As part of the ongoing management of backlog maintenance within NHS Fife properties, an annual commitment of capital funding is made in conjunction with the Scottish Government to reduce the level of backlog maintenance. Within the year 2012/13, £2.548m capital funding was committed to the reduction of outstanding backlog and statutory maintenance requirements, with a further £2.461m committed within the 2013/14 financial year. Between years 2013/14 and 2017/18 inclusive a total of £15.5m million has been scheduled to assist in further reducing backlog maintenance. The vast majority of this funding is allocated to clinical areas.
Backlog Maintenance Costs Prediction 2013/14 to 2018/19
Year 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 Backlog Maintenance Cost at Commencement of Year (1st April) £50,233,000 £41,819,473 £24,549,857 £20,757,386 £17,491,386 £14,225,386 Backlog Maintenance and /or Statutory Funding for Year
£2,461,000 £3,266,000 £3,266,000 £3,266,000 £3,266,000 Not Known
Backlog Reduction for Year due to
Acquisitions and/or Disposals
£5,952,527 £14,003,616 £526,471 £0 £0 £0
Total Reduction for Year
£8,413,527 £17,269,616 £3,792,471 £3,266,000 £3,266,000 Not Known
Acquisitions and/or Disposals Detail for Year and Associated Backlog Reduction: (Note some of these elements and the timing of possible disposals are indicative only and subject to change if different clinical strategies emerge due to changes in clinical delivery). Further updates will include the write down of Backlog due to other capital investments, e.g. QMH developments. Possible Property Disposal £5,399,000 Possible Property Disposal - £4,016,449 Potential Property Disposal £526,471 Potential Property Disposal - £108,000 Potential Property Disposal £6,424,000 Potential Property Disposal - £54,315 Potential Property Disposal £3,175,667 Potential Property Disposal £391,212 Potential Property Disposal £387,500
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In addition the rationalisation of the use of NHS Fife Estate is resulting in an ongoing reduction in the level of backlog maintenance due to the decommissioning of properties and the refurbishment of buildings in relation to clinical service development.
Planned energy conservation expenditure from 2012/13 to 2014/15 inclusive, amounts to £4.03 million, the majority of which will bring a corresponding reduction in backlog maintenance.
Due to ongoing survey and condition assessment of properties, the total backlog figure can rise and fall, e.g. within the year 2011/12 and additional £13 million backlog maintenance was identified following the completion of remaining surveys.
Further surveys have been completed within the 2012/13 financial year for some remaining GP premises and clinics. The 2012 NHS Scotland State of the Estate report identified a £62 million drop in risk assessed backlog maintenance with NHS Fife contributing £7 million to this reduction
The total backlog maintenance costs for NHS Fife are £ 30.7m Category B (Acceptable Condition),
£37.4m Category C (Requires Investment) and £4.4m Category D (Unacceptable Condition), total backlog maintenance cost for NHS Fife of £72.5m. This assumes all existing estate will be retained
and used. Please note that the Risk Assessed backlog maintenance figure is significantly less than the total backlog maintenance figure.
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5. Where Do We Want To Be?
Clinical Service
How assets are managed in the NHS is ultimately driven by health policy. All NHS organisations have plans to redesign their services to achieve the aims of the Scottish Government’s key policies as set out in ‘Better Health, Better Care – Action Plan’ and the 2020 Vision . This service redesign will require significant changes in the way that assets are managed and used in the NHS.
NHS Fife’s former service delivery initiative ‘Right for Fife’ and the new ‘Getting Better in Fife ‘have been incorporated into a thorough review of the organisation’s corporate and service strategies and plans for change, considering key questions such as:
What services will the organisation provide in the future? How will they differ from those services currently provided? Where will they be located in relation to the areas they serve? Who will provide them and how?
When will these changes take place?
The PAMS must then interpret the proposed service changes in terms of their impact on the need for physical assets. It should demonstrate how the current supply of physical assets will need to change through investment, acquisition or disposal to meet future service needs. This inclusion of the organisation’s current strategies and plans for change is fundamental to the identification of the gap between the organisation’s vision and the adequacy and ability of its existing asset base to support that vision. Those current strategies and plans are embodied within the current version of the NHS Fife Local Delivery Plan (LDP) and the clinical service strategy ‘Right for Fife’ and evolving ‘Getting Better in Fife’ strategy, which is the frontline driver for achievement of the Scottish Government objectives within the ‘Better Health, Better Care – Action Plan’ and the 2020 Vision . Hence with regards to clinical service provision and ‘Where do we want to be’, the aforementioned documents represent the current ‘needs based’ requirements. Many of the Acute Services aims within ‘Right for Fife’ were embodied in the General Hospitals and Maternity Services project which is currently in place and meeting the project targets.
NHS Fife’s Strategic Overview
The Scottish Government set out the national framework for improving Scotland’s health and healthcare
in its Quality Strategy2 which sets out NHS Scotland’s vision to be a world leader in healthcare quality,
described through 3 quality ambitions: effective, person centred and safe. These ambitions are articulated through the 6 Quality Outcomes that NHS Scotland is striving towards:
Everyone gets the best start in life, and is able to live a longer, healthier life; People are able to live at home or in the community;
Healthcare is safe for every person, every time; Everyone has a positive experience of healthcare; Staff feel supported and engaged;
The best use is made of available resources.
The Quality Strategy builds on Better Health, Better Care3 and together with subsequent supporting publications they provide the overall strategic context.
2
The Scottish Government. The Healthcare Quality Strategy for NHS Scotland; Edinburgh 2010 3
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Since 2002, NHS Fife Board has been delivering an ambitious programme of development and modernisation designed to improve the range and quality of healthcare services and to improve the quality of the premises from which services are provided.
To deliver Patient centred, Safe and Clinically Effective care and enable people to maintain their contribution to society, through prompt assessment, diagnosis, and intervention.
By ensuring that
90% of patients who are referred have their assessment, diagnosis and treatment within 18 weeks
from referral.
95% of patients who are referred with a suspicion of cancer receive assessment, diagnosis and
treatment (if required) within 62 days from referral.
95% of patient diagnosed with cancer receive their treatment within 31 days from the decision to treat This programme will maximise the use of technology and make effective use of all resources on all sites. This will reduce unnecessary hospital visits, reduce unwarranted variation and will deliver a person- centred, timely, high quality planned care service.
‘Getting Better in Fife’ builds on the ‘Right for Fife’ it is a re-fresh not a re-start. It sits in the context
of:
SGHSCD 2020 Vision
NHS Scotland Quality Strategy
NHS Scotland Efficiency & Productivity Framework And alongside …
Fife’s Health & Wellbeing Plan 2011-14 Community Plan
Single Outcome Agreement
FHSCP Service Delivery Plan 2012-15
Responding to the Coming Challenges
While services have changed and continue to change, the challenges facing the NHS continue to grow. As a society, we are getting older, with more people living longer and fewer people in the workforce. Lifestyle diseases such as obesity are generating new healthcare demands and advancing technology, including new drugs, means the NHS can do more to help more people.
The NHS can only reconcile that growing need with the reality of contained resources by doing more with less. Our investment programme, in new community facilities as well as new hospitals, has put us in a strong position already but we need to do more.
Our vision for 2020 is that everyone is able to live longer healthier lives at home, or in a homely setting. We will have a healthcare system where we have integrated health and social care, a focus on prevention, anticipation and supported self management. Primary Care has a key role in helping the healthcare system as whole make improvements. When hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm. Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.