location increasing Island resilience and creating additional capacity to support repatriation and service developments. It will provide a total of 49 en-suite bedrooms for inpatient, assessment, maternity and mental health needs. Two local GP practices will also co-locate in the new building together with support accommodation.

Stirling Care Village
An innovative new £38 million Care Village will transform the way services are delivered by bringing a wide range of health, social care, training and GP services together in one location. The plans will see a new Care Hub created for older people who require additional short-term care, an assessment or rehabilitation following an illness, an operation or an acute hospital admission. Services will be delivered in a modern, purpose-built facility with more than 100 short-stay care beds. A new Primary and Urgent Care Centre is also being developed to house a number of existing health services on the community hospital site. In addition, the Scottish Ambulance Service plan to relocate their existing ambulance station in the Riverside area of Stirling. Currently in construction, the majority of the new facilities are expected to be operational by Autumn 2018. Final building works, roads and car parking are expected to be completed by Autumn 2019.

East Lothian Community Hospital
The new £70 million hospital which is currently in construction, will deliver a range of primary care and outpatient services, step-down care, mental health services, and accommodation for care of the elderly. The hospital will include the reprovision of services currently provided from the Roodlands and Herdmanflat Hospital sites in Haddington. It will also include a transfer of beds from the Midlothian Community Hospital as well as supporting wider reconfiguration plans across NHS Lothian. Through repatriation of services this proposal will release space on other Edinburgh sites which in turn supports NHS national drivers.

Sector plans

The need for investment continues to exceed the available budget, therefore, there will be a continuing need to prioritise spend; to work collaboratively with partners through hub in both the procurement of new and management of existing assets; and to test the suitability of new developments for delivery through innovative financing mechanisms.

Over the next five years it will be necessary to ensure sufficient capital funding is made available:

• for all legally committed projects;

• to maintain the quality of the existing estate;

• to ensure statutory compliance of buildings, plant and equipment (including re-equipping hospitals built over the last ten years); and

• to make contributions towards the costs of development (e.g. feasibility, planning, design), advice (e.g. legal, financial, technical) and enablement (e.g. land purchase or preparatory works) for NPD schemes and towards similar costs for hub-led schemes.

Beyond the next five year period, it is anticipated that there will be increasing emphasis placed on the following areas of investment:

• procuring medical equipment technology that supports the Healthcare Quality Strategy and in particular reinforces the need to diagnose and treat early stage disease; offer a range of treatments that befits a world class health service and reflects the needs of an ageing population;

• ensuring blueprints for the future at major health campus sites are translated into infrastructure that support healthcare services to achieve more efficient patient pathways;

• promoting major service redesign in community and primary care facilities to reflect changes in treatments, and technology; trends in demographics, epidemiology and access to services as well as making sure the care and services that are being provided are affordable, sustainable and tackle inequalities; and

• providing fit-for-purpose facilities to support integrated health and social care services, and through this support the Scottish Government's policy of shifting care closer to people's homes.

Despite the challenges associated with falling capital budgets over the coming years, the Scottish Government is committed to taking forward projects to increase service efficiency, effectiveness and sustainability in the health sector, including:

Health and Social Care Centres in Greenock and Clydebank
Two new state-of-the-art centres in Greenock and Clydebank will be developed which will include GP practices, a community hub, dentistry, podiatry, physiotherapy, sexual health, treatment rooms, district nursing, health visiting, school nursing, home care teams, child and adolescent mental health, speech and language therapy, out-patient clinics and a cafe. Construction is expected to start in 2018 and both sites are due to open in 2020.

The Baird Family Hospital and The ANCHOR Centre
This £164 million project includes two distinct elements, the development of a new hospital which will provide maternity, gynaecology, breast screening and breast surgery services. It will also include a neonatal unit, centre for reproductive medicine, an operating theatre suite, Community Maternity Unit ( CMU) and research and teaching facilities. And also the development of a new centre which will provide out-patient and day-patient investigation and treatment services for patients with cancer and for patients with blood and bone marrow disorders, including non-cancerous conditions as well as cancers. The centre will also include an aseptic pharmacy suite and research and teaching facilities.

Elective Centres
The £200 million Elective Centre Programme delivers on the commitment for the creation of a network of Diagnostic and Treatment Centres across Scotland. These centres will deliver additional, sustainable elective capacity which meets the need of a growing and increasingly elderly population, thus reducing waiting times and reliance on private sector provision.