Available data on cleaning performance displays significant cost variation but consistently good quality ratings [Box 27]. Levels of patient and staff activity, length of opening hours, number and configuration of sites and complexity are relevant factors that are expected to increase cleaning costs per metre squared at appropriate quality standards. The different scale and geographic dispersion of NHS Board operations reflect these factors and partly explain these variations in cleaning cost per metre squared. However, the 2006-07 data indicates that Boards of similar size with broadly comparable operations are achieving significantly different results.
The scale of expenditure – £93.4 million in 2006-07 suggests that there is the potential for performance improvement if the results of better performers can be replicated by the majority of NHS Boards.
Facilities Management
6
Box – 26
Data Availability by Indicator Category
Financial Patient Focus
Output Cost Sustainability Quality Operations
Price Volume/Use Mix
Future
Leadership Data Staff Investment
Good >75% of Boards
Patchy >25% of Boards
Limited <25% of Boards
None No data
Derived ISD Developed Data
Box – 27
Cleaning Costs 2006-07
Note 1 Note 2
Column A B C D E F
Spend Cost Quality Rank B1 C1
NHS Board £m £/m2 Rating Score PI Rank
Shetland 0.4 33 96.9 10 7 3
Golden Jubilee 0.4 11 95.5 10 1 9
Tayside 7.4 27 95.5 13 3 10
Dumfries and Galloway 2.5 39 98.0 14 13 1
Fife 5.7 32 95.9 14 6 8
Grampian 10.3 36 97.0 14 12 2
Western Isles 0.7 35 96.5 14 9 5
Greater Glasgow and Clyde 22.4 29 94.6 15 4 11
Ayrshire and Arran 6.8 36 96.3 17 11 6
State Hospital 0.5 25 88.0 18 2 16 Borders 3.0 49 96.7 19 15 4 Lothian 15.2 29 94.0 19 5 14 Lanarkshire 6.4 34 94.5 21 8 13 Orkney 0.6 85 96.2 23 16 7 Highland 5.8 36 93.9 25 10 15 Forth Valley 5.2 43 94.6 26 14 12 Scotland Total 93.4
Note 1 – Quality Rating is based on the annual average rating for each Board taken from the NHS Cleaning Services Specification Quarterly compliance reports.
Note 2 – Rank scores are calculated as the aggregate of each Boards individual ranking for unit costs (£/m2) from the NHSScotland cost book and quality rating.
Data Availability
The development of consistent, comparable management information for catering services is part of the ongoing Facilities Management Systems pilot project. SGHD are sponsoring NHS Tayside to undertake this project to define, develop and test the practical provision of detailed service management information. Unfortunately, in the absence of this enhanced information dataset comparative catering benchmarking data is very limited. The ISD cost book provides information on annual catering expenditure and related activity (cost per prepared meal) and this has been used in this report to provide a high-level picture of performance.
The data needed to populate an outline catering services balanced scorecard across the key perspectives of performance is therefore limited. Indicators to monitor output, sustainability, patient focus and future development initiatives are not yet in place [Box 28].
7. Overall Estates and Facilities Scorecard
Potential Improvement
Based on the 2006-07 comparative data, the potential exists for NHS Boards to achieve a theoretical efficiency saving if all NHS Boards can match the levels of performance achieved by the better performers. There is a need for targeted investment to improve service quality, better organisation and accountability to improve productivity.
Good Practice
Cleaning services practitioners have identified staff organisation, training, behavioural change and clear accountability arrangements for cleaning performance as key drivers for long-term performance improvement.
Behavioural change aims to increase health protection and reduce waste. Re-organisation of cleaning arrangements, investment in staff training and improved performance monitoring aim to improve quality and productivity through better accountability (Appendix A).
Box – 28
Data Availability by Indicator Category
Financial Patient Focus
Output Cost Sustainability Quality Operations
Price Volume/Use Mix
Future
Leadership Data Staff Investment
Good >75% of Boards
Patchy >25% of Boards
Limited <25% of Boards
None No data
Overall Estates and Facilities Scorecard 27
7
Potential Improvement
Based on the 2006-07 comparative data, the potential exists for NHS Boards to achieve efficiency savings if all NHS Boards can match the levels of performance achieved by the better performing Boards.
There is a need for targeted investment in kitchen information systems and staff training to improve catering standards. Different profiles of patient and staff catering cross-subsidy and the diversity of Boards operations make more modest improvement a more realistic possibility.
Good Practice
Catering managers have identified the establishment of nutritional and meal preparation standards; improved catering information systems; and staff training as key drivers for the long-term improvement of catering performance. Better information systems which provide kitchens with appropriate benchmarks on meal nutrition, preparation, efficiency and quality assurance are currently being developed to deliver step change improvement (Appendix A).
2006-07 Basic Performance Indicators
Despite problems with information gaps and data consistency, the available data on catering performance displays significant variation in the basic efficiency indicator provided [Box 29]. This level of variation is also reflected in data for 2004-05 and 2005-06 indicating that these comparative NHS Board differences are recurring.
The scale of kitchen operations, related patient and staff meal consumption are key factors which drive the average cost of meals prepared. The different scale and geographic dispersion of NHS Board operations reflect these factors and partly explain these variations in cost per meal. However, Boards of similar size with broadly comparable operations are achieving significantly different results.
The scale of NHSScotland expenditure, £73.7 million in 2006-07, suggests that there is the potential for performance improvement if the results of better performers can be replicated by the majority of NHS Boards. Current NHS initiatives [see good practice below] provide a basis for improving performance by understanding key differences in local practice. Box – 29 Catering Costs 2006-07 NHS Board £m £/meal Highland 3.0 0.87 Lothian 8.7 0.91 Forth Valley 3.8 1.05 State Hospital 0.6 1.07 Borders 1.5 1.10 Grampian 6.8 1.13 Fife 4.2 1.16
Greater Glasgow and Clyde 20.2 1.17
Lanarkshire 7.2 1.27
Tayside 6.9 1.33
Ayrshire and Arran 6.1 1.40
Dumfries and Galloway 2.2 1.50
Shetland 0.4 1.58
Western Isles 0.8 2.21
Orkney 0.4 2.51
Data Availability
In 2005, the NHSScotland Linen and Laundry Services Review identified a range of detailed cost, productivity and efficiency indicators as part of an evaluation of service development and improvement options. Due to the commissioning of new facilities and service changes in recent years the data contained in the review is now out of date. The Key Performance Indicators highlighted in the 2005 review are not routinely collected. The 2006-07 ISD cost book provides the only source of comparative information on annual laundry service expenditure and related activity (price per 100 articles processed).
The data needed to populate an outline laundry services balanced scorecard across the key perspectives of performance is therefore limited. Indicators to monitor output, sustainability, patient focus and future development initiatives are not yet in place [Box 30].
2006-07 Basic Performance Indicators
Despite problems with information gaps and data consistency, the available data on laundry services performance displays significant variation in its basic efficiency indicator [Box 31]. Levels of patient and staff activity, number and configuration of sites and utilisation of laundry capacity are relevant factors that are expected to impact laundry costs.
The different scale and geographic dispersion of NHS Board operations reflect these factors and partly explain these variations in laundry costs.
The scale of expenditure – £24.6 million – in 2006-07 suggests that there is some potential for performance improvement if the results of better performers can be replicated by the majority of NHS Boards.
Box – 31
Laundry Costs 2006-07
NHS Board £m £/100 pieces
State Hospital 0.0 0.00
Borders 0.2 11.62
Greater Glasgow and Clyde 6.0 16.64
Forth Valley 1.0 23.88
Lanarkshire 2.4 24.51
Grampian 2.4 29.36
Fife 1.3 29.49
Dumfries and Galloway 0.7 35.86
Golden Jubilee 0.1 36.05
Tayside 2.7 40.08
Western Isles 0.2 40.62
Highland 1.4 41.35
Ayrshire and Arran 1.8 52.94
Orkney 0.2 65.42
Shetland 0.2 87.11
Lothian 4.0 31.94
Potential Improvement
Based on the 2006-07 comparative data, the potential exists for NHS Boards to achieve an efficiency saving if all NHS Boards can match the levels of performance achieved by the better performers.
Configuration of the laundry network, diversity of Board operations and the need for changes in working practices and organisational behaviour to improve workflow, capacity utilisation and productivity makes theoretical improvement unrealistic. More modest improvement is possible and gains are likely to be more achievable if laundry services are developed in a collaborative manner.
Good Practice
Laundry services practitioners have identified reducing staff absence, raising productivity per operator hour, investing in new equipment and staff development as key drivers for medium to long-term performance improvement. In addition, the 2005 Linen and Laundry Services Review identified the need for NHS Boards to work collectively to better manage capacity utilisation across the laundry network (Appendix A).
Box – 30
Data Availability by Indicator Category
Financial Patient Focus
Output Cost Sustainability Quality Operations
Price Volume/Use Mix
Future
Leadership Data Staff Investment
Good >75% of Boards
Patchy >25% of Boards
Limited <25% of Boards
None No data
8
298. Findings and Recommendations
Key Recommendations
■ A dedicated Programme Board should be established, chaired by a NHS Board Chief Executive. The Programme Board will provide leadership for the implementation of the recommendations in this report and will report to the NHS Efficiency and Productivity Steering Group. Recommendation 1
■ The Programme Board is expected to work with local NHS Boards to develop and oversee a
programme of work that co-ordinates and delivers improvement activities across estates, energy, waste, and facilities management. Recommendation 2
■ The NHS Efficiency and Productivity Steering Group should make available resources for project management to oversee and report on implementation of the recommendations in this report. Recommendation 3
■ Health Facilities Scotland (HFS) should be commissioned to project manage implementation of this report and use its established network of Estates and Facilities management groups to work with NHS Boards to re-focus attention on benchmarking; accelerate the adoption of good practice, and support action-based performance improvement. Recommendation 4
■ A performance management framework for Estates and Facilities should be developed by adopting an overall Balanced Scorecard supported by function specific scorecards underpinned by
consistently defined outline measures to benchmark the continuous improvement of NHS Boards. Recommendation 5
■ This performance management framework will be supported by the development of appropriate
information systems, such as a Asset Management System (AMS) and Facilities Management System (FMS), to collect and regularly report on all aspects of estates and facilities performance across all operational settings. This is in keeping with recommendations in the Audit Scotland Report: ‘Asset Management in the NHS in Scotland’ (January 2009). This will be developed and delivered by HFS. Recommendation 6
■ HFS should ensure that existing Estates and Facilities working groups focus on developing benchmarking activities and support the identification and implementation of good practice. Recommendation 7
■ NHS Boards should develop appropriate information systems to collect and collate risk management information into a high-level Estates and Facilities risk register. This should enable high risk, high priority matters to be consistently monitored and financial resources appropriately matched to business risk. The Benchmarking Project Steering Group will monitor progress on this.
Recommendation 8