Argyll and Bute CHP Committee 29 November 2007 Item: 11.0

ARGYLL AND BUTE CHP Estate Condition Survey 2007/08

Report by the Head of Planning, Contracting and Performance

The CHP Committee is asked to:

‹ Note the findings of the estate condition survey conducted on its properties ‹ Note and endorse the action plan drawn up ‹ Note that the CHP Capital planning group has been remitted to performance manage and monitor progress against the action plan

1 INTRODUCTION

Each NHS Board has to approve a 5-Year Capital Investment Programme and a key element within this is ensuring that the Boards estate is fit for purpose in terms of statutory compliance, function and effectiveness to inform its property strategy and requirements. The CHP commissioned consultants to undertake an Estate condition survey on all the NHS Board owned premises.

This appraisal of condition and performance of the estate follows well established guidance described in NHS Estatecode. These appraisals are a high level assessment of condition and performance aimed at providing a baseline from which property strategies can be developed.

This Estate condition report is based on a detailed survey of the property condition & the other facets listed below. Full technical details are retained within a property database, which will be regularly updated. Information is gathered from both physical surveys and historic information gathered & retained by Estate Officers. Copies of the Estate Condition Database are retained by the operational Estate Officers and additional detailed information which is summarised in the main reports can be extracted for each individual building or site owned by Argyll & Bute CHP.

The report identify “black spots”, investment priorities and opportunities for rationalisation of the estate and are a key stage in the development of capital investment programmes and estate maintenance programmes. The appraisal covers the following facets: • Physical condition

• Energy Efficiency

• Compliance with fire, DDA and other statutory standards

• Functional suitability

• Space utilisation

Working with you to make Highland the healthy place to be 2 FINDINGS

2.1 Estate Profile:

The pie chart overleaf summarises the CHP owned estate profile:

Analysis of the Estate by Building Type & % of Other -GP Health Houses, flats, oTfotal Area Centres, GP & fices etc Dental Surgeries 7% 7% General Hospitals (1) 17% A&B Hospital 24%

Community Hospitals (6) 45%

2.2 Physical Condition Appraisal

This facet of the appraisal examined 19 elements of the building (structure, roof, external fabric, heating system, electrical systems etc.) and identified the expenditure required to ensure that these elements remain operational with an acceptable level of risk in terms of failed elements/services.

2 Physical Condition Expenditure Req'ment % of Total Hospital/Building £000 Expenditure

Argyll & Bute Hospital 8277 56%

Campbeltown Hospital 94 1%

Islay Hospital 386 3%

Dunoon Hospital 2141 15%

Victoria Hospital, Rothesay 589 4%

Rothesay Health Centre 128 1%

Victoria Annex, Rothesay 767 5%

Victoria Infirmary (Helensburgh) 699 5%

Lorn & Islands 65 0%

Aros 797 5%

Aros & Duncuan flats 225 2%

All other properties 524 4%

Total: 14692 100%

2.3 Energy Performance and Expenditure

The table below shows the energy performance indicators for the CHP’s hospitals and compares these with the current “All Scotland” and NHS Highland performance indicators.

2005/06

Climatically Adjusted Current Total Hospital Total Hospital Energy Fuel Expenditure GJ/100cu.m £ All Scotland (current) 68 NHS Highland 85 Argyll & Bute Hospital 44 471,381 Campbeltown Hospital 91 114,573 Dunoon Hospital 58 113,073 Islay Hospital 81 48,441 Lorn & Islands Hospital 73 234,978 Victoria Hospital,Rothesay 103 40,833 Victoria Annex, Rothesay 90 31,744 Victoria Hospital (Helensburgh) 76 50,005 New Mid Argyll 84 206,447 CHP Total 1,311,475 CHP Average 78 Savings @2% per annum to 2010 £101,812 Savings if target 65GJ/100cu.m met £214,989

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The table shows that the CHP’s overall performance (78 GJ/100 cu.m) is worse than the average for Scotland (68 GJ/100 cu.m) but better than the average for NHS Highland (which has the poorest energy performance indicator of NHS Boards in Scotland).

2.4 Fire Risk Assessment

From 1 October 2006, the CHP are required to undertake a fire safety risk assessment in respect of the premises, consider the outcome of this assessment and take appropriate action as necessary. The fire safety risk assessment must be reviewed regularly and updated it if required.

At the time of the exercise described in this report (May 07), fire safety risk assessments had not been completed. This is serious matter for the CHP and will need to be addressed as a matter of urgency.

Without the results from fire safety risk assessments, it is difficult to accurately assess the expenditure requirement for this facet. However, a broad assessment has been made and this indicates an expenditure requirement of at least £1 million. Examples of significant items of expenditure are: • All the main sites require greater coverage of “life rated” (L1) fire detection and early warning system. • Argyll & Bute Hospital – serious non-compliance in terms of compartmentation, travel distances, structural integrity etc • Rothesay Victoria Hospital – similar issues to Argyll & Bute Hospital • Dunoon Hospital – excessive travel distances with no fire doors, lack of staircase protection, hazard rooms not enclosed. (i) • Islay Hospital – Fire doors, smoke control in corridors • Vic Infirmary (Helensburgh) – 1st floor unusable due to lack of fire escape. Note: (i) Many fire compliance issues at Dunoon will be resolved as part of the new development & upgrading works, currently in progress.

2.5 Disability Discrimination Act

A full survey of the CHP’s properties for compliance with the Disability Discrimination Act was completed in 2004 and identified £2.8 million of expenditure required to bring the buildings to full compliance. A summary of this is shown in the table that follows. (ii)

Expenditure Required £000

A&B Hospital 837 Campbeltown & Kintyre 345 Rothesay 281 Dunoon & Cowal 527 Islay 153 Jura 5 Lorn & Islands 325

North Argyll 348

Total: 2821

4 Note: (ii) A phased programme of DDA compliance works is currently being implemented, with an on-going annual funding allocation provided to achieve compliance across Argyll & Bute CHP following an agreed prioritisation strategy and programme by the CHP capital planning group.

2.6 Health & Safety A wide range of health and safety legislation applies to the CHP’s estate including: • The Management of Health & Safety at Work Regulations 1999 • Control of Substances Hazardous to Health (COSHH) 2002 • Electricity at Work Regulations 1989 • The Provision and use of Work Equipment Regulations 1998. Health and safety is managed by the CHP’s risk management group and is outside the scope of this exercise. However, the following concerns in relation to the estate were identified during the appraisals and are provided in order to provide a complete “picture” of the current condition and performance of the estate. The list should not be taken as a comprehensive schedule of risks that the CHP needs to manage.

• Control of legionaella • Safe hot water and surface temperatures • Safe work in confined spaces • Asbestos Regulations • Healthcare Acquired Infection • Slips & Trips – A survey of flooring in 2006 identified 86% of floors in the main hospital sites to be medium or above slip risk as shown in the table below.

Percentage of rooms with Slip Risk Hospital Number Classification: of rooms Total surveyed Medium Significant High Medium & above Lorn & Islands DGH 102 20% 33% 11% 64% Argyll & Bute 65 51% 29% 15% 95% Rothesay 22 36% 32% 18% 86% Campbeltown 59 34% 44% 20% 98% Islay 43 14% 19% 67% 100% Dunoon 41 7% 34% 51% 93% All sites 332 27% 33% 26% 86%

Whilst in some cases this risk can be managed by measures other than flooring replacement, these results do highlight another area of potentially significant expenditure required on the estate.

2.7 Functional Suitabiltiy

This facet of the appraisal aims to identify how well the buildings support the delivery of operational services and focuses on three key questions:

• Are the buildings the right size, design and layout to enable modern, best practice healthcare services to be delivered?

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• Are there sufficient support facilities and amenities in the building (toilets, bathrooms, storage space, waiting areas etc)?

• Is the location of the building right in terms of enabling access by public and private transport, proximity of car parking, travel distances between key linked departments etc?

Findings identified the following sites as “unsatisfactory & needing major change” in relation to: – Argyll & Bute Hospital – Dunoon – Victoria Rothesay & Annex – Islay – Victoria Infirmary, Helensburgh

2.8 Space Utilisation This facet of the appraisal focused on two key questions: • Is the space provided being used?

• How intensively is the space used over time? The table overleaf summarises the key findings of the survey

Hospital/Site Percentage of space that Percentage of space is in use but unused/empty Underutilised Argyll & Bute Hospital 85% 30% Mid Argyll Community Hospital 10% 13%

Lorne & Islands DGH 10% 10% Helensburgh Victoria Hospital 40% 20%

Campbeltown Hospital 20% 10% Islay Hospital 20% 10% Victoria Hospital, Rothesay 25% 15%

Dunoon Hospital 15% 15%

How much of this under utilised space can be turned into empty space that can be used for alternative use (or declared available for disposal) can only be determined through detailed estate redevelopment planning. However, the assessment does indicate that there is considerable potential for improving the utilisation of space through a combination of:

• Better allocation and planning of space use

• Increasing activity in the smaller, currently under utilised GP/Dental surgeries and health centres through the use of 3 session days, evening and week-end sessions.

• Continued Improved performance through developing new working practices in relation to clinical activity i.e. discharge planning, reducing lengths of stay etc.

• Improved policies and protocols in relation to use of space for non-patient activity such as storage, staff facilities and offices

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• Changing the culture of the organisation in relation to the use of office accommodation with a shift toward a much more dynamic use of offices i.e. shared use, mobile and home working, flexible working etc.

3 NEXT STEPS

The CHP has now in its possession a powerful tool to assist in identifying its property requirements and informing its capital investment decisions linked to its service planning priorities. Furthermore the database informing the condition survey can be updated on an annual basis by the CHP and is designed to be accessible to Locality Management and locality based estate staff.

Since completion of the Survey in May of this year, the findings have been used in two workshops aimed at assessing the implications of these findings regarding our service priorities utilising a scenario service planning model and a subsequent event to identify and populate an action plan to address the issues raised within the report. This is attached as an annexe to this paper.

The CHP management team has remitted it Capital planning group to performance manage and monitor progress and continue the development of the action plan as it is the decision making body for allocation and management of the CHP capital expenditure (for ref. it has an allocation of £8,677 million and an expenditure plan of £6,186 million for 2007/08).

3. Governance Implications

Corporate Meets local delivery plan and corporate objectives and targets

Financial: Aligned with Financial management plan Staff Governance Implications where outcomes lead to service change Patient Focus & Public Required where outcomes lead to service change Involvement Clinical Governance Affects quality and sustainability of service provision Equality & Diversity Not applicable Impact:

Stephen Whiston Head of Planning, Contracting and Performance

9th October 2007

Annexe 1- Argyll and Bute CHP Estate condition Survey Action plan

7 Argyll and Bute CHP Committee 29 November 2007 Item: 11.0 Issue Action Target Lead Progress/Completed

Joint Estate Planning The strategic planning An initial stage of information sharing exercise is required covering: Progress report to CHP SW workshop identified that there is potential and Capital Planning group – • Key facts on property portfolios – numbers, locations, size of an enthusiasm for further exploration of joint End of Dec 07 buildings etc estate planning across the whole of the public sector. Whilst there are a number national • Condition & performance analysis information groups developing guidance in this area, there remains some uncertainty on how this can be • Property/estate strategies progressed at a very local level. • Capital programmes It was agreed that initially this should involve Argyll & Bute Council and the CHP but would extend later to other partners such as SEPA, Forest Enterprise etc. S Wilson & Nick Allan from A&B council to identify and contact a designated person and commence sharing of information. Scenario Planning - It is clear from the It was recommended that a small scenario planning group is set up to Meeting March 08 and 6 SWh strategic planning workshop that there is continue the work started at the strategic planning workshop and to further monthly thereafter. considerable uncertainty around the future. develop of the skeletal scenarios developed at the workshop with the aim Therefore, it is important that the CHP of reducing the uncertainty around the future. continues to develop its strategic response to a number of different futures. This will help the S Whiston to form a small group to take this forward. The Group will meet CHP to take action to maximise the benefit of twice yearly commencing March 08 and prepare reports for the Capital favourable scenarios but also think through Planning Group. Prior to first meeting Nick Allen (A&BC) to provide contingency plans for less desirable scenarios. update to SWh on “Hub” initiative. Updating Estate condition database and The master copy of property condition database will be regularly updated, Annual – April/May each S locality terrier report on an annual basis, by Project Manager (capital). Details of capital works year Wilson/ completed during the previous year will be added and all operational D Estate Officers will be consulted to ensure any new major maintenance Millwar issues identified during the previous year are recorded and the property d & condition information is maintained up to date. The updated database will Estate be re-issued to Estate Officers. Where links from this database are used to officers update the summary Terrier report issued to Locality Managers, this will also be updated and the reports re-issued incorporating the updated information

Working with you to make Highland the healthy place to be Issue Action Target Lead Progress/Completed

Shared Services/Joint working - Whilst the It was agreed to establish working group to explore in detail the potential SWh to contact D Logue SWh services delivered by the different public sector for shared services/joint working on administration & support services and ASAP with view to first organisations may be quite different, the the following action on “New Ways of Working”. group meeting by end administrative and support services that Dec 07 underpin these services are likely to be very Nick Allen advised that A&BC already have an initiative on these issues in similar i.e. office based functions such as relation to their Social Work Department which is being led by David corporate services, finance, HR, etc. These Logue. SWh to contact David and invite him to lead the group and act as administrative and support functions provide “champion” on these action points. obvious “common ground” for the partner organisations to work together on in relation to determining future property requirements. Potential benefits range from simple sharing of ideas and best practice to integration of services and shared use of buildings

New ways of working - the introduction of Included in Shared Services/Joint Working action above. As above As new technology has been a major driver in above recent years for the development of new ways of working. These new ways of working cover a wide range of ideas such as: • Shared use of offices – hot desking, hotelling etc • Teleconferencing • Flexible working • Home working • Mobile working The implementation of these new ways of working are more advanced in other sectors such as commerce, banking etc and have shown that they can have a considerable impact on the organisation’s property requirements (20% less space per capita).

9 Issue Action Target Lead Progress/Completed

Fire Risk Assessments -The CHP are D Millward advised that this is being progressed and external consultants Actively in progress J required to undertake a fire safety risk have been commissioned to complete the fire risk assessments of all Swatm assessment in respect of the premises, properties during the month of October. an consider the outcome of this assessment and (JS) take appropriate action as necessary. The fire Following completion of the assessments an action plan will be developed safety risk assessment must be reviewed to address the gaps and areas of non compliance identified. regularly and updated it if required. At the time of the exercise described in this report (May 07), fire safety risk assessments had not been completed. This is serious matter for the CHP and will need to be addressed as a matter of urgency.

Health & Safety – The estate appraisals A CHP risk register is in place but it needs to be reviewed to ensure that Report to Capital Pat identified a number of H&S concerns in relation the issues identified in the Property exercise are integrated into the CHP’s Planning Group by end of Tyrrell to: overall Risk Management Strategy. Capital Planning Group to receive Dec 07 (PT) • Control of legionaella information/reports to inform capital investment priorities. Leads on various • Safe hot water and surface issues are: temperatures • Control of legionaella - JS • Safe work in confined spaces • Safe hot water and surface temperatures - JS • Asbestos Regulations • Safe work in confined spaces - JS • Healthcare Acquired Infection • Asbestos Regulations - JS • Slips & Trips • Healthcare Acquired Infection - PT • Slips & Trips - JS

Space utilisation - Continued Improved Develop and integrate partner options with partner organisations. SLA Project report to SWh performance through developing new working Implement redesign in clinical services progress over the next 2 practices in relation to clinical activity i.e. years discharge planning, reducing lengths of stay etc can have a significant impact on the utilisation of space. Space utilisation - given the high property Develop options for improving the utilisation of the estate and thereby Ongoing Locality ownership costs of space, the space utilisation reducing facilities management costs. All future bids for capital should Manag appraisal is useful for identifying potential confirm that under utilised space has been considered and no better use ers/CP savings. For instance, a 15% reduction (9,000 could be made of the existing estate before new buildings are considered. G

10 Issue Action Target Lead Progress/Completed sq.m) in the CHP’s property would represent a C&PPG Group have agreed to commission Strategem to produce an Booklet by end of Nov 07 saving in excess of £1 million per annum in “Estate Terrier” booklet to which highlights estate performance including property related costs (capital charges, space utilisation on a site by site basis. This should help Locality SW maintenance, energy, cleaning etc) Managers and their Estate Managers to continually review the performance of the estate and the utilisation of space. Argyll & Bute Hospital Closure plans need to Mental Health modernisation project to support progression of new service Closure targeted for 2 Joseph be progressed as a matter of urgency as there model and estate requirements years ine are major issues in relation to the estate on this Bown site. It may be helpful to develop short, A&B hospital short term site rationalisation and decommissioning plan to John medium and long term plans for the site be developed and enacted Dregho thereby enabling the most urgent issues to be March 2008 rn (JD addressed quickly (e.g. Health & Safety) and potentially releasing some of the financial resources from the site to contribute towards other developments. Plans need to take into account the current under utilisation of the Mid Argyll Community Hospital and Integrated Care Centre Victoria Hospital and Annex, Bute - A lot of Finalise development plans for Bute - the potential for greater partnership Re-assess future clinical V thinking has been done on the issues around working with the Local Authority & the Independent sector needs to be services for 5 to 10 years. Smith these sites over recent years but given the rigorously examined to reduce the capital investment, particularly “new Council decision on long (VS) results from the condition and performance build”, associated with moving to the preferred option. term care imminent appraisal described earlier in this report, this Reviewed/refreshed business case required. work now needs to be urgently progressed. Dunoon Hospital - Plans are already Current plans need to be examined in the context of the significant backlog Phase 1 underway – 2 VS advanced in terms of refurbishing part of the maintenance expenditure identified in this exercise for the site as a whole. year prog. Hospital as a move towards the preferred There are also issues in relation to the overall utilisation of the site which Integrated HC – VS model of rationalisation and integrating a range need to be addressed before capital intensive “new build” plans for moving consideration of of services onto this site. services onto the site are finalised. development of clinical services. Need agreement from GPs. OBC for sustainability of services in Dunoon – 2 years. Victoria Infirmary, Helensburgh – With the .Finalise the strategic service vision for this locality including examination Local working grp to George

11 Issue Action Target Lead Progress/Completed decision re the Jeannie Deans Unit, and the , of: identify options for future Morriso the condition and performance appraisal • Developing the site as a Primary & Community Care Centre (co- use of site – short & long n showed that there are significant issues in locating GPs, Community Services, Mental Health, Social Work etc). term use site – initial relation to backlog maintenance expenditure, meeting organised in Oct • Increasing the range of services delivered locally such as diagnostics, fire compliance, space utilisation and functional 07 etc with the aim of reducing the current flows of activity to Glasgow. suitability on the site. This locality serves a large population (26,000) and there is now an Given the significant investment likely for all of these options it is essential urgent need to develop/finalise the vision for that the potential for shared use of property with the Local Authority and this site so that investment in property can be other partners is thoroughly explored in order to minimise capital planned expenditure. Nick Allen and Sandy McTaggart (A&BC) on project group) Mid Argyll Community Hospital - The main Plans for alternative use should be progressed so that the under utilisation Feasibility of dementia John issue relating to this new facility is its current issue can be resolved. This could also provide opportunities for resolving services moving in – Dregho poor utilisation (long term care ward and day some of the issue in relation to A&B Hospital. consultation phase rn (JD) hospital). currently Mid Argyll Community Hospital – current Review energy performance with the PPP/PFI partner and develop Parson B being asked to JD poor energy performance detailed plan for improving performance. provide energy report for the year – Oct 07 Lorn & Isles Hospital – The main issue here Develop solution to under utilisation including examining the potential on Option appraisal exercise David is the under utilisation of the hospital where this site to increase the acute services activity which could reduce activity Oct/Nov assess re use of Whiteo Nelson Ward has been closed for some time. flows to Glasgow. The planning needs to take into account the fact that Nelson Ward for Dental ak the leased clinic facility in Market Street is in poor condition and a access treatment centre. (DW) maintenance liability at present.

Islay Hospital - The age, condition and Further work needs to be done on developing the Progressive Care model Planned workshop day JD location of this hospital has led to some in relation to the Island’s needs and the implications for the estate. This Nov for developing the thinking in recent times on its refurbishment or work needs to take into account the property portfolios of partners since concept of Progressive re-provision. Ideally, the model would be there are a relatively large number of health and social care buildings on Care. based on the Progressive Care approach used Islay and there may well be opportunities for rationalisation and on Mull & Jura and this would involve a smaller integration. This work should also address the question of whether the Community Hospital element to the facility. current hospital site is the best location for investment in facilities for the future.

Jura - Whilst the recently completed Examine the feasibility and case for investment in expanding GP surgery. Low priority JD Progressive Care Centre will meet most of the needs of community for the foreseeable future,

12 Issue Action Target Lead Progress/Completed there is potential for providing more minor surgery type services if the existing treatment room in the GP surgery could be enlarged/upgraded. Campbeltown Hospital - The main property There is a need to progress and finalise the service strategy in relation to A&E refurb underway. JD issues on this site relates to the need to ensure care of the elderly (29 beds) since this will potentially free up space to Pending Council decision that this facility is fully utilised since the enable a number of developments to be progressed. This can then be on CoE. Future use of appraisals indicated that there is potential for followed by prioritisation and further development of the development vacant ward is a question more services to be provided from this site control plan for the site. that needs answering including dental, and social work. There is also an issue in relation to the need to provide more single room accommodation. Tiree & Colonsay Develop progressive care models similar to Jura Low priority SWh

Dental Services Developing service profile and business case for dental access services Actively in progress SW/JH complete March 2007

GP Premises Review properties and policy for investment/modernisation/rationalisation, End of 2008 LM/CD including succession planning – 1 year. SWh

Energy Utilisation Locality Estate Managers to identify action plan to reduce energy usage in Ongoing report – May D CHP estate 2008 Millwar d/LMs

Key: LM- Locality Managers CD- CHP Clinical Director

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