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 Investm ent 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 Equipm ent Replacem ent 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
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.