State of the NHSScotland Estate 2011

Annex C: NHSScotland Soft Facilities Management (Soft FM) Update Paper

Purpose

This annex provides a summary of the service delivery issues and challenges for Soft Facilities Management Services (soft FM) across NHSScotland. It highlights areas for further investigation which have the potential for improving both the efficiency and quality of service delivery.

In future years, data from the FMS benchmarking system will be used to provide a more in-depth perspective on the Soft FM services within the State of the Estate Report.

Scope

Soft Facilities Management Services covers:

• Portering Services
• Catering Services
• Domestic Services
• Transport
• Linen and Laundry Services
• Retail

Context

Soft FM is a distinct (but allied) set of services to Estates and are delivered across all NHSScotland sites and have a significant impact on the patient environment. Many of these services are linked directly with Estates services, often through the use of assets such as buildings, infrastructure and equipment. In forthcoming years both Estates and Soft FM Services face the challenge of improving the efficiency of service delivery whilst maintaining and improving the quality of service.

The potential for change and performance improvement

Over recent years, significant change has taken place in Soft FM services as a result of Scottish Government initiatives such as the HAI Taskforce and Nutritional Improvement Programme. However, what has not been undertaken is a full and comprehensive NHSScotland wide strategic review of the basic systems and processes within soft FM to ensure they remain effective and efficient. In particular, there is a need to assess the potential for utilising relevant technological innovations to improve service effectiveness and efficiency.

Portering Services

Service Provision: Supporting patient's movement within hospitals and goods throughout the hospital.

Workforce & Costs:

• Staff numbers - 1,756 (source ISD National Statistics as at 30 September 2010)
• Costs - £46 million (2009/2010)

Opportunities for Improvement: Investigations are taking place into improving performance by using computer based management and communication systems. A business case is needed to demonstrate that the investment in the system will be cost effective and will deliver benefits.

Catering Services

Service Provision: Providing good quality, nutritious food to patients and staff. Meeting specialist requirements for therapeutic, texture modified, cultural and allergen free diets. Promoting healthy eating to patients.

Workforce & costs:

• Staff numbers - 2,078 (source ISD National Statistics as at 30 September 2010)
• Costs - £84.446 million (2009/2010)

Opportunities for Improvement: there is potential to improve patient experience and reduce the costs of catering, examples include:

• New technology - New meal delivery systems can reduce food waste and the cost per patient meal. This type of meal delivery system can also provide a more patient centred service.
• Centralisation/regionalisation of food production - some NHS Boards in Scotland have improved catering efficiency by moving to central production facilities within their NHS Boards. There may be benefits from extending these facilities to provide services on a regional basis. In addition, the spare capacity within central production units could potentially support community services such as "meals on wheels".
• Reduce purchasing cost by moving to a restricted national menu - currently each NHS Board operates at least one menu, sometimes many more. Moving to one basic national NHS menu which requires NHS Boards to serve, for example, chicken on Monday, lamb on Tuesday etc. could reduce costs through enhanced purchasing power.
• Reducing staffing requirement and space required for production by buying in prepared vegetable, proteins etc - Reducing the staff time spent on food preparation by buying in more prepared food (e.g. vegetables) could reduce costs.

Domestic Services

Service Provision: Providing clean healthcare environments that reduce the likelihood of HAI. Development of the generic housekeeper role which may include the serving of food to patients and undertaking other general domestic duties around the hospital.

Workforce & costs:

• Staff numbers - 5,316 (source ISD National Statistics as at 30 September 2010)
• Costs - £116 million (2009/2010)

Opportunities for Improvement: There may be opportunities for improvement in domestic services through the use of:

• New technology - the use of microfibre cleaning materials which eliminate the need for a variety of existing cleaning methods. Other technology such as ultrasonic tanks has been successfully used to clean equipment such as bins, drip stands and wheelchairs quickly and more effectively.
• Evidence based working - current cleaning practices should be benchmarked against best practice, including in other countries.
• Using evidence based cleaning agents - current guidance requires that terminal cleans of isolation rooms is carried out using chlorine based cleaning agents. These are expensive and degrade the hospital environment. Recent trials indicate that other agents (not chlorine based) are equally or more effective.
• Recognising the role of the cleaning specialist / technician - Cleaning in hospitals is undertaken by a number of different people, only one of whom is a cleaning specialist. For example, the cleaning of nursing equipment, beds and patient equipment is often undertaken by nurses. This will need to be reviewed as it may not be the most cost effective use of resources and it reduces the time nurses can spend with patients. However, it may be that nurses are the most appropriate group of staff to understand the risk of infection / contamination arising from items linked directly to the patients since they are caring for the patient. Hence, quality and safety have to be taken into account as well as potential savings.
• Adherence to the National Cleaning Services Specification - Monitoring and assessment of the extent to which cleaning procedures are being carried out correctly to identify any remedial action and to provide an audit trail.

Transport Services

Service Provision: Moving services, goods and patients between facilities, fleet management, staff and patient travel planning and negotiations with service providers e.g. bus & train operators.

Opportunities for Improvement: There may be opportunities for improvement through the use of:

• New Technology - fleet management systems may be appropriate to manage aspects of transport services such as route planning to reduce fuel costs and provide stricter control of vehicle movement. Using electric cars for short journeys and hybrid vehicles for longer journeys should be considered.
• Centralisation / regionalisation of services - regionalisation of transport services across a number of NHS Boards may offer opportunities for service improvement and economies of scale.
• Audit Scotland's report "Transport for health and social care" (August 2011) made a number of recommendations for improving efficiency and effectiveness of transport including:

• Collect routine and accurate data on the activity, cost (including unit costs) and quality of service
• Assess the impact of proposed service changes on users and other providers
• Integrate and/or share services across public sector organisations
• Ensure that transport for health and social care services is based on an assessment of need.
  

Linen and Laundry Services

Service Provision: Provision of clean linen for patients and staff uniforms.

Workforce:

• Staff numbers - 555 (source ISD National Statistics as at 30 September 2010)

Opportunities for Improvement: Opportunities for service improvement in Linen and Laundry services come mainly from the following areas:

• New Technology - New types of linen are now available for hospital beds that improve comfort for the patient and have reduced laundering costs. Many laundries in Scotland are aging and using technology up to thirty years old. Efficiencies could be made in terms of energy usage, and staffing requirements by introducing new equipment including management systems which measure every step of laundering process. However, it needs to be recognised that given the shortage of capital funding it is unlikely that laundry equipment will feature high in any NHS Board's priorities.
• Further Centralisation / regionalising of service provision - There are presently eight laundries serving NHSScotland, some of which serve a number of NHS Boards. There may be a case for investigation into further centralisation of services. However, with increased centralisation it becomes more important that there is provision for sufficient contingency within the laundry system.

Retail Services

Service Provision: Almost all medium to large acute Hospitals offer some form of retail catering services either as a patient, visitor or staff facility or in some case as a staff only dining room.

Opportunities for Improvement: Opportunities for improvements could exist by:

• Ensuring that retail is operated as a business and that staff have retail as well as catering skills.
• Expansion of the NHSScotland Aroma brand across major sites to deliver a high quality service and generate income.
• Work in partnership with national and local voluntary organisations, community groups and social enterprise groups to provide high quality, affordable services at smaller sites.