Property and Asset Management Strategy 2013/14 (PAMS) Approved Ver 16a(rev4) 2013 July 2013

Transcription

1 Property and Asset Management Strategy 2013/14 (PAMS) Approved Ver 16a(rev4) 2013 July 2013 For further information on any aspect of this document please contact: Mr. J. Leiper, Director of Estates, Facilities &Capital Services, NHS Fife. Tel:

2 PROPERTY ASSET MANAGEMENT STRATEGY Age Profile Number of Blocks 2 Area Sq.m. Backlog Cost Backlog Cost per m Pre , ,713, , ,121, , ,882, , ,414, or more recent 37 82, , Unreported 5 2, ,238, , Totals: , ,233, NHS Fife Age Profile of Properties Backlog costs include Physical Condition C, D or unreported and all Statutory Compliance condition ratings All other costs have been excluded Costs included are Owned, Leased or Endowment tenure Number of Blocks and Area include all tenures except 3rd party ownership Front Cover Pictures ; Top left clockwise ; Queen Margaret Hospital Victoria Hospital St Andrews Community Hospital Randolph Wemyss Hospital Adamson Healthcare Campus Kirkland Dental Centre 2

3 Section Title Page Number Contents Chief Executive Foreword 4 1. Executive Summary Strategic Background & Introduction The Property Strategy Process Where are we now? Where do we want to be? How do we get there? Implementation Plan Roles & Responsibilities Performance Monitoring IM&T Vehicles / Transport / Travel Plans Medical Equipment Asset Data Tables Table 12.1 Chart 12.1A Chart 12.1B Table 12.2 Table 12.3 Chart 12.3A Table 12.4 Chart 12.4A Table 12.5 Table 12.6 Table 12.7 Table 12.8 Table 12.9 Table Chart Table Table Table 1.2 Table 1.3 Primary Care Premises ; Desk top studies An Analysis of the Existing Estate by Area Physical Condition - Percentage of Blocks with Overall Block Condition Physical Condition - Percentage of Square Metres with Overall Block Condition The Physical Condition of the Estate Risk Profiled Backlog Costs Physical Condition Risk Profiled Backlog Costs Statutory Compliance Risk Profiled Backlog Costs Statutory Compliance Risk Profiled Backlog Costs Energy Performance Ratings Results from the Appraisal of Functional Suitability Results from the Appraisal of Space Utilisation Results from the Appraisal of Quality Typical Analysis of Property Types Typical Analysis of Property Ownership Analysis of Size Range of Properties Age Profile of Properties Summary of Property Appraisal Results Backlog Maintenance Costs Physical Condition Risk profiled Backlog Maintenance IM&T Asset Spreadsheet Medical Equipment Asset Spreadsheet Transport Asset Spreadsheet HEAT Target Energy Reports Postal Addresses

4 Property & Asset Management Strategy Chief Executives Foreword In 2002 Fife Health Board embarked upon an ambitious programme of service redesign across all the strands of healthcare in Fife. This plan became known as Right for Fife and anticipated many of the issues which have caused all healthcare systems to review how services can be provided. The success of Right for Fife has put NHS Fife in a good position to move forward. Much of Right for Fife was structural and has resulted in improved in-patient facilities for patients at St Andrews Community Hospital, Adamson Healthcare Campus, Stratheden, Lynebank, Randolph Wemyss Memorial Hospital and Victoria Hospitals, and new community facilities for example in Anstruther and Dunfermline and across Fife in respect of dental access centres. Importantly, it also encompassed new models of care and patient pathways resulting in reduced lengths of stay, reduced waiting times and reduced numbers of hospital attendances through developments of increased one stop clinics and services provided on an ambulatory, or day case, basis. So, ten years on we have achieved much, but there is still more to do. My goals over the next five years are to: Recognise the need for continuous improvement and to enable staff to redesign services they provide while continuing to provide safe and effective care in a changing environment. Build on the good work of Right for Fife, ensure we finish what we started and further improve clinical care. Moving Forward Getting Better in Fife Getting Better in Fife is the name for our healthcare improvement plan for the next five years. It describes our priority areas for improvement in the delivery of clinical services. It underpins our strategic objectives. The aim of Getting Better in Fife is to improve the patient experience through reducing harm, waste and unwarranted variation. Getting Better in Fife describes our five areas of strategic priority relating to the healthcare services we provide. Some of these services are delivered in partnership and others by NHS Fife alone. NHS Fife also has a responsibility to improve the health of the population. This responsibility is driven by related strategies and action plans developed in partnership with local council and primary care colleagues who have a significant contribution in improving the quality of services 1. So the focus of Getting Better in Fife is the systematic improvement of the clinical services delivered to our local population across the whole healthcare system. Modernising NHS Fife s Estate The major infrastructure changes in NHS Fife have largely taken place already, but we will continue to improve the healthcare environments and deliver the necessary equipment and technology systems to enable the highest possible clinical care provision to our patients. Our Property and Asset Management Strategy, (PAMS) will target the areas of improvement over the next five years and beyond. The work undertaken as part of this improvement plan will guide the decisions and priorities for our capital investments. John Wilson Chief Executive NHS Fife March Delivering Quality in Primary care National Action Plan, Scottish Government August

5 1. Executive Summary Overview The Scottish Government Health Directorate s Capital Planning and Asset Management Division Policy CEL 35 (2010) requires that all NHS Boards have a Property and Asset Management Strategy that reflects the following policy aims to: Ensure that NHS Scotland Assets are used efficiently, coherently and strategically to support the Scottish Governments plans and priorities, identified clinical strategies and models of care. Provide, maintain and develop a high quality sustainable asset base that supports and facilitates the provision of high quality healthcare and better health outcomes. Ensure that the operational performance of assets is appropriately recorded, monitored, reported and reviewed, and where appropriate improved. Ensure an effective asset management approach to risk management and service continuity. Support and facilitate joint asset planning and management with other public sector organisations. The Position in NHS Fife NHS Fife considers efficient asset management to be a fundamental requirement for the delivery of the balance of our previous long term service strategy Right for Fife and the integration of our new Getting Better in Fife strategy. In order to ensure the seamless implementation of the service strategy it is essential that it is supported and complemented by a well managed Property and Asset Management Strategy, (PAMS). NHS Fife will build on the previous PAMS submissions and use its 2013/ 2014 Property and Asset Management Plan to: Provide a basis for corporate and consultative strategy development. Ensure that clinical service needs drive forward the asset strategies. Ensure overall efficient and effective use of assets. Bring clarity to the way assets are managed within the organisation. Provide corporate processes for assets. Provide performance measures and targets for assets. Ensure robust data management and measurement of estate performance. Since 2002, NHS Fife has significantly changed the way it contributes to the health and healthcare of the population. Over the decade we have transformed a very large part of the way NHS care is provided. The paragraphs which follow offer some key headlines from a much longer story. 5

6 In terms of health improvement and primary prevention we are for example: Strengthening the ability of General Practice and Independent Contractors By supporting chronic disease management, developing and strengthening our community and public health nursing, podiatry, speech and language, physiotherapy and occupational therapy services, increasing direct access to diagnostic services and through investment in modern premises, including the refurbishment of Rosyth and Kirkcaldy Health Centres, the redevelopment of Cupar Health Centre and the development of Skeith and Linburn Health Centres. Strengthening the ability of General Dental, Ophthalmic and Pharmaceutical Services Through investment in premises - 10 new dental services centres, by further improving links to specialist care (e.g. the eye care project) and in the introduction of a range of pharmacy based services including the roll out of the new community pharmacy contract, and a range of local services based on need. Implementing and sustaining a range of health improvement programmes Including smoking cessation, alcohol brief interventions and weight management, Mental health through investment in two new dementia facilities at Stratheden Hospital, therapies, earlier diagnosis and interventions for dementia and better collaboration across services NHS Fife participates in a national accreditation programme for People with Learning Disabilities. To ensure staff are highly trained in this specialty area and additional investment has been made in Community Based Care with additional specialists in post to deliver the care and enable the capital investment and development of the Learning Disabilities Unit Mayfield and the Regional Learning Disabilities Daleview Units at Lynebank Hospital. In terms of improving care, we are for example: Strengthening the workforce by Training and developing highly specialised clinicians e.g. Advanced Nurse Practitioners, Specialist Nurses and other Allied Health Professionals Using Redesign, Organisational Learning and Development resources, in-house and external training programmes and organisation-wide IT investment implementation of the electronic Knowledge and Skills Framework to provide our workforce with the skills required to deliver 21 st century healthcare Moving to new ways of delivering care for example by Implementing the Scottish Patient Safety Programme methodology including the use of care bundles, use of Day Surgery where possible and appropriate, shorter waiting times for investigation and treatment, one stop clinics, state of the art facilities, increasing use of IT e.g. Electronic Prescribing, Telehealth, Telecare and Video Conferencing including Telepresence, Electronic Patient Referral processes and ordering of investigations Redeveloping hospital facilities including The work currently underway to reshape the healthcare provision at the Queen Margaret Hospital; the recently completed major extension of the Victoria Hospital; the provision of Mayfield, the Learning Disabilities Assessment & Treatment Unit and Daleview, the Regional Learning Disabilities Unit located at Lynebank Hospital; Elmview & Muirview, the two new mental health wards at 6

7 Stratheden Hospital; the replacement of the old St. Andrews Memorial Hospital with the new St. Andrews Community Hospital; the redevelopment of Adamson Healthcare Campus, Whyteman s Brae Hospital and Randolph Wemyss Memorial Hospital. Rationalisation of the Estate As a direct result of the major investment strategy and the redesign and transfer of clinical services into modern facilities in NHS Fife, several older properties including; St Andrews Memorial Hospital, Forth Park Maternity Hospital, Netherlea Hospital, Lynebank Hospital (part surplus land), Castlehill Clinic, Barrie St Clinic, Staff houses at Cupar and Stratheden Hospital are now in the process of being sold for housing and other redevelopment. This 2013/2014 document describes a property strategy for NHS Fife for the period 2013 to The strategy uses a process that asks three basic questions in relation to the Board s estate: Where are we now? Where do we want to be? How do we get there? The full response to these questions for NHS Fife is detailed in Sections 4, 5, and 6 respectively, however an executive summary of the response to those key questions is as follows. Where Are We Now? The initial stage of the Property and Asset Management Strategy involved analysis of the current condition and performance of the Board s estate under six facets: Physical condition Statutory Compliance (Fire and Health & Safety standards) Functional suitability Space utilisation Quality Environmental Management The analysis is based on the current guidance document, Strategic Property and Asset Management Guidance for NHS Scotland, which enables a consistent approach to determining the condition and performance of NHS Scotland s property and capital assets. The condition and performance results for the period up to March 2013 /14 from the appraisal are summarised in Table 1.1 and identify that there are significant issues to be addressed by the PAMS in terms of the current condition and performance of the estate. The table identifies for each of the six facets, the key indicators with regards to performance and suitability. Further details around the current clinical service plans within NHS Fife are detailed in Section 4. 7

8 Table 1.1: Summary of Estate Condition and Performance Facet Physical Condition Physical Condition - Backlog Cost Functional Suitability Quality Category A B C / CX D / DX Definition Area m2 Very Satisfactory Satisfactory Not Satisfactory Unacceptable Not Categorised 74, , , , % of Estate Area in Category 24.25% 54.09% 19.22% 0.01% 2.43% Backlog Cost 000's , , , % of Backlog Cost in Category 0.00% 42.34% 51.62% 6.04% 0.00% Area m2 74, , , , , % of Estate Area in Category 24.18% 53.32% 17.27% 1.47% 3.76% Area m2 75, , , , , % of Estate Area in Category 24.33% 44.51% 25.71% 1.69% 3.76% Facet Space Utilisation Category E U F O Definition Area m2 Empty / Not Used Underused Fully Used Overcrowded Not Categorised 32, , , , % of Estate Area in Category 10.47% 4.69% 77.41% 7.44% 0.00% Facet Category D or better E F G Definition less than 60 kg of CO 2 per m 2 between kg of CO 2 per m 2 between kg of CO 2 over 100 kg of CO 2 per m 2 Not Categorised Environmental Management Area m2 66, , , , , % of Estate Area in Category 33.69% 3.70% 16.62% 39.29% 6.70% Facet % Compliance Statutory Compliance 81.4 The table indicates that the backlog maintenance requirements identified in the appraisal exercise were 30.7m, 37.4m and 4.4m for categories B, C and D respectively. The total requirement is, therefore, 72.5m to address the accumulated statutory and life cycle replacement issues and elements of outstanding maintenance. Please note this is not the Risk Assessed backlog which will significantly less. The targeting of allocated funds will be prioritised by risk in a structured plan, with the intention of bringing the estate into a satisfactory condition. Where Do We Want To Be? Last Update 06 March 2013 NHS Fife has, within the previous long term service strategy, Right for Fife, been very active in addressing the performance of the estate and moving towards the provision of safe, secure, high-quality healthcare buildings appropriate for the delivery of modern healthcare services. The remaining service objectives from Right for Fife have been developed and realigned with the current Getting Better in Fife strategy and the NHS Fife Local Delivery Plan. To deliver Patient Centred, Safe and Clinically Effective care and enable people to maintain their contribution to society, through prompt assessment, diagnosis, and intervention. 8

9 By ensuring that 90% of patients who are referred have their assessment, diagnosis and treatment within 18 weeks from referral. 95% of patients who are referred with a suspicion of cancer receive assessment, diagnosis and treatment (if required) within 62 days from referral. 95% of patient diagnosed with cancer receive their treatment within 31 days from the decision to treat This programme will maximise the use of technology and make effective use of all resources on all sites. This will reduce unnecessary hospital visits, reduce unwarranted variation and will deliver a personcentred, timely, high quality planned care service The key objectives and requirements of the NHS Fife Property and Asset Management Strategy are as follows: 1) To assist in achieving the NHS Fife Local Delivery Plan objectives by creating Masterplans for the retained estate and continuing to implement and deliver an estates rationalization programme through the ongoing management, acquisition, development and disposal of assets where required i.e. what assets are required, where and when? 2) To deliver the remaining objectives within the Right for Fife strategy and continue to progress with the implementation of the new Getting Better in Fife strategy. 3) To operate and maintain assets in a cost effective, appropriate and safe manner. 4) To continually improve the Physical Condition of assets, updating surveys of NHS Fife properties, to enhance a risk based action plan which incorporates renewal, refurbishment and removal of assets and results in all NHS Fife properties being classified as a minimum Satisfactory condition and reduce the Backlog Maintenance burden on the estate 5) To improve and enhance the Functional Suitability of NHS Fife properties, indentifying on a needs not wants basis, the prioritised actions required and associated timescales necessary to achieve the desired improvement of NHS Fife properties to a minimum Satisfactory standard. 6) To improve the Quality of NHS Fife healthcare environment, identifying the prioritised actions and associated timescales to achieve a minimum Satisfactory standard based on the quality criteria of Amenity, Comfort Engineering and Design. 7) To drive more effective Space Utilisation within NHS Fife properties, to implement a plan which shows on a progressive basis the reduction of Empty/Not Used, Underused and Overcrowded spaces, ultimately maximising the percentage of Estate Area in the Fully Used category. 8) To continue the good practice in Environmental Management in NHS Fife to progressively reduce CO 2 emissions in line with Scottish Government targets and in doing so, progress a sustainable, low to zero Carbon footprint focusing on a green, healthy environment and improvements in biodiversity. 9) To progress toward full Statutory Compliance within NHS Fife properties reducing the level of risk through the implementation and management of a risk prioritised, target led, evidence based action plan. 10) To provide an accessible service in line with current Equality & Diversity guidance. 11) To progress improvement and strive for excellence in relation to Healthcare Environment Inspectorate assessments. 12) To actively embrace and exploit new Technologies to improve healthcare delivery and health outcomes. 13) To support the development and implementation of the Mental Heath Strategy in NHS Fife by the provision and development of property based and other assets and through the implementation of 9

10 innovative delivery of improved Community Care pathways and reducing the necessity for hospitalisation. 14) To progress the integration of the Scottish Government Policy on Single Room provision and the formation and implementation of a strategy for delivering of the same in terms of both the existing estate and new build developments. 15) To seek efficiency improvement through the Transport Service Review and Travel Planning Strategy for NHS Fife. 16) To help progress and improve the Independent Contractors services compliance of primary care premises, (Dental, Pharmacy, GP Practices and Opticians) with NHS Scotland standards for practices, protocols and premises. The aims and objectives are to integrate the asset details on to the 3i system, (the database that holds detailed information on the NHS Fife property asset portfolio), and inform future PAMS reports. 17) To Work in Partnership with staff and other Public Sector Organisations in driving needs based services. NHS Fife, Fife Council and other Public Sector partners have made good progress on working collaboratively and this has led to the development of significant number of new, joint initiatives providing services and facilities to the benefit of the people in Fife, e.g. the provision of the 10 new Dental Access Centres across Fife 18) To provide best value in the delivery of patient centred, safe and clinically effective services 19) To ensure procurement of future assets through the most appropriate route such as Frameworks 2, HUB, capital procurement or leasing. 20) To implement local plans in conjunction with Social Care partners, exploiting the allocation of Scottish Government s Change Fund introduced in to maximise benefit with the most effective use of combined resources in the provision of older people's services to the people of Fife. The ground-breaking pilot work that allows patients to be treated effectively in their own homes, avoiding the difficulties many people experience because of hospitalisation, is now a successfully implemented delivery care pathway in West Fife. Planning is currently underway on how this initiative will be rolled out across the remainder of NHS Fife and consideration is being given to the opportunities and implications of the change this will bring to the functionality and use of existing property assets. 21) To capturing the innovation generated by the staff in all of the NHS Fife Directorates and Departments as they produce Project Initiation Documents as part of the formalized tracking process for service improvements and redesign initiatives in order that any future implications for estate rationalisation, asset management, procurement, IT infrastructure etc and the management and oversight of NHS Fife s capital assets can be incorporated into the established programmes of the Board. How Do We Get There? The NHS Fife Board s programme of service change and modernisation as defined in Right for Fife and now in Getting Better in Fife will continue: Investing in current healthcare facilities to allow them to be used to deliver models of care effectively and efficiently in the most appropriate location. Investing in new buildings to enable and facilitate the new models of care and service delivery to be fully implemented. There has been significant investment in the Fife Board area in the last 10 years that has allowed the new build, general refurbishment and improvement to NHS Fife s healthcare facilities and building services systems in a number of locations. This programme of work, implementing Right for Fife and now in Getting Better in Fife, has greatly improved the physical condition, quality of the environment and the level of statutory compliance in the physical estate. In order to maintain and improve upon what has been achieved, each key objective within the service strategy must have corresponding actions identified within the PAMS. Those actions are as detailed within Section 6. 10

11 Quality Ambitions, Outcomes and Indicators and the 2020 Vision The Quality Strategy of NHS Scotland encompasses 3 Quality Ambitions with 6 Quality Outcomes and 12 Quality Indicators. NHS Fife fully supports the Quality Strategy. Three Quality Ambitions: person-centred; safe; effective. Six Quality Outcomes: everyone has the best start in life and is able to live longer healthier lives; people are able to live well at home or in the community; everyone has a positive experience of healthcare; staff feel supported and engaged; healthcare is safe for every person, every time; best use is made of available resources. Twelve Quality Indicators: care experience; staff engagement; Healthcare Associated Infection; emergency admission rate/bed days; adverse events; Hospital Standardised Mortality Ratio; premature mortality; Patient Reported Outcome Measures (PROMS); self-assessed general health; % of time in the last 6 months of life spent at home or in a community setting; appropriate birth weight for gestational age; resource-use Vision ; By 2020 everyone is able to live longer and healthier lives at home,or in a homely setting and that we will have a healthcare system where; We have integrated health and social care There is a focus on prevention,anticipation and supported self management Hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm Whatever the setting, care will be provided to the highest possible standards of quality and safety, with the person at the centre of all decisions There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission 11

12 2. Strategic Background & Introduction The acquisition and ownership of assets themselves is not an objective for the NHS, they are only a means to an end. The function of a Property and Asset Management Strategy, (PAMS), is to demonstrate the influence that assets can have on objectives similar to those contained in Better Health, Better Care: Action Plan, i.e. making a significant step towards a 'Healthier Scotland' and its three main components of health improvement, tackling health inequality and improving the quality of healthcare. The PAMS therefore, will be used to 1. Improve care for people who use NHS services in Scotland; 2. Provide safe, secure and appropriate assets that support service requirements and contribute to achieving Scottish Government policies on health and sustainability; 3. Ensure that the NHS achieves value for money from its management of assets. The report on Property and Asset Management in Scotland recommends that NHS bodies should: develop strategies for each type of asset and then develop a corporate asset management strategy and plan which links with their clinical strategies; ensure they assess estate condition, statutory compliance, functional suitability, and space utilisation on a regular basis; ensure all information is held electronically; and review their performance management arrangements and, where required, develop performance measures and targets for assets. The strategic aims and objectives of the NHS Fife Property and Asset Management System are therefore: acquisition and development of assets that support service/capacity requirements and national/local policies; the provision of safe, secure and high quality healthcare environments which can aid patient outcomes/satisfaction levels and staff retention/morale; to provide a plan for change that enables progress towards goals to be measured; to provide a clear commitment to complying with sustainable development and carbon reduction initiatives; to provide a means of targeting investments to minimise the risks associated with asset ownership; to provide an opportunity to optimise asset ownership costs; to provide flexibility to respond to future service changes; to provide an opportunity to dispose of surplus and/or poorly-used assets and reinvest the released resources; ensure that consideration of whole-life costing is a requirement for all investment decisions and that maintenance budgets are provided throughout the life of the asset. 12

13 The PAMS is a comprehensive document covering all assets within NHS Fife, and includes: Land Buildings Engineering Systems Medical equipment Non Medical Equipment IM&T Hardware Vehicles The Property and Asset Management Strategy will continue to be used throughout NHS Fife as a basis for asset planning and management decision making. The production and development of the Property Asset Management Strategy system has been a challenge in the last two years with the available resources to collate all of the necessary information and produce a report that reflects all the good proactive work that has been achieved and also that which continues to be delivered in terms of effective asset management. The Directorate of Estates, Facilities and Capital Services are currently completing an internal restructuring exercise that will better provide the necessary technical and administrative skills and responsibilities to support and sustain the PAMS process. The NHS Fife Capital Planning Group (CPG) has recently been reorganized to provide a representative central forum for strategic analysis of the capital plans and scenario planning for all future developments taking in to the impact of proposed developments on a Fife wide basis. The membership of the CPG captures the broad spectrum of clinical services from primary and secondary care, finance, estates and facilities, IT, transport, travel planning, and equipment procurement. Fife-wide groups with specific responsibility for minor capital works and equipment procurement have been formed that will report their recommendations for prioritised procurement of projects and equipment directly into the CPG for consideration and approval. The assessment process shall be on a risk based prioritisation and on the resultant benefits to be achieved in terms of improvement to the six facets of condition, statutory compliance, functional suitability, space utilization, quality and environmental management. Factors such as estate rationalisation, financial and non financial benefits will also be factored into the overall assessment process. 13

14 3. The Property Strategy Process This Property Strategy has been developed using a nationally agreed process that asks three basic questions in relation to the Board s Estate Where are we now? Where do we want to be? How do we get there? Where are we now? This is the starting point for the development of a board wide Property Strategy. This is where the existing Estate is analysed using the six facet methodology i.e. Physical Condition Statutory Standards Space Utilisation Environmental Management Functional suitability Quality These six facets give a standardised way of measuring Estate performance. The facets will be used to list the Board s risks across all of these headings. Where do we want to be? This is the next stage in the process. This process is driven by national policies and the Board s Corporate objectives, strategic plans and clinical strategic direction. This stage looks at the impact that service change has on the Board s Estate. Targets are set for improvements in Estate performance and condition and for ensuring that the Estate closely matches the required service need. How do we get there? This is the final stage in the process and involves prioritisation of capital spending and capital investment or disinvestment projects that are required to deliver the Board s programme of change and modernisation of Health Services. This involves redesign and refurbishment of existing facilities, acquisitions, disposals, leases, working collaboratively in sharing facilities with other Public Sector partners, and new capital projects. It is important that the Board takes a holistic approach to the management of the estate in order that the estate can be reshaped and changed in order that the necessary and appropriate facilities can be provided in the right place to help the Board to deliver quality health services to the people of Fife. In addressing this, the Board will take strategic decisions on the following key elements: Planning What assets are required and when. Acquisition How assets are funded and what partners might be involved. Operation and Maintenance Ensuring assets are maintained and performing adequately. Disposal What is the best future use for an asset? Performance management and monitoring Collecting and managing data to inform asset management including Key Performance Indicators (KPIs). 14

15 This part of the Strategy will include options that will be clearly linked to strategic clinical direction of patient care and will be subject to options appraisal including do nothing and do minimum as well as other radical and challenging alternatives. The option appraisal will explore financial and non financial considerations with benefits, cost and risk analysis. A discounted cash flow appraisal in line with the Treasury Green Book will also be carried out to ensure that the Board takes informed and prudent strategic decisions. These processes will be embedded within the business case arrangements for capital procurement and the purchase of Medical Equipment, IT investment and all capital projects and be submitted to the Capital Planning Group for project approvals for onward decisions by the Strategic Management Team, Finance & Resources Committee and the Board. As part of any options appraisal the Board will seek to work with Community Planning partners to determine whether there are opportunities for joint working or shared services and premises. 15

16 4. Where Are We Now? Clinical Service The Scottish Government set out its plans for improving Scotland s health and healthcare in the document Better Health, Better Care (published December 2007). Since 2002 NHS Fife has, through the Right for Fife long term service strategy, been delivering an ambitious programme of development and modernisation designed to improve the range and quality of healthcare services and to improve the quality of the premises from which services are provided. As a precursor to this programme in January 2000 NHS Fife launched its widest ever consultation process on the future of healthcare in Fife. Every Fife resident and member of NHS Fife staff was given the opportunity to help shape the future through the initiative entitled "Right for Fife". The consultation process was part of a comprehensive review of the full spectrum of healthcare services in Fife, covering Mental Health, Learning Disabilities, Care of the Elderly, Primary Care and Community Services and Services for Children and Young People in addition to General Hospital and Maternity Services. The process comprised of two stages. The first was a period of informal consultation over a period of 7 months, the outcome of this process being a short list of options, which were scored in a wide ranging option appraisal process. In August 2001 Fife Health Board, informed by the informal consultation, announced a preferred option for the provision of future healthcare services in Fife. The Board then entered into the second stage of the process, formal consultation. The preferred option took into account an increase in the proportion of the elderly population and anticipated a commensurate increase in those conditions associated with an older population such as cancer, coronary heart disease and stroke. This included a projected increase in the numbers of people presenting with complex conditions requiring multi-specialty management and support. The inclusion of new technologies and treatment methods within the preferred option called for a higher level of interaction between medical and surgical sub-specialties and a greater degree of integrated service delivery, particularly at the acute/secondary interface and within multi-disciplinary teams. In wishing to retain the widest possible range of services for its population, NHS Fife acknowledged that the configuration of acute services was subject to increasing pressures which, if not addressed would become unsustainable due to the inability to continue to meet clinical, quality, accreditation and service standards. Services under severe pressure included general surgery, paediatric surgery, and anaesthetics. Specifically, with regard to General Hospital and Maternity Services, three important aspects emerged from the consultation process: The need to improve waiting times for services The need to improve the physical environment within which some services are provided. The need to provide services that are sustainable with appropriate clinical links and support. In March 2002 the formal consultation process culminated in a decision to provide acute services across two local general hospitals, Victoria Hospital (Kirkcaldy) and Queen Margaret Hospital (Dunfermline), with trauma, specialist inpatient services and critical care being centralised on the Victoria Hospital site. In January 2012, as part of the wide ranging development process, Fife NHS Board opened the reshaped and reconfigured General Hospitals and Maternity Services (GH&MS) extension to the Victoria Hospital campus in Kirkcaldy. This recent development represents a significant proportion of the required 16

17 improvements in healthcare services across Fife. NHS Fife s current engagement in the transition from the Right for Fife initiative to Getting Better in Fife will continue to have a significant impact on the NHS Fife estate and its utilisation during the course of the next five years. The development plan for services to be delivered from Queen Margaret Hospital is currently being reconfigured and updated as the process proceeds. General Hospitals & Maternity Services Project Since the Publication of Right for Fife (RFF) the GH&MS Project Team has successfully delivered the new wing at Victoria Hospital under the Public Private Partnership (PPP) procurement method and numerous major pieces of work within the original Victoria Hospital buildings as described below. The major infrastructure changes have largely taken place and we are now in the process of completing the RFF construction programme. In the ten years since Right for Fife process began, the models of care have inevitably changed, and in 2012 the Board published Getting Better in Fife (GBiF) which sets out the health care improvement plan for the next five years. The priorities within GBiF are: Improving Flow and Emergency Access Improving Elective Flow Reshaping Older Peoples Services (Including Integrating Health and Social Care) Safe and Accessible Mental Health Services Safe and Effective Medicines Management. This year work has started on the refurbishment of Queen Margaret Hospital in order to produce a one stop, community based, facility which will pull together the disparate services in West Fife and meet the goals of GBiF. The following gives an update on the status of the PPP element already delivered under RFF and the related work within the existing Victoria Hospital site. PPP Investment The new wing at Victoria Hospital was handed over to NHS Fife in October 2011 and became fully operational in March It was a great tribute to the commissioning team and clinical staff that the transition was carried out with the minimum disruption to the service delivery. As part of the Post Project Evaluation a benefits realization questionnaire was completed by the user groups. The benefits were taken from the business case and the users asked to score how well these had been achieved. The scores showed that there was general agreement that the project had delivered the benefits envisaged. During the process for selection of preferred bidder the Achieving Excellence Design Evaluation Toolkit (AEDET) evaluation tool had been employed to score the bidders submissions. The users were asked to complete a further AEDET exercise on the completed building and the results were compared. The results showed that overall the completed building exceeded the user s expectation at the preconstruction stage evaluation. Capital Investment in the Existing Estate The opening of the new wing necessarily incurred a change in the way facilities management services are delivered, and work was carried out to provide a new service yard facility linking to the PPP service corridor in the new wing. This produced a better and safer working environment for portering and other support staff. A new mortuary with post mortem and viewing facilities has now been formed in the existing basement which enabled the existing obsolete building to be closed and post mortem facilities to be centralised on the Victoria Hospital site. 17

18 Land Acquisition In addition to this the Board acquired additional land adjacent to the Hospital on which a new a new laboratory building and additional car parking have been built. This enabled Laboratory services to enhance their services to meet the needs of the centralised acute services within the PPP new wing within a facility which meets the latest accreditation standards. The Victoria Hospital Pharmacy has also been extensively upgraded to provide safe and secure pharmacy services within the extended hospital campus. Transport /Travel Planning Steps were taken to provide increased car parking around the hospital and in particular to improve visitor access to the main hospital and to A&E. In addition the main access to the extended site and the main route through it were designed to maximize access for buses. The Hospital is now an integral part of many of the main bus routes through Kirkcaldy. Infrastructure Investment; Power, IT, Energy & Environmental The infrastructure within the Victoria site has also been upgraded, with a new High Voltage power supply installed to serve the whole site and a new Data Centre with the capability for expansion has been built in one of the existing buildings. The PPP energy centre is fitted with a state of the art Combined Heat and Power system, a highly efficient way of delivering heat and electricity to the hospital; biomass boilers burning fuel that is zero-rated for Carbon and hence highly environment-friendly and this, combined with a centralized Medium Temperature Hot Water, (MTHW), system which will eventually serve the whole site, is already bringing improvements in energy and carbon efficiency. A pneumatic tube system has been installed across the whole site linking the Wards to the Labs and Pharmacy and provides a faster service and real reductions in the requirement to manually transport samples etc across the site. Estate Rationalisation Ongoing work for the financial year 2013/14 will include completion of the pharmacy improvements by the provision of a new Aseptic Suite replacing the obsolete building and meeting the latest accreditation standards. Plans are in hand to complete the MTHW circuit which will enable the demolition of the old Victorian buildings to the west of the hospital and allow the completion of the car parking scheme for the site. Ongoing work in future years will include new traffic layouts to the laundry and kitchens and improvements in the workplace transport safety measures. Queen Margaret Hospital Reconfiguration Work to reconfigure Queen Margaret Hospital has been re-evaluated in light of evolving clinical advances and requirements since Right for Fife and to incorporate the goals of Getting Better in Fife. Work started in financial year 2012/13 on the Endoscopy Reprocessing Unit which is the first stage of the integrated Diagnostic and Treatment Centre (DTC). Work is to be completed in financial year 2013/14 will include the remainder of the DTC including provision of day surgery; urology, day intervention and 23 hour stay facilities. This will improve the patient flows and the facilities for elective procedures. Backlog Maintenance Reduction Work will also be undertaken to upgrade the existing older people s services accommodation in particular it is planned to carry out work to correct some backlog maintenance issues. This will ensure the ongoing viability of these areas. Service Integration; Re balancing Investment During financial year 2014/15 work will commence on forming an integrated primary care facility to provide a centre for health and social care services as envisaged in GBiF. This will involve relocating 18

19 Dental services and Mental Health Outpatients from diverse locations centres in West Fife to provide integrated and one stop services. The ANITT (Anorexia Nervosa Intensive Treatment Team) service will be relocated to more appropriate upgraded premises on the Queen Margaret campus and the Child and Adolescent mental health service will also be relocated to the Queen Margaret Hospital. Estate Rationalisation The work to integrate Primary Care Services at Queen Margaret Campus will mean that it will be possible to rationalise some Primary Care services and facilities in West Fife. These are existing old, disfunctional facilities, some of which have a high backlog maintenance liability and are increasingly inappropriate for the delivery of modern healthcare services. Patient access and clinical improvements could be achieved by innovative redesign. Analysis of Estate using Current NHS Scotland Guidance A summary of the current in NHS Fife asset data is contained within in the Board Level Report from the NHS Fife Asset Management System. The purpose of the Board Level Report is to present key asset management information which allows an informed decision making process in relation to the improvement, development and care of the estate. The Board Level Report is presented within Section 12 of this document. The current condition and performance of the existing Estate has been analysed in accordance with current NHS Scotland guidance which appraises the estate under 6 facets: Physical condition Compliance with Fire and Health and Safety Environmental Management Functional Suitability Space Utilisation Quality Physical Condition The results shown in Table 4.2 indicate that a substantial part of the estate (78%) is in a satisfactory physical condition, however there are several areas within the infrastructure of the estate that require to be addressed. This is carried out on risk based prioritisation. Those aspects of the physical condition of the estate which fall into a category C/CX or D/DX are risk rated relative to clinical service impact and are incorporated into the NHS Fife 5 Year Capital Plan. Category A B C / CX D / DX Facet Definition Very Satisfactory Satisfactory Not Satisfactory Unacceptable Not Categorised Physical Condition Area m 2 74, , , , % of Estate Area in Category 24.25% 54.09% 19.22% 0.01% 2.43% Table 4.2: Summary of Estate Physical Condition Last Update 06 March

20 The investment required to bring the Estate up to an acceptable condition is known as backlog costs. The guidance defines backlog costs as the costs required to bring an element up to an acceptable condition (i.e. A or B). The guidance also states that the backlog costs should be expressed as a works cost only. Additional costs that are dependent upon the solution chosen (VAT, Fees, Decant, and Temporary Services) are excluded from the backlog costs however will be included within project costs being brought forward for consideration. The total backlog maintenance costs for NHS Fife are 30.7m Category B (Acceptable Condition), 37.4m Category C (Requires Investment) and 4.4m Category D (Unacceptable Condition), total backlog maintenance cost for NHS Fife of 72.5m. This assumes all existing estate will be retained and used. Please note that the Risk Assessed backlog maintenance figure is significantly less than the total backlog maintenance figure. Detail of the costs on backlog maintenance are as shown in Section 12, Table 12.3 Risk Profiled Backlog Costs and Chart 12.3A Physical Condition Risk Profiled Backlog Costs. As backlog maintenance figures are produced it is necessary to identify the risks associated with these costs. Functional Suitability Table 12.6 in Section 12 shows the results of the Functional Suitability analysis i.e. a total of 77.5% of the available space being either Satisfactory or Very Satisfactory and a total of 18.7% of available space being Unacceptable (3.76% Unreported). Quality Table 12.8 in Section 12 shows the results of the Quality analysis i.e. a total of 68.6% of available space being either Satisfactory or Very Satisfactory and a total of 27.62% of available space being Not Satisfactory or Unacceptable (3.79 % Unreported). Space Utilisation Table 12.7 in Section 12 shows the results of the Space Utilisation analysis i.e. a total of 10.47% of available space being Empty/Not Used, 4.69% being Under Utilised, 77.41% Fully Utilised and 7.44% Overcrowded. Environmental Management Effective Environmental Management in NHS Fife is currently achieved through integrated management responsibilities with a professional lead from the Energy and Environment Manager. Current management systems and initiatives include the monitoring and targeting of utilities in line with Scottish Government targets, waste management and reduction initiatives in accordance with the NHS Scotland Waste Management Action Plan: 2007, transport rationalisation and efficacy, carbon management plan, environment action plan and the formation of a Sustainability Strategy. Implementation of the NHS Fife Sustainability Strategy will be rolled out into 2013/14and will incorporate elements of climate change, energy management, waste management, transport and travel planning, sustainable procurement, sustainable construction carbon management. 20

21 Many of the objectives contained within the Sustainability Strategy will directly and indirectly influence the outcomes of the Property and Asset Management Strategy and will also ensure that the operations of NHS Fife do not have a detrimental effect on the health of the general population of Fife. Current performance on energy consumption in each of our buildings is measured using an Energy Performance Certificate, which is a legal document which identifies the energy efficiency of a building based on the standardised way that the building is used. Carbon dioxide (CO 2 ) ratings are shown in bandings from A to G, with A being the least polluting. Table 12.5 Energy Performance Certificates in Section 12 shows for the ratings for each of those buildings. (NB a property can contain a number of buildings), Energy Conservation Funds NHS Fife has been successful in obtaining further energy conservation funding from both the Carbon Reduction Programme and the Central Energy Efficiency Fund. The Operational Division schemes included within this funding are as follows: Queen Margaret Hospital Queen Margaret Hospital (High Efficiency Boilers and Solar Panels) - Installation of new high efficiency boilers within the Residences. System uses solar panels to preheat domestic hot water; also the boilers are of the high efficiency condensing type. The calculated savings are approaching 9,000 per annum, with completion of the works scheduled for March Queen Margaret Hospital (District Heating Scheme) System will use heat generated by the Fife Council anaerobic digestion system which produces hot water for heating from burning gas generated from a Fife Council landfill site at Wellwood by Dunfermline. The funding (approved for year 2014/15) will allow for the adaption of the boiler plant at Queen Margaret Hospital in order to accommodate the hot water supply. Fife council is currently producing plans for the pipeline which will connect the anaerobic digestion system heating supply to Queen Margaret Hospital. The calculated savings are over 100,000 per annum, with completion of the scheme scheduled for year 2014/15. NHS Fife Improvement and Efficiency Single Page Project Initiation Document (SPPID) SPPID Reference (PMO to complete at present) Business Unit and Directorate: Estates & Facilities Business Unit Exec Lead: J Leiper Clinical Lead: N/A Project Lead: B Gillespie Project/scheme purpose: Installation of plant and equipment throughout Queen Margaret Hospital that will utilise hot water from Dunfermline District Heating Scheme. Objectives : 1. Reduction of CO2 emissions from Queen Margaret Hospital. 2. Improve energy performance of Queen Margaret Hospital. 3. Replacement of steam raising plant at Queen Margaret Hospital. 4. Cost reduction in supply of heating services to Queen Margaret Hospital. Milestones (dated and capable of being evidenced): 1. Prepare tender and specification documents by 31 st March Work completed to install network supply pipe in QMH boiler house by March Work on Queen Margaret heating plant to commence Oct Work on Queen Margaret heating plant to be completed March

22 Impact Pay (R/N-R) Non Pay (R/N-R) Capital Impact Start Date 14/15 Impact 15/16 Impact 2014/15 30, ,000 (Energy) 20,000 (CRC- Carbon Reduction Commitment ) Total 120, /15 1,320,000 Carbon Reduction Programme funding. Business Unit GM/Director Signature: J Leiper 0 Medical Director/Clinical Director Signature N/A Activity & Quality impacts not covered in Objectives (quantified) Reduction in CO2 emissions will reduce number of CRC allowances to be purchased. Impact on other services: No impact. Critical assumptions: Cost of hot water being supplied by Fife Council to match gas price at contract rates. Confirmation of funding for network pipe to connect QMH to district heating scheme. Scope: Queen Margaret Hospital. Out of Scope: N/A Project/scheme Lead Signature: B Gillespie Lynebank Hospital A survey and report was provided by the Carbon Trust. The Carbon Trust receives funding from the Scottish Government and the Welsh Government. The primary objective of this project was to evaluate the options available to the hospital to improve the existing heating system. In particular, the following options were to be evaluated: Part Decentralisation, New Central Boiler, Overnight DHW Part Decentralisation, New Central Boiler, No Overnight DHW Full Decentralisation Evaluation of the above options indicates that the most attractive option that should be progressed by Lynebank Hospital is part decentralisation with no overnight hot water (i.e. new DHW systems installed so that the central boiler can be shut down overnight). The main aspects of this proposal are as follows: Closure of wards 1-6 New 800 kw gas fired central boiler existing boiler to be retained as back-up Pentland 2 No. 60kW wall hung gas boilers Campsie 2 No. 60kW wall hung gas boilers Wards No. 80kW wall hung gas boilers Gardeners Work Shed 2 No. 50kW gas fired warm air heaters Levendale 3 No. 80kW wall hung gas boilers Domestic Hot Water Gas fired water heaters for kitchen, electric point of use water heaters elsewhere 22

23 NHS Fife Improvement and Efficiency Single Page Project Initiation Document (SPPID) SPPID Reference (PMO to complete at present) Business Unit and Directorate: Estates & Facilities Business Unit Exec Lead: J Leiper Clinical Lead: N/A Project Lead: B Gillespie Project/scheme purpose: Decentralisation of existing central LTHW boiler plant and replace with local high efficiency gas condensing boilers at Lynebank Hospital. Objectives : 5. Improve energy performance of Lynebank Hospital. 6. Reduction of CO2 emissions from Lynebank Hospital. 7. Replacement of LTHW boiler plant. 8. Improve security of heating supply to hospital. Milestones (dated and capable of being evidenced): 5. Prepare tender and specification documents by 31 st March Work to commence by May Completion of work March 2015 Impact Pay (R/N-R) Non Pay (R/N-R) Capital Impact Start Date 13/14 Impact 14/15 Impact 2013/ ,000 (Energy) 4,000 (Carbon Reduction Commitment) Total 54, /14 363,024 Carbon Reduction Programme funding. Business Unit GM/Director Signature: J Leiper 363,024 Carbon Reduction Programme funding. Medical Director/Clinical Director Signature N/A Activity & Quality impacts not covered in Objectives (quantified) Reduction in CO2 emissions will reduce number of CRC (Carbon Reduction Commitment) allowances to be purchased. Impact on other services: No impact. Critical assumptions: Savings will only be realised when existing central boiler plant is no longer required. NB: Savings identified for 14/15 are estimated to be half of the total as only 50% of the required work will be completed at that point. A further 50,000 (energy) and 4,000 (CRC) cost reduction will be added in year 15/16, bringing total cost reduction to 108,000. Scope: Lynebank Hospital. Out of Scope: N/A Project/scheme Lead Signature: B Gillespie Stratheden Hospital A survey and report was provided by the Carbon Trust. The Carbon Trust receives funding from the Scottish Government and the Welsh Government. The primary objective of this project was to explore the options available to the hospital for improving the existing heating system in order to achieve energy and cost savings. In particular, this project was to consider the following options: Potential for removing steam heating from the site Full decentralisation of the hospital heating system Installation of decentralised CHP A decentralised biomass system 23

24 Following evaluation of the above options, this report recommends that Stratheden Hospital progress with full decentralisation of the heating system and the removal of steam heating. This project would require the installation of the following: Wards No. 200kW floor standing gas boilers Ward 14 3 No. 60kW wall hung gas boilers Medical Offices 2 No. 60kW wall hung gas boilers Workshop 1 No. gas combi boiler Greenhouses 1 No. 50kW gas boiler Laundry 2 No. 50kW gas boilers and new radiators NHS Fife Improvement and Efficiency Single Page Project Initiation Document (SPPID) SPPID Reference (PMO to complete at present) Business Unit and Directorate: Estates & Facilities Business Unit Exec Lead: J Leiper Clinical Lead: N/A Project Lead: B Gillespie Project/scheme purpose: Decentralisation of existing central steam raising boiler plant and replace with local high efficiency gas condensing boilers at Stratheden Hospital. Objectives : 9. Improve energy performance of Stratheden Hospital. 10. Reduction of CO2 emissions from Stratheden Hospital. 11. Replacement of steam boiler plant. 12. Improve security of heating supply to hospital. Impact Pay (R/N-R) Non Pay (R/N-R) Capital Impact Start Date 13/14 Impact 14/15 Impact 2013/ ,000 (Energy) 3,200 Carbon Reduction Commitment (CRC) Total 42, /14 298,861 Carbon Reduction Programme funding. Business Unit GM/Director Signature: J Leiper 298,861 Carbon Reduction Programme funding. Medical Director/Clinical Director Signature N/A Milestones (dated and capable of being evidenced): 8. Prepare tender and specification documents by 31 st March Work to be started by May Work to be completed March 2015 Activity & Quality impacts not covered in Objectives (quantified) Reduction in CO2 emissions will reduce number of CRC (Carbon Reduction Commitment) allowances to be purchased. Impact on other services: Improved reliability of heating services. Critical assumptions: Savings will only be realised when existing central boiler plant is no longer required. NB: Savings identified for 14/15 are estimated to be half of the total as only 50% of the required work will be completed at that point. A further 39,000 (energy) and 3,200 (CRC) cost reduction will be added in year 15/16, bringing total cost reduction to 84,400. Scope: Stratheden Hospital. Out of Scope: N/A Project/scheme Lead Signature: B Gillespie 24

25 Victoria Hospital Victoria Hospital (Replacement of Steam Plant) The scheme will replace the existing steam heating system for the retained estate on the Victoria Hospital site by connecting to the hot water heating system used for the new Phase 3 building. The funding provided will allow for the conversion of the existing heating plant I order to accommodate the new hot water supply. The calculated savings are over 200,000 per annum with completion of the scheme scheduled for March NHS Fife Improvement and Efficiency Single Page Project Initiation Document (SPPID) SPPID Reference (PMO to complete at present) Business Unit and Directorate: Estates & Facilities Business Unit Exec Lead: J Leiper Clinical Lead: N/A Project Lead: B Gillespie Project/scheme purpose: Removal of 6 no. existing steam tumble dryers and replace with 6 no. high efficiency gas tumble dryers in Central Laundry, Victoria Hospital. Objectives : 13. Improve energy performance of Victoria Hospital site. 14. Reduction of CO2 emissions from Victoria Hospital site. 15. Improve productivity and efficiency of Central Laundry service. Impact Pay (R/N-R) Non Pay (R/N-R) Capital Impact Start Date 12/13 Impact 13/14 Impact 2013/ ,000 (Energy) 8,500 (Carbon Reduction Commitment) Total 128,500 cost reduction. 2012/13 549,990 (from Carbon Reduction Programme) Business Unit GM/Director Signature: J Leiper 0 Medical Director/Clinical Director Signature N/A Milestones (dated and capable of being evidenced): 11. Prepare tender and specification documents by 31 st October Tender return by Friday 16 th Nov Work to be completed by 31 st March Activity & Quality impacts not covered in Objectives (quantified) Reduction in CO2 emissions will reduce number of Carbon Reduction Commitment (CRC) allowances to be purchased. Impact on other services: Improved efficiency and productivity of laundry service. Critical assumptions: N/A Scope: Central Laundry, Victoria Hospital. Out of Scope: N/A Project/scheme Lead Signature: B Gillespie 25

26 Victoria Hospital Central Laundry Renewal of Tumble Dryers NHS Scotland has developed a grant scheme to assist with the reduction of CO 2 emissions by Health Boards. The scheme is administered by Health Facilities Scotland. Grants are awarded to NHS Boards for schemes that can demonstrate a high and continuous reduction in CO 2 emissions. The Central Laundry, sited at Victoria Hospital in Kirkcaldy, serves the needs of both NHS Fife and NHS Forth Valley, 18 hospitals in all. As one of only 9 laundries across NHS Scotland it is part of a loose coalition of NHS laundries participating in reciprocal contingency planning. The laundry produces some 7 million plus articles per annum. Replacement of the dryers with gas heated models will have the following benefits: A reduction in energy consumption in the order of 3,742,875 kwh and a saving at current costs of more than 78,266, a consequent reduction in CO 2 emissions of 692 tonnes is anticipated. Carbon Management; NHS Fife has set a challenging target within its Carbon Management Plan to achieve a 30% reduction in CO 2 emissions from a baseline figure of 36,134 tonnes. This project would contribute a reduction of 2.02% towards meeting this target. CRC Energy Efficiency Scheme; The CRC Energy Efficiency Scheme is a new mandatory emissions trading scheme and started on 1 st April The scheme places duties on organisations that have been designed to encourage improved energy efficiency through behaviour and infrastructure change. Participants in the scheme will be required to purchase and surrender emissions allowances that correspond with their carbon dioxide emissions. At the current price of 12 per tonne of CO 2, this project will reduce the amount of allowances to be purchased by 8,748. In addition, the reduction in emissions will result in a higher position in the revenue recycling table and potentially a higher bonus payment. A reduction in downtime and consequent costs due to: o o o increasing unreliability of the current dryers downtime involved in manual cleaning of lint screens downtime involved in servicing/checking of heating battery banks. Improved health and safety: o o o o reduced requirement to clean rooftop lint traps reduced reliance on steps to access lint traps within the laundry. a reduction in noise within the laundry environment. a reduction in lint within the laundry environment As a major user of gas generated steam, replacing the dryers would achieve a significant proportion of NHS Fife s target for reduction of reliance on fossil fuels. OTHER EFFICIENCY SCHEMES The replacement of the tumble dryers would be complimentary to several other energy improvement schemes that have been implemented within the laundry plant. Recent successful schemes have included: Heat recovery from washer discharge water Review of water temperature control in batch washers Refurbishment of steam traps Renewed lagging 26

27 Other schemes currently being investigated include: Lighting improvements Water recycling Efficiency schemes which would run simultaneously with the proposed dryer renewal include the removal of one calender. This energy improvement is reliant upon the introduction of a new style of fitted bedding and the anticipated improved drying capabilities of the new dryers. Removal of a calender will have the energy efficiency benefits in the order of 200,000 kwh and consequent CO 2 savings of 37 tonnes (financial savings are already included in the above 78K). Statutory Compliance The percentage statutory compliance for each property listed in Table 4.3 pages below is derived from the NHS Scotland Statutory Compliance Audit and Risk Tool (SCART). This system produces a compliance score for each of the 39 statutory compliance topics addressed within it e.g. legionella, electrical systems, fire compliance, workplace transport, medical gases, sterilisation and disinfection. In addition, the system displays the risks associated with non-compliance and allows the provision of the information contained in the SCART Summary shown in Table 5.1.on page 39 The prime benefit of the SCART system is that it applies a default risk rating to each of the shortfalls identified in an audit, the risk rating being calculated using the standard NHS Scotland 5x5 matrix. This then allows the production of a risk prioritised action plan and resulting Statutory Compliance Capital Plan as shown in Table 4.4 on page 29 shows the initial section of the remaining 2013/14 Statutory Capital Compliance Plan Site Name % Compliance Abbeyview Clinic Adamson Hospital Area Distribution Centre Cameron Hospital Cardenden Health Centre Carnegie Clinic Cowdenbeath Clinic Cowdenbeath Dental Access Centre Cupar Dental Access Centre Cupar Health Centre Dalgety Bay Health Centre Dovecot Clinic Fair Isle Clinic Glenrothes Hospital Glenwood Dental Access Centre Glenwood Health Centre Gordon Cottage Clinic

28 Haldane House Clinic Kelty Health Centre Kennoway Health centre Kinghorn Health Centre Kirkcaldy Health Centre Ladybank Clinic Leven Health Centre Lynebank Hospital Masterton Health Centre Oakley Health Centre Pitteuchar Health Centre Queen Margaret Hospital Randolph Wemyss Memorial Hospital Skeith Health Centre St Andrews Community Hospital Stratheden Hospital Victoria Hospital (Fife) Weston Day Hospital Whytemans Brae Hospital West Fife Community Properties Average % Compliance for all NHS Fife Sites NHSScotland National Average % Compliance TABLE 4.3: Percentage Statutory Compliance NHS Fife Sites Last Update 05 Mar

29 Table 4.4: Statutory Compliance Capital Plan 2013/14 - NHS Fife Summary. NB Plan is a draft version only at 8th March 2013 and will change subject to further assessment of Statutory Compliance issues and Risk Assessed Backlog Maintenance.Total funding of 2,461,000 available for year 2013/14. Project Number Project Location Risk Assessment Criteria Used 1 Food Waste Processing Units NHS Fife Wide Inspection / Audit Likelhood (1-5) Severity (1-5) Risk score Datix Reference Not available at present Lead Funding Required 2013 /14 Cumulative Total BG 150, , GH&MS Installation of LV Switchboards. Window Replacement (Inc asbestos removal) Victoria Hospital Lynebank Hospital Service / Business Interruption Inspection / Audit Not available at present Not available at present EG 230, ,000 AW 100, ,000 4 Fire Precautions 5 Emergency Lighting 6 Workplace Transport Works Queen Margaret Hospital Queen Margaret Hospital Queen Margaret Hospital Inspection / Audit Inspection / Audit Not available at present Not available at present Injury Not available at present BG 100, ,000 GR 150, ,000 EG 40, ,000 7 Fire Precautions Victoria Hospital Inspection / Audit Not available at present BG 100, ,000 8 Window Security Victoria Hospital Inspection / Audit Not available at present BG 100, ,000 9 Fire Compartmentation Glenrothes Hospital Inspection / Audit Not available at present AW 270,000 1,240, Workplace Transport Works Stratheden Hospital Inspection / Audit Not available at present AW 100,000 1,340, Stonework Repairs Stratheden Hospital Inspection / Audit Not available at present AW 50,000 1,390, VHK Lift Improvement Works 13 Workplace Transport Works Victoria Hospital Lynebank Hospital Service / Business Interruption Inspection / Audit Not available at present Not available at present EG 470,000 1,860,000 GR 100,000 1,960, Legionella Precautions NHS Fife Wide Inspection / Audit Not available at present BG 65,000 2,025, Walk in Freezers - Refrigeration System 16 Signage Victoria Hospital Victoria Hospital Service / Business Interruption Inspection / Audit Not available at present Not available at present EG 90,000 2,115,000 EG 40,000 2,155, Roofing Replacement Lynebank Hospital Inspection / Audit Not available at present GR 100,000 2,255, Asbestos Removal NHS Fife Wide Inspection / Audit Not available at present BG 80,000 2,335, Phase 2 Roofing, Mezzanine Level. 20 Gas Safety Works 21 Hearing Induction Loops Victoria Hospital Stratheden Hospital NHS Fife Wide Service / Business Interruption Service / Business Interruption Inspection / Audit Not available at present Not available at present Not available at present EG 100,000 2,435,000 AW 20,000 2,455,000 BG 50,000 2,505,000 29

30 Backlog Maintenance As part of the ongoing management of backlog maintenance within NHS Fife properties, an annual commitment of capital funding is made in conjunction with the Scottish Government to reduce the level of backlog maintenance. Within the year 2012/13, 2.548m capital funding was committed to the reduction of outstanding backlog and statutory maintenance requirements, with a further 2.461m committed within the 2013/14 financial year. Between years 2013/14 and 2017/18 inclusive a total of 15.5m million has been scheduled to assist in further reducing backlog maintenance. The vast majority of this funding is allocated to clinical areas. Backlog Maintenance Costs Prediction 2013/14 to 2018/19 Year 2013/ / / / / /19 Backlog Maintenance Cost at Commencement of Year (1st April) 50,233,000 41,819,473 24,549,857 20,757,386 17,491,386 14,225,386 Backlog Maintenance and /or Statutory Funding for Year 2,461,000 3,266,000 3,266,000 3,266,000 3,266,000 Not Known Backlog Reduction for Year due to Acquisitions and/or Disposals Total Reduction for Year 5,952,527 14,003, , ,413,527 17,269,616 3,792,471 3,266,000 3,266,000 Not Known Acquisitions and/or Disposals Detail for Year and Associated Backlog Reduction: (Note some of these elements and the timing of possible disposals are indicative only and subject to change if different clinical strategies emerge due to changes in clinical delivery). Further updates will include the write down of Backlog due to other capital investments, e.g. QMH developments. Possible Property Disposal 5,399,000 Potential Property Disposal - 108,000 Potential Property Disposal - Potential Property Disposal 54,315 Possible Property Disposal - 4,016,449 Potential Property Disposal 6,424,000 Potential Property Disposal Potential Property Disposal 3,175,667 Potential Property Disposal 526, , ,500 30

31 In addition the rationalisation of the use of NHS Fife Estate is resulting in an ongoing reduction in the level of backlog maintenance due to the decommissioning of properties and the refurbishment of buildings in relation to clinical service development. Planned energy conservation expenditure from 2012/13 to 2014/15 inclusive, amounts to 4.03 million, the majority of which will bring a corresponding reduction in backlog maintenance. Due to ongoing survey and condition assessment of properties, the total backlog figure can rise and fall, e.g. within the year 2011/12 and additional 13 million backlog maintenance was identified following the completion of remaining surveys. Further surveys have been completed within the 2012/13 financial year for some remaining GP premises and clinics. The 2012 NHS Scotland State of the Estate report identified a 62 million drop in risk assessed backlog maintenance with NHS Fife contributing 7 million to this reduction The total backlog maintenance costs for NHS Fife are 30.7m Category B (Acceptable Condition), 37.4m Category C (Requires Investment) and 4.4m Category D (Unacceptable Condition), total backlog maintenance cost for NHS Fife of 72.5m. This assumes all existing estate will be retained and used. Please note that the Risk Assessed backlog maintenance figure is significantly less than the total backlog maintenance figure. 31

32 5. Where Do We Want To Be? Clinical Service How assets are managed in the NHS is ultimately driven by health policy. All NHS organisations have plans to redesign their services to achieve the aims of the Scottish Government s key policies as set out in Better Health, Better Care Action Plan and the 2020 Vision. This service redesign will require significant changes in the way that assets are managed and used in the NHS. NHS Fife s former service delivery initiative Right for Fife and the new Getting Better in Fife have been incorporated into a thorough review of the organisation s corporate and service strategies and plans for change, considering key questions such as: What services will the organisation provide in the future? How will they differ from those services currently provided? Where will they be located in relation to the areas they serve? Who will provide them and how? When will these changes take place? The PAMS must then interpret the proposed service changes in terms of their impact on the need for physical assets. It should demonstrate how the current supply of physical assets will need to change through investment, acquisition or disposal to meet future service needs. This inclusion of the organisation s current strategies and plans for change is fundamental to the identification of the gap between the organisation s vision and the adequacy and ability of its existing asset base to support that vision. Those current strategies and plans are embodied within the current version of the NHS Fife Local Delivery Plan (LDP) and the clinical service strategy Right for Fife and evolving Getting Better in Fife strategy, which is the frontline driver for achievement of the Scottish Government objectives within the Better Health, Better Care Action Plan and the 2020 Vision. Hence with regards to clinical service provision and Where do we want to be, the aforementioned documents represent the current needs based requirements. Many of the Acute Services aims within Right for Fife were embodied in the General Hospitals and Maternity Services project which is currently in place and meeting the project targets. NHS Fife s Strategic Overview The Scottish Government set out the national framework for improving Scotland s health and healthcare in its Quality Strategy 2 which sets out NHS Scotland s vision to be a world leader in healthcare quality, described through 3 quality ambitions: effective, person centred and safe. These ambitions are articulated through the 6 Quality Outcomes that NHS Scotland is striving towards: Everyone gets the best start in life, and is able to live a longer, healthier life; People are able to live at home or in the community; Healthcare is safe for every person, every time; Everyone has a positive experience of healthcare; Staff feel supported and engaged; The best use is made of available resources. The Quality Strategy builds on Better Health, Better Care 3 and together with subsequent supporting publications they provide the overall strategic context. 2 The Scottish Government. The Healthcare Quality Strategy for NHS Scotland; Edinburgh The Scottish Government. Better Health, Better Care; Action Plan; Edinburgh

33 Since 2002, NHS Fife Board has been delivering an ambitious programme of development and modernisation designed to improve the range and quality of healthcare services and to improve the quality of the premises from which services are provided. To deliver Patient centred, Safe and Clinically Effective care and enable people to maintain their contribution to society, through prompt assessment, diagnosis, and intervention. By ensuring that 90% of patients who are referred have their assessment, diagnosis and treatment within 18 weeks from referral. 95% of patients who are referred with a suspicion of cancer receive assessment, diagnosis and treatment (if required) within 62 days from referral. 95% of patient diagnosed with cancer receive their treatment within 31 days from the decision to treat This programme will maximise the use of technology and make effective use of all resources on all sites. This will reduce unnecessary hospital visits, reduce unwarranted variation and will deliver a personcentred, timely, high quality planned care service. Getting Better in Fife builds on the Right for Fife it is a re-fresh not a re-start. It sits in the context of: SGHSCD 2020 Vision NHS Scotland Quality Strategy NHS Scotland Efficiency & Productivity Framework And alongside Fife s Health & Wellbeing Plan Community Plan Single Outcome Agreement FHSCP Service Delivery Plan Responding to the Coming Challenges While services have changed and continue to change, the challenges facing the NHS continue to grow. As a society, we are getting older, with more people living longer and fewer people in the workforce. Lifestyle diseases such as obesity are generating new healthcare demands and advancing technology, including new drugs, means the NHS can do more to help more people. The NHS can only reconcile that growing need with the reality of contained resources by doing more with less. Our investment programme, in new community facilities as well as new hospitals, has put us in a strong position already but we need to do more. Our vision for 2020 is that everyone is able to live longer healthier lives at home, or in a homely setting. We will have a healthcare system where we have integrated health and social care, a focus on prevention, anticipation and supported self management. Primary Care has a key role in helping the healthcare system as whole make improvements. When hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm. Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission. 33

34 What is our aim? Reshaping Older People s Services (Including: Integrating Health and Social Care) To meet the needs of the older population now and in the coming years, all Health and Social Care Services should have a primary aim of maintaining and supporting independent living and maintaining quality of life. The resources of local people and communities will be at the centre of social care provision. Within the context of Getting Better in Fife we aim to: Ensure that older people with complex needs are well supported by all parts of the care system. Develop care settings, with partners that will help older people to remain at home; or in a homely setting; and developing community capacity to enable older people and their communities to develop local systems of self-care. Reduce the length of stay for older people in hospital, and avoid any unnecessary transfers in care. Reduce falls-related admissions to hospital in the over 65s by 20% through the implementation of integrated falls and fracture care pathways. Build relationships with the voluntary sector and private providers to develop community capacity models, and new models of care. Develop and invest in support for Carers. And in particular to: Develop a new Integrated Assessment and Community Support Service (ICASS) which provides hospital at home, intermediate care and home re-ablement services that are responsive to need and will prevent admission to hospital as well as supporting early discharge. Review the community bed resource, in line with our intention to move to more care at home and agree a plan of reduced inpatient based care and treatment. Why will this improve the patient experience and reduce harm, waste and variation? Hospitals have generally been viewed as the source of expert care and the public have become accustomed to receiving inpatient care as the first option when faced with a crisis or emergency. Hospitals do not always provide the most appropriate environment in which to provide care that is not of a specialist nature. This is particularly so for elderly frail patients and other vulnerable groups. Importantly patients have also expressed the preference to remain in their own homes and to be treated there if possible. Smooth transition for patients between health and social care sectors in Fife will reduce the opportunity for duplication and improve the patient experience A patient safety approach to developing a transfer bundle will improve communication, and ensure transfers in care are undertaken efficiently and without harm. The ICASS model currently being implemented across Fife plans to deliver a fully integrated service for frail older people who would have otherwise been admitted to hospital for common conditions. The re-ablement and Home Care Change Programme will enable patients to maintain their skills and independence for longer periods. Developing the use of technology for example using mobile telecare devices can support people beyond the confines of their own home allowing them to remain in the community. 34

35 Building on our programme of falls and fracture prevention has significant potential to improve the patient experience and reduce harm waste and variation Mental Health A focus on modernising current day services and day hospital models will promote independence and reablement, and avoid unnecessary admissions to institutionalised based care. The provision of therapeutic facilities and environments which offer privacy and maintain dignity is an essential aspect of good patient care. We will continue to seek improvements in the quality of the mental health estate with the initial focus on developing a proposal for the re-provision of the Intensive Psychiatric Care Unit. We will develop and provide a Forensic Low Secure inpatient unit on the Stratheden Hospital site. This development will ensure NHS Fife better meets its responsibilities for the care and supervision of patients with forensic mental health needs. It will enable Fife patients to be cared for in a local facility, improving the patient experience and service efficiency, and will eliminate the need to purchase services from outside Fife and so realise expenditure savings. The following provides a brief resume of the clinical developments planned at Stratheden hospital and the resulting changes to the use of the estate. Forensic Low Secure Unit This new service is due to become operational on or around 1 April The service will be provided in Radernie ward (ward 21) following redesign and refurbishment. The current patient group in this ward (old age psychiatry) will transfer to Cairnie House following its refurbishment. Current Use Planned Use Cairnie House Vacant Old Age Psychiatry Radernie ward (21) Old Age Psychiatry Forensic Low secure Rehabilitation Redesign The rehabilitation redesign programme is a collaborative programme with Fife Council Social Work Department, which will result in the discharge of up to 45 patients from the adult rehabilitation and long stay wards over the next 2 years. This should result in the closure of two wards. To date, a sufficient number of patients have been discharged to enable the closure of one ward (Falkland ward 2) within the next few months. Current Use Planned Use Lindores ward (1) Rehabilitation/Longstay Rehabilitation/Longstay Falkland ward (2) Rehabilitation Closure Dunino ward (14) Rehabilitation/Longstay Rehabilitation/Longstay Edenview ward (26) Rehabilitation/Longstay Probable future closure Intensive Psychiatric Care Unit (IPCU) The IPCU (ward 4) at Stratheden is increasingly falling behind appropriate standards for the healthcare provision delivered and NHS Fife has identified its replacement as a priority. An options paper has been submitted to the Strategic Management Team (SMT) for consideration and proposals are currently being developed for a new eight bed IPCU on the Stratheden site. The timescale for the new build will be as soon as practically possible; anticipated within the next two years, given the necessary permissions and approvals. The clinical preference for the location of the new build is on the north eastern part of the Stratheden campus, to the north of the East Wing (K block) adjacent to the planned Forensic Low Secure Unit. 35

36 Current Use Planned Use IPCU (4) Intensive Care Future closure New build IPCU N/A Intensive Care As a result of these planned and proposed developments, there would be only two inpatient wards remaining in the Victorian buildings Lindores (1) and Dunino (14). Plans for the future of these facilities will be included in the master planning for the site. Mental Health East The East psychiatry team is based in no. 6 Stratheden Court and deal with Community Old Age Services. Alternative accommodation has been identified in the redeveloped Adamson hospital, and the team will be relocating shortly. This will leave no.6 Stratheden Court empty.nhs Fife Board has declared no. 6 Stratheden Court as surplus to requirement and the property will be sold in early course. There are, currently, no other developed plans or proposals for developments or changes on the Stratheden Hospital site. Asset Targets The asset related targets within the Local Development Plan (LDP) are listed within the current NHS Fife Balance Scorecard listed under the headings of Patient Experience, Planning Service Improvement and Delivery and Efficiency and they are: Patient Experience HAI we will aim to reduce the rate of staphylococcus aureus bacteraemia (including MRSA). Health & Safety we will develop and implement the annual local action plan for Health and Safety. Planning Service Improvement Reduction in Emergency Bed Day Rates for Patients Aged 75+. Scottish Patient Safety Programme (SPSP) we will aim to deliver the aims of the Scottish Patient Safety Programme. SEAT (South East and TAYSIDE) we will contribute to the SEAT Regional Work Plan and linked activity. Service Alignment we will aim to ensure that planning and delivery of services in NHS Fife and NHS TAYSIDE are aligned in such a way that would improve patient flows. Resilience Planning we will continually review and refine our emergency planning arrangements for Business Continuity and Pandemic Flu. Stroke Services To improve stroke care. Clinical Redesign Agree an approach and framework for strategic planning and redesign for NHS Fife, which identifies redesign priorities for the Board and which results in an outcomes-driven redesign programme with performance measures in place to monitor progress. Integrating Health & Social Care onwards Reshaping Older Peoples Care: Hospital at Home ICASS 2013 onwards Delivery and Efficiency. Health We will identify and implement solutions to support improved and safer patient care. Financial performance NHS boards to operate within their agreed revenue resource limit; operate within their capital resource limit; meet their cash requirement. Cash Efficiencies In 2013/14 NHS Fife Board to deliver a 5.3 m Efficiency Savings Target. Rate of Attendance at Accident and Emergency To support shifting the balance of care, NHS Boards will achieve agreed reductions in the rates of attendance at A&E between 2009/10 and 2013/14. 36

37 A&E Waiting Time NHS Fife Board will aim to have 98% of attendees seen within 4 hours. Cancer Waiting Times From the quarter ending December 2011, 95% of all patients diagnosed with cancer to begin treatment within 31 days of decision to treat, and 95% of those referred urgently with a suspicion of cancer to begin treatment within 62 days of receipt of referral. 18 Weeks Referral to Treatment - We will aim to deliver a maximum 18 weeks referral to treatment timescale. Drug and Alcohol Waiting Times By March 2013, 90% of clients will wait no longer than 3 weeks from referral received to appropriate drug or alcohol treatment that supports their recovery. Faster Access to Mental Health Services - Deliver faster access to mental health services by delivering 26 weeks referral to treatment for specialist Child and Adolescent Mental Health Services (CAMHS) services from March 2013 and 18 weeks referral to treatment for specialist Psychological Therapies by December The main aims within the General Hospitals and Maternity Services Project, the main thrust in achieving the acute services related objectives within the Right for Fife and Getting better in Fife initiatives, are as follows: To Improve Waiting Times for Services National standards for waiting times must be met or exceeded. To Improve the Physical Environment in which some Service are Provided To provide all patients and staff with accommodation that provides the best possible environment for healthcare, all accommodation being to a minimum Physical Condition category B (Satisfactory). To Provide Services that are Sustainable To meet the demands of the projected increase in the elderly population. To retain training accreditation for junior doctors thus sustaining the supply of same. To continue to recruit and retain consultants. To retain all current specialist services within Fife. To Provide Services that have the Appropriate Clinical Links and Support Continue with the single-site in-patient provision for smaller specialties. Provide all appropriate services as locally as possible. Provide Fife-wide maternity provision from Kirkcaldy. Physical Condition It is vitally important to understand the risk around continued deterioration and/or failure of estate assets. As the Property Asset Management Strategy moves forward it will be important for the Board to take investment decisions based upon the risk areas in relation to the physical condition of the estate and to develop risk prioritised investment plans which address any shortfalls. The aim for NHS Fife, will as per current objectives, be to bring all retained properties to a minimum condition B (Satisfactory), within a timescale determined through risk analysis and projected available funding or disposal. This will therefore involve targeting of the remaining 6% of our properties which fall within the Unsatisfactory condition category. Current actions in relation to the acquisition and disposal of property will have a positive impact on the condition assessment and these will therefore be taken into account in the proposals for investment in relation to the physical condition of our properties.. Functional Suitability The aim of the functional suitability assessment is to determine how well the available accommodation supports the delivery of healthcare and is assessed on the basis of three elements: internal space relationships; support facilities and location. NHS Fife currently have 18.7% of properties to be classified 37

38 as either Not Acceptable or Unacceptable. The aim of NHS Fife is to bring the functional suitability of all the properties in use to either Satisfactory or Very Satisfactory assessment level. This will be achieved through the acquisition and disposal of properties and implementation of the current investment plan. In those areas requiring improvement the aim will be to ensure: the layout of the accommodation allows safe and effective service delivery; the available accommodation is sufficient for the department to function appropriately; critical rooms are adequately sized; good observation of patients is possible. adequate toilet and bathrooms facilities are available; adequate storage space is available; adequate seating and waiting space is available; Public areas are accessible for all. location close to inter-dependant departments; access via vertical or horizontal circulation is good (lifts, stairs etc); Quality The aim of the quality assessment is to determine how well the available accommodation provides a comfortable, modern, pleasing environment in which healthcare services can be provided. It is assessed on the basis of three elements: amenity; comfort engineering; and design. The current report shows 26% of NHS Fife property being not satisfactory. The NHS Fife objective in relation to the quality of our properties will be to ensure that all properties fall within the Satisfactory or Very Satisfactory categories. In those areas presently not within those categories the aim will be to provide: an attractive and pleasing area for patients and staff (for example in terms of privacy, dignity, comfort, working conditions, signposting) an acceptable environment (for example is it well lit, adequately heated and cooled, noise and odor free) An internal/external environment attractively designed (for example in terms of good color schemes, well decorated, well furnished, enhanced by art, plants, landscaping, views etc) Space Utilisation The NHS Fife aim with regards to space utilisation will be to bring all properties within the Fully Utilised category. This will ensure, that in those retained spaces which are currently underutilised will be used intensively and that: Usage is maximised over time i.e. on a working day and/or on a working week. Space usage will compare favourably with national guidance. This approach will assist in ensuring that all remaining space in use is productive and essential to the provision of healthcare. Environmental Management An ongoing objective of NHS SCOTLAND is to reduce energy-based carbon emissions and to continue a reduction in energy consumption to contribute to the greenhouse gas emissions reduction targets set in the Climate Change (Scotland) Act In accordance with this implementation of the NHS Fife Sustainability Strategy (which will incorporate the existing Environment Strategy) will be extended into 2013/14 and will incorporate elements of climate change, energy management, waste management, transport and travel planning, sustainable procurement, sustainable construction and carbon management. Many of the objectives contained within the Sustainability Strategy will directly and indirectly influence the outcomes of the Property and Asset Management Strategy and will also ensure that the operations of NHS Fife do not have a detrimental effect on the health of the general population of Fife. Current environmental aims of NHS Fife are: 38

39 For a structured investment plan to be in place which will assist in enabling compliance with the Scottish Government targets for energy and carbon consumption reduction NHS Fife Sustainability Strategy has been approved and shall be implemented in 2013 /14 NHS Fife Environment Action Plan targets achieved i.e. o o o o o o Implementation of Greencode Environmental Management System. Monitor energy, water and waste consumptions using emart (Energy Monitoring and Reporting Tool) software. Review carbon emissions performance and inventory of facilities. Review estates management policies and operations to ensure compliance with the biodiversity duty. Engage with partners to initiate or review local/ regional transport strategies. Review current waste management practices and develop monitoring policies for all types of waste. We will aim to reduce: o o CO ² emissions, from the consumption of fossil fuels, by 3% per year. Energy consumption by 1% per year. Statutory Compliance NHS Fife will achieve the required improvement on Statutory Compliance and other facets by ensuring that the identified actions are controlled and co-ordinated with responsibility being allocated to staff accountable for the ongoing management and effectiveness of the asset management system. In addition, NHS Fife will integrate the use of the asset management system into the roles and responsibilities of all NHS Fife Estates and Facilities staff in order that the data within the system is appropriately updated, accurate and reliable. The current aims and performance summary for Statutory Compliance are as shown in Table 5.1 SCART Statutory Compliance Summary Item No Assessment Date: 8th March 2013 Item Response Notes Percentage of Properties that have been Assessed Average Percentage Compliance - NHS Fife SCART Master Summary - Number of Very High risks Average Very High Risks/Subject SCART Master Summary - Number of High risks 98% 81.40% Increase of 6% since last year. There are 9 properties which have been assessed but have not been entered on system. Drop of 1.7% on last year s figure due to inclusion of individual CHP sites. National average is 72.1% Note - method of recording number of risks has changed since 2012 report. Now refers to SCART Master Summary risk numbers. Note - method of recording number of risks has changed since 2012 report. Now refers to SCART Master Summary risk numbers. Note - method of recording number of risks has changed since 2012 report. Now refers to SCART Master Summary risk numbers. 39

40 6 Average High Risks/Subject 0.79 Note - method of recording number of risks has changed since 2012 report. Now refers to SCART Master Summary risk numbers. 7 SCART Master Summary - Number of Medium risks 6 Note - method of recording number of risks has changed since 2012 report. Now refers to SCART Master Summary risk numbers. 8 Average Medium Risks/Subject 0.15 Note - method of recording number of risks has changed since 2012 report. Now refers to SCART Master Summary risk numbers. 9 Risk Prioritised Action Plans in Place Yes As before SCART compliance is now a standard agenda item on all H&S meetings. The NHS Fife Statutory Compliance Capital Plan is prioritised on risk rating. 10 Date of last Report to Board Sept 2012 to SMT Reported within the Property and Asset Management Strategy annually. Table 5.1: NHS Fife Statutory Compliance Summary 40

41 6. How do we get there? Clinical Service and Overview Having detailed analysis of the existing estate is the first stage of the development of this Property Asset Management Strategy. This provides a comprehensive picture of the current performance of the Board s property portfolio in supporting the delivery of current services. It is clear from this analysis that significant investment is needed to address the risk adjusted backlog maintenance issues across the Estate. The second stage of the process examined the Board s corporate and strategic vision for change that identified that further changes to the Estate would be required to support future service needs. To simply invest in the Estate to bring it up to an acceptable condition and performance would not ensure that the Estate was fit for purpose in the future. Therefore, the Property Asset Management Strategy must be a combination of: Investment in current buildings that have a role to play in future service delivery that are described in the Board s Corporate aims and service objectives. Investing in new buildings and facilities to enable and facilitate the programme of service improvements. Rationalisation of the existing building portfolio to ensure the effective and efficient use of buildings to support services. Disposal of properties which can no longer support the current and future models of service delivery and are surplus to requirements. As the Board s service strategy Getting Better in Fife develops it will be necessary to align the Board s Property and Asset management Strategy to this. The options that are considered as part of the developing service strategy will require to be costed and be subject to both financial and non financial benefits analysis and rigorous risk assessment. The Property Portfolio Initiatives The Board s capital investment plans are scrutinised to ensure best value derived from the resources provided. There will be an increasing requirement to bid for prioritised capital allocations and it is, therefore, imperative that NHS Fife demonstrates how its Property Asset Management Strategy prioritises spending decisions that are linked to the Board s clinical services strategy. This 2013 PAMS demonstrates that this process has been followed. The Board will align its capital programme priorities to the allocation from the Scottish Government. These capital spending priorities will be assessed against the following criteria and then included within the relevant clinical service strategy document, e.g. Getting Better in Fife, the Local Delivery Plan, which will in turn form the basis of any changes within the Property and Asset Management Strategy: Delivery of patient and clinical benefits To be open within the next five years Their impact upon other health services in Fife The need to meet legislative requirements The impact upon and extent of contractual commitments Affordability within the Financial Plan bearing in mind future financial settlements The level of financial expenditure incurred to date The level of planning work completed to date The amount of spending on projects to date The NHS Fife Board has to agree this Property and Asset Management Strategy. From this the Board s Capital Investment Programme will be developed and agreed. In bidding to the centre for capital funding the Board will demonstrate that: 41

42 It has well considered and developed strategies for its Assets linked to its service and quality strategies It has an effective asset management approach to risk management and service continuity It has effective review and performance management processes in place regarding assets It has plans for rationalisation of the Estate that will: o Reduce age profile of Estate o Improve physical condition of Estate o Reduce risk adjusted Statutory compliance costs o Reduce risk adjusted backlog maintenance costs o Generate capital receipts o Improve space utilisation o Improve functional suitability o Reduce Carbon Emissions o Reduce costs of office accommodation (costs/m 2, costs/wte, space/m 2 ) The identified projects and initiatives proposed and considered for inclusion in future the Board s Capital Investment Programmes are summarised below: TABLE 6.1: NHS Fife Planned Capital Projects, Initiatives and 2020 Vision Year Service Strategy Service Strategy Aim Site(s) Project or Initiative 2013/14 Right for Fife Development of services in NEF. St Andrews Memorial Hospital Disposal Planning Consent secured for Sale of Hospital on open Market. Sale to be completed in Autumn 2013/14 Right for Fife GH&MS Project Accommodate rationalisation of Acute services Victoria Hospital Alterations to existing retained estate services and accommodation. 2013/14 Getting Better in Fife Rationalise Acute Services Forth Park Hospital Initial sale of Hospital on open market unsuccessful. Assistance being sought from SFT funds to part demolish and re-market Netherlea Hospital Initial sale of Hospital on open market unsuccessful. Assistance being sought from SFT funds to re-market 2013/14 Getting Better in Fife Care of the Elderly Rationalisation of Community Services CHP Premises Cameron Hospital Hospital at Home Initiative Review of bed model with a view to rationalising use of accommodation and services. Glenrothes Hospital 2013/14 Getting Better in Fife Rationalisation of Community Services Barrie Street Clinic Disposal - Sale of Clinic. 42

43 Year Service Strategy Service Strategy Aim Site(s) Project or Initiative Castlehill Clinic, Cupar Plan for disposal on open market House at Back Lebanon, Cupar Plan for disposal on open market Houses 4-6 Stratheden Court, Cupar Plan for disposal on open market 2013/14 Getting better in Fife Rationalisation of Community Services Glenwood Health Centre Capital funded started on site, completion Feb 2014 Retain and enhance links with Community partners for future development Gallatown Development Kirkcaldy Business Case under consideration/development Kelty HC Business Case under consideration/ development Lochgelly HC Business Case under consideration/ development 2013/14 Mental Health Strategy Mental Health Services Review and Rationalisation of Landholdings. Mental Health Properties i.e. Stratheden, Whyteman s Brae and Queen Margaret Hospitals Initiative - Review of functional suitability and space utilisation of properties in line with NHS Fife Mental Health Strategy, incorporating effects and requirements of Getting Better Fife. Rationalisation and disinvestment in landholdings on various sites. IPCU Business Development to support new build on east of Stratheden Hospital site 2013/14 Statutory Compliance Provision of compliant decontamination services NHSF Dental Clinics Initiative Continuation of improvement to Local Decontamination Units in Primary and Secondary Care. Initial estimate of 600k for modifications to existing premises. Required spend to be prioritised over time as allocation allows. 43

44 Year Service Strategy Service Strategy Aim Site(s) Project or Initiative 2014/15 GHMS Project Rationalise Acute Services Queen Margaret Hospital Construction - Conversion to Ambulatory Care and Diagnostic Centre. GHMS Project. 2014/15 Energy/Carbon Reduction Programme Partnership initiative with Fife Council on sustainable energy from Anaerobic Digestion Wellwood Landfill site to QMH Base line energy for the hospital from sustainable source. 2015/16 GHMS Project Rationalise Acute Services Queen Margaret Hospital Construction - Conversion to Ambulatory Care and Diagnostic Centre. GHMS Project. 2015/16 Primary Care Clinical Review Improve GP Premises due to changing demography Primary Care facilities Review and adjust. Capital Investment Programme The Scottish Government Health and Social Care Directorate (SGHSCD) are to provide the following allocations to NHS Fife in 2013/14: (1) Formula Allocation 6.7m (2) Specific Allocations 12.6m (3) Carbon Reduction Programme 2.0m Formula capital is designed to cover ongoing requirements for equipment, IT, Minor Capital works schemes and Statutory Compliance / Backlog Maintenance. Specific Capital includes the next installment of funding for the General Hospitals and Maternity Services project, with funding intended to cover completing works on the Victoria Hospital site, the refurbishment of Queen Margaret Hospital and the Section 69 payment to Fife Council. Specific Capital funding is also being provided for the Glenwood Health Centre project which is now being procured as a Design and Build scheme instead of the Revenue funded Design, Build, Finance and Maintain (DBFM) scheme. Carbon Reduction Programme covers the cost of two schemes for the decentralisation of existing steam plants on the Lynebank and Stratheden Hospital sites. In addition to the above sources of funding, the Board is able to supplement these allocations through the Hub Initiative which can provide Revenue funding to finance Primary Care and Community Care development proposals. The financial requirements arising from the PAMS are translated into the NHS Fife 5 Year Capital Investment Plan as follows: Capital Expenditure Proposals 2012/ /17 13/14 14/15 15/16 16/17 17/18 '000 '000 '000 '000 '000 Specific Schemes Dunfermline & West Fife Lynebank Decentralization of Boilers

45 Capital Expenditure Proposals 2012/ /17 13/14 14/15 15/16 16/17 17/18 '000 '000 '000 '000 '000 Kirkcaldy & Levenmouth Stratheden Decentralization of Boilers Stratheden IPCU Glenrothes & North East Fife Glenwood Risk 120 Glenwood ICT 66 Glenwood Equipment 226 Glenwood D & B Operational Division General Hospitals & Maternity Services General Hospitals & Maternity Services -S69 Road Works General Hospitals & Maternity Services, QMH Victoria Hospital Phase 3 Boilerhouse 1250 QMH District Heating System 1320 Fife Wide Gas Fired Boilers Telephone System NHS Fife Wide Routine Expenditure NHS Fife Wide - Condemned Equipment NHS Fife Wide - Equipment NHS Fife Wide - Information Technology NHS Fife Wide - CPG Infrastructure Planning NHS Fife Wide - Minor Capital NHS Fife Wide - Radiology Equipment NHS Fife Wide - Scheme Development NHS Fife Wide - Statutory Compliance/Backlog Maintenance NHS Fife Wide - Vehicles Physical Condition The aim for NHS Fife, will as per the objective detailed in Getting Better in Fife, be to bring all properties to a minimum condition B (Satisfactory), within a timescale determined through risk analysis and projected available funding. This will therefore involve targeting of the 6% of our properties which fall within the Unsatisfactory condition category. Current actions in relation to the procurement and disposal of property will have a positive impact on the physical condition assessment and these will therefore be taken into account in the proposals for physical condition investment. Increasing progress towards a minimum condition B (Satisfactory) will be attained through an ongoing risk based evaluation of condition, which in turn will result in inclusion in the Capital Investment Plan of those projects which qualify for risk prioritised funding. 45

46 Functional Suitability We currently have 18.7% of our properties classified as either Not Acceptable or Unacceptable. The aim of NHS Fife is to bring all in use properties in to either a Satisfactory or Very Satisfactory category. This will be achieved through the procurement, refurbishment and disposal of properties through implementation of the current investment plan. Timescales around attainment of this standard will be determined by progress of the capital investment plan. Quality The NHS Fife objective in relation to the quality of our properties will be to ensure that all properties fall within the Satisfactory or Very Satisfactory categories. As with Functional Suitability, the required quality standards will be achieved through the procurement, refurbishment and disposal of properties by implementation of the current investment plan. Timescales around attainment of this standard will be determined by progress of the capital investment plan Space Utilisation The NHS Fife aim with regards to space utilisation will be to bring all properties within the Fully Utilised category. The procurement, refurbishment and disposal of properties in line with clinical service will contribute to improving space utilisation standards; however it is incumbent upon NHS Fife to instill an attitude of effective space management within all relevant staff and to ensure that a general awareness of space management opportunities is created. This will be done through existing management forums, the NHS Fife Facilities Managers taking the lead on this. Planning and Disposal Strategy Introduction Background to the 4 sites that NHS Fife is promoting for inclusion in the Fife Plan Local Development Plan. Forth Park Hospital With the development of new facilities at the Victoria Hospital, Kirkcaldy the Forth Park Hospital has become surplus to requirements and was vacated in early This creates a development opportunity on this large brownfield site. The site comprises some 2.3 hectares currently containing a variety of buildings including several listed buildings: the former coach house, stables, cottage and boundary walls are all Category B listed. NHS Fife was granted Planning Permission in Principle in August 2011 (reference 10/02309) for residential development including change of use of the Mansion House and Stables Buildings to residential use. The plans and technical information submitted with the application demonstrated that the site could accommodate circa 69 houses including 9 affordable units. NHS Fife has since marketed the site and development opportunity on a national basis, and although there was some interest from house builders and other developers, none of these interests led to an offer to purchase the site.nhs Fife has spoken with the interested parties and concluded that the presence of the large hospital building on the site, and the requirement to retain the listed buildings present two barriers to the development of the site. There are also many greenfield housing sites in Kirkcaldy which offer more certainty and viability to prospective developers. NHS Fife is currently considering demolishing the main hospital buildings and taking forward discussions with Historic Scotland regarding the future of the listed buildings. 46

47 NHS Fife did put forward the Forth Park site as a potential housing site in response to the consultation on the Mid Fife Local Plan in 2009/10. Fife Council chose not to allocate the site when it published and adopted the Local Plan. The Main Issues Report for the FifePlan Local Development Plan now raises the question over whether the site should be allocated as a brownfield development opportunity. NHS Fife considers that the site is a brownfield development site. The responses to the questions in the FifePlan confirm that the site is an effective housing site that has a reasonable prospect of being developed within the plan period under consideration. NHS Fife has asked that Forth Park is allocated in this Local Development Plan as a brownfield development site that could accommodate around 69 houses. Lynebank Hospital The hospital is situated in the north eastern part of Dunfermline, on the southern side of Halbeath Road, to the east of its junction with Linburn Road. It covers an area of 16.2ha, and comprises a number of buildings, some of which are linked. There are two sites that are either surplus or potentially surplus to requirements. Site A extends to 3.9ha, and is in the southern part of the campus. It has been cleared of buildings, and is now grassed over. This is surplus to requirements and is available for immediate redevelopment. The other site, Site B, extends to 4.0ha, and is in the northern part of the campus. It contains a number of buildings, some of which are still in use, and car parking areas. Site A Site A has been allocated for housing development in the Dunfermline & West Fife Local Plan, with the Plan indicating a capacity of around 100 units. The Plan states that this development may be subject to the preparation of a masterplan for the hospital complex as a whole so that the access proposals for this site can be considered alongside the access proposals for other sites that may come forward for redevelopment within the grounds of the hospital. NHS Fife has asked that this allocation is taken forward for inclusion in the Local Development Plan as a housing development site with an estimated capacity of 100 units. A copy of the transport statement that accompanied those previous representations is submitted with this response. To assist in its assessment of the effectiveness of the site we refer back to paragraph 113 of the Scottish Government Reporter s Report to Fife Council, June In recommending that the site be allocated for housing the Government Reporter noted that the site is an effective site. He concluded that those factors relating to ownership, contamination, deficit funding, marketability, infrastructure and land use could potentially be met. On physical factors, the access arrangements for the site will require careful consideration, but the information provided by the council and by NHS Fife indicates that there are a number of possible options. In light of this, the Reporter considered that the principle of a residential development here can be accepted and although he agreed that access issues would best be dealt with through a transport assessment, he was satisfied that this does not require to be completed before an allocation is made. Furthermore there is nothing to show that development in this location would result in an increased risk of flooding, and no reason to believe that surface water could not be adequately managed. In the circumstances, the Reporter considered that the site is effective. NHS Fife can confirm that nothing has changed since the Reporter published his report in June 2012 to alter this view. 47

48 Site B This part of the campus is still partly is use although these uses are expected to cease in the early part of the Plan period. The site would then become surplus to requirements and available for redevelopment. NHS Fife had previously sought policy support in the DWFLP for the redevelopment of this site and the remainder of the hospital for appropriate uses that are compatible with the surrounding area. At that time there was uncertainty about when parts of the hospital would become surplus and what proposals may come forward. In his Report to Fife Council, June 2012 the Reporter concluded that proposals should be judged on their own merits. In specific reference to Site B the Reporter noted at paragraph 115 that there are no barriers to its redevelopment for housing or other appropriate uses. The position now is that NHS Fife anticipates that Site B will be vacated and available for redevelopment in On this basis and given that the site does present an effective brownfield housing site with an estimated capacity of around 100 units. Notwithstanding this there has been interest from other public sector bodies with a view to occupying or developing new office space within Site B. For this reason NHS Fife have asked that the allocation enables the development of housing or other appropriate uses including office space. Stratheden Hospital & Stratheden Park Stratheden Hospital is a large hospital complex located 1.5 miles south west of Cupar. It contains a number of buildings of varying ages which provide a variety of in- and out-patient healthcare services. The majority of the built development within the estate is located in the northern area, comprising the original stone buildings. These have been altered and extended over the years and form the heart of the hospital. Additional buildings are located to the south and east of these main buildings. These contain office accommodation, wards and clinics. The hospital and particularly those buildings detached from the main buildings are set within large areas of open space. A number of ward buildings are located in the east and in the south the former HQ building for NHS Fife lies vacant along with several single storey clinic buildings. The main entrance to the hospital is to the north from Stratheden Park and a short distance from the A91. A secondary entrance is located in the south west of the estate. An estate road runs through the estate linking the various buildings and open spaces. The hospital estate is owned by NHS Fife together with several of the adjoining fields. Some of these are let to Elmwood College and for other agricultural uses. Surplus Land and Property NHS Fife has been consolidating healthcare services in Stratheden resulting in the development of a new ward in the east of the estate and the refurbishment of parts of the main buildings. These and other improvement works will result in some of the detached ward, clinic and office buildings becoming surplus to requirements. At this point in time it is thought unlikely that any of these buildings will be suitable for alternative health care use. It is intended that the existing Stratheden Hospital will remain as a facility at Stratheden albeit it in a manner which is a better fit for purpose. The property that could be available for redevelopment is to become surplus to requirements through further consolidation and rationalisation of the hospital estate. The site is allocated in the St Andrews and East Fife Local Plan where the campus is identified as a site that could accommodate a mix of uses either in place of or alongside the current health uses. These alternative uses are listed in the Stratheden Settlement Plan SED 01 as: health, together with possible low-density housing, hotel, leisure, education and open space use. Under the status, additional development requirements, and other information section the Council has set the detailed requirements that will ensure that the surplus land is developed in a strategic and planned way. 48

49 Going forward NHS Fife respectfully have asked that this current Local Plan allocation is carried into the Fifeplan Local Development Plan. The flexibility and certainty given by the current allocation enables NHS Fife to properly plan the consolidation and rationalisation of the hospital estate, and to ensure that it can generate receipts from land sales that can be reinvested within the NHS Fife estate. Land Adjacent to Stratheden Park In addition to the main campus area at Stratheden, NHS Fife also owns several fields around the campus. Formerly part of the hospital farm, these are leased on a short and long term basis for agricultural uses. Of these fields, NHS Fife has identified that the field on the opposite side of the road to the north of the campus is surplus to requirements. NHS Fife has further identified that this land could accommodate a small housing development as an extension to the existing settlement pattern. NHS Fife has not commissioned any technical advice in respect of the capacity of the site or the local infrastructure to accommodate housing development. This could be commissioned if Fife Council felt that it was necessary to support the further consideration of the site for redevelopment. If the southern roadside part of the field were to be developed then we estimate that between 16 and 32 units could be developed in a similar pattern to the existing housing at Stratheden Park. 49

50 The site plan above shows the Lynebank Hospital site with the surplus land identified as Area A and B with the retained estate indicated as Area C. 50

51 7. Implementation Plan - Roles and Responsibilities The Scottish Governments CEL 35 (2010) places a requirement on NHS Fife to develop strategies for each type of asset held and integrate them into a Property and Asset Management Strategy (PAMS) and plan, linking to the NHS Fife service strategy. Since 2011 the PAMS strategy has been routinely submitted annually to the Capital Planning and Asset Management Division of SGHSCD in a time frame consistent with the submission of local Delivery Plans and features the following requirements: Ensure we assess estate condition, statutory compliance, functional suitability and space utilisation on a regular basis. (20% of entire Estate annually); Ensure all information on assets is held electronically; Review their performance management arrangements and, where required, develop performance measures against targets for assets. The CEL 35 (2010) also places the following mandatory requirements: All NHS SCOTLAND bodies must have appropriate Board level and supporting governance, accountability and reporting arrangements in place to ensure the efficient and effective planning, operation, management and disposal of assets. NHS Fife Status; This has been actioned with recent restructuring resulting in the Director of Estates, Facilities and Capital Services taking up a Corporate position on the Board. The PAMS will be reported into the newly established Capital Planning Group chaired by the Director of Finance who will also undertake the role of Asset Champion on behalf of NHS Fife All NHS SCOTLAND bodies must hold appropriate up to date information to ensure the effective planning, operation, management and disposal of the assets held and utilised in support of service delivery. NHS Status; The initial population of the 3i system database for NHS Fife owned properties is nearing completion for Condition and Statutory Compliance. Following the establishment and introduction of the NHS Fife Support Team in 2013/14 an action plan will be developed to fully populate and maintain the system database. All NHS SCOTLAND bodies must have a PAMS which is technically robust, achievable and affordable within the context of agreed financial plans (capital and revenue). NHS Fife Status; Future PAMS will be programmed and approved in parallel with the established programme structure set up for the annual Financial Plan Such strategies should demonstrate clear and explicit links to Scottish Government and Local Delivery Plan objectives, HEAT targets and clinical/service strategies, Local Authority Structure Plans and broader planned outcomes. Where NHS SCOTLAND bodies are responsible for the delivery of regional and/or national services, the PAMS must reflect the links to the appropriate regional and/or national service strategies, priorities and targets. In addition to the above our Board must ensure an appropriate structure of suitably qualified staff to provide the comprehensive management of the Estate, covering all statutory and mandatory requirements. 51

52 The responsible Department will demonstrate a suitable range of qualifications, being experienced, up to date and capable of delivering the informed client role when commissioning support from external sources. NHS Fife Status; This role will be provided by the Capital Planning & Property Team within the Estates, Facilities and Capital Services Directorate. This Directorate will also have the responsibility for managing the survey work required annually to populate the electronic Asset Management System. The implementation plans to establish the team responsible for made reasonable progress over the last year and should be fully functional in 2013/14. This restructuring process has taken significantly longer than first envisaged, due to the necessary changes to individual job descriptions and subsequent evaluation under Agenda for Change. The intention is to manage corporate asset management through the Board s recently introduced Capital Planning Group which is chaired by the Director of Finance. RICS best practice guidance on Asset Management recommends that the Board appoint an Asset Champion and responsibility for this role will be undertaken by the Director of Finance on behalf of NHS Fife. This Champion has been charged with promoting and sustaining good practice in Asset Management within the Board. The Boards Capital Planning Group will set priorities in accordance with the Boards service strategy Getting Better in Fife and PAMS strategy within the resources available. The Boards Capital Planning Group will agree the PAMS and the resulting priorities in order to inform the annual capital investment plan. The PAMS and Capital Investment Plan will be agreed by the CPG and Senior Management Team before submission to the Financial Resources Committee prior to consideration by the Board for approval on an annual basis. Capital Planning Group: Role and Remit Purpose The Capital Planning Group is responsible for managing and monitoring the NHS Fife capital programme including the prioritisation of the Fife wide minor capital allocation for projects. The Group shall ensure that the requirements of the SGHD Policy CEL 35 (2010) are implemented and support the development and updating of the Boards annual Property and Asset Management Strategy. Membership The core membership of the Capital Planning Group will be: Director of Finance ( Asset Champion ) Capital and Planning Finance Director of Estates,Facilities & Capital Services Head of Planning and Property Head of Estates Head of Primary Care Administration Head of ehealth Infection Control Manager Operational Division Kirkcaldy & Levenmouth CHP Glenrothes & North East Fife CHP Dunfermline & West Fife CHP Facilities Manager HR Representative Staff Side Representative Other individuals may be invited to attend as necessary. 52

53 Meetings The Capital Programme Management Group shall meet as necessary to fulfil its purpose. Routinely, the group shall meet every month but this can be varied at the discretion of the chair. Whenever possible, the groups meetings shall be scheduled to fit in with the timing to allow for papers to be submitted to the Capital Planning Group. The Agenda and any supporting papers shall be sent out at least 5 working days in advance of the meeting, to allow for due consideration of the issues. Remit The remit of the group is to: Prepare the 5 year Capital Plan by recognising all the strategic developments and the ongoing capital commitments for submission in due course to the SMT and Finance and Resources Committee for recommending approval to the NHS Fife Board. In line with the approved 5 year Capital Programme and taking cognizance of the Capital Allocation, prepare the Annual Property Asset Management Strategy for submission for consideration by the Capital Planning Group then SMT and thereafter recommendation of approval by the Finance and Resources Committee to the Board. Routinely monitor the progress and expenditure of individual capital schemes against the funding available. Identify any in-year slippage and make proposals through the Senior Management Team to the Finance and Resources Committee for any substitution of schemes or banking with the Scottish Government Health and Social Care Directorate for utilisation in subsequent years. Update Capital Programme in year for any additional allocations received. Ensure that any revenue consequences associated with the approval of a Capital Scheme have been provided for within the board s overall Financial Framework. Receive information from various capital subgroups to inform the overall process ehealth, Medical Equipment, Radiology, Transport, Statutory Compliance, and Capital Building Works. Keep under review all property acquisitions, disposals and leases. Commission and review proposals for changes in the use of accommodation within and across services. Receive and consider mini Business-cases for projects in excess of 100,000. The Group will also consider other matters perceived to fall within its remit and any other issues remitted to it from time to time by the Finance and Resources Committee. Authority The Group has been given the authority by the SMT to monitor and prepare Capital Plans and Programmes to address the strategic priorities of NHS Fife. All aspects of the Capital Planning and allocation process are to be addressed by the group to inform SMT and the Finance and Resources Committee and facilitate decision making. Reporting Arrangements The group will prepare regular and ad hoc reports as needed for the Capital Planning Group to inform SMT and the Finance and Resources Committee and the NHS Fife Board for approval, in line with the constitution and terms of reference for the Finance and Resources Committee within the Code of Corporate Governance. 53

54 Environmental Management Implementation of the NHS Fife Sustainability Strategy (which will incorporate the existing Environment Strategy) has been extended in to 2013 and will incorporate elements of climate change, energy management, waste management, transport and travel planning, sustainable procurement, sustainable construction and carbon management. Many of the objectives contained within the Sustainability Strategy will directly and indirectly influence the outcomes of the Property and Asset Management Strategy and will also ensure that the operations of NHS Fife do not have a detrimental effect on the health of the general population of Fife. The means of achieving the environmental aims of NHS Fife are: Management of a structured investment programme which will assist in enabling compliance with the Scottish Government targets for energy and carbon consumption reduction. Ongoing management of Environmental issues through appointed NHS Fife sub groups i.e. Energy, Waste, Greenspace and Transport, all working in partnership with staff and other public and private partners. Management of the NHS Fife Sustainability Strategy, identifying responsible officers for attainment of the SMART objectives therein. Management of NHS Fife Environment Action Plan targets by appointed officers: o Implementation of Greencode Environmental Management System. o Monitor energy, water and waste consumptions using emart (Energy Monitoring and Reporting Tool) software. o Review carbon emissions performance and inventory of facilities. o Review estates management policies and operations to ensure compliance with the biodiversity duty. o Engage with partners to initiate or review local/ regional transport strategies. o Review current waste management practices and develop monitoring policies for all types of waste. Statutory Compliance In order to achieve the required improvement on Statutory Compliance and other facets, it will be necessary to ensure that the actions identified are controlled and coordinated, with line responsibility being allocated to staff accountable for the ongoing management and effectiveness of the asset management system. In addition it is essential that the use of the asset management system is integrated into the roles and responsibilities of all NHS Fife Estates and Facilities staff in order that the data within the system is constantly live and reliable. This restructuring process has taken significantly longer than first envisaged, due to the necessary changes to individual job descriptions and subsequent evaluation under Agenda for Change. The improvement target set for NHS Fife for Statutory Compliance is to reduce risk level figures for High Risks per site by the end of the current 2013/14 year. This will be facilitated by allocating responsibilities to specific Estates Managers/Officers within NHS Fife and integrating them into personal objectives formalised within the current eksf system. Progress continues to be monitored on a 2 monthly basis at NHS Fife Estates Health and Safety meetings chaired by the Head of Estates. Issues relating to capital will be entered on the risk prioritised Statutory Compliance Capital plan and addressed accordingly. The statutory compliance action plans based on SCART will always be prioritised on a risk rating basis thus eradicating higher risk items initially and progressing down to lower risk rated items. 54

55 8. Performance Monitoring Scottish Government guidance lists a set of PAMS key performance indicators (KPIs) which must be reported against. These KPIs must be Specific, Measurable, Agreed, Realistic and Timed. NHS Fife has Key Performance Indicators for the measurement of the performance of property and related assets. These KPIs will progressively demonstrate improvements through the following objectives: Reduce age profile Improve physical condition Reduce backlog maintenance Improve space utilisation Improve functional suitability Improve environmental performance Improve quality Improve statutory compliance These KPIs as demonstrated in the table below will be reported to the Board annually NHSScotland National Asset & Facilities Performance Framework Current Current 2020 Quality KPI NHSF Performance Measure Key Performance Indicator Perf'nce Ambition No National NHS Fife 2013 Target Perf'nce Perf'nce Quality of physical environment 1 Percentage of properties categorised as either A or B for Physical 90% 71% 68% 78% Condition facet of estate appraisals (EAMS Board Report - Chart 1B - add category A and B percentages) 2 Percentage of properties categorised as either A or B for Quality facet of 90% 61% 69% 69% estate appraisals (EAMS Board Report - Table 11 - add category A and B percentages) Patient Patient opinion of healthcare 3 Positive response to Patient Questionnaire on patient rating of hospital Centred accommodation environment 95% 83% (? ) Patient needs are accommodated 4 Percentage of properties less than 50 years old 70% 73% 76% 76% in modern, well designed facilities (EAMS Board Report - Table 15 - add areas for , and 2001 or more recent, then divide by total area) PAMS reflective of service needs 5 PAMS Quality Checklist Overall Score (max score 100) and patient preferences (Only available from Health Facilities Scotland) Statutory compliance status of 6 Overall percentage compliance score from SCART 95% 68% 83% 83% property asset base (SCART system) Backlog maintenance expenditure 7 Cost per square metre for backlog maintenance requirement (EAMS Board Report - Table 16 - total backlog expenditure required Safe divided total GIA) Level of risk associated with 8 Significant and high risk backlog maintenance as percentage of total 10% 45% 39% 37% outstanding backlog maintenance requirement backlog expenditure requirement (EAMS Board Report - Table 16 - add high and significant risk backlog expenditure then divide by total backlog expenditure) Estate Functionally suitability 9 Percentage of properties categorised as either A or B for Functional 90% 65% 77% 77% Suitability facet of estate appraisal (EAMS Board Report - Table 8 - add category A and B percentages) Estate Utilisation(from Property 10 Percentage of properties categorised as 'Fully Utilised' for space 90% 75% 75% 77% Appraisals) utilisation facet of estate appraisals (EAMS Board Report - Table 10 - fully utilised percentage) Estate Utilisation (from Cost Book) 11 Building Volume 100 cu.m per Consumer Week (from Cost Book) (Finance) Cleaning 12 Cleaning Costs per 100 cu.m (from Cost Book) (Finance) Property maintenance 13 Property maintenance costs per 100 cu.m (from Cost Book) (Finance) PFI - Facilities Management 14 PFI - Facilities Management Costs per 100 cu.m (from Cost Book) (Finance) Effective Energy consumption 15 Energy Costs per 100 cu.m (from Cost Book) & (Finance) Efficient Rent & rates 16 Rent & Rates Costs per 100 cu.m (from Cost Book) (Finance) Catering 17 Catering Cost per consumer week (from Cost Book) (Finance) Portering 18 Portering Costs per consumer week (from Cost Book) (Finance) Laundry & Linen 19 Laundry & Linen Cost per consumer week (from Cost Book) (Finance) Waste 20 Waste Cost per consumer week (from Cost Book) (Finance) Vehicles 21 To be confirmed 0 0 Medical Equipment 22 To be confirmed 0 0 IM&T infrastructure and equipment 23 To be confirmed 0 0 Further routine reports on energy performance/heat targets for the main hospital sites and CHP areas are attached in Section 12 55

56 9. Information Management and Technology ehealth Strategy The ehealth Strategy ( ) provides the outline plan for NHS Fife to delivery its commitments. This is closely aligned with delivering the NHSS Quality and ehealth Strategies and provides continuity for building on our successes from the previous strategy in This plan provides an opportunity to focus on goals and outcomes that directly support the key objectives for NHS Fife underpinning improvements in the delivery of care and measurable and specific outcomes to help make our service more effective and efficiently over this next period. NHS Fife will continue the application of IT innovation ensuring this remains embedded in daily working practice and directly contributes to service plans delivering improvement with measurable outcomes. This is an approach we have pursued since our original plan in 2003, delivered in our focus since 2008, and the difference in is outcomes will be measurable and agreed within the plan. ehealth Standards The ehealth Department (Infrastructure) was awarded the ISO27001 accreditation in February 2012 and continues to improve on standards achieved. The ultimate aim is to have the whole ehealth Department accredited and are working towards this goal. ISO is a specification for an information security management system (ISMS). An ISMS is a framework of policies and procedures that includes all legal, physical and technical controls involved in an organizations information risk management processes. The ISO ensures that the IT assets are maintained and managed in a controlled environment. This includes the IT Infrastructure, Clinical Systems, and Inventories detailed. All the ehealth Infrastructure Department Policies conform to the ISO27001 standard as are those IT Policies that affect the whole organisation. The ehealth / IT Infrastructure The infrastructure required to support the multitude of systems and applications that now depend on it is continuously being upgraded. This is required to keep up with the standards required for speed, resilience, data integrity and security. A new data centre has been built to service this changing demand which includes a green air cooling system. The server estate now takes advantage of blade technology with virtualization, so reducing power demands. The network infrastructure is continually being updated and full opportunity is taken to include upgrades in any building or refurbishment schemes. There is a small but significant move towards more direct patient care devices requiring connection to the hospitals networks. This, along with other technologies such as IP telephony and IP Television, means that the data network has far more pressure on it now than ever before. The wireless network has also seen a significant growth in usage and the coverage that this provides has been extended so that all the main sites have some, if not complete, coverage. There has been a significant move to replace small printers with multi-function devices moving from an average of 1:8 users per printer device to 1:50 per device. This is contributing to significant reduction in the organisation s carbon footprint. The ehealth Infrastructure also incorporates all Telephony and the department is converging the data and phone networks where the opportunities arise. This is in the form of utilising the data cabling network for phones rather than installing separate phone cabling. Where this has been implemented it provides a much more flexible system and allows quicker deployment of phones. 56

57 The existing main telephony system will go End of Life in 2017 which will directly impact 5 of NHSFife s hospitals: Victoria, Kirkcaldy (Phases 1, 2 & outside buildings only) Queen Margaret, Dunfermline Lynebank, Dunfermline Cameron, Cameron Bridge, Windygates Stratheden, Cupar There are opportunities to combine the work required at Queen Margaret Hospital with the current redevelopment of Queen Margaret which will take place over the next 2/3 years. The estimated costs for the scheme which will include upgrading the data network are 6.33m. ehealth Clinical Systems There is an ongoing programme that is delivering many of the building blocks that are required as the organisation moves towards the delivery of an Electronic Patient Record (EPR). A number of systems have been implemented recently including a document management solution, clinical portal and electronic ordering for radiology investigations and laboratory tests. These, together with the existing systems including laboratories, Radiology, PACS, Theatre amongst others, give a solid foundation to move towards an EPR. A single outpatient booking system is in place, providing a single view of patient outpatient appointments. In addition electronic referrals from GP Practices are now triaged on line and processed through the system in order to comply with 18 Weeks RTT; this is now implemented across all key clinical services. A programme to replace ageing GP systems was completed during 2011/12. The new systems (EMIS and INPS) provide the ability to link patient information with secondary care systems. IT Management and Inventories All IT assets across the whole of the NHS Fife board area including the GP's are managed by the ehealth Department. Although the ehealth Department funds much of the IT equipment and software purchased departments can and do provide their own funding. To ensure compatibility with the ehealth Strategy and the infrastructure users are provided with a service catalogue from which they can purchase pre agreed products. All IT Procurement is though approved for use by the ehealth Department whether from the service catalogue or a non-standard purchase. The Altiris Client Management suite combined with Active Directory and the Assyst Service Desk are used to track and manage all assets on the network. A total of 6767 devices (PCs, laptops) and 1044 printers are currently managed in this way. The following table shows how the various items of information from the required dataset are collected: IT Assets The standard asset database proforma as requested by Scottish Government can be found in Section 12 of this document 57

58 IT Management Inventories Dataset Item Asset Register Reference Serial Number Location Model Make Supplier Purchase / Acquisition Date Purchase Cost Expected Standard Life Annual Depreciation Estimated Replacement Cost Maintenance Information Planned Preventive Maintenance and Repairs Service Histories Data provided by Assyst/Alteris Assyst/Alteris Assyst/Altiris Assyst/Altiris Assyst/Altiris Finance System Finance System Finance System Variable dependent on device Finance System Variable dependent on device Manufacturer s Warranties & Support Variable dependent on device Assyst ehealth can confirm that an up to date IT Asset Register is available via Altiris and that all IT Business Cases are approved at the appropriate level. ehealth Management Costs The total budget for IM & T including all resources, revenue spends on equipment and external contracts 9,700,000. IT Asset Management Methodology The ehealth Department endeavours to replace assets as they become obsolete however there is a historical underfunding of the replacement programme. Departments are in some circumstances left to provide funding for their own equipment which is not a satisfactory situation. In order to consolidate printing equipment and reduce the overall number of printers across the organisation a printing protocol has been put in place which emphasises the use of networking multi functional devices are opposed to small desktop printers. IT Maintenance Costs The majority of the IT equipment is maintained in-house or via manufacturer s warranty. Generally speaking PCs or peripheral devices are not covered by maintenance contracts, however the Multi Functional Devices (MFD's) are covered by a support agreement. The majority of new general use printers are also being purchased with a support agreement. Other hardware such as servers and specialist items will typically have a maintenance contract in place IT Risk Assessment ehealth risks are managed by the ehealth Risk Group and all risks are logged in the organisations risk recording system with appropriate risk levels. This includes any risks to the physical equipment or that may be caused by the condition of the equipment. IT Environmental Management Both of the data Centres have environmentally green air cooling systems installed. 58

59 By default all IT equipment that has environmental power settings have these set to the most practical settings before deployment. Many of our deployed services utilise virtualisation which has reduced the number of physical servers in the data centres therefore reducing the power consumption within the server environment. All condemned IT hardware is disposed of securely and safely as described in the Condemnation of IT Hardware Procedure. This ensures that NHS Fife, ehealth Infrastructure Department has the appropriate arrangements in place. IT Independent Health Care Contractors All of the IT assets within the GP Practices in NHS Fife are managed by ehealth Department via a Service Level Agreement. The service is funded in its entirety via GMS Funding managed by the Primary Care Manager. IT Implementation of ISO Part of the NHS Fife IT Governance Project Business Drivers Major IS Security Breach with negative publicity Need to provide assurance re. Information Security Need to utilise established standards and best practice Need to ensure that we are working in compliance with policies How have we done it? Built on existing IT Governance Project o COBIT o ITIL Re-focused on information security processes Set process target levels Established process improvement plans The audit process Mock compliance audit(s) o Highlighted key weaknesses o Corrective actions Internal/External Audit Independent Certification Audit (SGS) ISO27001 CERTIFICATION (Feb 2012) monthly surveillance audits Has it made a difference? Raised awareness of information security POSITIVELY security culture Policies and procedures in place Corporate Information Security Report Improved Incident / Risk Management Established BC / DR Plans & Tested Lots more...even a CLEAN DESK POLICY 59

60 ehealth Service Delivery Team ALL made a positive contribution ALL competent dealing with Information Security ALL PROUD of our achievement and recognition we have received. Next Steps Continue implementing corrective actions Extend the scope of ISO27001 to cover other components in ehealth Annex A 60

61 Annex B Annex C: Sustainable ehealth NHS FIFE Green ehealth commitment The NHS Fife Green ehealth refers to the commitment of the NHS Fife to provide environmentally sustainable IT and Telecommunications, in order to reduce the environmental impact of our IT and Telecommunications operations. These includes the practice of designing, manufacturing, using, and disposing of computers, servers, and associated subsystems - such as monitors, printers, storage devices, networking and communications systems - efficiently and effectively with minimal or no impact on the environment."[1] The main goals of Green ehealth are: Reduce the use of hazardous materials like toners Maximize energy efficiency during the ICT product's lifetime To promote the recyclability or biodegradability of decommissioned ICT NHS FIFE Green ehealth approaches ehealth products longevity - we are conscious one of the biggest contributions to green computing usually is to prolong the equipment's lifetime, including upgradability and modularity. Data centre design - Data centre facilities are heavy consumers of energy. NHS Fife recently redesign one of the main data centres. All energy use aspects were considered and an eco friendly design was selected from all bids. The main areas of focus are: 61

62 Environmental Virtualisation - NHS Fife is progressively virtualising all servers and considering future desktop virtualisation. Virtualization refers to the abstraction of computer resources by sharing physical hardware between several individual logical systems, thereby unplugging the original hardware and reducing power and cooling consumption. Terminal servers - NHS Fife still supports Citrix. When using the system, users at a terminal connect to a central server; all of the actual computing is done on the server, but the end user experiences the operating system on the terminal. This reduces up to 1/8 the amount of energy of a normal workstation, resulting in a decrease of energy costs and consumption. Power management - when possible NHS Fife supports ICT and Telecommunications equipment compliant with ACPI (Advanced Configuration and Power Interface), an open industry standard that allows an operating system to directly control the power-saving aspects of its underlying hardware. This allows a system to automatically turn off components such as monitors and hard drives after set periods of inactivity. In addition, a system may hibernate, where most components (including the CPU and the system RAM) are turned off. Materials recycling - NHS Fife engages with 3 rd parties for disposal and recycling of computing equipment, including but not exclusively ICT and Telecommunications equipment and toners. This action can keep harmful materials such as lead, mercury, and hexavalent chromium out of landfills, and can also replace equipment that otherwise would need to be manufactured, saving further energy and emissions. Telecommuting - NHS Fife is committed to provide more teleconferencing and telepresence technologies, including OCS. The advantages are many; increased worker satisfaction, reduction of greenhouse gas emissions related to travel, and increased profit margins as a result of lower overhead costs for office space, heat, lighting, etc. These also offer savings opportunities. Voice over IP (VoIP) reduces the telephony wiring infrastructure by sharing the existing Ethernet copper. VoIP and phone extension mobility also made hot desking more practical. Multi funtional devices - combining printing, photocopying and faxing in a single machine reduces CO 2 emissions and paper usage. NHS Fife is implementing a strategy for reducing the amount of individual and departmental printers, photocopiers and faxes by providing more efficient shared devices (MFDs). Since the project started in October 2011, NHS Fife already saved sheets of paper (157 trees) and avoidance of manufacturing CO 2 (required to produce paper) of KgCO. NHS Fife continues monitoring the CO 2 reductions trend as part of the MFDs project. 62

63 63

64 10. Vehicles/Transport/Travel Planning All commercial vehicles operated within NHS Fife are managed by the Transport department, which is a part of Estates Facilities & Capital Services Directorate. The Current fleet consists of 103 vehicles. All vehicle data is held on Chevin Roadbase transport software. Vehicles are sourced through national contracts and the Government Procurement Service, using their multi quote system. Where possible all vehicles are sourced locally. Routine maintenance and all mandatory checks are pre planned 12 months in advance as recommended by Vehicle Operator & Service Agency, (VOSA). Maintenance is carried out by several suppliers, including Fife Council. All new vehicles remain with franchised approved dealers during warranty period, normally three years. Fleet Complement Commercial vehicles up to 3.5 Tonnes (58 vehicles) These vehicles are used for a variety of functions by various departments in NHS Fife. Their tasks include meals delivery, labs/courier service, estates, horticulture, clinical waste, dental service and chilled vaccine delivery. Vehicles over 3.5 Tonnes (8 Vehicles) This type of vehicle is required to carry heavier loads and come under the O licence regulations and therefore require regular planned safety checks. The drivers require c licences, Certificate of Professional Competence and strict medical assessment. These vehicles are used to carry laundry, stores, clinical waste and carries and heavy/bulky cargo such as, beds, furniture, and pallets of goods. The clinical waste drivers also require vocational training every four years and may be subject to roadside checks by enforcement authorities. Patient carrying vehicles (7 Minibuses) These vehicles are used exclusively for transport of children to Child Assessment Centres in Fife. As such they are built to a child friendly specification. This reduces the amount of awkward lifting required b to be carried out by staff. The seats in the most recent four are on tracks to allow for sufficient spacing between passengers where required. The vehicles are 14/15 seat capacity reduced to 8/9 to allow for extra space required. As passenger carrying vehicles they are, voluntarily, subject to Public Service Vehicle inspection regulations, drivers must also hold Midas training certificate. Cars (21 vehicles) The cars are used primarily for light goods, patient /staff transfer, case notes, NHS Fife Primary Care Emergency Service etc. 3 vehicles are used as pool cars and two are 4x4 used by security which is redirected for bad weather duties as and when required. Transport Fleet Safe Operation All vehicles are subject to driver daily walking round checks, any defect should be reported immediately to transport department. 64

65 All vehicles have service schedules issued every three months. responsibility to ensure vehicles are submitted on the appropriate date. It is the user department s All service and defect sheets and vehicle histories are held by the Transport Department. The Transport department ensures repairs are carried out by the appropriate supplier. Vehicles are inspected for damage at each service inspection and the Transport Department notified of any immediate repair required. Body damage is repaired as soon as possible. Transport department records all vehicles on the Motor insurance database (MID), and manages the system. All accidents and incidents are dealt with by the department. NHS Fife Transport Department is required to comply with the following regulations. o Road traffic act (1988) o Road Vehicles (Construction & Use) Regulations 1986 o Road vehicles(authorised weight) Regulations 1998 o Regulation(EC0 561/2006 Drivers Hours o International Carriage of Dangerous Goods by Road o (EU) Council directive 94/55EC o The Carriage of Dangerous Goods and Use of Transportable Pressure Equipment Regulations 2009 o Public Service Vehicle Regulations 1981 o Waste Framework Directive (2008/98/EC) o certificate of registration under Control of Pollution (Amendment) o Act 1989 (Waste Carriers Licence) Fleet Management Recent initiatives to reduce cost and contribute to carbon emissions targets include: o A reduction in large vehicles o Improved fleet utilisation o Review of latest technology and vehicle improvements, incorporating national targets and industry KPIs o Use of tracking and fuel saving equipment, providing reduced fuel consumption o Implementation of multipurpose vehicles to further increase utilisation NHS Fife in association with National Procurement, Government Procurement Service, and Health Facilities Scotland and various advisory panels and manufacturer liaison visits have resulted in the following: o o o Cost effective insurance Environmental Improvements Improved fuel efficiency The fleet at present is 70% purchased and 30% leased. Purchasing is dependent on capital funds available at the start of the financial year. At present the policy for vehicles is open procurement method. This system is best suited to NHS Fife s needs, it allows purchase the most cost efficient vehicle available for the funding available, rather than be committed to a fixed price/supply vehicle contract. NHS Fife services are continually evaluated using information exchanges through HFS Transport working group. There are also informal meetings between Health Boards to discuss working practices and legislative matters. Where possible there is engagement with local authority partners where experiences are shared, and information exchanged. 65

66 NHS Fife also engages with third party suppliers and transport operators to maintain knowledge of various improvements, new technology, best value products and efficient vehicles. There is also a good relationship with the Freight Transport Association and Fife Police regarding training and prior notification of regulation changes, which may affect NHS Fife. NHS Fife has presence on the HFS Transport and Travel Advisory Group, National Procurement Commodity Advisory Panel, where we both give and receive advice on pertinent transport matters, including insurance and vehicle purchasing/leasing. NHS Fife transport officer also sits on the Scottish Freight Council. Target vehicle replacement programme. o Pool cars - 5 years o Commercial vehicles up to 3.5 Tonnes - 4/6 years dependant on condition o Large Goods Vehicles - 5/7 years o Minibuses - 5/6 years Environmental management. At the procurement stage, the issues taken into account are: o o o o o CO 2 Emissions Fuel consumption Fuel type Recyclability Whole life costs The Future A working group was formed in 2012 with membership drawn from all transport user departments. The remit of this group is to make efficiency improvements and reduce the size of the fleet by: o o o Analysing the use of all vehicles in the fleet Mapping the journeys of each vehicle to identify overlaps Reviewing the type/size of vehicles used for each function Transport Assets The standard asset database proforma as requested by Scottish Government can be found in Section 12 of this document Travel Planning Travel planning is a management process that brings together transport and other business issues in a co-ordinated strategy within an organisation. A Travel Plan sets out measures and initiatives that aim to provide practical alternatives to single occupancy car use, i.e. a choice of other, easy and convenient methods of travelling. Travel planning also aims to make travelling by car, where necessary, more sustainable as well as reducing the need to travel at all through the use of technology, thus realising energy and time savings or reducing pollution of the local environment. Successfully implemented measures and initiatives within a Travel Plan also have a positive influence on the accessibility of an organisation. This increases the pool of potential employees available for recruitment and reduces stress through less congestion. A Travel Plan has the potential to realise cost savings for both the organisation and the individual and to improve access to serve the wider community. In August 2006 NHS Fife Board published A STRATEGIC TRAVEL PLAN FRAMEWORK FOR NHS FIFE, 4 Since then a number of site-specific travel plans have been developed, focusing on issues 4 A STRATEGIC TRAVEL PLAN FRAMEWORK FOR NHS FIFE, pub. NHS Fife Board (2006), available from the URL %20Board/8.1(a)(i)%20Travel%20Plan%20Framework.doc 66

67 relevant to those sites, however many of the measures contained therein are common since they are intended to achieve the following aims: Increase social inclusion by improving transport links for patients and visitors to our facilities Increased access to health care services and facilities for all Improved health of employees, patients and visitors by encouraging more active travel (walking, cycling) Reduced transport based pollutants entering our local environment Reduced traffic congestion Reduced road traffic accidents Increased opportunities for employment and education Travel Plan Measures introduced across NHS Fife Since 2006, a number of measures have been introduced this section aims to summarise these to date, with subsequent annual updates demonstrating how the organisation is shifting to more sustainable methods of travel. NHS Fife works closely with partner organisations, including Fife Council Transportation Services (FCTS), Fife Constabulary, the south-east Scotland regional transport partnership (SEStran), Stagecoach East Scotland (SES), Sustrans and Cycling Scotland. Public Transport NHS Fife, together with FCTS and SES, produces the How To Get To.. series of leaflets, which summarise Public Transport that serves Ninewells Hospital (Dundee), QMH, SACH and VHK sites - these major sites all have on-site bus-stops with shelters. The cost for producing the leaflets is shared equally between NHS Fife, FCTS and SES, with NHS Fife receiving 75% of each print run. Leaflets are available from hospitals, GP surgeries and health centres, as well as Fife Council buildings. Buses also serve Adamson, Cameron, Glenrothes, Lynebank and Randolph Wemyss hospitals, with health centres and GP surgeries having stops also adjacent or nearby. At all sites, timetables for relevant bus/train routes are usually available in reception areas. NHS Fife has dedicated on-line Traveline Scotland journey planners for QMH, SACH, VHK sites (both on the intranet and on the public facing website), where users can enter their home postcode and preferred date/time of travel to produce a dedicated journey plan that details bus stop locations, necessary changes etc. The NHS Fife intranet (for staff) also has links to downloadable apps (usually free) for some smart phones. Walking & Cycling NHS Fife operates a Cycle to Work salary sacrifice scheme: to date there have been two windows, each of which attracted 30 users before funding was fully allocated. Of the 60 scheme members, 30 are based in Kirkcaldy, with the remainder based all around Fife. Downloadable cycle/walking maps are available on the NHS Fife intranet to cover Dunfermline, Glenrothes, Kirkcaldy, Levenmouth and St Andrews areas. The Kirkcaldy area map is also available on the internet as part of the Make Your Move Kirkcaldy campaign. Cycling route planners are also available on the intranet & internet, with downloadable apps for smart phones also available. In October 2012 NHS Fife gained the Cycle Friendly Employer award from Cycling Scotland for each of its Glenrothes, QMH, Lynebank, SACH, Stratheden and VHK sites: current cycle parking provision is summarised in Table

68 Table 10.1 Cycle parking at major sites. Site Cycle lockers Covered storage Uncovered storage Adamson Hospital 10 4 Cameron Hospital 4 Glenrothes Hospital 8 Lynebank Hospital 10 QMH 20 SACH 5 18 Stratheden Hospital 10 VHK 10+ (bulk locker) 30 Total Car-sharing NHS Fife has operated a free, voluntary staff car-sharing scheme since Take-up has slowly risen since the scheme was introduced, as shown in Table Membership increases within the last few years can be directly attributed to marketing campaigns (e.g. national lift share week, on-site roadshows etc.) however growth still remains slow. Table 10.2 Membership rates for NHS Fife s car-sharing scheme. Year New members Members Cumulative registered in year removed in year total members Parking provision & management NHS Fife has a staff parking policy (GP/C8), which advises staff as to where they should and should not park. In general, beyond dedicated blue badge and operational user (i.e. key staff) spaces, most on-site parking across NHS Fife sites is available for both the general public and staff, with the latter encouraged to use facilities further away from entrances. At QMH and VHK, there are protected spaces for non-staff use (i.e. patients and visitors), located close to entrances. Table 10.3 summarises parking provision across NHS Fife sites. Car-park policy, protected patient/visitor spaces, blue badge provision. Table 10.3 Car parking at major sites. Site Blue badge Patient/visitor Short stay Total spaces spaces spaces spaces Adamson Hospital Cameron Hospital Glenrothes Hospital 2 64 Lynebank Hospital

69 Site Blue badge Patient/visitor Short stay Total spaces spaces spaces spaces QMH Randolph Wemyss Hospital 3 39 SACH Stratheden Hospital VHK Total Please note the figures for QMH and VHK will change as a result of the of the GHMS reconfiguration. Both Car Park 2 at QMH and Car Park B at VHK are controlled by barriers, which are raised manually at 09:00 on weekdays this means that staff (who usually start by then) are discouraged from using these spaces. Car Park H at VHK is also intended for outpatients and access is controlled by means of showing a valid appointment letter. Security staff routinely sticker/and or leaflet inappropriately parked vehicles, with the aim being to educate and encourage behavioural change where possible, to achieve staff buy-in. Operational user parking on both sites is managed by swipecard to gain access to dedicated, barriered parking (72 spaces within Car Park 4 at QMH and 84 spaces within Car Park K at VHK). Blue badge parking on both sites is covered by traffic regulation orders (TROs), as are on-site double yellow lines within these sites. 69

70 11. Medical Equipment Medical equipment is essential for the delivery of healthcare. A report by Audit Scotland titled Equipped to Care: Managing medical equipment in the NHS in Scotland was published in March The report highlighted the following: That medical equipment is essential to patient care; That the correct equipment needs to be available in the right place at the right time; That properly trained staff must be available to use the equipment; The need for NHS organisations to have adequate systems in place to manage their medical equipment; The importance of these issues with the establishment of a formal duty of clinical governance; That given the strategic importance of medical equipment overall responsibility needs to be taken at Board level. A subsequent report was published in February 2004 entitled Better equipped to care? This reviewed progress across Scotland since the first report. Its main findings were: Strategic management of medical equipment needs to be given a higher priority; More needs to be done to manage medical equipment risks; Information to support the management of medical equipment needs to improve. These reports and guidance from the UK Medicines and Healthcare products Regulatory Agency (MHRA) have guided arrangements for the management of medical equipment in NHS Fife. Policies and Procedures Compliance with CEL 35 (2010) CEL 35 (2010) requires: Boards to manage their medical equipment effectively, with supporting strategies governance and reporting arrangements. Boards to have clear knowledge of their medical equipment (condition, lifecycle replacement programme, value, and cost of ownership). Lead for compiling the information Health Boards should identify a lead for compiling the information. Recognising that the information is held by different people, the lead will need to identify these individuals and compile the return with their help examples of individuals are given associated with different equipment groups Property Asset Management Strategy (PAMS) The collection of information on Medical Equipment is part of the work Boards require to do to complete their PAMS report. Board should have supporting strategies and governance arrangements for their medical equipment, the narrative of which should be included in the Board s PAMS report. This document and collection concentrates on specific data on medical equipment. Whilst collecting data on Medical Equipment, Boards are encouraged to look for examples that demonstrate appropriate team work across the CEL 35(2010) asset strands: Estates, Medical Equipment, Vehicles and IM&T. 70

71 Sharing best practice Benchmarking using KPIs help identify good practice and so the work for 2012/13 includes some KPIs. These are limited in scope but will develop year-on-year with the development of the process of compiling data. NHS Fife has written policies and procedures to cover the various stages in the life cycle of equipment. Our Good Practice Guide to Managing Equipment is currently being updated to reflect changes in practice. This guide is underpinned by the following up to date written procedures: Equipment Procurement; Accessing Equipment; Equipment Inventory; Equipment on Loan or Free Issue; Equipment permanent Location Change; Condemnation of equipment; Transfer of liability for Written-Off Equipment Equipment Maintenance. There is also a separate policy for the management of Electro-Medical equipment. This outlines the responsibilities of Medical Physics, Estates, the Department Equipment Controllers and links to the EMG and the other Equipment Policies. It also includes the Code of Practice to Ensure Safety in the Servicing and Maintenance of Anesthetic and Respiratory Equipment. Equipment Management Group There is an established Equipment Management Group (EMG) in NHS Fife which meets on a monthly basis. Until now it has had responsibility for the Acute Hospitals only but as of 2013 will be responsible for equipment management throughout NHS Fife. There is a formal role and remit for the EMG. Its roles and responsibilities are: To carry operational responsibility for medical equipment policy development and implementation;. Agree policies on standardisation of equipment between units and sites where appropriate; Ensure Equipment Asset Register and Maintenance register are appropriately maintained by providing the necessary information; Oversee the needs assessment process and initial prioritisation for medical equipment; Prioritise the funding allocated by NHS Fife for procurement of Capital equipment and recommend the same for approval by the Capital Planning Group; To agree the equipment specification and agree the final business case; Take into account the impact of the procurement on the wider services within NHS Fife; To review a rolling programme of equipment replacement and to advise on the consequences; To oversee the procurement of medical equipment; To review incidents involving equipment failure or misuse and recommend, alter, change practice or equipment to reduce the risk of repetition; To ensure that appropriate training is organised for staff working with equipment; 71

72 Ensure appropriate policies and procedures are in place for all aspects of equipment procurement, use, maintenance, repair, decontamination, disposal and replacement and that staff are aware of all these policies. The Group is chaired by NHS Fife s Equipment Manger and all Directorates are represented on the EMG. There is also representation from Procurement, Estates, Finance, Infection Control, Risk Management and Training. Department Equipment Controllers Each ward or department formally nominates a person to carry out the duties of the Department Equipment Controller (DEC). Overall responsibility for Equipment Control lies with the line manager/charge nurse. The duties of the DEC include: Maintain an up to date list of all equipment in the department; Participate in equipment selection arrangements; Ensure new equipment is commissioned before use; Be responsible for User equipment servicing; Record all events and build a history of each item in conjunction with Estates Department; Ensure equipment is maintained in accordance with manufacturer s recommendations; Record movement of equipment. A record of all Department Equipment Controllers is held within Estates Department. Management and Inventories A comprehensive asset and maintenance register is required to enable us to know what equipment we are looking after and provide its service history. In NHS Fife this information is managed by the Estates Department utilising Apollo: a commercial asset management database. All new equipment is given an electronic asset tag and is logged by Estates Department in Apollo and also locally by the Department Equipment Controller. Procurement of Medical Equipment The process for procuring medical equipment is laid out in the aforementioned Equipment Procurement Policy and the Board s Financial Operating Procedures. The capital equipment budget is managed and allocated by the EMG. EMG maintains a list of requests for new or replacement equipment that has been identified by departments. All requests are scored using the same grading matrix and held on a list to be allocated when funding is available. EMG monitors the procurement of the equipment and ensures all processes are carried out effectively. National contracts are utilised where these exist. If no national contract exists then appropriate tendering procedures are used dependant on the value of the equipment. There is also a Condemnation budget. Requests to this budget are managed by Finance. Imaging Equipment Due to the high value of all Imaging Equipment a percentage of the equipment budget has been ring fenced annually for the purchase of Imaging Equipment. This has enabled a planned equipment replacement programme to be identified and equipment replaced on a rolling basis. This work has been done in conjunction with the National Imaging Equipment Group of Health facilities Scotland in order to improve the cost effectiveness of purchasing and maintaining this type of equipment. This replacement programme will be ongoing. 72

73 Renal Dialysis In conjunction with our Technical services manager from NHS Lothian all dialysis machines are identified with planned replacement dates and this information is shared with the equipment management Group. Infusion Devices Work is currently ongoing in Fife to standardise on one Infusion Device. This work has become more important with the move of all major acute services on to one hospital site in Jan/Feb2012. Work is currently being done to identify a suitable method for procuring new devices. It has also been recognised that with changes to Infusion guidelines more devices will be required to meet our obligations. Safety Action Notices NHS Fife has a distribution system for the dissemination of all safety warnings received. This work is undertaken by Corporate Services. Equipment Incidents All reportable incidents in NHS Fife are recorded using Datix. Each month a report on all those relating to equipment is issued to the EMG. These are then reviewed at our monthly meeting to ensure that all appropriate action has been taken. This may involve for example ensuring that the incident has been reported nationally or that additional staff training has been delivered. Recent Work Examples Patient Monitoring The requirement to replace Patient Monitoring Equipment in Theatres, ICU and Coronary Care was identified to be done in 2010/11. It was agreed to defer the replacement so that all new equipment could be installed straight in to the new build hospital. This was planned with the company and contractors and took place late 2011 in time for departments moving in early Endoscopy Decontamination VHK Again this procurement was planned so that the new machines were installed and commissioned in the new build in time for services being transferred from other sites in Fife. The procurement process is also underway for the new decontamination unit for Endoscopy Day Surgery on QMH site. Medical Equipment Assets The standard asset database proforma as requested by Scottish Government can be found in Section 12 of this document. 73

74 12. Asset Data: Primary Care; Independent Contractors NHS Fife - Desk Top Study - GP Practices Property Assets Number of Properties/Sites: 33 Floor Area (000's sq.m) NUMBER Net Book Value ( m) NOT KNOWN Age Profile (%): Over 50 years old 12% years old years old 76% 25 Up to 10 years old 12% 4 Tenure Types (%): Owned 79% 26 Leased 21% 7 PPP/PFI 0 0 Other 0 0 Condition Ranking - % of total in each category: A 18% 6 B 79% 26 C 3% 1 D 0% 0 Functional Ranking - % in each category: A 15% 5 B 70% 23 C 12% 4 D 3% 1 Quality Ranking - % in each category: A 18% 6 B 76% 25 C 3% 1 D 3% 1 Space Ranking - % in each category Empty Nil Underused 9% Fully used 82% Overcrowded 9% Non Clinical Backlog Cost ( m): Clinical areas Areas Low Risk Items NOT KNOWN NOT KNOWN Moderate Risk Items NOT KNOWN NOT KNOWN Significant Risk Items NOT KNOWN NOT KNOWN High Risk Items NOT KNOWN NOT KNOWN Total Backlog NOT KNOWN NOT KNOWN Estimated capital receipts from property disposals over the next 5 years NOT KNOWN 74

75 NHS Fife - Desk Top Study - GP Practices % of the estate (by area) surveyed in last year Property Assets % of the estate (by area) surveyed in 5 years 100% Average SCART Score: Energy Consumption (GJ) Heated Volume (100m 3 ) Energy Performance (GJ/100m 3 ) CO 2 Emissions (000's Tonnes) Water Consumption (m3/m2) Waste Volume (Tonnes): Waste Recycled (Tonnes) Number of Estates & Facilities Staff NOT KNOWN NOT KNOWN NOT KNOWN NOT KNOWN NOT KNOWN NOT KNOWN NOT KNOWN NOT KNOWN Managerial NUMBER by DV for rent purposes Technician NHS Fife - Desk Top Study - Dental Practices Property Assets NUMBER Number of Properties/Sites: 57 Floor Area (000's sq.m) 5910 Net Book Value ( m) NOT KNOWN Age Profile (%): Over 50 years old 74% years old 14% years old 5% 3 Up to 10 years old 7% 4 Tenure Types (%): Owned 81% 46 Leased 19% 11 PPP/PFI 0 0 Other 0 0 Condition Ranking - % of total in each category: A 12% 7 B 84% 48 C 4% 2 D 0 0 Functional Ranking - % in each category: A 26% 15 B 70% 40 C 4% 2 D 0 0 Quality Ranking - % in each category: 75

76 NHS Fife - Desk Top Study - Dental Practices Space Ranking - % in each category Property Assets NUMBER A 33% 19 B 63% 36 C 4% 2 D 0 0 Empty 0 0 Underused 24% 14 Fully used 72% 41 Overcrowded 4% 2 Backlog Cost ( m): Clinical areas Non Clinical Areas Low Risk Items NOT KNOWN Moderate Risk Items NOT KNOWN Significant Risk Items NOT KNOWN High Risk Items NOT KNOWN Total Backlog NOT KNOWN Estimated capital receipts from property disposals over the next 5 years NOT KNOWN % of the estate (by area) surveyed in last year by DV for rent % of the estate (by area) surveyed in 5 years 100% purposes Average SCART Score: NOT KNOWN Energy Consumption (GJ) NOT KNOWN Heated Volume (100m 3 ) NOT KNOWN Energy Performance (GJ/100m 3 ) NOT KNOWN CO 2 Emissions (000's Tonnes) NOT KNOWN Water Consumption (m3/m2) NOT KNOWN Waste Volume (Tonnes): NOT KNOWN Waste Recycled (Tonnes) NOT KNOWN Number of Estates & Facilities Staff Managerial Technician NHS Fife - Desk Top Study - Pharmacies Property Assets Number of Properties/Sites: 81 Floor Area (000's sq.m) NOT KNOWN Net Book Value ( m) Age Profile (%): NOT KNOWN NUMBER Over 50 years old 53% years old 20% years old 22% 18 Up to 10 years old 5% 4 76

77 NHS Fife - Desk Top Study - Pharmacies 77 Property Assets NUMBER Tenure Types (%): Owned NOT KNOWN Leased NOT KNOWN PPP/PFI NOT KNOWN Other NOT KNOWN Condition Ranking - % of total in each category: A 35% 28 B 58% 47 C 7% 6 D 0 0 Functional Ranking - % in each category: A 32% 26 B 54% 44 C 14% 11 D 0 0 Quality Ranking - % in each category: A 32% 26 B 61% 49 C 7% 6 D 0 0 Space Ranking - % in each category Empty 0 Underused 0 Fully used 100% Overcrowded 0 Non Clinical Backlog Cost ( m): Clinical areas Areas Low Risk Items NOT KNOWN NOT KNOWN Moderate Risk Items NOT KNOWN NOT KNOWN Significant Risk Items NOT KNOWN NOT KNOWN High Risk Items NOT KNOWN NOT KNOWN Total Backlog NOT KNOWN NOT KNOWN Estimated capital receipts from property disposals over the next 5 years NOT KNOWN % of the estate (by area) surveyed in last year NOT KNOWN % of the estate (by area) surveyed in 5 years NOT KNOWN Average SCART Score: NOT KNOWN Energy Consumption (GJ) NOT KNOWN Heated Volume (100m 3 ) NOT KNOWN Energy Performance (GJ/100m 3 ) NOT KNOWN CO 2 Emissions (000's Tonnes) NOT KNOWN Water Consumption (m3/m2) NOT KNOWN Waste Volume (Tonnes): NOT KNOWN Waste Recycled (Tonnes) NOT KNOWN

78 NHS Fife - Desk Top Study - Pharmacies Number of Estates & Facilities Staff Property Assets Managerial NUMBER Technician NHS Fife - Desk Top Study - Opticians Property Assets NUMBER Number of Properties/Sites: 47 Floor Area (000's sq.m) NOT KNOWN Net Book Value ( m) NOT KNOWN Age Profile (%): Over 50 years old 77% years old 17% years old 0 0 Up to 10 years old 6% 3 Tenure Types (%): Owned NOT KNOWN Leased NOT KNOWN PPP/PFI NOT KNOWN Other NOT KNOWN Condition Ranking - % of total in each category: A 26% 12 B 74% 35 C 0 0 D 0 0 Functional Ranking - % in each category: A 23% 11 B 77% 36 C 0 0 D 0 0 Quality Ranking - % in each category: A 62% 29 B 38% 18 C 0 0 D 0 0 Space Ranking - % in each category Empty NOT KNOWN Underused NOT KNOWN Fully used NOT KNOWN Overcrowded NOT KNOWN Non Clinical Backlog Cost ( m): Clinical areas Areas 78

79 NHS Fife - Desk Top Study - Opticians Property Assets Low Risk Items NOT KNOWN Moderate Risk Items NOT KNOWN Significant Risk Items NOT KNOWN High Risk Items NOT KNOWN Total Backlog NOT KNOWN Estimated capital receipts from property disposals over the next 5 years NOT KNOWN % of the estate (by area) surveyed in last year NOT KNOWN % of the estate (by area) surveyed in 5 years NOT KNOWN Average SCART Score: NOT KNOWN Energy Consumption (GJ) NOT KNOWN Heated Volume (100m 3 ) NOT KNOWN Energy Performance (GJ/100m 3 ) NOT KNOWN CO 2 Emissions (000's Tonnes) NOT KNOWN Water Consumption (m3/m2) NOT KNOWN Waste Volume (Tonnes): NOT KNOWN Waste Recycled (Tonnes) NOT KNOWN Number of Estates & Facilities Staff Managerial NUMBER NOT KNOWN NOT KNOWN NOT KNOWN NOT KNOWN NOT KNOWN Technician 79

80 Asset Data: NHS Fife Properties Functional Types Area (Sq.m.) % of Total Area Area Value 01 Acute Hospital 115, % 265,594, Childrens Hospital % Maternity Hospital % Specialist Hospital % Mental Health Hospital 38, % 62,175, Community Hospital 15, % 39,848, Older People Hospital 15, % 17,876, Multi Service Hospital % Health Centre 14, % 18,286, Clinics (inc. Day Hospitals and Resource Centres) 12, % 14,415, Offices 20, % 84, Support Facilities 36, % 337, Staff Residential Accommodation 3, % Patient Residential Accommodation % GP Practice (not measured) % Dental Practice (not measured) % Pharmacy (not measured) % Optician (not measured) % Non NHS Functions (not measured) 5, % 4,994, Other 29, % 1,432, UnReported % 0.00 Totals: 308, % 425,043, Table 12.1: An analysis of the existing estate by area Value is Net Book Value using only Blocks '00' Blocks w ith code no. '00' have been excluded from the area calculation 3rd party tenure has been excluded from this table Last Update 06 March

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83 Functional Types A - New Physical Condition Backlog (and Impending Backlog) Cost 000/Percentage of Total B - Acceptable Condition C - Requires Investment Cost 000 % Cost 000 % Cost 000 % Cost 000 % Cost 000 % Cost Acute Hospital , , , Childrens Hospital Maternity Hospital Specialist Hospital Mental Health Hospital , , , Community Hospital , Older People Hospital , , , Multi Service Hospital Health Centre , , Clinics (inc. Day Hosp. & Resource Centres) , , Offices , , , Support Facilities , , , Staff Residential Accommodation , , Patient Residential Accommodation GP Practice Dental Practice Pharmacy Optician Non NHS Functions Other , , , , UnReported % of Overall Total , , , , Table 12.2: The physical condition of the estate D - Unacceptable Condition Unreported Total 3rd party tenure and PFI tenure has been excluded from this table Blocks w ith Code '00' have been included in this table Last Update 06 March

84 Functional Types Physical Condition Backlog Cost 000/Percentage of Total Low % Moderate % Significant % High % Unreported % Total 01 Acute Hospital , , , Childrens Hospital Maternity Hospital Specialist Hospital Mental Health Hospital , , , Community Hospital Older People Hospital , , Multi Service Hospital Health Centre , Clinics (inc. Day Hosp. & Resource Centres) , Offices , Support Facilities , , , Staff Residential Accommodation , Patient Residential Accommodation GP Practice Dental Practice Pharmacy Optician Non NHS Functions Other , , , UnReported % of Overall Total 4, , , , , Table 12.3: Physical Condition - Risk profiled backlog costs This table includes only costs where the physical condition grading is not A or B 3rd party tenure and PFI tenure has been excluded from this table Blocks with Code '00' have been excluded from this table 84 Last Update 06 March 2013

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86 Functional Types Statutory Compliance Cost 000/Percentage of Total Low % Moderate % Significant % High % Unreported % Total 01 Acute Hospital , , , Childrens Hospital Maternity Hospital Specialist Hospital Mental Health Hospital Community Hospital Older People Hospital , , Multi Service Hospital Health Centre Clinics (inc. Day Hosp. & Resource Centres) Offices Support Facilities Staff Residential Accommodation Patient Residential Accommodation GP Practice Dental Practice Pharmacy Optician Non NHS Functions Other UnReported % of Overall Total , , , Table 12.4: Statutory Compliance - Risk profiled backlog costs This table includes all statutory compliance (A, B, C, D) including unreported 3rd party tenure and PFI tenure has been excluded from this table Last Update 06 March

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88 Functional Types Area m 2 C or Better No. of Bldgs. Area m 2 D No. of Bldgs. Area m 2 EPC Ratings 01 Acute Hospital 50, , , Childrens Hospital Maternity Hospital Specialist Hospital Mental Health Hospital , , Community Hospital 10, Older People Hospital , Multi Service Hospital Health Centre 1, , , , Clinics (inc. Day Hosp. & Resource Centres) 2, , , , Offices 1, , , Support Facilities , , Staff Residential Accommodation , Patient Residential Accommodation GP Practice Dental Practice Pharmacy Optician Non NHS Functions Other , UnReported % of Overall Total 66, , , , , No. of Bldgs. Table 12.5: Energy Performance Certificate E F G Unreported Area m 2 No. of Bldgs. Area m 2 No. of Bldgs. Area m 2 No. of Bldgs. This table show s the total GIA and the number of blocks w ith a record in in the Block Condition table w ith a facet of 9 - Environment All condition ratings are included plus unreported but condition A, B and C ratings are show n added together in one column Blocks w ith Code '00' have been excluded from this table Last Update 06 March

89 Functional Suitability Functional Types A - Very Satisfactory B - Satisfactory C - Not Satisfactory D - Unacceptable Unreported Total Area m 2 % Area m 2 % Area m 2 % Area m 2 % Area m 2 % Area m 2 01 Acute Hospital 50, , , , , Childrens Hospital Maternity Hospital Specialist Hospital Mental Health Hospital 4, , , , , Community Hospital 10, , , Older People Hospital , , , Multi Service Hospital Health Centre 1, , , , Clinics (inc. Day Hosp. & Resource Centres) 2, , , , Offices , , , Support Facilities 5, , , , Staff Residential Accommodation , , , Patient Residential Accommodation GP Practice Dental Practice Pharmacy Optician Non NHS Functions , , Other , , , , , UnReported % of Overall Total 74, , , , , , This table is based on ratings allocated against rooms/areas 3rd party tenure and PFI tenure has been excluded from this table Table 12.6: Results from the appraisal of functional suitability Last Update 06 March

90 Space Utilisation Functional Types E - Empty, Not Used U - Under Utilised F - Fully Utilised O - Overcrowded Unreported Total Area m 2 % Area m 2 % Area m 2 % Area m 2 % Area m 2 % Area m 2 01 Acute Hospital , , , , Childrens Hospital Maternity Hospital Specialist Hospital Mental Health Hospital 1, , , , Community Hospital , , Older People Hospital 1, , , Multi Service Hospital Health Centre , , , Clinics (inc. Day Hosp. & Resource Centres) , , Offices , , , Support Facilities , , , , Staff Residential Accommodation , , , Patient Residential Accommodation GP Practice Dental Practice Pharmacy Optician Non NHS Functions , , Other 27, , , UnReported % of Overall Total 32, , , , , This table is based on ratings allocated against rooms/areas 3rd party tenure has been excluded from this table Table 12.7: Results from the appraisal of space utilisation Last Update 06 March

91 Quality Functional Types A - Very Satisfactory B - Satisfactory C - Not Satisfactory D - Unacceptable Unreported Total Area m 2 % Area m 2 % Area m 2 % Area m 2 % Area m 2 % Area m 2 01 Acute Hospital 50, , , , , Childrens Hospital Maternity Hospital Specialist Hospital Mental Health Hospital 4, , , , , Community Hospital 10, , , Older People Hospital , , , , Multi Service Hospital Health Centre 1, , , , Clinics (inc. Day Hosp. & Resource Centres) 2, , , , Offices , , , Support Facilities 5, , , , Staff Residential Accommodation , , , Patient Residential Accommodation GP Practice Dental Practice Pharmacy Optician Non NHS Functions , , Other , , , , , UnReported % of Overall Total 75, , , , , , This table is based on ratings allocated against rooms/areas 3rd party tenure has been excluded from this table Table 12.8: Results from the appraisal of quality Last Update 06 March

92 Functional Types Endowment (GIA) Sq.m. Leased (GIA) Sq.m. Owned (GIA) Sq.m. PFI (GIA) Sq.m. Unreported (GIA) Sq.m. Area (GIA) Sq.m. % of Total Area 01 Acute Hospital , , , % 02 Childrens Hospital % 03 Maternity Hospital % 04 Specialist Hospital % 05 Mental Health Hospital , , % 06 Community Hospital , , , % 07 Older People Hospital , , % 08 Multi Service Hospital % 21 Health Centre , , % 22 Clinics (inc. Day Hosp. & Resource Centres) , , % 23 Offices , , , % 24 Support Facilities , , % 25 Staff Residential Accommodation , , % 26 Patient Residential Accommodation % 41 GP Practice % 42 Dental Practice % 43 Pharmacy % 44 Optician % 91 Non NHS Functions , , % 99 Other , , % UnReported % Totals: , , , , % Table 12.9: Typical Analysis of Property Types Block code no. '00' has been excluded from this table 3rd party tenure has been excluded from this table Last Update 06 March

93 Ownership Area (GIA) Sq.m. % of Total Area Endowm ent % Leas ed 2, % Owned 243, % PFI 62, % Third Party Owners hip % Unreported % Totals: 308, % Table 12.10: Typical Analysis of Property Ownership Block code no. '00' has been excluded f rom this table Last Update 06 March

94 Chart 12.11: Analysis of Size Range of Properties s k c lo B f o r e b m u N Block Area sq.m. Block code '00' has been excluded from this chart Third party ownership tenure has been excluded Last Update 06 March

95 Age Profile Number of Blocks Area Sq.m. Backlog Cost Backlog Cost per m 2 Pre , ,713, , ,121, , ,882, , ,414, or more recent 37 82, , Unreported 5 2, ,238, , Totals: , ,233, Table 12.12: Age Profile of Properties Block code no. '00' has been excluded from this table Backlog costs include Physical Condition C, D or unreported and all Statutory Compliance condition ratings All other costs have been excluded Costs included are Ow ned, Leased or Endow ment tenure Number of Blocks and Area include all tenures except 3rd party ow nership Last Update 06 March

96 Functional Type GIA Sq.m. GIA as % of Total Area Low Risk Moderate Risk Significant Risk High Risk 01 Acute Hospital 115, % Childrens Hospital % Maternity Hospital % Specialist Hospital % Mental Health Hospital 38, % Community Hospital 15, % Older People Hospital 15, % Multi Service Hospital % Health Centre 14, % Clinics (inc. Day Hosp. & Resource Centres) 12, % Offices 20, % Support Facilities 36, % Staff Residential Accommodation 3, % Patient Residential Accommodation % GP Practice % Dental Practice % Pharmacy % Optician % Non NHS Functions 5, % Other 29, % UnReported % % of Overall Total 308, % Table 12.13: Summary of Property Appraisal Results Backlog Expenditure Required ( m) Unreported Total millions Block code no. '00' has been excluded from this table Backlog costs include Physical Condition C, D or unreported and all Statutory Compliance condition ratings All other costs have been excluded Number of Blocks and Area include all tenures except 3rd party ow nership Last Update 06 March

97 Physical Condition Backlog (and Impending Backlog) Cost 000/Percentage of Total Functional Types A - New B - Acceptable Condition C - Requires Investment D - Unacceptable Condition Total Cost 000 % Cost 000 % Cost 000 % Cost 000 % Cost Acute Hospital , , , Childrens Hospital Maternity Hospital Specialist Hospital Mental Health Hospital , , , Community Hospital , Older People Hospital , , , Multi Service Hospital Health Centre , , Clinics (inc. Day Hosp. & Resource Centres) , , Offices , , , Support Facilities , , , Staff Residential Accommodation , , Patient Residential Accommodation GP Practice Dental Practice Pharmacy Optician Non NHS Functions Other , , , , UnReported % of Overall Total , , , , Table 1.2: Backlog Maintenance Costs Last Update 06 March

98 Functional Types Physical Condition Backlog Cost 000/Percentage of Total Low % Moderate % Significant % High % Total 01 Acute Hospital , , , Childrens Hospital Maternity Hospital Specialist Hospital Mental Health Hospital , , , Community Hospital Older People Hospital , , Multi Service Hospital Health Centre , Clinics (inc. Day Hosp. & Resource Centres) , Offices , Support Facilities , , , Staff Residential Accommodation , Patient Residential Accommodation GP Practice Dental Practice Pharmacy Optician Non NHS Functions Other , , , UnReported % of Overall Total 4, , , , , Table 1.3: Physical Condition - Risk profiled backlog maintenance costs ( 000's) Last Update 06 March

99 IM&T Assets Number of individual pieces of equipment or separate systems under each of these headings Age (by number of pieces of equip or % of system): Less than 2 years 2 to 5 years > 5 years Condition (by number of pieces of equipment or % of system): Cabling Networks Infrastructure Servers IM&T Assets Equipment Communications systems Desktop Mobile 21, ,097 5,507 1,060 5, , ,619 4, , , Worn out or damaged beyond economic repair 1% 0% 1% 0 0 Unreliable (based on service history) 0.1% 5% 1% 0 0 Technically obsolete 0% 0.4% 3% 4% 6% Spare parts no longer available 0% 0% 1% 4% 6% Superceded by more cost effective or effective equip 5% 0% 75% 0 0 Insufficient capacity to cope with loads/usage 10% 4% 10% 10% 10% Net Book Asset Value at 31/03/12 226,530 Replacement Cost at 31/03/12 0 3,455,451 49,766 1,023,980 23, , ,778 43,

100 Total maintenance & servicing expenditure for the year to 31/03/12: in-house staff TBC TBC TBC TBC TBC external contracts TBC TBC TBC TBC TBC Equipment/system availability - No days in year when available for use Equipment/system downtime - No days in year when not available Equipment/system utilisation - No days in year when in use Expenditure for year ending 31/03/12 on new equipment/systems: Has there been a survey of the infrastructure in the last 2 years? Yes/No Is there a costed 5 year replacement programme in place? (Yes/No) Confirmation that there is an up-to-date asset register (Yes/No) Confirmation that there is an up-to-date IM&T Strategy (Yes/No) Cabling Networks 75,000 Servers Communications systems 75,000 25,000 Desktop Mobile Capital 275, ,588 12,412 Revenue ,000 Leases Partial Y Partial Y Y y (3) y (1) y (2) y (3) y (3) y y y y y y y y y y What is your general assessment of the current level of risk associated with IM&T: General Safety Disruption to services High Significant Moderate Low 100

101 Poor Fairly well Good Excellent What is your general assessment of how well the current provision of IM&T equipment and infrastructure supports service delivery? What is your general assessment of the opportunities in relation to IM&T equipment and infrastructure for investing in: More efficient technology Safer technology High Significant Moderate Low DEFINITIONS: Technically obsolete Assets in our inventory (within their life span) that won t be used because is technically obsolete. Superceded by more cost effective or effective equip assets in our inventory (within their life span) that are in use but there are more cost effective options in the market Insufficient capacity to cope with loads/usage assets in our inventory (within their life span) that are in use but have capacity issues 101

102 Medical Equipment Assets ; Notes The following pro-forma is a standard template issued by Scottish Government for recording details of Medical Equipment Assets Global Overview: The template starts with a general section seeking information on all medical equipment within NHS Fife. Specific Sections: Specific Medical Equipment Types: Medical equipment is diverse and specific worksheets are developed to record data appropriate to particular type or types of medical equipment. For the 2012/13 return, only a limited number of equipment types was covered, but this will increase annually working towards a complete picture of all medical equipment types within NHSScotland Questions on imaging equipment, ultrasound imaging, and radiotherapy have been removed from this NHS Board level pro-forma as this information is to be collected from NIEG Key Performance Indicators Key Performance Indicators are useful tools for managing medical equipment and have been, and will continue to be, developed for each section 102

103 Global overview Medical Equipment NHS Board: 1 2 Question Answer Comment Notes Estimated value of all medical equipment Capital Asset Register - Net book value 27,554,894 Estimated inflated purchase price for ME for ME in excess of 5,000 list price inc VAT Comment on how estimated and its accuracy 13,381,797 What is the value of all medical equipment on the capital asset register 3 Capital Charges Pool. 3,065,243 Based on ME excludes any PM Total value of the Capital Charge Pool 4 Total spend this financial year 3,196,337 Include estimate of expenditure up to end of financial year 4.1 Total that is capital 3,196,337 Give as much data as 4.2 Total that is revenue 65,906 possible. If you only know 4.3 Overall total 3,26,2243 the overall total please give it 4.4 Of the total, how much was 26,28,763 "additional" equipment 5 Total expenditure on "leases " 221, All Dental Equipment Leases. Summarise the Leases taken out 6 Total expenditure on "Managed Equipment Services" 1,394, Laboratory Managed Service Contractsx3 Summarise the Managed Equipment Services and their scope Anticipated actual spend 2013/14 2,926,000 Estimate as accurately as possible Anticipated actual spend 2014/15 2,210,000 comment as applicable on the estimates Anticipated actual spend 2015/16 2,420,000 Anticipated required spend in 2013/14 2,420,000 Note this is expenditure that can be justified based on 103

104 Anticipated required spend in /15 Anticipated required spend in /16 Strategy - Does your Board have 8 an approved medical equipment strategy? Does your Board have an 8.1 approved medical equipment business / investment plan 9 Risks and Opportunities: What is your general assessment of the current risk level 9.1 associated with medical equipment related to general safety What is your general assessment of the current risk level 9.2 associated with medical equipment related to disruption to services What is your general assessment 9.3 of the opportunities for investing in more efficient technology What is your general assessment 9.4 of the opportunities for investing in safer technology What is your general assessment of how your current medical 9.5 equipment supports service delivery On a separate sheet, provide further details of the risks & 9.6 opportunities associated with medical equipment. Provided? No No Low Low Moderate Moderate 2,420,000 out of support, exceeds recommended life-span Answer: yes / no Answer: yes / no Answer: High / Significant / Moderate / Low Answer: High / Significant / Moderate / Low Answer: High / Significant / Moderate / Low Answer: High / Significant / Moderate / Low Good Answer: Poor / Fairly well / Good / Excellent Yes Answer: yes / no 104

105 B.5 Specific Renal Dialysis (Haemodialysis) Question Answer Comment Notes 1 All Haemodialysis equipment This section includes all whether home or hospital 1.1 Replacement value 969, Number of units 61 in use 1.3 Purchase costs this year 159, annual maintenance cost of equipment - external contracts plus adhoc parts and adhoc repairs 20, Total spent (including build works) this financial year 1.5 Annual maintenance cost of equipment WTE staff 91, aged <2 years 10 Give the number of units aged >2 <5 years 19 in the age range aged >5 <7 years 13 The age should be based aged >7 years 19 on 31 March Home dialysis 2.1 Number of home dialysis patients (average for year) 0 3 Hospital dialysis 3.1 Number of dialysis bays in dedicated outpatient Renal Dialysis Units 42 Kirkcaldy, Dunfermline, St Andrews 3.2 Total Number of dialysis patient sessions per week

106 3.3 Number of evening/overnight patient sessions per week Number of in-patient bays. Exclude the number given in question B.6 Specific Cardiac defibrillators Question Answer Comment Notes 1.1 Replacement value of all in HB 595, Number of units - all in HB Expenditure this year - all HB 2, Replacement value - hospitals only 419, Number of units - hospitals only 84 How many of these are back-up spares 1.7 Expenditure this year - hospitals only Nil 1.8 annual maintenance cost of equipment - external contracts plus ad hoc parts and ad hoc repairs 1.9 Hours spent on maintenance - inhouse staff 1.10 Number of ad hoc repair call-outs for defibrillators 5, Hospital maintenance only. Cost of spare parts etc All repairs in-house 234 Hospital only 48 Hospitals only 106

107 1.11 Number of those in '1.10' where no fault was found Nil aged <2 years 11 All in HB Give the number of units aged >2 <5 years 28 All in HB in the age range aged >5 <7 years 28 All in HB The age should be based aged >7 years 78 All in HB on 31st March 2012 B7 Specific Endoscopy Questions Answer Comment Notes 1.1 Replacement value N/Known 1.2 Number of units Purchase costs this year Nil 1.4 Annual maintenance cost of 204, equipment external contracts plus ad hoc parts and ad hoc repairs aged <2 years 2 Give the number of units in the age range aged >2 <5 years aged >5 <7 years 25 The age should be based on 31 March aged >7 years Flexible endoscopes within dedicated endoscopy units 2.1 Replacement value N/Known 2.2 Number of units Purchase costs this year Nil 2.4 Annual maintenance cost of Inc in above equipment external contracts plus ad hoc parts and ad hoc repairs aged <2 years aged >2 <5 years aged >5 <7 years aged >7 years Number of endoscopy rooms 6 107

108 Board NHS Fife Transport Fife Details of Board Contact and Person Responsible for Data 2012/13 Name James M c Ilroy Grade Band 6 address [email protected] Transport//Fleet Staffing Information Number of Staff (establishment posts) Fleet Management Managers 1 Transport/Logistics Managers & Supervisors Operators Licence Holder 1 Transport Drivers Administrators/Clerks/Receptionists/PAs 1 Transport Plans and Accounts Please provide an organization chart of the transport section/dept Does the authority have a Transport/Fleet Strategy? Does the authority have a Transport/Fleet Business Plan? Available (Y/N) N Y N Vehicle and Plant Acquisition Funding (total figures) Vehicle Purchase Total Capital Expenditure 2012/13 86,870 Total Leasing Capital Expenditure (Capital cost of vehicle, not leasing cost) 415,000 Risk What is your assessment of the current level or risk associated with vehicles? High Significant Moderate Low General Safety X Disruption to services X What is your general assessment of the opportunities in relation to vehicles for investing in? High Significant Moderate Low More efficient technology X Safer technology X What is your general assessment of how well the current provision of vehicles supports service delivery? Poor Fairly well Good X Excellent 108

109 On a separate sheet, identify the main focus for investment in vehicles over the next 5 years, as identified in your Fleet Management Strategy and the contribution that this will make to service delivery/safety, etc. Fife Total Fuel costs 2012/13 Cost Litres Arval fuel contract 262, ,109 External contracts Internal fuel provision Total 262, ,109 Internal fuel provision Site location - Town Storage capacity (ltrs) Site 1 Site 2 Site 3 Site 4 Site 5 Total 0 Fife MANAGEMENT INFORMATION Fleet Management System State the name of the Fleet Management Information System used (include the version of the software being used): State which of the following modules of the Fleet Management Software you use (a) Fleet Inventory and Control: (b) Stores Inventory and Control: (c) Service & Maintenance Scheduling: (d) Standard maintenance rates (ICME times): (e) Monitoring Workshop Performance: Chevin Roadbase Yes Yes Yes Yes 109

110 Database reporting tool (if applicable): (f) Accident recording and claims handling: (g) Vehicle replacement programme: (h) Vehicle disposal management: (i) Electronic link to fuel system: (j) Vehicle utilisation monitoring: (k) Driver records and monitoring: (l) External vehicle hire: (m) Expenditure, income, & budgets: (n) Charging to internal devolved budget-holders: (o) Invoicing external customers: (p) Producing Management & Exception Reports: (q) Internal vehicle hire Other Modules? (please state) Yes Yes Yes YES Fife Staff Car Scheme Leased Owned cars Pool/Opps cars Totals cars Number of vehicles Age (by number of vehicles): Less than 2 years to 5 years > 5 years 0 Condition (by number of vehicles): Good - no significant wear or damage Acceptable - some signs of wear and minor damage 0 Poor - signs of significant wear and damage 0 Fuel type by number of vehicles: Petrol

111 Diesel LPG 0 Bio fuels 0 Electric 0 Net Book Asset Value at 31/03/13 Replacement Cost at 31/03/13 3,643,905 3,643,905 Total mileage per annum 2,912,000 2,912,000 Total maintenance & servicing cost for year to 31/03/13 if not included in lease cost: in-house staff 0 External contracts/expenditure 0 Total Tyre Costs per annum 0 Annual Spend on new vehicles for year 2012/13 0 Depreciation 0 Leases 626,910 Lease return penalties 0 Class 1a National Insurance 86,900 Contributions towards private use of vehicles: Cost Leases 362,917 Enter total for all staff Fuel Enter total for all staff Administration 25,680 Enter total for all staff Insurance 53,340 Enter total for all staff Accident damage Enter total for all staff Return penalties Enter total for all staff Total 441,937 Enter total for all staff 111

112 Expenses - Business mileage claim Lease car scheme vehicles Expenses - Business mileage claims for Grey fleet Cost Mileage 138,445 1,064,960 Fife 112 Leased Vehicle Assets Pool/Opps Large Buses/people Small van HGV Agricultural Other Total cars vans carriers Number of vehicles Age (by number of vehicles): Less than 2 years to 5 years > 5 years Condition (by number of vehicles): Good - no significant wear or damage Acceptable - some signs of wear and minor damage Poor - signs of significant wear and damage Fuel type by number of vehicles: Petrol Diesel LPG Bio fuels Electric Replacement Cost at 31/03/12 149,000 45, ,000 90,000 16, ,000 Total mileage per annum 100,000 90, ,000 70,000 35, ,000 Total maintenance & servicing cost 2012/13

113 in-house staff External contracts/expenditure n/a n/a n/a n/a Total Tyre Costs per annum Annual Spend on leased vehicles 2012/13 Leases 32,712 6, ,319 21,870 5, ,893 Return Penalties 1,600 5,000 6,600 Pool/Opps cars Small van Large vans Hired Vehicle Assets Buses/people HGV carriers Agricultural Other Total Long Term hires Number of vehicles - long term hires 1 1 Number of hire days Total hire costs 1,110 1,110 Pool/Opps Buses/people Small vans Large vans HGV cars carriers Agricultural Other Total Number of vehicles Age (by number of vehicles): Less than 2 years to 5 years > 5 years Condition (by number of vehicles): Good - no significant wear or damage Acceptable - some signs of wear and minor damage Poor - signs of significant wear and damage Fuel type by number of vehicles: 113

114 Petrol Diesel LPG Bio fuels Electric Replacement Cost at 31/03/12 149,000 45, , , ,000 Total mileage per annum 100,000 90, ,000 70,000 35, ,000 Total maintenance & servicing cost 2012/13 in-house staff External contracts/expenditure n/a n/a n.a n/a Total Tyre Costs per annum Annual Spend onleased vehicles 2012/13 Leases 32,712 ######## ######## ####### 5, ,893 Return Penalties 1,600 5,000 6,600 Long Term hires Number of vehicles - long term hires Pool/Opps cars Hired Vehicle Assets Buses/people Small van Large vans HGV carriers Agricultural Other Total 1 1 Number of hire days Total hire costs 1,110 1,

115 NHS Fife Energy Performance / HEAT Targets The following tables and graphs provide a sample illustration of the NHS Fife monitoring and performance data that is shared on Fife Wide basis with the Operational Division and the three Community Health Partnerships The Energy Efficiency Heat Target covers a five year period staring in 1 st April 2010 to 31st March 2015 and is based on 2009/10 consumption data. It is based on energy consumption at Hospitals only The C02 performance HEAT Target is a year on year reduction target of 3% per annum on all oil, gas,,butane and propane usage. The target period is the same as above. It is based on fossil fuel consumption at hospital only Sample selection of consumption of Electricity, Gas and Water for premises 115

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122 Address GP Surgeries Town Postcode Skeith Health Centre, Crail Road, Cellardyke Anstruther KY10 3FF The Health Centre, 12 Carswell Wynd Auchtermuchty KY14 7AW 31 High Street Strathmiglo KY14 7QA The Surgery, Main Road Charlestown KY11 3ED Muiredge Surgery, Merlin Crescent Buckhaven KY8 1HU 173 Stenhouse Street Cowdenbeath KY4 9DH 94 Main Street Crossgates KY4 8DF Nethertown Surgery Elliot Street Dunfermline KY11 4TF Newpark Medical Practice, 163 Robertson Road Dunfermline KY12 0BL Hospital Hill Surgery, Izatt Avenue Dunfermline KY11 3BA Millhill Surgery, 87 Woodmill Street Dunfermline KY11 4JW Bellyeoman Surgery, Bellyeoman Road Dunfermline KY12 0AE North Glen Medical Practice, 1 Huntsman s Court Glenrothes KY7 6SX Cos Lane Surgery, Woodside Road Glenrothes KY7 4AQ Inverkeithing Medical Group, 5 Friary Court Inverkeithing KY11 1NU 30 High Street Aberdour KY3 0TR Nicol Street Surgery, 48 Nicol Street Kirkcaldy KY1 1PH St Brycedale Surgery, St Brycedale Road Kirkcaldy KY1 1ER Path House, 7 Nether Street Kirkcaldy KY1 2PG The Surgery, 27 Commercial Road Ladybank KY15 7JS The Surgery, Anderson Drive Leslie KY6 3LQ Balmullo Surgery, 1 Pitcairn Drive Balmullo KY16 0DZ 11 Main Street Leuchars KY16 0HB Benarty Medical Centre, Lochleven Road Lochore KY5 8DA Markinch Medical Practice, 19 High Street Markinch KY7 6ER Methilhaven Surgery, 361 Methilhaven Road Methil KY8 3HR The Surgery, 118 High Street Newburgh KY14 6DA Tayview Medical Practice, 16 Victoria Street Newport-on-Tay DD6 8DJ 21 Dougall Street Tayport DD6 9JG Pittenweem Surgey, 2 & 9 Routine Row Pittenweem KY10 2LG The Surgery, Wadeslea Elie KY9 1EA Primrose Medical Centre, 3-5 Jutland Street Rosyth KY11 2ZL The Cannons, Ajax Way Methil KY8 3RS 122

123 Address Dental Practices Town Postcode 9 East Shore, Anstruther KY10 3AB 23 Backdykes, Auchtermuchty KY14 7AB 2 Brown Street, Buckhaven KY8 1JW 100 Sommerville Street, Burntisland KY3 9DH 154 Station Road, Cardenden KY5 0BL 1 Foulford Street, Cowdenbeath KY4 9NB 98 Bonnygate, Cupar KY15 4LB 12 Crossgate, Cupar KY15 5HH 17 Kirkgate, Cupar KY15 5AN 34 Crossgate, Cupar KY15 5AS 7 Moray Way North, Dalgety Bay KY11 9NH 7 Bay Centre, Regent's Way, Dalgety Bay KY11 9NH 3 Comely Park, Dunfermline KY12 7HU 32 Canmore Street, Dunfermline KY12 7NT 15 Comely Park, Dunfermline KY12 7HU 38 Canmore Street, Dunfermline KY12 7NT Century House, East Port, Dunfermline KY12 7JA East Wing Surgery, 32 Maygate, Dunfermline KY12 7NH 6a High Street, Dunfermline KY12 7AR 18 St Margaret Street, Dunfermline KY12 7PE Lorne House, East Port, Dunfermline KY12 7JB 32 Maygate, Dunfermline KY12 7NH 16 Park Avenue, Dunfermline KY12 7HX 16 New Row, Dunfermline KY12 7EF 8 Abbey Park Place, Dunfermline KY12 7PD 11 Culzean Place, Glenrothes KY7 4RX Unit 5c, Heritage House, North Street, Glenrothes KY7 5SE Huntsman's Court, 2 Huntsman's Road, Glenrothes KY7 6SE 4 North Street, Glenrothes KY7 5NA 15 Jubilee House, Pentland Park, Glenrothes KY6 2AH Unit 3c, Heritage House, North Street, Glenrothes KY7 5SE Woodside Dental Practice, Balbirnie Road, Glenrothes KY7 5ED 111 High Street, Inverkeithing KY11 1NW 74/76 Main Street, Kelty KY4 0AE 10 High Street Kincardine FK10 1RJ 100 High Street, Kinghorn KY3 9UE Beauly Place, Kirkcaldy KY1 1YA 1 Charlotte Street, Kirkcaldy KY1 1RN 25 Links Street, Kirkcaldy KY1 1QE 5 Park Road Kirkcaldy KY1 3EL 1/7 Redburn Wynd, Kirkcaldy KY1 1HZ 5 South Fergus Place, Kirkcaldy KY1 1YA 4 Viceroy Street Kirkcaldy KY2 5HT 308 High Street, Leslie KY6 3AT Albion House, Shorehead, Leven KY8 4NR 3 Parkhill Terrace, Commercial Road, Leven KY8 4LB Banbeath Court, Banbeath, Leven KY8 5GY 68 Bank Street, Lochgelly KY5 9QN 242 Wellesley Road, Methil KY8 3BW 123

124 Address Dental Practices Town Postcode 53/55 High Street, Newburgh KY14 6AH 26 Union Street, Newport on Tay DD6 8BP 1 Parkgate, Rosyth KY11 2JW 122 Queensferry Road, Rosyth KY11 2QZ 2 Lockhart Place, St Andrews KY16 9XB 4 St Mary's Place, St Andrews KY16 9UY Eden House, 35 Largo Road St Andrews KY16 8NJ 13 Castle Street, Tayport DD6 9AE 10 Viewfield Terrace, Dunfermline KY12 7HZ 124

125 Name Opticians Address Postcode Govan Opticians 6a Shore Street, Anstruther KY10 3EA PLM 19 Rodger Street, Anstruther KY10 3DU Ferrier & MacKinnon 129 High Street, Burntisland KY3 9AA Ferrier & MacKinnon 148 High Street, Cowdenbeath KY4 9NH Optical Express 319 High Street, Cowdenbeath KY4 9QJ McLeish, McPhee & Laing 24 Bonnygate, Cupar KY15 4LE PLM 40 Crossgate, Cupar KY15 5HS Walkers Opticians 5 Moray Way North, Dalgety Bay KY11 9NH Asda Opticians Halbeath Retail Park, Halbeath Road, Dunfermline KY11 4LP Boots Opticians Unit 7, Kingsgate Centre, Dunfermline KY12 7QA Gunn & Galbraith 49 Queen Anne Street, Dunfermline KY12 7BA Ferrier & MacKinnon Chalmers Street, Dunfermline KY12 8AT Specsavers 131 High Street, Dunfermline KY12 7DR Vision Express Unit 18, Kingsgate Centre, Dunfermline KY12 7QU Tesco Opticians Calais Farm Road, Duloch Park, Dunfermline KY11 4QX Spex Direct(Scotland)Ltd 3a Dickson Court, Elgin Street, Dunfermline KY12 7SG For Eyes Opticians 12 Abbeyview, Dunfermline KY11 4HA Boots Opticians 6 Lyon Way, Glenrothes KY7 5NW PLM 49 Bighty Avenue, Glenrothes KY7 5AD Rach Optometrists 8 Lyon Square, Glenrothes KY7 5NR Specsavers 32 Lyon Way, Glenrothes KY7 5NN Value Specs 48 Unicorn Way, Glenrothes KY7 5NU Ferrier & MacKinnon 14 High Street, IInverkeithing KY1 1NN Carrick Opticians 23 Main Street, Kelty KY4 0AA Asda Opticians Carberry Road, Mitchelston Estate, Kirkcaldy KY1 3NU A & S M Pattison 2 Park Place, Kirkcaldy KY1 1XL The Eye Centre 65 High Street, Kirkcaldy KY1 1LN The Spectacle Shop 35 Whytescausway, Kirkcaldy KY1 1XF Boots Opticians 129 High Street, Kirkcaldy KY1 1LR Vision Express Unit 7, Mercat Centre, Kirkcaldy KY1 1NX PLM 138 St Clair Street, Kirkcaldy KY1 2BX Optical Express 137 High Street, Kirkcaldy KY1 1JD Specsavers Opticians 201 High Street, Kirkcaldy KY1 1JD D T Hay 56 High Street, Leven KY8 4NA McLeish, McPhee & Laing Shorehead, Leven KY8 4NR PLM 44 North Street, Leven KY8 4LY Specsavers Opticians 68 High Street, Leven KY8 4NA Optical Express 26 High Street, Leven KY8 4LX Carrick Opticians 19 Bank Street, Lochgelly KY5 9QQ McLeish, McPhee & Laing 285 Wellesley Road, Methil KY8 3BN Ferrier & MacKinnon 3-5 Cupar Road, Newport on Tay DD6 8AF I Sight 7 Station Road, Oakley KY12 9QF The Eye Centre 10 Aberlour Road, Rosyth KY11 2RD Boots Opticians 9 Bell Street, St Andrews KY16 9UR Govan Opticians 83 South Street, St Andrews KY16 9QW Duncan & Todd Optometrists 147 Market Street, St Andrews KY16 9PF Specsavers Opticians 169 South Street, St Andrews KY16 9EE Govan Opticians 6a Shore Street, Anstruther KY10 3EA PLM 20 Rodger Street, Anstruther KY10 3DU 125

126 Name Pharmacy Address Town Postcode M Jackson 30 High Street Aberdour KY3 0SW The Central Pharmacy Ltd 23 Rodger Street Anstruther KY10 3DU T&K Brown Ltd Shore Street Anstruther KY10 3AQ Rowlands Pharmacy 42 High Street Auchtermuchty KY14 7AP Rosewell Pharmacy 12 Benarty Square Ballingry KY5 8NR Your Local Boots Pharmacy Merlin Crescent Buckhaven KY8 1HJ Lloyds Pharmacy 239 High Street Burntisland KY3 9AQ B Johnston 191 Station Road Cardenden KY5 0BN Your Local Boots Pharmacy 187 Station Road Cardenden KY5 0BN Charlestown Pharmacy Ltd Charlestown Medical Practice Charlestown KY11 3ED Gordons Chemists 20 Broad Street Cowdenbeath KY4 8HY Boots the Chemist Ltd High Street Cowdenbeath KY4 9QW Wm Morrison Pharmacy 1-2 Raith Centre Cowdenbeath KY4 8PB Crail Pharmacy Ltd High Street Crail KY10 3TE The Co-operative Pharmacy 92 Main Street Crossgates KY4 8DF Rowlands Pharmacy Bonnygate Cupar KY15 4BY Lloyds Pharmacy 19 Crossgate Cupar KY15 5HA Boots the Chemist Ltd 2-6 St Catherine Street Cupar KY15 4BT Rowlands Pharmacy 12 Bay Centre, Regents Way Dalgety Bay KY11 9YD The Co-operative Pharmacy Douglas Street Dunfermline KY12 7EB The Co-operative Pharmacy 3 Abbeyview Dunfermline KY11 4HA Boots the Chemist Ltd High Street Dunfermline KY12 7DL JBB Dick Ltd 28 East Port Dunfermline KY12 7JB Lloyds Pharmacy 43 Bellyeoman Road Dunfermline KY12 0AE The Co-operative Pharmacy St Andrews Street Dunfermline KY11 4QG Asda Pharmacy Ltd Halbeath Retail Park Dunfermline KY11 4LP The Co-operative Pharmacy Elliot Street Dunfermline KY11 4TF Lloyds Pharmacy Unit 6, Block 1, Turnstone Road Dunfermline KY11 8JZ Alderston Pharmacy 6 Alderston Drive Dunfermline KY12 0XU Fisher Pharmacy (Dunfermline) Ltd 85 Woodmill Street Dunfermline KY11 4JN Dysart Pharmacy Unit 21, High Street Dysart KY1 2UG Elie Pharmacy 42 High Street Elie KY9 1DB Lomond Pharmacy The Cross, High Street Falkland KY15 7BU Lloyds Pharmacy 2 Glenwood Centre Glenrothes KY6 1PA JCW McIntyre 8 Cadham Centre Glenrothes KY7 6RU Your Local Boots Pharmacy Cos Lane, Woodside Road Glenrothes KY7 4AQ Superdrug Pharmacy 10 Falkland Gate Glenrothes KY7 5NS Dears Pharmacy 3 Glamis Centre Glenrothes KY7 4RH Boots the Chemist Ltd 14 Lyon Square Glenrothes KY7 5NR High Valleyfield Pharmacy Ltd Chapel Street High Valleyfield KY12 8SJ Lindsay & Gilmour 51 High Street Inverkeithing KY11 1NL The Cross Pharmacy, 8 High Street Inverkeithing KY11 1NN Lindsay & Gilmour The Co-operative Pharmacy 39 Main Street Kelty KY4 0AA Dears Pharmacy 60 Main Street Kelty KY4 0AE Lloyds Pharmacy 19 Bishops Court Kennoway KY8 5LA The Co-operative Pharmacy 31 High Street Kincardine FK10 4RJ Lloyds Pharmacy 63 High Street Kinghorn KY3 9UW Lomond Pharmacy 50 Main Street Kinglassie KY5 0XA Boots the Chemist Ltd High Street Kirkcaldy KY1 1NQ 126

127 Name Pharmacy Address Town Postcode Lloyds Pharmacy 18 High Street Kirkcaldy KY1 1LU Lloyds Pharmacy 1 The Postings Kirkcaldy KY1 1HN Lloyds Pharmacy 28 Mid Street Kirkcaldy KY1 2PN St Clair Pharmacy 233 St Clair Street Kirkcaldy KY1 2BY Asda Pharmacy Ltd Asda Superstore, Carberry Road Kirkcaldy KY1 3NG Boots the Chemist Ltd Unit 11, Fife Retail Park, Chapel Level Kirkcaldy KY2 6QL Lloyds Pharmacy 222 Dunearn Drive Kirkcaldy KY2 6LE Lloyds Pharmacy 2 Viceroy Street Kirkcaldy KY2 5HT W Davidson & Sons Ltd 30 Commercial Road Ladybank KY15 7JS Lloyds Pharmacy Anderson Drive Leslie KY6 3LQ Leuchars Pharmacy 14 Main Street Leuchars KY16 0HN Boots the Chemist Ltd 47 High Street Leven KY8 4NE T W Buchanan (Chemists) Ltd 30 Commercial Road Leven KY8 4LD Leven Pharmacy Commercial Road Leven KY8 4LD Rosewell Pharmacy Ltd 4 Bank Street Lochgelly KY5 9QQ The Co-operative Pharmacy 66 Bank Street Lochgelly KY5 9QN Rosewell Pharmacy Ltd 60 Lochleven Road Lochore KY5 8DA Lundin Links Pharmacy Ltd 2 Emsdorf Street Lundin Links KY8 6AB Markinch Pharmacy Ltd 53 High Street Markinch KY7 6DQ The Co-operative Pharmacy 303 Wellesley Road Methil KY8 3BS C Buchanan Ltd 345 Methilhaven Road Methil KY8 3HR W Davidson & Sons Ltd 40 High Street Newburgh KY14 6AQ Rowlands Pharmacy 16 Victoria Street Newport on Tay DD6 8DJ Oakley Pharmacy Ltd 14 Wardlaw Way Oakley KY12 9QH Pittenweem Pharmacy 7 Market Place Pittenweem KY10 2PH The Co-operative Pharmacy Castlandhill Road Rosyth KY11 2PZ 6 Queens Buildings, Queensferry Rowlands Pharmacy Road Rosyth KY11 2RA Wm Morrison Pharmacy 45 Largo Road St Andrews KY16 8PJ Boots the Chemist Ltd Market Street St Andrews KY16 9PE Rowlands Pharmacy 32 Castle Street Tayport DD6 9AF W Davidson & Sons Ltd 76 Main Street Thornton KY1 4AG Your Local Boots Pharmacy Ajax Way Methil KY8 3RD M Jackson 31 High Street Aberdour KY3 0SW The Central Pharmacy Ltd 24 Rodger Street Anstruther KY10 3DU T&K Brown Ltd Shore Street Anstruther KY10 3AQ Rowlands Pharmacy 43 High Street Auchtermuchty KY14 7AP 127

128 Name NHS Premises Address Postcode Abbeyview Clinic Abbeyview, Dunfermline KY11 4HA Adamson Dental Centre Bank Street, Cupar KY15 4LG Adamson Hospital Bank Street, Cupar KY15 4JG Barrie Street Clinic Barrie Street, Methil KY8 3BU Bennochy Medical Centre 65 Bennochy Road, Kirkcaldy KY2 5RB Cameron Hospital Cameron Bridge, Windygates KY8 5RR Cardenden Health Centre Wallsgreen Road, Cardenden, Lochgelly KY5 0JE Carnegie Clinic Inglis Street, Dunfermline KY12 7AX Castlehill Clinic Castlehill, Cupar KY15 4AH Cowdenbeath Dental Centre off Stenhouse Street, Cowdenbeath KY4 9DG Cowdenbeath Clinic 80 Rowan Terrace, Cowdenbeath KY4 9JQ Cupar Health Centre Bank Street, Cupar KY15 4JN Dalgety Bay Health Centre Regents Way, Dalgety Bay KY11 9UY Dovecot Clinic 2 Russell Drive, Glenrothes KY7 5JJ Fair Isle Road Clinic Fair Isle Road, Kirkcaldy KY2 6EE Fife College of Health University of Dundee, Fife Campus, Forth Avenue, Kirkcaldy KY2 5YS Finance Offices Evans Business Centre, Mitchelston Drive, Mitchelston, Kirkcaldy KY1 3NB Forth Park 30 Bennochy Road, Kirkcaldy KY2 5RA Forth Child Development Centre Carleton Nursery Building, Bighty Road, Glenrothes KY7 5AS GH&MS Project Office Forbo Nairn Offices, c/o Victoria Hospital, Hayfield Road, Kirkcaldy KY2 5AH Glenrothes Hospital 1 Lodge Rise, Glenrothes KY7 5QT Glenwood Dental Unit Napier Road, Glenrothes KY6 1HL Glenwood Health Centre Napier Road, Glenrothes KY6 1HL Gordon Cottage (Day Centre) 118 Cocklaw Street, Kelty KY4 0DJ Haldane House Assessment Unit 71 Priory Lane, Dunfermline KY12 7DT Kelty Health Centre 80 Main Street, Kelty KY4 0AE Kennoway Health Centre Jordan Lane, Kennoway KY8 5JZ Kincardine Health Centre 19 Kilbagie Street, Kincardine FK10 4QX Kinghorn Health Centre Rossland Place, Kinghorn KY3 9RT Kinglassie Clinic 32 Main Street, Kinglassie KY5 0XA Kirkcaldy Health Centre Whyteman s Brae, Kirkcaldy KY1 2NA Kirkland Dental Unit Methil Brae, Leven KY8 2EX Ladybank Clinic Commercial Road, Ladybank KY15 7JS Leslie Dental Centre Anderson Drive, Leslie KY6 3LG Leven Child Assessment Unit Victoria Road, Leven KY8 4EU Leven Health Centre Victoria Road, Leven KY8 4ET Linburn Dental Centre 124 Nith Street, Dunfermline KY11 4LT Linburn Road Health Centre 124 Nith Street, Dunfermline KY11 4LT Lochgelly Health Centre David Street, Lochgelly KY5 9QZ Lynebank Hospital Halbeath Road, Dunfermline KY11 4UW Masterton Health Centre 74 Somerville Street, Burntisland KY3 9DF Netherlea Hospital 65 West Road, Newport-on-Tay DD6 8HR Oakley Health Centre Wardlaw Way, Oakley KY12 9QH OHSAS Navy House, Stuart Road, Rosyth Dockyard, Rosyth KY11 2BJ Pitteuchar Health Centre Glamis Centre, Glenrothes KY7 4RH 128

129 Name NHS Premises Address Postcode Queen Margaret Hospital Whitefield Road, Dunfermline KY12 0SU Randolph Wemyss Memorial Hospital Wellesley Road, Buckhaven KY8 1HU Rosewell Clinic Ballingry Road, Lochore KY5 8ET Rosyth Health Centre Park Road, Rosyth KY11 2SE Skeith Health Centre Crail Road, Cellardyke, Anstruther KY10 3FF St Andrews Health Centre 68 Pipeland Road, St Andrews KY16 8JZ St Andrews Community Hospital Largo Road, St Andrews KY16 8AR St Andrews Memorial Hospital Abbey Walk, St Andrews KY16 9LG Stratheden Hospital Springfield, nr Cupar KY15 5RR Supplies Service/Transport Dept Unit 7, Midfield Road, Mitchelston Industrial Estate, Kirkcaldy KY1 3NL Thornton Clinic 7-11 Strathore Road, Thornton KY1 4DU Townhill Day Hospital Muir Road, Dunfermline KY12 0EG Valleyfield Health Centre Chapel Street, High Valleyfield KY12 8SJ Victoria Hospital Hayfield Road, Kirkcaldy KY2 5AH Weston Day Hospital West Port, Cupar KY15 4AN Whyteman s Brae Hospital Whyteman s Brae, Kirkcaldy KY1 2ND Houses: 34/36 Hazel Avenue, Kirkcaldy KY2 5EB 24 Back Lebanon, Cupar on Adamson site KY15 4JW Hayfield Clinic KY2 5AD Matthew Street Residences KY2 5AT 4-6 Stratheden Court, Stratheden Hospital KY15 5SP 76 Fraser Avenue, Inverkeithing KY11 1EH 129