Asset Management Plan - NHS Grampian · staff responsible for modernisation, service delivery,...

Asset Management Plan

2016 to 2026

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

Status

Version16.3

June 2016

02/06/16 Approved

Author G Legge

Reviewed G Donald

Sponsor A Gray

NHS Scotland ’20:20 Vision’

Our vision is that by 2020 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. 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.

The Asset Management Plan is also available in large print and other formats and languages, upon request.

Please call NHS Grampian Corporate Communications on (01224) 551116 or (01224) 552245.

Contents

Contents Page

Executive Summary 1

Introduction 4

Where are we now? 7

o Progress over the last year

o Property – Condition and Performance

o Medical Equipment - Condition and Performance

o Facilities and Support Services – Condition and

Performance

o ICT Equipment – Condition and Performance

Where do we want to be? 37

o Challenges that will influence our plan

o Partnership Working

o Healthfit Vision – Clinical Service Strategy

o Strategic benefits and investments that are

necessary

How do we get there? 70

o Our investment plan for the next 5 years

o Our investment priorities for years 5 to 10

Implementation Plan 85

o How we will implement the plan

o Governance

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

Glossary

Executive Summary

Context

Changes are taking place both within Grampian and across the

country to make sure that NHSScotland is in the best possible

shape to meet future health needs and improve people’s well-

being. There are a number of national and local policies and

initiatives aimed at making NHSScotland more effective and

efficient such as Better Health, Better Care: Action Plan, the

NHSS Quality Strategy, the Efficiency and Productivity

Framework and “Achieving Sustainable Quality in Scotland’s

Healthcare” – A 20:20 Vision and the emerging NHS Scotland

Clinical Strategy.

The developing strategy for NHS Grampian is built around four

healthcare delivery themes; Prevention; Self-Management of

long term Conditions; Planned Routine and Urgent care in the

right Place and Time; Unscheduled care in the Right Place and

Time.

We have continued to develop a system for monitoring and

prioritising all current and future capital and revenue projects

through the SCIM process. This has been achieved through the

development of Strategic Assessments and the use of the

Capital Planning System. All future planned investments will be

directly linked to the NHS Grampian Clinical Strategy

Investing in our infrastructure

NHS Grampian covers a geographic area of over 8,700 sq.km.,

and provides services to a population of over 584,000 from 26

hospitals, 27 health centres 22 clinics and 5 separate dental

units along with 2 hub procured health centres and the health

Village with a net book value of £453m. There are also over

20,000 individual items of medical equipment, ICT, vehicles and

other equipment with a net book value of over £50m.

We have a current backlog of £138m which is the second

highest of the 22 Health Boards in Scotland and an annual

capital allocation of £12.71m.

Progress in the last 12 months

In the previous 12 months we have:

Through the use of our capital allocation, asset sales receipts

and endowment funds we have continued with the backlog

investment programme focused on reducing High and Very

High Risk in clinical areas, particularly at Aberdeen Royal

Infirmary. Since 2012, we have reduced backlog maintenance

by £55m equating to a 28% reduction from the £193m base

point.

Invested £7.7m in new medical equipment, including a Robot

for Theatres and Endoscopy equipment for the Health Village.

Both these investments have brought significant clinical

benefit to our patients.

Through an extremely charitable donation from the Wood

Group Foundation we have been able to plan for a multi-

storey car park on the Foresterhill campus for exclusive use

by patients and visitors. It will provide a net additional 1000

spaces and will be adjacent to the front door of ARI Phase1.

Through investment in IT infrastructure Windows 7 rollout

and replacement of older PCs was completed. Storage and

networking capacity and further development of core patient

management applications was progressed in preparation of

the move to an Electronic Patient Record System EPR).

Confirmed five year investment programme

Looking forward our five year investment programme will

continue to be focused on

Commissioning of new health facilities including the Baird

Family Hospital and ANCHOR Centre, the Inverurie Health

Centre and Community Midwife Unit, replacement

Foresterhill Health Centre and a new Denburn Health

Centre, the latter supported significantly by the use of

developer contributions.

Progressing with the development of a new Diagnostic and

Treatment Centre on the Foresterhill site after the

announcement of Scottish Government funding of £40m and

a £19m capitalised value for Health Centre investment in the

North of Aberdeen City using the hubCo model.

Continuing with our backlog maintenance programme,

medical equipment replacement and ICT investment.

To support this significant programme of investment, the Board

agreed to set aside revenue funding over the next three years to

ensure the programme is suitably resourced.

Priorities for further investment

Whilst acknowledging the announcements around the

Diagnostic Centre and primary care investment, the Board is

facing an immediate and significant challenge in relation to the

following key areas:

Medical Equipment

At present there are 1,572 assets fully written down with a

replacement cost of £44m. Based on our forecast projections,

and taking account of future investment, it is likely that the

replacement cost of fully written down medical equipment in use

will increase to over £100m by 2026. Within the context of our

10 year plan, we are developing a detailed equipment

replacement strategy informed by a comprehensive assessment

of risk.

Whilst equipment can be used and maintained beyond the

depreciated life, a planned replacement medical equipment

programme cannot be adequately sustained within the

Board’s current level of capital allocation, particularly given

the corresponding requirements to address statutory and

backlog maintenance. We have committed £3m in 2016/17, £3m

in 2017/18 rising to £6m in each of the following three years for

essential equipment replacement. This will however not enable

replacement of medical and ICT equipment at the rate required

to reduce the risk to an acceptable level.

Community and Primary Care Premises

Based on the Local Development Plans for Aberdeen City,

Aberdeenshire and Moray the number of new housing units is

anticipated to increase by over 40,000 by 2023, with the

potential for an increase in patient population of between 80,000

and 100,000.

Our GP premises strategy identified a need for investment in

additional infrastructure in excess of £100m to meet the

demands that these new and emerging communities will place

on our primary and community based services. We will be

submitting further strategic cases for revenue funding

through the hub model and continue to advocate for

Developer Contributions where appropriate to support

proportionate development needs.

Acute Sector Infrastructure

Together with an ageing estate, and a growth in demand for

services, this 10 year asset plan has identified the need for

priority investment in a number of key areas within our acute

sector infrastructure – MRI capacity; laboratory and medical

equipment accommodation; replacement laundry and CDU

facility; and new mortuary accommodation. Furthermore the

full replacement of the theatre block and remaining inpatient

capacity requires to be addressed within 15 years. The

backlog programme provides capability to extend life of the

estate, but investment in this area without new replacement

buildings in itself is not sufficient.

We welcome and recognise the support and close working

relationships we have with colleagues in the Scottish

Government, Scottish Futures Trust (SFT) and Health Facilities

Scotland (HFS).

We will continue to develop our Asset Management Plan and

supporting strategic assessments to support cases for further

capital funding in line with the priorities set out in our Clinical

Strategy.

In addition agreement to undertake further rationalisation will be

essential to ensure sustainability, whilst allowing NHS Grampian

to support the population in Grampian through our principles of

“Caring, Listening and Improving”; achieving the NHS Grampian

Healthfit Vision and developing Clinical Services Strategy; and

that of the National 2020 Vision.

Introduction

The 2016/17 Asset Management Plan reflects our “Healthfit

Vision” and is very much informed by our developing Clinical

Services Strategy. It is entirely consistant with Chief Executive

Letter CEL35(2010): setting out our future investment priorities

and our financial planning assumptions, along with how

performance, management and utilisation of the Boards entire

asset base will be monitored.

The AMP is reveiwed annually and is one of a coherent suite of

supporting and enabling plans demonstrating how NHS

Grampian will successfully deliver Scotland’s health policies. It

covers all assets, and includes vehicles, equipment, information

and communication technology and property.

Aims of the Asset Management Plan

The aims of this Asset Management Plan are to support the

requirements of the National 20:20 Vision and the world leading

desires of the Healthcare Quality Strategy for NHSScotland. It

will also support the delivery of the developing NHS Grampian

Clinical Strategy, as described within the Healthfit Vision – NHS

Grampian’s strategy for future delivery of healthcare services in

Grampian. It will also:

Demonstrate the appropriate governance and management

structure to effectively manage the Boards assets.

Identify all the issues that are driving the need for change

and ensure all assets are used in such a way as to support

the existing and future requirements of the service and the

change required.

Manage all assets within NHS Grampian, by maintaining,

enhancing, replacing or disposing of; ensuring the plan

takes us towards the national ambitions of care which is

person centred, safe and effective.

Provide/maintain an appropriate number of quality

affordable assets complementing and supporting the high

quality services which meet the population needs and are

financially sustainable over the long term.

Address backlog maintenance and essential equipment

replacement where there is a high, significant or moderate

risk likely to impact on the Board’s ability to deliver current

and future services.

The Plan covers the period 2016 to 2026, with detailed

investment proposals covering the next five financial years,

considering a range of scenarios and sensitivity analysis

building in flexibility and agility into our longer term plans

covering the 5 to 10 year period and beyond.

Developing the Plan

The Plan involves wide consultation with many key members of

staff responsible for modernisation, service delivery, finance,

facilities, medical staff and asset management as well as our

many stakeholders including Aberdeen University. The Plan is

led by the Head of Property and Asset Management and his

team but involves information, direction and management from

the Board and Senior Management to ensure it reflects the

requirements of the NHSScotland 20:20 Vision and NHS

Grampians developing Clinical Strategy which underpins our

“Healthfit vision”.

This year NHS Grampian has been developing a Clinical

Strategy to underpin our Healthfit Vision and meet the needs of

the population of Grampian and the North of Scotland. We have

continued to develop a system for monitoring and prioritising all

current and future capital and revenue projects through the

SCIM process. This has been achieved through the

development of Strategic Assessments and the use of the

Capital Planning System. By developing Strategic Assessments

through a workshop process with Stakeholder and Public

representation we are ensuring that our development plans are

open and transparent and outline the need for change, describe

early thoughts on any potential investment proposal and allow a

methodology of prioritising all projects against the NHS

Grampian Clinical Strategy and the national 2020 vision.

The development of the AMP also encompasses ongoing

dialogue with the three Local Authorities in developing the

Structure Plan and Local Development Plans: the principle of

securing Developer Contributions under Section 75 of the Town

and County Planning (Scotland) Act 1997, as amended by the

Planning etc. (Scotland) Act 2006 : and continued discussions in

the provision of joint projects.

The Plan was approved by the Asset Management Group

(AMG) prior to recommendation for approval at the full public

board meeting held in June 2016.

Commitment to the Plan

NHS Grampian prioritises available capital and revenue funding

including proceeds from the ambitious asset disposal

programme to carry out the day to day activities required of us,

to enhance our asset base and improve the healthcare

environment ensuring it is safe, effective and responsive to their

needs.

The following pages evidence where we are now with regard to

our asset base, identifies the issues driving the need for change

and explains the investment that has occurred in the last year

since the previous AMP. It also describes new investment

bringing forward major projects, including the Baird family

Hospital and Anchor Unit on the Foresterhill site, and funding for

General Practices in existing and emerging communities. It also

demonstrates the move of activity to community settings;

partnership working with Local Authorities including the impact

of the new Integration Joint Boards (IJB’s); the importance of the

Voluntary Sector; and the importance that technology has for a

Board covering a large rural area.

Thereafter, it describes where we want to be and how the

Board’s assets contribute towards achieving our strategic

outcomes, influencing discussions, affordability, patient care and

the ongoing modernisation agenda. This will range from

developing home and community based solutions with a

consequential impact on inpatient hospital care, and how

technology assists in delivering the outcomes described in the

Grampian Clinical Strategy.

We also consider NHS Grampians prioritised investment needs

against available finance and how the retained asset base can

best be used to improve the Board’s performance, reduce

backlog maintenance, and positively contribute to the health of

the people in Grampian.

Finally, we describe how NHS Grampian, will implement this

plan within the funding available to it and demonstrate how all

available resources will be utilised to meet the programme of

prioritised investment described within this AMP.

Whilst acknowledging the significant funding that has been

made available for major infrastructure investments at Aberdeen

Royal Infirmary and in new Primary Care Premises the existing

and projected core capital formula funding cannot fully

address: property maintenance backlog and statutory

compliance; essential equipment replacement and provide

the required level of resilience and functionality within our

IT networks and supporting infrastructure.

Where are we now?

NHS Grampian’s progress over the last year

In the last 12 months NHS Grampian has been developing an

ambitious Clinical Strategy that underpins our “Healthfit Vision”,

the aim of the strategy is to ensure NHS Grampian continues to

work collaboratively with patients, the public and our partners to

improve health and clinical outcomes for the population of the

north and north east of Scotland. The proposed strategy not

only sets out NHS Grampian's priorities, but also aims to outline

the shared intent of the newly created Health and Social Care

Partnerships (HSCP’s) of which there are three in Grampian and

alignment with the recently published National Clinical Strategy.

This plan underpins that developing strategy through

widespread consultation of all stakeholders and the

development of Strategic Assessments for all proposed areas of

investment. In terms of action taken forward in the last 12

months we would highlight the following:

Provision of high quality specialist acute care

Replacement Maternity Hospital and Cancer Centre -The

Scottish Government have approved the Initial Agreement

for NHS Grampian to commence with the £156m

development (inclusive of VAT and equipment). This will

provide a new hospital which will provide maternity,

gynaecology, breast screening and breast surgery services

to be known as the Baird Family Hospital (item1 on fig1

overleaf) and a new centre to provide out-patient and day-

patient investigation and treatment services for patients with

cancer and blood disorders. The centre will be known as the

ANCHOR Centre and will include pharmacy, research and

teaching facilities (item 2 on fig1).

Multi-storey car park – Foresterhill – NHS Grampian was

exceptionally pleased to have been offered a donation from

the Wood Foundation to design, procure and construct a

multi storey car park on the Foresterhill campus for exclusive

use by patients and visitors. It will provide circa an additional

1000 parking spaces (item4 fig1).

NHS Grampian had the ambition to be the first Board in

Scotland to implement robotic surgery focusing initially on

Urology – Radical Prostatectomy. Robotic surgery has been

utilised in many health organisations globally to improve

outcomes for patients as well as long term financial benefits

to service providers.

Aberdeen Royal Infirmary has become the first hospital in

NHS Scotland to use an O-Arm scanner. This sophisticated

machine generates high-resolution 3D images of patients'

spine, bone and soft tissue structures, improves the speed

and accuracy of operations, removes the need for repeated

X-rays, reduces the extent of incisions, and improves

recovery time.

Therapeutic Roof Garden at Aberdeen Royal Infirmary

opened in January 2016, the green space which was funded

entirely by charitable donations provides a floodlit rooftop

garden primarily for patients to reflect and heal.

Provision of community based health care

The Masterplanning of Inverurie Hospital site including a

new Health Centre has continued to be developed; this will

enhance primary care services in an area of high population

growth. The development will provide a Health Centre,

Community Maternity Unit (CMU) along with a Community

Dental suite, Diagnostic and Treatment suite, X-ray suite

and improved car parking. This will establish a new model of

service, bringing together and integrating a range of health

and social care services to create a “Care Hub”. The design,

specification, business case and local community

consultation have all been progressed in the last year with

the aim of work on site commencing autumn 2016, and

being operational in 2018. This project will be delivered

through the hub Design Build Finance and Maintain (DBFM)

procurement and is bundled with the Foresterhill Health

Centre.

The design and planning of Foresterhill Health Centre has

continued enabling NHS Grampian to free up the site

required for the Baird Family Hospital (item1 fig1). The new

facility will accommodate 2 GP practice’s, speech and

language therapy, podiatry, dietetics, a health and social

care integrated team and a retail pharmacy and will be

located at item3 on fig1

Fig1 Foresterhill Site Development

With the government announcement of £19m to be invested

in general practice premises to the north of Aberdeen City,

the Board has established a Project Board to fully consider

the needs of the communities in the corridors of Bucksburn

and Blackburn; Dyce and Newmachar; and Balmedie and

Ellon

Completion of work at Northfield Medical Centre with the

provision of a new temporary building (planning consent for

up to 5 years) to expand the accommodation allowing the

existing services to continue in the short to medium term.

Currently on site at Cullen Medical Centre carrying out a

refurbishment of the premises which is due for completion in

July 2016.

Sustainability and Carbon Reduction

The Carbon Energy Fund (CEF) contract with Vital

Energi was signed on the 29th December 2015, the

programme includes :- replacement of boiler plant at Dr

Gray’s, provision of a steam & condensate link from the

Energy Centre to the Foresterhill Laundry which will allow

the closure and removal of East End Boilerhouse, provide

energy links from the Energy Centre to Royal Cornhill

Hospital, Dental School, Dental Institute and further

proposed developments, provision of a new Foresterhill

High Voltage (HV) intake substation and improvements to

the existing HV infrastructure, replacement of a large

number of chiller units at ARI and extensive lighting

replacement at RCH and ARI. NHS Grampian will benefit

from a significant reduction in carbon emissions from this

investment as well as improvements to infrastructure

estimated at c £15.m over the 25 year life of the contract.

The project to replace the heating plant at Woodend

Hospital with more efficient gas fired boilers has

progressed. The scheme will reduce operating costs,

reduce carbon emissions and ensure future service

delivery and will become operational in September 2016.

Third party and independent sectors

The new Crimmond Medical Centre, being constructed by

a local benefactor and operated as a charitable trust

commenced on site in 2013 and once complete will allow

the existing medical practice to relocate to a new purpose

built building. This model is attractive to NHS Grampian as it

allows community ownership and provides modern fit for

purpose facilities and space at no additional cost.

Charlie House – NHS Grampian have approved the

proposal to grant a concessionary lease to Grampian

Children’s Respite Care for an area of land within the

Woodend Hospital Site from which they intend to provide a

centre for children’s respite care. The project known as

We need to secure integrated working between

health and social care, and more effective

working with other agencies and with the Third

and Independent Sectors.

NHSScotland ‘20:20’ Vision

Charlie House will provide a home from home environment

where children will be fully cared for in a safe, supportive

and stimulating setting with or without their families.

Addressing backlog and statutory compliance issues

A major backlog programme at Aberdeen Royal Infirmary

has been under way in the East End 2 and Phase 2 blocks

to reduce overall backlog within inpatient areas of the

hospital and the relocation of the Eye Out Patient

Department to Phase 1 at ARI. The East End 2 project was

completed and operational in September 2014. Stage1 of

Phase 2 works was completed in November 2015 with

Stage 2 in progress with a completion date of June 2016.

The programme provides a safer and more appropriate

environment for our patients, staff and visitors, and

continues to reduce our backlog maintenance requirements.

The works have so far completed approx. 50% of the

programmed £15m targeted reduction.

Fire Precaution works – a planned programme of fire

precaution works has continued with projects at:-

o Royal Cornhill Hospital, Corgarff ward

o Woodend Hospital, General Block

o Woodend Hospital, South Block

o ARI, Ward 205

Asbestos – Over £195k of encapsulation, remediation and

removal of asbestos contaminated areas at:-

o Aberdeen Royal Infirmary, Kitchen

o Woodend Hospital, Boilerhouse

o ARI, Laundry

o ARI, Mortuary

Woolmanhill Hospital, Aberdeen - the relocation of the

remaining services of Ear Nose and Throat and pathology

stores will be complete during 2016 allowing NHS Grampian

to progress with the sale of this listed building site which was

built in 1749. It has substantial backlog maintenance and is

no longer suitable for modern health care provision. After

marketing a preferred bidder has been identified.

Investment in essential equipment

Developing systems and process around the Management of

Medical Equipment, including the development of a Global

Medical Equipment Register using the Real Asset Management

system (RAM) to record, plan and monitor Medical equipment

usage has been focused on this year.

A primary element of our investment programme is the

replacement of essential equipment and critical assets. We have

had significant engagement with clinical services this year in

order to assess and prioritise available funding to target at

essential equipment that is critical to continued service delivery

and the acquisition of equipment that enables NHS Grampian to

achieve key organisation goals.

Due to the aging profile of our medical equipment many of the

equipment purchases this year have been due to actual or

imminent critical equipment failure.

During 2015/16 we also committed £2.8m of capital expenditure

on strategic health investments – establishment of the first

robotic and minimally invasive surgery service in Scotland and a

new endoscopy service at Aberdeen Health and Social Care

Village. Both of these developments are having positive

impacts on patient outcomes and access to high quality care.

Equipment purchased this year includes:-

Ophthalmic Biometry Instruments

HD Laparoscope Stack

Renal Chairs

Endoscopic Ultrasound Endoscope

ENT Scopes

Video Laryngoscopes

A Number of Ultrasound Scanners

Patient Monitors

Stacks with Video Bronchoscopes

Lower GI Diagnostic Endoscopic Equipment

CJD equipment

Surgical Drills

Cardiac heater Cooler Units

Nerve monitor

NSD MISEQ

Tourniquets

Atrial Lifts

Ventilator

Colonoscope

Osmometer

Radiology Workstations

Spinal Operating Table

Real time PCR system

Transfer Monitor & Ventilator

Maternity Birthing Beds

Audiology Hearing Aid Calibration

Patient Beds

IT investment supports changes in working practices

Investment in IT infrastructure creates the foundation for a move

towards the NHS Grampian’s Healthfit Vision, by enabling more

services at home or in local communities, including:

The installation of wireless technology within all GP

practices (including the remote rural branch surgeries)

llowing community nursing teams to access the network

(in these premises) where 3G is not yet widely available.

A “Guest” Wi-Fi solution enables members of the public

to access the internet from wireless networks whether

Acute, Community or GP premises. This is greatly

enhancing NHS Grampian’s “No Delays” initiative,

enabling patients to manage their own symptoms and

treatments with bespoke advice and videos.

New IP telephony for all main office accommodation was

completed in 2015, allowing flexibility for staff to work at

any desk and login to their own telephone extension. This

supports our progress towards a “smarter office” initiative

described in the office accommodation section of this

document.

Vision 360 – the procurement of the Vision 360 software

provides general practices and nursing teams with

secure, remote access to patient's clinical data including

medical history, therapy and test results. It allows GP’s

and nursing teams to view, record and edit patient

consultation details whilst away from the practice – e.g.

fig 2.

The rollout of Windows 7 operating system to all NHS

Grampian PC’s including the purchase of 1700 new PC’s

to replace outdated machines concluded in March 2016.

Fig 2. Visual representation of Vision 360

Wardview - The purchase of the Wardview software

application provides a presentation display of the

TrakCare and other clinical systems to provide a co-

ordinated view of a wards current patient status (length of

stay, current medical alerts, status of referrals, consultant

etc.) which improves bed management, ward efficiency,

patient safety and ultimately reduces average length of

stay.

Careview – Care View enables the service to receive and

discharge patient admissions by utilising the virtual ward

facility in TrakCare 2014. The patient’s home becomes a

“bed” in a virtual ward thus ensuring the same focus of

care while reducing hospital admissions and relieving

pressure on beds. This is currently being installed in a

number of community locations. Screenshots are shown

in figs 3 and 4.

Fig 3. Sample screen shot of the Care View

Fig 4. Care View geographical map view

Purchase of Cisco Guest allows Consultant, GP or

Nursing consultations via secure Video conferencing to

an IPad, laptop or PC at home. This innovative approach

is being trialled by the diabetes service.

Investment in IT local and wide area networks (LAN,

WAN) and increased central data storage and backup

facilities.

NHS Grampian Endowment Fund

The Endowment Fund is a registered charity and operates in

compliance with charity legislation. The fund (over 1,000

separate funds individually restricted for a particular use) is

made up of money donated by patients and their families, or

from legacies, and interest received on the investment of the

Fund. The aims of the Fund are:

Improvement of the physical and mental health of the

Grampian Health Board’s population and our staff;

Prevention, diagnosis and treatment of illness;

Provision of services and facilities in connection to the

above; and

Research into any matters relating to the causation,

prevention, diagnosis or treatment of illness, or any other

matters relating to the health services, as the Trustees

see fit.

Applications are considered against the following criteria

The scheme is in line with NHS Grampian’s Healthfit

vision

The scheme is in line with the charitable purposes of the

fund

The endowment funded elements do not substitute core

NHS provision

There is demonstrable benefit to patients or the wider

population

NHS Grampian acknowledge the continued support of donors

and community fund-raising which will enable the establishment

of a multi-storey car park, an additional MRI scanner at

Woodend Hospital and a new renal dialysis facility in

Stonehaven. Provision has been made within the financial plan

for the revenue running costs of these new facilities which will

deliver improved access to key services for patients.

Some of the other major investments aproved in the last year include the following:

Key Worker Accommodation – an investment of £1.7m to purchase a two-storey apartment block in Maybaird Avenue, comprising six two-bedroom and nine one-bedroom units for key worker accommodation.

Peterhead Community Maternity Unit - funding for the refurbishment and reconfiguration of the Maternity Unit at Peterhead Community Hospital.

Sandpiper Trust - Wildcat Project – project to create a

network of trained Cardiac Responders across the north-east

of Scotland. Based at 50 locations around the region, they’ll

be primed to deliver swift, on-the-spot medical care to people

who have suffered cardiac arrest.

Mortuary – an investment of £299k for a scheme to add an extension to the mortuary which will improve the accommodation for visitors including facilities for the viewing and identification of a body, a waiting room and appropriate toilets.

Stephen Hospital – £60k for aesthetic improvements including flooring and decoration.

Disinvestment and sales

Progress has continued with the ambitious disinvestment

programme providing much needed additional funding to

support our investment needs, consistent with NHS Grampian’s

Clinical Service Strategy and Healthfit vision with the sale of :-

Former Ross Clinic

Former Forres Health Centre

Upper and Lower Royal Cornhill Hospitals

The affordability of our planned works at ARI Phase 2 is

dependent upon delivery of the asset disposal programme. To

assist in mitigating the risks associated with the uncertainty of

timing of asset disposals the programme is being delivered in 3

distinct stages with Board approval requested prior to the

commencement of each stage; this ensures each stage of the

programme is affordable.

The disposal programme requires to deliver net proceeds of

circa £16m over the next 3 years, which with Scottish

Government agreement will be re-invested in the planned

backlog maintenance programme. The disposal programme and

delivery of the required actions is monitored by the Board’s,

Asset Management Group (AMG). Major advances have also

made with a number of sales expected to be concluded within 3

years, subject to planning constraints and include:

431 North Deeside Road

The Former Maud Hospital

Bilbohall (the Firs), Elgin

Site at Westburn Road, Aberdeen

Land Registration: The Scottish Ministers require the transfer

from the Sasine Register to the Land Register for all Health

Boards to be complete by 31st May 2019. Work is ongoing to

meet this requirement.

Property – Condition and Performance

Condition and performance of the property portfolio follows the

format of Health Facilities Scotland guidance “A risk based

methodology for Property Appraisal”. The emphasis is on

providing a consistent approach assessing condition and

performance of properties within NHSScotland.

NHS Grampian owns and manages a large property portfolio on

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

estate, 75% (by floor area) is hospital based accommodation.

This percentage has decreased from previous years with the

demolition of older hospital buildings (RCH and Raeden) and

the building of new health and care centres at Forres and

Woodside, and the purchase of premises at Inverurie Road,

Bucksburn and Cullen Medical Centre.

A detailed analysis of the results of the appraisal of condition

and performance of the Board’s estate is provided in Appendix

C and the key summarised messages are as follows:

The six facet appraisal of the property portfolio produced results

which were not unexpected for such a large and complex estate:

66% of properties are physically satisfactory, 72% are

functionally suitable, and 91% of space is fully utilised whereas

only 2% is overcrowded. The analysis of six facets and the

condition and performance of our properties are included in the

following table 1:

Table 1

The areas identified as “Not Used” by NHS Grampian are currently awaiting

disposal. ↑- increase on previous year, ↓- decrease on previous year

The table shows a significant improvement in the condition,

functional suitability and quality of our property portfolio over the

previous years. This is due to the significant investment NHS

Grampian has made to improve the physical environment

(including the disinvestment in poor buildings).

Like most health boards, NHS Grampian’s ability to reduce the

level of outstanding backlog maintenance is very challenging

given existing capital formula allocation.

Very

Satisfactory Satisfactory

Not

Satisfactory

Very

Unsatisfactory

A B C D

Physical Condition 12% ↑ 54% ↑↑ 29% ↓↓ 5% ←

Functional Suitability 19% ↑ 53% ↑ 16% ↓ 12% ↓

Quality 19% ↑ 55% ↑ 14% ← 12% ↓

Average SCART

Score

Average Energy

Consumption PI

Category Not Used Under Used Fully Used Overcrowded

E U F O

Space Utilisation 5% ↓ 1% ← 91% ↑ 2% ↑

Facet

Analysis of Property Performance

59.79

75 GJ/m3

The Current Backlog at April 2016 is shown in table 2 below:

Table 2

This demonstrates an overall backlog improvement of £37.4m

from the 2012 baseline of £193.4m, but more significantly it

shows a reduction in high or very high risk backlog of £35.8m

against our 80% targeted reduction of £61m. We will continue

with our programme of targeted expenditure initiatives, asset

disposals and site rationalisation to meet this target.

If we were however to remove the backlog associated with our

surplus properties that are programmed for disposal including

demolitions then the Backlog profile would be represented in

table 3 below.

Table 3

These figures provide a more realistic representation of our

Backlog profile due to the fact that we would not be investing in

buildings that are to be demolished or sold in the near future.

However we should still not become complacent by the progress

ElementLow Medium High V.High Total

Physical Condition

External Works & Grounds 5,054,768 212,184 264,760 0 5,531,712

Structure 721,788 202,835 1,205,039 6,780,000 8,909,661

External Fabric 11,574,427 1,688,892 729,185 0 13,992,504

Roofs 2,032,085 2,392,799 1,509,938 0 5,934,822

Drainage 4,754,758 303,554 1,365,151 0 6,423,463

Internal Fabric 9,092,109 1,015,072 2,423,350 0 12,530,531

Internal Fixtures & Fitttings 2,461,422 677,925 18,450 0 3,157,796

Hot & Cold Water Systems 2,555,642 863,967 36,050 0 3,455,659

Electrical Installation 5,539,732 3,326,055 3,724,208 1,367,300 13,957,295

Comms - telephone & paging 163,500 249,483 0 0 412,983

Comms - Alarm/Safety 281,203 593,986 270,989 0 1,146,178

Heating Systems 2,637,328 2,061,437 1,691,475 0 6,390,239

Steam systems 6,905,515 329,460 574,020 0 7,808,995

Ventilation & Conditioning 1,697,999 12,745,954 5,178,220 306,000 19,928,172

Piped Medical Gases 2,997,015 481,889 181,930 0 3,660,834

Lifts 163,850 1,247,780 547,260 0 1,958,890

Boilers and Calorifiers 177,975 1,513,240 2,095,020 0 3,786,235

Fixed Plant & Equip 3,113,453 565,396 0 0 3,678,849

Fuel Storage and Distribution 5,680,007 77,148 21,470 0 5,778,625

Energy Conservation 1,260,635 844,174 316,400 0 2,421,209

Physical Condition Total 68,865,209 31,393,227 22,152,914 8,453,300 130,864,650

Statutory Standards

Safe Hot Water Temp 291,451 1,286,712 1,879,364 96,050 3,553,577

Legionella 839,203 511,374 378,830 500 1,729,907

Asbestos 552,331 4,093,051 367,050 361,600 5,374,032

Firecode 2,516,220 1,517,997 3,640,083 2,511,838 10,186,136

Health & Safety 1,312,947 195,264 173,399 365,698 2,047,308

Disabled Access 1,657,014 613,330 5,650 0 2,275,994

Waste Collection 509 0 0 0 509

Statutory Standards Total 7,169,674 8,217,727 6,444,375 3,335,686 25,167,461

Total Backlog 76,034,882 39,610,954 28,597,290 11,788,986 156,032,111

NHSG Backlog Register 1st April 2016

Element Low Medium High V.High Total

Physical Condition

External Works & Grounds 5,264,074 215,816 279,057 0 5,758,947

Structure 683,645 151,717 1,265,347 0 2,100,709

External Fabric 10,829,591 1,532,048 697,100 0 13,058,738

Roofs 1,897,042 1,656,344 1,591,474 0 5,144,860

Drainage 5,004,697 246,772 1,097,487 0 6,348,955

Internal Fabric 7,553,175 1,024,627 350,711 0 8,928,513

Internal Fixtures & Fitttings 2,392,719 555,018 996 0 2,948,734

Hot & Cold Water Systems 2,676,682 834,506 11,794 0 3,522,982

Electrical Installation 5,784,172 3,115,367 3,676,244 1,441,134 14,016,917


Comms - Alarm/Safety 265,421 603,737 109,572 0 978,730

Heating Systems 2,636,591 2,016,188 1,679,026 0 6,331,806

Steam systems 7,278,413 336,516 598,237 0 8,213,166

Ventilation & Conditioning 1,736,589 13,413,140 3,582,844 322,524 19,055,097

Piped Medical Gases 3,158,258 493,619 191,754 0 3,843,631

Lifts 95,282 765,200 131,252 0 991,734

Boilers and Calorifiers 186,395 1,216,075 230,651 0 1,633,120

Fixed Plant & Equip 3,269,669 550,117 0 0 3,819,786

Fuel Storage and Distribution 5,969,778 69,449 22,629 0 6,061,856

Energy Conservation 1,265,347 860,013 333,486 0 2,458,846


Statutory Standards

Safe Hot Water Temp 244,155 1,249,644 1,906,622 77,416 3,477,837

Legionella 873,605 499,953 399,287 0 1,772,845

Asbestos 581,931 3,467,230 36,871 12,204 4,098,236

Firecode 2,083,018 1,502,736 2,885,683 2,562,422 9,033,859

Health & Safety 1,377,891 203,318 180,380 294,946 2,056,534

Disabled Access 1,510,195 635,791 5,955 0 2,151,941


Statutory Standards Total 6,671,331 7,558,672 5,414,797 2,946,988 22,591,788

Total Backlog 74,775,151 37,311,339 21,264,459 4,710,646 138,061,595

NHSG Backlog Register 1st April 2016 with surplus property removed

made so far as other backlog elements of low and medium risk

potentially progress to become high and very high risks in

coming years.

There remains an obvious disparity between the costs of

reducing backlog maintenance and the level of available

funding. Quite simply time and cost factors are outpacing

availability of resources to invest.

Focus of investment - property

The proposed investment programme for the next five years

reflects the commitment within NHS Grampian to address our

backlog maintenance requirement by prioritising available

capital and revenue funding together with asset disposal

proceeds. Specific objectives that we aim to deliver include:

Improvements in functional suitability of the estate which are

measured through on-going re-assessment of the functional

suitability facet as well as annual review of the AMP to

ensure that accommodation meets the operational and

service needs of the organisation.

Improvements in the quality of the operational estate which

are measured through reductions in backlog maintenance

costs/risks and by using annual patient perception surveys.

Improvements in statutory compliance and risk reduction

which are measured through reductions in non-compliance

with statutory legislation, incident rates, and an increase in

each property’s Statutory Compliance and Audit Reporting

Tool (SCART) score.

Improvements in energy performance (in line with

mandatory targets for NHS organisations in Scotland) and in

compliance with Corporate Greencode requirements.

Reductions in our property footprint and reduction in the

revenue cost of the operational estate over time (which can

be measured by mapping trends in overall maintenance

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

ratio).

Projects planned for investment over the next 5 years

include; The New Baird Family Hospital and Anchor Centre;

Inverurie Care Hub; Foresterhill HC; Diagnostic and

Treatment Centre (dependent on SG funding); the

introduction of a major trauma centre within ARI (dependent

on SG agreement and funding); Backlog Maintenance and

further Carbon Reduction Schemes. Planned GMS

developments include:

Replacement of Denburn HC

Land purchase for Ellon HC and potential health and

social care facility in Balmedie

Bucksburn/Blackburn area health centre(s)

Dyce/Newmachar area health centre(s)

Portlethen HC extension and

Cullen Medical Practice refurbishment

Projects planned for investment beyond the 5 years include

Ambulatory Care facility and new Theatre Block and

Surgical Wards at Aberdeen Royal Infirmary

New Medical Physics and Laboratory Accommodation

Replacement mortuary

New Health / Community Hubs in areas of population

growth

Medical Equipment - Condition and Performance

Governance of medical equipment is devolved to three main

areas: Radiology, Medical Physics (looking after General

Medical Equipment, Radiotherapy Equipment and Nuclear

Medicine Equipment), and Laboratories.

NHS Grampian has circa 4,000 items of medical equipment

capitalised assets with a total net book value of £35.9m. The

table below details this information in line with the requirements

of the Audit Scotland Report, ‘Better Equipped to Care’. It

should be noted however that there are also a further circa

13,000 minor equipment items (non-capitalised) with an

estimated value of around £15m used throughout our services.

The devolved medical equipment areas are responsible for the

ongoing management and replacement of equipment within their

own area, and in a wider sense to provide specialist

advice/support to other departments regarding the equipment

replacement programme.

The replacement of equipment across NHS Grampian is a key

element of our Capital Plan, and forms part of the Local Delivery

Plan (LDP). A clear strategy for the replacement of equipment

that represents highest risk of failure is vital in order to protect

patients and operational services.

Co-operation exists between each of the devolved areas in

order to prioritise our requirements ensuring that available

resources are targeted effectively, using a risk managed

approach on an annual basis. This process will be managed by

a newly formed NHS Grampian Equipment Group, which will be

a sub-group of our Asset Management Group. Each medical

equipment lead is a member of the group along with senior

management. Our annual planning process involves a peer

review of all equipment requirements. Key considerations when

assessing assets’ remaining useful life, in addition to the

obvious priority given to issues that affect patient safety and

clinical benefit, include:

Age and intensity of use;

Availability of spare parts;

Image quality where relevant;

maintenance and upgrades;

Radiation dose where relevant

The work undertaken by the three medical equipment areas include:

Medical Equipment Category Cost of

Purchase

Net Book Value

@1/3/15 Imaging (CT / Ultrasound / MRI / Gamma

Cameras) £14.2m £6.2m

Other X ray (Angio / Dental / Fluoroscopy

/ General X Ray) £7.3m £2.9m

Radiotherapy £6.5m £4.5m

PET Replacement Programme £1.5m £0.3m

IV systems (Syringe and Volumetric

Pumps) £0.6m £0.2m

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

£75.5m £21.8m

TOTAL £105.6m £35.9m

Radiology The Clinical Radiology service is responsible for the direct

provision of diagnostic equipment and interventional services to

patients throughout Grampian, Orkney and Shetland on a 24/7

basis. The department directly manages imaging services

located at Aberdeen Royal Infirmary, Royal Aberdeen Children’s

Hospital, Woodend Hospital, Dr Gray’s Hospital, 11 Community

Hospitals and the Aberdeen Health Village. The modalities

provided include general radiography; dental radiography;

fluoroscopy; CT; angiography and interventional radiology,

cardiology, mammography; MRI and ultrasound. Approximately

300,000 examinations are performed annually.

A five facet appraisal of our Radiology equipment is still ongoing

and will continue to be enhanced as we implement a global

medical equipment register. We do however know that 79% of

Radiology Equipment is in a physically satisfactory condition

and functionally suitable for the task required. The analysis of

this performance is included in the following table 4:

Analysis of Radiology Equipment Performance

Facet

Very Satisfactory

Satisfactory Not

Satisfactory Very

Unsatisfactory

A B C D

Condition 37% 42% 13% 8%

Modern Standards

37% 42% 13% 8%

Functional Suitability

37% 42% 13% 8%

Quality 37% 42% 13% 8%

Category Not Used Under Used

Fully Used Additional Required

E U F O

Utilisation 0% 0% 100% 0% Table 4

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

on continuing with timely equipment replacement of the very

unsatisfactory equipment (identified above), which will be

informed by the development of an NHS Grampian 2020

Imaging Strategy. Plans are in force for the establishment of

two new plain film services in community hospitals at Aboyne

and Inverurie hospitals and continuing with establishment of the

imaging service at the Health Village. Other priorities are a

review of in-patient radiology facilities at ARI to include

interventional facilities and fluoroscopy services, reviewing

options to increase MRI capacity on the ARI site and for

provision within Moray. A PACS refresh will occur during 2016,

(current PACS contract expires 2017).

General Medical Equipment

The General Medical Equipment infrastructure team has a

critical role in governing medical equipment requirements for all

wards and departments across the organisation. The Medical

Equipment and Consumables Commodity Action Group

(ME&C-CAG) co-ordinates the review and prioritisation of

medical equipment requirements. The group brings together

senior clinical and management representation from the

organisation, with the operational component provided through

NHS Grampian's Medical Electronics Service. Typically the

ME&C-CAG will progress replacement of the full range of

medical equipment including defibrillators, dialysis, heart/lung

machines, IV systems, endoscopes and diagnostic ultrasound

scanning and other imaging equipment where this is carried out

by medical/clinical staff. There is very close co-operation

between the Medical Electronics team, laboratories, the Clinical

Radiology service, Estates and eHealth.

A five facet appraisal of our General Medical equipment is

ongoing and will continue to be enhanced as we implement a

global medical equipment register using RAM. This will include

the management of data on reusable medical equipment

requiring maintenance and support and will fulfil the

requirements of CEL 35 (2010). Our current information

demonstrates that 90% of Equipment is in a physically

satisfactory condition, 95% is functionally suitable for the task

required, and an estimated 43% of the equipment is

underutilised whereas 10% of equipment is under resourced.

The analysis of this performance is included in the following

table 5:

Analysis of Electronic Equipment Performance

Facet

Very Satisfactory

Satisfactory Not

Satisfactory Very

Unsatisfactory

A B C D

Condition 1% 89% 3% 7%

Modern Standards

3% 93% 2% 2%


3% 95% 1% 1%

Quality 0% 0% 0% 0%



E U F O


Utilisation = 110% because 10% is an additional requirement that increasing the utilisation level

cannot address

Focus of investment – General Medical Equipment

The Medical Electronics Service procures and maintains

equipment management activities for NHS Grampian's General

Medical Equipment will introduce a medical equipment library

service leading to more efficient use of all mobile medical

equipment. It is piloting a radio frequency tracking enabling NHS

Grampian to specify future requirements for the tracking of

significant mobile Medical Equipment allowing the introduction

of a library. There remains a significant short term investment

requirement in a number of areas including re-equipping the

main theatres and recovery areas at ARI and Woodend Hospital

and ITU area at ARI with replacement patient monitoring

equipment. No funding has currently been allocated or is indeed

available for this currently.

A “Patient Monitoring Learning Workshop – Improving Patient

Care”, was targeted at medical staff, nursing staff, medical

equipment and planning staff with the aim of sharing knowledge

about; improving patient care, new ways of working, what we

can do now that we have not been able to do before, to set

goals focusing the specification requirements for current and

future purchases of medical equipment. By improving data

quality in our medical equipment registers, we hope to provide

more accurate forecasts of future investment needs.

Radiotherapy

The radiotherapy equipment replacement program is managed

nationally with an annual plan for equipment replacement. In

2013 the first phase of the new radiotherapy facility opened with

two new replacement linear accelerators. The second phase

went operational in 2014 when Phase 2 with one additional

linear accelerator and a complete rebuild of the radiotherapy

facility. The three linear accelerators provides improved service

efficiency and capacity and better outcomes and experience for

staff.

Table 6 below shows the current 5 facet condition of our

Radiotherapy Equipment and reflects that we have just invested

in 3 Linear Accelerators.

Analysis of Radiotherapy Equipment Performance

Facet

Very Satisfactory

Satisfactory Not

Satisfactory Very

Unsatisfactory

A B C D

Condition 50% 42% 8% 0%

Modern Standards

50% 42% 8% 0%


50% 42% 0% 0%

Quality 50% 50% 0% 0%



E U F O


Utilisation The 17% under Utilisation reflects the additional capacity available with the use of a

3rd linear accelerator.

Focus of investment – Radiotherapy Following guidance from Scottish Government the replacement

interval for CT simulators has now been set at seven years. As

a result a replacement CT Simulator has been purchased to tie

in with the move to the new Radiotherapy Centre. The new

Anchor Centre will be built adjacent to the Radiotherapy Centre

to provide out-patient, day patient investigation and treatment

services for patients with cancer or blood and bone marrow

disorders.

Nuclear Medicine

The department functions well despite being in accommodation

that is not functionally suitable for nuclear medicine. A new

corridor has been built recently to improve access to the building

and alleviate a health and safety issue with patients and staff.

The accommodation however limits delivery of a modern

effective service. The department does not have

accommodation to house a modern standard gamma camera.

Consequently it is limited to choosing a system based on

available size. A new replacement PET/CT was purchased and

commissioned in 2014/15 with funding from the SGHSCD. This

has enhanced image quality and reduced radiation doses

therefore improving patient outcomes and operational efficiency.

The following table 7 shows the current 5 facet condition of our

Nuclear Medicine Equipment, this evaluation will be enhanced

over the coming years with the development of our Real Asset

Management (RAM) database.

Analysis of Nuclear Medicine Equipment Performance

Facet

Very Satisfactory

Satisfactory Not

Satisfactory Very

Unsatisfactory

A B C D

Condition 50% 50% 0% 0%

Modern Standards

50% 50% 0% 0%


100% 0% 0% 0%

Quality 100% 0% 0% 0%

Category Not Used Under Used Fully Used Additional Required

E U F O


Focus of investment – Nuclear Medicine

A National agreement has now been reached for all

replacement of Nuclear Medicine; based on a rolling programme

for all Boards, ensuring that nuclear medicine in Scotland

remains at the forefront of technology.

In the medium to long term the Nuclear Medicine service will

require to be relocated to accommodation on the Foresterhill

site more suited to patient access and which is also able to

accommodate the latest advances in nuclear medicine

technology. A short term alternative could be the incremental

consolidation and upgrade of the existing accommodation as

described below:-

During Gamma camera replacement (£750k) - upgrade the old

scanning room and the main corridor to a standard that meets

infection control guidelines and enables the equipment to be

installed (£50k) and divide the current main scanning room and

install the radiation protection measures to enable the

SPECT/CT to function correctly (£70k).

These steps could result in a single controlled area, capable of

housing the equipment with support and office facilities adjacent

to it.

Laboratories

Department of Health figures state that 70% of all clinical

decisions are informed by diagnostic testing. For that, a well-

equipped, modern and efficient laboratory service is required.

Laboratories hold a Managed Service Contract (MSC) (leased

equipment) for major analysers in the departments of Clinical

Biochemistry, Haematology and Dr Gray’s hospital

laboratory. This contract has been extended for a further 2

years and will expire in 2017. The contract also includes blood

gas analysers within Foresterhill.

Other departments within Laboratories currently have equipment

procured via capital/revenue purchases or various leasing/

rental type arrangements. This equipment base is degrading as

there is less capital/revenue monies available for timely

replacement.

Significant investment will be required in laboratory

equipment over the next few years to maintain the levels of

service expected by the organisation. Many of the

analysers and pieces of equipment used have procurement

lead-in times of months. Any failures will have a direct

effect on our ability to provide essential diagnostic

information affecting patient pathways and turnaround

times.

Laboratory Genetics is a National Services Division (NSD)

funded service and receives equipment either from NSD

nationally funded initiatives or from NHSG capital.

The tables 8 and 9 overleaf show the current 5 facet condition of

Labs MSC Equipment and owned equipment. It reflects the fact

that the MSC equipment has been replaced in a contracted

equipment refresh. The tables also demonstrate the advantages

of the MSC over the capital funding of the Labs Assets.

Analysis of Labs Owned Equipment Performance

Facet

Very Satisfactory

Satisfactory Not

Satisfactory Very

Unsatisfactory

A B C D

Condition 0% 50% 50% 0%

Modern Standards

0% 50% 50% 0%


0% 45% 55% 0%

Quality 0% 50% 50% 0%



E U F O


Focus of investment – laboratories

After reviewing options given by our current MSC service

provider, Laboratories are commencing on the business case to

procure a new MSC to start in 2017 to ensure a smooth

transition at the expiry of the current contract.

Aberdeen University require the Virology and Genetics

department to vacate the space currently occupied in the

Polworth building (approximately 25-30% of the University

Polwarth Building). These moves will necessitate extending the

existing lab accommodation within the east end special block.

The Project requires the significant movement of administrative

and storage space from the Link Building into the ‘Special block’

allowing movement of Virology and Genetics into the Link

Building. This requires significant investment to refurbish areas

Table 9

to become fit for purpose laboratory accommodation. Clarity on

the timing of the Genetics move is urgently required as the

proposed area within the East End Special Block, is prime

space being considered for other uses.

It is expected that if the East End buildings can be utilised

that this would provide a working solution until 2025. The

aim is to provide a new modern Blood Services Department

post 2025.

The departments of Medical Microbiology, Pathology and

Immunology reviewing the MSC model and options which could

result in a single directorate wide contract.

Analysis of Labs MSC Equipment Performance

Facet

Very Satisfactory

Satisfactory Not

Satisfactory Very

Unsatisfactory

A B C D

Condition 0% 100% 0% 0%

Modern Standards

0% 100% 0% 0%


0% 100% 0% 0%

Quality 0% 100% 0% 0%


E U F O

Utilisation 0% 0% 100% 0%

The mortuary based at Foresterhill is in poor condition. Short to

medium term measures have been put into place to

accommodate anticipated demands due to changes in

legislation and requirements to improve access for waiting and

viewing areas.

In the medium to longer term a new mortuary build is required.

Partnership options with the local authority around the

replacement of the police and public mortuary should be

considered.

The laboratory Information Management System (LIMS) is

approximately 19 years old and requires a replacement. A

specification has been drawn up and is now with NSS for

verification. This requires to be procured in 2017/18 as it would

be unreasonable to carry out this work during the retendering of

the MSC. The estimated costs (based on the last major Scottish

Heath Board procurement) is estimated to be approximately

£1.8M. The timeline and cost implications of the information

management system replacement will be considered as

part of our forward capital plan.

Medical Equipment Incident data

All risks associated with Medical Equipment are captured and

monitored at a service level with all incidents, risks and

mitigating actions captured within the Risk Management

Information System (DATIX). A search of the DATIX system was

conducted to identify Medical Equipment related incidents for

the period 01-04-2015 to 31-03-2016, from this a total of 531

incidents were identified, these are broken down in the tables

below:

For this period there were a total of 34 Adverse Events showing

an outcome where ‘Harm’ is indicated, these were investigated

further to identify severity of harm any learning outcomes that

should be shared.

NHS Grampian requires that all incidents resulting in actual

harm or with the significant potential to have done so or is

regarded as a near miss is recorded in DATIX, including

property damage or loss. This allows local management of the

incident by managers who are also responsible for initiating an

investigation and escalating or fast-tracking incidents to

managers or to topic specialists, as appropriate. Any incident

that has a severity of outcome grading of Major or Extreme,

involves an accidental death, or is reportable under

RIDDOR should have an investigation carried out to identify

actions and learning.

There were no adverse events rated either ‘Extreme’ or ‘Major’

during this period.

Incidents by Adverse event and Result Harm Near Miss No Harm Property Total

Lack/unavailability of device 9 6 37 8 60

Failure of a medical device or equipment -

decontamination issue(s)2 47 65 28 142


electrical/electronic fault(s)8 12 48 7 75


mechanical/physical fault(s)8 46 104 7 165

Failure of a medical device or equipment - user

error(s)5 9 31 2 47

Failure of a medical device or equipment - wrong

or missing part(s)2 8 19 6 35

Radiation dose greater than intended - Equipment

malfunction0 0 7 0 7

Totals: 34 128 311 58 531

Incidents by Result and Severity Negligible Minor Moderate Major Extreme Total

Occurrence resulting in injury, harm or ill-health 3 19 12 0 0 34

Near Miss (Occurrence prevented) 119 9 0 0 0 128

Occurrence with no injury, harm or ill-health 237 70 4 0 0 311

Property damage or loss 28 25 5 0 0 58

Totals: 387 123 21 0 0 531

Adverse event Harm

Lack/unavailability of device 9x 9 No Occurrence resulting in injury, harm or ill-

health


decontamination issue(s)2

x 2 No Occurrence resulting in injury, harm or

ill-health

x 7 No Occurrence resulting in injury, harm or ill-

health,

x 1 injury Occurrence resulting in injury, harm

or ill-health


health,

x 2 injury Occurrence resulting in injury, harm

or ill-health

Failure of a medical device or equipment - user

error(s)5

x 5 Occurrence resulting in injury, harm or ill-

health

Failure of a medical device or equipment - wrong or

missing part(s)2


health

Totals: 34


electrical/electronic fault(s)8


mechanical/physical fault(s)8

Facilities and Support Service assets- Condition and Performance

Facilities and support services are responsible for a critical part

of infrastructure supporting clinical services incorporating

Laundry, Central Decontamination Unit (CDU), transport,

property maintenance, cleaning, portering and catering services.

The net book value of the Facilities Directorate assets at 1st

March 2016 is £9.6m. Table 10 below summarises this

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

financial planning template.

Equipment Category Cost of

Purchase

Net Book Value

@1/3/16

Support services vehicles £0 £0

Other vehicles £3.3m £0.5m

Plant and machinery £15.4m £5.8m

Other equipment £5.4m £3.3m

TOTAL £24.1m £9.6m

Table 10

Linen Services

Laundry and CDU are located within the south east of the

Foresterhill Health Campus. They share a common building and

both rely on the use of steam. The building has significant

backlog issues which include asbestos, roof leaks and dated

infrastructure. Steam is supplied from the new energy centre

and from the older East End boiler house (built 1933). The

laundry used high pressure steam from Mile End but investment

in gas fired dryers removes some of the dependency on high

pressure steam if required. NHSG signed up to the Carbon

Energy Fund (CEF) contract in January 2016, which will, with

the installation of new steam and condensate, enable the

closure of the East End boiler house and demolition of same by

the end of 2016. The CDU facility can already be supplied solely

from the new energy centre.

Focus of investment – Linen Services

A service review has resulted in the older laundry facility at

Woodend Hospital closing, allowing NHS Grampian to

concentrate all linen processing on the Foresterhill site.

Consideration is being given to cladding the existing Asbestos

roof on a temporary basis to prolong the life of the building until

a permanent home is identified.

Decontamination Services

The main Decontamination equipment has been invested in and

is now at an acceptable standard with a life expectancy in

excess of 15 years. However the building condition remains a

significant risk to service continuity.

Focus of investment – decontamination services

Previous investment in an additional washer disinfector /dryer at

Foresterhill has increased the throughput and improved overall

efficiency within the decontamination facility. Within the next five

years investment will require to be prioritised to replace a

number of autoclaves which will be beyond their economic life.

In the longer term relocation of the Foresterhill CDU closer to

the main users of the service at ARI (which accounts for almost

80%) must be considered. Accommodation and funding require

to be identified,

Catering Services

Relocation of the Central Production Unit (CPU) (cook/chill) from

Kittybrewster, Aberdeen to Dr Gray’s Hospital, Elgin is now

complete, concentrating production of food onto three sites

(ARI, Royal Cornhill and Dr Gray’s). Investment during the last 2

years has brought the CPU and kitchen equipment up to an

acceptable standard with a life expectancy in excess of 15 years

Focus of investment – catering services

The focus of investment will continue with timely replacement of

end of life catering equipment ensuring the ability to provide

quality catering service to our patients. Currently catering to

Kincardine Community Hospital is provided by the onsite care

home. A regeneration kitchen will be installed at the Kincardine

Community Hospital as part of the 2016/17 capital plan.

Vehicles

Transport is essential in providing services to the community,

whether it is moving patients from their home to hospital or

delivering essential drugs to those that require them including

the transportation of various stores, equipment, catering, mail,

phlebotomy and cytology specimens and pharmaceutical

deliveries. Clinical waste collection and disposal service is

provided to and from GP surgeries, dentists, pharmacies and

other healthcare users. Clinical waste is managed in-house and

involves collection from over 600 sites equating to 38 tonnes of

clinical waste per week. This waste is moved to the transfer

station on the Foresterhill site and then uplifted by a third party

for disposal.

NHS Grampian has 417 vehicles, 350 of which are leased and

67 are owned vehicles, ranging from the large 7.5 tonne delivery

lorries to the small 2 seat car (the profile of these can be seen in

the tables below. These vehicles are spread across a wide

range of users who have very different requirements.

Table 11

Table 12

Table 11 and 12 above demonstrates we have 25% of vehicles

over 5 years old.

Petrol Diesel

Cars (pool) Less EV 1 8 5 4

Small vans 8 25 33

Large Vans 3.5 Tonne 6 7 13


Mini Buses up to 18 seats 1 1 2

Electric Vehicles

Total 1 23 43 5 62

Owned Vehicles

Type<2 years

old

2-5 years

old

>5 years

old

Fuel Type

Petrol Diesel

Cars (pool) Less EV 19 163 19 121 80

Small vans 23 58 40 121


Large Vans 7.5 Tonne

Mini Buses up to 18 seats 2 4 6

Electric Vehicles 12*

Total 56 233 61 121 217

Leased Vehicles

Type<2 years

old

2-5 years

old

>5 years

old

Fuel Type

In addition there are 434 lease cars which are provided to staff

who qualify as essential users on the basis that this is the most

cost-effective means for NHS Grampian staff to travel. Staff

qualifying as an essential user are required to pay for the lease

costs associated with all personal use and this is automatically

deducted from their monthly salary payments. This is constantly

kept under review and opportunities are continually sought to

minimise staff travel through use of alternative methods, such as

video-conferencing.

A high level five facet appraisal of the performance of the

commercial vehicles described above are shown in tables 13

and 14 below;

Table 13

Table 14

NHS Grampian carries out a broad range of work with the large

commercial fleet (3.5 and 7.5 tonne), these vehicles work 5 days

a week with an average of 2500 miles per month. Currently 4 x

7.5 tonne vehicles are 8 years old and costing significant

revenue funding to keep them operational. It is a similar picture

with the 3.5 tonne vehicles with 6 of them in poor condition. A

priority based replacement programme has been agreed for

2016/17 and 2017/18.

NHS Grampian has also made use of Government funding to

lease 12 Electric vehicles and currently have 4 charging stations

across Grampian each capable of charging 2 vehicles at a time.

Focus of investment – vehicles

The efficient utilisation of vehicles is critical and this should be

maximised wherever possible. Vehicles that are utilised less

than 40% of their maximum will be reviewed and an alternative

solution considered. This could be through daily hire or even

public transport.

Very


Not

Satisfactory

Very

Unsatisfactory

A B C D

Condition 4% 93% 3% 0%

Modern Standards 4% 96% 0% 0%

Functional Suitability 97% 3% 0% 0%

Quality 0% 100% 0% 0%

Analysis of Lease Vehicle Performance

Facet

Very


Not

Satisfactory

Very

Unsatisfactory

A B C D

Condition 1% 67% 30% 2%

Modern Standards 1% 82% 17% 0%

Functional Suitability 1% 79% 20% 0%

Quality 1% 61% 36% 2%

Analysis of Owned Vehicle Performance

Facet

The average cost of a pool car including insurance is £2,428; to

hire a similar car would cost £16.66 per day including insurance.

Table 15 below shows current utilisation of the NHSG fleet by

mileage.

Table 15

From the table we can see that there are currently 143 vehicles

below the 40% utilisation requirements.

25% of NHS Grampian vehicles have been held on the asset

register for a period of over 5 years. This has led to increased

costs due to reliability and high maintenance. Current analysis

clearly identifies that leased vehicles are a more cost effective

solution than holding a depreciating vehicle asset on the asset

register and the associated liabilities. Technology is forever

changing, particularly in the area of alternative fuels, and by

leasing on a 3-5 year period NHS Grampian may also be able to

stay up to date with the latest innovations within the fleet

market.

CarSmall

Van

Large

Van 3.5

Tonne

Large van

7.5

Tonne

Mini BusElectric

VehicleTotal

100% 80 19 15 8 122

80% 23 15 5 1 6 2 52

60% 13 19 3 1 2 2 40

40% 21 28 49

20% 15 37 6 58

0% 14 20 2 36

Total 166 138 23 10 8 12 357

Utilisation of Vehicles by Type

ICT Equipment – Condition and Performance

eHealth/ICT encompasses much more than the deployment of

computer technology. It requires both hardware and software

within a compatible environment, including; desktops, networks,

storage, backup systems and resilience built in throughout. It is

an essential element in support of modern healthcare and

provides advances to both healthcare professionals and patients.

The Electronic Patient Record (EPR) is a key enabler of this

technology and a critical area for investment for NHS Grampian

to ensure that the Healthfit Vision and Clinical Services Strategy

are achieved.

A considerable amount of work has already been done to

implement an EPR in NHS Grampian, this includes:

Within Acute Services 75%-80% of individual patient

information is held electronically.

Over the past 5 years NHS Grampian has consolidated much

of its patient management from 4 separate IT systems onto 1

system; PMS Trakcare. This has also included Lab and

Radiology order requests, bed management, waiting times

management, and eVetting of referrals. It is used across all

Acute, Community, Maternity and Mental Health services.

Access to information from the SCI Store (medical data) has

increased from 680 in 2007 to over 5 million in 2015.

Trackcare has in excess of 11,000 registered users and

includes staff who previously did not have access to an IT

system.

More information is available during unscheduled attendances

so clinicians can make better decisions.

Placement to speciality can be more accurate which leads to

better care and shorter stays.

Good progress has been made in the development of the EPR

but requires further momentum over the next 5 years to ensure

the EPR fully supports the themes identified in the emerging

clinical strategy as well as improving patient safety and clinical

efficiency.

The Value of NHS Grampian’s ICT assets are shown in table 16

below

ICT Assets Cost of

Purchase

Net Book Value @1/3/15

Networks and Cabling £3.9m £1.0m

Servers £2.1m £0.7m

Communication systems £1.7m £0.7m

Other Hardware £7.4m £2.8m

Applications/Other IT Systems £16.7m £3.1m

TOTAL £31.8m £8.3m Table 16

A very high level five facet appraisal of the performance of this

ICT hardware has been carried out; covering three categories;

network systems; desktop systems and; server equipment.

Table 17 Analysis of ICT Desktop Performance

Facet

Very Satisfactory

Satisfactory Not

Satisfactory Very

Unsatisfactory

A B C D

Condition 33% 30% 26% 11%

Modern Standards

36% 31% 22% 11%


60% 30% 10% 0%

Quality 33% 30% 26% 11%


E U F O


Table 19 Analysis of ICT Server Performance

Facet

Very Satisfactory

Satisfactory Not

Satisfactory Very

Unsatisfactory

A B C D

Condition 16% 53% 8% 22%

Modern Standards

16% 49% 8% 27%


16% 49% 10% 24%

Quality 16% 53% 6% 24%


E U F O


Table 18 Analysis of ICT Networks Performance

Facet

Very Satisfactory

Satisfactory Not

Satisfactory Very

Unsatisfactory

A B C D

Condition 60% 24% 9% 7%

Modern Standards

67% 31% 2% 0%


62% 29% 9% 0%

Quality 64% 24% 4% 7%


E U F O


The preceding tables 17,18 and 19 reflect an improvement from

previous years with the investment in new servers including the

upgrade of software to Microsoft server 2012, the installation of

new wireless technology in NHS Grampian properties and the

purchase of 1700 new PC’s or laptops which has allowed NHS

Grampian to upgrade to Windows 7.

Although £1.2m has been invested since 2014 in the purchase

of 1,700 new devices, desktop performance remains low. NHS

Grampian owns a total of 11,000 PCs and laptops. This recent

investment represents a replacement of only 15% of the overall

estate. The typical desktop PC/laptop lifecycle is 5 years; to

achieve this, a recurring £1.5m investment is required to

refresh 20% of the desktop estate annually. In absence of

the level of funding required to achieve this, the desktop estate

has been allowed to age. The current age of desktop equipment

ranges from 1 to 9 years.

Focus of investment - ICT

As indicated above considerable progress has been made in the

development of the EPR in NHS Grampian. It is important,

however, to summarise the key issues which have an influence

on the development of priorities for the future. These are

summarised below:

Vulnerability of Paper Records – A programme to

radically reduce paper record storage in our buildings forms

part of the agreement with the Information Commissioner to

reduce the risk associated with these paper records; whilst

at the same time making more efficient use of our building

and facilitates a move towards “Smarter Working”

Dual Paper and Electronic Record Use - Whilst 75%-80%

of acute services patient information is held electronically

there continues to be a paper record for every patient in the

system. This results in inefficiency with resources employed

in the maintenance of both paper and electronic systems.

Community Nursing and Health Visiting - The absence of

an electronic information system for community nursing and

health visiting means that staff cannot efficiently plan their

case work or interface with other systems.

Allied Health Professionals - Like community nursing and

health visiting the availability of electronic systems for AHPs

is at a very low level.

Child Health Services - The increasing integration of the

approach to child health required by the Children Act

requires the development of information systems and

records which can facilitate a high level of information

sharing between professionals.

Mental Health Services - The rollout of document scanning

to support Mental Health clinicians requires to be completed

and Mental health services requirements are required to be

included in the development of the EPR within Trakcare.

Information Sharing - As indicated above a key challenge

is the ability to which information can be shared between

clinicians and agencies involved in the delivery of health and

social care. The vision for the EPR states that clinicians

should have systems that provide the information they need

to make their contribution to the patient's care within the

context of the wider health and social care team. This could

be done by the use of paper based systems but it would be

cumbersome, expensive and could not be available in real

time.

Given the current progress on the implementation of the EPR

and the key challenges it is necessary to set out the proposed

priorities for further development towards a comprehensive

clinical information system, this is currently being considered

along with a programme of works.

The Trakcare infrastructure (servers, storage etc.) will also be at

end of life and require replacement by July 2017. This requires

an investment of around £1.2m with a 6 month lead time to

ensure a managed change over to minimise disruption to

services. Funding has been identified to meet this requriement.

There is also a requirement for an investment of around £1m in

increased data storage and key backup systems in 2017/18 for

NHS Grampian to maintain existing services. This will be

assessed as part of our planning for future years..

Where do we want to be?

Changes are taking place both within Grampian and across the

country to make sure that NHSScotland is in the best possible

shape to meet future health needs and improve people’s well-

being. There are a number of national and local policies and

initiatives aimed at making NHSScotland more effective and

efficient such as Better Health, Better Care: Action Plan, the

NHSS Quality Strategy, the Efficiency and Productivity

Framework and “Achieving Sustainable Quality in Scotland’s

Healthcare” – A 20:20 Vision and the emerging NHS Scotland

Clinical Strategy.

Healthfit Vision

The NHS Grampian Healthfit Vision was approved by the NHS

Grampian Board in October 2011 and sets out the ambition for

modernising health services across Grampian. It brings together

significant information and advice which has been provided by

managed clinical networks (MCNs), pathfinder projects, the

clinical advisory structure and the management structure. This

information and advice, together with the National 20:20 Vision,

the Quality Ambitions described in NHS Scotland’s Quality

Strategy and the emerging NHS Scotland Clinical strategy

clarify the overarching principles that guide the development of

our strategic vision and the service and infrastructure scenarios

that we believe are required to meet future health need.

The changes in the demography of the Grampian population are

predicted to have a significant impact on all public services,

particularly health. These include:

Over the next 20 years the population in Grampian is

predicted to grow by 87,000 to 672,000. Under current

allowances this equates to a requirement of 58 additional

GP’S that will require appropriate accommodation.

Over the next 20 years the population aged 65-84 will rise by

39% and those over 85 by 123%.

By 2034 there are likely to be 35,000 people in Grampian

living with diabetes, one third higher than the current 27,000.

Nationally, the number of people with dementia is likely to

rise by 75% and the number of people living with cancer

could rise by 28% in 2022.

Grampian Clinical Strategy – emerging themes

NHS Grampian is currently developing its clinical strategy

through wide engagement with clinicians, managers and the

public across the north east of Scotland. The clinical strategy

will be published later on this year and will take its place

alongside the strategic plans of the new Health and Social Care

Partnerships (HSCPs) of Moray, Aberdeenshire and Aberdeen

City which have already been approved by the relevant

Integration Joint Boards (IJBs). The engagement to date has

identified that prevention, self-management, elective care and

unscheduled care, are key themes.

The aim of the Grampian clinical strategy is to ensure NHS

Grampian continues to work collaboratively with patients, public

and our partners to improve health and clinical outcomes for the

population of the north east of Scotland and beyond.

Grampian has an excellent track record of innovation, leading in

service delivery and, importantly, improving care, health and

patient outcomes. However we have a number of significant

challenges in relation to the increasing age of the population,

people living with multiple long term conditions, workforce

availability, funding and geography as described later.

The clinical strategy sets out NHS Grampian's priorities and

outlines the shared intent of health and social care partners in

the north east of Scotland and beyond. The strategy supports

priorities from the emerging Health and Social Care

Partnerships and the recently published National Clinical

Strategy.

The developing strategy is built around four healthcare delivery

themes; Prevention; Self-Management of long term Conditions;

Planned Routine and Urgent care in the right Place and Time;

Unscheduled care in the Right Place and Time.

These four strategic themes should not be seen as separate.

They are interlinked and change in one theme will have an

impact on the other. The more we do to prevent illness the less

requirement there will be for planned care and unscheduled

care. Increased self-management will reduce planned care and

unscheduled care, and if our planned care services are more

accessible it is less likely that people will require unscheduled

care. The aim is to achieve the right balance of change and

improvement across all four strategic themes.

Prevention

NHS Grampian will have a healthcare environment purposefully

shaped to promote the health and wellbeing of those who work

in them, and those who visit them whether as patient, carer or

visitor. To enable this:

Making Every Opportunity Count will be widely implemented

across NHS settings

A pilot staff health and wellbeing programme will be trialled

Generic health coaches will be piloted in a clinical setting

and lessons will be learned about whether to expand their

provision

Self-Management of Long Term Conditions

NHS Grampian will ensure people who are living with long term

health conditions are supported, minimising their risk of

complications and premature mortality, optimising their sense of

health and wellbeing, and maximising their ability to live the life

of their choosing. Supporting self-management is a fundamental

component of the move to develop person-centred health and

social care services. Very little of learning to live with a health

condition actually happens on healthcare premises. Yet finding

answers to what it means to be living with a health condition

often multiple health conditions, finding ways to cope with

associated uncertainties and anxiety, increasing self-confidence

and self-belief, and finding constructive ways to overcome

health-related obstacles to everyday functioning are vital to

developing an increased sense of being able to self-manage.

Integrated Joint Boards and NHS Grampian will support

communities to develop and strengthen a wide range of

resources for people to draw on to support their own health.

This will be achieved by:

Collaborative communication, agenda setting and decision-

making skills will be part of all health and social care

professionals’ annual appraisals and personal learning and

development plans. Training will be available to support this.

Organisational development and service improvement

programmes will include a focus on the provision of

collaborative, person-centred services mindful that many will

be living with multiple complex long term conditions.

The participation of those who use services in helping

design, develop, improve and deliver services is a

fundamental part of the Community Empowerment (Act)

Scotland 2015. The opportunities for HSCPs and NHS

Grampian to co-create services with third sector and civil

society groups will be grasped.

Alongside formal systems of social prescribing, new trial

roles such as health coaches and community link workers

will be developed and coordinated, to help bridge the gap

between healthcare services and their users’ local

communities and these will be evaluated.

HSCPs and NHS Grampian will play an active role in

Community Planning Partnership, helping to build healthier

and stronger communities and supporting research and

evaluation to better understand self-management of long

term conditions.

Strategic Asset Impact

We will digitise health promotion advice onto the No Delays

platform.

NHS Health Scotland’s Place Standard will be trialled to inform

planned developments at Foresterhill or another NHS site and the

healthcare retail standard will be achieved across NHS setting

Increase access for those with greatest need to preventive clinical

services

IJBs and NHS Grampian will work with Voluntary

Organisations experienced in developing peer-led support

and education programmes and buddying schemes to

incorporate these into clinical services pathways, ensuring

suitability for people with multiple conditions:

Planned Routine and Urgent care in the Right Place and

Time

Planned care is the name given to those diagnostic and

treatment services which are not carried out in an emergency.

The services can be delivered routinely or on an urgent basis

within community, primary and secondary care settings by a

wide range of health care professionals e.g. pharmacists, GPs,

nurses, physiotherapists and consultants. NHS Grampian will

ensure a wide range of treatment and care is provided to

patients on this planned basis i.e. non-emergency; to support

patients to make decisions about their treatment; to make

treatment and care more accessible in a wider range of

locations closer to home; improve the efficiency of care; reduce

the need for multiple attendances which add no value to the

individual and better connect clinicians to improve the continuity

of care. Patients will be assessed and treated in the right place,

at the right time, and by the right person.

The main components of the programme to change and improve

planned care include:

Diagnostic and Treatment Services: The Scottish

Government has earmarked capital funding for NHS

Grampian to develop Diagnostic Treatment facilities. The

intention of this funding is to ensure that sufficient capacity is

available to meet the needs of the increased elderly

population for planned care over the next 10 years and

beyond. NHS Grampian and the HSCPs for Aberdeen City,

Aberdeenshire and Moray will work together during 2016/17

to review all aspects of planned care to develop an agreed

way forward for the north east of Scotland. It is through this

process that a specification for diagnostic and treatment

facilities will be prepared in 2017. The aim will be to bring

new diagnostic and treatment facilities into use by 2020.

Modernising Primary Care: NHSG will enhance the support

provided for a wide range of improvements and innovations

that are being taken forward across Grampian in both

planned care and unscheduled care. This change includes

the implementation of different workforce models, developing

new ways of working with acute services, and developing

new relationships with patients and partner organisations in

communities.

Patient Pathway Development: A more coordinated

approach to pathway development is being planned to

ensure that clearer agreements are in place between primary


A wide range of resources will be provided to give professionals

additional support to help people to self-manage including:

traditional and digital information and education for people and

their carers

self-monitoring resources

virtual consultations via digital communication technologies

tele-health devices and telephone services.

care and hospital based clinicians in relation to the referral

and treatment of patients. This will not only contribute to

ensuring that care is provided in the right place and at the

right time, but also improve efficiency in terms of patient time

and staff time.

Doing outpatient integration together (DOIT): This is a

national programme aimed at transforming the delivery of

outpatient services. The programme focuses on; reducing

reliance on traditional outpatient appointments by use of

improved communication and processes e.g., electronic

advice referral, e-triage; developing alternatives to face to

face appointments; Actively managing return activity –

patient initiated returns and working collaboratively across

Scotland to test and share new ways of working including

developing the clinical workforce in the context of ensuring

‘that consultants do what only a consultant can do’

Orthopaedic Quality Drive: This is focused on the

development of pathways to manage musculoskeletal (MSK)

conditions to ensure patients are seen at the right time and

by the right clinician. This work involves collaboration of all

the disciplines involved in MSK pathways to both develop the

pathway and ensure they are fully implemented.

Maximising Theatre Utilisation: Operating theatres are an

important part of the pathway of planned care for many

patients and it is important that they are used as efficiently

and effectively as possible. A programme of work to improve

utilisation is underway and this will be linked to the work on

the diagnostic and treatment centre.

Enhanced recovery: This includes the implementation of

evidence based practice to optimise patient recovery from

surgical procedures and minimise length of hospital stay.

This is only partially implemented in Grampian and full roll

out is dependent on creating the time for clinical teams to be

appropriately supported to realign current practice.

Deep community engagement: This process is being taken

forward as part of the modernising primary care initiative. A

Community enterprise has been engaged to develop

innovative ways of engaging local communities associated

with practice populations. The aim is to maximise the

potential of patients to self-manage, connect with local

communities and develop capacity to support community

health and wellbeing.


There is a significant amount of co-ordinated work being undertaken

to create a planned care system that meets the predicted needs of

our population. Our future asset requirements and investment

programme will be determined through joint planning and coordination

of community, primary care and hospital based professionals, and the

work being undertaken on a regional basis.

Unscheduled Care (USC) in the Right Place and Time Unscheduled Care is defined as care which cannot reasonably

be foreseen or planned in advance of contact with the relevant

healthcare professional, or is care which, unavoidably, is

delivered out with core working period e.g. overnight/weekends.

As this demand can occur at any time, services must be

available 24 hours a day to respond as appropriate. The scope

of unscheduled care is therefore extremely broad and includes

primary care and community services including GPs, social

care, nursing, pharmacists, opticians, dentists secondary care

hospital services and specialist major trauma services.

NHS Grampian will ensure that treatment and care will be

provided as close to home as possible by a team of

professionals who will be provided with advice to support

decision making on treatment and transfer to the right service if

required. The pathway of care for USC will be organised by the

HSCPs with the emphasis on ensuring that any stay in hospital

is appropriate to the care needs of individuals.

The focus for improvement will include:

The Scottish Government ‘6 Essentials Actions’ approach

will be implemented in a coordinated way across the health

and social care settings.

Acute services and HSCPs work closely to better manage

flow through the system. This will focus on clear, agreed and

shared pathways – reducing delays so that patients receive

the right care at the right time in the right place improving the

patient experience and the quality of the care received.

Improve the movement and transfer of patients to the right

place at the right time by working closely with the Scottish

Ambulance Service.

Targeting delayed discharges as part of focusing on patient

flow

Further extend the clinical decision support service to

improve the level of care that can be provided locally,

convert unscheduled care to planned care wherever possible

and ensure quick access to specialist care when required.

Develop the workforce to ensure that skills and experience

are applied effectively e.g. by employing more advanced

practitioners, physician associates etc.


We will develop innovative approaches to out of hours care through

the development of primary care. We will also contribute to the

development of a network of major trauma care for the north of

Scotland and establish a major trauma centre in Aberdeen to be the

hub of the network, as part of the national trauma network.

Grampian Clinical Strategy – enabling change

The four Healthcare delivery themes will be supported by the

following key elements:

Continuous Improvement

A Quality Improvement Hub will provide the focus, context and

support for the improvements required at organisation and

service level by providing direction to deliver improvements on

agreed priorities and support to test, spread and implement

improvements at both small and large scale. It will utilise the

expertise of Hub members to build organisational improvement

capacity to effect step change and actions set out in our

implementation plans and it will enable clinical and

administrative data to be readily available which will be linked to

support improvement, performance and assurance at all levels.

Information Sharing Across the System

Information sharing agreements will be developed with the

Health and Social Care Partnerships and Councils in Moray,

Aberdeenshire and Aberdeen City to enable the appropriate

sharing of information to improve treatment and care outcomes.

A key element of this will be the implementation of the electronic

patient record (EPR) which will improve the management of

care across the health and social care system.

Collaborative Working & Networking Around the

Individual & Communities

Systems and processes which bring acute services and Health

and Social Care Partnerships together will be strengthened to

co-ordinate care across the system, develop effective patient

pathways, improve access to services for communities and

support the implementation of the nine health and social care

outcomes.

Services which are provided across the north east of Scotland

will be encouraged to work effectively as networks of care and

there will be closer working with NHS Boards in the north of

Scotland to ensure that a range of tertiary services are

developed and maintained to provide good access for people in

the north east and north of Scotland.

Promoting Staff Health and Wellbeing

NHS Grampian will actively promote and support staff health

and wellbeing by working with staff to improve the environment

for the provision of services and care, identifying and addressing

causes of injury or ill-health. It will also promote healthier

lifestyles and support staff in their own self-management and by

collaboratively working with staff will address the impact of

health on the capacity of the individual to work.

Maximising Innovation

A culture of innovation will be promoted to stimulate and support

staff to be innovative in meeting the challenges facing health

and social care. This will include the establishment of an

Innovation Hub to provide a focus for innovation to support

health and social care integration and the development of

innovation partnerships with other public service organisations

and industry. Work will be done in partnership with the Scottish

Government as part of the Innovation Year 2016 and provide a

foundation for future innovation. Digital health technologies will

continue to be developed and implemented, such as “No

Delays” to encourage people to improve their own health and

self-manage their own conditions.

Acute setting bed numbers are likely to remain broadly similar to

existing provision. A piece of work is currently in development

confirming that there is unlikely to be any further reduction with

the possibility of marginal increase. Management of an

increasing population will be achieved through efficiency

programmes to improve system flow.

Older people services have largely been transferred to

community settings and this will continue. Again review of the

ageing population in Grampian is an ongoing feature of local

planning and this is confirming a decentralised model of care.

Similar to older people services, mental health services are

already largely embedded in community settings and deviation

from this model is highly unlikely in the emerging health and

social care context.

As well as ageing, the Grampian population is undergoing

significant growth with new settlements/communities emerging

across the region. Again this is a consideration for the planning

and prioritisation of primary and community based health and

adult social care services.


Our Healthfit Vision and Clinical Strategy puts the application of

technology at the forefront of a new sustainable model of patient

care. The way to do this is to improve the availability of electronically

held patient information which, subject to the application of good

practice, can be exchanged efficiently between clinicians and carers.

This requires the development and implementation of a comprehensive

electronic patient record – an EPR

Developing our workforce

A capable, flexible and sustainable workforce will be developed

with the necessary skills to deliver care and support across the

health and care system, including the Third Sector and non-paid

carers. A key focus will be on modernising the workforce,

developing and extending new roles including physician

associates and improving the attractiveness of support roles.

Our workforce of the future will be organised in an integrated

way, focusing on the needs of the individual rather than the

desires of the professional. Whilst managing growth and

demand, healthcare professionals will be more accessible to the

public and to each other. The particular matters that will

influence our future strategy regarding workforce will include:

The number of staff working in Scotland’s NHS is reported

as reaching an all-time high. However this is not yet the case

in Grampian. In some specialties it is difficult to recruit skilled

medical staff to sustain services. There have also been

challenges with recruitment to low-skilled labour, although

this may improve with changes in the north east oil and gas

economy.

An ageing population with a growing burden of chronic

disease has implications for staff numbers, skill mix and

competencies.

Importantly the creation of the new Integration Joint Boards

covering all adult health and social care services will result in

one of the most significant changes in the configuration and

delivery of health and social care for some time. This will

require staff to have a mix of health & social care

competencies.

Increased investment in technology will mean that the skills

staff require will need to be supported by investment in

assets which will support a technologically adept system of

care delivery.

Key worker accommodation - The Grampian area has been

unique in the Scottish economy largely due to the buoyancy

of the Oil and Gas sectors, more recently that economy has

fallen away. The net impact on public services such as NHS

Grampian is the affordability of housing whether to purchase

or lease and despite the downturn this remains an issue.

This has had a significant effect on recruitment and retention

of staff. In response to this NHS Grampian has identified a

site at Foresterhill to provide key worker accommodation

which would be operated by a Registered Social Landlord

providing accommodation at mid-market rentals primarily for

key workers in the public sector. This site is likely to provide

c100 residential units based on short assured tenancies. In

addition we are working with the Scottish Government,

Aberdeen City Council and the private sector to identify

affordable housing options for staff. A key challenge is the

appropriate use of the Strategic Housing Investment Plan

(SHIP) grant monies and how the qualifying criteria can be

revised to accommodate those classified as key workers,

this includes household income caps and length of tenure. If

through the use of the SHIP funds the qualifying criteria

cannot be more flexible then alternative solutions will require

to be identified. Other options under consideration are;

extending the staff home (Woodend); former Craiginches

Prison; former Summerfield Academy site; Smithfield Court;

and through site sales buying affordable housing units

through the use of endowment funds.

Consistent with the Healthfit vision our workforce requiring

an office will be working differently in the future. The use of

technology and an effective ICT network along with the

previously mentioned IP telephone will facilitate this. Office

based costs must be reduced allowing redirection of funds

into frontline healthcare, once a sustainable technology and

ICT network is funded.


Technology will be used to bring people closer together, more staff

will be working flexibly, not require a permanent base or office, with

links to wider support facilitated by enhanced use of IT and tele-links.

Integrated team working will become increasingly vital to successful

delivery of the Healthfit vision. Supporting teams to come together to

work in a different, integrated way will require active encouragement

and support.

Teams will be empowered to actively remove barriers to delivering

person-centred care, to develop core behaviours and skills to enable

better and more streamlined delivery of service.

Partnership working

In terms of partnership working we have a strong level of

engagement with our partners in the North East which extends

beyond an awareness of the Local Development Plans and

respective asset management plans. This commitment to

partnership working is reflected in a number of ways:

Regional Working

North Territory Programme Board (TPB): the TPB comprises

16 public sector participants and is responsible for the Strategic

Leadership of the hub programme, ensuring there is a

coordinated approach to planning future accommodation needs

across all participants. hub has delivered Aberdeen Health

Village (NHS Grampian working in partnership with Aberdeen

City Council and Grampian Police) and concluded a bundle of

health centre projects specifically Forres and Woodside

(including Tain and working in partnership with NHS Highland

and with support from The Moray, Aberdeen City and The

Highland Councils).

North of Scotland Planning Group: is a collaboration of six

NHS Boards – NHS Grampian, NHS Highland, NHS Orkney,

NHS Shetland, NHS Tayside and NHS Western Isles, delivering

significant benefits to patients in the North of Scotland through

collaborative working often for patient groups where services

need a critical mass greater than available in any one Board.

NHS Highland: the hub process has enabled greater joint

working between NHS Grampian and colleagues in NHS

Highland delivering the Health Centre at Tain, which was

completed in April 2014. The Capital Planning and Hard FM

working group has been considering regional working and have

identified NHS Grampian and NHS Highland as a pilot for further

development, wishing to build upon the joint working established

through hub. Significant progress towards a regional solution

has been made.

North East Scotland Joint Public Sector Group: continues to

meet and co-ordinate asset management plans to ensure the

opportunities of joint working through co-location and integration

remain very much at the forefront of all asset investment.

NESTRANS: The Regional Transport Partnership, Nestrans

continues to invest in active travel networks and to lead on

Behaviour Change initiatives in the Grampian region through the

“Getabout” partnership. A programme of events has been

carried out and marketing initiatives conducted to promote

active and sustainable travel in Aberdeen City & Shire. NHS

Grampian are represented on the NESTRANS Board.

Health Transport Action Plan (HTAP): For a number of years,

NHS Grampian has worked collaboratively to produce and

deliver on a range of Health and Transport initiatives through a

partnership with Aberdeen City, Aberdeenshire and Moray

Councils; Scottish Ambulance Service and Nestrans. A

Steering Group coordinating the work and supported by a full-

time member of staff funded by Nestrans and NHS Grampian

has overseen a refresh of the HTAP and established two sub-

groups to develop initiatives under the headings of Access to

Health & Social Care and Transport & Public Health.

THInC (Transport to Health Information Centre): One initiative

delivered by HTAP provides an information centre handling

enquiries relating to travel, to and from healthcare

appointments. Initially operating out of Elgin, the centre is now

based within Aberdeenshire Council. A database of all public

transport, community transport and third sector transport

providers in the region has been compiled, along with other

voluntary schemes. Callers can be directed to appropriate

transport through an understanding of available options,

eligibility criteria and travellers’ needs.

Community Planning Partners

Within Grampian relationships are well developed with our

Community Planning Partners (CPP’s). In the last year, we have

held meetings with the 3 local authorities to identify joint capital

investment priorities and participate in future infrastructure

requirements for services resulting from development sites

supported through the Local Development Plan process. This

has led to further detailed discussions with:

The Moray Council regarding joint development of a vision

for the area, based on the concept of our Healthfit Vision.

This includes the process of identifying opportunities of joint

working and developing proposals which may be linked in

part to the Moray Local Development Plan and include

Developer Contributions to meet the needs of the Moray

population.

The Integrated Joint Board of Moray will have the

opportunity to co-locate staff and specifically vacate the

Spynie site in Elgin in readiness for disposal.

Aberdeenshire Council regarding joint service developments

around Inverurie, Banff, Fraserburgh, Peterhead, Ellon,

Banchory and Balmedie as well as the sharing of

accommodation.

Aberdeen City Council regarding the joint marketing of

shared surplus assets, potential for future joint

developments and the sharing of accommodation.

Local Authority Development Planning

As a “key agency” NHS Grampian continues to engage with it’s

four Planning Authorities to ensure infrastructure requirements

are identified to support service delivery in local areas. This

engagement has allowed NHS Grampian to be one of the first

Health Boards in Scotland to ensure health is supported in

terms of Developer Obligations to support the delivery of

infrastructure as a consequence of patient growth due to house

building.

In the Grampian Board area supplementary guidance in most of

the Local Development Plans now recognize health as one of

the services that may require support from Developers

Contributions along with a methodology of what contributions

and/or provision of land for infrastructure will be sought.

In terms of potential Developers Obligations funding and land

could amount to £80m. To date NHS Grampian have secured

contributions of circa £8m plus land through legal agreements.

Aberdeen City and Shire Strategic Development Plan

The Aberdeen City and Shire Strategic Development plan

identifies strategic growth areas which will be the main focus for

development in the area up to 2035.

The new plan was approved by Scottish Ministers and came into

force on 28 March 2014.

Local Development Plan (LDP)

The Local Development Plans for Aberdeen City and Shire

support the delivery of the Strategic Development Plan with a

target of 70,000 housing units over the next 20 years. To meet

the strategic development 50% of the planned housing will be

delivered in Aberdeen City with the balance delivered within the

main commuting routes in Aberdeenshire. The Moray Council

has published strategic housing land requirements for the period

2013 to 2025 and aims to ensure that a five year effective

housing land supply is maintained. The Moray LDP was formally

adopted on 31st July 2015.

The Cairngorms National Park includes areas within

Aberdeenshire and Moray and form part of NHS Grampian’s

service area. It sets out policies and proposals for development

and use of land for the next 5-10 years, and gives the basis for

the assessment of all planning applications made across the

Cairngorms National Park.

For more detailed analysis see Appendix F

Community Empowerment Bill

The Community Empowerment Act gives community

organisations a right to ask to take over control of public land or

buildings. An asset transfer request has to be made by a

community transfer body to a relevant authority. The community

transfer body can make a request about any land or buildings

which the relevant authority owns, or rents from someone else.

They can ask to buy or rent the land or buildings or have other

legal rights, for example to occupy or use the land.

The relevant authority must listen to what the community

transfer body wants to do with the land or building. If a

community transfer body wants to buy land or a building through

asset transfer, they must become a company, a Scottish

Charitable Incorporated Organisation (SCIO) or a Community

Benefit Society.

The Act says all relevant authorities must make a list of all the

land and buildings they own or rent, and let everyone see it.

The law on asset transfer is not yet finished.


We will continue to progress discussions with all partners in Grampian and

the North of Scotland around engagement in developing joint asset plans,

assessing the impact of all future residential developments and continuing

to seek developer contributions for Health Care Infrastructure where

appropriate.

Strategic benefits and investment that is necessary NHS Grampian will move in the agreed strategic direction as

described in our Clinical Strategy, putting a renewed emphasis

on Prevention and Self-Management as well as Planned

Routine and Unscheduled Care. We will also endeavour to

improve: management and performance of all buildings,

equipment and infrastructure as per the performance framework

over the next 10 years. There is, however, limited funding

available and consequently all investment needs will require

careful scrutiny based on greatest risk and with reference to the

Local Development Plan process to identify and secure

developer contributions wherever appropriate.

In terms of our plans for the period of the AMP, we would

highlight the following strategic benefits across key service

areas:

Acute and Mental Health

Foresterhill Health Campus

The Foresterhill Health Campus is still in need of much

development to fulfil the Foresterhill Development Framework

(approved in 2008 and updated 2014). It has rightly formed the

spine to redevelopment of the site over the last 6 years in terms

of planning, design, style and quality of the built environment.

Considerable progress has been made with the completion of a

range of strategic developments including the Suttie Centre,

Aberdeen Dental School and Hospital, new Radiotherapy

Centre which will form part of the new Anchor Cancer Centre,

two new minimal invasive operating theatres to accommodate

robotics and the Emergency Care Centre. In addition, significant

reconfiguration works (ARP) are currently underway in the

inpatient areas of ARI, which is planned for completion 2017/18,

to ensure that they are fit for purpose for the next 10-15 years.

Funding has been identified by the Scottish Government to

allow the development of the Baird Family Hospital and Anchor

Centre within the Foresterhill Campus in Aberdeen. The

enabling works for this project also requires the replacement of

the Foresterhill Health Centre and the relocation of the Eye

Outpatient Clinic. These projects will be delivered by capital

expenditure and expected for completion in 2020.

The Scottish Government have also announced £40m funding

for the provision of a new Diagnostic and Treatment Centre –

NHS Grampian aim to carry out a detailed planning exercise

over the next 9-12 months to develop the strategy for elective

care in the North of Scotland with the aim of producing a

specification for this new centre as part of that process.

NHS Grampian are also looking to contribute to the

development of a network of major trauma care for the north of

Scotland and establish a major trauma centre, which will be the

hub of the network, within the newly developed Emergency Care

Centre.

NHS Grampian is developing a new multi storey car park on the

Foresterhill campus after being offered a donation from the

Wood Foundation. The car park will provide circa an additional

1000 parking spaces for exclusive use by patients and visitors.

The next stage of the strategic development of the campus will

require investment in, Phase 1 and East End of ARI for

Ambulatory Care, New Laboratory Building (referenced above),

New Mortuary, a solution for Nuclear Medicine, accommodation

for Medical Physics and the relocation of CDU and Laundry. All

of the foregoing requires funding to be identified.

To plan for the next stages a major service planning exercise

has been carried out and was reported to the AMG in March

2016. This included participation from clinicians, heads of

service and other key stakeholders.

The exercise demonstrated more detailed analysis is now

required to demonstrate the proposals for the next stages of

reconfiguration are feasible and will provide a good level of fit for

the predicted levels of activity (clinical, educational and

research) and changing service delivery models that are

emerging.

Other Acute and Mental Health developments under consideration are:

Relocation of the Learning Disability in-patient service into

the Royal Cornhill Hospital. This would increase safety for

patients and staff whilst guaranteeing a quick response to

emergency calls and improved access to on-call staff during

anti-social hours.

There is a requirement to carry out refurbishment works to

all Mental Health and Learning Disability ward areas across

Grampian to enable the patient environmental

improvements, HAI targets, significant self-harm risk

management concerns and wider health & safety issues

which were revealed by workplace inspections. These works

would significantly improve the quality and safety of our

patients, staff and visitors experience.

Of the 7 Child Development Teams (CDT) 5 are currently

accommodated in unsuitable accommodation. A business

case is required to be developed to establish the most

appropriate development programme to suit the needs of

the service.

The potential of a hotel being created on the Foresterhill site

which may include a “patient hotel” element, for those

patients not requiring a hospital bed.

Community Hospitals

Many changes have affected community hospitals with this likely

to continue as health and social care services integrate and

focus on different care models including, prevention, self-care

and care at home.

The immediate future investment will be around the following:

Provision of a new healthcare facility within the existing

Inverurie Hospital site incorporating a Health Centre,

Community Maternity Unit (CMU), Community Dental suite,

Diagnostic and Treatment suite and an X-ray suite. These

new facilities have been established based on a new service

model which will bring together a range of health and social

care services to create a “Care Hub”.

As part of the new development at Inverurie hospital, NHS

Grampian has relocated the Dementia Assessment unit to

co-locate with Aberdeenshire Council Services at Bennachie

View, Inverurie. This has provided the capability on the

hospital site to deliver the new “Care Hub” facilities and

services.

The detailed future configuration of Community Hospitals will be

the subject of comprehensive community planning work

undertaken jointly by the NHS, Local Authorities and the third

sector using the existing Community Planning Structures.

Primary Care

The NHS Grampian Primary Care Premises Plan sets out the

strategic investment needs of each of the HSCP’s in line with

NHS Grampian’s Healthfit Vision, and includes General

Practice, Dental Practice, Pharmacy and Optometry. The key

overall priorities and investment need is assessed by this group.

The Primary Care Premises Plan was approved by the AMG in

May 2014 (updated May 2015) and is included in appendix H.

NHS Grampian currently own 27 Health Centres, 22 clinics and

5 separate dental units along with 2 Hub procured Health

Centres and the Health Village. In addition, there are a - 71 GP

(owned or leased) premises, 70 dental premises, 121

pharmacies and 52 ophthalmic premises.

The Primary Care Premises Group awards grants (that meet set

criteria) for a range of needs allowing some premises to be

extended, improved and comply with the needs of

legislative/HAI requirements.

Pharmacy

There are National Plans (e.g. Prescription for Excellence) to

increase the role of community pharmacists in the provision of

health services, this is further explored in the Clinical Services

Strategy. These may include but not limited to; prescribing;

lifestyle support; administering vaccines and management of

prescriptions. These changes will increase the need for

consultations with patients and space to carry them out.

Pharmacies will require to ensure they have the capacity and

layout to cope with this increased workload over the next 10

years and that their premises meet the high standards expected

of a healthcare environment.

Many pharmacies are keen to offer integrated/shared premises

within local communities and certainly co-location of GP and

Pharmacy services would encourage closer working

relationships as per British Medical Association and Royal

Pharmaceutical Society recommendations. Properly designed

consulting rooms in pharmacies could allow GP consultations

from pharmacy premises to become an acceptable option of

service delivery, particularly in rural areas where separate

accommodation is not viable. NHS Grampian are currently

looking at this option within the Aberdeenshire and Moray area.

This could also include nurse dressing clinics being offered from

these same pharmacies.

To enable some of these opportunities there will also be a need

to improve IT connectivity to many of the Pharmacies as

described in NHS Grampian’s requirement for an EPR, this

move to share electronic records could significantly improve

patient safety.

Optometry

Over the next 10 years, premises developments are largely

dependent on independent practitioners. National developments

in care and treatment will influence internal premises redesigns.

It is hoped that the implementation of the EPR can mean that

Optometrists can have access to hospital Ophthalmology notes

through SCI Store and the Emergency Care Summary (ECS),

which can lead to two major improvements: safer co-

management of patients, sometimes with Independent

Prescribing qualified Optometrists and also fewer re-referrals of

patients who have been seen by Hospital Eye Service and

discharged.

The aging demographics in Grampian, as in the whole of

Scotland, have led to increased demand for wet Age-Related

Macular Degeneration (ARMD) treatment. To assist with this

demand, there has been a two-fold response by NHS Grampian.

Firstly with more Ophthalmologists in the Eye Out-Patient

Department, there is now capacity for more clinics to run in

peripheral hospitals. Secondly, these peripheral clinics

commission local Optometrists who can also help with follow-up

appointments in their own practices. Improving technology has

also meant that virtual meetings can feed back results from the

community Optometrist to the treating Consultant. In the past

few years the General Ophthalmic Services contract has

incorporated Ocular Coherence Tomography (OCT) as an

examination prior to referral of ARMD, allowing accurate

diagnosis and appropriate urgency of referral for this condition.

This has been aided by the addition of funding to Optometry

practices to install OCT machines. Financial assistance for

scanners has also assisted appropriate referrals for visual field

plots by scanning results from suspect glaucoma patients.

Currently there is a spread of 60 practices throughout Grampian

(see map 1 overleaf). Although each practice has its own patient

base, this is fluid as there is no registration of patients. The Eye

Health Network is a successful model of care for those needing

unscheduled appointments for eye emergencies. The spread of

practices means that patients can attend locally and if an

appointment is not available, the practice can find the patient a

‘home’ at a nearby practice.

Over the next 10 years, as the population age rises, there will be

more need for eye care and related age conditions e.g. macula

problems. In some areas of Grampian e.g. Alford, Laurencekirk,

Insch, Mintlaw, Keith and Fochabers, there is limited or no

access to optometry practices. There is future potential to

incorporate Optometry rooms within future community builds as

in a ‘hub’ (both in the new build sites and the emerging

community sites (see map). This could assist with keeping and

treating patients in the community by the community

Optometrists running virtual glaucoma and macula clinics;

results can be forwarded to the hospital eye service. Tele health

links installed in these rooms would also aid this type of

consultation. In the auspices of Modernising Primary Care

agenda, GMS could also utilise these Optometry hub facilities

by directing patients accordingly, both for General Ophthalmic

and Enhanced Services.

Through NHS Grampian Premises funding, many of Grampian

community Optometry practices have been made more

compliant with the Equality Act 2010 e.g. wheelchair ramps.

Map 1

Dental

Dental Services have improved significantly in Grampian over

the last 5 to 10 years through our modernisation agenda firmly

supported by the SGHSCD. Presently there are 120 modern

dental practices in Grampian identified as fit for purpose through

our rigorous practice inspection process. This enables sufficient

capacity for dental services to offer comprehensive care to all.

The development of the Aberdeen Dental School with new

dentists graduating annually in Aberdeen made a contribution to

25 new practices opening since 2006. The introduction of quality

assured courses for dental nurses and dental technicians now

also makes Grampian a more stable environment for NHS

dental services and high quality care.

NHS Grampian is developing a dental locality planning model

based on the needs of small localities of about 20,000 people.

This system will be used to monitor service availability and

target access initiatives where required.

General Practice

Recently projects have been completed through the hub

initiative at Woodside Fountain Health Centre (Aug 2014) and

Forres Health and Care Centre (Sept 14); and plans are well

advanced for replacement facilities for Inverurie and Foresterhill

health centre under the hub revenue funded model and Denburn

Health Centres as a hub capital scheme.

There has already been considerable change to the

requirements of GP premises while we attempt to move the

balance of care to our local communities. Larger integrated

premises are required for, prevention and self-management

information or clinics, increased diagnostic and treatment

services, training and community nursing teams. The increasing

development of intermediate care facilities is changing the

demands on general practice. Increasingly integration and co-

production is used to describe how we will all work in the near

future, and this may provide opportunities to make investment

decisions which provide greater value for money for all parties.

The NHS Grampian Primary Care Premises Plan pulls together

many dimensions and sets the strategic context within each of

NHS Grampian’s HSCPs in line with our vision, highlights

current plans within our GP services and sets out key overall

priorities as assessed by the Primary Care Premises Group.

Further to the announcement of £19m to be invested in General

Practices the Board has been considering how best to use this

funding along with Developer Contributions and new primary

care funding to ensure maximum benefit for the patients. Focus

for this work has been concentrated on the corridors of Dyce

and Newmachar; Bucksburn and Blackburn; and the community

of Balmedie.

The next emerging bundle of projects which NHS Grampian will

be seeking funding support from the Scottish Government will

include Banchory, Ellon and Danestone all of these practices

now have sites identified and all provide funding through

developer contributions.

Work has also progressed with strategic planning (stakeholder

workshops) around a future development at Keith and short to

medium term solutions for Northfield and Portlethen Medical

Practices through GMS grants.

Whilst we have achieved much of our earlier priorities, the

pressures of the National 2020 vision coupled with the the

significant growth of population in this area, is focusing

attention on the need to identify solutions and investment

to cope with the services the required to support new and

emerging populations.

Listed below are the priorities identified by each of NHS

Grampians Integration Joint Boards for the next 10 years, these

will however continue to be assessed and prioritised on an

annual basis in line with this AMP.

Bucksburn/Dyce Medical Practices (Aberdeen) (part of

£19m bundle)

Banchory Medical Practice (Aberdeenshire) (emerging

Bundle)

Ellon Medical Practice (Aberdeenshire) (emerging

Bundle)

Northfield/ Mastrick Medical Practice (Aberdeen) (temp

solution, portacabins)

Keith Medical Practice (Moray) (strategic planning stage)

Danestone Medical Practice (Aberdeen) (emerging

Bundle)

Kincorth Medical Practice (Aberdeen)

Torry Medical Practice (Aberdeen)

Fochabers Medical Practice (Moray)

Office Accommodation

The NHS Scotland Asset and Facilities Management

Programme Board, supported by Scottish Government, have set

up a programme of activity for all office accommodation to

ensure best use is made of resources, identify savings and

efficiencies. Within this programme is the development of new

ways of working.

NHS Grampian has made a commitment to improve the

utilisation of its office accommodation across the office portfolio

by identifying opportunities for consolidation and rationalisation,

increased agile working and shared use of space with other

public sector partners.

NHS Grampian are currently working alongside our local

authority partners in a number of ways – (a) learning from their

recent experiences of implementing Smarter Working; (b)

implementing these same principles throughout NHS Grampian

where appropriate; and (c) co-location of office accommodation

with the introduction of Health and Social Care Integration

incorporating the Smarter Working principles.

“Worksmart” culture workshops have taken place in many of

our health and social care offices along with the local authority

“Worksmart“ teams. This has allowed us to co-locate Health and

Social Care staff which in turn optimises the use of office space,

improved communication between services which will improve

patient outcomes.

The success of the initiative is being measured by:

Improved communication for Health and Social Care Staff

which leads to improved patient outcomes;

A reduction in running costs and our office

accommodation footprint;

A reduction in energy and water consumption as well as

reduced waste and carbon emissions;

An overall improvement in the space utilisation of our

office accommodation;

NHS Grampian has invested in sensors to gather

comprehensive information on desk and office utilisation which

is informing our implementation of the “Worksmart” programme.

It has already highlighted a 60% underutilisation of desk space

in some of our offices areas.

A summary of the main office accommodation within NHS

Grampian is set out in table 20 below.

Table 20

Description Floors GIA m²

Usable

Area

Desk

No.s Staff

Desk

Ratio

Per 10

Staff

Floor

Ratio

Per m²

Person

Revenue

Costs

Costs Per

m2

Costs Per

Person

Ashgrove House 5 6399 3800 266 235 11 16 £739,668 £195 £3,148

Foresterhill House 2 613 436 30 30 10 15 £88,601 £203 £2,953

Foresterhill Lea 4 1074 566 81 60 14 9 £146,991 £260 £2,450

Spynie 3 767 708 99 73 14 10 £283,760 £401 £3,887

Summerfield House 2 3608 2173 260 237 11 9 £573,489 £264 £2,420

Westholme 4 2698 1991 220 247 9 8 £302,131 £152 £1,223

181 Union Street 3 1350 965 9 9 10 107 £287,009 £298 £31,890

Total 891 £2,421,648

A number of case studies are also taking place at Summerfield

House, Westholme and Spynie. These studies have been

implemented to demonstrate good practice, the investment

required for medium and long term gain and the cultural change

required to ensure success.

Where are we going?

NHS Grampian will continue to maximise utilisation of office

space in order to provide more flexible working styles to

employees and reduce costs. This will include ensuring we have

the appropriate furniture, appropriate IT infrastructure,

appropriate HR support for flexible working options,

depersonalised desks, de-cluttering and limited storage (as

highlighted in the case studies) which will create a flexible

modern environment for everyone, anywhere.

“Worksmart” is about achieving the best utilisation of office

space reducing costs and providing more flexible working styles

to employees. It is also about a cultural change where work is

thought of as being something you do and not somewhere you

go – not to focus on the place but focus on the task.

How will we achieve the change required?

NHS Grampian is targeting a desk ratio of 7 desks for 10 staff

located in all office locations. Plans are in place to move the

remaining 9 staff from 181 Union Street to alternative

accommodation in 2016/17, freeing up the revenue associated

with running the building.

Aberdeenshire HSCP has introduced “Worksmart” which had

already been adopted by Aberdeenshire Council. This flexible

style of working has already demonstrated a significant change

in the culture of the HSCP, the ability to work from different

locations, its travel patterns, use of technologies and use of

space.

NHS Grampian, supported by the Scottish Futures Trust, will

continue with our cultural change programme of introducing

alternative work styles. The initiative will be rolled out initially in

our larger offices and then throughout NHS Grampian including

clinical areas.

ICT infrastructure is laying the foundation for this change

programme to commence:-

Wireless installation in all offices, community hospitals and

in all GP premises including branch surgeries which was

completed in the summer of 2014.

Implementation of ‘Microsoft Direct Access’ which is

allowing access to the NHS Intranet Network with an NHS

PC/Laptop from any internet point, testing has completed

and is currently being rolled out to those staff requiring

access.

The replacement of the N3 contract, which ended last year,

with the Scottish Wide Area Network (SWAN) introduces

greater speed, bandwidth and improved links with our other

public sector colleagues. The NSS replacement of all N3

circuits within a 12 month timescale lays the foundation for

this improved access to other public sector agencies.

ICT transformation project replaces the Microsoft XP

operating system on all PC’s and laptops and the upgrade

of NHS Grampian domain which is based on Windows 2003

to Server 2012 will be a major foundation builder. This work

was completed in March 2016. This required the

replacement of all older PC’s and laptops.

IP telephony for all main office accommodation was

completed in 2015, allowing flexibility for staff to work at any

desk and login to their own telephone extension.

In order for NHS Grampian to remain viable and sustainable, we

must move forward with “Worksmart” in line with the NHS

Grampian Healthfit vision, the IJB strategies and the NHS

Grampian Clinical Strategy. This is will ensure a balanced and

consistent approach for our office staff in implementing Health

and Social Care Integration.

Essential equipment and ICT replacement programme

As at 31st March 2016 NHS Grampian’s equipment and ICT

assets had a net book value of £50m (gross cost before

accumulated depreciation of £152m). At this date 1,572

individual assets were fully written down of which 350 are older

than 10 years – see table 21 below.

Cost When

Purchased

Additional No

of assets

Assets – fully written down as at 1 April

2013

£44m 1,572


2018

£58m 1,560


2023

£46m 1,091


2026

£4m 137

£152m 4,360

Table 21

Assuming no investment in essential equipment and ICT, by

2026 there would be 4,360 items fully written down with a

replacement cost of £152m plus inflationary uplifts.

Equipment

A primary element of the investment programme is replacement

of essential equipment and critical assets. Clinical services have

been fully engaged in order to assess and prioritise available

funding for essential equipment replacement. With an ageing

estate, together with a growth in demand for services, our asset

plan has identified the need for priority investment in a number

of key areas within our acute sector infrastructure – MRI

capacity; laboratory and medical equipment accommodation;

replacement laundry and CDU facility; and new mortuary

accommodation.

Within the ten year plan, we are developing a detailed

equipment replacement strategy, informed by a comprehensive

assessment of risk. £3m is earmarked in 2016/17, £3m in

2017/18 rising to £6m in each of the following three years for

essential equipment targeted at those areas of highest risk.

Further funding will be required however to meet future

essential equipment replacement requirements.

ICT

The implementation of the EPR is not just about information

systems. Implementation requires wide scale redesign to ensure

that working practices of clinical staff are transformed to ensure

maximum benefit can be achieved. Implementation will also

include redesigning support staff and systems in heath records

and health IT, as the use of paper based records reduces and

electronic information becomes the sole source of clinical

information.

The priority areas for development in the EPR programme are

summarised below:

Acute Services - move towards the elimination of paper

based records by increasing the level of digitally generated

information at source and supporting changing practice to

make electronic record usage routine

Mental Health Services - significant workflow redesign is

required to improve management of waiting lists, complete

the rollout of scanning into the CCube document

management system, link CCube to Trakcare so that

information can be viewed within Trakcare (as per SCI Store).

Maternity Services - extend Badgernet to Community

Midwifery and provide interface to GP records, work to

provide a paper free maternity record which conforms to the

National Scottish Women’s Hand Held Maternity Record

(SWHMR).

General Practice - exploit the potential to use Vision 360 to

support mobile working within GP practices and the

reconfiguration of services within HSCPs.

Community Nursing - develop and configure the Community

Vision system to support the work of community nurses,

health visitors and school nurses etc,

Allied Health Professionals - extend use of PMS Trakcare

to those AHPs not covered by the AHP Advanced Practice

Musculoskeletal (MSK) project.

The move to the EPR being the sole record is a significant

change with no contingency plans based on paper records.

Therefore the resilience of eHealth Services, server

infrastructure and network resilience needs to be reviewed and

enhanced. There will also be a requirement for additional

support from both eHealth ICT Services and PMS Application

Support as a consequence of the increased use of services,

devices, network traffic and storage etc. eHealth resilience is

required to be a significant part of the EPR implementation

programme.

Improvement will also be targeted as follows:

Provision of additional ICT roaming features to users to

overcome the inflexibility of a wired network in difficult or

remote locations.

Installation of IP telephony to complement and replace

traditional analogue telephone systems.

Fundamental review and upgrade of ICT estate to a

common supported platform with increased security to

enhance protection.

Clinical Decision Support will bring together a wide range of

clinicians to support professionals at the first point of contact

with patients requiring unscheduled care. This service when

developed has the potential to provide support to other NHS

bodies, public sector partners such as local authorities,

prisons and police, and could extend to commercial partners

within the oil and gas sector.

No Delays aims to transform the relationship that patients

have with services and clinicians in planned care. No Delays

will provide patients and GPs with information, support and

involvement in the care of a range of conditions by using

video and tailor-made websites for patients called patient

postcards. We are currently piloting and evaluating the No

Delays concept at 13 GP practices throughout NHS

Grampian. The success of the project longer term will be

dependent upon investment in our ICT infrastructure.

Table 22 on the following page sets out the proposed

programme for change in relation to the development of the

EPR and the resource requirements.

If we are to realise our ambitions to unlock the potential of

ICT to support developments such as – clinical decision

support and No Delays - further investment beyond that in

our current plan will be required.

Key Action Description Expected Outcome

Patient Management System EPR

A transition programme of work will be agreed with to support the move from paper records to electronic.

Trakcare will be the prime patient record with users able to update a patient record from work or home.

Maternity EPR

The Maternity EPR will join Acute staff with Community staff onto the same EPR, with links to GP systems to provide summaries of patient contacts.

In advance of the Baird Hospital opening the EPR in Badgernet should be available for all Maternity staff with summary information updating GP systems automatically.

Community Vision/Child Health

To be developed for Health Visitors, School Nurses, Community Nurses and District Nursing and will contain a scheduling and caseload tool and a clinical recording system. This system is absolute critical if we are to meet our GIRFEC responsibilities.

Community based nursing staff will have a IT system that will support NHS Grampians Children and Young Person’s Act responsibilities. e.g Child Plan.

AHP Rollout

This will complete the rollout of Trakcare to all AHPs in Grampian.

All AHPs will have access to and use Trakcare as their core IT system.

Digital Dictation/Speech Recognition

This will permit standardisation on methods of interacting with the EPR – recording notes to be converted to text and navigating

through forms etc.

This will assist with the desire to create and record information in PMS Trakcare without having to transcribe from paper.

Patient eCommunication

This solution allows correspondence with patients, such as appointment letters, clinical instructions and clinic letters, can, optionally, be done online or printed centrally reducing cost.

Patient Correspondence will be sent electronically, either for posting from a centralised location or to be viewed on line.

Patient Management System Infrastructure

The PMS Infrastructure is at end of its useful life and requires replacement. From a resilience point of view we will continue with the failover/failsafe approach to minimise the risk of unscheduled downtime and review any additional requirement e.g. storage (SAN) that the move away from paper based systems brings.

A resilient EPR infrastructure, appropriately supported and maintained, including OOH support for applications.

ARI Records Library Risk Reduction

Two major floods in the ARI subbasement in the past year have damaged 8,500 paper records beyond repair and as NHS Grampian has a duty of care to patient information the decision has been taken to move inactive records offsite and to clear the bottom shelves of filing.

Over time with the development of the EPR the requirement to recall file rom offsite storage will reduce.

Table 22

Targets for improvement Backlog reduction

The targets for our property portfolio (Table 23) below have

been developed on the following assumptions:

Surplus properties identified for disposal will have been sold

or demolished by April 2021 thus removing the associated

backlog.

Programmed new builds such as the Baird Family Hospital

and Primary Care Projects will provide high quality buildings

that score A’s on the 6 facet performances.

By 31st March 2021, a further reduction in backlog of £7m

(significant and high risk) as a result of further rationalisation

of the estate.

Targets for Improvement in Property Condition and Performance

Table 23

Facet

Condition / Performance of NHS Grampian’s

Property Portfolio

Previous

Performance 2011/12

Previous

Performance 2013/14

Previous Performance

for 2015/16

Current Performance

for 2016/17

Target Performance

for 2020/21

Physical Condition

(Appraisal ranking A or B) 41% 48% 52% 66% 85%



Quality


Space Utilisation

(% fully utilised) 80% 89% 90% 91% 93%

Average SCART Score 54.6 59.8 59.8 75 85

Average Energy

Consumption PI

(GJ/100m3)

78.9 75 70 60 55

Backlog Maintenance

(High &Very High risk

items)

£77m £69m £67m £21.6 £9m

Sustainability and Carbon Reduction

Environmental Sustainability

In January 2012, the Scottish Government Health and Social

Care Directorate published A Sustainable Development Strategy

for NHS Scotland, alongside CEL 2 (2012); A Policy on

Sustainable Development for NHS Scotland. The documents

have shared objectives, which are, to improve the sustainability

of NHS Scotland’s activities, primarily in the context of estates,

property and asset management, in addition to contributing to

the Scottish Government’s overall purpose and wider strategic

objectives.

The role which sustainability plays within NHS Scotland

continues to increase, and is necessary in the planning and

delivery of modern health and social care facilities and services.

Therefore the role of getting it right, has many direct and indirect

implications for the NHS:

Improved healthcare outcomes for patients, staff and

communities;

Financial and resource efficiency,

Both legal and mandatory policy compliance, with consequent

reputational benefits or risks.

NHS Grampian has produced a Sustainable Development

Action Plan (SDAP) which sets out a clear route map for NHS

Grampian’s contribution towards meeting the Government’s

sustainability targets, aims and objectives and how they are

being integrated into the core business.

There are a number of key national drivers for embedding

sustainability and climate change activities across NHS

Grampian, these include:

Climate Change (Scotland) Act 2009. This places a duty

on public bodies to contribute to carbon emission reductions

and climate change adaptation and to act sustainably in

exercising its functions.

Climate Ready Scotland: Scottish Climate Change

Adaptation Programme. This sets out Scottish Ministers’

objectives in relation to adaptation to climate change.

Scotland’s Zero Waste Plan (2010): This sets an overall

7% reduction target for all waste by 2017. With the 2025

targets aiming for a 15% reduction in all waste, 70%

recycling and no more than 5% waste to landfill.

The Waste (Scotland) Regulations 2012: These

introduced mandatory source-segregation of recyclates

(2014) and mandatory source-segregation of food waste for

recovery (2016 for hospitals). This was further strengthened

by a ban on the disposal of food waste to public drains or

sewers (2016) and on biodegradable municipal waste to

landfill (2021).

The Procurement Reform (Scotland) Act 2014: This

places a Sustainable Procurement Duty on contracting

authorities to improve the economic, social, and

environmental wellbeing of the authority’s area

The Nature Conservation (Scotland) Act 2004: This

places a duty on public bodies to conserve biodiversity. For

NHS Grampian this means improving greenspace quality,

linked to ministerial priorities to reduce prominent healthcare

conditions (heart disease, obesity, etc.) through active use

of Scotland’s outdoor environment, including the healthcare

estate.

The Wildlife and Natural Environment (Scotland) Act

2011. This requires NHS Boards to publish details of their

biodiversity actions from 2015 and then every 3 years.

Public Bodies’ Duties Climate Change Reporting. The

Scottish Government has introduced mandatory climate

change reporting for all ‘major player’ public bodies, which

includes NHS Grampian.

EU Energy Performance of Buildings Directive (EPBD).

This requires all public buildings in the EU over a particular

size to display a valid Energy Performance Certificate

(EPC).

Scottish Building Standards and BREEAM. The Scottish

Building Standards have recently been revised to improve

the energy and carbon performance of new and refurbished

buildings with further changes expected to be triennially.

While the scale of new-build is relatively small in

comparison to the existing estate, this will still have a

marked impact on the overall sustainability and climate

change performance.

Linked to the above, all new NHS Scotland buildings over

£2 million must achieve a minimum BREEAM standard of

‘Excellent’ and refurbishments must achieve ‘Very Good’.

Over and above these NHS Grampian also has other local

drivers for sustainability across Grampian which include:

Recognition of the important role of a high quality

environment in supporting health and wellbeing;

NHS Grampian’s own sustainability targets and objectives;

Participation in the EU Emissions Trading Scheme (EU ETS)

and the Carbon Reduction Commitment (CRC) Energy

Efficiency Scheme;

Rising costs of energy, fuel and waste management,

including landfill costs;

Depletion of finite resources, scarce materials and health

care supply risks;

Need to conserve resources, increase efficiency and support

Scottish Government ambitions for a more circular economy;

and

The Duty of Best Value in public services to demonstrate a

contribution to sustainable development.

NHS Grampian is currently in the process of setting up a Carbon

Management and Sustainability Group (CMSG) which plans to

meet on quarterly basis. The aim of this group is to both drive

and monitor progress on actions contained within the SDAP.

A non-executive Board member has also been appointed as the

Sustainability Champion for NHSG. The Board employs a head

of sustainability compliance and risk, who has the responsibility

for co-ordinating the CMSG, including progress on actions,

reporting internally and to Health Facilities Scotland and

Scottish Government, preparing and implementing the Boards

Waste Management Action Plan, Carbon Management Plan and

Adaptation Action Plan, whilst ensuring that carbon reduction

targets are met.

Sustainability is embedded throughout the NHS Grampian in a

number of ways which are summarised below:

Use of the Good Corporate Citizen Assessment Model

(GCCAM) to foster cross-organisational engagement and

assessment.

Regular sustainability performance reviews by managers and

the Board.

Consideration of potential climate change and sustainability

impacts and /or benefits of all projects, tenders and contracts.

Daily procedural duties that all staff must adhere to such as

IT switch off office temperature policy, waste recycling etc.

NHSG also plans to develop a local communication strategy

that involves a range of activities that support national and

local initiatives information about this will be circulated to staff

via, the intranet and the newsletter.

The Good Corporate Citizen Assessment Model (GCCAM) is a

web-based toolkit designed to facilitate the integration of

sustainability aims and objectives into the daily delivery of

healthcare services. It encourages a Board-wide self-

assessment of sustainability against key criteria, the result of

which forms the basis of the NHS Grampian SDAP.

Good Corporate Citizenship means following the five principles

of the UK Sustainable Development Strategy:

Living within environmental limits.

Ensuring a strong healthy and just society.

Achieving a sustainable economy.

Using sound science responsibly.

Promoting good governance.

There are six key areas for action covered in the GCCAM:

1. Community Engagement - including community consultation

and partnership decision making.

2. Procurement - including equipment, food, and sustainable

building materials.

3. Buildings - design, refurbishment and construction of NHS

Grampian sites.

4. Facilities Management - including building maintenance and

land management.

5. Travel - including journeys to, from and between sites by

staff and NHS Grampian fleet.

6. Workforce - including staff recruitment, retention and

training.

Corporate GREENCODE® has been developed for NHS

Scotland Boards as a Corporate Environmental Management

System (EMS) which has been designed to achieve the same

standard as ISO14001. Work within this area will continue to be

progressed.

Carbon Energy Fund (CEF)

NHS Grampian has the third highest energy –consuming

hospital in Scotland (Aberdeen Royal Infirmary) and has a

number of hospital sites with Energy consumption well in excess

of the Scottish national average.

The Fund is designed to encourage innovation from prospective

bidders for the supply, maintenance and energy management of

large scale energy investment opportunities within NHS Estates.

The third party service provider’s costs, in the form of a unitary

charge, are covered by contractually guaranteed savings from

reduced energy consumption and greenhouse gas (GHG)

emissions.

Following shortlisting and evaluation Vital Energi were

appointed to deliver a series of infrastructure investments aimed

at improving the carbon efficiency of three Grampian sites,

Foresterhill, Royal Cornhill and Dr Gray’s. The contract signed

on 29 December 2015.

An overall reduction in carbon emissions of 16% is anticipated in

the life of the contract. NHS Grampian will also benefit from

investment in infrastructure estimated at circa £15.6m over the

25 year life of the contract; £10.4m of initial investment with

£5.2m lifecycle replacement of lights and chiller units throughout

the contract period.

A significant component of the contract is the creation of an

energy link between Foresterhill and Royal Cornhill Hospital

which will also allow all areas of the Foresterhill site to be

serviced from the main CHP plant. This will facilitate the closure

and demolition of the east end boiler house.

The project is due to complete on 2 January 2017.

The key project milestones are as follows :-

Dr Gray’s Boiler Replacement – 3rd August 2015

ARI Chiller replacements – 29th June 2016

Steam & Condensate to Laundry from ARI Energy Centre –

15th July 2016

Energy Link (ARI to Royal Cornhill) – 2nd September 2016

Dental School & Institute integration – 7th October 2016

Mile End Boiler House Demolition – 14th October 2016

ARI High Voltage Ring – 28th October 2016

Lighting upgrade ARI and Royal Cornhill - 18th November 16

Project handover – 28th November 2016

It is anticipated that this project will eliminate £2.6m of backlog

risk.

Transport NHS Grampian is working in partnership with NSS through the

shared services review, investigating and identifying potential

options and structures for a northern fleet operation.

The review identified opportunities for a more joined up

approach across Scotland, with potential to realise better

utilisation of vehicles and logistics resources whilst improving

the effectiveness and efficiency of day to day operations.

In order to achieve the strategic vision of modern and efficient

fleet management and logistics functions, the Strategic Facilities

Shared Services Programme Board approved the

recommendation to create a regional fleet management

structure with national support and it was agreed that a detailed

implementation plan be produced.

The proposed structure could also result in the number of

commercial fleet operations being reduced from 22 to 5

territorial operations plus the Scottish Ambulance Service

(SAS).

It is proposed that a lead from an NHS Board within each region

will provide fleet management for the region and will be

responsible for ensuring all fleet requirements are met.

Within Grampian, THInC have identified gaps in patient

transport provision within Aberdeen City. Partners have

collaborated with Buchan Community “Dial a Bus” and

successfully secured Change Fund monies, awarded by

Aberdeen Council of Voluntary Organisations. This has enabled

a one year pilot to be established providing transport options for

those previously unable to access health and social care in

Aberdeen with bookings managed by THInC. The pilot was

launched on 2nd March 2015.

Where do we want to be - Conclusion

The Board believes that our investment plan should be directed

towards:

Delivering our Healthfit Vision and developing the Clinical

Strategy by responding to new and improved ways of

delivering services that require fewer assets as services

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

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

new technologies such as the EPR and video

conferencing.

Seeking further innovative solutions to property needs

through co-location, integration and shared

services/resources across Grampian with all its partners.

Improving estate and asset performance on all key

performance indicators, including a targeted reduction in

significant and high risk backlog maintenance and a

continued programme of essential equipment replacement.

Disinvesting from buildings with high operating costs,

backlog maintenance requirements, or short remaining life

where these do not meet future service requirements.

Investing and developing new technology that achieves

simplification of the existing ICT infrastructure, while

simultaneously allowing additional investment.

Within the following section of the plan, we set out how our

assumed capital allocation will be invested for the next five

years and our priorities for the five years beyond. However there

remains a high degree of risk associated with the need for

further significant investment in the replacement of:

Essential medical equipment

Upgrading the 15 year old ICT infrastructure

The plan aims to reduce backlog maintenance by £68m

compared to an overall maintenance requirement in excess of

£193m (Restated April 2012 fig), targeting investment at high

and significant risk as a priority.

Whilst this will improve the performance of our estate, further

availability of capital would enable significant issues to be

addressed within the

major hospital environment and a number of our health

centres;

essential Medical Equipment and ICT infrastructure which is

fundamental in providing the necessary platform to modernise

and improve efficiency of clinical care.

How do we get there ?

Making Service Change Happen

Engagement with stakeholders is a key factor in making change

happen, whether with respect to Asset Management or the

design of new buildings. Encompassing this in our plans

Having stakeholder engagement from inception through delivery

of our Clinical Strategy and Asset Management Plan will ensure

NHS Grampian delivers the appropriate services that best meet

the needs of the population of Grampian.

The Scottish Capital Investment Manual (SCIM) sets out the

requirements for this in detail from Service Planning, Strategic

Assessment, Initial Agreement through to Outline and Full

Business Cases.

Asset Investment Prioritisation

The Scottish Capital Investment Manual has provided the

template for NHS Grampian to develop its prioritisation and

monitoring process of capital and revenue infrastructure

projects.

The process was approved and managed by the Asset

Management Group;

SBAR and Strategic Assessment submitted to the AMG for

consideration, when approved it will be given a project

number and added to the project list.

If approved the project will then be prioritised through the

decision criteria as follows:

o Service Planning will score the Strategic Fit (patient

centred) against the National 2020 Vision and Quality

Ambitions, our Clinical Strategy and provide a rationale

for the score.

o Each member of the AMG will score both the service and

business need (effective quality of care) and non-financial

benefits (health of the population) based on the

requirements of the project and provide the rationale for

the score.

o Property and Asset Development Team with specialist

input will score the risk reduction (Safe) against our risk

register, backlog maintenance, patient safety,

service/business interruption, adverse publicity etc. and

provide the rationale for the score.

o Finance department will provide the value for money

score based on information available at the time, whether

capital, revenue, endowments, fund raising etc. and


o Acceptability will be scored by corporate services against

political (local and national) and social acceptability and


All scores will be reviewed (up or down) as more information

becomes available through the approval process or if the

project is altered for any reason. Acceptability in particular

will score higher as a project progresses through the

process. The resultant total scores will then be fed into the

Capital Planning System to give a prioritised order for all

projects.

AMG will either reject, request re-submission with further

details or give approval to submit an Initial Agreement (I.A.)

If the I.A. is given approval AMG will either request that the

project proceeds to Outline Business Case (OBC) or

Standard Business Case (SBC), projects over £3m will also

require Capital Investment Group (CIG) approval.

If OBC is approved then AMG will request that the project

progresses through to Full Business Case (FBC), projects

over £3m will also require CIG approval.

All projects will require either SBC or FBC approval by AMG and

the Board and in some cases CIG to progress through to an

approved and committed project.

The table overleaf lists the current NHS Grampian

prioritised Investment Requirements. The top 20 projects

have a supported Strategic Assessment completed.

NHS Grampian Asset Investment Prioritisation

Item Project Type Description

Overall

scorePriority

Tota

l

Sco

re

P002 Inverurie Hosp and HC site development Development

The development of a new Inverurie Health and Care Hub on

the Inverurie hospital site that will also replace the existing

health centre. The proposed new integrated model of service

delivery is fully in line with national and local policies and

the strategic direction of NHS Grampian and Aberdeenshire

Council in shifting the balance of care and the integration

health and social care. 838.5 1

P008-P007 Baird Family Hospital and Anchor Unit Replacement

This will include a new Maternity Hospital and woman's

services in one central hub on the Foresterhill site and the

provision of a new Cancer Centre adjacent to the new liear

accelerators. 836.5 2

P001 New Denburn BacklogExisting Health Centre requires to be replaced due structural

issues with the building. 816.5 3

P024 Bucksburn/Dyce Medical Solution ReplacementNew Medical Centres solution is required within the

Bucksburn/Dyce community as a result of population growth,

aging accommodation and limited space for expansion. 783.5 4

P025 Banchory Medical Practice ReplacementA new joint Health and Social Care Facility is required within

the community. 748 5

P004 Westburn Road site (inc. Foresterhill Court) Sale

717 6

P042 Inverurie Hospital – Steam Boiler Backlog Replace Steam Boiler 716 7

P051 Peterhead CMU DevelopmentPeterhead Community hospital to provide a Community

Midwife Unit (CMU). 710.5 8

P040 Multi-Storey Car Park Development Provision of a new Multi-Storey Car Park to be built on the

Foresterhill site. 704.5 9

P026 Ellon Health Centre Replacement

A replacement/extension to the Health Centre is currently

being discussed with Aberdeenshire Council as a result of

population growth and the need to provide local accessible 702 10

P028 Keith Medical Practice ReplacementA replacement to the Health Centre is required as a result of

population growth and no space for expansion. 693 11

P016 Learning Disability (Elmwood) ReplacementIn-patient service to be considered for moving on to the

Royal Cornhill Hospital 678 12

P041 Woodend Hospital – Steam Boiler Backlog

Replace Steam Boiler 662 13

P020Laboratory Information Management System

(LIMS) Replacement

The existing dated LIMS is in need of replacement. 661.5 14

P009 ARI Reconfiguration Development

The Foresterhill site rationalisation plan identifies Phase 1 as

the future location for ambulatory care services in the

medium term. Haematology outpatients and day unit and the

Upgrade of ARI Pharmacy inc. new robot 658.5 15

P039 Foresterhill Health Centre Replacement

A new Medical Centre is required within the Foresterhill Site

to allow the demolition of the existing building to enable the

build of the new Baird family hospital. 658.5 16

P027 Northfield/Mastrick Medical Practice Replacement

A new Medical Centre is required within the community as a

result of population growth, aging accommodation and

limited space for expansion. 655.5 17

P003 Woodend South Block

New provision for Care of the Elderly (non-Acute) services in

Aberdeen. The Granary building is being considered for the

main base and certain day services. An option appraisal to be

undertaken for in-patient services. Maidencraig to be

relocated to Westview (either redesign or extension).

Replacement of hydrotherapy is being considered on a

partnership basis with ACC, and long term options for

wheelchair services and other services located within the

east of the site shall be considered by the Woodend

blueprint group. There will also be costs associated with

decommissioning a significant part of the site. 649.5 18

P023 Increased imaging and MRI Capacity Development

There is a requirement to increase imaging capacity in

particular MRI capacity on the ARI site and for a new MRI

provision within the Moray area. 643.5 19

P052Mental Health and Learning Disability Ward

ImprovementsBacklog

There is a requirement to carry out refurbishment works to

all Mental Health and Learning Disability ward areas across

Grampian to enable the patient environmental

improvements, HAI targets, significant self-harm risk

management concerns and wider health & safety issues

which were revealed by workplace inspections. 638 20

P022 IT Solution(s) for Community based Staff Development

This is required to assist with Health and Social Care

Integration and the Children and Young Persons act e.g. the

Child’s Plan/named person responsibilities. 628 21

Item Project Type DescriptionOverall

scorePriority

Tota

l

Sco

re

P019 HEPMA DevelopmentA new Hospital Electronic Prescribing and Medicine

Administration system is required. 627.5 22

P013 Laboratory Accommodation, ARI Development

Combine a number of clinical laboratory services into shared

Blood Sciences accommodation. Also longer term

requirements to develop Genetics accommodation on the

ARI site for period 2020-2030 in line with national capital

framework. 621 23

P039 ARI - Theatre Ventilation replacement. BacklogThere is a requirement to replace the Theatre Ventilation

Plant at ARI. 619.5 24

P018 Mortuary Replacement

There is a need to review all mortuary facilities within

Grampian to ensure the service meet all demand

requirements and comply with modern standards. The

mortuary at Foresterhill is accommodated in 1930’s facilities

and we also have dated facilities at Woodend, Dr Grays and

Spynie. 615.5 25

P005 Spynie Hospital Sale Relocation of existing services and sale of site 612 26

P021 Patient Portal Development

At present NHSG utilises several websites, sitting in isolation

of each other and containing varying degrees of partial,

complete and duplicated information. The benefits of a

Patient Portal is to allow patients access to safe, trusted 584 27

P006 Office accommodation for Spynie staff Replacement 570.5 28

P029 Danestone Medical Practice Replacement


result of a large population growth and very limited space for

expansion. 560.5 29

P015 Ear Nose and Throat (ENT) ReplacementA permanent solution is required for the accommodation of

ENT facilities with the city of Aberdeen. 557.5 30

P010 New Surgical Ward and Theatre Block, ARI Replacement

There is a requirement to replace the remaining outdated

surgical wards and theatre accommodation with high quality

accommodation that meets modern standards. 554 31

P011 Cardiac Centre, ARI DevelopmentConsider the expansion of the current cardiac

accommodation on the Foresterhill site. 542.5 32

P036 Balmedie, Aberdeenshire DevelopmentExisting settlement in Aberdeenshire with no GMS premises 524.5 33

P047 Aberdeen City Equipment store Replacement

Having problems with using the warehouse in the city as an

equipment store - it is failing to meet required standards of

cleanliness etc. 505 34

P030 Kincorth Medical Practice Replacement


result of a large population growth and very limited space for

expansion. 497.5 35

P017 Foresterhill Laundry and CSSD Replacement The current laundry and CSSD facility is required to move due

location, building condition and backlog maintenance costs. 491.5 36

P035 Newmachar, Aberdeenshire DevelopmentExisting settlement in Aberdeenshire with no GMS premises 490.5 37

P040 AMH - Interim Works Backlog Refurbishment of Theatre, Firecode works and the Neonatal

and Labour ward ventilation requires replacement. 490 38

P012 Medical Physics Accommodation, ARI Replacement

The General Medical Equipment Department requires to be

relocated to accommodation fit for purpose and more central

to its core users. 471 39

P032 Torry Medical Practice Development

An extension to the existing building is required to

accommodate the large population growth within the Torry

area of Aberdeen. 431 40

P033 Victoria Street Medical Practice Replacement

An extension to the existing building at Kingswells is

required to accommodate patients from the Victoria Street

branch when the lease terminates in 2017 431 41

P043 New dental facilities at Stonehaven Development 426.5 42

P031 Fochabers Medical Practice Replacement A new Medical Centre is required within the community as a

result of population growth and limited space for expansion. 424.5 43

P045Increased space for Orthopaedics Outpatients

and office accommodation at WoodendDevelopment

New Theatres at Woodend has led to an increase in staff

levels, additional accommodation is required for these staff

members (space audit required). 415 44

P034 Portlethen Medical Practice Development

An extension to the existing building at Portlethen is

required to accommodate the population growth within

Portlethen itself and the surrounding area. 414 45

P014 Clinical Research Facility, FHC DevelopmentWork jointly with Aberdeen University in the Foresterhill

Health Centre 398 46

P048 Healthy Hoose, Aberdeen Replacement

The Council have indicated that we shall need to be out of

the existing building by December 2016. Most of the

residents are going to be relocated in the surrounding area

and we shall come under immense pressure to reprovide the

service. 381.5 47

P046 Countesswells, Aberdeen Development Emerging settlement in Aberdeen with no GMS premises 376.5 48

P044 New dental facilities at Peterhead Development 373 49

P037 Blackburn, Aberdeenshire DevelopmentExisting settlement in Aberdeenshire with no GMS premises 337.5 50

P038 Elsick, Aberdeenshire DevelopmentEmerging settlement in Aberdeenshire with no GMS

premises 286.5 51

Our investment programme for the next 5 years

The Asset Management Plan sets out the Board’s investment

priorities to support the delivery of patient care and associated

services across Grampian. This is integral to the delivery of the

NHS Grampian Healthfit vision, our Clinical Strategy and our the

strategic plans of each of the three Integration Joint Boards.

The investment programme is focused on actions across four

main areas:

Investment in infrastructure consistent with our strategic

health priorities as described earlier including initiatives to

reduce carbon emissions;

Reduction in high and significant risk backlog maintenance

in clinical areas and compliance with statutory

requirements;

Replacement of essential equipment and ICT infrastructure

to enable the Healthfit vision;

Disposal of assets declared surplus to requirements.

The supporting financial plan incorporates the resources aligned

against expenditure areas financed from revenue, capital and

through asset sales.

We have assumed a formula capital allocation over the five

years of the plan consistent with that outlined in the Board’s

Local Delivery Plan.

Our infrastructure programme also includes £15.5m of

investment to be financed from charitable donations, a

combination of individual philanthropic donations for specific

projects such as the new MRI scanner and the Foresterhill car

park and new equipment purchases and ward refurbishment

through the Board’s Endowment Funds.

Our plans are summarised as follows in table 24:

Table 24

Investment in strategic health priorities

During the five year period of this local delivery plan, we will

progress the new Baird Family Hospital, ANCHOR Cancer

Centre and Diagnostic and Treatment Centre for which

Capital funding has been allocated.

A planned programme of enabling works will commence during

2016/17 and 17/18 which will include the replacement of the

Foresterhill Health Centre and the relocation of the Eye

Outpatient Centre.

Investment in integrated services

The plan assumes that we will progress a number of priority

primary care developments during the next five years:-

Provision of new healthcare facilities within the existing

Inverurie Hospital site incorporating a Health Centre,

Community Maternity Unit (CMU) along with a Community

Dental suite, Diagnostic and Treatment suite and an X-ray

suite. This will establish a new model of service. Integrating

a range of health and social care services to create a “Care

Hub”. The specification, schedule of accommodation,

design, business case and local community consultation

have all been progressed in the last year with the aim of

reaching financial close by summer 2016 and work on site

commencing autumn 2016. The project is currently planned

for completion in in the first quarter of 2018.

Since the government announcement of £19m to be

invested in General Practices the Board has considered

how best to use this funding supported by Developer

NHS GRAMPIAN SUMMARY INFRASTRUCTURE AND BACKLOG MAINTENANCE PROGRAMME

16/17 17/18 18/19 19/20 20/21

Total 5

Year Plan

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

Core CRL

Formula allocation 12,751 12,751 12,751 12,751 12,751 63,755

Allocation Adjustment 7,500 0 (2,500) (2,500) (2,500) 0

Baird & Anchor 2,000 4,000 60,877 71,875 7,000 145,752

Diagnostic & Treatment Centre 0 10000 20000 10000 0 40,000

Revenue to capital 0 0 0 0 0 0

Capital to revenue (1,000) (1,000)

Radiotherapy Equip Prog 247 150 247 0 0 644

Additional allocation - backlog maintenance 11 0 0 0 0 11

Sub Total Core CRL 21,509 26,901 91,375 92,126 17,251 249,162

Withdraw al of NBV benefit by SGHSCD (2,630) 0 0 0 0 (2,630)

Net CRL 18,879 26,901 91,375 92,126 17,251 246,532

Non Core CRL

CRL Cover est - Inverurie - hub 0 10,100 0 0 0 10,100

CRL Cover est - Foresterhill - hub 0 7,816 0 0 0 7,816

CRL Cover est - Other Primary Care - hub 0 0 19,000 0 0 19,000

Sub Total Non Core CRL 0 17,916 19,000 0 0 36,916

Total Gross CRL 18,879 44,817 110,375 92,126 17,251 283,448

OTHER FUNDING SOURCES - CAPITAL

Estimated Actual NBV benefit on disposal - property 3,394 3,918 995 1,729 0 10,035

Estimated Actual NBV benefit on disposal - equipment 0 0 0 0 0 0

Estimated Actual NBV benefit on disposal - hub Sub Debt 0

OTHER FUNDING SOURCES - CHARITABLE CONTRIBUTIONS

Endow ments - Phase 2 ari 1,594 0 0 0 0 1,594

MRI - Woodend 1,257 0 0 0 0 1,257

Endow ments - Mortuary 299 299

Endow ments - Stroke and Plastic Surgery accommodation 125 125

Endow ments - Roxburgh House 291 291

ARI Multi Storey Car Park 10,401 10,401

Endow ment - Equipment 500 500 500 500 500 2,500

OTHER FUNDING SOURCES - REVENUE

Estimated Net Surplus on Disposal of Property 3,203 8,286 2,094 2,596 0 16,179

Estimated Net Surplus on Disposal of Equipment 0 0 0 0 0 0

Developer Contributions 925 100 100 100 100 1,325

Estates Maintenance operational budget 1,140 1,140 1,140 1,140 1,140 5,700

Additional Estates Maintenance 0

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

Inverurie Enabling IJB Funding 130 130

VAT Recovery 0

TOTAL FUNDING AVAILABLE FOR INFRASTRUCTURE AND BACKLOG MAINTENANCE42,388 59,011 115,454 98,441 19,241 334,534

PLANNED EXPENDITURE

HUB Schemes on Balance Sheet (inc New Build Equipping Costs) 0 17,916 19,000 0 0 36,916

Strategic Investment inc New Build 13,891 18,010 84,487 77,875 0 194,263

Backlog Maintenance/Statutory Standards 21,415 17,798 2,420 1,200 1,184 44,017

Essential Equipment Replacement 6,571 4,775 9,036 18,855 17,546 56,783

Other 511 511 511 511 511 2,555

TOTAL GROSS EXPENDITURE 42,388 59,010 115,454 98,441 19,241 334,534

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

Contributions to ensure maximum benefit for patients. Focus

for this work will concentrate on the corridors of Dyce and

Newmachar; Bucksburn and Blackburn; and the

community of Balmedie.

Denburn Health Centre – the existing health centre

requires to be replaced due to structural issues with the

building. A site has been identified and a new build will be

provided under a hub capital scheme with developer

contributions significantly assisting in the provision of the

facility.

Crimmond Medical Practice will relocate to a new purpose

built building provided by a local benefactor which will be

run and operated by a charitable trust. The cost of which will

be no more than currently paid.

Renal services south of Aberdeen City - There are

currently no dialysis facilities in the south of Aberdeenshire

meaning that patients who require dialysis have to travel to

Aberdeen 3 times weekly for between 4 and 6 hours of

treatment. The patients, staff and Grampian Kidney Patient

Association have chosen Stonehaven as the next site for a

satellite haemodialysis unit which will be situated within

Kincardine Community Hospital.

Charlie House – The Scottish Government and NHS

Grampian have approved the proposal to grant a

concessionary lease to Grampian Children’s Respite Care

(to provide an area of land within Woodend Hospital Site) to

provide a centre for children’s respite care. It is expected

that the centre, currently known as Charlie House will

provide a home from home environment where children will

be fully cared for in a safe, supportive and stimulating

setting.

Child Development Teams (CDT) – new property leases

are required to accommodate 2 of the CDT’s within

Aberdeen City, there is also a requirement for capital

funding to deal with a further 3 teams within Aberdeenshire

who are currently accommodated in inadequate

accommodation. A business case is being developed to

establish the most appropriate development programme.

Establishment of an NHS Grampian cyclotron – NHS

Grampian are currently working with Aberdeen University to

finalise the options for replacement of the existing Cyclotron,

which has reached the end of its useful economic life, and is

owned and operated by Aberdeen University. The cyclotron

is a particle accelerator used to produce radioactive isotopes

for medical imaging purposes. Typically it is used to produce

Fluorine 18 which is a positron emitter that can then be

injected into patients and imaged using a PET scanner.

These isotopes have a half-life of up to a few hours so

production and imaging are ideally done in the same

geographical location and continuity of the diagnostic PET

scanning service based at Aberdeen Royal Infirmary, which

currently serves all of NHS Grampian, NHS Highland, NHS

Orkney and NHS Shetland, is dependent on a sustainable

local source of supply.

Reducing carbon emissions

The Board is committed to reduce the level of carbon emissions

across our property base and all new developments are

delivered with integral technology designed to reduce energy

use and consequently carbon emission levels.

The Carbon Energy Fund (CEF) contract with Vital Energi was

signed on the 29th December 2015, the programme includes :-

replacement of boiler plant at Dr Gray’s, provision of a steam &

condensate link from the Energy Centre to the Foresterhill

Laundry which will allow the closure and removal of East End

Boilerhouse, provide energy links from the Energy Centre to

Royal Cornhill Hospital, Dental School, Dental Institute and

further proposed developments, provision of a new Foresterhill

High Voltage (HV) intake substation and improvements to the

existing HV infrastructure, replacement of a large number of

chiller units at ARI and extensive lighting replacement at RCH

and ARI. NHS Grampian will benefit from a significant reduction

in carbon emissions from this investment as well as

improvements to infrastructure estimated at c £15.m over the 25

year life of the contract.

Reduction in backlog maintenance statutory compliance

The Annual State of NHSScotland Assets and Facilities report

highlighted, nationally, many of the issues that are the focus of

our Asset Management Plan. The report places particular

emphasis on the extent of backlog maintenance that the

remaining estate requires in order to bring accommodation up to

the relevant physical and statutory standards.

Accordingly our financial plans allow for substantial resources to

be targeted at delivering a demonstrable reduction in high and

significant risk backlog maintenance inpatient clinical areas,

whilst maintaining an essential equipment replacement

programme.

The total assessed backlog risk across all NHS Grampian

properties at April 2016 was £138m (this excludes backlog

associated with surplus properties) of this £26m was high or

very high risk.

Our programme will continue with targeted expenditure

initiatives, asset disposals and site rationalisation resulting in a

substantial reduction in backlog maintenance compared to the

£193m1 2012 base point.

A major element of this programme was the planned package of

works to be undertaken in the East End 2 and Phase 2 blocks at

ARI and the relocation of the Eye Out Patient Department to

Phase 1 at ARI.

The work associated with the East End 2 block (target price

£5.452m) is now complete with services operational in their new

accommodation September 2014.

Stage1 of the Phase 2 works was completed in November 2015

with Stage 2 due for completion June 2016.

1 Please note that the above values used to quantify backlog maintenance

risk are stated net of VAT, fees and other on costs which means that the

actual project costs necessary to deliver the required works are often well in

excess of these values

In February 2016, the Board approved Stage 3 of the project at

a not to be exceeded cost of £10m. This stage will involve the

establishment of a new general surgery department and surgical

high dependency unit and will be completed during 2016/17.

The final stages of the Phase 2 backlog project will be

undertaken during 2017/18 and 2018/19. The Project is

providing a safer and more appropriate environment for our

patients, staff and visitors.

It is assessed that the East End 2 and Phase 2 programmes will

contribute £14.72m (net of VAT, fees and other on costs) to the

reduction in backlog maintenance.

In February 2016, the Board also approved the initial stage of

the Phase 1 ARI backlog maintenance project (including

relocation of the Eye Out Patient Department and upgrading of

the lifts) at a cost not to exceed the identified budget of £6m

including all risk and contingency allowances and the

replacement of the Aseptic Pharmacy Suite located within

Phase 2 of ARI.

The overall programme at ARI is underpinned by a complex

series of service moves, a “decant plan”, which is agreed on a

stage by stage basis by both clinical leaders and the acute

sector management team. The decant plan aims to ensure

services are only require to move once prior to occupying their

permanent accommodation.

The following table 25 from our financial plan summarises the

budgeted expenditure on backlog maintenance (inclusive of

VAT fees and other on costs) and the sources of funding

available to support the programme over the 9 years 2012/13 to

2020/21

NHS Grampian Backlog Programme

Table 25

Residual backlog at March 2020/21

Whilst NHS Grampian will significantly reduce its backlog by

March 2021 (by £61m), a sizeable backlog risk will remain in

our estate (£132m). Remaining backlog over time will

increase in value and level of risk unless a new build or

backlog maintenance programme is continued.

The largest remaining area with a future clinical use with high

levels of backlog is Phase 1 and the Theatres at ARI. The

Foresterhill site rationalisation plan identifies Phase 1 as the

future location for ambulatory care services in the medium term.

Following agreement on the service plan a works programme

will be established to deal with the remaining backlog.

Replacement of essential equipment

A key element of our capital programme is replacement of

essential equipment and critical assets. There has been

significant engagement with clinical services in order to assess

the level of risk and prioritise available funding to target

essential equipment replacement.

The detailed equipment replacement strategy is gradually being

refined, and is informed by a comprehensive assessment of

risk. The commitment to the priority backlog maintenance

programme impacts on funding available to fully support a

replacement equipment programme.

During 2015, the AMG agreed a detailed investment plan for

equipment replacement, informed by a comprehensive

assessment of risk. £3m was committed in 2016/17, £3m in

2017/18 rising to £6m in each of the following three years for

essential equipment. The available funding will be targeted at

those areas of highest risk.

There are a number of areas where investment is required such

as re-equipping the main theatres, recovery and ITU areas at

ARI and Woodend Hospital with replacement patient monitoring

equipment the cost of which is around £3m. Currently there is

no funding within the 5 year plan to address this.

Disposal of surplus assets

A key element of the capital plan is achieving the programmed

disposals of surplus assets. Our financial plan requires £17m

of receipts in 2016/17 and £8m in 2017/18. The disposal

programme is closely monitored by the Asset Management

Group.

Clearly our planning must remain realistic regarding additional

resource to support new service development over the period of

the plan. We continually refine our expenditure proposals to

and shape our programme to ensure that we can take account

of uncertainties in terms of asset disposal receipts.

Our ability to meet aspirations of the asset management plan is

therefore dependent on delivering asset sales including:

Denburn Health Centre

Woolmanhill Hospital, Aberdeen

Woodend Hospital – South Block

Westburn Road site (including Allotments, Foresterhill

Court and surrounding premises), Aberdeen

Spynie Hospital, Elgin

A further asset base review is planned for the second quarter of

2016/17. As we implement our clinical strategy, it is envisaged

further premises will not meet future service requirements and

may be disposed of to free up capital and revenue and for re-

investment in reducing the backlog deficit.

Table 26

ElementLow Medium High V.High Total

Physical Condition

External Works & Grounds 108,620 55,977 6,780 0 171,376

Structure 78,818 61,585 5,650 6,780,000 6,926,053

External Fabric 2,187,306 513,570 929,990 28,250 3,659,116

Roofs 949,946 916,615 298,040 0 2,164,601

Drainage 19,210 55,560 2,260 0 77,030

Internal Fabric 4,413,001 376,285 0 0 4,789,286

Internal Fixtures & Fitttings 426,124 236,870 11,300 0 674,294

Hot & Cold Water Systems 80,931 414,991 36,160 0 532,081

Electrical Installation 256,806 674,373 283,630 0 1,214,809


Comms - Alarm/Safety 71,075 62,150 38,985 0 172,210

Heating Systems 243,890 252,352 112,435 0 608,677

Steam systems 5,000 2,760 6,780 0 14,540

Ventilation & Conditioning 142,263 431,353 3,390 0 577,006

Piped Medical Gases 15,565 23,560 0 0 39,125

Lifts 135,600 56,670 67,800 0 260,070

Boilers and Calorifiers 128,820 532,456 1,188,760 0 1,850,036

Fixed Plant & Equip 21,280 123,170 0 0 144,450

Fuel Storage and Distribution 0 8,280 3,955 2,260 14,495

Energy Conservation 169,046 602,565 0 0 771,611


Statutory Standards

Safe Hot Water Temp 68,794 135,066 667,216 33,900 904,976

Legionella 11,800 92,810 23,843 500 128,953

Asbestos 2,000,226 870,275 107,345 474,600 3,452,446

Firecode 53,966 275,018 369,461 91,530 789,975

Health & Safety 6,780 47,630 11,583 1,565 67,557

Disabled Access 259,327 51,563 0 0 310,889


Statutory Standards Total 2,400,892 1,472,361 1,179,448 602,095 5,654,795

Total Backlog 11,902,001 6,984,240 4,175,363 7,412,605 30,474,209

Total Impact of Asset Disposals 2012 to 2018

Investment priorities for 5 to 10 years

A formal mechanism for prioritising and monitoring capital and

revenue infrastructure projects has been approved by the Asset

Management Group to underpin the developing model of care

largely resulting from the Integration of Health and Social Care

as previously described. Strategic assessments, as required

under SCIM have already been carried out or are in the process

of being completed for the priorities listed below, which have

yet to be funded.

Provision of high quality care environments focused on

meeting patient need

Ambulatory Care – (£30m) The Foresterhill site

rationalisation plan identifies Phase 1 as the future location

for ambulatory care services in the medium term. A firm

works programme will be agreed after the service

configuration is finalised.

New Surgical Ward and Theatre Block – (£250m) there is

a requirement to replace the outdated surgical ward and

theatre accommodation with high quality accommodation

that meets modern standards.

Cardiac Institute - The strategic vision is for a new

“Cardiac Institute” incorporating a 3rd Hybrid Cath Lab,

dedicated CMR and embedded enhanced clinical research

accommodation. A joint NHS Grampian and Aberdeen

University fundraising initiative is now underway in

partnership with a major oil company and is expected to

raise funds in the region of £12 million.

Medical Physics Accommodation – (£10m) The General

Medical Equipment department requires to be relocated to

accommodation more central to its core users, in the heart

of our clinical accommodation. A short term solution is

being considered within the East End 3 of ARI.

Laboratory Accommodation - in the short term

consideration has been given to using released space in

East End 3 at ARI for the lab facility to expand into. The

long term strategic vision is for an integrated Blood

Sciences Service which would provide capacity to meet the

demand for the service. This change can only be delivered

through the provision of a new purpose designed and built

laboratory facility, somewhere central to the clinical care.

Mortuary – (£10m) the mortuary at Foresterhill is

accommodated in 1930’s facilities. In the short term minor

improvements will be made but there is a need for a new

mortuary to meet the demands of the service and comply

with modern standards. The new mortuary could be located

with the Blood Sciences Service if a suitable location is

identified.

Nuclear Medicine - will require to be relocated to

accommodation on the Foresterhill site more suited to

patient access which can accommodate the latest

advances in nuclear medicine technology.

Clinical Research Facility – A site has been identified

adjacent to the life sciences Centre to the east of the

campus. The University have been seeking grant funding

and may yet achieve this through working with Opportunity

North East (ONE).

Learning Disability – (£1.5m) The in-patient service wish

to move into the Royal Cornhill Hospital Clerkseat building.

This would improve safety for staff by reducing isolation,

provide a much quicker response to emergency calls and

improve access for on-call staff during anti-social hours.

Patient safety would also be improved by better quicker

responses as a consequence of clinical and nursing

emergencies.

Bringing our infrastructure up to modern standards

Foresterhill Laundry – The current laundry facility needs

to move because of location and backlog maintenance

cost. However NHSG is engaged through the shared

Services Programme, with colleagues from Highland,

Tayside, and Fife in relation to a regional laundry / linen

service. All of these Boards have significant property and

asset investment needs regarding Laundry facilities in the

next 1 – 5 years.

Investing in our communities

Improving Facilities for Older People in Grampian –

(£4m) Proposals will be developed to provide a community

base for Care of the Elderly Services in Aberdeen. The

Granary at the Health Village may be considered as one of

the options. If an appropriate solution is found then this will

enable NHS Grampian to vacate the South Block at

Woodend Hospital.

As demographics and settlements change including new

and emerging settlements, there may be the need for NHS

Grampian to review general practice patient boundaries.

This may include the current boundary configuration of

services within IJB’s.

Major IM&T Investment

HEPMA – (£3m) a new Hospital Electronic Prescribing and

Medicine Administration system is required. The

introduction of a HEPMA system could provide a significant

change to current practice and improve patient outcomes. It

would affect all hospital staff who prescribe, administer or

handle medicines, Improving levels of legibility, accuracy

and prescribing decision support that cannot be achieved

with the current paper-based systems.

Laboratory Information Management System (LIMS) -

(£2m) the existing dated LIMS is in need of replacement.

Patient Portal - (£2m A Patient Portal would allow patients

access to safe, trusted information related to them

personally and the management of their medical conditions,

including appointments, correspondence, questionnaires

etc. This would be huge step forward from the current

websites used which have no security. A Project Board has

been formed to develop a model for the future and bring

forward a Business case.

Major Medical Equipment

Increased imaging and MRI Capacity – (£7m) there is a

need to increase imaging capacity in particular MRI

capacity on the ARI site and for a new MRI provision within

the Moray area.

Primary Care Infrastructure

Banchory Medical Practice – (£12m) a new joint health

and social care facility is required which could include other

public. A site has been identified in the emerging local

development plan which appears to be well supported by

Banchory residents and local politicians. The current health

centre has temporary buildings which have temporary

planning consent, this is due to expire in August 2016.

Discussions are ongoing with the local authority. Developer

contributions will be required.

Ellon Health Centre – (£11m) The Health Centre requires

replacement or extension and has temporary buildings with

a planning consent due to expire in December 2016. The

neighbouring academy site provides an ideal opportunity to

retain health in the centre of the community. Aberdeenshire

Council are currently developing a masterplan for the

academy site, which will include health provision and a land

price has been agreed in principle: Developer contributions

will be required.

Danestone Medical Practice – (£11.5) a new Medical

Centre is required within the community as a result of a

large population growth and no space for expansion.

Discussions are well advanced with the owners of the

neighbouring site at Grandholm (7000 new residential units)

to secure a site and developer contributions. The site could

be available in 2016.

Northfield/Mastrick Medical Practice – (£8m) a new

Medical Centre is required within the community as a result

of population growth, ageing accommodation and limited

space for expansion. A temporary solution has recently

been put into place by way of temporary buildings. The

expansion of residential housing in neighbouring

Greenferns provides an opportunity to identify a suitable

long term site option. Discussions are ongoing with the

owner of the site, Aberdeen city Council. Developer

contributions will be required.

Keith Medical Practice – (£9.5m) a replacement to the

Health Centre is required to address functional suitability

issues and a lack of space.

Kincorth Medical Practice – (£6m) a new Medical Centre

is required within the community as a result of a large

population growth and very limited space for expansion.

Developer contributions will be required.

Fochabers Medical Practice – (£4.5m) a new Medical

Centre is required within the community as a result of

intrinsic population growth over a number of years and

limited space for expansion. Developer contributions will be

required

Torry Medical Practice – (£4m) an extension to the

existing building is required to accommodate the large

population growth within the Torry area of Aberdeen.

Developer contributions will be required

Major Backlog Maintenance Priorities

Woodend Hospital – Theatre Ventilation replacement

Aberdeen Royal Infirmary - (£3m) Theatre Ventilation

replacement.

Laundry and CSSD Roof – Cladding of the laundry roof is

required to extend the life of the building until a longer term

solution is identified.

A more efficient and effective asset base

Office Rationalisation - Develop and implement plans for

new flexible work styles for administrative staff. Best

practice will be applied to all offices and their use which

potentially will lead to office accommodation being

rationalised. This could include taking advantage of any

opportunities that may arise through the new Integrated

Joint Boards or Local Authority office rationalisation. The

result will be improved efficiency, improved staff

satisfaction, and reduced office accommodation costs

which will in turn release resources for patient benefit.

More Effective Access – Improve access to inpatient and

outpatient facilities at major hospital sites by improving

accessibility of car parking spaces for both patients and

visitors. This will be achieved by improved traffic

management and where possible increased parking

numbers.

The Implementation Plan

How we will implement the plan

The Healthfit Vision and developing Clinical Strategy will be

supported by the asset investment /disinvestment plan and

whilst not limited to will focus on:

Public engagement

Involvement and participation in change – taking account

of the public’s views and raise public awareness on the

future of health and care services

Implement a consistent decision making process –

producing a consistent and rational approach to decision

making and resource which is measured against

organisational priorities

Formulating health and healthcare plans to improve and

modernise

Service reviews – formulate a process for Grampian-wide

service reviews

Locality reviews – along with the newly created IJB’s

formulate a process for reviewing the needs of the

population of localities and how those needs can best be

met through service redesign.

Managed Clinical Networks (MCNs) – to be re-focused to

support planned and unplanned care and service

integration

Joint commissioning plans – Enhance plans to support the

integration of services for elderly people

Regional working through the North of Scotland Planning

Group, ensuring regional wide approaches to service

delivery and predominantly with the acute and mental

health sectors.

Manage and develop our assets and planned investment

into assets more effectively by utilising expertise on a

regional basis.

Developer Contributions

NHS Grampian will continue in partnership with its local

Authorities to mitigate the impact of new housing development

by seeking developer contributions. Where appropriate these

funds would be best used to develop joint community solutions

working with the Community Planning Partnerships.

Business Case Development

Each case will be developed through the NHS Grampian

prioritisation process in line with the new SCIM process. This

includes a Strategic Assessment, an Initial Agreement through

to Standard Business Case or Outline and Full Business case

for every project. Again, very much in line with the new SCIM

process, the focus will at all times be on improved patient

access, outcomes and benefits. Innovation, and new ways of

working will be encouraged to be considered as options.

Public Procurement in Scotland

On April 18th 2016 some of the biggest changes to public

procurement in Scotland come into effect. The implementation

of the new EU Public Procurement Directives through the

Public Contracts (Scotland) Regulations 2015 and the Public

Procurement Reform (Scotland) Act 2014 through the

Procurement (Scotland) Regulations 2016 which place

significant new duties on all public bodies’ with a procurement

activity total contract value above £50,000.

To take account of these changes a Procurement Protocol has

been issued via Budget Steering Group. Awareness sessions

regarding its application are currently underway across

Grampian. To assist with compliance all product or services or

works contracts with a value of >£50k shall be tendered by

NHS Grampian’s Strategic Procurement department via the

PCS-Tender system.

NHS Grampians Standing Financial Instructions (SFI’s) have

been modified to reflect these changes and are awaiting formal

Audit Committee and Board approval.

Governance, Performance and Risk Management

The implementation of this plan will be supported and

monitored through a robust governance and performance

management framework, the key elements of which are set out

below.

Performance monitoring - an explicit and integral part of

this plan is regular reporting of performance to the Asset

Management Group and Performance Governance

Committee of the Board.

The Project Director for all approved investment projects

in excess of £0.5m has to prepare a highlight report for

consideration at each bi monthly Asset Management

Group meeting demonstrating expenditure against budjet,

programme, change control, issues and opportunities and

major risks to objectives.

Key Performance Indicators – key performance indicators

identified in CEL 35 (2010) are monitored by the Property

and Asset Development Team and reported to the Asset

Management Group.

Asset Condition Surveys – we aim to continue reviewing

NHS Grampians property condition and performance data

through a five yearly cycle of re-surveys as required in

CEL 35 (2010). The most cost effective way of

progressing would be by employment of 2 surveyors (1x

building and 1x engineering), who would survey and

record all of NHS Grampians 6 Facet Survey

requirements including property condition on a five yearly

cycle. Monies to progress employing surveyors are the

matter of ongoing dialogue.

Through continued involvement in Structure and Local

Development Plans as developed by Planning Authorities,

identify sites required for healthcare and have them

categorised for healthcare use; ensuring the Local

Development Plan’s recognise that from time to time

healthcare assets will become surplus and that alternative

uses consistent with other surrounding uses would be

acceptable; and to ensure that NHS Grampian can benefit

from Developer Contributions where appropriate.

Continued critical review of NHS Grampian’s Asset Base

including early identification of sites for healthcare use

The importance of investment in and maintenance of our asset

infrastructure is reflected as a strategic risk to NHS Grampian,

articulated as follows:

There is a risk that our infrastructure will not be fit for purpose if

we are not able to fund an adequate asset investment,

replacement and backlog maintenance programme or redesign

of service provision to reduce dependence on physical

buildings. (NHS Grampian risk Register)

The responsible officer for managing assets and the

consequential risk on behalf of the Board is the Director of

Finance, who provides formal assurance to the Senior

Leadership Team and the Board (through the Performance

Governance Committee) on the actions taken to mitigate risk

and ensure the strategic risk register is reflective of the

organisations current position.

The monitoring of a projects programme, cost, quality and risk

is managed as a programme by the Asset Management Group

which is chaired by the Director of Finance

Beyond the strategic risk register, risks associated with our

infrastructure are captured and monitored at a service level

through our operational performance arrangements, with all

risks and mitigating actions captured within the DATIX system.

At an individual project level, detailed risk registers are also

maintained and updated through the respective project boards

established to monitor their progress from inception through to

commissioning.

Further details of roles and responsibilities around the

performance framework are presented in Appendix A

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