ROYAL NATIONAL ORTHOPAEDIC HOSPITAL. The Estate we are in! Key Estates and Facilities Management Performance Indicators

Transcription

1 ROYAL NATIONAL ORTHOPAEDIC HOSPITAL The Estate we are in! Key Estates and Facilities Management Performance Indicators 1. Introduction This paper provides the Board with details of the Key Estate and Facilities Performance Indicators, these will enable overview and assurance that assets are appropriately managed and that targets will be set to improve performance, the data will also aid in decision making and input into the estate strategy. Regular reporting will provide the Board with comprehensive information to oversee improved management and decision-making processes associated with the Trust s assets. In addition a set of Facilities Management Performance indicators are proposed which will enable informed decisions to be made regarding the service, its efficiency and future service efficiency and improvement plans. 2. Current Guidance In preparing this paper reference has been made to the following Department of Health guidance: Estatecode and developing an exemplar Estate Strategy. In addition, use of the standard definitions referenced by the Estates Reconciliation Information Collection (ERIC) returns has also been utilised. The Estates and Facilities Directorate are also part of NHS NPAG best value forum, through which future KPI s will be influenced and monitored. 3. Principle Drivers The principle driver for delivering these KPI s is an increased focus on the optimal management of the Trust s asset base and the FM services provided, recognising that: The quality of the physical environment plays a key role in the wellbeing and recovery of patients. The changing environment of the NHS requires a focus on the performance and management of assets and specifically the contribution they make towards the delivery of clinical services, business, financial plans, risk reduction and registration with the CQC. Potential for improvements in value for money and cost savings exists that can release resources for other uses. Asset utilisation is a major cost driver. The cost of developing and maintaining assets must be recovered through the income received from commissioners. Systems, records and procedures have to be in place to assure that assets are compliant with statutory legislation/regulation and governance responsibilities. 1

2 Services provided through the FM team can influence patient safety and the perception of the public regarding the overall patient experience when visiting the Trust. 4. How KPI s should be used KPI s should be used to inform the: Trust s Estates Strategy and Development Control Plan (DCP). Acquisition/Rationalisation and Capital Investment Plans. Quality and Cost Improvement Programmes. Informing business cases and investment decisions. Benchmarking exercises. Annual returns submitted to the Department of Health. (ERIC) Records maintained to provide evidence of compliance with statutory legislation and governance responsibilities. Reference portfolio for the CQC, NHSLA and Auditors (ALE) in fulfilling their inspection /assessment and auditing roles. PEAT assessments are used as a reference source by the Care Quality Commission in its annual assessment of health care services. 5. Estates KPI s 5.1 Where Are We Now? The estate, some 111 buildings with a gross footprint area of 37,289m 2 is predominately single storey buildings. An assessment of the estate performance was analysed by assessing the condition of properties using the six facet Estatecode categories. A large part of RNOH estate and services are more than 60 years old and many of the buildings and services are past their useful life. Poor investment in backlog maintenance over the years has exacerbated this situation to a point where only a very few buildings remain serviceable and suitable for modern healthcare. The current estate is not providing an inclusive environment, i.e. one that can be used by everyone regardless of age, gender, ethnicity or disability as clearly demonstrated in the six facet Estatecode surveys. 2

3 5.2 The Age Profile The following table summarises the age profile: Pre present Baseline 54% 8% 13% 0% 13% 6% 4% 2% 100% The above table identifies that 62% of the building stock was constructed before 1954, providing the Trust with considerable challenges relating to its operational management. The situation has been exacerbated by minimal maintenance over many years due to lack of funding. This is reflected in the high level of backlog maintenance now accrued, which is estimated to be in the region of 50m. A prime example of this is the slope wards built in 1938 on a gradient and were of a temporary design for wartime use. These buildings are known as an EMS wards and are steel framed block infill clad with corrugated asbestos sheet. All the slope wards are single storey with solid ground floors. The situation is similar in relation to residential buildings with 54% built before 1940 and a further 21% built before It is important to acknowledge that due to the age and condition of the estate it is not possible to significantly improve energy conversation and meet the government agenda on sustainability (improvements in energy performance in line with mandatory targets for NHS organisations in England to reduce the level of primary energy consumption by 15% or 0.15 million tonnes of carbon from March 2000 to March 2010). Achievement of a carbon reduction strategy is also clearly comprised unless significant investment is expended. 5.3 Property Portfolio Value and Asset Schedule The Trust currently has an estate spread across two different sites. The first is the main site at Stanmore which provides both the main Outpatient and Inpatient services and secondly the site at Bolsover Street which provides diagnostic and assessment services in Central London. The Bolsover Street site has been disposed of with a lease back arrangement with the developer and is therefore not included in the schedule below. The main hospital site at Stanmore has the following portfolio: Landlord Land area (Hectares) Building footprint (m 2 ) Building GIA(m 2 ) Massing ratio (m 2 /Hectare) RNOH ,289 47,

4 5.4 Physical of the Estate The physical condition profile examines the building structure and fabric together with mechanical and electrical engineering installations. It shows what proportions of the building areas are within one of four specific categories and a backlog cost to upgrade these areas to acceptable standards, that is Estatecode condition B. Physical (Building) A - Meets modern standards. B Acceptable. C - Below standard. D Unacceptable. s CX and DX provide supplementary ratings to indicate that a facility is so below standard that nothing but a total replacement will suffice. A B C CX D DX Baseline The above table shows that only 18 % of the estate has been graded in condition B or above. This classification reflects the high levels of ageing and physically unsuitable estate, which will either require substantial investment or total replacement to bring it to an acceptable standard. The table below shows that just 23% of the relevant infrastructure achieves a rating at or above condition B. As with the Physical ratings, substantial investment would be required to bring the facilities to a suitable standard and in many cases the only financially viable option would be to replace the buildings. Physical (M & E Services) A - Meets modern standards. B Acceptable. C - Below standard. D Unacceptable. s CX and DX provide supplementary ratings to indicate that a facility is so below standard that nothing but a total replacement will suffice. A B C CX D DX Baseline Functional Suitability of the Estate The functional suitability analysis describes how effectively a site, building or part of a building supports the delivery of a specific service. The criteria used in such assessments include: Space relationships Services Amenity Location Environmental conditions Overall effectiveness The table shows that only 40% of the estate achieves condition B or above, i.e. appropriate for delivering modern healthcare. 4

5 Functional Suitability A - Meets modern standards. B Acceptable. C - Below standard. D Unacceptable. s CX and DX provide supplementary ratings to indicate that a facility is so below standard that nothing but a total replacement will suffice. A B C CX D DX Baseline Space Utilisation of the Estate The space utilisation analysis indicates under or over utilised floor space. Under-use of space is serious since it represents a waste in terms of property overhead costs, for example energy, maintenance, cleaning, capital charges and rates. Unused spaces may be difficult to reuse or release because of their physical features, scattered locations and physical barriers to their rationalisation. Over utilised space may impede the effective delivery of healthcare. Utilisation definitions defined by NHS Estates are as follows: Space Utilisation E Empty: U Under used: F- Fully used : O Overcrowded E U F O Baseline 8% 14% 61% 17% 100 The above table shows that only 61% of the Estate is currently being fully utilised, with equal amounts either under or over crowded (14% each). This reflects that the current space standards are not achieved by the accommodation and that the facilities are not suitable for the services for which they are being used. 5.7 Energy Performance The energy performance profile examines the building structure and fabric together with mechanical and electrical engineering service installations for energy efficiency. The NHS target for the Healthcare estate is GJ/100 m 3 by 2010 for existing buildings. Energy is difficult to measure on this site, as most buildings are not individually metered; therefore an energy audit was carried by Action Energy to assess problems with individual buildings. The following is an extract from this report: Some wards have been upgraded to improve their appearance and energy performance; however, some still remain in very poor condition with single glazing and low statutory compliance. The present site in Stanmore is made up a large number of old buildings, at least 60 years old, many much older, with little improvement to their fabric since they were built. Most are single storey, thereby maximising their surface areas and heating requirements. 5

6 The original older buildings are heavyweight construction, with solid walls and single glazed sashed windows. Wards are primarily single storey and are reminiscent of Nissen huts. Timber hut structures are used as the Gatehouse and the Post Room. For these reasons outlined, the older buildings are poor energy performers by modern standards. Some new buildings have been recently constructed on the site, notably the Aspire National Training Centre building, which includes a large swimming pool, sports centre and gymnasium and these are of good quality. Some new temporary buildings providing core services are also of good quality, namely new twin theatres, IT building and the Centralized Booking Office. The incinerator building is now unused and was decommissioned about 10 years ago due to pollution issues and non-compliance with standards. Waste is now removed from site by a specialist contractor and Laundry facilities are also no longer provided on site, except for minor washing facilities in the staff residences. Staff residences are provided on-site, and these are of various types, normally blocks of flats, though some are single storey dwellings. These buildings range in age from about 80 years to 30 years. The heated volume in 1999/2000 was 125,000m 3 and has now decreased to 118,662m 3 in 2008 due to non compliant housing stock being taken out of use. The site has a heated floor area of approximately 34,579m 2. The site has 217 beds and 10 operating theatres. Most of the heating is provided by the central steam boilers installed in 1960, using shell and tube heat exchangers in plant rooms in each building to produce low pressure hot water (LPHW). A waste heat recovery system is currently being installed to increase the efficiency of the ageing boilers and to reduce the Trust s carbon emissions. The LPHW is used to heat radiator circuits within the wards and offices with a standard flow temperature of 82 C. Modern conventional gas-fired boilers are installed in the newer buildings and these provide LPHW to radiator circuits. Condensing boilers, which are more efficient, are installed in the Trust s new twin theatre complex and the new IT building, although it must be noted these are temporary buildings. Controls for heating include compensators in each Ward s plant room, though these are not monitored or controlled by BMS from the Estates Department offices, so there is no knowledge of failure or efficiency of any system. The air conditioning plant for the operating theatres is controlled by Staeffa controllers, and this can be monitored from the Estates Department by the BMS. The numerous extract ventilation systems serving machinery in the Orthotics Workshops are poorly controlled, being left on for hours each day wastefully when machinery is unused. A Trend Building Management System (BMS) is installed to control and monitor the steam boilers, the new buildings and to monitor the operating theatre air conditioning plant. It has not been set up to control any other services such as lighting, local heating systems or ventilation. Mechanical services are generally of a poor standard and it is clear that energy consumption could be reduced by controlling their use. 6

7 Lighting comprises of a large proportion of the electrical load on the site. Some of the lighting is high frequency type which is dimmable, although a large proportion are of the old T8 type (large diameter), though these are being phased out. Only a minimal amount of lighting controls such as absence sensing or daylight sensing which could reduce energy consumption, are installed in offices, toilets and workshops. The lack of sub-meters installed in the hospital premises due to cost restraints prevents the Energy Manager producing building performance trends on individual buildings to enable targeting of consumption. The following table summarises the energy performance in the Estatecode categories. The table below illustrates the issues with the energy performance, showing that only 12% of the estate meets modern standards: Energy Performance A - Meets modern standards. B Acceptable. C - Below standard. D Unacceptable. s CX and DX provide supplementary ratings to indicate that a facility is so below standard that nothing but a total replacement will suffice. A B C CX D DX Baseline Mandatory Fire Safety/Statutory Compliance There is a wide range of statutory standards relating to hospitals and a number of nonstatutory standards required by the Department of Health. Compliance is measured through the Better Standards for Health. These standards include Health Technical Memoranda, Health Building Notes and all Firecode documents. Analysis of compliance is provided yearly to NHS Estates via the web based ERIC returns. Not surprisingly the estate performs poorly in compliance with standards and a number of buildings have recently been taken out of use due to non-compliance. Compliance with Standards A - Meets modern standards. B Acceptable. C - Below standard. D Unacceptable. s CX and DX provide supplementary ratings to indicate that a facility is so below standard that nothing but a total replacement will suffice. A B C CX D DX Baseline Estate Performance criteria Below is a copy of the Performance Indicator (PI) Summary Table produced from the annual ERIC return information. The Trust PI Data has been collated and benchmarked against other specialist orthopaedic institutions, of which there are three others in the country namely: Nuffield Orthopaedic Hospital NHS Trust, Oxford,Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Trust, Shrewsbury, Royal Orthopaedic Hospital NHS Trust, Birmingham. 7

8 Figures in green boxes represent no or very limited problems. Figures in amber represent some deficiencies and figures in red represent serious concerns. ROYAL NATIONAL ORTHOPAEDIC HOSPITAL NHS TRUST /2009 Grouping PI (Percentile Bands) PI SUMMARY Trust PI 33% 34% 33% Space Efficiency Income 10/m² and Activity/100m² and Asset Value 10/m² and Occupancy Cost /m² and Asset Productivity Asset Value 10/m² and Capital Charges /m² and Backlog /m² and Rent & Rates /10m² and Asset Deployment Land /m² and Building 10/m² and Equipment /m² and Capital Charges /m² and Estate Quality Asset Value 10/m² and Depreciation /m² and Critical Backlog /m² and Risk Adjusted Backlog /m² and Cost of Occupancy Rent & Rates /10m² and Energy/Utility /10m² and Maintenance Costs /10m² and Capital Charges /m² and Note: Awaiting 2009/10 KPI data from DH Estates via the annual ERIC return Evaluating the Performance Indictors The Trust s income ratio is lower compared to the others in the cluster due to the size of the estate and the unemployed capacity within it. The complexity of patient care provided has a major impact on the average length of stay causing activity throughput to be lower. This has an adverse effect on the activity indicator. The Trust is aiming to improve its performance with respect to capital charges and backlog maintenance, by decreasing spending on capital charges by estate rationalisation. Empty building stock that is beyond economical repair will be demolished to avoid paying capital charges and to reduce the bottom line backlog maintenance figure, this is in-line with our redevelopment enabling plans. 8

9 Other building stock that is surplus to requirement will be disposed of to generate income in line with our Outline Business Case for redevelopment. The building and equipment ratios are low because of the age of the assets, again highlighting the need for modernisation. There are also strong indications that the quality of this estate is generally below acceptable standards. This is in keeping with reality as the majority of the buildings are pre 1948, functionally unsuitable, with a large number of buildings disused. Backlog maintenance is extremely high, reflecting an estate, which is near the end of its designed life with an increasing number of backlog failure and replacement pressures. Health & Safety and Fire and Physical Backlog are both significantly in the red, indicating that the quality of the estate is below acceptable standards, subjecting patients and staff to increased risk. The asset value of the buildings is low due to their poor general condition. The only reason the PI is showing amber is due to the high land value of the estate. Energy and utilities suggest that the Trust is amber status having an Estatecode rating of C. This is again to be expected with a site with an antiquated central boilerhouse and distributed steam mains. Many of the buildings do not have compensated heated systems, effective control systems or double-glazing. Overall the Performance Indicators highlight an estate, which is near the end of its designed life and is in need of rationalisation to achieve a more modern and functionally suitable estate. Interestingly the maintenance cost per square metre is low; this can be explained by the fact that the Trust is not investing significant amounts of money into the estate because the majority of buildings are only expected to remain in use for another eight years until the site redevelopment has been completed. 6. Facilities Management KPI s 6.1 Patient Environment Action Team (PEAT) The Patient Environment Action Team (PEAT) programme was established to assess NHS hospitals in Under the programme, every Inpatient healthcare facility in England with more than ten beds is assessed annually and given a rating of excellent, good, acceptable, poor or unacceptable. The assessment teams consist of NHS staff, including nurses, matrons, doctors, catering and domestic service managers, executive and non-executive directors, dieticians and estates directors. 9

10 They also include patients, patient representatives and members of the public. In line with the approach of the Healthcare Commission, PEAT is a self-assessment process, with validation visits to a small number of sites. The NPSA issues the assessment framework and timetable, and also gives guidance on the composition of teams. They recommend that teams include staff with expertise in hotel services as well as nurses and members with infection control expertise and Trust s are also asked to include a patient representative. The table below demonstrates the Trust score over the last five years: Year Environmental Score Food Score Privacy & dignity 2005/06 Good Excellent N/A 2006/07 Good Excellent N/A 2007/08 Good Excellent Good 2008/09 Good Good Acceptable 2009/10 Good Good Acceptable 6.2 Facilities Benchmarking (based on ERIC data 2008/9) Service Measure RNOH Small Acute Trust Catering Cleaning Grounds/Gardens Linen Portering Post Telecommunications Waste Water & Sewage cost/main meal requested cost/square metre cost/hectare 1,968 2,303 cost/piece cost/square metre cost/square metre cost/square metre cost/square metre cost/square metre Occupied floor area (m 2 ) Note: The Trust has re-tendered the main soft FM contract (Portering, Cleaning and Catering) and is currently evaluating the tenders. The current figures are based on the existing contract with Medirest. 10

11 6.3 Maintenance response times and work completion statistics % Completed 1 hour 12 hours 24 hours >24 hours 8% 17% 3% 72% * Based on a sample of work requests The above information was taken from our SHIRE helpdesk system and clearly shows that more than a quarter of all reactive maintenance requests are completed within 24 hours. The user receives an acknowledgment of their request with a unique job number and is also notified on completion of the works. We will use our Benchmarking group (NPAG) to try and get a comparison with other Trusts performance. The Estates department are working hard to reduce the number of jobs that have taken more than 4 weeks to complete. When looking into the causes, these range from waiting for materials, to failure to update the system on work completion. We hope to report with more detailed benchmarking information later in the year. 7. Recommendations It is recommended that the Trust Board: Receive this paper and endorse the use of the Estate and Facilities KPI s as measures against which the Trusts assets will then be reported on annually or at intervals determined by the Trust Board. To note that the data provided is based on 2008/9 data as the 2009/10 data is expected to available by December 2010, therefore a further report will provided to the Trust Board, if requested. Facilities costs are benchmarked again as part of the soft FM retendering exercise, prior to the awarding of the new contract in April Mark Masters, Director of Projects, Estates and Facilities September