Achieving Excellence: through NHS Lanarkshire s Property & Asset Management Strategy

Transcription

1 Achieving Excellence: through NHS Lanarkshire s Property & Asset Management Strategy

2 Contents Page No Executive Summary Introduction 6 PART A: Where Are We Now? Current Asset Arrangements Current Assets Current Asset Locations Asset Conditions & Performance State of the Board s Property Assets Physical Condition of Buildings Functional Suitability of Buildings Space Utilisation Quality Salus PIP Contract Leased Accommodation Independent Contract (3 rd Party Premises) Statutory Compliance & Assurance Statutory Compliance (Property) Fire Safety Fire Incidents Fire Safety Work Plan Backlog Maintenance Environmental Management Strategy State of the Board s Office Accommodation State of the Board s Medical Equipment State of the Board s Vehicular Fleet State of the Board s IM&T Assets Competing Asset Based Investment Needs 55

3 Part B: Where Do We Want To Be? National Context for Service Change Local Context for Service Change 56 Part C: How Do We Get There? Competing Service-Based Investment Needs The Strategic Asset Plan Prioritised Investment & Disposal Plans Prioritisation of Investment Proposals Investment Plans Disposals Plans Implementation Plans Property Asset Resource Arrangements Risks & Constraints to Successful Delivery of the PAMS Next Steps Monitoring Performance in PAMS 69

4 List of Tables Page No 1.1 NHS Lanarkshire s 5 year Planned Capital Expenditure Profile An Analysis of the existing state by ownership An Analysis of the existing state by building type Age profile of the owned/pfi Estate in 2016/ Property Asset Condition Surveys Status The Physical Condition of the NHS Lanarkshire Estate 2016/ Properties identified as needing improvement to their physical condition Results from the appraisal of functional suitability (a) Properties identified as needing improvement to their 17 functional suitability 3.4 Results from the appraisal of space utilisation Properties identified as overcrowded Results from the appraisal of quality Properties identified as needing improvement to their quality to 3.12 Summary of Condition and Performance of Buildings List of leased or licensed properties associated with Salus PIP Contracts to 3.18 Summary of Condition and Performance of Buildings (3 rd Party Premises) Risk profiled backlog /statutory compliance costs (as at 10 th May 2017) 33

5 3.20 Public Sector Climate Change Duties Report Data for Energy Efficiency and CO 2 Reduction Target Energy Savings Projects Spend to Save Energy Savings Projects SEEP NHS Scotland Waste Management Action Plan Target ( ) NHS Lanarkshire s Accommodation Costs 2015/ / NHS Lanarkshire s against NHS Scotland Board s Average Accommodation Costs Investment Plan in Medical Equipment Annual Capital Revenue Expenditure on Vehicle Assets End Users Devices Age distribution in years as at January Age Distribution of Physical Service Estate Prospective Capital Allocation 2017/ Age Distribution of Core Network Equipment Age Distribution of Edge Network Assets Age Distribution of Telephony Switch User IM&T Asset Replacement Value 2016/ Targets for improvement in estate condition & performance NHS Lanarkshire Investment Plan (as at 1 st April 2017) Target profile of capital receipts from disposals from 2017 to

6 List of Charts 1.1 NHS Lanarkshire s Property Performance KPS s (SAFR 2016) Page No NHS Lanarkshire s Board Expenditure Analysis of NHS Lanarkshire Property Portfolio By Building Size March Progress against the Energy Efficiency Reduction Target Progress Against the CO 2 Reduction Target A Breakdown of Medical Equipment Replacement Value ( ) Analysis of Vehicle Asset by type Vehicle Age Profile Annual Performance Improvement of NHS Lanarkshire s Property Assets 2015/ /17 70 List of Plates 2.1 Extract showing location NHS Lanarkshire s Hospitals, Health Centres and Clinics 14 List of Figures 7.1 Governance of Capital Investment Decisions & Implementations 7.2 Management of Property Asset & Investment (Management Structure) Asset Resource Arrangements 67

7 EXECUTIVE SUMMARY During 2016, NHS Lanarkshire developed its Healthcare Strategy entitled Achieving Excellence, which was approved by NHS Lanarkshire Board on 1 st March 2017 and by the Cabinet Secretary for Health and Sport on 28 th April Achieving Excellence sets out NHS Lanarkshire s vision for providing healthcare services over the next ten years. The strategy is integrated into the Joint Strategic Commissioning Plans for the North and South Lanarkshire Health and Social Care Partnerships and also reflects the ambitions of both the National Clinical Strategy (Scottish Government 2016) and the National Health and Social Care Delivery Plan, published by the Scottish Government in December The Property and Management Asset Strategy (PAMS) is required to reflect on the current condition of assets, the future investment requirements and shape of NHSL assets going forward. This PAMS replaces the original Property & Asset Management Strategy ( ) and provides a refreshed look ahead for the period 2017/18 to 2022/23. In addition this PAMS gives a detailed look back over asset performance during the financial year 2016/17, building upon previous years annual updates and investment plans. For the first time this PAMS is able to be written with direct linkage to the ambitions set out in the Healthcare Strategy and the Joint Strategic Commissioning Plans for North and South Lanarkshire Joint Integration Boards. A series of ongoing work streams have been tasked with delivering these agreed ambitions and the PAMS is therefore an evolving document which will crystallise over time in relation to property and other asset management condition and investment required to support the delivery of the ambitions set out in Achieving Excellence. This strategy considers Where are we now? and then assesses Where we need to be? to effectively manage the assets which are needed to meet the needs of Achieving Excellence for the next five years and beyond. The strategy then identifies investment needs and priorities and gives direction on How to get there? In addition to Achieving Excellence, the Scottish Government s Health & Social Care Delivery Plan (December 2016) sets out the programme to further enhance health and social care services to meet new patterns of care, demand and opportunities for new treatments and technologies. It also acknowledges that change must take place in collaboration with partners across the Health Service, wider public sector and outside of the public sector. The need to make the most effective use of resources and assets is key to supporting these goals. The last two years 2015/16 and 2016/17 also saw the transition from the current planning system to one which incorporates the Joint Strategic Commissioning Plans (JSCPs), prepared by the two new Health and Social Care Partnerships (North and South Lanarkshire). Achieving Excellence is guided by an initial set of planning assumptions ( givens ) for the Acute estate which are: Any future refurbishment or replacement for Monklands will have an Emergency Department (ED). This will be designed to be fit for purpose, with emergency assessment and treatment facilities. Planned greater use of outpatient and day care services reducing the number of people requiring admission as an in-patient, the net result of which will be more day care beds and fewer in-patient beds. NHSL PAMS (NHSL Board (final)) 1

8 * Document.pdf Monklands and the new Lanarkshire Beatson Facility (opened in November 2015) is now a Centre of Excellence for Lanarkshire cancer services (with some cancer care also provided in other Lanarkshire hospitals and neighbouring NHS Boards). Wishaw General Hospital and Hairmyres Hospital will continue to operate under the existing PFI contracts, and will be fully utilised to provide acute clinical services. A refurbishment or replacement for Monklands District Hospital is essential and a key goal for NHS Lanarkshire. NHS Lanarkshire s quality vision is to achieve transformational improvement in the provision of safe, person centred and effective care for our patients. Our patients need to be confident that this is what they will receive, no matter where and when they access our services. UK and international evidence shows that up to 25 per cent of patients experience a safety incident while in hospital. We do not believe this is acceptable for our patients. To achieve our quality vision, we are committed to transforming the quality of health care in Lanarkshire through investment in and continuous reliable implementation of patient safety processes and safe patient environments in which NHS Lanarkshire can truly Achieve Excellence. Through this we aim to: be the safest health and care system in Scotland; have no avoidable deaths; reduce avoidable harm; deliver care in partnership with patients that is responsive to their needs; meet the highest standards of evidence based best practice; be an employer of choice; develop a culture of learning and improvement, characterised by our values of Fairness, Respect, Quality and Working Together. There are many challenges that need to be addressed across the asset base in the short term. These include: Monklands District General Hospital has greatly exceeded its design life, which poses many operational and financial challenges. Despite a major project to upgrade Monklands theatres and critical care facilities at a cost of million, the remaining investment required to address all backlog maintenance at Monklands is currently 30.5m. It is NHS Lanarkshire s intention to continue to seek a replacement of the service capacity provided by Monklands Hospital and an Initial Agreement (IA) has been lodged with Scottish Government for approval to proceed to Outline Business Case Stage, in accordance with SCIM (Scottish Capital Investment Manual). Continuing to invest in primary care facilities that support the drive towards delivering care closer to home, without affecting longer term changes being considered to the acute and elderly care service models. Investing in existing buildings that will improve the quality of health and social care provision and patient experience. Investing further in backlog maintenance and statutory compliance to continue the trend towards reducing the associated property related risks and improve asset condition. Rationalising the existing building portfolio to ensure the most effective and efficient use of buildings to support service delivery. Managing and updating the Estate Asset Management System (EAMS). Incorporating all assets into the investment prioritisation and decision making process, so that resources can be focussed on greatest need and benefit. NHSL PAMS (NHSL Board (final)) 2

9 These challenges have informed NHS Lanarkshire's current investment and disinvestment plans which are outlined within this PAMS, which will deliver the following specific outcomes; Provide infrastructure to support the delivery of the shift in the balance of care from hospital to more homely settings. Continued investment in improving facilities to further reduce backlog maintenance and statutory compliance risks at Monklands Hospital, with knowledge of the intent to replace this key facility in due course. Despite the progression of the Monklands business case, investment in the Monklands Business Continuity (MKBC) programme is essential to manage current operational risks associated with the age and condition of the buildings. Continued delivery of a risk based approach to improvements to other existing facilities, with outstanding backlog maintenance and statutory compliance and Statutory Compliance assessed as 'Significant'. Continued investment in the lifecycle replacement of Medical Equipment. Continued investment in the lifecycle replacement of Vehicles and reducing NHS Lanarkshire s Carbon footprint. Develop an implementation strategy for delivering on the seven national ehealth strategic aims. The total capital expenditure planned over the next 5 years to deliver these improvements is 80.89m, as outlined in Table 1.1 below (subject to available funding): Table 1.1: NHS Lanarkshire's 5 year Planned Capital Expenditure Profile Total Capital Planned Expenditure 2017/18 (m) 2018/19 (m) 2019/20 (m) 2020/21 (m) 2021/22 (m) Property Medical Equipment IM&T Transport & other PSSD Equipment Total 19.62m 16.11m 14.14m 18.63m 12.39m These investment plans will enable NHS Lanarkshire's property and other assets base (Transport, Medical Equipment and Information Management and Technology (IM&T) to continue to improve in its condition, functional suitability and performance. This funding will reduced risks associated with ageing equipment, backlog maintenance and statutory compliance, and thus provide fit for purpose accommodation for the delivery of modern quality healthcare services. It will also build upon the significant capital investment undertaken in recent years, which has modernised and re-shaped major aspects of NHS Lanarkshire's property and other assets in order to deliver service improvement. This investment has resulted in: Elimination of buildings categorised as presenting high risk. Enhanced patient and staff experience (better quality of physical environment). Enhanced opportunities to shift the balance of care away from acute hospital sites to community facilities. Improved productivity (new spaces designed for modern services). Increased efficient use of overall space (enabling disposal of surplus assets). Improved underlying building characteristics (condition, functionality, flexibility etc). Increased environmental sustainability. Improved patient safety and statutory compliance. NHSL PAMS (NHSL Board (final)) 3

10 The outcome of the investments made can be seen in Chart 1.1 below, which compares 10 property KPI's between NHS Lanarkshire's performance and the average for all NHS Scotland Board as published in the annual 'State of NHS Scotland's Asset & Facilities Report (2016). Chart 1.1: NHS Lanarkshire's Property Performance KPI s (SAFR2016) Note: green bars above the horizontal axis (0%) indicate a positive improvement on last year whereas a red bar below the horizontal axis (0%) indicates a performance reduction. NB: NHS Lanarkshire reported 4% backlog maintenance expenditure of the National spend in The Backlog KPI shows a positive position in that the Backlog/Statutory risk reduction investment is being prioritised to support business continuity, statutory compliance and patient safety. Inpatient Patient Experience Survey 2016 Question 20: Overall rating of hospital/ward environment 85% Recorded 37% responded very positive, 48% responded positive and 13% responded neutral. There is an upward trend of 5% from 2014 survey. Chart 1.1 highlights that, overall, NHS Lanarkshire's property assets are in good condition, which is supported by its modern PFI based hospital accommodation with full lifecycle funding to maintain to condition B. Also, the SCART score, which reports on the appropriate statutory compliance policies and procedures being in place across the estate, is one of the highest achieving in NHS Scotland (Backlog per m 2 ). However, the continuing challenges faced by NHS Lanarkshire, are in relation to the overall level of backlog maintenance/statutory compliance and associated significant risks most notably within Monklands DGH. The challenge is therefore to ensure sufficient annual investment is available to maintain high performing properties and further reduce the outstanding cost of backlog maintenance. It is this baseline level of performance and these challenges which have been considered when developing priorities for future investment plans, and it is anticipated that NHS Lanarkshire's properties will continue to improve in condition and performance against these targeted and measured KPI's. This level of performance and NHS Lanarkshire commitment to further improve performance will enable NHS Lanarkshire to further its aims to deliver a patient centred, safe and effective property asset base, from which NHS Lanarkshire's strategic vision, aims and objectives can be delivered. This is the second edition of the 5 Yearly Property and Asset Management Strategy to be implemented by NHS Lanarkshire. The achievements over 2016/17 continue to demonstrate a significant improvement to the provision of community health care and to the general improvement to the NHSL Property Asset Base. NHSL PAMS (NHSL Board (final)) 4

11 An established Property Strategy Group represents all areas of NHSL and is supported by:- o o The Acquisitions and Disposals Sub Group to advance transactions in accordance with the Scottish Property Transactions Handbook. This group includes representation from the CLO and Valuation Office Agency. Close liaison also takes place with Scottish Futures Trust s (SFT) Property Team including their support for particularly difficult to sell properties. Property Strategy Group taking in a corporate overview of allocating space to services, aligning Achieving Excellence need to allocate available space on a priority basis. Under the risk based managed programme there is a Monklands Business Continuity Programme (MKBC) providing investment of 1.752m in 2016/17 at Monklands Hospital. This annual programme is necessary to address backlog maintenance and statutory compliance, with a number of significant risks being addressed. The main areas of investments in 2016/17 were: Fire Safety Works (improved compartmentation) Drainage Works Infection Protection Control Works (Toilet & Shower areas) Flat Roof repairs Decontamination Works Access Control and CCTV upgrades Also the MKBC programme is delivering a major project to fully refurbish and replace all seven new theatres (well underway) and the programme has now provided an impressive new Intensive Care Unit on the site. MKBC forms part of the overall risk assessed reduced backlog maintenance and statutory compliance total for NHSL at the end of 2016/17 is now 37.6m down from 37.88m in 2015/16. This is a reduction of 280,000. NHS Lanarkshire s Other Assets The total spend on medical equipment in period (2016/17) was 5.27m, as detailed in Section 3.6. As at 2016/2017 the estimated replacement value for medical equipment was 61.8m. The total net cost for vehicles assets was 1.92m in 2016/17. This is a reduction in net cost from 2015/2016 figure of 2.37m as Section 3.7. The majority of the fleet are now leased or hired (revenue). The total spend in the period (2016/17) for IM&T infrastructure and equipment was 3.54m. As at 2016/17 the estimated replacement value for IM&T infrastructure and equipment was 24.38m. NHSL PAMS (NHSL Board (final)) 5

12 1.0 Introduction This new Property and Asset Management Strategy provides an update on the delivery of this strategy for the period 2017/18 to 2022/23, and provides a look ahead for the next 5 years, aligning with NHS Lanarkshire s Healthcare strategy Achieving Excellence. The Scottish Government Health Directorate s Property Management Policy CEL 35 (2010) - A Policy for Property and Asset Management in NHS Scotland requires that all NHS Boards have property and asset management strategies that reflect the following policy aims: To ensure that NHS Scotland assets are used efficiently, coherently and strategically to support Scottish Government s plans and priorities and identified clinical strategies and models of care. To provide, maintain and develop a high quality, sustainable asset base that supports and facilitates the provision of high quality health care and better health outcomes. To ensure that the operational performance of assets is appropriately recorded, monitored and reviewed and, where appropriate improved. To ensure an effective asset management approach to risk management and service continuity. To support and facilitate joint asset planning and management with other public sector organisations. This Property and Asset Management Strategy is the Board s current vision for realising the potential that its property and other assets have to play in facilitating change and improvement in service delivery and modernising the NHS. It uses Achieving Excellence as the basis for aligning its Property and Asset Management Strategy as a vision for supporting infrastructure for clinical excellence in NHS Lanarkshire. This will involve not only maintaining existing assets, but re-profiling and modifying assets to achieve this goal going forward. Methodology for Developing PAMS The Property and Asset Management Strategy described in this report has been developed using an established process that asks three basic questions in relation to the Board s assets; Where are we now? Where do we want to be? How do we get there? 1.1. Where Are We Now? The initial stage of developing the strategy analyses the current condition and performance of the Board s assets under the following facets: Physical condition Compliance with statutory standards Functional Suitability Utilisation Quality Environmental Management NHSL PAMS (NHSL Board (final)) 6

13 The analysis provides a consistent approach to determining the condition and performance of NHS Estate Where Do We Want To Be? This stage considers the improvements necessary in service delivery and the future provision of new models of care to address the requirements of the national and local services and policies. It aims to develop an understanding of what impact these service changes will have on the Board's assets. It also aims to set targets for improving the condition and performance of the estate, and for ensuring that all assets closely align with service needs for the foreseeable future, as per Achieving Excellence How Do We Get There? This final stage of the process involves identifying and prioritising the capital investment projects needed to deliver the Board s challenging programme for change and modernisation of services. In the current economic climate, producing a longer term investment programme is challenging and the Board will need to adapt its ambitions, and subsequent implementation processes, to match the reality of the Government s reductions in available capital investment. NHS Lanarkshire will also have to sustain its requirement to align the functionality of its assets portfolio with service needs, including service development and improvement. NHSL PAMS (NHSL Board (final)) 7

14 PART A: WHERE ARE WE NOW? About NHS Lanarkshire NHS Lanarkshire is the third largest NHS Board in Scotland serving a population of 653,310 (based on population estimates for 2017). It is now fully coterminous with North and South Lanarkshire Councils. The legal entity is the Lanarkshire NHS Board with a single Acute Division and two Integrated Joint Boards (IJBs) (North Lanarkshire & South Lanarkshire). A range of pan-lanarkshire services are hosted by the IJBs, for example primary care (South IJB) and mental health (North IJB). The population needs analysis which underpins Achieving Excellence predicts that the population will remain broadly static over the next 20 years. The key facts about Lanarkshire s population include: Lanarkshire s population is expected to increase by only 1% by The over 75s population is expected to grow by 11% by 2020 and 29% by 2025, which is a higher rate of growth for Lanarkshire when compared to Scotland as a whole. There will be fewer children in the future population. There will be fewer people of working age in the future. Life expectancy is increasing in Lanarkshire. Death rates from the so-called big killer diseases of cancer, coronary heart disease (CHD) and stroke continue to falls but still caused almost half of all deaths in NHS Lanarkshire employs around 14,000 staff over a geographic area of 2,181 square kilometres. Its annual expenditure of 1.34 billion in 2016/17 was used to provide a wide range of healthcare services, as shown in Chart 2.1 below: NHSL PAMS (NHSL Board (final)) 8

15 Chart 2.1: NHS Lanarkshire's Board Expenditure Primary Medical Services 2,971 - Other costs (e.g. treatments provided by health bodies outside Scotland) 9,243 52,292 84,412 Pharmaceutical Services General Dental Services 185, ,078 48,489 13,536 General Ophthalmic Services 782,314 - Treatment provided in NHS Lanarkshire Treatment in Board Area of NHS Scotland Patients Other NHS Scotland Bodies Health Bodies outside Scotland, primary care bodies and uk residents based outside scotland Private Sector 2.0 Current Asset Arrangements The net book value of owned premises is circa 171 million (stated in EAMS) but in addition the Board uses property assets which are the subject of PPP/PFI agreements and commercial leases. Table 2.1 shows an analysis of the existing property ownership and shows that the PPP/PFI hospitals at Wishaw, Hairmyres and Stonehouse account for over a third of the gross internal area (GIA) occupied by the Board. This is one of the highest proportions for any NHS Board in Scotland and so the proactive performance management of PFI and Hub contracts is a key feature of the work of Property & Support Services. NHSL PAMS (NHSL Board (final)) 9

16 Table 2.1: An analysis of the existing estate by ownership Area (GIA) sqm % of Total Area Area (GIA) sq.m Year Mar-16 Mar-17 % of Total Area Owned By NHSL 162, , PPP/PFI 109, , Leased 8, ,216 3 Hub 16, ,509 5 Other (Non-operational) 0 0 1,388 Less than one percent Total 296, % 299, % 10 th May 2017 Source: Estate Management System (GIA = Gross Internal Area) Chart 2.2: Analysis of NHS Lanarkshire property portfolio by building size March th May 2017 Source: Estate Management System NB: Block 162 has been excluded from this table. Third Party Owned Buildings have been excluded L106H Monklands District Hospital is built up of 10 no. blocks of various sizes. The net book value of owned premises is circa 171 million, but in addition the Board uses buildings, which are the subject of PPP/PFI agreements and commercial leases. (Source: Estate Management System, 10 th May 2017). Table 2.2 also shows that non-hospital space is 30% of the estate. With three District General Hospitals, Lanarkshire has a higher ratio of hospital areas to Health & Social Care Partnership (HSCP) areas, compared to those Boards with only one or two District General Hospitals. NHSL PAMS (NHSL Board (final)) 10

17 Table 2.2: An analysis of the existing estate by building type Analysis of Existing Estate Year 2015/ /17 Area (GIA) sq.m % of Total Area Area (GIA) sq.m % of Total Area Hospitals-Acute (3no) 171, , Community In-patient areas (12no) 35, , Corporate Sites (including West of Scotland Laundry)* HSCP North - Health Centres, Clinics Offices HSCP South - Health Centres, Clinics and Offices Other (Non-operational) 19, , , , , , ,388 Less than one percent Total 296, % 299, % 10 th May 2017 Source: Estate Management System *Corporate Premises Kirklands HQ, Kirklands House, Bungalow, Law House & 14 Beckford Street, Kirklands HQ, Kirklands House, Bungalow, Law House & 14 Beckford Street There has been a slight change in the overall floor area between 2015/16 and 2016/17 with completion of the Monklands ICU building. The change & difference in the HSCP North & South GIA is legacy issue. The former Wishaw HC had been reported in North Lanarkshire Council catchment area. The Houldsworth HC is now correctly reported in correct catchment of South Lanarkshire Council. Table 2.3 shows the age profile of the existing estate. The hospital estate has a relatively large proportion of modern facilities, which is heavily influenced by its three PPP/PFI hospitals. One of NHS Lanarkshire s main Acute Hospitals, however, is now nearly 50 years old, which presents NHS Lanarkshire with risks and service restrictions. Overall, only 8% of the estate is over 50 years old, which presents evidence of a well-balanced investment programme on property assets over the last 50 years. The main challenge in coming years will be the increasing investment needs for those properties between 30 and 50 years old, which appears a predominant issue for community healthcare properties. Of particular note is that Monklands Hospital comes within this category and is a significant challenge in terms of investment needs and business continuity risks, which places a disproportionate demand on available capital and backlog maintenance revenue. These risks and demand are expected to increase with time and are one of the catalysts for the development of the MRRP project to refurbish or replace Monklands District General Hospital. NHSL PAMS (NHSL Board (final)) 11

18 Table 2.3: Age profile of the owned/pfi estate in 2016/17 Age Profile of the Estate Age Hospitals (Area/m 2 ) HSCP North (Area/m 2 ) HSCP South (Area/m 2 ) Overall (Area/m 2 ) Pre 1967 Over 50 years old 18, ,154 25,202 8% Overall (%age) years old 67,228 9,977 11,954 89,159 30% years old 128,131 6,266 7, ,970 47% Post 2007 Up to 10 years old 6,277 22,637 14,588 43,502 15% Total 220,308 39,256 40, , % 10 th May 2017 Source: Estate Management System 2.1 Current Assets Since the implementation of CEL35: 2010, analysis is now based on SGHD's Risk based methodology for Property Appraisal. This requires use of risk based methodology for property appraisal and is supported by the EstateManager System for data management to produce information on the following facets of property appraisal information: Age Profile (including those funded under PFI/PPP) Physical Condition Backlog Maintenance Functional Suitability Space Utilisation Quality Environmental Performance With the support of HFS to undertake property asset condition/statutory appraisal surveys, NHS Lanarkshire had all its properties surveyed as of 2015, and all properties are now in-line with the National Appraisal Guidance. 2015/16 and 2016/17 (Phase 7 & 8) saw the start of the 5 year review of properties which includes life cycle costs elements into the surveys. Table 2.4 demonstrates the timeline of the level 2 physical condition surveys of NHS Lanarkshire s Estate. NHSL PAMS (NHSL Board (final)) 12

19 Table 2.4: Property Asset Condition Surveys Status Surveyed Estate Year Total 2015 Area (GIA) sq.m 2015/16 Phase 7 Area (GIA) sq.m 2016/17 Phase 8 Area (GIA) sq.m Monklands Hospitals 51,895 51,895 - Hospitals-CHP(excluding Stonehouse PPP/PFI) 33,438-13,990 Hairmyres Retained Estate 11,041 11,041 - Corporate Sites (including West of Scotland Laundry) 18, HSCP North - Health Centres, Clinics 34, HSCP South - Health Centres, Clinics 30, Other Total 179,128 62,936 13,990 This Property and Asset Management Strategy (2017/18 to 2022/23) looks back at performance over 2016/17 and looks ahead to expected investment in property, fleet, ehealth and medical equipment assets in 2016/17. It is the Board s current vision for realising the potential that its property and other assets have to play in facilitating change and improvement in service delivery, and modernising the NHS. 2.2 Current Asset Locations There are three district general hospitals, twelve in-patient areas, 42 Health centres and clinics within Lanarkshire. The geographically representation of the locations can be found on Plate 2.1. NHSL PAMS (NHSL Board (final)) 13

20 Plate 2.1: Extract showing Location NHS Lanarkshire's Hospitals, Health Centres and Clinics Each of these Acute Hospitals has an emergency department and provides a range of specialist medical and surgical services eg. Maternity Services are based at Wishaw General Hospital. Health and Social Care is provided in the community and includes health centres / clinics, community health centres / day hospitals; as well as general practitioners (GPs), dentists, pharmacists, ophthalmists, health visitors and a wide range of allied health professionals. Some of these represent high quality estate that is designed for modern healthcare. Overall, services are provided from circa 56 different sites with a total of 162 buildings on these sites ranging in size from 15 m 2 to 65,000 m 2. However, the majority of these buildings are relatively small, with 112 buildings less than 1,000 m 2, as geographically shown in Plate 2.1 above. NHSL PAMS (NHSL Board (final)) 14

21 3.0 Asset Conditions & Performance 3.1 State of the Board s Property Assets Physical Condition The appraisal of physical condition is based on Property Appraisal Guidance for NHS Scotland: A risk based methodology for property appraisal and examines individual building and engineering elements depending on the type of property being appraised and identifies the expenditure required to bring these elements back to a satisfactory condition. The appraisal of physical condition looks at the condition of the individual building and engineering elements of a property to ascertain its overall condition. The results from the appraisal of physical condition are summarised in Table 3.1. Table 3.1 also includes the three PFI/PPP hospitals at Stonehouse, Hairmyres and Wishaw. Whilst they are well maintained in accordance with the contract, the properties are over five years old and are now considered as physical condition B. This rating reflects the contractual requirements to maintain each facility at this high level for the duration of the contract term. Table 3.1: The physical condition of the NHS Lanarkshire estate 2016/17 Ranking A Excellent as New Physical Condition of the Estate B Satisfactory Year 2015/2016 C Poor Condition D Unacceptable Area sq.m (GIA) 14, ,880 23,713 0 Percentage of the estate (area) in each category 6% 87% 8% 0% Year 2016/2017 Area sq.m (GIA) 30, ,641 44,807 0 Percentage of the estate (area) in each category 10% 75% 15% 0% 10 th May 2017 Source: Estate Management System The results shown in Table 3.1 indicate that substantial part of the estate (85%) is now in a satisfactory /excellent physical condition, reflecting further refurbishment works during 2016/17. The less than satisfactory physical condition of the properties transferred from Glasgow in 2014/15 has hindered the good progress of improving the physical condition. However, whilst NHS Lanarkshire still maintains an improving overall picture in the period of the previous PAMS, there still remain issues to be addressed in terms of the physical condition, as 15% of the estate is not currently in a satisfactory condition (is a poor condition), representing an increase of 7% since 2015/16. This attributed to the three properties identified that are needing improvement to their physical condition, as shown in Table 3.2. NHSL PAMS (NHSL Board (final)) 15

22 Table 3.2: Properties identified as needing improvement to their physical condition CHP Properties: Hospitals and Community Facilities: L105H Wester Moffat House L106H Monklands Hospital L001A Beckford Street Wester Moffat house has since been closed and is in set back (minimal maintenance) and the Board also continues to aspire to closing Beckford Street as part of further office rationalisation. Both are listed buildings Functional Suitability of Buildings The overall aim of the functional suitability appraisal is to assess how well a building supports the current and future (known demand) delivery of services. The appraisal of functional suitability is an important one since functionality can have a major impact on the organisation s ability to deliver effective and efficient services. Poor functional suitability often results in inefficient working practices, increased staffing levels, staff and patient dissatisfaction and poor clinical outcomes. Therefore, it is an important component of the organisation s overall performance. A stakeholder management workshop was held in 2015 to review the three of the six facets (Functional Suitability, Quality and Space utilisation) of NHS Lanarkshire s properties was held in The overall results from the stakeholder event to determine the level of functional suitability are shown in Table 3.3 which showed no significant change overall in the period 2015/16 and 2016/17. Table 3.3: Results from the appraisal of functional suitability Ranking A Excellent as New Functional Suitability B Satisfactory Year 2015/2016 C Poor Condition D Unacceptable Area sq.m (Floor Area) 94,335 89,686 21,969 42,472 Percentage of the estate (area) in each category 38% 36% 9% 17% Year 2016/2017 Area sq.m (Floor Area) 94,299 91,545 22,276 42,341 Percentage of the estate (area) in each category 38% 36% 9% 17 % 10th May 2017 Source: Estate Management System The functional suitability table above shows no change in terms of percentage in each category of functional suitability, however overall the square metreage of properties of categories B and C has slightly increased with overall increase in floor area. NHS has identified four properties as being Unacceptable, as shown in Table 3.3(a) and will be considered in future investment priorities. NHSL PAMS (NHSL Board (final)) 16

23 Table 3.3(a) Properties identified as needing improvement to their functional suitability CHP Properties Hospitals and Community Facilities: L105H Wester Moffat House L106H Monklands Hospital L015B Kingshill Medical Practice L207H Lady Home Cottage Hospital Space Utilisation Space utilisation is a complex and sensitive subject as it touches on staff sensitivities. The overall aim of this appraisal is to make a broad assessment of how well existing space is being used. The appraisal attempts to answer three main questions: How intensively is the space being used i.e. is it empty, fully used etc? How does usage of the space vary over time? How does the space provision compare to national guidance (where applicable)? The appraisal of space utilisation is an important one since the cost of owning space/property is significant. This expenditure, which includes capital charges, building and engineering maintenance, energy (heat, light & power), cleaning etc., is broadly correlated to space occupied/used. Hence, the aim is to hold only as much space as is needed to support the delivery of effective and efficient services. In addition to the direct costs of space/property ownership, there are indirect costs such as those associated with overcrowding which can result in inefficient working practices and poor clinical outcomes, including issues relating to the control of infection. Table 3.4 shows no change between 2015/16 and 2016/17, with 95% of the available space being Fully Utilised and a total of only 2.5% of the available space being underutilised, with 2% available space being overcrowded. Table 3.4: Results from the appraisal of space utilisation Ranking E Empty Space Utilisation U Under Utilised Year 2015/2016 F Fully Utilised O Overcrowded Area sq.m (Floor Area) 0 6, ,193 6,309 Percentage of the estate (area) in each category 0% 3% 95% 3% Year 2016/2017 Area sq.m (Floor Area) 1,296 6, ,377 6,309 Percentage of the estate (area) in each category 0.5% 2.5% 95% 2% 10 th May 2017 Source: Estate Management System This suggests that overall NHS Lanarkshire uses the estate efficiently. These results show the figure of 2% of overcrowded accommodation has reduced in the period (from 3%). The NHSL PAMS (NHSL Board (final)) 17

24 wards at Caird Street, Udston Hospital, Croy, Braeside and Crawford Clinics account for the areas being empty or under-utilised in the period. NHS Lanarkshire has identified three properties as being overcrowded, as shown in Table 3.5 and these will be considered in future investment priorities. Table 3.5: Properties identified as Overcrowded Primary Care Estate Hospitals L204B Motherwell Health Centre L106H Monklands Hospital L201B Biggar Health Centre NHS Lanarkshire rationalised office accommodation during NHS Lanarkshire s Property Strategy Group is currently again reviewing the use of office and clinical accommodation across the estate in line with the healthcare strategy, with a view to implementing a further property rationalisation plan. The aim of the plan is to reduce NHSL s property portfolio by making more efficient use of the current estate and providing an opportunity to terminate leases or sell properties and reduce operating costs. Target properties for disposal include non-clinical buildings with a significant backlog maintenance liability, such as Beckford Street. Appropriate business cases will be developed with a view to implementing Smarter Offices principals in office accommodation such as Law House and Kirklands. Where properties are identified as being under-utilised, projects will be developed to vacate non-clinical premises with potential disposals of redundant assets where they relate to under-utilised office type accommodation Quality Quality is whether the available accommodation provides (as defined in Property Appraisal Manual) a comfortable, modern, pleasing environment in which healthcare services can be provided. From a stakeholder event, the quality of the estate was also reviewed for each property. The results from this event are shown in Table 3.6 and show similar results to that of functional suitability, with the main difference being the assessment of Monklands Hospital affecting category C for quality and D for functional suitability. 76% of the estate (by floor area) is now been appraised as having a Satisfactory or Very Satisfactory ranking. Table 3.6: Results from the appraisal of quality Ranking A Very Satisfactory Quality Appraisal B Satisfactory Year 2015/2016 C Not Satisfactory D Unacceptable Area sq.m (Floor Area) 94,720 94,606 59,880 0 Percentage of the estate (area) in each category 38% 38% 24% 0% Year 2016/2017 Area sq.m (Floor Area) 94,754 94,465 60,180 0 Percentage of the estate (area) in each category 38% 38% 24% 0% 10 th May 2017 Source: Estate Management System NHSL PAMS (NHSL Board (final)) 18

25 From the stakeholder event, twelve properties of NHS Lanarkshire s sixty properties were identified as being Not Satisfactory. Two of the twelve properties are vacant or surplus and in the future, plans to dispose of the remaining sites will be considered in future investment priorities. Table 3.7: Properties identified as needing improvement to their Quality Primary Care Estate L235L Crawford Clinic L307H Caird House Hospitals L204B Motherwell Health Centre L105H Wester Moffat Hospital (offices) L109C Croy Clinic * L207H Lady Home Hospital L202C Forth Clinic * L209H Lockhart Hospital L419C Muirhead Clinic L206H Kello Hospital *Now Vacant L106H L218H Monklands Hospital Airbles Road Centre (part) The following Tables 3.8 to 3.12 provide details on all property assets and demonstrates the overall condition and performance of the estate is in good order. The colour coding of the appraisal categorisation (Blue = excellent, Green = satisfactory, Orange = unsatisfactory, Red = poor) enables quick identification of those properties in most need of improvement and thus prioritised investment. The space utilisation definitions are: E U F O empty or grossly underused at all times (excluding temporary closure) underutilised: utilisation could be significantly increased fully utilised: a satisfactory level of utilisation overcrowded, overloaded and facilities generally stretched Table 3.8: Summary of Condition and Performance of Buildings (Acute Hospitals) Site Code Name GIA (m 2 ) GIA % Total Area Area Designation Acute Hospitals L106H Monklands DG Hospital 55, Clinical C D C O 30,513,916 L302H Hairmyres Hospital * 37, Clinical B A A F 0 L302H Hairmyres Retained Estate 11, Clinical B C B F 310,595 L308H Wishaw District General Hospital * 69, Clinical B A A F 0 10 th May 2017 Source: Estate Management System *PFI Estate Physical Condition Functional Suitability Quality Space Utilisation Total Backlog Cost ( ) NHSL PAMS (NHSL Board (final)) 19

26 Table 3.9: Summary of Condition and Performance of Buildings (Community Hospitals) Site Code Name GIA (m 2 ) GIA % Total Area Area Designation Community Hospitals L103H Coathill Hospital 9, Clinical B B B F 340,030 L104H Victoria Memorial Cottage Hospital Clinical B C B F 39,942 Clinical L105H Wester Moffat Hospital 3, B D C F 2,121,224 Clinical L203H Cleland Hospital 1, B B B F 33,504 Clinical L206H Kello Hospital B C C F 53,896 Clinical L207H Lady Home Cottage Hospital B D C F 37,956 Clinical L209H Lockhart Hospital B C C F 49,128 Clinical L218H Airbles Road Centre B C C F 188,153 Clinical L304H Stonehouse Hospital B B B F 0 Clinical L305H Udston Hospital B B B U 234,050 Clinical L307H Caird Street Campus B B C U 146, th May 2017 Source: Estate Management System Table 3.10: Summary of Condition and Performance of Buildings (Corporate Services) Physical Condition Functional Suitability Quality Space Utilisation Total Backlog Cost ( ) Site Code Name Corporate Properties Non L001A Beckford Street 3, clinical Non L012A West of Scotland Laundry 3, clinical Non L201A Law House 5, clinical Non L216H Kirklands Hospital 6, clinical 10 th May 2017 Source: Estate Management System GIA (m 2 ) GIA % Total Area Area Designation Physical Condition Functional Suitability Quality Space Utilisation Total Backlog Cost ( ) C B B F 1,417, B A A F 5, B B B F 88, B A A F 13, NHSL PAMS (NHSL Board (final)) 20

27 Table 3.11: Summary of Condition and Performance of HSCP North Facilities (Health Centres, Clinics & Offices) Site Code Name GIA (m 2 ) GIA % Total Area L101B Abronhill Health Centre L103B Central Health Centre L104B Kildrum Health Centre L106B Condorrat Health Centre L106C Townhead Clinic L107B Coatbridge Health Centre L109C Croy Clinic L204B Motherwell Health Centre L205B Shotts Health Centre L207B Harthill Health Centre L210B Newmains Health Centre L222C Fullwood Clinic L319B Airdrie Community Health Centre L306H Coathill House L336B Houldsworth Health Centre* 7576` 2.35 L338B Kilsyth Health Centre* L409C Bellshill Community Health Clinic L419C Muirhead Clinic L414C Buchanan Centre th May 2017 Source: Estate Management System *Hubco (NPD) Estate Area Designation Physical Condition Functional Suitability Quality Space Utilisation Total Backlog Cost ( ) Clinical B B B F 59, Clinical B B B F 36, Clinical B B B F 41, Clinical B B B F 92, Clinical B B B F 51, Clinical B B B F 7, Clinical B C C U 69, Clinical B B C O 412, Clinical B B B F 25, Clinical B B B F 46, Clinical B B B F 31, Clinical B B B F 2, Clinical B A A F 70, Clinical B B B F Clinical A A A F 0 Clinical A A A F 0 Clinical B A A F 71, Clinical C C C F 77, Clinical B A A F 0 NHSL PAMS (NHSL Board (final)) 21

28 Table 3.12: Summary of Condition and Performance of HSCP South Facilities (Health Centres, Clinics & Offices) Site Code Name GIA (m 2 ) GIA % Total Area L013B Glebe Medical Centre Clinical B B B F 30, L015B Kingshill Medical Practice Clinical B D B F 22, Clinical L201B Biggar Health Centre B B B O 34, Clinical L202C Forth Clinic B C C F 40, Clinical L208B Carnwath Health Centre B B B F 37, Clinical L209B Viewpark Health Centre B B B F 13, Clinical L216H KylePark Assessment Centre B B B F 73, Clinical L235C Braeside Clinic B B B U 15, Clinical L235L Crawford Clinic B C C U 18, Clinical L302B Blantyre Health Centre B B B F 47, Clinical L303B Greenhills Health Centre B B B F 28, Clinical L304B Strathaven Health Centre B B B F 59, Clinical L315B Lanark Health Centre B B B F 25, Clinical L315C Audiology Department B B B F Clinical L318B Carluke Community Health Centre B A A F 72, Clinical L332B Rutherglen Health Centre B B B F 261, Clinical L337B Hunter Community Health Centre * A A A F 0 Clinical L391B Larkhall Clinic B B B F 15, Clinical L392E Central Clinic (Hamilton) B B B F 21, Clinical L393C Quarry Street Child & Family Clinic B B B F 70, Clinical L392E Alison Lea Medical Centre B B B F 3, Clinical L410C Douglas Street Clinic B B B F 26, Clinical L425C Cambuslang Clinic B B B F 55, th May 2017 Source: Estate Management System *Hubco (NPD) Estate Area Designation Physical Condition Functional Suitability Quality Space Utilisation Total Backlog Cost ( ) NHSL PAMS (NHSL Board (final)) 22

29 3.1.5 Salus PIP Contract Leased Accommodation The introduction of the DWP Personal Independence Payment Scheme (PIP) in 2013 presented an ongoing opportunity for NHS Lanarkshire (Salus) to provide an important public service, ensuring that those who qualify for benefit receive a fair and consistent assessment. The contract is managed through a Steering Group chaired by the General Manager (Salus). The Steering Group reports to the Salus Board, which in turn reports regularly to the NHS Lanarkshire Corporate Management Team and Board on progress and contract performance. The management of the leased and licensed properties necessary to fulfil these contracts, as detailed Table 3.13, is carried out by NHS Lanarkshire PSSD, on behalf of Salus. Servicing and Maintenance is carried out (at a local level) depending on the agreed conditions of lease/licence and arranged by the leasee/leaser as appropriate. Salus has been successful in tendering for additional contracts and the demand for suitable accommodation is growing. Where possible this is contained within the NHSL Estate, however additional leased premises have proven appropriate where geography dictates or lack of available fit for purpose space is not readily available. It has not been possible to enter details of these leased and licensed properties to the Estate Asset Management System (EAMS). This is because the Information Services Division (ISD) allocated site codes include a geographic Board identifier, which means it is not possible to allocate a site code to a property out with NHSL s geographic area. This matter has been raised with ISD for further consideration. Table 3.13: List of Leased or Licensed Properties associated with Salus PIP Contract Lease/Licence Lease/Licence Termination Address Start Date Date The Bridge, 225 Argyle Street, Glasgow 13 th March st March Osborne Terrace, Haymarket, Edinburgh 1 st May th June 2019 Lochthorn Medical Practice, Dumfries 1 st May th Sept 2019 Waverley Medical Practice, Stranraer 24 th July th Sept 2019 Beresford Court, Ayr 1 st April th Sept 2019 Bellford Mill, Kilmarnock 1 st May th Sept 2019 Ormidale Sports Pavilion, Isle of Arran 1 st May th Sept St Vincent Street, Glasgow 11 th Jan th Jan Condition of Independent Contractor (3 rd Party) Premises There are a range of independent contractor facilities which provide a supporting role to NHS Lanarkshire in the delivery of health and care services across the locality. This amounts to 105 main medical practices, 16 branch medical practices, 139 dental practices, 141 pharmacies, and 99 ophthalmic opticians. The practices, pharmacies and opticians are currently on the EAMS with a temporary site code. PSSD are liaising with Information Services Division (ISD) to produce a National Code for each of the properties. Whilst acknowledging that independent contractors are responsible for their own facilities, this strategic overview will help to inform local priorities relevant to the Board's own primary care estate and its strategic direction for change. NHSL PAMS (NHSL Board (final)) 23

30 During 2016/17 NHS Lanarkshire s JIBs carried out level 1 (high level/least detailed) method of appraisal, which comprised of a desktop review of independent contractors properties. The initial approach was to apply a R-A-G rating to each of the properties to establish a baseline condition position as shown in Table It is recognised that the description of each property s condition is not necessarily accurate. A case for funding the detailed surveys necessary to confirm (or otherwise) this information will be made through Health Facilities Scotland, as part of the annual survey programme. Of the 3 rd Party Premises conditions, 22% provide the services from within NHS Lanarkshire Healthcare premises. There were no dental practices rated as Red (poor), 3% were rated at Amber (Unsatisfactory) and 97% as Green (satisfactory). All 141 pharmacy premises were rated at Green (Satisfactory) and of the 99 optician premises, 11 were domiciliary only, 88% were rated at Green (Satisfactory) and 2% Amber (Unsatisfactory). Of the 121 GP practices 50% provide their service from a NHS Lanarkshire property, 91% were rated at Green (Satisfactory) and 9% Amber (Unsatisfactory). The following Tables 3.14 to 3.18 provide details on all property assets and demonstrates that overall the condition and performance of the independent contractor facilities is in good order. The colour coding of the appraisal categorisation (Blue = excellent Green = satisfactory, Orange = unsatisfactory, Red = poor) enables quick identification of those properties in most need of improvement and thus prioritised investment. NHSL PAMS (NHSL Board (final)) 24

31 Table rd Party Premises Guidance for suitability rating Guidance for Suitability Rating Red, Amber, Green (R,A,G) Red Poor Property is one of the following: (i) too small for current purpose, (ii) property is in a poor condition and is no longer able to be easily maintained to fit for purpose clean patient environmental standards and (iii) there have been recent material complaints about condition of this property from users. Amber Green Unsatisfactory (i) This property is of a size which meets current needs but is likely to be too small for future demographic demands within the next 5 years or (ii) property requires refurbishment and/or relocation within the next 5 years due to condition of fabric or (iii) property has had some complaints from customers in the last 5 years which wants further investigation Satisfactory (i) Property is of adequate size for current needs and foreseeable 5 year demand (ii) property is well maintained and requires no refurbishment within the next 5 year period (iii) property has received less than 1 complaint in recent years in relation to its condition and suitability Functional suitability A very satisfactory, ideal accommodation, no change needed B satisfactory with only minor change needed C not satisfactory with significant change needed D unacceptable in its present condition, major change needed X supplementary rating added to D only, to indicate that it is impossible to improve without replacement Quality A a facility of excellent quality B a facility of satisfactory quality with only general quality improvements required C a facility of less than satisfactory quality with investment needed D a facility of poor quality with significant investment needed X improvements are either impractical or too expensive to be tenable only total rebuild or relocation will suffice Space utilization E empty or grossly underused at all times (excluding temporary closure) U underutilised: utilisation could be significantly increased F fully utilised: a satisfactory level of utilisation O overcrowded, overloaded and facilities generally stretched Site Code L/GP/*** L***B/C Narrative GP s Practice out of own premises GP s Practice out of NHSL premises NHSL PAMS (NHSL Board (final)) 25

32 Table 3.15: Summary of Condition and Performance of Buildings (GP Surgeries South Lanarkshire Area) Site Code Name Shared Premises RAG Rating Physical Condition Functional Suitability L302B Auchinraith Medical Practice Y G B B B U L/GP/003 Bothwell Medical Centre N G B B B U L/GP/004 Ardoch Medical Practice N A C B B F L/GP/006 Dr C M McCann N A C B B F L303B Dr I A Hathorn & Partners Y G B B B F L/GP/013 Dr M M Herbert & Partners N G B B B U L201B Dr A M D Goldie & Partners Y G C C C O L302B Calderside Medical Practice Y G B B C O L302B Dr M V Church & Partners Y G B B C O L/GP/018 Dr T M Bonnes & Partners N G B B B U L332B Overtoun Medical Practice Y G B B B F L318B High Mill Medical Practice Y G B B B F L318B St Luke's Medical Practice Y G B B B F L/GP/025 The Stonelaw Practice Y A C B B F L319B The Campbell Practice Y G A A A F L337B Kirkview Medical Practice Y G A A A F L337B Dr L A Hay & Partners Y G A A A F L337B Kilbryde Medical Practice Y G A A A F L337B Calderglen Medical Practice Y G A A A F L209B The Surgery N G A A A F L337B Dr H McNeil Y G A A A F L/GP/052 Calderlea Surgery N G B B B U L203B Strathcalder Practice N G B B B U L015B Kingshill Medical Practice N G C C C O L/GP/056 Burnbank Medical Centre N G B B B O L302B Kittoch Medical Practice Y G B B B F L/GP/058 Dr J Fulton & Partners N G B B B U L/GP/059 Oak Lodge N G B B B O L/GP/060 Dr W M Young & Partners N G B B B U L/GP/061 Dr K G Irvine & Partners N G B B B U L304B Dr S L Russell & Partners N G B B B F L304B Dr J M Simpson & Partners N G B B B F L204B Blackwood Medical Practice N G B B C O L/GP/070 The Lanark Doctors N G B B B F L204B Douglasdale Medical Practice N G B B C O L209B Dr N Balkrishna N G B B B F L319B Cambuslang Gate Medical Practice N G A A A F L/GP/074 The Avon Medical Centre Y G B B B F 10 th May 2017 Source: Estate Management System Quality Space Utilisation NHSL PAMS (NHSL Board (final)) 26

33 Table 3.16: Summary of Condition and Performance of Buildings (GP Surgeries South Lanarkshire Area) Site Code Name L204B Glebe Medical Practice Y G B B C O L332B Dr D J Bruce & Dr S J Friel Y G A A A F L319B Dr R Afuakwah N G A A A F L319B North Avenue Surgery N G A A A F L319B The Craigallian Avenue Practice N G A A A F L332B Wardlaw Medical Practice Y G B B B F L332B Drs Tierney & Canning Y G B B B F L337B Mavor Medical Practice Y G A A A F L304B Strathaven Medical Practice Y G B B B F L304B Avondale Medical Practice Y G B B B F L/GP/108 Lincluden Medical Centre N G B B B F L208B Medwyn Medical Practice N G B B B F 10 th May 2017 Source: Estate Management System Shared Premises RAG Rating Physical Condition Functional Suitability Quality Space Utilisation NHSL PAMS (NHSL Board (final)) 27

34 Table 3.17: Summary of Condition and Performance of Buildings (GP Surgeries North Lanarkshire Area) Site Code Name Shared Premises RAG Rating Physical Condition Functional Suitability L/GP/001 Dr T Idrees N G B B B F L106B Tinto Medical Practice Y G B B B F L103B Dr D Walker Y G B B B F L318B Wellwynd Practice Y G B B B U L336B Logan Practice Y G A A A F L104B Adam Avenue Practice Y G B B B F L315B Mossend Surgery N G B B B F L207H John St Surgery N G B B B U L/GP/019 Moodiesburn Practice N A C B B F L/GP/020 Nalagatla Medical Practice N A C B B F L/GP/022 Stepps Surgery N A C B B F L/GP/026 Town House Practice Y G B B B U L204B Dr Brough & Partners N G B B C O L101B Centenary Surgery N G B B B F L101B Dr J Fife & Partners Y G B B B F L101B Dr K B P Singh & Partner Y G B B B U L101B Waverley Medical Practice Y G B B B U L222C Coatbank Medical Practice Y G B B B U L103B Bankhouse Medical Practice Y G B B B F L414C Church Street Medical Practice Y G B B B U L107B Dr E M Flynn & Partners Y G B B B F L107B Dr U Handa & Partners Y G B B B F L414C Caledonia Medical Practice Y G A A A F L414C Dr G Carroll & Partners Y G A A A F L319B Kenilworth Medical Centre N G A A A F L101B Dr J S Twaddle & Partners Y G B B B F L319B Dr D J Clifford Y G A A A F L107B Thistle Medical Practice Y G B B B U L/GP/046 Dr S Gaddis & Partners N G B B B O L205B Dr A Porte & Partners N G B B B O L/GP/055 Glenboig Surgery N G B B B U L302B Forestbank Medical Partnership Y G B B B F L/GP/066 Dr M K Rao & Partner N G B B B U L338B Kilsyth Medical Partnership Y G A A A F L204B Orchard Medical Centre N G B B B F L210B Dr M E Tilley & Partner Y G B B B F L204B Dr L Bell & Partners Y G B B B F L207B Dr J Keenan & Partners N G B B B F 10 th May 2017 Source: Estate Management System Quality Space Utilisation NHSL PAMS (NHSL Board (final)) 28

35 Table 3.18: Summary of Condition and Performance of Buildings (GP Surgeries North Lanarkshire Area) Site Code Name L204B Dr Blake & Partners Y G B B B F L319B The Well Medical Practice Y G A A A F L222C Dr C M McKibbin Y G B B B U L/GP/086 Newarthill Medical Practice N G B B B U L208B MacInnes Medical Centre N A C B B F L205B Dr N P M Dear & Partners Y A B B B O L210B Dr A A W Majumdar & Partner Y A C B B F L302B Dr S S Reddy & Partner N G B B B F L205B Dr George Practice Y G B B B U L205B Dr C P MacFarlane & Partners Y G B B B U L/GP/093 Rosehall Surgery N G B B B F L409C Old Mill Surgery Y G B B B F L409C The Willow Practice Y G B B B F L204B Dr K E H McKay & Partners Y A C B C O L210B Dr C M Clark & Partners Y A B B B F L336B Dr C M Maule & Partners Y G A A A F L/GP/102 Jamieson Medical Practice N G B B B F L336B Branchalwood Medical Practice Y G A A A F L409C Atrium Medical Practice Y G B A A F L336B Calder Valley Surgery Y G A A A F 10 th May 2017 Source: Estate Management System Shared Premises RAG Rating Physical Condition Functional Suitability Quality Space Utilisation NHSL PAMS (NHSL Board (final)) 29

36 3.2 Statutory Compliance & Assurances Statutory Compliance (Property) Health Facilities Scotland has developed the Statutory Compliance Audit Risk Tool (SCART), a national audit system used to support Health Boards in assessing current levels of property related statutory compliance. PSSD have a dedicated SCART manager who works to an annual audit plan, and reports audit findings using a prescribed process. In November 2016, HFS launched a new on-line reporting tool that will improve the usability and flexibility of the system for all Boards. NHSL reported a compliance score for 2016/17 of 92% compared to the national average of 72%. The audit programme for 2016/17 was determined by referring to the previous year s topic and site scores and also the backlog maintenance priorities identified within EAMS. This resulted in 15 individual audits carried out covering 4 of the 39 SCART topics. A SCART audit was carried out at WDGH with some areas for improvement identified and appropriately actioned to achieve 100% compliance. SCART topics Audited 1) Asbestos; 2) Legionella; 3) Slips, Trips and Falls; 4) Contingency planning; 5) WDGH SCART audit. The audit results showed across all topics that actions and tasks were being completed, with only minor omissions in the administration of some paperwork which were quickly the subject of corrective actions. All findings are reported quarterly at the PSSD Statutory compliance meetings. Activity on SCART is also reported by the Head of Estates Projects, Compliance & PFI Contracts Performance in the monthly report to the PSSD Divisional Management Team. This ensures the Head of Maintenance and other PSSD senior managers are aware of any shortcomings and take appropriate action relating to their areas of responsibility. An annual report on SCART compliance is also tabled, for approval, at NHS Lanarkshire s Planning, Performance & Resource Committee (PPRC) Committee Fire Safety The NHS Lanarkshire Annual Fire Safety Report for 2016/2017 is scheduled to be presented in September 2017 to NHS Lanarkshire Board, as mandated by Fire Safety Policy for NHS Scotland CEL 11(2011) NHSL Fire Safety Policy, which was revised in May 2016 and is due for a periodic review in May Fire Incidents The total number of Fire Incidents for year 2016/17 was 205. This includes Unwanted Fire Alarm Signals, Actual Fire Incidents and Fires of Significant Interest. The total represents an increase of 7.8% from year 2015/16. In all cases investigations are carried out and any corrective action needed is taken. NHSL PAMS (NHSL Board (final)) 30

37 Unwanted Fire Alarms Signals The number of Unwanted Fire Alarm Signals (UFAS) for reporting period 2016/17 totalled 179. This represents a 2.8% increase on the reporting period 2015/16. NHSL continue to work in partnership with Scottish Fire and Rescue Service local officers in an attempt to reduce the number of Unwanted Fire Alarm Signals experienced in NHSL buildings Fire Safety Work Plan NHS Lanarkshire has identified an action plan to further improve performance for the reporting period 2017/18, the details of which are: NHS Lanarkshire s Fire Safety Group will receive continuing update reports on Fire Risk Management and fire safety compliance progress. Designated investment will be used to address building and fire safety deficiencies throughout NHS Lanarkshire Property Assets. The investment and the positive impact this has on mitigating fire risks will continue to be recorded in the Estates Management Asset System and reviewed by NHS Lanarkshire s Fire Safety Group. Mitigating the fire related risks inherent in the design of Monklands continues to be progressed as part of the Monklands Business Continuity Plan. This work is being closely monitored by Scottish Fire & Rescue. The focus for the new reporting period will be to improve the fire compartmentation within inpatient and other clinical areas. Continue with the Fire Risk Assessment review programme with a target of 100 reviews to be completed in the new reporting period. Continue with the programme of Fire Safety Control Book sample audits with a target of 25% of Fire Safety Control Books to be audited in the new reporting period. Continue to deliver a programme for General Fire Safety Awareness Training beginning in April 2017 until March The General Fire Safety Awareness Training Online Programme will continue to be available through the Learnpro Platform. Investigate the cause of Unwanted Fire Alarm Signals and recommend appropriate corrective and preventative action. Continue to develop and strengthen links with Scottish Fire and Rescue Service Backlog Maintenance The investment required to bring the estate up to an acceptable condition is known in the NHS as Backlog Costs, since it arises from the backlog of maintenance that has built up over a number of years and is now giving rise to poor property condition and performance. The guidance defines backlog costs as the base costs required to rectify the deficiency and bring the element/sub element up to an acceptable condition (Condition A or B). The guidance is also very clear in stating that Backlog Costs should be expressed as works costs (that is, the base cost to undertake the work). Additional costs that are dependent upon the project solution chosen (for example fees, VAT, decanting and temporary services to other areas) should be excluded from backlog costs, but included in the overall cost of investment required when projects are being approved. As part of the overall appraisal of condition, it is also recognised that there is a need to assess the risks associated with the continued deterioration and/or failure of estate assets. This is achieved using the NHS Scotland Risk based methodology for Property Appraisal guidance. The risks associated with sub-standard assets that are assessed as high and NHSL PAMS (NHSL Board (final)) 31

38 significant risks should be addressed as a priority, and included as part of estate investment planning process. The costs reflect the prices as at Quarter II, 2017 which has been set by HFS as the Base year using Building Cost Information Service (BCIS) Cost Indices. These baseline costs reflected in this paper are current under review by HFS with a potential significant percentage uplift anticipated. The consequences of failing to address the poor condition of the estate are clear: Increasing risk of building/engineering systems failure resulting in service interruption. Increased risk to patients - including Infection (HAI) Failure to comply with statutory requirements and increased potential litigation Low staff morale and recruitment difficulties Accelerated deterioration increased short term capital investment needed. Increasing value of backlog maintenance and therefore growth in future investment requirements. The national property appraisal risk-based methodology for establishing and maintaining backlog maintenance costs is well-presented, and clearly explains the approach to employ. This recommended approach has stood the test of time, and has proven to be an extremely valuable managerial tool, both locally and nationally. The national guidance recommends a detailed survey across a range of building and engineering infrastructure elements including fire, environmental and statutory by external building surveyors. These initial surveys are carried out by external surveyors and are then reviewed by PSSD Maintenance Managers. This review pays particular attention to those areas which initially generate significant and/or high levels of assessed risk. NHS Lanarkshire s approach to corporate risk management is then applied. This results in a more accurate picture with respect to the assessed risk to patient safety and business continuity. The approach ensures that the investment required is prioritised into those premises which require improvement sooner than others. The introduction of the property appraisal guidance and EstateManager has enabled an improved unified understanding of appraising properties and assessing backlog maintenance costs, through a consistent risk prioritised approach. The investment needed to bring the estate back to an acceptable condition ( Backlog Costs ) is summarised in Table This investment need has been risk assessed to produce the profile shown, showing an improving picture in 2016/17, where 37.6m was the remaining cost identified in backlog maintenance ( 30.5m at Monklands and 7.1m in the rest of the estate). This is an improvement of 280,000 from 2015/16. NHSL PAMS (NHSL Board (final)) 32

39 Table 3.19: Risk profiled backlog / statutory compliance costs (at 10 th May 2017) Backlog Maintenance/Statutory Costs Risk Category Year 2015/16 Total (m) Annual Trends Low Moderate Significant High % 36.08% 38.34% 2.34% 100.0% Year 2016/17 Low Moderate Significant High % 42% 25% 0% 100.0% 10 th May 2017 Source: Estate Management System Overall, there has been a slight reduction in the backlog maintenance value since 2015/16, with more now in the high risk category. This is due to a number of initiatives, including a strategy towards reducing high and significant risk backlog maintenance within NHS Lanarkshire's existing estate. The risk assessment of the current backlog maintenance and statutory investment has also resulted in an updated risk profile which shows a removal of high risk areas and overall reduction in the proportion of significant risk. This, once again, is due to updated appraisal information as well as changes and improvements to the estate as a consequence of investment carried out; particularly the investment carried out at Monklands Hospital to reduce its high and significant risks (progress on this is being monitored by the Monklands Business Continuity Programme (MKBC)). It should be noted that the 2017/18 backlog and statutory investment requirement of 37.6 million is based on maintaining the existing buildings and their current usage. It will do little to improve the functionality of existing properties or to modernise them for future use, but will address Business Continuity issues in relation to the building. There is also a need to understand and plan for the disruption to existing operational services which would inevitably be involved in this scale of work. Any practical programme for undertaking the work will need to comply with the requirements of HAI Scribe, patient safety, dignity and to allow for decanting space/facilities. In addition, the practical approach to undertaking this scale of work would be to combine it with refurbishing and upgrading to bring departments up to modern standards. Without such refurbishment, the quality of environment for patients and staff is likely to deteriorate. Generally any service improvement/change the building projects will take the opportunity to address any backlog maintenance works needed. It is important to recognise that the full investment/project costs will need to increase to include fees, VAT, builder s preliminaries, contingencies and decant. Whilst the extent of these additional costs will depend on the solution adopted for executing the work it is none the less likely to result in a substantial percentage increase on the 37.6m identified above. In the period the overall investment of 3.46m (Monklands 1.75m and Primary Care Estate 1.71m), resulted in the removal of 0.88 million high risks elements within EAMS. NHSL PAMS (NHSL Board (final)) 33

40 3.4 Environmental Management Strategy This section reviews NHS Lanarkshire s success in improving its overall management of the environment and focuses on sustainable development, climate change adaptation, energy and water consumption, waste management and NHS Lanarkshire fleet and staff business travel. NHS Lanarkshire, as the organisation responsible for leading efforts to improve the health of the people of Lanarkshire has a Sustainability Policy supported by a Sustainable Development Action Plan (SDAP). The Board s Sustainable Development Action Plan (SDAP) is managed by the Sustainability & Environmental Group, which is chaired by the Director of Strategic Planning & Performance. The SDAP is submitted to Scottish Government annually in October and contains a number of strategies and initiatives underpinned by projects which relate to sustainable development, energy efficiency and climate change adaptation. The Good Corporate Citizenship Assessment Model (GCCAM) [NHS CEL 14 (2010)] is used to assist the Board in identifying and addressing some of the wider sustainability challenges faced, such as: Energy use in buildings Sustainable Procurement Staff Travel and fleet Waste Management Workforce Community Engagement Climate Change Adaptation and Biodiversity CEL 2 (2012) A Policy on Sustainable Development for Scotland states that NHS Boards should as a minimum carry out the following; Compliance with The Climate Change (Scotland) Act 2009 (CCA), which places duties on public bodies relating to climate change. Further to the Act, in 2015 the Scottish Government introduced an Order requiring all 150 Public Bodies who appear on the Major Player List to report annually to Scottish Ministers on their compliance with the climate change duties. Carrying out of energy performance surveys to all properties in compliance with the Energy Performance of Buildings Directive (2009/91/EC). Development of an Environmental Management System (EMS) Corporate Greencode for NHS Scotland. Adoption of the Good Corporate Citizenship Assessment Model to create an integrated approach to managing corporate environmental, social and economic impacts for NHS Lanarkshire. Compliance with the Carbon Reduction Commitment - Energy Efficiency Scheme, which requires NHS Lanarkshire Board to monitor their CO 2 emissions based on their energy use in buildings and to buy allowances for each tonne of CO 2 emitted. NHSL PAMS (NHSL Board (final)) 34

41 NHS Scotland Energy & Greenhouse Gas Emissions Targets The NHS Scotland HEAT targets were replaced in with an alternative reporting methodology. The new energy and GHG (Greenhouse Gas) emissions targets (introduced in 2013) are designed to not only achieve NHS Scotland's contribution to the Climate Change Act (CCA) targets but also to ensure that NHS Scotland continues to lead by example within the public sector. The targets ensure that NHS Scotland contributes to the Scottish Government's National Outcome to "reduce the local and global environmental impact of our consumption and production". As noted above, Scottish Government also requires Major Players to report progress annually on via the Public Bodies Climate Change Duties Report. A summary of NHS Lanarkshire s report is shown in Table Table 3.20: Public Sector Climate Change Duties Report Reference Year Baseline carbon footprint Year 1 carbon footprint Year 2 carbon footprint Year 3 carbon footprint Year Year Type Financial (April to March) Financial (April to March) Financial (April to March) Financial (April to March) Scope 1 (tonnes) Scope 2 (tonnes) Scope 3 (tonnes) Total (tonnes) Comments 14,766 16,811 1,705 33,282 The Baseline for the report is data. It should be noted that this is different from the NHS Scotland Energy Efficiency and GHG emissions reports which use a 3 year average baseline and is normalised for floor area and weather corrected. 13,630 17,189 3,223 34,042 This was the first full reporting year. 16,989 15,528 3,283 35,800 Clinical Waste is not included as published conversion factors are not available. - The 2016/17 data will be reported to Scottish Government by 30 th November 2017 as per scheme guidance. The baseline for the new Energy & Greenhouse Gas Emissions targets is based on an average of to with the reporting period covering to The following charts 3.1 and 3.2 show tracked reductions in CO 2 and kwh. It should be noted that the targets are not year-on-year targets and the 6.79% target is a straightforward reduction through to NHSL PAMS (NHSL Board (final)) 35

42 *Table 3.21: Data for Energy Efficiency and CO 2 Reduction Target Gas Electricity Degree Days kwh Tonnes kwh Tonnes Baseline (average to 13-14) 85,318,803 13,843 33,277,842 15,999 3,391 Actual Actual ,837,958 12,363 34,864,741 17,232 2, ,177,101 16,080 33,543,788 15,380 3, ,408,861 14,243 34,724,301 14,308 3,521* *It has been noted that the published Degree Day figures for are not as expected and HFS are investigating this with the Contractor who supplies the data. As a result of this the energy performance figure may change. *Chart 3.1: Progress against the Energy Efficiency Reduction Target kwh 124,000, ,000, ,000, ,000, ,000, ,000, ,000, ,000, ,000, ,000, ,000, ,000,000 Baseline 2014/ / / / / / /21 Actual kwh 118,596,6 110,946,4 121,630,0 109,273,0 Target kwh 117,410,6 117,410,6 117,410,6 117,410,6 117,410,6 117,410,6 117,410,6 Chart 3.2: Progress against the CO 2 Reduction Target 35,000 33,000 31,000 29,000 27,000 25,000 23,000 21,000 19,000 17,000 15,000 Tonnes Baselin e 2014/ / /1 7 Actual Tonnes 29,842 29,595 31,460 28, / / / /2 1 Target 27,816 27,816 27,816 27,816 27,816 27,816 27,816 * Figures for charts 3.1 and 3.2 are provisional at time of publication pending final billing * * Baseline is the average consumption of to *** Target Year is NHSL PAMS (NHSL Board (final)) 36

43 It can be noted from the above graphs that performance in the last three years is approaching the target and that NHS Lanarkshire is broadly on track. As energy consumption is directly related to weather and service provision, performance will continue to be closely monitored. Whilst good progress is being made towards the targets, continued investment in further projects is needed to ensure that the target is achieved. The added benefit of the above reductions will reduce the financial burden of The Carbon Reduction Commitment Energy Efficiency Scheme for the remaining two years of the scheme. NHS Lanarkshire Progress NHS Lanarkshire continues to work with Health Facilities Scotland (HFS) and other parties such as Resource Efficient Scotland appointed consultants, on the identification of energy efficiency and carbon reduction schemes. To support this work there are also a number of projects that have been surveyed and costed in-house and were successfully carried out in The planned estate changes, including the rationalisation of a number of existing health centres into three large new health centres, was completed in when the buildings became fully operational. The Lanarkshire Beatson facility also started receiving patients in November With changes in the grid emission factor, even if NHS Lanarkshire does not take action to reduce carbon emissions, they will still gradually fall over time. The following projects were carried out in as follows: Table 3.22: Energy Savings Projects Spend to Save Project Description Spend ( ) Energy Saving (kwh) Carbon Saving (tonnes) Payback (years) Installation of LED lighting to various NHS 25, , Lanarkshire sites Installation of insulation to new ceiling at 11,983 57, Airbles Rd Hospital Installation of PIR / Daylight sensors to 5,000 11, Cleland Hospital and Kello Hospital Installation of TRV s to LST radiators at Kello 2,500 19, Hospital Replace bed head lights at Kello Hospital with 1, low energy lamps Replacement of boiler with condensing boiler 1,200 15, at Law House workshop Monklands Hospital replacement of external 9,980 40, wall lights and external lamps with LED Kello Hospital replacement of external wall 3,106 10, lights and external lamps with LED Law House replacement of external wall lights 9,966 35, and external lamps with LED Shotts Health Centre installation of LED 14,700 45, lighting Installation of Smart Boiler Controls to various 99,900 2,635,803 2,635 2 sites Installation of Inverters to CBW at WoSL 23,767 98, Installation of LED and SMART Lighting controls to various sites 31, , NHSL PAMS (NHSL Board (final)) 37

44 WOSL LED Lighting Installation 26,964 87, Replacement of SON external lighting with LED 11,412 48, TOTAL 279,286 3,315, In NHS Lanarkshire made a successful bid for SEEP funding, specifically Low Carbon Infrastructure Transition Programme (LCITP) funding, in partnership with South Lanarkshire Council. The award was for projects in the Hamilton area as follows: Table 3.23: Energy Savings Projects SEEP Total Cost LCIPT Grant Bid NHS Contribution Gas Savings pa Electrical Savings pa Carbon Savings pa Scheme Payback (years) NHS Payback (years) 123,210 98,568 24,642 15,155 4, NHS Site Energy Efficiency Measure Total Estimated Cost Douglas Street Site Lighting 3,390 Insulation 3,000 Caird House Upgrade of valves/mixers 1,130 Improvement to chiller controls/compressors 4,500 Lighting Insulation 3,500 Beckford Street Glazing 58,790 Insulation 33,900 Lighting Upgrade 10,000 In NHS Lanarkshire funded their contribution of the above projects as per SEEP guidance. The remaining projects will be funded via the LICPT and claims submitted in Climate Change Adaptation In HFS appointed Consultants to carry out Climate Change Risk Assessments on the NHS Lanarkshire Estate. The report was designed to help the Board identify and quantify opportunities and risks that climate change poses for the organisation s functions, responsibilities and infrastructure. It also demonstrates how to incorporate climate risk assessment into the Board s planning processes to reduce vulnerability to the impacts of Climate Change. Waste In March 2017 HFS issued DL (2017) 03 - NHS Scotland Waste Management Action Plan In response to the DL, NHS Lanarkshire has developed a strategy and range of measures to ensure that the Board meets the targets set out in the Plan. NHS Lanarkshire is fully compliant with the current Waste Scotland (2012) Act and has measures in place to remove food waste from the general waste stream / macerator disposal route. Further segregation is also in place for glass, plastic, batteries, furniture, metal, WEE and cardboard. NHSL PAMS (NHSL Board (final)) 38

45 Table 3.24: NHS Scotland Waste Management Action Plan Target ( ) Year Requirement Source 2017 Reduce waste by 7% against a 2011 baseline Making Things Last strategy 2020 Landfill ban on biodegradable municipal waste Waste (Scotland) Regs Maximum 5% of waste to landfill Making Things Last strategy 2025 Reduce waste by 15% against a 2012/13 baseline Making Things Last strategy % recycling rate Making Things Last strategy 2025 Reduce food waste by 33% against a 2011 baseline Making Things Last strategy 2050 Reduce greenhouse gas emissions by 80% against a 2011 baseline Climate Change Fleet & Staff Travel In April 2015 NHS Lanarkshire piloted a Pool Car scheme for the grey fleet, (which is made up of staff using their own vehicle on business). These vehicles pose an additional risk and have a greater environmental impact compared to using lease, hire or pool cars. In place of mileage claims, staff in high mileage teams has been provided with either a car share vehicle, a pool car (Switched On Fleets Grant Funded vehicle) or a short term hire car. Over 160 staff signed up to the scheme on the day and Enterprise noted that this was the most successful launch of a car share scheme to date with any organisation. The hire car scheme has been operating successfully with the Biomedical and Labs teams across the three Acute sites, PSSD and Coathill Hospital since January Staff requiring a hire car book the vehicle using the Enterprise B2B website and can have the vehicle delivered to their home or place of work. To date over 19,886 miles have been driven over a rental period of 413 days, displacing mileage which would otherwise been claimed as staff business expenses. Switched On Fleets Grant Scheme The Switched On Fleets initiative provides funding for public sector fleets to increase the number of electric / low emission vehicles on the road. The Scottish Government has ambitious climate change targets that include phasing out all petrol and diesel fuelled vehicles by 2050, the scheme has to date assisted in the introduction of over 200 electric vehicles across Scottish Local Authorities and Community partners. In March 2015 NHS Lanarkshire was awarded 49,000 grant funding from the scheme from a total of 144,561awarded to partners in North and South Lanarkshire Councils. The Grant was used to pay for the 3 year lease of 3 vehicles to support the NHSL fleet and the pool car scheme. The lease vehicles are petrol hybrid and are estimated to have running costs of around 2-3 p/mile when on pure electric mode as opposed to running costs of around 16p/mile for an average family car. In September 2016/17 further funding of 22,000 was awarded to NHSL. This funding has been used for a 3-year lease of an electric van to support the PSSD Fleet and a range extended (petrol/electric hybrid) to be used as a pool car. NHSL PAMS (NHSL Board (final)) 39

46 It is positive that NHS Lanarkshire has continued to fund energy saving schemes internally year on year, which is evident from the NHS Lanarkshire Annual Sustainability Report and Carbon Reduction Commitment (CRC) Annual Reports that good progress continues to be made. The Government s Draft Climate Change Plan (RPP3) has extremely challenging targets for reductions in energy and greenhouse gas emissions. It is also felt by NHS Scotland Boards that the proposed national targets are not representative of current technological and financial constraints and does not take cognisance of the fact that many of the quick win projects have already been carried out and the future focus will have to switch to spend-to-save projects requiring a higher level of capital investment. Once the national targets are finalised, NHSL will develop plans to determine how they can be achieved. The NHS Boards in Scotland have been proactive in reducing energy consumption and associated GHG emissions and since 1990 (the baseline year of the Climate Change (Scotland) Act 2009), energy consumption across the NHS Scotland estate has fallen by circa 23% and associated GHG emissions by circa 40% (based on figures from 2015/16). These reductions were achieved mainly through the eradication of coal as a heating fuel across the estate and an 88% reduction in oil. Other energy efficiency/ GHG reduction projects have included improvements in insulation, enhanced building management systems (BMS) and boiler sequence controls, variable speed drives (VSD) on pumps and motors, LED lighting replacements, biomass boiler installations and gas-fired combined heat and power (CHP) installations. With the impacts of service expansion and the new Health Centre sites which are significantly more energy intensive, efforts need to be intensified to identify sufficient projects to ensure that carbon reduction and energy efficiency targets are met. Going forward NHS Lanarkshire has developed a programme of energy investment linked to EAMS and the NHS Lanarkshire Property & Assessment Management Strategy It should be noted that at this point no technologies have been rejected and that all projects will be considered on a /tonne CO 2 saving and payback. The Board will continue to identify opportunities and will update the NHS Lanarkshire Project Register as this is a live document. The following recommendations will be implemented to ensure that NHS Lanarkshire continues to identify carbon reduction measures across all areas of the organisation: Calculate NHS Lanarkshire carbon footprint and model the impact of business as usual / growth on future years to ensure that sufficient schemes are identified to meet the NHS Scotland energy and greenhouse gas targets noted in RPP3. Update Energy Audit programme for all sites (inc. PFI) as follows: o o o o List of projects that are easily replicable Cost and identify energy and carbon savings of the above projects Update NHSL Project Register Update EAMS 3.5 State of the Board s Office Accommodation In keeping with the Smarter Offices and NHSL Accommodation and Space Management Policy and supporting procedures NHSL aims to improve utilisation of properties across the NHSL estate in the development of a strategic approach to accommodation. To achieve the following benefits: NHSL PAMS (NHSL Board (final)) 40

47 Provision of affordable support accommodation to the NHS that is better able to respond to future changes in strategic direction Improved quality of working environment which facilitates the retention and recruitment of staff Improved availability of staff welfare facilities promoting positive staff morale. Flexible, well designed, efficient space that is able to cope with uncertainty around future property needs, support opportunities to change working practices, and introduce new technology Supporting Scottish Government environmental sustainability agendas through the appropriate procurement, design and operation of its property assets. Maximised opportunities for staff to develop and deploy their knowledge, skills and personal qualities creatively to add value to the organisation. More integrated/collaborative working and thereby encourage better use of skills and resources. Synergies from shared use of accommodation and support services. The table 3.25 shows a slight improvement NHS Lanarkshire position in relation to these benchmarks, as well as a slight increase in the costs associated with this accommodation type. The space standards have improved over the last 12 months with the space per WTE changing from 5.4 to 6.0m 2 and the desk to WTE ratio changing from 80% to 82%. Variance across Boards suggests scope for even further improvement in these indicators. The total occupancy cost per net internal area has increased slightly by 5%. Table 3.25: NHS Lanarkshire's Accommodation Costs 2015/ /17 Year Annual Change Variance NHS Lanarkshire Accommodation Costs Space Standard (sq.m NIA) Space Space per per WTE desk Desk to WTE NIA Ren t/sq.m NIA Rates / sq.m NIA Service Charge/ sq.m NIA Hard FM/ sq.m NIA Soft FM/ sq.m NIA Energy Cost/ sq.m NIA % % Total Cost/ sq.m NIA % NHSL PAMS (NHSL Board (final)) 41

48 The table 3.26 shows NHS Lanarkshire position in relation NHS Scotland Boards benchmarks, as well as the annual change in costs associated with this accommodation type. For NHS Lanarkshire space standards is reported better than national average with a space per WTE of 6m 2 against average 12m 2 and the desk to WTE ratio changing from 82% to 97%. NHS Lanarkshire total occupancy cost per net internal area is slightly better than national average of 81 against 190 per m 2. Table 3.26: NHS Lanarkshire's against NHS Scotland Board s Average Accommodation Costs Year NHS Lanarkshire Accommodation Costs Space Standard Desk Ren Service (sq.m NIA) Rates to t/sq Charge/ Space Space / sq.m WTE.m sq.m per per NIA NIA NIA NIA WTE desk Hard FM/ sq.m NIA Soft FM/ sq.m NIA Energy Cost/ sq.m NIA % NHS Scotland Board s average 2016 Total Cost/ sq.m NIA % Change Variance % State of the Board s Medical Equipment The following section provides an overview of Medical Equipment assets which brings together condition and performance information on these other assets alongside NHS Lanarkshire's property assets. The procurement of Medical Equipment is devolved into two main categories: i. General Medical Equipment; ii. Radiology Equipment. NHS Lanarkshire has circa 3000 medical equipment assets with an overall estimated replacement value of 61.8m (excluding laboratory equipment which is covered under a management service agreement). Chart 3.3 provides a breakdown of the value of each equipment type. Chart 3.3: A breakdown of Medical Equipment Replacement Value ( ) NHSL PAMS (NHSL Board (final)) 42

49 The status of the medical equipment within each of the identified main headings is summarised below: General Medical Equipment The Medical Physics, Radiology and Procurement Departments play a critical role in coordinating the medical equipment requirements for all wards and departments across the organisation. Replacement of medical equipment is informed by NHS Lanarkshire's healthcare strategy (local and national) and enactment of replacement equipment criteria (see below). The replacement programme is constantly under review as the equipment investment strategy also has to respond to service developments and unforeseen events, such as equipment failures, that have implications for the safe operation of NHS Lanarkshire. The investment prioritisation criterion for medical equipment is updated annually and generally consists of: Category 1 - Equipment that is used to monitor or deliver treatment in critical settings and if not replaced could result in serious deterioration in health or potential death. Category 2 - Equipment touches on Category 1 but alternative options may exist on other sites. The patient would require the procedure/intervention within a time limited period. There would be some risk as there would be a delay in delivering the service. Category 3 - Equipment that is required to maintain and improve capacity to deliver waiting time and other national guarantees. All Equipment acquisitions are approved by the Core Equipment Group vis Business Case assessment with overall sanction from the Capital Investment Group. In , NHS Lanarkshire invested 5.27m in replacement of medical equipment. The investment in replacement medical equipment is 8.5% of the overall replacement value for medical equipment which suggests a full replacement cycle of circa years, it should be noted that in earlier years the investment in capital equipment has been significantly higher therefore this figure is not a true reflection on the overall replacement activity, however the cost to keep pace with replacing medical equipment alone is of the order of circa 5-6m per annum. Table 3.27 outlines the proposed minimum investment in medical equipment from 2016/17 to 2020/21, subject to availability of funding. Table 3.27: Investment Plan in Medical Equipment 5 Year Property & Asset Management Investment Programme Medical Equipment 2016/17 M 2017/18 M 2018/19 M 2019/20 M 2020/21 M Radiology Equipment The Radiology service is responsible for the direct provision of diagnostic and interventional services to patients throughout Lanarkshire on a 24/7 basis. The major pieces of Radiology equipment that are owned by NHS Lanarkshire are based at the Monklands and Hairmyres sites. Radiology equipment sited at Wishaw Hospital is provided as part of the PFI. NHSL PAMS (NHSL Board (final)) 43

50 Laboratories Equipment As of April 2013 the Laboratory Service became a Managed Service with assets transferred to the provider under a seven year contract arrangement. The provider is required to equip the laboratories to meet the requirements of the contract specification. 3.7 State of the Board s Vehicular Fleet Current Status of NHS Lanarkshire's Vehicle Assets All vehicles operated within NHS Lanarkshire are managed by the Transport Department, which is a part of Property and Support Sevices Division (PSSD). The majority of the vehicles are leased or hired, with only five agricultural and one dental vehicle being owned. All NHSL vehicles are sourced through national contracts and the Government Procurement Service, using the multi quote system. All mandatory checks and routine maintenance are pre planned 12 months in advance as recommended by Vehicle Operator & Service Agency, (VOSA), and maintenance is carried out by approved suppliers. All new vehicles remain with the franchised approved dealer during the warranty period, which is normally three years. The current fleet consists of 995 vehicles which comprises; 907 staff leased Cars (managed by a dedicated leased department within Finance) 8 Pool Cars (Operational Lease) 6 Small Vans (Operational Lease) 4 Large Vans (Operational Lease) 1 HGV 18T Box Lorry (Operational Lease) 4 HGV 7.5T Box Lorry (Operational Lease) 4 Pool Cars (Operational Hires) 11 Small Vans (Operational Hires) 42 Large Vans (Operational Hires) 2 Patient Carrying Vehicles (Operational Lease) 5 Agricultural Plant (Owned) 1 Other (Owned) Chart 3.4: Analysis of Vehicle Assets by type NHSL PAMS (NHSL Board (final)) 44

51 Source 10 th May 2017 The vehicle age profile are shown in chart 3.5 highlights that circa 60% of the vehicles are less than two years old and less than 1% over 5 years old. This represents a reasonable age profile for this asset group and indicates that investment is currently maintaining a reasonable standard of vehicle asset provision. This is also reflected in the overall good / adequate condition of these vehicles. Chart 3.5: Vehicle Age Profile Source 10th May 2017 Overall, NHS Lanarkshire s current vehicle assets are of good standard with circa 60% of the assets being less than 2 years old and 40% being between 2 and 5 years old. The insurance and accident costs per vehicle is less than the national average, however the average leased vehicle and fuel costs are higher than the national average. Overall the average total net costs per vehicle are 1,932 which is less than national average of 4,321 as shown in Table NHSL PAMS (NHSL Board (final)) 45