Property and Asset Management Plan

Property and Asset

Management Plan

2013 to 2023

NHS Grampian’s response to the Scottish Government CEL 35(2010)

Status

Version6

March 2013

19/03/13 For Approval

Assets which are in the right place at the right time,

suitable for their purpose and well maintained will

positively support service delivery and enhance service

users’ experiences.

2009 Audit Scotland Report “Asset Management in the NHS in Scotland”

This strategy is also available in large print and other formats and

languages, upon request. Please call NHS Grampian Corporate

Communications on (01224) 551116 or (01224) 552245.

Contents

Contents Page

Executive Summary 1

Introduction 3

Where are we now? 6

o Progress over the last year

o Condition of our property portfolio

o Condition of our medical equipment

o Condition of our non-clinical service assets

o Condition of our ICT infrastructure

Where do we want to be? 23

o Challenges that will influence our plan

o Strategic Vision – Healthfit 2020

o Strategic benefits and improvements we will deliver

How do we get there? 39

o How we will implement the plan

o Our investment plan for the next 5 years

o Our investment plan for years 5 to 10

Appendices A – Performance Framework B – Prioritisation and Risk C – Performance of the Board’s Property Estate D – Medical Equipment E – ICT Infrastructure F – Proposed Impact of Local Plans G – NHS Grampian Geographic Areas (Maps) Glossary

Executive Summary

At a strategic level, the Board of NHS Grampian is regularly faced with significant

investment and disinvestment decisions as part of the ongoing modernisation of the

asset base to respond to and support the delivery of service reconfiguration across

Grampian. The challenge is heightened by funding pressures, which means that the

Board must prioritise its investment and disinvestment requirements more rigorously

ensuring affordability and continued development of community based facilities as

stated in Healthfit 2020 – NHS Grampian’s Strategy.

Much has been achieved by way of asset investment during the last year:

Opening of the new Emergency Care Centre:

• Emergency services in one building

• Replacement of 40% inpatient beds at Aberdeen Royal Infirmary (ARI)

• Telemedicine Centre for Unscheduled Care

Replacement Linear Accelerators and bunkers (Stage 1)

Essential Medical Equipment

• Mobile x-ray equipment

• New bone density scanner

• New ultrasound systems

• Image Intensifier for Vascular

• Upgrade of Gamma Cameras

Essential Non-medical Equipment

• Laundry equipment

• CSSD equipment

Replacement Vehicles

• 6 New commercial vehicles (improved CO2 and economy)

• 5 New Minibuses and parking arrangements at Foresterhill

Sustainability and Energy

• New energy centre at Foresterhill

• Approval of funding for new biomass boilers at Royal Cornhill Hospital

• Electric vehicles for transport of mail at Peterhead, Stonehaven and

Fraserburgh, jointly with Aberdeenshire Council, Grampian Police and

Grampian Fire and Rescue Services

Investment in technology

• Implementation of core Patient Management System (PMS)

• Video Conferencing in support of telehealth

• Wireless networking in all Hospitals

Aberdeen Health and Care Village provided the first contract close of a

Design Build Finance and Maintain Project in Scotland made under the

Scottish Futures Trust “hub” mechanism

Backlog maintenance was reduced by £5.4m and plans in place to reduce

current significant and high risks to £10m by 2021

Acceleration of essential equipment replacement by £5m.

The above was part funded and some backlog risks removed through the disposal of

Balgownie Day Centre, Aberdeen; Square 13, Aberdeen; Watson Avenue, Huntly;

Site at Westburn Crescent, Aberdeen; and Campbell Hospital, Portsoy.

Despite the progress and improvements made, much yet needs to be done. Our

backlog maintenance costs estimated at £157m are the second highest of all the

Scottish Health Boards. In terms of Information Communication Technology (ICT) if

we are truly to advance the use of technology as described in the 2020 vision then

investment beyond that currently available will be required to improve the

infrastructure and resilience. Finally, further investment in equipment again beyond

that currently available will be required even to stand still.

The organisation is large and diverse, currently requiring access to many buildings,

equipment, technology and vehicles. This has created a vast asset base which in the

longer term is unsustainable against a backdrop of further efficiency measures. The

2020 vision provides a mechanism for some of that change. In summary, we need to

progress the 2020 vision through engagement with our multiple stakeholders and

look towards a future that provides a more diverse means of investment in assets.

Introduction

The Scottish Government’s “Policy for Property and Asset Management in NHSS”

issued in September 2010(CEL 35(2010)) requires all NHS Scotland (NHSS) bodies

to have a Property and Asset Management Strategy1 (PAMS) which is reviewed and

approved by the Board annually. In response to that requirement, the latest version

of the NHS Grampian’s Property and Asset Management Plan (PAMP) has been

reviewed and updated to reflect the priorites set out within Healthfit 2020 – NHS

Grampian’s Strategy. It is intended to support the implementation of future priorities

of the Board and provide the basis for monitoring performance, management and

utilisation of NHS Grampian’s asset base.

The PAMP is one of a coherent suite of supporting and enabling plans which

demonstrate how the Board will successfully deliver Scotland’s health policies, as set

out in Better Health, Better Care and the shared national ambition for achieving

world leading quality in our healthcare services as well as meeting local needs and

priorities. The PAMP has been developed in accordance with the guidance and

processes described in the Scottish Government’s “Developing a Property and Asset

Management Strategy PAMS” published by Health Facilities Scotland in 2010, it

includes vehicles; equipment; information and communication technology; and

property.

Aims of the Property and Asset Management Plan

The aims of this PAMP are to:

Support the delivery of the NHS Grampian Health Plan and vision set out within

Healthfit 2020 – NHS Grampian’s strategy for the future delivery of healthcare

services in the area.

Ensure that assets are used efficiently, coherently and strategically to support

the future clinical and service needs of the population as agreed by the Board.

Ensure that all assets (property, Information and Communication Technology

equipment and vehicles) are known and those that require funding are included

within this Plan as no other Capital funding or business cases will be considered

by the NHSG Asset Management Group (AMG) or by the Scottish Government

Health and Social Care Directorate (SGHSCD).

Provide and maintain an appropriate number and quality of affordable assets

which complement and support the provision of high quality services which meet

the population needs and are sustainable over the long term.

1 NHS Grampian has a single strategy – Healthfit 2020. In preparing the Property and Asset Management Plan,

we have met with the requirements set out for the development of Property and Asset Management Strategy but have chosen to refer to the document as a Plan.

Address the backlog maintenance and essential equipment replacement issues

where there is a high, significant or moderate risk which could impact on the

Board’s ability to deliver current and future services.

The Plan covers the period 2013 to 2023, with detailed investment proposals

covering the next five financial years.

Developing the Plan

The development of the Plan was led by Head of Property and Asset Development,

with the Director of Finance being the Board Executive Sponsor. Its development

involved a period of wide consultation with key members of staff responsible for

service delivery and asset management. The process also reflected ongoing

dialogue and work with partner organisations which are involved in joint projects and

future plans around asset management.

In terms of formal approval, the Plan was approved by the Asset Management Group

and discussed with Board members in seminar format prior to submission for

approval at the full public board meeting in April 2013.

In terms of the condition of our asset base, we will commit c£140m in the following

investment priorities for the next five years:

Investment in new assets (primarily property) to improve the quality and

standard of our clinical care environment

£46m

Investment in reducing significant and high risk backlog maintenance in

clinical areas

£54m

Investment in replacement of essential equipment and upgrading our

ICT infrastructure

£40m

Whilst this represents significant investment in improving our asset base, it will not

fully address our property maintenance, essential equipment replacement backlog,

and the need to provide a resilient ICT infrastructure which will facilitate further

efficiencies in providing services to a largely rural area.

The following pages of the document will evidence where we are at now with regards

to our asset base and the changes that have occurred in the last year since the

previous PAMP version. This will include the move of activity to community settings

including treatment at home, partnership working with local authorities and the

importance of the voluntary sector through to the use of innovation and the

importance that tele-healthcare has for a Board covering a large rural area.

Thereafter, we will describe where we want to be and how the Board’s assets

contribute towards achieving that strategic outcome, influencing discussions,

affordability, patient care and the ongoing modernisation agenda. This could range

from developing home and community based solutions with a consequential impact

on inpatient hospital care, and how technology can assist in delivering outcomes

some of which are described in the 2020 vision.

Finally, we will consider available finance, just how the retained asset base can best

be used to improve the Board’s performance, reduce backlog maintenance, and

positively contribute to the health of the people in Grampian.

Where are we now?

NHS Grampian’s progress over the last year

Over the last 12 months our capital programme has enabled investment in a number

of strategic projects:

Provision of high quality care environments focused on meeting patient need

The £110m Emergency Care Centre (ECC) opened its doors to staff and public in

December 2012, bringing significant benefits to the way we deliver unscheduled care

across the North East of Scotland. This new world class facility has facilitated a

significant redesign of clinical services through:

The co-location of accident and emergency, primary care out of hours service

(GMED), NHS 24 and services for people who require urgent assessment and

treatment into one building on the Foresterhill site.

Replacement of 40% of the inpatient beds at Aberdeen Royal Infirmary in state of

the art, predominantly single room accommodation. This should further reduce the

risk of infection and improve privacy and dignity throughout the entire building.

The provision of a multi-professional decision support hub and telemedicine

centre for unscheduled care, allowing specialised treatment in local communities

across the North of Scotland. This investment in modern design and technology

will bring many benefits for the care of patients, including early management of

unscheduled care episodes in the community, enhanced medical support and

improved management of emergency admissions.

Chalmers Hospital, Banff, was refurbished for outpatient activity and provides

inpatient accommodation in a new purpose built ward with 100% single rooms for the

communities of Banff and the surrounding area. A new Health Centre replaces the

previous one on site and improves services for the people of Banff. The project

included the closure and sale of the former Campbell Hospital, Portsoy.

The Integrated Drug Treatment and Rehabilitation Centre at the Timmer Market,

Aberdeen, is a purpose built building accommodating for the first time the joint

services of NHS Grampian and Aberdeen City Council (a joint venture build

programme between Aberdeen City Council, NHS Grampian and Grampian Housing

Association). It reflects the need for integrated community based treatment and

rehabilitation services as recommended nationally and is central to the Scottish

Government Strategy “Road to Recovery”.

Addressing backlog and statutory compliance issues

Dr Gray’s Hospital, Elgin, refurbishment planned - moving inpatient beds from the

old part of the hospital into the more modern hospital area, improving the standard of

inpatient bed environment and spacing along with organising services more

appropriately by providing better clinical adjacencies, and allowing compliance with

NHS Firecode requirements.

We have now agreed a plan to vacate Woolmanhill Hospital, Aberdeen, by the end

of 2013. Phase I of the plan will involve the relocation of the Osteoporosis Unit and

Diabetes service to the Health Campus at Aberdeen Royal Infirmary by 31 March

2013.

Investment in essential equipment replacement

A key element of the capital programme is replacement of essential equipment and

critical assets within clinical and non-clinical services. Prioritising the capital formula

allocation along with additional investment from the Scottish Government Health

Directorate resulted in a £11.8m replacement programme of essential and critical

equipment during 2012/13.

Diagnostic investment Diagnostic services have been improved by:

The National Radiotherapy programme funding has provided replacement Linear

Accelerators and bunkers in a configuration which is consistent with the future

development of the Cancer Centre. The first stage of this was complete in June

2012, with the second stage being completed during 2014/15. The West End

MRI Suite at Foresterhill replaced the old MRI scanner in the East End, is more

centrally located and has considerably improved image quality.

Investment in essential equipment including additional mobile x-ray units, bone

density scanner for the Osteoporosis Unit, four Ultrasound Systems (ARI x2, Dr

Gray’s and Woodend), Image Intensifier for Vascular Service, Gamma Cameras

to incorporate CT and installation of radiation shielding.

The addition of increased Computerised Tomography (CT) capacity within the

ECC. These investments will improve access and diagnosis for patients, enhancing the

quality of care, improving patient outcomes, and providing a better working

environment for staff, through investment in modern up to date equipment and

buildings.

In addition to the diagnostic equipment noted above, the investment in essential and

critical2 equipment included:

Laundry Tunnel washer, tumble driers Critical £1.1m

CSSD Washer /disinfector driers Critical £1.0m

Medical Various items which were prioritised by

our joint medical equipment committee

Essential £5.7m

Vehicles Replacement vehicles that were beyond

useful life, improving economy and

reducing CO2

Essential £0.3m

Commitment to sustainability

In recognition of the importance of meeting carbon reduction targets and taking

responsibility for the creation of an environmentally sustainable infrastructure

investment in the last 12 months included:

A new Energy Centre at the cutting edge of technology. It was commissioned at

the end of 2011. The Centre, costing £12.5m, meets the heating and electricity

needs of the Foresterhill site for the next 20 years, reduces NHS Grampian’s

carbon output by 800 tonnes per year and provides energy resilience to the

Foresterhill site. Confirmation of funding for a new Biomass plant at Royal

Cornhill Hospital has been received from the Scottish Government.

Linked to the new arrangements on the Foresterhill site to improve access for

patients and visitors, NHS Grampian has worked with commercial partners to

introduce additional public bus routes and to increase the frequencies of existing

runs. Separately, but related, a project to address inter-site traffic congestion has

been introduced - five shuttle buses run from external sites to and on the

Foresterhill Campus, enabling staff and visitors free and easy access to the

Campus. Approximately 250 people per day are making use of the service. This

initiative has dramatically reduced the requirements for staff bringing their own

vehicles on site.

NHSG has recently completed a joint working project with Grampian Fire and

Rescue Service, Grampian Police and Aberdeenshire Council, which involved

the purchase of electric vehicles (through European funding), to transport mail

and other items from central drop off points, to locations which NHSG delivered

to, in Stonehaven, Fraserburgh, and Peterhead.

2 Non-medical or clinical service equipment which if not operative would have a significant and detrimental

impact on the continuity of the delivery of healthcare across NHS Grampian.

The Health Transport action Plan Steering Group (NHSG, Nestrans, Scottish

Ambulance Centre, Aberdeen City Council, Aberdeenshire Council and The

Moray Council) has commenced a pilot project, known as Transport for

Healthcare Information Centre (THInC), based in Elgin. It is being developed to

provide an integrated cross service appointment booking, transport scheduling

and vehicle/transportation deployment system which makes use of all available

public transport where it exists, before considering any alternative methods of

transport. This should enable patients to attend appointments at healthcare

facilities at mutually suitable times.

In addition, the Board has become members of the Carbon Energy Fund and a

business case is under development to implement new technology at our four major

hospital sites that will see a guaranteed reduction in energy usage/carbon emissions

in the coming years.

Asset investment supports changes in working practices

During the last 12 months we have continued investment in our IT infrastructure

through:

Completion of the core Patient Management System programme (PMS).

Supporting bed management order communications modules.

Implementation of two national systems – Opera (theatre) and Patient Archive

Communications system (PACS); integrating the latter with our Radiology

System (RIS) within Aberdeen Royal Infirmary.

The efficient work programme has developed in-house systems for electronic

production, storage of clinical correspondence (ECCI letters) and for electronic Initial

Discharge letters.

NHS Grampian led on implementation of a National Video Conferencing Bridging

Service, especially supporting the Island Boards. Telehealth has seen introduced

Video conferencing equipment in every hospital in Grampian. Video conferencing

capability using webcams and bespoke desktop solutions via the internet is now

widely available reducing the need to travel.

Other investments in the last year include:

Introduction of wireless networking to Foresterhill campus, Dr Gray’s, Royal

Cornhill, Woodend and many community hospitals.

Update of our service desk support system to improve call handling and issue

resolution.

Enhanced switchboard performance through introduction of Interactive Voice

Response( IVR) and supported by Rotawatch, an 'On Call Rota'

application built specifically for the NHS.

The developed prioritisation process, established by structured interviews with

clinicians and managers assisted the AMG in effective decision making where

resources are limited. The prioritisation list will require further review annually to

ensure it remains fit for purpose.

Disinvestment and sales

Whilst investment is important equally is the ambitious disinvestment programme

which provides additional funding to support our investment needs and is consistent

with the Health Plan and our Healthfit 2020 vision.

In the last year, the following properties have been sold resulting in capital receipts

and reduced backlog maintenance:

Backlog reduction

Balgownie Day Centre (Aberdeen) £127,950

Watson Avenue (Huntly) £45,050

Square 13, Aberdeen £641,450

Campbell Hospital, Portsoy £127,950

Westburn Crescent plots, Foresterhill N/A

Condition and performance of NHS Grampian’s Property Portfolio

Information on condition and performance of the property portfolio follows the format

of the Health Facilities Scotland guidance “A risk based methodology for Property

Appraisal”. The emphasis is on providing a consistent approach to assess the

condition and performance of properties within NHSScotland.

NHS Grampian has the responsibility for owning and managing a very large property

portfolio on behalf of the Scottish Ministers, ranging in size and age. Of that estate,

87% (by floor area) is hospital based accommodation.

A detailed analysis of the results of the appraisal of condition and performance of the

Board’s estate is provided in Appendix C and the key messages from it are

summarised as follows:

The six facet appraisal of the property portfolio produced results which were not

unexpected for such a large and complex estate: 46% of properties are physically

satisfactory, 64% are functionally suitable, and 78% of space is fully utilised whereas

12% is overcrowded. The analysis of six facets and the condition and performance of

our properties are included in the following table:

Analysis of Property Performance

Facet

Very Satisfactory

Satisfactory Not

Satisfactory Very

Unsatisfactory

A B C D

Physical Condition 8% 38% 48% 4%

Functional Suitability

14% 50% 17% 18%

Quality 14% 55% 14% 16%

Average SCART Score

54.6

Average Energy Consumption PI

75 GJ/m3

Category Not Used Under Used Fully Used Overcrowded

E U F O

Space Utilisation 6% 4% 78% 12%

**

Much of the areas identified as “Not Used” by NHS Grampian are currently awaiting

disposal.

Not unlike most health boards, the significant challenge for NHS Grampian is to

reduce the level of outstanding backlog maintenance. The current estimated

Backlog Cost is £157m (excluding any uplift allowances for fees, VAT, contingency,

inflation, etc.). This backlog has reduced in the current year by £5.4m, with the

current investment profile providing further benefits in future years. The profile of the

backlog costs is as follows:

Property Type

Area sq.m

Backlog Maintenance Risk Profile TOTAL

BACKLOG Physical

Statutory Compliance

Low Moderate Significant High

Hospitals 372,998 123,402,902 25,288,876 87,600,094 14,706,810 39,999,874 6,385,000 148,691,778

Health Centres, Clinics, and Day Centres

36,076 8,516,750 752,902 1,470,925 984,760 683,967 6,130,000 9,269,652

Hospice 3,228 29,900 45,977 37,868 3,650 34,359 0 75,877

Support Facilities (including offices)

13,115 1,385,050 520,001 1,027,950 513,700 170,083 0 1,711,733

(less backlog complete 2012/13)

-1,000,000 -2,000,000

-3,000,000

TOTAL 225,417 132,334,602 26,607,756 56% 10% 26% 8% 156,749,040

There remains an obvious disparity for NHS Grampian between the costs of

reducing backlog maintenance and the level of available funding.

Focus of investment - property

The proposed investment programme for the next five years reflects the commitment

within NHS Grampian to address this gap by prioritising available capital and

revenue funding together with asset disposal proceeds to target an 88% reduction

in high and significant risk backlog maintenance in clinical areas over the next

five years.

Other specific objectives that we would wish to deliver include:

Improvements in the functional suitability of the operational estate (which can be

measured through on-going re-assessment of the functional suitability facet as

well as annual review of the PAMP) to ensure that accommodation meets the

operational and service needs of the organisation.

Improvements in the quality of the operational estate which can be measured

through reductions in backlog maintenance costs/risks and by using annual

patient perception surveys.

Improvements in statutory compliance and reduction in risk (which can be

measured through reductions in non-compliance with statutory legislation,

incident rates, and an increase in each property’s SCART score).

Improvements in energy performance (in line with mandatory targets for NHS

organisations in Scotland) and in compliance with Corporate Greencode

requirements.

Reductions in our property footprint and reduction in the revenue cost of the

operational estate over time (which can be measured by mapping trends in

overall maintenance costs, utilities costs and the Board’s income-to-asset value

ratio).

Condition of NHS Grampian’s Medical Equipment Procurement of Medical Equipment is devolved to five main clinical areas:

Radiology, Medical Physics, Radiotherapy, Nuclear Medicine and Laboratories.

NHS Grampian has circa 4,000 medical equipment assets with a net book value of

£30.6m at 31st March 2012. The analysis below details this information in line with

the analysis requested as part of the Local Delivery Plan (LDP) financial planning

template which is derived from those asset categories identified in the Audit Scotland

Report, ‘Better Equipped to Care’.

Medical Equipment Category Gross Cost @31/3/12

Net Book Value @31/3/12

Imaging (CT / Ultrasound / MRI / Gamma Cameras) £15.6m £7.5m

Other X ray (Angio / Dental / Fluoroscopy / General X

Ray) £11m £3.7m

Radiotherapy £3.1m £0.1m

PET Replacement Programme £1.5m £0.4m

IV systems (Syringe and Volumetric Pumps) £0.8m £0.3m

Other medical equipment e.g. defibrillators, dialysis machines, endoscopes

£61.5m £18.6m

TOTAL £93.5m £30.6m

Each of the devolved procurement areas is responsible for the ongoing management

and replacement of medical equipment within their own directly managed service

and in a wider sense to provide specialist advice and support to other departments

across the organisation regarding the overall equipment replacement programme.

There is close co-operation between each of these devolved areas in order to

prioritise our requirements and ensure that available resources are targeted

effectively on an annual basis. This process is managed by our capital equipment

prioritisation group which is a sub-group of our Asset Management Group. Each

department Head is a full member of this group along with senior management. Our

annual planning process involves a peer review of all equipment requirements. Key

considerations when assessing assets’ remaining practical useful life, in addition to

the obvious priority given to issues that affect patient safety and clinical benefit,

include:

Age and intensity of use;

Availability of spare parts;

Image quality where relevant;

maintenance and upgrades;

Radiation dose where relevant

The work undertaken within each devolved procurement area is summarised below. Radiology The Clinical Radiology service is responsible for the direct provision of diagnostic

and interventional services to patients throughout Grampian, Orkney and Shetland

on a 24/7 basis. The department directly manages imaging services located at

Aberdeen Royal Infirmary, Royal Aberdeen Children’s Hospital, Woodend Hospital,

Dr Gray’s Hospital and 11 Community Hospitals. The modalities provided include

general radiography; dental radiography; fluoroscopy; CT; angiography and

interventional radiology, cardiology, mammography; MRI and ultrasound.

Approximately 300,000 examinations are performed annually.

Imaging equipment condition expressed by category, age and investment as at

February 2013 is depicted graphically below. Capital requirements for radiology are

high due to the large amount of high cost equipment needed to deliver the service at

sites across Grampian.

Focus of investment – Clinical Radiology Over the next five years, investment in radiology will be focused on continuing with

timely equipment replacement which will be informed by the development of an NHS

Grampian 2020 Imaging Strategy. We are already planning for the establishment of

two new plain film services in community hospitals at Aboyne and Inverurie and the

upgrading of existing inpatient provision, reviewing options to increase MRI capacity

on the ARI site and for provision within Moray, and planning for a PACS refresh and

new national contract in the medium term (current PACS contract expires 2017).

£0.00

£500,000.00

£1,000,000.00

£1,500,000.00

£2,000,000.00

£2,500,000.00

£3,000,000.00

£3,500,000.00

>9

7<9

5<7

0<5

Medical Physics

The Medical Physics Department has a critical role co-ordinating the medical

equipment requirements for all wards and departments across the organisation. The

department supports the Joint Medical Equipment Committee (JMEC) in the review

and prioritisation of basic medical equipment requirements. The Committee, which

has senior clinical and management representation from the service, is allocated a

budget annually and has delegated authority from our Asset Management Group to

target available resource towards the replacement of essential medical equipment

assets. Typically JMEC will progress replacement of the full range of medical

equipment including defibrillators, dialysis, heart/lung machines, IV systems, scopes

(e.g endoscopy, colonoscopy, bronchoscopy) and in many cases ultrasound

scanning and other imaging equipment where this is carried out by consultant

medical staff within their individual wards and departments. There is very close co-

operation between the Medical Physics team and the Clinical Radiology service.

Focus of investment – Medical Physics

The Medical Physics Department requires to be relocated to accommodation more

central to its core users, in the heart of our clinical accommodation. This will enable

NHS Grampian to introduce a medical equipment library service leading to far more

efficient use of all our mobile medical equipment.

Radiotherapy

The radiotherapy equipment replacement program is managed nationally. There is a

year on year plan for equipment replacement. Phase 1 of this programme provided

two replacement Varian Truebeam linear accelerators. This new and improved

technology will allow for much improved treatment delivery.

Focus of investment – Radiotherapy

Phase 2 will commence in January 2014 replacing the third linear accelerator which

is anticipated being operational by March 2014. The third machine provides an

element of additional capacity which will be available to improve service efficiency

and allows for growth in capacity beyond that currently projected.

Nuclear Medicine

In general the department has been well equipped and equipment replaced in a

timely manner. However accommodation, location and functionality whilst being far

from ideal has not deterred a high quality nuclear medicine service being delivered.

Focus of investment – Nuclear Medicine

The nuclear medicine service requires to be relocated to accommodation more

suited to patient access and which is also able to accommodate the latest advances

in nuclear medicine technology which requires far more space to be sited.

Laboratories

Laboratories hold a Managed Service Contract (MSC) for major analysers in the

departments of Clinical Biochemistry, Haematology and Dr Gray’s hospital

laboratory. This contract is due to end in 2015 (there is an option to extend for a

further 2 years). The contract also includes all blood gas analysers sited within the

Foresterhill site.

The other departments within Laboratories currently have their equipment procured

via capital purchase or various leasing/ rental type arrangements. Genetics is a

National Services Division (NSD) funded service and receives equipment either from

NSD nationally funded initiatives or from NHSG capital.

Focus of investment – laboratories

Technology will facilitate many changes for Laboratories over the next three to five

years, moving from heavily automated single disciplines into a single Department of

Blood Sciences with the majority of the analysers, and therefore diagnostic sample

testing, on a common tracked system.

The departments of Medical Microbiology, Pathology and Immunology are also

pursuing MSC’s taking advantage of the financial and risk benefits to NHS

Grampian.

Towards the end of next year, Laboratories will be commencing a business case

process to validate the most cost effective option for the Managed Service Contract

to allow a smooth transition at the expiry of the current contract in 2015.

Condition of NHS Grampian’s facilities and support service assets

Facilities and support services are responsible for a critical part of the infrastructure

that supports our clinical services. This incorporates Laundry, Central

Decontamination Unit (CDU), transport, property maintenance, cleaning, portering

and catering services. This has been a key area for us during 2012/13 which has

seen significant investment to replace ageing Laundry and CSSD plant, vehicles and

to create a sustainable cook / chill catering facility.

The net book value of these assets at 31st March 2012 was £5.3m. The table below

summarises this information in line with the analysis requested as part of the LDP

financial planning template.

Equipment Category Gross Cost @31/3/12

Net Book Value @31/3/12

Support services vehicles £1.9m £0.5m

Other vehicles £1.1m

£0m

Plant and machinery £12.1m £4.3m

Other equipment £2.4m £0.5m

TOTAL £17.5m £5.3m

In terms of our non-clinical asset portfolio and replacement plan, we would note the

following:

Linen Services

The Foresterhill Laundry and CDU are located at the south east corner of the Health

Campus. They share a common building and both rely heavily on the use of steam.

The building has significant backlog issues which include asbestos, roof leaks and

dated infrastructure. Steam is supplied from the new energy centre and from the

older Mile End boiler house. The laundry uses high pressure steam from the older

Mile End boiler whereas the decontamination facility can be supplied solely from the

new energy centre.

The additional capital investment of £1.2m in the Foresterhill Laundry during 2012/13

brings the prime processing equipment up to an acceptable standard with a life

expectancy in excess of 15 years before any further significant prime processing

equipment expenditure would be required. The move to gas fired dryers removes the

need for high pressure steam and would allow, with some further capital investment,

the closure of the Mile End boiler house.

Focus of investment – Linen Services

Further investment to deal with a condensate return issue will require c£1.5k. This

additional funding will allow the closure of the East End boiler house. Following this,

a service review may also see the older laundry facility at Woodend Hospital closing

allowing NHS Grampian to concentrate all of its linen processing on the one site at

Foresterhill. There is an annual backlog allocation of £350k for smaller ongoing

equipment replacement.

Decontamination Services

The additional capital investment of £1m during 2012/13 brings the prime processing

equipment up to an acceptable standard with a life expectancy in excess of 15 years

before any further significant prime processing equipment expenditure would be

required. There is an annual backlog allocation of £350k for smaller ongoing

equipment replacement to continue to maintain equipment at an acceptable

standard.

Focus of investment – decontamination services

Additional investment of £250k would allow the potential to close the

decontamination facility at Woodend Hospital allowing NHS Grampian to concentrate

all of its decontamination processing on the one site. Over the next five years

investment will be required to replace a number of our autoclaves at an anticipated

cost of c£600k

If funding were available, we could relocate the Foresterhill decontamination facility

closer to the main users of the service which accounts for almost 80% of the output.

The service could be housed in the basement of the ARI Phase II complex with

direct access into the back of the main theatre complex. It would also allow the

possible future co-location of the new Central Endoscopy Decontamination Facility

from the floor above as this service is also managed by the Decontamination

Service.

Catering Services

The additional capital investment of £1m during 2012/13 will bring the Central

Production Unit and the prime processing equipment up to an acceptable standard

with a life expectancy in excess of 15 years before any further significant prime

processing equipment expenditure in cook/chill would be required. This investment

allows NHS Grampian to relocate its catering cook/chill facility from the Kittybrewster

facility (Aberdeen) to the Dr Gray’s Hospital site in Elgin allowing concentration of

production kitchens on to three sites (ARI, Royal Cornhill and Dr Gray’s). There is an

annual backlog allocation of £350k for smaller ongoing equipment replacement to

continue to maintain equipment at an acceptable standard.

Focus of investment – catering services

As funding becomes available, consideration will be given to closing the older

kitchen on the Foresterhill site and focusing the city production on the newer Royal

Cornhill Hospital site.

Vehicles

NHS Grampian has 238 commercial or pool vehicles which are leased and 71 owned

vehicles. Maintenance costs for our owned vehicles is £160,699 per annum and our

fuel costs for both leased and owned vehicles is £476,867 per annum using

2010/2011 costs.

Focus of investment – vehicles

The fleet management policy is to replace vehicles within five years of procurement.

This has been successful for the leased fleet, but less so for the owned fleet due to

financial constraints. Consequently, NHS Grampian is liaising with Local Authority

partners on an option to soft market test outsourcing the commercial vehicle

requirements, including maintenance, management and replacement of the entire

fleet. A similar option is also being considered with the logistics provider at the NHS

National Distribution Centre.

Lease cars are provided to staff who qualify as essential users on the basis that this

is the most cost-effective means for NHS Grampian essential travel. Staff qualifying

as an essential user are required to pay for the lease costs associated with all

personal use and this is automatically deducted from their monthly salary payments.

We constantly keep the number of essential car users under review and seek to

identify opportunities to minimise staff travel through use of alternative methods,

such as video-conferencing. Currently, there are 434 vehicles in this category.

Condition of NHS Grampian’s ICT Equipment NHS Grampian eHealth/ICT encompasses much more than the deployment of

computer technology. It conveys the message of electronics in support of health and

stimulates thought and discussion about the broad range of issues and opportunities

that technology offers in the health care setting to both healthcare professionals and

patients. NHS Grampian has an ageing ICT Infrastructure with structured cabling

now in excess of 15 years since it was installed. The Value of NHS Grampians IT

assets are shown in the table below

ICT Assets Depreciated Asset Value Replacement Value

Cabling Networks £1,484,500 £1,928,500

Servers £1,941,357 £3,653,500

Communication systems £857,143 £1,500,000

Desktops £1,261,332 £4,734,000

Mobile £489,501 £869,610

Total £6,033,833 £12,685,610

Focus of investment - ICT

Should additional monies become available, we must invest in the aging

infrastructure to provide resilience to the 2020 vision and alternative work styles.

In order to deliver most efficiently and cost effectively what is required, the eHealth

team is moving towards the following business model as part of the need to develop

systems and processes to support the business requirements. The red star is our

assessment of our current position and the blue star shows our target for around

2014 with the aspiration of complying with the full business model around 2020, this

may well be difficult to achieve as the level of investment required is generally only

made by financial and blue chip companies.

Uncoordinated,

Manual

Infrastructure

Knowledge Not

Captured

Security Risk

Inefficient

Managed IT

Infrastructure

Limited

Knowledge

Capture

Limited

Automation

Managed &

Consolidated IT

Infrastructure

Extensive

Knowledge

Capture & Use

Extensive

Automation

Fully Automated

Management

Automated

Knowledge

Capture & Use

Dynamic

Resource Usage

Business Linked

SLAS

Cost Centre –

Fighting Fires

More Efficient

Cost Centre –

Gaining Control

Business

Enabler

Strategic

Asset

BASIC STANDARDISED RATIONALISED DYNAMIC

Uncoordinated,

Manual

Infrastructure

Knowledge Not

Captured

Security Risk

Inefficient

Managed IT

Infrastructure

Limited

Knowledge

Capture

Limited

Automation

Managed &

Consolidated IT

Infrastructure

Extensive

Knowledge

Capture & Use

Extensive

Automation

Fully Automated

Management

Automated

Knowledge

Capture & Use

Dynamic

Resource Usage

Business Linked

SLAS

Cost Centre –

Fighting Fires

More Efficient

Cost Centre –

Gaining Control

Business

Enabler

Strategic

Asset

BASIC STANDARDISED RATIONALISED DYNAMIC

A productive asset base to support our strategy

The knowledge of what we have and the condition it is in is covered in the preceding

paragraphs. Using that knowledge, we will utilise existing assets, advise on

investment needs to maximise capacity, increase service productivity within available

funding and achieve a productive asset base that:

Fully supports improved access and service user experience.

Provides accommodation and assets that are clinically suitable and effective,

and meet or exceed patient and staff expectations and are affordable and

sustainable.

Minimises risk and promotes safety for people who use our services, our staff

and visitors.

Disinvests from assets with high operating costs, backlog maintenance

requirements, or short remaining life where these do not meet future service

requirements, releasing capital to reinvest into new and existing assets.

Improves property and asset performance on all key performance indicators,

ensuring that we meet all targets set by the SGHD.

Develops supporting infrastructure for optimum operational effectiveness.

Co-locates or preferably integrates services with other health and care facilities

wherever possible thereby improving inter-professional working.

Develops inherent flexibility in our owned and leased assets, to enhance our

responsiveness to service needs or activity adjustments, for both positive and

negative variations.

Develops an ICT infrastructure that supports the organisational

objectives, including reducing the number, complexity and power consumed by

our PCs and Server estate.

Utilises technology to maximise efficiency.

The Board will further engage with its partners through groups such as Grampian

Public Sector Strategic Property Asset Group (GPSSPAG) to rigorously examine the

opportunities to collaborate, co-locate and where possible integrate services. This

should be fully reflected in the reviewed GPSSPAG Integrated Property Strategy and

support and enable this PAMP.

Where do we want to be?

Changes are taking place both within Grampian and across the country to make sure

that NHSScotland is in the best possible shape to meet future health needs and

improve people’s well-being. There are a number of national and local policies and

initiatives aimed at making NHSScotland more effective and efficient such as Better

Health, Better Care: Action Plan, the NHSS Quality Strategy and the Efficiency and

Productivity Framework.

Challenges that will influence our infrastructure plan

Some of the most significant challenges to be faced relate to demography, location

of existing and new (emerging) settlements (communities), public health, finance and

the age and condition of the facilities and buildings used for the delivery of

healthcare in Grampian. All of these challenges need to be understood and influence

the change that is necessary. The condition of our infrastructure is set out in the

preceding section, with a summary of other influencing factors noted below:

Demography

The changes in the demography of the population in Grampian are predicted to have a significant impact on the pressures on all public services, including health. These include:

Males in Grampian have the second highest life expectancy (77.3 years) and

females the fifth highest life expectancy (81.3 years), when compared with other

areas in Scotland. Population projections suggest that the population of

Grampian will increase 21.2% by 20352.

Children aged between 0-15 years are expected to increase 18% by the year

2035. Adults of working age (16-65 years of age) are predicted to increase by

9% and people over 65 years of age by 77% within the same time period.

In line with many parts of the UK, the age dependency ratio (the number of

people aged 65 and over compared to those aged 16-64 years) is increasing in

Grampian.

Strategic Asset Impact

Changes in our population profile have major implications for service provision. Older

people are high users of health services and once admitted, patients in this age

group typically have a longer length of stay in hospital compared to younger age

groups. In order to respond to these challenges, new models of health improvement

and care provision must be developed, involving a shift from more acute hospital

based care to community care, in line with both the Scottish Government’s and NHS

Grampian’s 20:20 Vision.

2

source GRO

Workforce

Consistent with Healthfit 2020, we have established a similar vision for the future of

our workforce centred around: employing a leaner, more flexible, multi-skilled

workforce and enabling and empowering people to take responsibility for their own

health. Our workforce of the future will be organised in an integrated way, focusing

on the needs of the individual rather than the desires of the professional. Whilst

managing growth and demand, healthcare professionals will be more accessible to

the public and to each other. The particular matters that will influence our future

strategy regarding accommodation will include:

Increased investment in technology will mean that the skills staff require will

need to change. Technology will be used to bring people closer together,

supported by investment in infrastructure which will support a technologically

adept system of care delivery.

Integrated team working will become increasingly vital to successful delivery of

the 2020 vision. Supporting teams to come together to work in a different,

integrated way will require active encouragement and support. Teams will be

empowered to actively remove barriers to delivering person-centred care, to

develop core behaviours and skills to enable better and more streamlined

delivery of service. Whilst many staff will work in teams, much as now, for others,

teams will be distributed. More staff will be working flexibly, not require a

permanent base or office, with links to wider support facilitated by enhanced use

of IT and tele-links.

Managers will have a role to support and encourage their teams to develop.

They will also support individuals to develop their leadership skills, trust and

respect. Developing themselves and others are key requirements for future

leaders within the NHS. Training and investment in staff development will be a

core competency for all managers if we are to sustain a skilled and competent

workforce.

Area based working – we have well developed relationships with the three local

authorities within the Grampian area and wider public sector partners. In the last

year, we have held joint meetings in relation to identification of capital investment

priorities and participate in the future infrastructure requirements for services

resulting from development sites supported through the Local Development Plan

process. This has led to further detailed discussions with:

The Moray Council regarding joint development of a 2020 vision for the area

based on the concept of our Healthfit 2020 vision. This has enabled us to

commence the process of identifying opportunities to work together to jointly

develop proposals or link developments in order to meet the needs to the Moray

population.

Aberdeenshire Council regarding joint service developments around Inverurie,

the potential for further joint working in other priority areas such as Fraserburgh

and Peterhead as well as the sharing of accommodation.

Aberdeen City Council regarding the joint marketing of shared surplus assets

and potential for future joint developments such as the integrated Drug

Treatment and Rehabilitation Centre which opened during 2012/13.

Development gain: we have progressed discussion with all local authorities in

Grampian around engagement in assessing the impact of future residential

developments and how this will ensure a joint approach to maximise the public

benefit by increasing the size of new and existing communities.

Settlements (communities)

Many of our buildings are historically located and take little or no account of the

demography changes, population movements or the creation of new settlements.

The Aberdeen City and Shire Strategic Development Plan was approved by Scottish

Ministers on the 14 August 2009. The new structure plan marks a radical departure

from previous documents by focusing on development needs over the next 20 years.

It lays out objectives, targets, delivery mechanisms and monitoring arrangements to

ensure the policies and proposals are achieved. The structure plan maps out

mechanisms to boost the North East population by 40,000 by 2030.

The structure plan called for quick progress in preparing Local Development Plans in

both City and Shire and for the release of land as quickly as possible.

The proposed Aberdeen City Local Development Plan (LDP) was published in

September 2010 and the proposed Aberdeenshire LDP was published in July 2010.

Both plans have progressed through the various consultation processes and were

approved by the Scottish Ministers and adopted by the Councils in Feb 2012 and

May 2012 respectfully.

The Growth expected within existing and new communities will necessitate NHS

Grampian to review how it currently provides services to communities which may

result in further financial investment in primary care premises.

The Moray Council is in the process of preparing a new LDP and has just published

the Main Issues Report for 12 week consultation period ending on the 15 Feb 2013.

The Property and Asset Development Team will be responding to this report on

behalf of NHS Grampian.

Partnership working

In terms of partnership working we have a strong level of engagement with our

sector partners in the North East which extends beyond an awareness of the Local

Development Plans and respective asset management plans. This commitment to

partnership working is reflected in a number of ways:

North Territory Partnering Board (NTPB): the NTPB comprises the 19 public

sector participants in the North Territory and is responsible for the Strategic

Leadership input into the hub programme and ensuring that there is a coordinated

approach to planning for the future accommodation and service delivery in the

territory. Through the hubCo process we have developed the Aberdeen Health

Village project (in partnership with Aberdeen City Council and Grampian Police) and

will shortly conclude a bundle of health centre projects (in partnership with NHS

Highland and with support from The Moray, Aberdeen City and The Highland

Councils).


Infrastructure requirements identified include potential land and buildings required to

support the services that the additional population will require. Healthcare

requirements, mainly for primary care, may be in the form of an extension to an

existing facility or a new facility if the existing one does not lend itself to expansion or

if the requirement is to support a new community.

The LDPs will identify where support is expected from landowners in the form of

developer contributions to provide sites and healthcare facilities.

For more detailed analysis see Appendix F

Improving Public Health

Scotland faces many public health challenges. Whilst good progress has been made

on cancer, heart disease and stroke, much needs to be done to ensure that

incidence rates and treatment standards are amongst the best in the world. Further

challenges remain including the rise in obesity, physical inactivity, harmful use of

alcohol and liver disease, and the ongoing need to reduce smoking rates.

In Scotland as a whole over 170,000 bed days in non-psychiatric hospitals in

2007/08 were associated with alcohol-related illness at a cost to NHS Scotland of

around £84 million. Specifically by percentage of population, the impact on Grampian

would be circa £8 million.

By 2016, it is estimated that Grampian will see an additional 1106 cases of cancer

each year. Colorectal cancer is expected to have the greatest increase, yet 43% of

this type of cancer is preventable according to the World Cancer Research Fund.

82% of lung cancer is related to smoking as is 86% of the diagnosis of chronic

obstructive pulmonary disease, which increases year on year in Grampian.

Scotland’s rate for coronary heart disease remains one of the highest in Western

Europe where around a third of hypertension and nearly half of type 2 diabetes are

due to obesity.


We are committed to working in partnership with local authorities, housing

associations and the voluntary sector to develop an integrated and joint approach to

maximising available infrastructure to encourage and promote a focus for public

health improvement in communities with specific plans. Empowering communities to

control their futures and create tangible resources such as services, funds and

buildings will form a key part of our medium to long term health improvement plan.

Strategic Vision – Healthfit 2020

In 2002, we began a new approach to developing a way forward for the health

service in Grampian, and how we might achieve it. Members of the public were

involved with doctors, nurses, allied healthcare professionals and managers in

thinking about how health services should be improved and developed across

Grampian. We have used this method since then and we call this process Healthfit.

We have just completed a refresh of the original Healthfit vision in order to provide

greater detail and direction, based on the Grampian Health Plan 2010-13, and the

emerging needs of the population of Grampian. The refresh of the strategic vision is

reflected in Healthfit 2020.

Healthfit 2020 brings together significant information and advice which has been

provided by managed clinical networks (MCNs), pathfinder projects, the

management structure and the clinical advisory structure. This information and

advice, together with the Quality Ambitions described in NHSScotland’s Quality

Strategy, clarify the overarching principles that guided the development of the

strategic vision. Healthfit 2020 (previously referred to as the Health and Care

Framework) was approved by the NHS Grampian Board in October 2011.

The Healthfit Vision for 2020 supported by the Health and Care Framework process

puts the application of technology at the forefront of a new sustainable model of

patient care, utilising the investment in PMS to create an electronic health record

system, allow patients to book appointments remotely and with further investment in

technology support patients in their homes.

The change envisaged in Healthfit 2020 can be achieved through the development

of a number of themes, all of which will have significant implications for this plan.

These themes are summarised as follows:

Organisation of healthcare around communities:

Integration of healthcare around communities and with acute services and key

partners. To be supported through decentralising access to acute services

and investment in information technology.

Reducing the need for inpatient care:

Actively developing more opportunities for home and community based care

through partnership working with local authorities, the third sector and

communities themselves

Planned re-use of existing inpatient resources, by more appropriate

community based care – revenue funding, capital funding, staff, buildings, etc.

Creation of a new infrastructure for healthcare with less emphasis on

buildings, but with more emphasis on technology and more innovative use of

community resources, ensuring that the facilities that are necessary for

healthcare are well maintained and equipped

Developing and empowering communities:

Active participation of individuals and communities in the promotion of health

and supporting the more efficient use of health resources

Provide a focus for public health improvement in communities with specific

plans for community/public/voluntary/private sector involvement

Empower communities to control their futures and create tangible resources

such as services, funds and buildings

Transform services for older people:

Focus on partnership working with local authorities and the third sector

through the Change Fund

More rapid move from inpatient care to home/community care

Better Health, Better Care Better Health, Better Care sets out the actions that would lead towards a ‘Healthier

Scotland’ and its three main components of health improvement, tackling health

inequality and improving the quality of health care.

In developing our Plan for asset management, we have maintained a focus on

ensuring that our investment plan supports people to sustain and improve their

health, especially in disadvantaged communities. Investments in services and our

asset base across NHS Grampian will ensure that we provide better, local and faster

access to services.

The design of our services and future infrastructure will be based around

improvement in patient centred care which is respectful, compassionate and

responsive to individual patient preferences, needs and values. Principles that we

have adopted in terms of our decision making process include integration of health,

social and individualised care; health improvement and inequalities focus; large

scale application of best practice; and re-allocation of resources to target need and

deprivation.

Strategic benefits and improvements that we will deliver Property

NHS Grampian will take action to move in the agreed strategic direction as laid out in

our 2020 vision; we will also endeavour to improve the management and

performance of all our buildings, equipment and infrastructure as per the

performance framework. There is, however, limited funding available and innovative

solutions will be required to meet our needs.

In terms of our plans for the period of the PAMP, we would highlight the following

strategic benefits:

Foresterhill Health Campus

The Foresterhill Health Campus is still in need of much development in line with the

Foresterhill Development Framework that was completed in 2008. It has formed the

background to significant recent redevelopment on site including the Emergency

Care Centre, Aberdeen Dental School and the Energy Centre.

Over the next five years, we will:

realise clinical service improvements and benefits for unscheduled care arising

from the opening of the Emergency Care Centre investment of decision support

across the North of Scotland;

invest in the creation of additional theatre capacity as part of our commitment to

improving access to operative treatment in Grampian. An associated investment

in increasing orthopaedic theatre capacity at Woodend Hospital will also be

made;

implement the reconfiguration plan which will facilitate the significant reduction in

backlog maintenance within inpatient accommodation (Phase II and East End

Block 2) and the transfer of services from Woolmanhill Hospital (enabling this

site with significant backlog maintenance to be closed); and

progress investment in cancer services including completion of the linear

accelerator replacement programme, the opening of the Maggie’s Centre on the

campus and commissioning of a further fundraising campaign to support the next

phase of infrastructure investment.

In the medium to longer term the Foresterhill site Development Framework will be

reviewed to ensure it meets the requirements of our vision, and other emerging

issues on the site. Decisions will be required on the investment/disinvestment plans

for Phase I, Phase II, ARI East End, Maternity Hospital, Medical Physics current

accommodation and the East End of the site including the CSSD, Laundry and the

Estates buildings.

Other Acute and Mental Health facilities

In terms of other significant acute and mental health facilities, our plans for the

immediate future will focus on the following:

Completion of the sale of surplus property on the Cornhill Hospital site

(Aberdeen). Preferred bidders have been appointed and sales proceeds are

anticipated in 2014/15 and 2015/16;

Completion of the reconfiguration works at Dr Gray’s Hospital including fire

regulation works and relocation of the cook / chill catering facility from Aberdeen;

and

Significant progression of the closure of South Block at Woodend Hospital and

relocation of services to fit for purpose accommodation, which may result in part

of the site being declared surplus.

Community Hospitals

Community Hospitals will continue to play a significant role as part of the pattern of

services and facilities which deliver healthcare to local communities. There have

been many changes affecting community hospitals and this change will continue as

the health and social care services integrate and focus on care at home.

The form the facilities take in the future will be different depending on the position of

existing services, local authority and third sector activity, and the capacity of the local

community to participate in the healthcare system.

The detailed future configuration of Community Hospitals will be the subject of

comprehensive community planning work undertaken jointly by the NHS, local

authorities and the third sector using the Community Planning Structures of the local

authorities.

Non-clinical accommodation

We will have a programme focused on reducing our footprint required for non-clinical

accommodation through a commitment to exploiting alternative work styles. We

have already identified opportunities to decrease office accommodation

requirements in Aberdeen and rationalisation of non-clinical accommodation in Elgin

through a relocation of administrative staff to other sites in town. We are in the

process of identifying opportunities to deliver benefits through working with our local

authority partners.

The targets set out below for our property portfolio have been developed on the

following assumptions:

A £24m reduction in backlog by the 31st March 2014 is as a result of the

committed major capital schemes being completed, including the disinvestment

of the old emptied areas, plus prioritised expenditure directed at significant and

high risk backlog.

A further £15m reduction in backlog between 2014 and 2016 is as a result of

disposals and an increased prioritised expenditure directed at significant and

high risk backlog.

By 31st March 2021, a further reduction in backlog of £10m as a result of further

rationalisation of the estate driven by service redesign and prioritised

expenditure directed at significant and high risk backlog. Targets for Improvement in Property Condition and Performance

Facet

Condition / Performance of NHS Grampian’s

Property Portfolio

Previous

Performance

2011/12

Current

Performance

2012/13

Target

Performance

for 2013/14

Target

Performance

for 2016/17

Target

Performance

for 2020/21

Physical

Condition

(Appraisal ranking

A or B)

41% 45% 50% 70% 85%

Functional

Suitability

(Appraisal ranking

A or B)

64% 67% 75% 80% 85%

Quality

(Appraisal ranking

A or B)

70% 72% 80% 85% 90%

Space Utilisation

(% fully utilised) 80% 81% 82% 83% 90%

Average SCART

Score 54.6 54.6 65 75 85

Average Energy

Consumption PI

(GJ/100m3)

78.9 75 70 60 55

Backlog

Maintenance

(Significant &

High risk items)

£59m £53.6m £35m £20m £10m 1

1 Over the period of the PAMS other risks will escalate to become significant or high and they are as yet unidentified.

Essential equipment replacement programme

NHS Grampian had equipment assets with a net book value of £50m at 31st March

2012 (gross cost before accumulated depreciation of £145m). At this date some

1,600 individual assets were fully written down with 330 older than 10 years – see

below.

Gross Cost No of assets

Assets – fully written down as at 1 April 2012 £43m 1,556



Assets – fully written down as at 1 April 2025 £8m 212

£145m 4,234

Equipment

Recognising our ageing asset base, and with additional financial help from the

SGHSCD, we invested a total of £15.3m in equipment purchases during 2012/13 of

which £13.9m was targeted at essential equipment replacement and £1.4m at new

technology initiatives that will result in reduced waiting times.

Whilst this represented a significant investment in the replacement of essential

equipment, the above table highlights the extent of the backlog that we have to

address.

ICT

The key target over the term of this Strategy is to progress with the move to an

Electronic Patient Record system (EPR) and to exploit the options for increased

operational effectiveness. Some of the components to deliver this include:

Ongoing development of PMS and inclusion of additional clinical modules

Move to Scan on Demand for Acute, Mental Health and A & E Records

Review options for Appointment/Result reminders and Patient Self Check-in

Capture of all Clinical Correspondence electronically

We will also target improvement as follows:

Reductions in the number of desktop PCs and the power consumed by them by

implementing thin client terminals running virtual desktops

Provision of additional ICT roaming features to users and to overcome the

inflexibility of a wired network in difficult or remote locations

Installation of IP telephony to complement and replace traditional analogue

telephone systems

Our financial plans outlined in the Local Delivery Plan (LDP) provide for investment

in essential equipment replacement as follows:

PLANNED INVESTMENT IN EQUIPMENT REPLACEMENT

Asset Category 13/14 14/15 15/16 16/17 17/18 Total

£000s £000s £000s £000s £000s £000s

Imaging (CT / Ultrasound / MRI / Gamma Cameras) 494 772 714 713 1,089 3,782

Other X ray (Angio / Dental / Fluoroscopy / General X Ray) 967 1,512 647 295 451 3,872

Radiotherapy 1,643 0 0 704 150 2,497

PET Replacement Programme 0 2,070 0 0 0 2,070

IV systems (Syringe and Volumetric Pumps) 288 450 416 416 635 2,205

Other medical equipment e.g. defibrillators, dialysis machines, endoscopes 1,752 2,217 2,120 2,118 2,749 10,956

Support services vehicles 0 250 0 250 250 750

Other vehicles 0 0 0 0 0 0

Plant and machinery 0 0 0 0 0 0

Other equipment 200 280 0 250 250 980

Storage, comms, networks and data centres 496 500 463 462 1,059 2,980

Other IT equipment 0 0 0 0 0 0

IT systems 441 444 411 410 941 2,647

Total 6,281 8,495 4,771 5,618 7,574 32,739

Sustainability and carbon reduction Environmental sustainability

As an organisation, NHS Grampian has set the priority of the drive towards

improvement in environmental performance. Examples of this commitment include:

Following the release of the Scottish Government Zero Landfill Directives, NHS

Grampian is initiating a programme of work that will play a key part in moving

towards achieving these. Working in partnership with our current Contractor, the

objective of this programme of work will be to change the way in which landfill waste

is managed throughout the organisation. Elements of the programme are already

underway and the reverse logistics process for materials that are being reclaimed is

being constructed. Part of this process will be to look at the potential use of electric

vehicles on the Aberdeen Royal Infirmary campus and other specific geographical

areas throughout NHS Grampian.

Transport The focus areas for improvement that have been identified include:

National Distribution Centre: Vehicle utilisation improvement

NHS Grampian: Significant reduction in “final mile” transport movement

NHS Grampian: Capital reduction vehicles

NHS Grampian is currently working in partnership with NSS National Procurement in

a “Final Miles” project, which is now awaiting approval to move to the next stage.

The objective is to identify and focus on specific areas for improvement that will

result in greater efficiencies in the overall Supply Chain and its Fleet Management

that will be mutually beneficial to both organisations and, therefore, to NHS Scotland

as a whole. Target to reduce “final mile” transport movements: initial data identifies

utilisation improvement of between £120,000 - £200,000 pa.

The outcomes from the above work and the future developments around it will have

a direct impact in vehicle investment for the next five to ten years for NHS Grampian.

Once all the work is complete and bedded in, this will inform and enable NHSG to

develop the appropriate planning around the future Fleet Strategy and its evolution.

Through the Health Transport Action Plan (HTAP) access to healthcare THInC pilot,

it is expected that a business case will be produced to confirm future direction as to

how access to healthcare can be improved. The HTAP initiative of shared mail run

and utilising electric vehicles is to be further developed to consider wider deliveries

of all logistics.

Recent purchase of HGVs, all with Euro5 engines, delivers a greatly reduced carbon

footprint and provides greater fuel efficiency. Safe and fuel efficient driving is part of

the driver CPC which all drivers are undergoing and this has shown how safe and

fuel efficient driving can result in average fuel savings of 10%, a reduction in carbon

and CO2 emissions, and a reduction in gear changes of 37%.

Conclusion

The Board believes that our investment plan should be directed towards:

Improving estate and asset performance on all key performance indicators,

including a significant reduction in significant and high risk backlog

maintenance and a continued programme of essential equipment replacement.

Responding to new and improved ways of delivering services that require fewer

assets as services will increasingly be delivered in people’s homes, on an

outpatient basis, on a mobile basis and through the use of new technologies

such as video conferencing.

Disinvesting from buildings with high operating costs, backlog maintenance

requirements, or short remaining life where these do not meet future service

requirements.

Seeking further innovative solutions to property needs through co-location,

integration and shared services/resources across Grampian with all its

partners.

Investing and developing new technology that achieves simplification of the

existing ICT infrastructure, while simultaneously allowing additional investment.

Within the following section of the Plan, we set out how we would propose to invest

our assumed capital allocation for the next five years and our priorities for the five

years beyond.

This represents a further significant investment in our asset portfolio; however there

remains a high degree of risk associated with the need for sufficient investment in

the replacement of:

Essential medical equipment

Upgrading the 15 year old ICT infrastructure

All of this is necessary to enable us to modernise the way we deliver efficient clinical

care that embraces the 2020 vision.

Backlog maintenance Within the PAMP, we are committing to a plan to reduce our backlog maintenance by

£59m (compared to an overall maintenance requirement in excess of £160m),

targeting investment at high and significant risk as a priority. Whilst this will improve

the performance of our estate, further availability of capital would enable us to

address significant issues within Aberdeen Maternity Hospital, the main outpatient

block at Aberdeen Royal Infirmary (Phase I) and a number of our health centres.

Essential Equipment

During 2012/13, we have demonstrated the significant benefits to the sustainability of

clinical and clinical support services through investment in the replacement of

essential equipment. Our ability to continue with the progress made during 2012/13,

will be dependent on commitment to the plan set out above and continuing to work

with Scottish Government to secure additional allocations, wherever possible.

ICT

Over the next five years, we will invest a further £5.7m in our ICT assets. Given the

key role that ICT will have in the modernisation and redesign of our clinical service

model, this will be insufficient to maximise the potential benefits that could be

delivered. If we are to realise our ambitions to unlock the potential of ICT to support

developments such as – clinical decision support and No Delays - further

investment beyond that in our current plan will be required (see table below)

Clinical Decision Support will bring together a wide range of clinicians to

provide support to professionals at the first point of contact with patients who

require unscheduled care. The basic infrastructure is included in the ECC. This

service if developed has the potential to provide decision support to other NHS

bodies, public sector partners such as local authorities, prisons and police, and

could extend to commercial partners within the oil and gas sector.

No Delays aims to transform the relationship that patients have with services

and clinicians in planned care. No Delays will provide patients and GPs with

much more information, support and involvement in the care of a range of

conditions by using video and tailor-made websites for patients called patient

postcards. Proof of concept work is underway which includes filming clinicians

in five specialties and evaluating the outcomes over the next three months.

The success of the project longer term will be dependent upon investment in

our ICT infrastructure.

Target

Replacement

Cost Per Annum

Current

Investment

2011/12

Target

Investment

2012/13

Target

Investment

for 2013/14

Target

Investment

for 2016/17

Target

Investment

for 2020/21

Servers/Data Centres (< 5 yrs) £778,000 100% 100% 100% 100% 100%

Desktop/Mobile (< 5 yrs) £1,900,000 18% 25% 70% 90% 100%

Telecoms (< 5 yrs) £214,000 21% 27% 50% 60% 100%

Networks (< 5 yrs) £220,000 37% 69% 70% 90% 100%

Wireless WiFi (Node Coverage) (< 5 yrs) £100,000 65% 85% 90% 100% 100%

Video Confernecing (< 5 yrs) £225,000 70% 65% 70% 90% 100%

Backlog Maintenance £3,437,000 £ 1,468,840 £ 1,693,830 £ 2,616,500 £ 3,116,900 £ 3,437,000

Facet

Condition / Performance of NHS Grampian’s

Property Portfolio

How do we get there?

How we will implement the plan

We will achieve the asset investment element of our Healthfit 2020 vision through,

but not be limited to, the following:

Public Engagement

Involvement and participation in change – taking account of public views and

raised public awareness of the future for health and care services

Implementing a consistent decision making process – which will give a

consistent and rational approach to decision making and resource allocation

throughout NHSG which is measured against and in line with the organisational

priorities

Formulating Health and Healthcare Plans to improve and modernise

Service Reviews – formulate a Process for Grampian-wide service reviews

Locality Reviews – formulate a process for reviewing the needs of the

population of localities and how those needs can best be met

Managed Clinical Networks – to be re-focused to support our focus on planned

and unplanned care and service integration

Joint Commissioning Plans – Ensure plans in place to support the improvement

and integration of services for elderly people

Business Case Development

Each solution will be developed through a business case process with every project

commencing with an initial agreement through to Standard Business Case or Outline

and Full Business case. Wide ranging options will be considered from do nothing or

do minimum, with each option being considered as the preferred option or rejected.

In order to achieve the 2020 vision, sometimes options that appear radical will be

considered, Maud being a case in hand whereby the community owns the facilities.

A similar option is now being developed at Crimond; where communities supported

by NHS Grampian wish to take the lead with sometimes ambitious plans to support

their community.

Governance, Performance and Risk Management

The implementation of this plan will be supported and monitored through a robust

governance and performance management framework, the key elements of which

are set out below.

We have clear and detailed arrangements for monitoring implementation. These

arrangements will include:

Performance monitoring - an explicit and integral part of implementing this plan

is the regular reporting on performance to the Asset Management Group and

Performance Governance Committee of the Board

Key Performance Indicators – key performance indicators identified in CEL 35

(2010) are monitored

Asset Condition Surveys – we have plans to continue to update the NHS

Grampian property condition and performance data through a five yearly cycle

of re-surveys as required in CEL 35 (2010).

Through continued full involvement in the development of Structure Plans and

Local Plans as developed by Planning Authorities. Continued critical review of

NHS Grampian’s Asset Base

The importance of investment in and maintenance of our asset infrastructure is

reflected as a strategic risk to NHS Grampian, articulated as follows:

There is a risk that our infrastructure will not be fit for purpose if we are not able to

fund an adequate asset investment, replacement and backlog maintenance

programme or redesign of service provision to reduce dependence on physical

buildings.

The responsible officer for managing this risk on behalf of the Board is the Director of

Finance who provides formal assurance to the Executive Team and the Board

(through the Performance Governance Committee) on the actions implemented to

mitigate the risk.

The monitoring of the actions implemented to mitigate the strategic risk is primarily

undertaken through the monthly meetings of the Asset Management Group.

Beyond the strategic risk register, risks associated with our infrastructure are

captured and monitored at a service level through our operational performance

arrangements, with all risks and mitigating actions captured within our DATIX

system. At an individual project level, detailed risk registers are also maintained and

updated through the respective project boards established to monitor their progress

from inception through to commissioning.

Further details of roles and responsibilities around the performance framework are

presented in Appendix A

Innovative use of technology

eHealth Strategy - focused on the longer planning horizon and matches the

ambition of the Healthcare Quality Strategy for NHSScotland and eHealth’s role

in enabling quality improvements to healthcare services across Grampian and

wider NHSScotland. The delivery plan will be agreed through the eHealth

Committee and National eHealth Programme Office at Scottish Government.

DALLAS (Delivering Assisted Living Lifestyles at Scale) - Utilise the DALLAS

project to test investment in the use of tele-healthcare and assistive

technologies for people living with long term conditions

Clinical Guidance Internet (CGI) - Consistent and credible guidance available

which guides clinicians in the use of clinical services and facilities

Our investment programme for the next 5 years

This Plan sets out the Board’s priorities for managing the infrastructure that supports

the delivery of patient care and associated services across NHS Grampian and is

integral to the delivery of the NHS Grampian Healthfit 2020 vision.

The plan is focused on actions across four main areas:

Investment in infrastructure consistent with our strategic health priorities

including initiatives to reduce carbon emissions;

Reduction in high and significant risk backlog maintenance in clinical areas and

compliance with statutory requirements;

Replacement of essential equipment and ICT infrastructure to enable the 2020

vision;

Disposal of assets declared surplus to requirements.

The supporting financial plan incorporates the resources aligned against these areas

of expenditure financed from revenue operating budgets, the capital programme and

through asset disposals.

We have assumed a formula capital allocation over the five years of the plan

consistent with that outlined in NHS Scotland Chief Executive’s letter of 10th

February 2012. This is in addition to previously approved brokerage and funding for

legally committed schemes and other nationally agreed investment programmes

such as the Carbon Energy Fund, hub initiative, the National Radiotherapy

equipment replacement programme and the National PET replacement programme.

Our plans are summarised as follows:

Investment in strategic health priorities

Our investment in modern new build facilities continues to be recognised in 2013/14

and 2014/15, with the hub projects – Health Village (£14.8m), Woodside Health

Centre (£4.0m) and Forres Health and Care Centre (£5.6m) reflected on our balance

sheet, the completion of Phase II of the National Radiotherapy programme,

investment in primary care facilities including a new Community Maternity Unit at

Inverurie (£700k) and Health Centre (£4m), and completion of additional dental

surgeries at Fraserburgh and Stonehaven. Each of these projects will have a direct

impact upon the delivery of our strategic vision for NHS Grampian.

Investment in integrated services

Aberdeen Health and Care Village (£14.8m) – as the first Design Build Finance

and Maintain (DBFM) project delivered under the hub revenue funding model in

Scotland, the Village project will provide a wide range of services and facilities in

a purpose built building at Frederick Street to support the community of

Aberdeen City primarily. The building will also accommodate partner agencies

such as Grampian Police and Aberdeen City Council. The Village will replace, in

part, outdated accommodation at the former Woolmanhill Hospital and Denburn

Health Centre which are no longer fit for purpose. The Project started on site in

April 2012 with completion expected by the end of 2013.

NHS GRAMPIAN SUMMARY INFRASTRUCTURE AND BACKLOG MAINTENANCE PROGRAMME

13/14 14/15 15/16 16/17 17/18

Total 5

Year Plan

AVAILABLE FUNDING £000s £000s £000s £000s £000s £000s

Sub Total Core CRL 34959 31895 10703 11254 13319 102129.5

Sub Total Non Core CRL 24393 0 0 0 0 24393

Total Gross CRL 59352 31894.5 10703 11254 13319 126522.5

Withdraw al of NBV benefit by SGHSCD (11,410) (397) (1,894) 0 0 (13,701)

Total Net CRL 47942 31497.5 8809 11254 13319 112821.5

OTHER FUNDING SOURCES - CAPITAL

Estimated Actual NBV benefit on disposal - property 4,883 5,992 3,160 0 0 14,035

Charitable Contribution - Theatres 600 0 0 0 0 600

OTHER FUNDING SOURCES - REVENUE

Estimated Net Surplus on Disposal of Property 1,289 1,859 1,922 0 0 5,069

Estates Maintenance operational budget 1,200 1,200 1,200 1,200 1,200 6,000

Non Value added Infrastructure budget 250 250 250 250 250 1,250

TOTAL FUNDING AVAILABLE FOR INFRASTRUCTURE AND BACKLOG MAINTENANCE 56164 40799 15341 12704 14769 139776

PLANNED EXPENDITURE

Strategic Investment 38,167 8,034 0 0 0 46,201

Backlog Maintenance/Statutory 6,654 23,135 10,375 6,890 6,999 54,053

Essential Equipment Replacement 10,597 9,134 4,471 5,319 7,275 36,796

Other 745 495 495 495 495 2,724

TOTAL GROSS EXPENDITURE 56163 40798 15340 12704 14769 139774

SURPLUS (+)/DEFICIT (-) 0 0 0 0 0

Investment in communities

Forres Health and Care Centre and Woodside Fountain Health Centre

(£9.6m) – These projects will provide new facilities to replace the existing Forres

Health Centre (and the ambulatory care functions currently delivered from

Leanchoil Hospital) and a new multi-disciplinary Medical Centre and Dental Unit

at Woodside, Aberdeen. The projects are being delivered under the hub revenue

funding model and contractually with NHS Highland who are delivering a new

centre at Tain. The transaction is scheduled to achieve financial close by 31st

March 2013.

Three new dental facilities at Fraserburgh, Stonehaven and Peterhead as

part of our commitment to further increasing the provision of NHS dental care in

areas of highest need and priority.

Develop increased GP capacity for Inverurie Health Centre and establishment

of the Community Maternity Unit at Inverurie Hospital. These two projects

are part of our programme to enhance primary care services for this area of high

population growth.

Denburn Health Centre requires replacement and along with the Medical

Practice we are actively looking for affordable appropriate solutions.

Crimmond Medical Practice will to relocate to a new purpose built building that

will be provided by a local benefactor and which will be run and operated by a

charitable trust.

For each of the above projects a Project Director and as appropriate a Project Team

will be appointed with clearly defined responsibilities and governance arrangements

through a Project Board reporting into the Asset Management Group. These

arrangements will also be extended to all future projects at the appropriate juncture

and in accordance with the Scottish Capital Investment Manual.

Investment in health priorities

Additional theatre capacity (£7.6m) will be created at Aberdeen Royal

Infirmary and Woodend Hospital as part of our strategic investment in planned

care capacity consistent with our commitment to meeting our obligation under

the Treatment Time Guarantee. More patients will have their operative

procedures delivered in Grampian as a result of the increased capacity which will

be available at the end of 2013.

National Radiotherapy Programme – The National Radiotherapy programme

funding up to 2014/15 will be used to provide replacement Linear Accelerators

and associated bunkers in a configuration which is consistent with the future

development of the Cancer Centre. The first stage of this was completed in June

2012, with the second stage to be completed during 2014/15.

Maggie’s Centre, currently under construction on the Foresterhill site, providing

compatible cancer therapies and being funded by donations to the Maggie

Keswick Jencks Cancer Caring Centre Trust.

Reducing carbon emissions

The Board is committed to reduce the level of carbon emissions across our property

base and all new developments are now delivered with integral technology designed

to reduce energy use and consequently carbon emission levels.

The new combined heat and power plant at Foresterhill was brought in to operation

during 2012/13 and funding approved through the national carbon reduction

programme to develop a biomass boiler at Royal Cornhill Hospital to be operational

in 2014.

In addition the Board has a become member of the Carbon Energy Fund and a

business case is under development to implement new technology at our four major

hospital sites that will see a guaranteed reduction in energy usage/carbon emissions

in the coming years.

Reduction in backlog maintenance statutory compliance

The Annual State of NHSScotland Assets and Facilities eport highlighted, nationally,

many of the issues that are the focus of our local Property and Asset Management

Plan. The report places particular emphasis on the extent of backlog maintenance

that our remaining estate requires in order to bring the accommodation up to the

relevant physical and statutory standards. Accordingly our financial plans allow for

substantial resources to be targeted at the key priority of delivering a demonstrable

reduction in high and significant risk backlog maintenance in clinical areas, whilst

maintaining an essential equipment replacement programme.

During 2012/13 we secured SGHCD support for our proposed backlog investment

programme over the next five years. This programme reflects the commitment within

NHS Grampian to address this gap by prioritising available capital and revenue

funding together with asset disposal proceeds to target an 88% reduction in high and

significant risk backlog maintenance in clinical areas over the next five years. The

key areas of focus are on the following:

Although recent events have required that we again re prioritise our investment plans

and this has impacted on timing of planned expenditure against specific schemes,

the overall impact of the re-phased programme on our backlog maintenance levels

over the period of the LDP remains consistent with that previously agreed.

The key areas of focus are on the following:

targeted investment at the sites with the highest level of backlog maintenance –

Aberdeen Royal Infirmary Phase II and East End Block II (£20.6m) and

Denburn Health Centre (GP practice will be relocated); and

commitment to a programme of works to address backlog and statutory

compliance issues across the range of our properties (£27m over the five year

period of the plan)

During 2012/13 targeted works included fire safety improvements at Dr Gray’s

Hospital and an upgrade of the Aberdeen Maternity Hospital theatre. In addition,

£4.5m is allocated to our programme specific statutory compliance and backlog

maintenance plan.

The tables on the following pages summarise the impact of the planned investment

over the period of the LDP.

Impact of Planned Backlog Activity over next 5 Years Clinical Non Clinical

Low/Medium

£m

Significant

/High

£m

Low/Medium

£m

Significant

/High

£m

TOTAL

Backlog Maintenance Totals 71.16 43.96 33.12 13.40 161.65

Phase II - ARI 4.48 13.79 18.27

East End 2 Blocks - ARI 1.97 1.56 3.53

Denburn Health Centre GP Re-provision 0.45 6.02 6.48

Dr Gray's Fire Risks 0.77 1.23 2.00

AMH Theatre 0.54 0.45 0.98

Impact of Targeted programme specific expenditure 4.12 12.38 16.51

Impact of Asset Disposal/Demolition programme 5.56 3.31 3.43 0.33 12.63

Backlog eliminated through total planned activity 17.91 38.74 3.43 0.33 60.41

Percentage Backlog Eliminated at end of 5 year plan period 25% 88% 10% 2% 37%

Potential Funding Options to Address Backlog Issues

Available Funding Analysis

2012/13 £000s

2013/14 £000s

2014/15 £000s

2015/16 £000s

2016/17 £000s

2017/18 £000s

TOTAL

Formula Allocation to Estates Backlog - Capital

9,819 (5,286) 10,729 9,421 7,659 5,149 37,491

Additional Agreed Brokerage - Capital (3,408) 3,401 5,443 (2,817) (2,619) 0 (1)

Additional Allocation – Backlog Maintenance - Capital 0 5,000 3,255 0 0 0 8,255

Estates Maintenance Budget - Revenue 1,450 1,450 1,450 1,450 1,450 1,450 8,700

Nett Profit on sale Receipts - Revenue 609 1,289 1,859 1,922 0 0 5,678

Total Available for Backlog Maintenance 8,470 5,854 22,736 9,976 6,490 6,599 60,124

Proposed Expenditure (Whole area refurbishment/Reprovision)

Phase II - ARI 754 12,844 3,305 16,903

East End 2 Blocks - ARI 1,200 2,500 3,700

Denburn Health Centre GP Reprovision 3,586 1,414 5,000

Dr Gray’s 1,956 300 2,256

AMH Theatre 820 0 820

Targeted programmed specific expenditure (Fire, Legionella, asbestos HEI/HAI, etc)

4,494 2,300 6,306 5,257 6,490 6,599 31,445

Total Planned Expenditure on Backlog Maintenance 8,470 5,854 22,736 9,976 6,490 6,599 60,124

Replacement of essential equipment

A key element of our capital programme is the replacement of essential equipment

and critical assets within our clinical and non-clinical services. Using our own capital

formula allocation and additional investment secured through the Scottish Government

Health Directorate, we were able to accelerate the replacement of essential equipment

during 2012/13. A total of £13.9m was allocated to this purpose in 12/13.

Given the pressures on future years’ capital funding, this investment will be important

in sustaining our commitment to replacement of essential equipment that is critical to

the delivery of care to NHS Grampian patients. We will commit to the continued

replacement of essential equipment with investment prioritised based on clinical need

and safety.

Our financial plans outlined in the previous section provide for continued investment in

essential equipment replacement on an annual basis.

In some instances however, such investment brings significant benefit to both the

patient experience and service efficiency and where this can be supported either

through other funding sources such as NHS endowments or other charitable

contributions or opportunistically within our formula capital allocation then we will

continue to progress these new initiatives. Recent examples include the purchase of

mini “c” arms for our theatres and vascular imaging equipment.

Disposal of surplus assets

A key element of the delivery of our capital plan is achievement of our programme of

disposals of surplus assets. This programme has now been agreed with Scottish

Government which will in effect increase our available capital funding by £8.2m over

the next four years. The disposal programme and delivery of the required actions is

monitored closely by the Board’s Asset Management Group.

Clearly our planning must remain realistic regarding expectation of additional resource

availability to support new service development over the period of the plan and this is

a key consideration when addressing strategic priorities locally. We continually refine

our expenditure proposals to achieve the correct balance and shape our programme

to achieve maximum benefit across the range of funding sources available to us.

Our ability to meet the aspirations of our property and asset management strategy is

therefore dependent on the delivery of asset sales over the short term, including:

Denburn Health Centre and Woolmanhill Hospital, Aberdeen

Woodend Hospital – South Block

Ward 5 (part), City Hospital, Aberdeen

Westburn Road site (including Allotments, Foresterhill Court and surrounding

premises), Aberdeen

Spynie Hospital, Elgin

Ross Clinic site Cornhill

Former Upper and Lower Hospital Cornhill

A further Asset Base Review is planned for the first quarter of 2013/14. As we

implement the Healthfit 2020 vision, it is envisaged further premises will be identified

which do not meet the future service requirements of NHSG, and may be disposed of

to free up capital and revenue and reduce the backlog maintenance.

Our investment programme for 5 to 10 years

In supporting the vision for a modern, sustainable health system, examples of other

potential developments that are in the process of being developed subject to funding

are as follows:

Provision of high quality care environments focused on meeting patient need

Cancer Centre – development of a Cancer Centre is regarded as an essential

element of the Campus and the new Linear Accelerator’s location has been

designed with the location of a new Cancer Centre in mind. As a result of

considerable public interest a joint fundraising effort involving the University and

NHS Grampian is under consideration.

Maternity Hospital -. The existing Maternity Hospital will be altered as necessary

to meet reasonable standards of accommodation until a new hospital can be

funded in c.15 years.

Bringing our infrastructure up to modern standards

Foresterhill Laundry – NHSG is currently engaging, via Health Facilities

Scotland, with colleagues from Highland, Tayside, and Fife in relation to regional

laundry / linen provision as each of these Boards has significant property and asset

investment needs regarding Laundry facilities in the next 1 – 5 years. The current

laundry facility needs to move because of location and backlog maintenance cost.

Mortuary – the mortuary at Foresterhill is accommodated in 1930’s facilities that

will be the subject of minor improvements in the short term but there is a need for a

new mortuary to meet the demands of the service and comply with modern

standards.

Medical Equipment Library – Allow NHS Grampian to ensure that appropriate

standardised Medical Equipment is available for use when and where it is required;

because it is standardised, users know how to use the equipment ensuring

equipment is decontaminated prior to re-use and equipment maintenance and

repairs are carried out in a timely way.

Investing in our communities

Improving Facilities for Older People in Grampian – Proposals will be

developed to provide the community base for the Care of the Elderly Services in

Aberdeen. The Granary building at the Health Village will be considered as one of

the options. If an appropriate solution is found then this will enable NHS Grampian

to review the need for the retention of the South Block at Woodend Hospital post-

2016.

Renal services South of Aberdeen City - The patients, staff and Grampian

Kidney Patient Association have chosen Stonehaven as the next site for a satellite

haemodialysis unit which will be situated within Kincardine Community Hospital. In

addition to a bequest of £250,000, a further £450,000, is required to set up this

unit consequently a fund-raising campaign was launched to raise the further

monies. Staffing and ongoing costs will be met by NHS Grampian. There are

currently no dialysis facilities in the south of NHS Grampian meaning that patients

who require dialysis have to travel to Aberdeen 3 times weekly for between 4 and

6 hours of treatment.

As demographics and settlements change including new settlements, there may

be the need for NHS Grampian to further review general practice patient

boundaries. This may include the current boundary configuration of services within

Community Healthcare Partnerships.

A more efficient and effective asset base

Office Rationalisation - Develop and implement plans for new flexible work styles

for administrative staff. Best practice will be applied to all offices and their use

which potentially will lead to office accommodation being rationalised. The result

will be improved efficiency, improved staff satisfaction, and reduced office

accommodation costs which will in turn release resources for patient benefit.

eHealth Projects - Looking forward, the next immediate IT systems requirements

are ePrescribing and medicines administration (we do not have an electronic

system at present) and extension of the wireless network/or planned replacement

of ageing structured cabling within the community setting

Property and Asset Management Plan

Documents

Transcript of Property and Asset Management Plan