The State Hospitals Board for Scotland - PAMS... · (P)AMS and associated assets annually through...

The State Hospitals Board for Scotland

Property and Asset Management Strategy 2015 – 2020

Contents:

1 Executive Summary

1.1 The Purpose of the State Hospital Property and Asset Management Strategy (P)AMS

1.2 The State Hospitals Board for Scotland

1.3 Other Assets and Investment

1.4 The State Hospital (P)AMS

1.5 Organisational Strategies

1.6 Governance and Performance Management

1.7 Current Status and Issues

2 Where are we?

2.1 Strategic context & The State Hospital Property and Asset Management Strategy


2.3 Property and Asset Management Structures and Governance

2.3.1 Accountability Arrangements 2.3.2 (P)AMS Production Process

2.3.3 Information systems

2.3.4 Assurance Statement

2.4 The assets and the issues

2.4.1 Land

2.4.2 Buildings and property

2.4.3 Site layout

2.4.3.1 Office Accommodation

2.4.3.2 Service changes

2.4.4 Vehicles

2.4.5 Security Equipment

2.4.6 eHealth and IM&T 2.4.7 Medical Equipment

2.4.8 Total Assets

2.4.9 Backlog Maintenance

2.4.10 Changes to SCART (Statutory Compliance and Risk Tool)

2.4.11 Planned Preventative Maintenance (PPM) and Reactive Maintenance 2.4.12 Sustainability, Energy and the Environment

2.4.13 Fire Risk Assessments and Emergency Preparedness

2.4.14 Workforce plan

3 Where do we want to be?

3.1 Significant National or Local plans, Key targets and Deliverables

3.2 Possible changes to need or to associated services

3.3 Consultation and Engagement

3.4 Risks and Challenges

4 How do we get there?

4.1 Projects and plans; costs, procurement, benefits, project lead and risks.

4.1.1 Minor planned or possible investment (to be managed within normal capital / revenue allocation):

4.1.2 Significant planned or possible investment (requiring additional funding):

4.1.3 Other Work Streams

4.2 Affordability

5 Appendices

Appendix 1: National Asset and Facilities Performance Framework

Appendix 2: Estates and Asset Management System high level Board report

1 Executive Summary

1.1 The purpose of the State Hospital’s Property and Asset Management Strategy ((P)AMS) The NHSS requires that each Health Board submit an annually reviewed Property and Asset Management Strategy covering the coming 5 – 10 years. The (P)AMS should meet defined criteria demonstrating that investments are:

Carefully considered and planned

Contributing to organisational aims

Used effectively and efficiently

Monitored and maintained appropriately

Decommissioned, disposed of & replaced effectively and efficiently 1.2 The State Hospitals Board for Scotland The State Hospitals Board for Scotland is a special health board proving high security mental

health care for Scotland and Northern Ireland. It occupies a single site of approximately 65Ha. It

has 140 beds and approximately 700 staff. A major rebuild of The State Hospital completed in

2012; 90% of the site is less than 7 years old, with the remaining 10% refurbished.

Its buildings include patient accommodation, off ward therapy areas, offices, carer’s facilities,

security buildings and estates buildings. In addition its other assets include IM&T, Estates and

Security equipment and infrastructure. The value of the organisations assets is £63m.

1.3 Other Assets and Investment

Uniquely, a high proportion of the hospitals assets are related to security; the majority of the

security equipment and infrastructure was replaced or refurbished over the process of

rebuilding. IT is also a significant element of the organisation’s assets. Both areas may require

significant investment over the life of this (P)AMS as high value assets approach end of life.

Work is underway to scope the extent of the requirements.

1.4 The State Hospital (P)AMS

The State Hospital (P)AMS includes consideration of assets in the following categories:

Land

Buildings

Security Equipment and Infrastructure

Medical Equipment

Estates Equipment and Infrastructure

IM&T Hardware and Infrastructure

Vehicles

And gives further consideration of

Service Changes

Sustainability

Backlog maintenance requirements

1.5 Organisational Strategies The Hospital’s strategy is described by The State Hospitals Local Delivery Plan (LDP). The LDP is the State Hospital’s description of how it will achieve the key deliverables of the Route Map to the 2020 Vision for Health and Social Care. Through compliance with The Asset Management Policy for NHSScotland, the State Hospital (P)AMS will in turn ensure that the strategic aims are supported by the performance management, maintenance and replacement of assets as required. 1.6 Governance & Performance Management The condition & performance of the hospitals assets is undertaken through a range of information systems including the Estates Asset Management System (EAMS) and the regularly updated asset register. As of this year the Health Facilities Scotland KPI dashboard will be regularly reported to the hospital’s Senior Management Team. Property and asset performance is considered annually by the Boards Audit Committee, and the Annual (P)AMS is reviewed and approved by the State Hospital’s Board.

1.7 Current Status and Issues

The majority of the organisation’s asset base is its buildings, all of which have been

replaced or refurbished within the last seven years.

The demand for high security beds remains stable and is likely to continue to remain so,

though the hospital has been able to operate across 11 of its 12 wards for part of the

year.

The national work streams around integration and shared services may have some

impact for the organisation, but is unlikely to impact significantly on assets.

This means that the (P)AMS is primarily focussed on monitoring and maintaining the

condition and performance of those new assets and maintaining or replacing other, more

minor, assets. A range of other important pieces of work are required to support the strategy;

amongst these some key issues are:

Monitoring the assets for changes in the speed of deterioration and the backlog maintenance requirement

Reviewing the future use of the Occupational Health and Management Centre buildings

Setting realistic energy and carbon reduction targets

Monitoring for long term change in demand for beds at The State Hospital and across the Network

Concluding and implementing reviews of vehicles & workforce

Concluding reviews of the secure perimeter and the IM&T network and planning investment and implementation

Continuing to engage with national work on Health and Social Care integration and shared services and monitoring for impact

Taking the opportunity to implement the wind turbine energy project should funding become available

2 Where are we now?

2.1 Strategic context & The State Hospital Property and Asset Management Strategy

The National Health Service in Scotland holds assets worth in excess of £5 billion. In order to

ensure effective use and governance of these assets each health board produces and submits

an annual Property and Asset Management Strategy covering the coming 5 – 10 years.

The State Hospital (P)AMS describes how the organisation uses its assets efficiently, safely and

in a way that contributes to health improvement as articulated in the Scottish Governments

2020 vision for high quality health. The (P)AMS does this by examining Where we are now,

looks ahead to Where we want to be and takes cognisance of risks, opportunities and potential

barriers to achieving these aims in How we will get there.

The strategic agenda for healthcare services in Scotland is set by The Healthcare Quality

Strategy for NHSScotland. The Local delivery Plan for The State Hospital details how the

organisation intends to meet the requirements of this strategy and other key strategies.

The strategic aims of the hospital align with the “HEAT” targets of

Health Improvement

Efficiency and Governance Improvements

Access to Services

Treatment appropriate to individuals

And are set within the overall context of the Quality ambitions set out in the NHSScotland

Quality strategy;

Person centred

Safe

Effective

The Asset Management Policy for NHSScotland establishes the policy environment and key

performance indicators for asset management, which include the submission to the Scottish

Government of annually updated asset management strategies. The policy provides a

framework against which the planning, delivery, management and disposal of assets is

undertaken. The framework (The National Asset and Facilities Performance Framework),

provides quality outcomes for assets and facilities that align with the 2020 vision through the

quality outcomes of the quality strategy. The performance framework includes consideration of

the physical environment, statutory compliance, costs, and the (P)AMS. The framework is

shown in full at Appendix 1.


The State Hospitals Board for Scotland is the sole provider of high security mental health care

for adult males in Scotland, also providing the same service for Northern Ireland. It is a Special

Health Board and provides 140 beds, with approximately 700 staff. It occupies a single site in

South Lanarkshire. The hospital was almost totally rebuilt over recent years, with building work

beginning in 2007 and progressing through 3 phases to completion in 2011.

Given that the patients do not have access to other services or communities, the Hospital

redevelopment addressed the clinical model aspiration of ensuring the site, as far as possible,

meets all of the patients needs (e.g. therapeutic, vocational, social, spiritual and physical

wellbeing) via a range of therapeutic, educational, diversional, health and recreational services.

The site configuration and security features mean that the majority of patients are able to access

the grounds and attend therapy departments without requiring escorting staff.

A post project review of the rebuild project has been undertaken this year and concludes that

the rebuild met its overarching targets of cost, time and quality and meets the aspirations of the

organisations clinical model. Positive feedback was received across all areas of the strategic

review, which included clinical effectiveness, safety and security, physical environment, staff,

patients, carers and finance. As would be expected the review identified some lessons to be

learnt with regard to future projects, operational and management matters.

All assets are located at the State Hospitals site (See Figure 1). Figure 1: The State Hospital Location

2.3 Property and Asset Management Structures and Governance

The (P)AMS supports the delivery of the clinical and corporate strategies and is approved at Board level. In order to ensure an effective link between the Hospital’s operational activities, planned objectives and national strategy, the (P)AMS Board lead is the Security Director.

The performance of assets is seen as critical by the State Hospitals Board. For the hospital to meet its strategic objectives it is essential that existing and planned investment is targeted and effectively utilised. The Board considers the contribution and performance and risks of the (P)AMS and associated assets annually through reporting to the Board’s Audit Committee and the (P)AMS is approved by The State Hospital’s Board. This includes consideration of the NHSS asset KPIs (Appendix 1). 2.3.1 Accountability Arrangements Operational Management of asset management systems is overseen by The Security Director and relevant stakeholders, particularly the Facilities department. An organisational chart demonstrating accountability arrangements and information systems within the facilities department is at fig 2; Information systems are further explained at section 2.3.2. In addition the Security Director is responsible to the Board for resilience issues and Health and Safety which results in regular informal and formal discussion taking place regarding the state of all assets. The Head of Estates and Facilities attends the Business Continuity Group, Health Safety and Welfare Committee and Infection Control Committee. A full facilities operational organisational chart is at fig 3. Fig 2: Accountability Arrangements

Security Director

Head of Estates & Facilities

Estates Officer Estates Co-ordinator

Responsibilities

3i Estate Asset Management System (EAMS)

3i Fire & Risk Manager

VFA Capital Planning Tool

Statutory Compliance Audit and Risk Tool (SCART)

Corporate Greencode -Environmental Management System (EMS)

Energy Monitoring and Reporting Tool (EMART)

NHS National Services Scotland – Health Facilities Scotland – Estates & Facilities Benchmarking KPI’s

Ofgem – Ongoing Compliance with Renewable Heat Incentive (RHI) and Feed-In Tariff (FiT) obligations

Estates Maintenance Management System, including Planned Preventative Maintenance

Estates elements of Property and Asset Management Strategy ((P)AMS)

All maintenance contracts for the hospital

Control of Contractors

TSH Board

Fig 3: Facilities Organisational Chart

Security Director

Head of Estates &

Facilities

Estates Co-

ordinator

(Operational)

Housekeeping &

Linen Services

Manager

Catering Services

Manager

Estates Staff:

Porters (6)

Maintenance Assistants

(7)

Electricians (3)

Fitters (2)

Joiner / Locksmith (1)

Linen & Sewing

Staff (3) Housekeeping

Staff:

Supervisors (3)

Housekeepers (65)

Catering Staff:

Food Production

Supervisor (1)

Cooks (6)

Catering Assistants (8)

Hard FM Soft FM

Estates Officer

(Projects)

Estates

Administrator

Estates Admin

Assistant /

Telephonist

Telephonist / Admin

Assistant (2)

2.3.2 (P)AMS Production Process

The (P)AMS is ultimately approved by the State Hospitals Board prior to submission to Scottish

Government via HFS. Prior to Board approval it is scrutinised and approved for submission to

the Board by the Senior Management Team (SMT) of the hospital. The SMT is chaired by the

Chief Executive and includes membership from all clinical and non clinical areas of the hospital.

The Security Director is responsible for production of the PAMS, assisted by Facilities and

Estates staff. The diagram below at figure 4 shows how the (P)AMS is created and approved

with appropriate engagement and inclusion.

Figure 4: (P)AMS creation

SMT &

Board

eHealth Finance

Monitoring &

Performance

Information

Facilities &

Estates

Staff

Draft

(P)AMS

Infection

Control

Comm.

HFS

Security

Director

Staff

Partnership

Forum

Finance

Director

Groups & Committees

Sustainability

Patient Partnership

Health, Safety & Welfare

Business Continuity

2.3.3 Information systems

A range of information systems exist to monitor performance and compliance across the estate.

As the amount of data required by these systems increases demands on the Facilities staff also

increase. This is considered further within the Workforce plan section of this document.

Information systems include:

Statutory Compliance and Risk Tool (SCART), Estates and Asset Management

System (EAMS) and Capital Planning Tool

The SCART is a high level tool measuring risk and statutory compliance across all areas

of operations.

The EAMS examines the “6 facets”, which are the recognised standard measurements

for building performance;

Building

Engineering

Statutory compliance

Energy performance

Space utilisation

Quality

And produces a high level report summarising conditions across all of the Boards

buildings (Appendix 2)

An additional EAMS module (Fire and Risk Manager) is now mandatory for Boards and

reports on fire risk management.

The Capital Planning Tool assists with long term planning, considers lifecycle

information, is informed by EAMS data, allows change modelling & must be used to

support any business case.

Environmental Management System (EMS) and Energy Monitoring and Reporting

Tool (EMART)

The Environmental Management System links operations to legislation in order to allow

identification and assessment of risk.

The EMART system monitors weather corrected energy consumption and calculates

carbon emissions against our baseline and highlights variance.

Facilities Monitoring System (FMS) and Maintenance Management System (MMS)

The FMS and MMS monitor cleanliness standards and Healthcare Environmental

Inspection issues and how they are being addressed.

Information from these systems populates a Scottish Government NHSS Estates and Facilities

KPIs dashboard. As of the start of 2015 – 2016 this information is also going to be provided to

The State Hospital Management Team. Benchmarking from this information is challenging due

to the unique nature of the State Hospital, but as other organisations refine their information we

may be able to compare our performance with Medium Secure Units or other mental health

facilities.

2.3.4 Assurance Statement

The accountability arrangements and organisational structure ensure that:

Information, control and governance systems are in place

All appropriate authorisation systems are complied with

All relevant legislation is identified, assessed and complied with

All statutory and mandatory policies are in place and complied with

All relevant information is reported through the Boards systems

All of which are regularly assessed and monitored through relevant groups and committees

reporting to the Senior Management Team and Board as appropriate.

2.4 The Assets and the issues

The size of the State Hospital coupled with its function mean that it holds no high value assets

other than the buildings, IT systems and Security systems. Full details of asset values are at

table 8. The hospital also operates a small vehicle fleet. Medical equipment forms an almost

negligible part of the asset base.

The hospital’s major redevelopment project means that 90% of the buildings on site are less

than 7 years old, with remaining buildings refurbished within the same timescale.

The State Hospital holds assets worth approximately £63m. These assets include:

2.4.1 Land

The State Hospital owns approximately 69Ha. 35Ha of operational land is contained within the

secure perimeter; another 3Ha of operational land is outside of the secure perimeter and

consists mainly of land immediately adjacent to the secure perimeter and car parking. The

remaining 31Ha has been declared non operational and is the process of being trawled through

Scottish Government for alternative use as part of the process of disposal.

There is no backlog maintenance associated with the surplus land, therefore there will be no

reduction in backlog maintenance once disposal is completed.

Land values are included at table 1.

Table 1: Land values

Asset Description Net Book Value Replacement Cost

East Wing Land – Plot A £164,883 £164,883

East Wind Land – Plot B £52,150 £52,150

East Wing Land – Plot C £3,274 £3,274

East Wing Land – Plot D £35,600 £35,600

East Wing Land – Plot E £18,217 £18,217

West Wing Land Operational £640,625 £640,625

Total £914,749 £914,947

2.4.2 Buildings and property

The hospital occupies 11 buildings, 9 of which are within the secure perimeter.

90% of the buildings have been built and 10% refurbished within the last 7 years. Buildings

include:

Patient Accommodation in 4 blocks, each containing 3 units of 12 beds. (Arran, Iona, Lewis and Mull) The blocks have clinical team space adjacent to patient accommodation and are configured around multi-disciplinary teams

The Skye Centre, containing a range of therapeutic and recreational facilities, psychological treatments and a Primary Care facility

Reception (Security building and Family Visiting facility)

Estates and Facilities buildings (Essential Services block A and B)

A refurbished 1990s built ward now converted to office space (Harris)

Refurbished community hall providing training and conference facilities (Islay)

Modular build office accommodation (Management Centre)

Modular build Occupational Health Service (OHS) building (Outside of secure perimeter)

Electrical Substation (Outside of secure perimeter)

Building values are below at table 2.

Table 2: building values

Asset Description

Net book value (000’s)

Replacement cost (000’s)

Arran Hub £7,314 £7,919

Iona Hub £7,329 £7,935

Lewis Hub £7,315 £7,919

Mull Hub £7,316 £7,919

Skye Centre £7,427 £8,119

Essential Services Block 1 £1,027 £1,131



Reception Building £2,800 £3,023

Family Centre £748 £812

Management Centre £385 £514

Islay £629 £761

Harris £2,372 £2,833

Occupational Health £269 £360

Electrical Sub Station £118 £125

Total £48,662 £53,342

2.4.3 Site layout

The aerial photograph at fig 5 shows the site layout, with more detailed information on the

statutory facets shown at table 3.

Fig 5: Site plan

Table 3: Statutory Compliance Chart

The measures of building condition included in this (P)AMS are:

Physical Condition A=Excellent, B=Satisfactory, C=Not satisfactory, D=Unacceptable

Statutory Compliance (SCART) %

Environmental Assessment % change of energy use and carbon production against baseline

Functional Suitability A - D

Quality A - D

Space Utilisation E=Empty, U=Underutilised, F=Fully Utilised, O=Overcrowded B

uild

ing

De

sc

riptio

n

Bu

ild Y

ea

r

Flo

or A

rea

GIA

(M2

)

Ph

ys

ical

Co

nd

ition

Environmental

Assessment

Qu

ality

Fu

nc

tion

al

Su

itab

ility

Space Utilisation

Sta

tuto

ry

Co

mp

lian

ce

(SC

AR

T S

co

re)

Fully

Used

Under

Used

Empty

Site N/A N/A N/A

2014 / 2015 Q3

HEAT Target Report

shows a 25.98%

saving on energy,

and an 69.66%

saving on CO2 (in

comparison to the

baseline year of 2009

/ 2010 for the same

period)

N/A N/A N/A N/A N/A N/A

Essential Services

Block C (Estates

& Facilities) 2009 978.16 B B A 98.53% 0% 1.47% 93.56%

Essential Services

Block B (Catering

& Procurement) 2009 1203.2 B B A 100% 0% 0% 94.89%

Essential Services

Block A (Boiler

house) 2009 324.5 B B A 100% 0% 0% 97.30%

Skye Centre 2009 3862.3 B B A 99.67% 0% 0.33% 94.19%

Management

Centre 2004 465.72 B B B 100% 0% 0% 92.33%

Islay 1937 429.79 B B B 100% 0% 0% 93.56%

Arran 2011 3270 B B A 68.17% 8.12% 23.71% 95.56%

Iona 2011 3290 B B A 84.94% 9.84% 5.22% 94.66%

Lewis 2011 3270 B B A 87.43% 8.29% 4.28% 94.86%

Mull 2011 3270 B B A 85.15% 10.08% 4.77% 94.71%

Harris 1995 1433.73 B B B 93.32% 6.68% 0% 97.07%

Family Centre 2011 223.34 B A A 41.04% 58.96% 0% 98.10%

Reception 2011 1304.77 B B A 94.85% 5.14% 0% 97.45%

Occupational

Health 2005 200.92 B B B 91.05% 8.95% 0% 95.24%

External Land N/A 32.47 ha N/A N/A N/A N/A N/A N/A N/A

Railway Bridge 1950 N/A B N/A N/A N/A N/A N/A N/A

Main Intake

Substation 2009 75.99 B B B 100% 0% 0% 97.08%

Essential Services

Compound Area 92.68%

Average

SCART

score 95.20%

Heated Volume

(m3) 60,726.19

2.4.3.1 Office Accommodation

The Scottish Futures Trust, working on behalf of HFS, undertook a review of office

accommodation across NHSScotland in 2013. The review reports average office space per user

as approx 11m2, with a 2020 target of 10 m2. The State Hospital average amount per user was

significantly in excess of this figure.

The SFT has worked with The State Hospital to identify opportunities for introducing smarter

ways of working and the following contributing factors, opportunities and constraints have been

identified:

Clinical Model

An essential part of the clinical model is co-locating the clinicians working with patients.

The four patient accommodation areas have office accommodation immediately above

them, allowing this co-location. The most efficient use of office accommodation would

potentially disrupt this model.

Managing demand

The State Hospital is the sole provider of high secure mental health care for Scotland and

Northern Ireland. The nature of its business means that this care cannot be provided by

another site. The accommodation for staff and patients needs to be able to absorb any

increase in demand.

Design of new hospital

The design for the new hospital included an allocation per office user of approximately

12m2. Although some offices are of a size that means occupancy could be increased,

many are not.

Split site working

A number of State Hospital staff work between The State Hospital and other sites and,

due to the nature of their work, require a single office.

Difficulties in use by others

Many organisations are able to flexibly sell, lease or lend their excess capacity to other

organisations. Due to the secure nature of The State Hospital this is not possible.

Opportunities; Management Centre and Occupational Health buildings

The management centre and occupational health buildings are modular and could be

dismantled with relative ease. Although this produces a financial saving there are potential

issues that need to be explored more fully:

Management Centre

There are significant benefits to the co-location of the executive team in one

building. The impact of this change would need to be carefully considered. In

addition, the management centre hosts one of the hospitals 2 data centres, and

demolition of the building would then create a need for major change to the

hospitals data network. This change may be necessary in approximately 2 years

as the data centre approaches the end of its life and network changes may be

required; potential changes to the data network are currently being considered.

This provides a logical timescale for further consideration of the future of the

building.

Occupational Health

The Occupational Health service provides an essential service to staff and is an

important part of the response of The State Hospital to staff absence. Any plans

to remove this building will require to be considered very carefully for potential

impact in partnership with staff. The OHS contract will be reviewed over the

coming year and consideration of the location of the service will take place as

part of that review.

2.4.3.2 Service changes

It is important to note that the nature of a high secure service and site means that, by definition,

patients who require that service cannot be housed elsewhere. As the State Hospital is the sole

provider of high secure mental health care in Scotland and Northern Ireland any peaks in

service demand must be met by the hospital and services and assets must retain sufficient

capacity to be able to absorb any such peak.

The State Hospital has a capacity of 140 beds, though there are 144 useable rooms. The

additional 4 rooms provides contingencies for both the whole site and locally within each

accommodation area. Some changes have taken place in the way that the service has been

delivered over the last year; the occupied beds at the hospital have remained at or around 120

for long enough that we have been able to retract and operate across 11 of the 12 wards. This

has allowed the 12th ward to be closed for maintenance and decorating. Our plan is for the ward

to be used as a decant ward over coming years, enabling longer term planning for maintenance

and refurbishment.

The apparent reduction in demand for high secure beds is not of sufficient volume or duration to

allow permanent change; the change to operation across 11 wards is something that can be

reversed quickly if necessary. It is also important to note that the bed numbers at the State

Hospital are complicated by the fact that 1 ward is specifically for patients with a learning

disability, with the remaining beds for patients with a mental illness. This means that an increase

in mental illness patient numbers of just 8 (at time of writing) would mean that we would need to

consider reopening the ward.

The change in occupancy level occurred in concert with the opening of more medium secure

beds at the Rohallion Clinic in Perth. The regular needs assessment for forensic services

conducted by the Forensic Managed care Network confirms that the Medium Secure estate is

now the right size. Historically, The State Hospital has admitted patients that require medium

security under an exceptional circumstances clause, but this has not been necessary since the

Rohallion Clinic opened. Despite capacity across the medium secure estate being addressed

by this, there are concerns that the configuration and location of beds could improve. Should

any changes take place the likely impact on The State Hospital would be that a small number of

learning disabled patients may be able to move, though the single ward service model for

patients with Learning Disability means there would be little opportunity to reconfigure services

on site.

Occupied bed numbers over 2010 – 2015 are detailed below in table 4.

Table 4: Occupied bed numbers 2010 – 2015

Month 2010/11 2011/12 2012/13 2013/14 2014/15

June 132 136 134 134 126

September 134 133 133 129 122

December 132 132 139 129 122

March 135 134 130 128 120

2.4.4 Vehicles

The State Hospital has a fleet of 16 vehicles. The vehicles are all owned by The State Hospital.

The table below (table 5) gives a high level summary of the split by type and their current net book value. In 2013 – 2014 part of the fleet used for patient transport was replaced and the fleet size reduced. Although some of the remaining fleet have a moderate or high risk assessment score, which would normally indicate replacement is required within the next 1-2 years, they are all low mileage and well maintained so the risk associated with their age is mitigated.

With the exception of 1 forklift (Electric) and a Quad Bike (Petrol), the fleet are 100% diesel; the older vehicles have poor emission ratings. Monitoring of usage has improved through the year with individual journey mileage being recorded.

Further review of The State Hospital fleet took place in March 2015 and the recommendations of

that review are currently being considered. Opportunities exist to improve fleet size and

efficiency through replacement of single purpose vehicles with more flexible multi functional

vehicles and by improving journey planning and logistics.

Nationally, a shared services review of transport and fleet management is underway and we will

continue to engage with that review and await the outcome.

Table 5: Asset values of vehicles

Vehicle Descriptions Number Net book value

Replacement Cost

Cars 1

Vans 5

Buses / People Carriers 4

Others 6

Total 16 £57,692 £313,625

2.4.5 Security Equipment

The security of the hospital is paramount for the safety of the patients, staff and public. As part

of the redevelopment of the hospital security equipment was updated in the following areas:

Specialised locks

Staff alarm and communication systems

Perimeter: Fences, Electronic detection and observation equipment Locks The locks will be of good condition, functionally suitable, fully utilised and low risk for at least the next 5 years. Staff alarm and communication systems The alarm and communication systems will continue to require regular investment to ensure that they remain effective, but with that investment should be good condition, functionally suitable, fully utilised and low risk for at least the next 5 years. Perimeter Like other technology, security technology is developing at an increasing rate, and much of the specialised security equipment has the potential to reach obsolescence whilst still retaining an asset value. Contact with suppliers suggests that equipment support will be available for the immediate future, but a full replacement programme will be required to ensure that our standard is maintained beyond that timescale. Security technology is beginning to move from analogue systems to digital, and at some point a critical mass will be reached leading to a requirement to migrate to newer systems to ensure support. The fences, observation and detection systems have previously been identified as impending backlog within the EAMS system and are currently subject of a total review of efficiency and likely life in line with a projection for major capital investment in 2017 – 2018; an outline business case will be prepared for 2016 – 2017. The asset value of security equipment is below at table 6.

Table 6: Security equipment asset value

Asset Description Net book value Replacement cost

Access & Egress Equip £405,557 £552,396

Staff safety systems £2,871,894 £3,487,546

Perimeter & Site security £2,462,778 £3,594,019

Public Safety systems £4,042 £96,157

Total £5,744,271 £7,730,118

2.4.6 eHealth IM&T Hardware; Network . There are 3 key elements to the hospitals physical IT infrastructure;

Servers: The Blade servers installed in April 2012 are just over half way through the projected life span of 5 years.

Fibre: The fibre network replaced during the hospital redevelopment programme now has a projected life of 6 - 9 years (depending on date of replacement).

Switches: Some of the network switches are now at or past end of life. There are spare switches held in on site storage to mitigate any failures. We are working in partnership with external agencies to plan the replacement and upgrading of older switches. Support arrangements need to be considered to ensure future resilience of the networks components.

In order to ensure we continue to have resilient hospitals systems, the IT infrastructure was recently audited. The outcome of these audits have identified further areas were the upgrading and replacement of equipment may be required. Additional work is being undertaken to identify and prioritise this upgrading to ensure that the Infrastructure continues to be resilient.

(Projected life of IT equipment is based on industry standards of how long products are

supported by the manufacturer.)

Hardware; Personal Computers

PC stock is, on average, about 70% through its operational life, and the ongoing replacement

programme will maintain this standard.

Software and Systems Further developments are being explored for the Electronic Patient Record (EPR). This system is now the integral to the hospital as its main clinical records system and has become a significant dependency for the organisation. Software and licences are still a major element of IT expenditure. Spend will need to continue for this requirement to ensure the support and compliance of applications and systems over coming years.

IM&T assets and values are detailed below at table 7 Table 7: IM&T Asset values

Asset Description Net book value Replacement cost

Clinical & Business Systems

£105,577 £661,307

Server & Network Infrastructure

£545,517 £1,454,093

Software Licenses £54,663 £158,859

Desktop & Client Hardware

£169,952 £569,743

Control Room & mailing £937,683 £1,120,105

Telephone System £0 £38,671

Total £1,813,392 £4,002,778

2.4.7 Medical Equipment

The State Hospital requires very little medical equipment. The total value is approximately £31k and is an immaterial part of the asset base. The equipment we have is mainly situated in the Health Centre (a small primary care facility within The Skye Centre) and is made up of dental, ophthalmic and other primary care equipment. We also have a small quantity of medical equipment (e.g. defibrillators) situated in various locations around the site.

2.4.8 Total Assets

Table 8: Total Assets

State Hospital Assets

Asset Description Net book value

NBV % Replacement cost

Buildings £48,661,908 77.68% £53,342,347

Land £914,749 1.46% £914,749

Vehicles £57,692 0.09% £313,625

Security Equipment £5,744,271 9.17% £7,730,118

IT £1,813,392 2.90% £4,002,778

Medical equipment £31,365 0.05% £74,494

Furniture £868,001 1.39% £1,346,987

Site Services £3,064,607 4.89% £3,313,323

Assets Under Construction

£65,092 0.10% £65,092

Other £1,419,796 2.27% £1,990,476

Total £62,640,973 100% £73,093,989

2.4.9 Backlog Maintenance

Backlog maintenance includes any work required to bring the estate back to an acceptable

condition. The backlog maintenance requirement for the hospital remains low at £334k, though it

has increased over the last year, primarily due to inflation. Detail of the Clinical / Non Clinical

split is below at table 9. The condition and depreciation of the estate and assets is closely

monitored to ensure accurate identification of any backlog maintenance requirement and to

identify any change in the pace of expected depreciation.

As depreciation has taken place as expected the majority of the estate is now at condition “B”

and will require relatively minor investment to remain at that level over the period of this (P)AMS.

A few areas remain at Condition “A”; no areas are at Condition “C” or “D”. Other than carpets

and decor requiring some attention, significant projects are:

New telephone system, previously identified within the EAMS system. Required as the

existing system becomes more challenging to maintain. Estimated cost of £80k.

The Secure Perimeter, also identified within the EAMS system as impending backlog with a

notional budget of £5m, planned for 2017 – 2018 with business case preparation beginning

this year.

Table 9: Clinical and non clinical backlog maintenance

Site

Code

Site Name Use Low Moderate Significant High Unreported Total

D101H The State

Hospitals

Board

for Scotland

Clinical 0.00 202,383.00 91,191.00 0.00 0.00 293,574.00

D101H The State

Hospitals

Board

for Scotland

Non

Clinical

1,130.00 4,520.00 34,444.00 0.00 0.00 40,094.00

TOTALS 1,130.00 206,903.00 125,635.00 0.00 0.00 333,668.00

2.4.10 Changes to SCART (Statutory Compliance and Risk Tool)

The SCART system has changed this year from a 99 item question set to 570 items, exploring

issues in considerably more detail. With the introduction of the additional question sets, it is

anticipated that our SCART score will drop initially, until systems and procedures can be put in

place to inform the updated tool. We are in the process of populating the system, so at this time

cannot predict how much our overall score will be affected.

Prior to introduction of the new question set the Board’s current average SCART score was

95.2% with no high risks identified; a screenshot of the SCART scoring system is at fig 6:

Fig 6: SCART Screenshot Compliance Scores at April 2015

2.4.11 Planned Preventative Maintenance (PPM) and Reactive Maintenance As part of the hospital re-development, the Estates Team redesigned their PPM programme to suit the new buildings and systems. This was carried out during construction, allowing the new PPM programme to go live immediately following handover of the new buildings. Initially all the required PPM's (both statutory and non-statutory) aimed for a typical NHS model of 70% planned, 30% reactive work. This target was challenging, as the nature of the hospital means reactive maintenance has historically been higher than 30%. A further review followed after greater understanding of the buildings and systems was

achieved. This allowed a move towards implementing a Condition Based PPM programme for

non-statutory PPM’s. This was achieved by analysing completed PPM's on a quarterly basis and

adjusting frequencies where appropriate. Technology such as the Building Management System

(BMS) also contributed to more intelligent monitoring and analysis of systems. In addition,

technical staff were consulted regarding their view of the impact of any planned change. Any

PPM's that were adjusted were regularly monitored for an increase in reactive tasks and

breakdowns to ensure there was no detrimental effect.

Condition Based Monitoring Case Study: Air Handling Units

Air handling units exist throughout the hospital and require maintenance to maintain efficiency

and ensure safety. Frequencies were revised from 3 monthly to 6 monthly intervals. The filters

are now changed in response to alerts from the BMS system which informs when there is a

significant change in that particular system or plant, or if it is performing outwith pre-

programmed parameters.

Condition Based Monitoring Case study: Biomass Boiler Maintenance

Biomass boiler maintenance is undertaken by an external contractor while performance and

service requirement is managed through our PPM system.

The maintenance contractor specification suggested service intervals of 800 hours. Through

monitoring the condition of the boiler internally via our PPM system and discussing the system

with technical staff, the service interval has been extended to 1,000 hours. During this time there

has been no detrimental effect on the boilers condition or operation. Plans are being developed

to extend the servicing intervals to 1,200 hours.

A quarterly PPM audit ensures that all statutory PPM’s are being carried out in compliance with

the relevant guidance. A further monitoring audit is carried out by NHS National Services

Scotland, Health Facilities Scotland – Facilities Monitoring System (FMS) quarterly KPI returns.

The FMS KPI system is a useful indicator of how we as a Board are performing against other

Boards, and includes costing information per m2. A screen shot of some of the national

benchmarking data produced from the FMS KPI system is below at figure 7:

Fig. 7: National Benchmarking data from FMS KPI system

2.4.12 Sustainability, Energy and the Environment

Sustainability

The hospitals Sustainable Development Group includes representation from all areas of the

hospital including patients and is chaired by the Finance and Performance Management

Director, who is the Board’s Sustainability lead.

The Group has produced a Sustainable Development Action Plan (SDAP) which addresses

sustainability issues across the organisation. Initial work by The State Hospital on a Carbon

Management Plan has been further informed and developed through the StEEP (Strategic

Approach to Energy Efficiency) programme and the plan now addresses energy and carbon

reduction targets including lighting, waste, energy control software and staff awareness.

A Sustainability Reporting Tool is currently being produced by Scottish Government which will

require an annual report from Boards, beginning in October 2015.

To ensure that the Boards knowledge and thinking on issues remains current there is regular

interaction with Health Facilities Scotland (HFS) with attendance at the HFS Sustainability

Steering Group and sub groups. HFS Sustainability staff recently attended the State Hospital

Sustainable Development Group to give an update to the group on the forthcoming mandatory

sustainability reporting requirements.

Environmental and Energy Management

The State Hospital Environmental Management System (Corporate Greencode) ensures

identification of all environmental aspects through an Aspects Register which links to a Legal

Register highlighting relevant legislative risks. These have been individually risk assessed and

the Board have no Red Risks for action.

Corporate Greencode is primarily managed by the Estates Team with input from the hospitals

Sustainable Development Group.

Energy and Greenhouse Gas targets

As reported in the 2014 – 2015 PAMS, since 2012 energy performance has been measured

year on year against a 2009 baseline. This baseline preceded the full commissioning of the new

hospital and resulted in performance significantly above targets.

Rather than the previous year-on year target model, targets are now percentage reduction

targets from a baseline year through to financial year 2020. Targets will apply to absolute energy

consumption and to GHG emissions from energy use only. The baseline year will be an average

of the three years 2011 – 2014.

NHS Boards should have ‘basic’ and ‘stretch’ targets. The State Hospital targets are shown at

table 10 below. The basic target should be based on what the Board thinks could be achieved if

the investment for energy efficiency projects remains at current levels; although the changes

made in the new hospital leave us with less scope for improvement, we have been able to make

changes that allow us to set a “basic” target of 10% The stretch target should be based on what

the Board thinks could be achieved if all identified projects receive 100% funding. The State

Hospital projects, identified jointly with HFS through the Strategic Approach to Energy Efficiency

(StEEP) programme, are the introduction of intelligent lighting controls and the erection of a

wind turbine. The programme identified annual savings, both in terms of £’s and tCO2, other

potential income such as Feed in Tariff (FiT) and Renewable Heat Incentive (RHI), lifetime

savings, payback periods and a risk assessment for each project. Both projects are on an HFS

potential funding list, should central funding become available.

In addition, to energy consumption targets, Boards should specify the percentage of energy

consumption in 2020/21 to be delivered from renewable energy sources. A significant proportion

of State Hospital energy use is from renewable resources due to the use of biomass as our

heating fuel. This has also enabled us to be awarded the Renewable Heat Incentive, resulting in

an income in the region of £115k pa.

Table 10: Energy targets

Criteria The State Hospitals Board for Scotland : Energy & GHG Reduction Targets for 2020/21 (against 3-year average baseline 2011/12, 2012/13 and 2013/14)

Basic Stretch

Energy Consumption (kWh/m2)

Electricity

-6%

Fossil Fuel

-2.8%

Biomass

-2%

Electricity

-30%

Fossil Fuel -9%

Biomass

-4.2%

Combined -3.4%

Combined -13.3%

Greenhouse Gas Emissions (kgCO2e/m2)

133 92.6

Criteria The State Hospitals Board for Scotland : Percentage of Total Energy Consumption from Renewable Energy Sources

Basic Stretch

Percentage of heat consumption from renewable energy

sources

55.6% 56.7%

Percentage of electricity consumption from renewable energy

sources

0% 30%

Percentage of total consumption from renewable energy

sources

39.6% 53.4%

Greenspace During the redevelopment of the hospital a landscape architect was employed as part of the

project team and greenspace was created across the site:

External art was commissioned and situated as a feature in the grounds in the form of

wooden benches sculpted to replicate the 360 degree visible horizon

Other benches are placed around the grounds to encourage exercise and maximise

opportunities to enjoy fresh air and the expansive views

Mosaic walls were installed at each of the entrances to the patient accommodation

buildings, made unique by incorporating the name of each of the buildings

Further greenspace work has been carried out by hospital staff; an internal greenspace

has been created with a botanic garden including a pond. This is actively used for staff,

patients and visitors

To fully utilise the wander paths which were incorporated as part of the redevelopment,

hospital staff and patients undertook a project to identify walking routes of varying length

and physical exertion which were then mapped and identified by colour coded bollards

throughout the site

Outdoor gymnasiums have been installed in various places around the grounds

The animal assisted therapy department encourages skills development and therapeutic interaction with a variety of animals

“External art was commissioned and situated as a feature in the grounds in the form of wooden benches sculpted to replicate the 360 degree visible horizon”

“Other benches are placed around the grounds to

encourage exercise and maximise opportunities to

enjoy fresh air and expansive views”

“Mosaic walls were installed at each of the

entrances to the patient accommodation buildings,

made unique by incorporating the name of each of

the buildings”

“Further greenspace work has been carried out by

hospital staff; an internal greenspace has been

created with a botanic garden including a pond.

This is actively used for staff, patients and visitors”

“To fully utilise the wander paths which were

incorporated as part of the redevelopment, hospital

staff and patients undertook a project to identify

walking routes of varying length and physical

exertion which were then mapped and identified by

colour coded bollards throughout the site”

“Outdoor gymnasiums have been installed in various places around the grounds”

“The animal assisted therapy department encourages skills development and therapeutic interaction with a variety of animals”

The secure nature of the hospital means that it would not be appropriate to engage with Scottish

Natural Heritage or Forestry Commission Scotland to develop and promote our greenspace.

2.4.13 Fire Risk Assessments and Emergency Preparedness

Fire Risk Assessments

The EAMS fire and risk module, made mandatory for all Boards this year, is fully utilised at The

State Hospital; fire risk assessments have been undertaken for all buildings and entered onto

the system. Scottish Fire and Rescue have audited the majority of these risk assessments. The

system is also being used to record any fire calls or false alarms.

Exercises

A live exercise was held in June 2014 which had 4 fire appliances and an ambulance in

attendance. A vacant ward was filled with smoke and the exercise included the reporting of 4

people missing in the building. The exercise was successful, with some minor learning points

noted. Most of the issues have been addressed and a plan is in place to address those

remaining.

2.4.14 Workforce plan

A workforce review is planned across The State Hospital during 2015 – 2016. Issues that

require further exploration across the Facilities and Estates areas of the hospital include:

Monitoring and performance information

The increase in demands from information systems has dramatically increased the demand on

estates staff. The size of The State Hospital and its Estates Department means this increased

workload falls on a smaller pool than in other Boards. This needs to be further assessed. A

review of the management arrangements within the Facilities Department was undertaken in

2013 with assistance from HFS, so the report from that exercise will provide a useful

benchmark.

Shift in workload

Increased monitoring and maintenance of systems to meet legislation may provide opportunities

to look at the skill sets in the department. As the department becomes more familiar with the

new requirements through the year we will be able to further assess the implications of the

change and how to address it.

Succession planning and resilience

We need to ensure that we are maximising the opportunities to develop our staff to enable them

to look to career progression in the future whilst also ensuring that the organisation is also

planning for the future. We also need to ensure that the department has resilience; it is a small

department with some areas of expertise held by a small pool of people.

1 Where do we want to be?

The State Hospital is in the fortunate position of having all assets on a relatively small single site

with new or recently refurbished buildings that are all at or above condition “B” and a low

backlog maintenance requirement. The State Hospitals Board plans to continue to ensure the

assets continue to support the achievement of the strategic aims it is therefore critically

important that we do not become complacent and must continue to effectively monitor suitability,

quality, performance and condition. Regular consideration needs to take place of:

Significant national or local plans, Key targets and deliverables

Possible changes to need or linked services provided by others

Risks and challenges

3.1 Significant National or Local plans, Key targets and Deliverables

The Scottish Government has developed a Route Map to the 2020 Vision for Health and Social

Care, providing 12 priority areas for improvement and 25 key deliverables. The specialist nature

of The State Hospital means that some of the priority areas and deliverables are not applicable;

The Route Map as it applies to the hospital is shown below at table 11.

Table 11: State Hospital Route Map to 2020 Vision

ROUTE MAP TO THE 2020 VISION FOR HEALTH AND SOCIAL CARE

Triple Aim Quality

Ambitions

12 Priority Areas

for Improvement 25 Key Deliverables

Quality of Care

Person-

centred

Person-centred

care

1 Person Centred Health & Care

Collaborative Implemented

2

Information and support to enable

people at home and during times of

transition

Safe Safe Care

3 Further increase in safety in Scottish

hospitals

4 New broader measure of safety

developed (SPSI)

5

Maternity, mental health and primary

care components of the Scottish

Patient Safety Programme

implemented with measurable

improvements

Health of the

Population

Effective

Prevention

19 Early detection of cancer

20 New restrictions on tobacco

advertising

Value &

Sustainability

Workforce

21 2020 Vision for NHSScotland

workforce

22 Detailed action plan agreed to deliver

2020 Workforce Vision

Innovation

23

A new fund to provide pump-priming

for innovative approaches to

healthcare

24

A new procurement portal will be

established to encourage working

with SMEs and third sector

Efficiency &

Productivity 25

Recommendations to increase

shared services

The key deliverables for the organisation based on the 2020 Route Map are below at table 12.

Table 12: State Hospital Key Deliverables

25 Key Deliverables TSH Executive

Lead Contact LDP mapping

1 Person Centred Health & Care Collaborative

Implemented Nursing Director Section 8

2 Information and support to enable people at

home and during times of transition Nursing Director Section 8

3 Further increase in safety in Scottish hospitals Nursing Director Section 9

4 New broader measure of safety developed

(SPSI) Nursing Director Section 9

5

Maternity, mental health and primary care

components of the Scottish Patient Safety

Programme implemented with measurable

improvements

Nursing Director Section 9

19 Early detection of cancer Medical Director Section 10

20 New restrictions on tobacco advertising Medical Director Section 10

21 2020 Vision for NHSScotland workforce HR Director Section 11

22 Detailed action plan agreed to deliver 2020

Workforce Vision HR Director Section 11

23 A new fund to provide pump-priming for

innovative approaches to healthcare General Manager Section 11

24

A new procurement portal will be established

to encourage working with SMEs and third

sector

Finance and

Performance

Management

Director

Section 11

25 Recommendations to increase shared services

Finance and

Performance

Management

Director

Section 11

Health and social care integration with the associated focus on care at home is likely to have a

major impact on much of the service delivered by territorial Health Boards; in addition, the

Shared Services Review may have some impact on some of the support services based at

hospital sites. These national streams of work will be closely monitored for impact. At present it

seems that national work streams and our key deliverables and their implementation are unlikely

to have a significant effect on our assets, which will continue to be based around delivery and

support of delivery of high secure mental health care at the current site. As actions against these

deliverables are reported and discussed at the SMT and Board, any implications for assets will

be identified at an early stage. A review of the Clinical Model is being considered, which will

further consider how our services are configured to meet need; it is not thought that this will

have any significant affect on assets.

The Scottish Futures Trust (SFT) “Smarter ways of working” programme has identified that The

State Hospital has office space that is significantly in excess of the national average; although

many of the opportunities for improvement available to other Boards are not available to us, we

will take opportunities to look for improvements when available. Reviews of the future of the

Occupational Health building and the Management Centre will take place in due course, and

occupancy trends may also lead to opportunities.

3.2 Possible changes to need or to associated services

The State Hospital is part of the Managed Care Network for Forensic Services (The Network).

The Network is hosted at the hospital and the State Hospital’s Medical Director is also the

Medical Director of The Network. This position gives us a central and well informed place in the

planning and delivery of forensic services in Scotland. In addition, State Hospital staff attend

strategic and governance meetings of the English High Security Hospitals, allowing us to remain

well informed about service changes across the UK.

As described in 1. Where are we now?, the hospital is currently operating across 11 wards.

National demand for high secure services has dropped slightly, but not far enough or for long

enough that it can be regarded as sufficiently robust for long term planning.

Most of our patients who move on from the hospital are returned to prison or rehabilitated

through Medium Secure units, and the opening of beds at the Rohallion unit has added sufficient

capacity to the medium secure estate to ensure that patients are usually able to move within

appropriate timescales. The potential for geographically reconfiguring medium secure beds

exists, and should this occur the system is likely to become more efficient. The change to health

care delivery across the prison service, with the responsibility for health care now vested with

Health Boards, has improved communication and continuity, but has had no impact on the

requirement for high security beds.

As regards legislation, demographics and the care and treatment delivered to those requiring

mental health care in conditions of security, there is unlikely to be any changes that would

significantly affect the assets required to support that care within the life of this (P)AMS.

3.3 Consultation and Engagement

The hospital endeavours to work in partnership with staff, patients, carers and other

stakeholders. Any significant change in the delivery of services will be fully consulted on with

those affected. This is particularly high on the agenda of the Board, as previous changes

affecting patients have resulted in legal challenge, particularly relating to consultation. A

previous example of effective stakeholder engagement is the development and delivery of the

new hospital, when consultation and engagement took place with staff, patients and carers, a

model that improved the process and outcome.

3.4 Risks and Challenges

The wider healthcare environment and The State Hospital face significant challenges in coming

years; in order to meet these challenges and continue to meet the needs of our patients it is

important that our assets remain effective in supporting our service. There are:

Risks that we need to address

Work streams nationally that we need to remain engaged with

Work streams within the organisation that we need to commission or conclude

Practices that we need to continue

Risks that we need to address

Potential service risks are explored above; it is unlikely that there will be any significant changes

to the service the State Hospital is required to provide within the life of this (P)AMS.

The organisation does face financial challenges, as absence and overtime remain high and

savings targets need to be met. Although financial balance was achieved in 2014 – 2015, the

balance of the savings delivered was non-recurring, and further work is required through this

year to deliver savings and to redress this balance. Significant savings were delivered in 2014 –

2015 through oil prices, which remain low, but have the potential to change quickly in response

to global events.

Any savings targets that have the potential to affect asset performance must be carefully risk

assessed.

At present there are no risks associated with the (P)AMS that are of sufficient significance to warrant inclusion on the corporate risk register. This will be reviewed as part of the annual (P)AMS review and regular risk review.

National Work Streams

Health and Social Care integration and the Shared Service Review are both likely to have some

impact on the organisation, though current thinking suggests that it will not significantly impact

on assets. We will continue to engage with these work streams and monitor for any likely

impact.

Work streams within the organisation

We need to:

Continue the process of disposal of non operational land

Review the use of the Management Centre and OHS buildings within 2 years

Conclude the fleet review and identify actions whilst remaining engaged and informed

regarding the national review

Continue the investment in alarm and communication systems

Complete the review of the Security systems, identify requirements and plan to address

them

Complete the review of the IM&T network, identify requirements and plan to address

them

Procure and commission the telephone system

Identify any workforce issues through a review of the Facilities department with particular

reference to increased information system demands and increased monitoring

Engage with any internal reviews such as the potential review of the Clinical Model

Work we need to continue

We need to:

Monitor patterns of bed occupancy

Maintain the systems and processes that manage risk and identify issues, reporting as

necessary to the SMT and Board

Engage with Stakeholders in order to inform and consult

Explore, and implement as appropriate, Condition based monitoring to reduce non -

statutory PPM’s

Regularly review and continue to implement the SDAP and CMP

Take advantage of funding if available to introduce projects that meet “stretch” energy

targets

4. How do we get there?

The State Hospital is unlikely to require any significant service change across the life of this

(P)AMS and beyond. The Board is informed on this position by close links with major national

work streams and its close connections with the Network. Our journey to “Where we want to be”

will be dependent on capital funding continuing at recent levels, additional funding being made

available for some major projects and revenue continuing to be available whilst savings targets

are met.

Structures are in place to:

Monitor and report on asset performance

Identify and plan for changes in need

Engage effectively with stakeholders

Prioritise any competing investment needs

Implement any investment plans

Investment project management arrangements are shown below at figure 8.

Figure 8: Investment Project Management Arrangements

Project

Project Managers:

Head of eHealth

Physical Security Manager

Head of Estates and Facilities

Security Director:

responsible for Capital

Planning

Senior Management

Team: representation

from all areas of the

hospital

The State Hospitals Board

Project Team:

Membership as appropriate

4.1 Projects and plans; costs, procurement, benefits, project lead and risks.

4.1.1 Minor planned or possible investment (to be managed within normal capital /

revenue allocation):

Telephones

This project has a projected cost of under £100k, with a high level of certainty

The project is currently in the process of procurement via traditional tendering and capital

funding.

Consultation regarding the new telephone system indicates that users require a system

with similar functionality to that in place, with increased resilience. The project will

address the resilience risk posed by the current system and provide users with an

effective and robust system for coming years that is matched to the user’s requirements.

The project will be led by the Head of Estates and Facilities. A project plan will be

created that is tailored to the new system once identified, and the plan will be approved

and monitored by the SMT.

There are no significant risks to this project.

Staff Safety System

This project has a projected cost of up to £20k with a high level of certainty.

The Staff Safety System is a large and complex system comprises of a number of

overlapping systems that provide a resilient response to any need for assistance across

the site. Component systems include:

o Individually held personal alarms

o A public address system

o Response pagers

o Radio system

Regular investment will continue to take place; approximately £20k per annum has been

required to ensure all components remain effective and current. Procurement is usually

restricted to the system installer.

Investment will ensure that the system remains effective provides a safe system of

requesting assistance in emergency situations.

The project will be led by the Physical Security Manager.

There are no significant risks to this project

Vehicles

This project has an estimated cost of under £100k; as the draft report is still under

consideration this estimate has a low level of certainty

Any potential procurement route will be established when the draft report has been fully

assessed.

The review will be submitted to the SMT with an associated action and investment plan

for approval.

Potential benefits of the project will be increased energy efficiency, reduced GHG

emissions, reduced capital cost due to a smaller fleet, and reduced revenue cost due to

reduced maintenance and fuel costs.

The lead for this project is the Head of Estates and Facilities.

There are no significant risks to this project

4.1.2 Significant planned or possible investment (requiring additional funding):

Secure Perimeter

The estimated cost of this project is £5m. The stage of the review of the perimeter

means that this estimate has a low level of certainty.

The perimeter comprises:

o A 5.2m security fence

o Detection systems

o Lighting system

o Thermal Image and Optical cameras

o A 24/7 Control Room with alarm and control systems

Work will continue through the coming year to fully identify future requirements,

potentially leading to a business case for investment in 2017 – 2018.

The procurement route for improvements to the perimeter will be established once the

size and scope of the project is identified

The Secure Perimeter is essential to ensure that public, staff and patient safety is

maintained. The provision of a secure perimeter also allows the effective implementation

of the clinical model.

This project be led by the Physical Security Manager, reported to the SMT and submitted

to the Board for approval.

This project is potentially complex. Project risks include:

o Failure to adequately assess need, resulting in a perimeter that is insufficiently

secure

o Failure to plan effective implementation of change, resulting in potential security

failings during implementation

Plans are in place to mitigate these risks; a specialist in physical security has been

commissioned to undertake the review of the perimeter; the nature of the equipment and

implementation will require specialist project management, and similar expertise will be

sought to project manage the implementation of any changes.

IM&T Network

This project has an estimated cost of £0.5 - 1m. The stage of the network review means

that this estimate has a low level of certainty

Reliable and resilient IM&T system are essential to the effective working of the hospital.

Over recent years IT system developments have become central to the day to day

working of the organisation. Particular developments include the introduction of an

Electronic Patient Record and a Patient Movement and Tracking System that monitors

all patient movement within the hospital. Through the course of the coming year the

network audit will identify any investment requirements, including plans to replace the

data centres which have a projected future life of approximately 2 ½ years.

A procurement route will be established once plans are developed to an appropriate

stage

This work will be led by the Head of eHealth and reported to the SMT, with Board

approval sought for any associated business case.

This project is potentially complex. Project risks include:

o Failure to adequately assess need, resulting in a network that is not fit for

purpose

o Failure to plan effective implementation of change, resulting in potential failings

during implementation

Plans are in place to mitigate these risks. A specialist has been commissioned to undertake the

review of the infrastructure. The nature of the equipment and implementation will require

specialist project management, and similar expertise will be sought to project manage the

implementation of any changes

Turbine and Lighting controls

These projects have a projected cost of £1.3m and £37k. The well developed nature of

these plans means this projection has a high level of certainty

These projects are not currently affordable within State Hospital budgets and are on an

HFS potential funding list. Procurement will be led by HFS.

The benefit of these projects will be significant reductions in energy consumption and

GHG production coupled with potential income from the Feed In Tariff.

The lead for liaison with HFS, and for implementation should funding become available,

is the Head of Estates and Facilities in conjunction with HFS.

There are no significant risks related to these projects.

4.1.3 Other Work Streams

Backlog Maintenance

Backlog maintenance has a projected annual cost of £60k. This can be predicted with a high

level of certainty. The low requirement for backlog maintenance means this should be

affordable within current budgets, though given the challenging savings targets for the coming

year this will require careful monitoring by the SMT and Board. A plan is in development for

approval by the SMT that will prioritise areas of risk and balance operational requirements with

the need to address the backlog maintenance requirement over the period of this (P)AMS.

There are no significant statutory compliance risks.

Disposals

The planned disposal of non-operational land will continue, with the intent to conclude this by

the end of this calendar year. Receipts from the disposal are likely to be in the region of £200k.

This figure has a high level of certainty. The lead for this project is the Head of Estates and

Facilities. Progress with this work will be reported to the SMT and Board as appropriate. On the

conclusion of the disposal of this land it is not anticipated that any other disposals will take place

for the foreseeable future.

Review of use of Management Centre and OHS Building

During the next 2 years a review of the use and future of these buildings will be concluded. The

Management Centre review will take regard of the future IM&T plans for changes to Data Centre

location and associated network changes; the OHS Building review will consider the review and

tendering of the OHS service. Both reviews will consult with all involved, identify potential

savings and service implications and look for best value. The lead for the review of the

Management Centre will be the Security Director, working closely with the Head of eHealth; the

lead for the review of the OHS Building will be the Security Director working closely with the HR

Director. The result and recommendations of these reviews will be presented to the SMT and

Board for approval.

Workforce Review

A review of The State Hospital workforce will be undertaken within this calendar year, led by the

HR Director. Within this overarching piece of work, the Estates and Facilities department will

consider our resilience needs and the demands of changing information systems, monitoring

routines and consider succession planning. The lead within Estates and Facilities will be the

Head of Estates and Facilities.

Service Changes

Changes to the need for High Secure or other forensic services will be identified through the

regular needs assessment undertaken by the Network. The pattern of need has remained

relatively stable for over 20 years, and there is no indication that this will change in any

significant way over in the short to medium term.

The review of the Clinical Model at The State Hospital may result in minor change to the asset

requirement, and this will be monitored as the work progresses.

Sustainability and Energy

Performance against the Sustainability Action Plan will continue to be reported to the SMT and

the Board.

The HFS KPI dashboard will be reported regularly to the SMT and performance monitored.

4.2 Affordability

As described above, the PAMS has significant future challenges relating to ensuring funds are available. The 2015 – 2020 Capital Plan is shown below at table 12. The plan may require some revision to ensure alignment with future (P)AMS and any emerging issues, which should be affordable within the overall envelope of available capital. The plan covering years 2015 - 2018 has been approved by The State Hospitals Board and in principle by SGHD. The years 2018 – 2020 are assumptions based on known allocations and information and have not yet received State Hospital or SGHD approval.

Table 12: Capital Expenditure 2015– 2020

Capital Expenditure 2015- 2020 2015 - 2016 £000s

2016 - 2017 £000s

2017 - 2018 £000s

2018 - 2019 £000s

2019 - 2020 £000s

Statutory Compliance and Backlog Maintenance

50 50 50 50 50

Other (Perimeter Security) 5000

Total Property Expenditure 50 50 5050 50 50

Medical Equipment 25 25 25 25 25

Vehicles 25 25 25 25 25

Plant and Machinery 100 100 100 100 100

Total Equipment Expenditure 150 150 150 150 150

E-Health projects 100 1100 100 100 100

Total IM&T Expenditure 100 1100 100 100 100

Other Capital Expenditure 0 0 0 0 0

Total Gross Direct Capital Expenditure 300 1300 5300 300 300

Appendix 1 National Asset and Facilities Performance Framework

Quality

Ambition

Performance

Measure

KPI

Number

Key Performance

Indicator

Indicative 10

year

performance

benchmark

Current

Performance

Performance

Score (For

SGHD / HFS

use)

Patient

Centred

Quality of Physical

Environment

1 % of properties in “A”

or “B” Physical

Condition

90% 100%

2 % of properties “A” or

“B” Quality

90% 100%

Patient opinion of

healthcare

environment

3 +ve response to

patient questionnaire

hospital environment

rating

95% N/A: TSH

patients not

included in

survey

Patient needs are

accommodated in

modern, well

designed facilities

4 % of properties below

50 Yrs old

70% 98%

PAMS reflective of

service need and

patient preferences

5 PAMS Quality

Checklist Overall

Score (X/100)

95

Safe Statutory

Compliance status of

property asset base

6 Overall SCART

compliance %

95% 95.2%

Backlog

Maintenance

expenditure

requirement

7 Backlog Maintenance

£ / M2

£100 £14.13

Level of risk

associated with

outstanding backlog

maintenance

requirement

8 Significant & High

Risk Backlog

Maintenance % of

total

10% 37%

Effective

and

Efficient

Functional Suitability 9 % of properties “A” &

“B” Functional

Suitability

90% 100%

10 % of property “Fully

Utilised”

90% 88.17%

11 Building Volume (m3)

per 1000 population

2240 N/A: Building

Volume

64055m3

National

service,

population

approx 6m

N/A

Property

Maintenance Costs

12 Property Maintenance

£ / m2

£958 £35 £35

Rent and Rate Costs 13 Rent & Rates £ per

m2

£411 £921 £552

Energy Costs 14 Energy

£ per m2

£617 £1,193 £1,393

Energy Consumption 15 Gigajoules per m2 per

year

44 55.53

Total Overall Performance Score

Appendix 2 - Scottish Health Board Report - The State Hospitals Board for Scotland

Table 1: An analysis of the existing estate by area

Area (Sq.m) % of Total Area Value 05 Mental Health Hospital 18,691.33 79.19 £48,661,908.00

23 Offices 1,899.45 8.05 £0.00

24 Support Facilities 3,011.64 12.76 £0.00

TOTALS 23,602.42 100.00 £48,661,908.00

NB: Value is Net Book Value using only Block '00'. Blocks with Code No '00' have been excluded from the Area calculation. 3rd Party Tenure has been excluded from this table.

Land Values are included within the Net Book Values.

Chart 1A: Physical Condition – Percentage of Blocks with Overall Block Condition

NB: Third Party Ownership tenure has been excluded. Block No. 00 has been excluded.

Chart 1B: Physical Condition – Percentage of Square Metres with Overall Block Condition

NB: Third Party Ownership tenure has been excluded. Block No 00 has been excluded.

Table 2: The physical condition of the estate

Physical Condition Backlog (and Impending Backlog) Cost/Percentage of Total A-New B-Acceptable Condition C-Requires Investment D-Unacceptable Condition Unreported

Type Cost % Cost % Cost % Cost % Cost % Total

05 Mental Health Hospital 3,955.00 0.07 5,306,230.00 94.45 286,229.00 5.09 21,449.00 0.38 0.00 0.00 5,617,863.00

23 Offices 0.00 0.00 11,300.00 33.33 18,080.00 53.33 4,520.00 13.33 0.00 0.00 33,900.00

24 Support Facilities 0.00 0.00 28,250.00 89.29 3,390.00 10.71 0.00 0.00 0.00 0.00 31,640.00

% of Overall Total 3,955.00 0.07 5,345,780.00 94.06 307,699.00 5.41 25,969.00 0.46 0.00 0.00 5,683,403.00

NB: 3rd Party Tenure and PFI Tenure have been excluded from this table. Blocks with Code No'00' have been included.

Table 3: Physical Condition – Risk profiled backlog costs

Physical Condition Backlog Cost/Percentage of Total Type Low % Moderate % Significant % High % UnReported % Total

05 Mental Health Hospital 0.00 0.00 202,383.00 65.78 105,295.00 34.22 0.00 0.00 0.00 0.00 307,678.00

23 Offices 1,130.00 5.00 4,520.00 20.00 16,950.00 75.00 0.00 0.00 0.00 0.00 22,600.00

% of Overall Total 1,130.00 0.34 206,903.00 62.01 125,635.00 37.65 0.00 0.00 0.00 0.00 333,668.00

NB: This table includes only Costs where the Physical Condition grading is Not A or B. 3rd Party Ownership and PFI Tenures are excluded from this table. Blocks with Code '00' have been included.

Chart 4: Physical Condition – Risk profiled backlog costs

NB: This chart only includes costs where the Physical Condition grading is Not A or B. Third Party Ownership tenure and PFI tenure are excluded.Blocks with Block No '00' are included.

Table 5: Statutory Compliance – Risk profiled backlog costs

Statutory Compliance Cost/Percentage of Total Type Low % Moderate % Significant % High % Unreported % Total

05 Mental Health Hospital 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

23 Offices 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

24 Support Facilities 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

% of Overall Total 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

NB: This table includes all Statutory Compliance (A,B,C,D) including unreported. Third Party Ownership and PFI tenure are excluded. Blocks with code '00' are included in this table.

Table 7: Energy Performance Certificate

EPC Ratings

C or Better D E F G Not Required Unreported

Type Area sq m No of

Bldgs. Area sq m No of






Bldgs.

05 Mental Health Hospital 17,185.64 6 1,304.77 1 200.92 1 0.00 0 0.00 0 0.00 0 0.00 0

23 Offices 0.00 0 1,899.45 2 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0

24 Support Facilities 2,935.65 4 0.00 0 0.00 0 0.00 0 0.00 0 75.99 1 0.00 0

TOTALS 20,121.29 10 3,204.22 3 200.92 1 0.00 0 0.00 0 75.99 3 0.00 0

This table shows the total GIA and the number of all blocks with a record in the Block Condition table with a facet of 9 - Environment. All condition ratings are included plus Unreported, but A, B and C

condition ratings are shown added together in one column. Blocks with Block No 00 are excluded.

Table 8: Results from the appraisal of functional suitability

Functional Suitability

A –Very Satisfactory B - Satisfactory C – Not Satisfactory D - Unacceptable Unreported Type Area sq m % Area Sq m % Area sq m % Area sq m % Area sq m % Total

05 Mental Health

Hospital

17,839.09 98.98 183.93 1.02 0.00 0.00 0.00 0.00 0.00 0.00 18,023.02

23 Offices 1,369.25 75.50 444.31 24.50 0.00 0.00 0.00 0.00 0.00 0.00 1,813.56

24 Support

Facilities

2,460.23 83.93 470.95 16.07 0.00 0.00 0.00 0.00 0.00 0.00 2,931.18

% of Overall Total 21,668.57 95.17 1,099.20 4.83 0.00 0.00 0.00 0.00 0.00 0.00 22,767.77

NB: This table is based on ratings allocated against Rooms/Areas. Third Party Ownership Tenure has been excluded.

Table 10: Results from the appraisal of space utilisation

Space Utilisation

E – Empty Not Used U – Under Utilised F – Fully Utilised O - Overcrowded Unreported Type Area sq m % Area Sq m % Area sq m % Area sq m % Area sq m % Total

05 Mental Health Hospital 1,216.78 6.75 1,358.16 7.54 15,448.09 85.71 0.00 0.00 0.00 0.00 18,023.02

23 Offices 0.00 0.00 91.40 5.04 1,722.16 94.96 0.00 0.00 0.00 0.00 1,813.56

24 Support Facilities 14.00 0.48 0.00 0.00 2,905.08 99.11 12.10 0.41 0.00 0.00 2,931.18

% of Overall Total 1,230.78 5.41 1,449.56 6.37 20,075.33 88.17 12.10 0.05 0.00 0.00 22,767.77

NB: This table is based on the ratings allocated against Room Areas. Third Party Ownership is excluded.

Table 11: Results from the appraisal of Quality

Quality

A –Very Satisfactory B - Satisfactory C – Not Satisfactory D - Unacceptable Unreported Type Area sq m % Area Sq m % Area sq m % Area sq m % Area sq m % Total

05 Mental Health Hospital 6,106.46 33.88 11,916.56 66.12 0.00 0.00 0.00 0.00 0.00 0.00 18,023.02

23 Offices 0.00 0.00 1,813.56 100.00 0.00 0.00 0.00 0.00 0.00 0.00 1,813.56

24 Support Facilities 0.00 0.00 2,931.18 100.00 0.00 0.00 0.00 0.00 0.00 0.00 2,931.18

% of Overall Total 6,106.46 26.82 16,661.31 73.18 0.00 0.00 0.00 0.00 0.00 0.00 22,767.77

NB: This table is based on ratings allocated against Rooms/Areas. Third Party Ownership Tenure has been excluded.

Table 12: Typical Analysis of Property Types

Functional Type Endowment

(GIA) sq m

Leased (GIA)

Sq m

Owned (GIA)

Sq m

PFI (GIA) Sq

m

Unreported

(GIA Sq m

Area (GIA) Sq

m

% of Total

Area

05 Mental Health Hospital 0.00 0.00 18,691.33 0.00 0.00 18,691.33 79.19

23 Offices 0.00 0.00 1,899.45 0.00 0.00 1,899.45 8.05

24 Support Facilities 0.00 0.00 3,011.64 0.00 0.00 3,011.64 12.76

TOTALS 0.00 0.00 23,602.42 0.00 0.00 23,602.42 100.00

NB Block Code 00 has been excluded from this table. Third Party Tenure has been excluded from this table.

Table 13: Typical Analysis of Property Ownership

Area (GIA) sq m % of Total

Area

Count of

Blocks

Owned 23,602.42 100.00 17

TOTALS 23,602.42 100.00 17

NB: Block 00 has been excluded from this table

Chart 14: Analysis of Size Range of Properties

NB: Block 00 has been excluded from this table. Third Party Ownership has been excluded.

Table 15: Age Profile of Properties

Count of Blocks Area (m2) Backlog Cost

Pre 1900 0 0.00 £0.00

1900 - 1960 3 429.79 £276,285.00

1961 - 1980 0 0.00 £0.00

1981 - 2000 1 1,433.73 £16,950.00

2001 or more recent 13 21,738.90 £40,433.00

UnReported 0 0.00 £0.00

TOTALS 17 23,602.42 £333,668.00

NB: Block 00 has been excluded from the Area Calculation but included in the Backlog Costs. Backlog Costs include Physical Condition C, D or Unreported and all Statutory Compliance conditions ratings. All

other costs have been excluded. Costs included only Owned, Leased or Endowment tenure. Count and Area Include all tenures except Third Party Ownership.

Table 16: Summary of Property Appraisal Results

Functional Type Gia Sq.m GIA as % of

Total Area

Backlog Expenditure Required

Low Risk Moderate Risk Significant Risk High Risk UnReported Total

05 Mental Health Hospital 18,691.33 79.19 - £202,383.00 £105,295.00 - - £307,678.00

23 Offices 1,899.45 8.05 £1,130.00 £4,520.00 £16,950.00 - - £22,600.00

24 Support Facilities 3,011.64 12.76 - - £3,390.00 - - £3,390.00

UnReported 0.00 0.00 - - - - - -

TOTALS 23,602.42 100.00 £1,130.00 £206,903.00 £125,635.00 - - £333,668.00

NB: Block 00 has been excluded from the area calculation but included in the backlog costs. Backlog Costs include Physical Condition C, D or Unreported and all Statutory Compliance conditions ratings. All

other costs have been excluded. Third Party Ownership has been excluded.

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