people strategy - doncaster and bassetlaw teaching hospitals...(dri) site. the 18 month lean project...

Estates and Facilities Strategy2017-2022 !

Patients

People

Partners

Prevention

Performance

Contents

Executive summaryWhere are we now?Where do we want to be?Aims and objectivesOur current positionOur future positionHow do we get there?Proposed programme of actionHow will we know when we've got there?ConclusionAppendices

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Executive summary

4. Demonstrate the achievement of both quality and efficiency through the delivery of quantitative KPI’s and qualitative outcomes and measures.

5. Ensure the estate is fit for purpose in line with NHS Estate Code definitions.

The achievement of these strategic aims will be supported by a transformation plan which consists of the following three workstreams:

Capacity & Capability Review

Qii Performance Project

Cultural Change Project

The transformation plan will be developed by a Virtual Improvement Team, drawing upon internal and external expertise as required.

The delivery of this 5 year Estates and Facilities Strategy will provide the physical infrastructure, and quality performance framework, with which the Trust can ensure the delivery of sustainable services into the future.

‘All patients will experience the best care possible by all staff and teams improving quality in their practice every day. Staff,

patients, carers and partners work together to co-create ideas and plans for continuous

improvement and innovation.

This 5 year Estates & Facilities Strategy is one of the ten key strategies underpinning the delivery of the Trust’s Strategic Direction 2017 – 2022 and is interlinked with the other nine. It recognises the value that delivering estates and facilities services can add by enabling an organisation to achieve its objectives and to continuously improve its performance.

The strategy has been developed in accordance with NHS Estates Guidance and aims to ensure that the Trust provides safe, secure, high quality healthcare buildings to support current and future needs. The strategy identifies where we are now, where we want to be, and how we will get there. Identifying the current state will be achieved by evaluating the condition of the existing estates through 7-Facet condition and performance surveys, and identifying backlog costs linked to estates risks. Qualitative and quantitative data will be used to assess our operational performance and to develop a transformation plan. Our future state will be identified in conjunction with clinical site development plans and through identifying local and national drivers for change. Key estates aims will be derived from this work, which will form the basis of site development plans detailing how we will get to our future state position taking account of key financial assumptions and risks to achievement. Our intentions to explore innovative partnerships with both the public and private sector to attract investment will be described. Performance will be measured against the following five estates and facilities strategic aims:

1. Have in place suitable systems and processes designed to ensure delivery of high quality services, working with internal customers to develop a Transformation Plan for Service Improvement.

2. Have appropriate staff deployed to deliver Estates and Facilities services to required standards.

3. Train and develop staff to maximise their individual performance and potential, ensuring they are engaged, motivated and empowered.

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Where are we now?

The services which form the wider Estates and Facilities Directorate at Doncaster & Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTH) are unusual when compared to peers in that most of the services are currently provided in-house, with the exception of security services and linen and laundry. However, work to market test in-house services which began in 2016/17 has recently resulted in Trust Board approval to outsource Patient and Retail Catering Services, achieving significant benefits to the Trust including improved quality and choice for patients, staff and visitors, and significant capital investment in infrastructure and equipment replacement. In addition, at the time of writing, tender evaluations are underway for the outsourcing of HSDU services with the aim of achieving similar benefits to those being realized within the catering outsource project, with the additional benefit of a potential to release valuable clinical accommodation on site.

In conjunction with the outsourcing of Patient and Retail Catering Services, Facilities Services have recently undergone significant transformation following a complete redesign of cleaning and portering services at the Doncaster Royal Infirmary (DRI) site. The 18 month LEAN project completed in the early part of 2017 and realised an improvement to the quality of services, at the same time as achieving significant efficiency savings.

During the last year a number of assets identified for disposal have successfully been disposed of, either on the open market or at auction, serving to both reduce underutilized estate and attract sales receipts. These include:

• Barrowby House – Worksop

• Victoria Residences – Worksop

• Highland Grove Plot – Worksop

• 9, 19 and 21 St David’s Close – Worksop

In addition, a mothballed Day Nursery building situated on the BDGH site has been leased to a local nursery provider, with the added benefit of offering priority places for Trust staff. Following a successful OFSTED inspection in August, the nursery is due to open in September 2017. Property currently on the market for disposal is:

• 5 Highland Grove, Worksop

Plans are in development to identify further underutilised assets for disposal, development, and off-site assets that require significant capital investment including:

• Southside Plot, Bassetlaw

• Nurses Home plot, Mexborough

• Chequer Road Clinic, Doncaster

Whilst successes have been seen in recent times within the Facilities Services areas, and in terms of asset disposals, the Estates Services face significant challenges due to the need to function from an aged estate which has endured chronic under investment for an extended period, particularly at the DRI site, and the need for substantial capital investment in the infrastructure. The most recent 7-Facet Survey undertaken in 2015/16 identified £58m of backlog maintenance, with a risk-adjusted figure of £24m, and a further £1.8m relating to statutory compliance. This type of historical lack of investment in the infrastructure can place Trusts at risk of severe interruption to services, as well as enforcement action by regulators. Both have been experienced in recent times at the DRI site, with intermittent power loss due to a historical lack of maintenance of the High Voltage system and generators being over 50 years old, and the issuing of enforcement notices by the local Fire Service. There is also a need to review the Estates workforce due to the requirement to improve performance with respect to planned preventative and reactive maintenance.

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Where do we want to be?

The Estates and Facilities Services must be able to ensure the delivery of a quality, safe environment within which the Trust delivers its services. All services delivered by Estates and Facilities must be of a high quality and be cost effective, being benchmarked in the top quarter percentile for quality and value in national metrics such as Carter and ERIC.

The Carter review, published in Feb 2016, identified a number of headline metrics for Estates and Facilities to achieve, followed a year later by the Naylor review which included recommendations to support better utilization of the estate and accelerated disposal schemes. Estates and Facilities must be responsive in adapting its services to changing clinical activity levels and specialties mix of the Trust.

The 5 Year Estates and Facilities Strategy is an underpinning strategy of the Trusts new Strategy Direction 2017 – 2022. Contained within the new Strategy are the following Trust objectives:

Maintaining quality of care is fundamental to our future plans and is at the heart of all we do. Our CQC rating is good in caring and well-led. Despite 74% of all areas being judged to be good, we were also judged as requires improvement in safe, effective and responsive therefore robust plans are in place to address these issues and continue to improve.

We have made good progress relative to our peers in delivering care in line with national standards and have seen improvements in mortality statistics and other quality markers, despite considerable financial difficulties. We strive to maintain and improve this position in the future by investing in improving access for all our staff to Quality Improvement and Innovation (Qii) tools to empower a culture of continuous improvement and innovation.

We have a vibrant and resilient workforce that has remained dedicated to maintaining high standards of care through a very difficult financial period and beyond. Our workforce has been engaged to shape the strategic vision and re-visit our values. We recognise that to deliver our vision we need to invest in the people in the organisation at all levels to make sure we have the leadership and skills necessary for delivering care now, and into the future. Building on our recent teaching hospital status, we will continue to develop our education, research and leadership offer.

Making our organisation a good place to work improves recruitment and retention of existing staff. We offer flexible working within the context of service demands and are supporting the development of new roles to meet service needs and to address workforce challenges.

To be able to deliver high quality and high performing, efficient and effective care we need to make best use of the facilities on each of our sites. We aim to improve pathways for patients who require planned care and we want to make sure that all of our expensive theatre, clinic and diagnostic resources are utilised to optimal levels. We also need to respond to changes resulting from implementing national best practice that are likely to result in increased pressure on emergency capacity at the DRI site and make sure that front door emergency services on both BH and DRI sites are functioning as efficiently and effectively as possible to deliver the right care in the right place.

Patients People Performance Partners Prevention

Patients Work with patients to continue to develop accessible, high quality and responsive services.

As a Teaching Hospital we are committed to continuously developing the skills, innovation and leadership of our staff to provide high quality, efficient and effective care.

We will ensure our services are high performing, developing and enhancing elective care facilities at Bassetlaw Hospital and Montagu Hospital and ensuring the appropriate capacity for increasing specialist and emergency care at Doncaster Royal Infirmary.

People

Performance

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Aims and objectives

This is the places that Qii will be evident.

In aligning the five Estates and Facilities strategic aims to those of the Trust, the contribution of the Estates and Facilities strategy to the delivery of the Trust Strategic Direction can be identified:

Patients: EFM Strategic Aim 1. Have in place suitable systems and processes designed to ensure delivery of high quality services, working with internal customers to develop a Transformation Plan for Service Improvement.

People: EFM Strategic Aim 3.Train and develop staff to maximise their individual performance and potential, ensuring they are engaged, motivated and empowered.

Performance: EFM Strategic Aims 2 & 4. 2. Have appropriate numbers of staff to deliver Estates and Facilities services to required standards. 4. Demonstrate the achievement of both quality and efficiency through the delivery of quantitative KPI’s and qualitative outcomes and measures.

Partners: EFM Strategic Aim 5. Ensure the Estate is fit for purpose in line with NHS Estate Code definitions.

How are we going to get there?The financial constraint within which the NHS must operate heightens the importance of ensuring the use of a robust and transparent system for risk based decision making and investment prioritisation. In developing a 7 year estates investment plan, the following key assumptions have been made:

• Revenue budgets will remain flat in real terms, and will be expected to flex in line with increases or reductions to clinical activity in response to STP/Accountable Care Systems.

• Internally generated capital investment will remain limited, and investment programmes will be risk based.

• Issues of safety and compliance have been prioritised according to the level of risk to patients, staff and the continued delivery of clinical services.

• The Estates and Facilities Strategy and Clinical Site Development Plan will align to reduce the overall footprint of the Trust, and increase Site Utilisation.

We will increase partnership working to benefit people and communities.

Support the development of enhanced community based services, prevention and self-care.

To achieve all of our objectives we need to be the best partner we can be to other health and social care providers, our local communities and most importantly our patients and service users.

We will continue to work in a ‘place-based way’ to provide the right services in the right place. We will effectively promote our organisational values and achievements, working with our stakeholders and staff to engage with the public we serve.

We provide a number of screening and community based services and intend to continue to do so. We will work in partnership to develop and implement appropriate models to provide care with the best outcomes in the right environment for patients and families. In our services we will support and encourage self-care and re-ablement, as appropriate.

We will also continue ongoing work to make sure that we maximise health promotion and wellbeing opportunities for our workforce, patients and visitors.

Partners Prevention

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BackgroundAll NHS Trusts have a statutory responsibility for the management of their assets. A well devised estates and facilities strategy is an essential element of that management. NHS Estates have issued guidance to Trusts to assist them to develop their Estate Strategies, entitled Modernising the NHS -Developing an Estate Strategy.

The Estates & Facilities Strategy is a long term plan for managing the estate in an optimum way in relation to the service and business needs of the Trust and the local health economy. It is required to be able to deliver a modern NHS fit for the 21st century, where buildings and equipment are in the right place, in the right condition, of the right type and are able to respond to future service needs. It includes:

• the analysis of the current estate and how it performs

• proposed changes to the estate over the next decade

• proposed performance improvements• estate rationalisation plans• site master plans• a comprehensive estate investment programme

Estatecode provides guidance on the methodology for analysing the estate, whilst the Capital Investment Manual sets out the process for procuring new capital assets. Estatecode includes standardised cost estimates for land, buildings, engineering plant and services, and external works and on average accounts (with the energy and manpower needed to operate it) for about 10% of the annual revenue expenditure of a Trust, and 85% of its capital programme.

The estate has a critical influence on the key quality issues of:

• safety• infection control• fire precautions• physical environment (internal and external)• environmental conditions (energy/emissions/

sustainability)• access

• suitability for function• transportation / car parking• aid to healing• recruitment and retention of staff.

The range of benefits to a Trust and the wider health economy in having a formal estate strategy are:1. An assurance that the quality of clinical services

provided will be supported by a safe, secure and appropriate environment.

2. A means of ensuring that capital investments reflect service strategies.

3. A plan for change in which progress can be measured.

4. A strategic context in which detailed business cases for all capital investment can be developed and evaluated.

5. A means by which the wider health economy can identify capital investment projects which will integrate with and support the objectives of the wider estate.

6. A clear strategy to:• establish sustainable development and

environmental improvements.• ensure assets are effectively managed.• ensure risks are controlled and investment

properly targeted to reduce risk.

The Estates Strategy was last substantially reviewed in 2010. Since then the Trust has undergone significant changes.

In 2013 the Trust produced a comprehensive 5-Year Strategic Direction document with the vision of becoming recognised as best healthcare provider in our class, consistently performing within the top 10% nationally. During 2015/16, the Trust financial position become more complex with the identification of an urgent requirement to achieve substantial savings; which will impact Trust objectives and consequently the objectives (and strategies to achieve them) of an aligned Estates and Facilities strategy.

February 2016 saw the publication of the Carter operational efficiency review, which identified a large number of potential cost normalisation opportunities, several of which relate to Estates & Facilities.

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Our current positionCarter Report , published in February 2016, identified a number of specific targets for Estates & Facilities to contribute to these savings; these are incorporated in Section 4.

We are an integral partner of the South Yorkshire and Bassetlaw Sustainability and Transformation Partnership (STP) which has now become a first wave Accountable Care System (ACS). As part of the ACS we work together with many health and social care partners across the South Yorkshire and Bassetlaw footprint.

2.1.2. Local Health Economy Factors (Political, Economic, Social)

2.1.2.1. Local Economy & Government

Doncaster Metropolitan Borough Council (DMBC)The Borough has a well-established pattern of inter-agency working led by the Team Doncaster strategic partnership. There is strong evidence of local partners collaborating effectively in bringing together integrated health and social care services. The local authority is planning to alter its pattern of service delivery by adopting the “hubs” (originally identified through LIFT activity) as highly accessible points from which integrated and comprehensive services can be provided.

Changes planned by the local authority in close collaboration with health and social care agencies will result in the concentration of the provision of services from fewer, more intensively used, buildings with the staff of local agencies (including the local authority) being either more peripatetic or working from home to a more significant degree. This will reduce the requirement for floor space and permit investment in providing improved quality.

Stronger links also exist between Trusts across the area, but the challenge of being responsive to changing clinical and community priorities brings about a greater need for agile responses which utilise new ways of working, including wider use of touch-down space, and innovative use of technology that promotes mobile working. Maximising user experience whilst minimising costs are challenges faced by each partner organisation.

Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust operates three principal in-patient sites: the Doncaster Royal Infirmary, Bassetlaw Hospital in Worksop and Montagu Hospital in Mexborough, providing a comprehensive range of healthcare services to a population of more than 420,000 across South Yorkshire, North Nottinghamshire and the surrounding areas.

Estates and Facilities provide the following services: Estates Maintenance Capital Development Medical Technical Services (MTS) Transport Decontamination Services (HSDU) Staff/Student Accommodation Car Parking Security Lead for Health & Safety Lead for Fire Safety Patient and Retail Catering Services Cleaning and Deep Cleaning Linen and Laundry Portering General Office/Post Room.

The current position will be assessed in this section, by first considering national, external, factors and progressively focussing inwards until Trust-specific and ultimately Estates & Facilities-specific factors have been considered.

2.1 External Context Factors will be considered using the usual PESTLE analytical methodology.

2.1.1. National Factors (Political, Economic, Social)The May 2017 General Election has resulted in a government which it is unlikely will remain in place until 2022. Government policy includes a commitment to the NHS Plan which, nationally, will provide another £8bn of funding, but which also requires £22bn of savings to be found to close the estimated £30bn of increased demand. This is likely to translate broadly into budgets which are flat in real terms. The full

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The Carter report, which identifies areas where sharing best practice and performance could achieve savings, contains several recommendations and metrics relating to Estates & Facilities - and these are discussed in later sections.

No significant legal factors have been identified. The Trust is fully licensed by NHS Improvement and registered by the Care Quality Commission.

2.1.5. Environmental FactorsAs with all businesses, the healthcare sector must have an increasing awareness of, and response to, environmental concerns and issues. Guidance has been produced by the Government for the NHS in the Adaptation Report for the Healthcare System (2015, Gov. Gateway Ref. 02845), which requires the Trust to develop and maintain a Sustainable Development Management Plan (SDMP).

2.2. Internal Context2.2.1. Trust Operational PositionThe Trust operates 3 acute hospitals with over 700 in-patient beds, and a comprehensive range of services:

• Treatment of disease, disorder or injury• Nursing care• Surgical procedures• Maternity and midwifery services• Diagnostic and screening procedures• Family planning • Termination of pregnancies• Transport services, triage and medical advice

provided remotely• Assessment or medical treatment for persons

detained under the Mental Health Act 1983.The Trust employs over 6,400 staff and has an annual turnover of £350m.

In October 2015, the Trust was the subject of a CQC inspection, with an overall rating of Requires Improvement.

The One Public Estate initiative will further embed a collaborative approach, with the establishment of a project team to co-ordinate and drive forward activity. Priority tasks are likely to be the gathering and publication of core data on public sector property and establishment forums to exchange information and to promote and share strategic thinking.

The need to consider requirements for physical co-location of services, in particular the associated IT requirements is one where a collaborative approach could benefit partners significantly.

The Doncaster and the Bassetlaw Strategic Estates Groups include representatives of the respective local authorities and will collaborate closely with the wider public service initiatives, and are committed to developing plans that takes in the whole of the STP.

2.1.2.2. Health CommissionersThe principal source of income for the Trust is that received in payment for services commissioned by Doncaster CCG and Bassetlaw CCG.

2.1.2.3. Other Local Health ProvidersThe Trust is the only acute trust in the area, and therefore does not experience competition from Rotherham, Doncaster & South Humber NHS Foundation Trust (providing Mental Health & Community Services). There is a private patients unit on the Doncaster Royal Infirmary site, which is leased and not operated by the Trust, which captures some orthopaedic business from the Trust.

2.1.3. Technological FactorsHealthcare is an area subject to significant technological developments. While the majority of these relate to clinical developments, such as drugs and therapies, there have been improvements particularly in facilities services, such as improved cleaning techniques & materials, food preparation & serving methodologies and ICT systems (helpdesk, scheduling/rostering, performance monitoring) which all lead to greater efficiencies.

2.1.4. Legal FactorsFollowing the Francis report, the Trust invested in Nursing Establishments, but there were no actions relating to Estates & Facilities

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2.2.2. Trust Business PositionThe key internal driver is the significantly more adverse financial position identified in November 2015; the impact of which is still being felt despite ending 2016/17 with a significantly improved deficit position of circa £6m. The requirement to achieve the control total by the end of 17/18 requires delivery of increased efficiency and transformation plans across many areas.

Estates & Facilities Position

2.2.2.1. Estates PortfolioThe Trusts estate portfolio covers a diverse range of core hospital site buildings and some smaller associated off site properties. The total estate portfolio of 161,152m2 Gross Internal Area (GIA) is identified by the DoH as being a “Large Acute Hospital Trust” and the second largest Trust in terms of area and volume in South Yorkshire.

The Trusts property assets consist of a mix of property type, style and range providing a diverse mix of age profiles, conditions of uses.

Key Property Metrics (from ERIC 2014-15) Doncaster Bassetlaw Montagu

Gross Internal Area (GIA) m2 107,626 39,131 14,395

Occupied Floor Area m2 107,626 38,132 14,015

NHS Estate Occupied Floor Area m2 100% 100% 100%

Site Heated Volume m3 273,225 105,128 36,630

Site Footprint m2 44,580 24,702 9,634

Site Land Area (Ha) 11.535 11.181 3.592

Patient Occupied Floor Area m2 52,617 18,743 8,005

Non Patient Occupied Floor Area m2 45,502 15,295 4,799

Not Functionally Suitable - Occupied 47% 38% 29%

Not Functionally Suitable - Patient Occupied 66% 54% 34%

Unutilised space 2% 12% 16%

Age Profile - 2015 to Present 0% 0% 0%

Age Profile - 2005 to 2014 0.1% 6.4% 11.7%

Age Profile - 1995 to 2004 2.2% 14% 27.7%

Age Profile - 1985 to 1994 9.6% 38.1% 24.5%

Age Profile - 1975 to 1984 0% 24.8% 0.9%

Age Profile - 1965 to 1974 51% 3% 17%

Age Profile - 1955 to 1964 23.7% 1.8% 3.3%

Age Profile - 1948 to 1954 0% 0% 0%

Age Profile - Pre 1948 13.4% 11.9% 15.0%

Parking Spaces Available 1177 819 332

Designated Disabled Parking Spaces 55 47 35

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The age data profiles of the Trust’s properties are important when reviewing the estate backlog, environmental condition and investment needs. The Trusts property portfolio clearly identifies areas of the sites that are now being maintained and operated outside of a typical building life expectancy based on age profile, use and maintenance.

Whilst there is no definitive mandatory set point for a building life cycle end date, professional research and guidance identified by property and engineering research institutions such as the Building Services Research and Information Association (BSRIA), Chartered Institute of Building Services Engineers (CIBSE), and Building Research Establishment (BRE) identify a range of criteria based on age profile, use and maintenance in assessing a buildings condition. The building’s infrastructure i.e. building services engineering components identifies life cycle ranges of between 20-25 for plant and equipment with building fabric and building envelope life cycle ranges around 50 years.

The Trust’s property portfolio and data sets clearly identify large proportions of the estate that are now establishing themselves near the end of their economic and useful life expectancies. The ERIC data set identifies the following information cumulatively for property built up to 1974 which is now operating for 42 years or longer and requires significant refurbishment/replacement:

Doncaster Bassetlaw Montagu

Built before 1975 74% 17% 35%

Without investment in major refurbishment of the building fabric and essentially the engineering services areas of the Trust estate will be operating outside of its design life. This scenario increases the operational risks associated with ownership and occupation as the buildings and associated services breakdown, fail or do not meet statutory or mandatory standards of compliance.

2.2.2.2. Latest 7-Facet Survey FindingsA comprehensive 7-Facet Survey of the owned estate was undertaken in the summer of 2015 using the NHS Estates Risk Based Methodology for Establishing and Managing Backlog Maintenance and the HTM 00-08 standard. Anything rated below Condition “B” is risk assessed – this includes both building fabric and engineering specialisms (such as electrical systems and fire safety) along with estimated rectification costs. The classifications are detailed in Section 8: Appendix A: 7-Facet Survey Facets, Condition & Risk Ratings.

2.2.2.3. Doncaster Royal InfirmaryDoncaster Royal Infirmary is a general hospital situated 1 mile from the town centre and is easily accessible due to good public transport routes and its location in the centre of the M1, M62, M18 and A1(M). The hospital predominantly serves the population of the Dearne Valley i.e. Doncaster, Barnsley and Rotherham.

The estate comprises an 11.386 hectare site with buildings constructed in multiple phases since the original building was constructed in 1930, West Ward Block. The East Ward Block opened in 1968, the Women's Hospital block in 1969 and the Children's Hospital Block in 1989.

The overall hospital floor area is 115,181 square metres based in information provided by the Trust.

Each year the hospital treats around 150,000 patients along with 95,500 A&E patients (combined figures for Doncaster Royal Infirmary and Montagu Hospital). The hospital currently has 683 beds available for General Medicine, Rehabilitation/Intermediate Care, General Surgery and Orthopaedics, Adult Surgery and Children’s Surgery.

Outpatient clinics are held in most specialities including General Medicine, General Surgery, Orthopaedic Surgery, Gynaecology, Antenatal Care, Paediatrics, ENT, OMFS and Ophthalmology.

The public car park has 705 spaces and demand currently exceeds available space.

A free Park & Ride scheme has also been implemented to assist in solving the long-standing parking problems at Doncaster Royal Infirmary (DRI). In addition there is a free Hospital Shuttle between Doncaster Royal Infirmary and Bassetlaw Hospital, which runs every 45 minutes, Monday to Friday, between 8.00am to 4.30pm. A second Shuttle Bus runs between Montagu Hospital and DRI.

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Projected Costs Condition and StatutoryThe total projected cost for the rectification of all items identified under Condition is £32,147,317. The total cost for Statutory Compliance is £1,203,510. An indication of the projected costs per year is shown in the table below:

Condition Statutory

Current Backlog £20,057,338 £1,203,510

Year 1 £426,270

Year 2 £878,741

Year 3 £1,195,558

Year 4 £883,483

Year 5 £3,285,141

Years 6 - 10 £5,420,786

Total £32,147,317 £1,203,510

Where defects were duplicated in Condition or Statutory Compliance, e.g. for inadequate heating, the costs were only recorded under one facet. In the Facet spreadsheet where the duplicated costs are not entered, the alternative location of the cost is displayed in the ‘Remedial Action’ column.

Please note these are net costs only and do not include for Project Management, Contractors allowance for overheads and profits, travelling time and transport, inspection of the works and VAT. Approximately, an additional 50% uplift will need to be applied to cover these costs.

A breakdown of the various ratings for both Condition and Statutory are shown in the tables below:

Physical Condition

A 0.04%

B 62.75%

B(C) 13.27%

C 7.30%

CX 16.40%

DX 0.25%

Statutory Compliance

A 0%

B 88%

C 12%

Backlog Maintenance CostsBacklog Maintenance and Statutory costs are graded as Low, Moderate, Significant and High Risk. The division of Low, Moderate, Significant and High Risks plus the calculation for Risk Adjusted totals were carried out as per the NHS Estates guide ‘A Risk-Based Methodology for Establishing and Managing Backlog’. The Risk Adjusted totals take into account the perceived ‘Risk’ of the defect in terms of ‘Likelihood’ and ‘Severity’, the estimated cost for rectification and, in the case of Low or Moderate Risks, the estimated remaining life of the building. For Low and Moderate Risks the projected costs are divided by the estimated life expectancy of the building as prescribed in the Guide.

The Risk adjusted backlog formula is based on the premise that the eradication of safety-critical backlog will have greater impact on the Risk Adjusted figure than non-critical backlog (and hence will focus attention on reducing ’High’ and ‘Significant’ risk sub-elements). Similarly, the higher the remaining life of each building/block the longer the period in which the lower risk sub-elements can be addressed and therefore the lower the risk adjusted backlog figure.

Within the MICAD system no building remaining life is normally assigned to Site Infrastructure, the result is that when running Risk Adjusted Backlog reports, risk totals for Site Infrastructure are not taken into account. To remedy this issue a building remaining life of 20 years has been assigned to Site Infrastructure to ensure all backlog risk items are included in the calculations.

The total Risk Adjusted Backlog cost, for both Condition and Statutory are shown in the table below:

Risk Totals (Condition & Statutory)

Low Risk Totals £425,950

Moderate Risk Totals £4,159,191

Significant Risk Totals £15,975,707

High Risk Totals £700,000

Total Risk Adjusted Backlog Cost £16,786,991

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The figures given above for the ‘Low’, ‘Moderate’, ‘Significant’ and ‘High’ Risk totals are the total sums taken from the ‘Condition’ and ‘Statutory’ spreadsheets. The ‘Total Risk Adjusted Backlog Costs’ are the totals for all the 4 Risk groups, but divided by the remaining life of the building where appropriate, hence the Total Risk Adjusted Backlog Cost appears less than the sum of the 4 Risk Groups.

A breakdown of the backlog costs, by risk for both Condition and Statutory are shown in the table below:

Risk Group Physical Condition


Low 2% 7%

Moderate 20% 9%

Significant 76% 67%

High 2% 17%

Impending Backlog costsImpending backlog relates to B(C) sub-elements; sub elements currently in Condition B that will fall below B within 5 years, assuming no major investment in the interim. The total Impending Backlog cost, for Condition is shown in the table below:

Impending Backlog by Risk Condition

Physical Condition Cost

Low Risk Totals 54% £3,583,794

Moderate Risk Totals 33% £2,199,529

Significant Risk Totals 13% £885,870

High Risk Totals 0% £0

Total Impending Backlog Cost £6,669,193

Projected Costs Function, Quality, Space and Environment

A breakdown of the Facet Totals for Functional Suitability, Quality, Space and Environment are shown in the table below. Note that Defects identified under these facets are not assigned a year for remedial action to be undertaken and no risk assessments are undertaken.

Total CostFunctional Suitability £20,758,130

Space Utilisation £32,300

Quality £3,212,990

Environmental Management £847,732

Total £24,851,152

Projected Costs DDA

DDA costs are graded as Low, Medium-Low, Medium-High or High Priority. For full Priority definitions, please refer to Appendix C. The total projected cost for the rectification of all items identified under Disabled Access is £1,916,415. A breakdown of the costs by priority is shown in the table below:

CostLow 14% £269,957

Medium Low 22% £412,648

Medium High 64% £1,233,810

High 0% £0

Total £1,916,415

Total Costs

A summary of the total costs for the whole surveyed Estate are shown in the table below:

Total CostPhysical Condition £32,147,317

Statutory Compliance £1,203,510

Quality £3,212,990

Functional Suitability £20,758,130

Space Utilisation £32,300


DDA £1,916,415

Total £60,118,394

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2.2.2.4. Bassetlaw Hospital

Bassetlaw Hospital is one of the key hospitals in the Doncaster and Bassetlaw Hospitals NHS Foundation Trust. The Hospital is situated in the residential area of Kilton, about half a mile from Worksop town centre and is easily accessible due to good public transport routes and its location with the A1, M1, and M18 all in close proximity.

The Hospital has 300 beds and each year treats around 33,000 patients along with 38,000 emergencies in the A&E Department.

Projected Costs Condition and Statutory

The total projected cost for the rectification of all items identified under Condition is £23,726,792. The total cost for Statutory Compliance is £354,534. An indication of the projected costs per year is shown in the table below:

Condition Statutory

Current Backlog £16,611,109 £324,534

Year 1 £160,557 £3,000

Year 2 £367,964 £3,000

Year 3 £1,121,486 £3,000

Year 4 £1,042,902 £3,000

Year 5 £750,040 £3,000

Years 6 - 10 £3,672,734 £15,000

Total £23,726,792 £354,534

The costs shown in the Table above include the additional backlog rebuild costs that have recently been added into MICAD by the Trust.

Where defects were duplicated in Condition or Statutory

Compliance, e.g. for inadequate heating, the costs were only recorded under one facet. In the Facet spreadsheet where the duplicated costs are not entered, the alternative location of the cost is displayed in the ‘Remedial Action’ column.

Please note these are net costs only and do not include for Project Management, Contractors allowance for overheads and profits, travelling time and transport, inspection of the works and VAT. An additional uplift of approximately 50% will need to be applied to cover these costs.


Physical Condition

A 0.1%

B 67.8%

B(C) 11%

C 7.1%

CX 13.6%

DX 0%


A 0.07%

B 95.1%

C 4.77%

Backlog Maintenance Costs

Backlog Maintenance and Statutory costs are graded as Low, Moderate, Significant and High Risk. The division of Low, Moderate, Significant and High Risks plus the calculation for Risk Adjusted totals were carried out as per the NHS Estates guide ‘A Risk-Based Methodology for Establishing and Managing Backlog’. The Risk Adjusted totals take into account the perceived ‘Risk’ of the defect in terms of ‘Likelihood’ and ‘Severity’, the estimated cost for rectification and, in the case of Low or Moderate Risks, the estimated remaining life of the building. For Low and Moderate Risks the projected costs are divided by the estimated life expectancy of the building as prescribed in the Guide.

The Risk adjusted backlog formula is based on the premise that the eradication of safety-critical backlog will have greater impact on the Risk Adjusted figure than non-critical backlog (and hence will focus attention on reducing ’High’ and ‘Significant’ risk sub-elements). Similarly, the higher the

15

remaining life of each building/block the longer the period in which the lower risk sub-elements can be addressed and therefore the lower the risk adjusted backlog figure.

The total Risk Adjusted Backlog cost, for both Condition and Statutory are shown in the table below:


Low Risk Totals £1,390,660

Moderate Risk Totals £8,569,552

Significant Risk Totals £6,479,125


Total Risk Adjusted Backlog Cost £7,199,380





Low 8% 2%

Moderate 50% 65%

Significant 39% 33%

High 3% 0%

Impending Backlog costs

Impending backlog relates to B(C) sub-elements; sub elements currently in Condition B that will fall below B within 5 years, assuming no major investment in the interim. The total Impending Backlog cost, for Condition is shown in the table below:



Low Risk Totals 34% £1,166,971

Moderate Risk Totals 44% £1,531,169



Total Impending Backlog Cost £3,442,949


A breakdown of the Facet Totals for Functional Suitability, Quality, Space and Environmental Management are shown in the table below.Please note in-line with Estatecode guidance any defects identified within these four facets are neither risk assessed or assigned a year for completion.

Total CostFunctional Suitability £2,719,085

Space Utilisation £0

Quality £21,082


Total £2,755,167

Projected Costs DDA

DDA costs are graded as Low, Medium-Low, Medium-High or High Priority. For full Priority definitions, please refer to Appendix C. The total projected cost for the rectification of all items identified under Disabled Access is £451,201. A breakdown of the costs by priority is shown in the table below:

CostLow 18.67% £84,250

Medium Low 32.46% £146,440

Medium High 48.61% £219,311

High 0.27% £1,200

Total £451,201

Total Costs



Statutory Compliance £354,534

Quality £21,082

Functional Suitability £2,719,085



DDA £451,201

Total £27,287,694

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2.2.2.5. Montagu Hospital

Montagu Hospital is one of the key hospitals in the Doncaster and Bassetlaw Hospitals NHS Foundation Trust. The Rehabilitation Centre was opened in October 2013, and provides care for people recovering from serious illness or injury.

Montagu Hospital is situated in the residential area of Mexborough and has a public car park providing 131 spaces and numerous bus services.

Projected Costs Condition and Statutory

The total projected cost for the rectification of all items identified under Condition is £2,470,963. The total cost for Statutory Compliance is £225,158. An indication of the projected costs per year is shown in the table below:

Condition Statutory

Current Backlog £526,885 £225,158

Year 1 £0

Year 2 £84,854

Year 3 £273,470

Year 4 £0

Year 5 £639,692

Years 6 - 10 £946,062

Total £2,470,963 £225,158

Where defects were duplicated in Condition or Statutory Compliance, e.g. for inadequate heating, the costs were only recorded under one facet. In the Facet spreadsheet where the duplicated costs are not entered, the alternative location of the cost is displayed in the ‘Remedial Action’ column.

Please note these are net costs only and do not include for Project Management, Contractors allowance for overheads

and profits, travelling time and transport, inspection of the works and VAT. An additional uplift of approximately 50% will need to be applied to cover these costs.


Physical Condition

A 9%

B 73%

B(C) 10%

C 4%

CX 4%

DX 0%


A 0%

B 92%

C 8%

Backlog Maintenance Costs

Backlog Maintenance and Statutory costs are graded as Low, Moderate, Significant and High Risk. The division of Low, Moderate, Significant and High Risks plus the calculation for Risk Adjusted totals were carried out as per the NHS Estates guide ‘A Risk-Based Methodology for Establishing and Managing Backlog’. The Risk Adjusted totals take into account the perceived ‘Risk’ of the defect in terms of ‘Likelihood’ and ‘Severity’, the estimated cost for rectification and, in the case of Low or Moderate Risks, the estimated remaining life of the building. For Low and Moderate Risks the projected costs are divided by the estimated life expectancy of the building as prescribed in the Guide.

The Risk adjusted backlog formula is based on the premise that the eradication of safety-critical backlog will have greater impact on the Risk Adjusted figure than non-critical backlog (and hence will focus attention on reducing ’High’ and ‘Significant’ risk sub-elements). Similarly, the higher the remaining life of each building/block the longer the period in which the lower risk sub-elements can be addressed and therefore the lower the risk adjusted backlog figure.

Within the MICAD system no building remaining life is normally assigned to Site Infrastructure, the result is that when running Risk Adjusted Backlog reports, risk totals for Site Infrastructure are not taken into account. To remedy

17

this issue a building remaining life of 20 years has been assigned to Site Infrastructure to ensure all backlog risk items are included in the calculations.

The total Risk Adjusted Backlog cost, for both Condition and Statutory (including costs for site infrastructure) are shown in the table below:


Low Risk Totals £40,572

Moderate Risk Totals £172,658

Significant Risk Totals £372,913


Total Risk Adjusted Backlog Cost £543,228





Low 7% 1%

Moderate 32% 2%

Significant 29% 97%

High 32% 0%

Impending Backlog costs

Impending backlog relates to B(C) sub-elements; sub elements currently in Condition B that will fall below B within 5 years, assuming no major investment in the interim. The total Impending Backlog cost, for Condition is shown in the table below:



Low Risk Totals 21% £208,283

Moderate Risk Totals 40% £403,173



Total Impending Backlog Cost £998,016


A breakdown of the Facet Totals for Functional Suitability, Quality, Space and Environmental Management are shown in the table below.Please note in-line with Estatecode guidance any defects identified within these four facets are neither risk assessed or assigned a year for completion.

Total CostFunctional Suitability £351,220


Quality £2,500

Environmental Management £0

Total £353,720

Projected Costs DDA

DDA costs are graded as Low, Medium-Low, Medium-High or High Priority. For full Priority definitions, please refer to Appendix C. The total projected cost for the rectification of all items identified under Disabled Access is £451,201. A breakdown of the costs by priority is shown in the table below:

CostLow 44% £12,075

Medium Low 18% £5,050

Medium High 38% £10,320

High 0% £0

Total £451,201

Total Costs



Statutory Compliance £225,158

Quality £2,500

Functional Suitability £351,220


Environmental Management £0

DDA £27,445

Total £3,077,286

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Doncaster Royal InfirmaryBuilding Name Backlog Cost £ Rebuild cost £

DRI00 Sub Duct and Undercroft 131,500 24,750,000

DRI02 D Block 696,638 5,378,250

DRI03 Squash Court 23,668 233,654

DRI04 Garages 5,814 180,496

DRI05 A Block 11,530 1,566,125

DRI06 B Block 199,950 1,581,099

DRI07 C Block 33,312 1,531,860

DRI08 Carousel Centre 3,260 396,179

DRI09 Women & Childrens Hospital 1,058,654 16,084,324

DRI10 Parkhill Hospital 1,767,650 5,120,665

DRI11 E Block (Old Bio-Engineering) 11,260 202,675

DRI12 West Cycle Store 35 21,079

DRI13 West Medical Gas Store 2,284 32,725

DRI14 West Ward Block 817,790 10,014,276

DRI15 Physical Medicine 267,802 4,567,723

DRI16 Pathology North 184,059 3,833,500

DRI17 Diagnostic South 1,133,500 13,202,750

DRI18 Emergency Block 148,096 4,808,375

DRI19 Outpatients North 449,176 9,520,500

DRI21 Estates Stores 5,257 169,579

DRI22 G Block (old Dietetics) 74,174 340,161

DRI23 East Ward Block 4,004,762 29,269,653

DRI24 South Block 43,054 8,316,000

DRI25 Theatres and HSDU 6,143,512 9,689,213

DRI26 South East Block 61,914 10,361,358

DRI27 East Kitchen & Dining 369,700 3,131,054

DRI28 Water Treatment Plant 371,988 248,256

DRI29 Estates Offices 3,606 566,445

DRI30 Energy Centre 224,639 3,319,278

DRI31 Water Tower 5,300 38,693

DRI32 Laundry 271,662 2,503,793

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Doncaster Royal InfirmaryBuilding Name Backlog Cost £ Rebuild cost £

DRI00 Sub Duct and Undercroft 131,500 24,750,000

DRI02 D Block 696,638 5,378,250

DRI03 Squash Court 23,668 233,654

DRI04 Garages 5,814 180,496

DRI05 A Block 11,530 1,566,125

DRI06 B Block 199,950 1,581,099

DRI07 C Block 33,312 1,531,860

DRI08 Carousel Centre 3,260 396,179

DRI09 Women & Childrens Hospital 1,058,654 16,084,324

DRI10 Parkhill Hospital 1,767,650 5,120,665

DRI11 E Block (Old Bio-Engineering) 11,260 202,675

DRI12 West Cycle Store 35 21,079

DRI13 West Medical Gas Store 2,284 32,725

DRI14 West Ward Block 817,790 10,014,276

DRI15 Physical Medicine 267,802 4,567,723

DRI16 Pathology North 184,059 3,833,500

DRI17 Diagnostic South 1,133,500 13,202,750

DRI18 Emergency Block 148,096 4,808,375

DRI19 Outpatients North 449,176 9,520,500

DRI21 Estates Stores 5,257 169,579

DRI22 G Block (old Dietetics) 74,174 340,161

DRI23 East Ward Block 4,004,762 29,269,653

DRI24 South Block 43,054 8,316,000

DRI25 Theatres and HSDU 6,143,512 9,689,213

DRI26 South East Block 61,914 10,361,358

DRI27 East Kitchen & Dining 369,700 3,131,054

DRI28 Water Treatment Plant 371,988 248,256

DRI29 Estates Offices 3,606 566,445

DRI30 Energy Centre 224,639 3,319,278

DRI31 Water Tower 5,300 38,693

DRI32 Laundry 271,662 2,503,793

Building Name Backlog Cost £ Rebuild cost £

DRI33 Gardeners Compound 5,380 80,905

DRI34 H Block (old Ambulance Station) 41,021 577,005

DRI35 Lister Court1 - 6 186,481 685,094

DRI36 Lister Court7 - 12 177,167 584,433

DRI37 Lister Court12A - 18 187,167 584,433

DRI38 Lister Court Garages 2,571 196,680

DRI39 Energy Centre Gas Meter House 0 30,498

DRI40 Underground Roadway 20,300 681,849

DRI50 35 Arklow Road 14,575 133,251

DRI51 37 Arklow Road 14,575 133,251

DRI52 39 Arklow Road 14,575 130,886

DRI53 49 Arklow Road 14,575 130,886

DRI55 61 Arklow Road 15,630 149,875

DRI57 10 Dargle Avenue 12,205 130,886

DRI58 14 Dargle Avenue 12,205 130,886

TOTAL £19,243,973 £175,340,556

Bassetlaw HospitalBuilding Name Backlog Cost £ Rebuild cost £

BDG06 Block 6 108,367 3,716,798

BDG07 Block 7 176,857 3,990,684

BDG08 Block 8 189,459 1,957,388

BDG09 The Lodge 23,626 248,080

BDG12 Estates Offices 83,768 309,011

BDG16 Medical Records 105,616 1,301,091

BDG18 Partial Booking Office 46,417 173,521

BDG25 Mortuary 45,126 1,168,316

BDG51 Tissue Viability & D Nurses 64,651 209,177

BDG77 Victoria Residential Block 1 224,270 669,125

BDG78 Victoria Residential Block 2 224,270 669,124

TOTAL £1,292,427 £14,412,315

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2.2.3. Compliance Systems and Issues (by Specialism)

The Trust assesses its position against the Department of Health’s NHS Premises Assurance Model (PAM) on an annual basis, this is likely to document a number of issues

2.2.3.1. Fabric Maintenance

Specialism Element Risk Rating % Capital £ Revenue £Building Fabric Flooring 16 497,000

Building Fabric Structural Frame 20 335,000

Building Fabric Roads, Footpaths & Car Parks TBC

2.2.3.2. Asbestos

Specialism Element Risk Rating % Capital £ Revenue £

Asbestos Annual Condition Monitor Survey /Re-inspection 16 25,000

Asbestos Annual Fibre Air Monitoring 16 15,000

Asbestos Management & Removal Programme 20 1,000,000

Asbestos Training 16 8,000

2.2.3.3. Water Systems

Specialism Element Risk Rating % Capital £ Revenue £

Ventilation Annual inspection and verification(critical systems) 15 50,000 50,000

Ventilation Authorising engineer audit 20 15,000

Ventilation Critical plant operating condition 20 3,200,000

Ventilation Duct cleaning (critical systems) 9 300,000 20,000

Ventilation Ductwork re-config critical ventilation systems 10 200,000

Ventilation Kitchen extract canopies 9 400,000

Ventilation Control of building environment and space temperatures 12 1,200,000

2.2.3.5. Medical Gases

Specialism Element Risk Rating % Capital £ Revenue £Medical Gases Audit remedial works TBC

Medical Gases Central oxygen system (VIE) 6 1,000,000

Medical Gases East Ward block pipework layout 12 700,000

Medical Gases Medical gas plant failure 16 1,800,000

with compliance against statutory requirements across a range of engineering specialisms. The assessment includes the preparation of Risk-Assessed Action Plans. These will be used to update the estates maintenance recording systems and capital programme list as appropriate.

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2.2.3.6. Pressure Systems

Specialism Element Risk Rating % Capital £ Revenue £Pressure Systems Limited heating systems 9 80,000

Pressure Systems Low surface temperature protection 16 50,000

Pressure Systems Refrigerant Gas Removal 5 800,000

Pressure Systems Refrigeration gas removal 5 800,000

Pressure Systems Steam & low temp hot water pipework distribution system 12 1,500,000

2.2.3.7. Lifts & Hoists

Specialism Element Risk Rating % Capital £ Revenue £Lifts & Hoists Capacity failure 12 850,000

Lifts & Hoists Patient movement 16 5,000,000

2.2.3.8. Fire Systems

The Trust successfully met the terms of three fire enforcement notices served by the local Fire Service in relation to two ward blocks at the DRI in June 17. The notices that remain in place relate to a programme of key milestones which include a wider physical work programme for the Women and Children’s block up to December 2018, and the East ward Block up to December 2019.

As a result the early part of the 7 year Capital Investment Programme will have a strong focus on remedial fire improvement works.

2.2.3.9. Security of Electrical Supply

The current electrical supply to the Doncaster site is running at maximum capacity of 2.6 mega volt amps (MVA) and is in an extremely poor condition. As it stands at present no further/additional development can take place without an increased electrical supply, resulting in programmes of work needing to be coordinated with the lead times and enabling works for any new electrical demand requirements. A modelling exercise was undertaken which showed the anticipated peak demand to be around 4.39 MVA.

Three options were considered; the option of doing nothing was discounted as the Trust would run out of supply to support any future expansion in service.

As a result a capital scheme will commence in January 2018 to increase supply capacity to 4.4 MVA against an estimated modelled peak demand summary of 4.39 MVA.

2.2.3.10. Decontamination Services (HSDU)

The Trust’s Decontamination (HSDU) Service is based on-site at DRI and through a series of shift patterns works on a 24 hour basis including weekends. The service supplies across all three sites and includes 3 deliveries to both BDGH and Montagu, reducing to 2 deliveries per day at the weekends. The department also provides some limited services to GP premises and other sites on a daily basis with a single delivery.

The HSDU service has in the past experienced some quality issues and there have been consequence issues of confidence within the service. The current position is more reliable and less problematic with improved relationships between HSDU and the main customers; however it is not ideal and significant investment will be required moving forwards.

In terms of contingency and resilience, although ad hoc arrangements are in place with other NHS Trusts which operate Decontamination services, there is no formal agreement in place should we experience any downtime with the service.

Although investment has been made into the equipment within HSDU, the quality of the instrumentation tracker and management systems within the service are not to a high standard. The systems operated by commercial providers generate significantly more management data including full visibility of the sterilisation process to enable clinicians to ascertain the whereabouts of instrumentation at any given time.

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The decontamination of surgical instruments is a critical area of compliance for the Trust and although compliance is in place at the present time with the following standards:

• ISO 13485-2013

• ISO 9001-2008

• Directive 93/42EEC

Over time, the requirements of compliance are becoming ever more demanding.

2.2.4. Medical Technical Services

Medical Technical Services (MTS) has bases at DRI and Bassetlaw Hospital and is engaged in the repair, maintenance and management of the trust’s extensive range of medical equipment. This includes in-house repair and calibration services, management of the equipment library, and external specialist contract management. This is an essential requirement of CQC standard 11. The department also manages the Central Alerting System (C.A.S.) for incoming safety alerts and advises on all matters relating to medical device purchase and on-going management, including training, repair, calibration and disposal. The department manages specialist renal technical support via in-house and external contracts as well as operational and financial aspects of compressed medical gas.

Developments for the next 5 years:

• Ensure staff succession planning by continuing to invest in apprentices, utilising the apprentice levy scheme where possible, estimated at 3 apprentices phased over 5 years.

• Carry out a detailed validation and review of the medical equipment database to ensure that it reflects as accurately as possible the assets held. (17/18)

• Develop a robust 5 year replacement program for capital medical equipment linked to the database and make this available on-line to care groups (17/18).

• Development of a Re-Turn centre providing effective measures to ensure in the first instance trust assets that are no longer required can be reused and redistributed across the Trust and items which cannot are auctioned (17/18)

• Establish and roll out RFID tagging technology for medical equipment following on from the medical records installation (17/18)

• Increase Inspection and Preventative Maintenance and condition monitoring program to ensure 100%

compliance in any rolling 12 month period is achieved (18/19)

• Increase use of electronic forms and on-line communication/ordering functionality to be paper light (18/19).

• Introduce scanning system for medical gas cylinders to compliment the HTM 20-01 requirements and increase security (18/19)

• Develop and incorporate into the equipment library a user friendly web based choose and book facility (18/19)

• Explore and develop video procedures initiative to support aspects of training and development with the aim of having a suite of procedures (19/20)

• Explore introduction of a bed library should funds and resources allow specifically bariatric devices (19/20)

• Increase use of in-house expertise by evaluating external contract costs and carrying out risk/benefit analysis annually, with the aim to reduce reliance on external contractors by 25% by 2020.

2.2.5. Space Utilisation and Planning

As the provider of acute services locally, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust occupy substantial property on 3 sites within Doncaster, having a total Gross Internal Area (GIA) of 124,098m2. The Trust has recently embarked on a revised strategy, aimed at facilitating quality improvements and new service models, but does not plan to reduce capacity due to commissioning intentions for out-of-hospital care.

High level indicators show excess estate of circa 23,159m2 for activity (13.5%) – this is significantly above the target of 2.5% identified in the Carter Report. A potential for the re-location of some 250-300 administrative staff off the DRI site has been identified, to enable development works on the main DRI site such as the development of multi-storey car park and a staff/student accommodation block. This should be considered in conjunction with the Carter target of no more than 35% of space used for non-clinical purposes – the current figure for the Trust is close to 40%.

3.2.6 Facilities Services

3.2.6.1 PLACE 2017 Scores

As PLACE assessment performance has improved nationally within recent years and criteria has been changed, due to lack of transformation and investment Estates & Facilities, scores have declined when compared to peers:

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3.2.6.2 Catering

The Catering service is provided by an in-house team delivering a bulk-traditional-cook service for the 500+ in-patients at Doncaster and the 170 at Bassetlaw with the 50 in-patients at Montagu receiving a dining room service for their main meals.

Retail catering facilities consist of 5 outlets on the DRI site, 1 at Bassetlaw and 2 at Montagu, ranging from coffee shops, through “grab-and-go” to full restaurants. There are no commercial partners on site, save for some rental/serviced vending machines.

The quality of food produced is good, and this is evidenced by the PLACE scores for quality of food and patient satisfaction audits. The Catering Departments on all three sites have been awarded the Five Star Food Hygiene rating for many years by the Local Authority Environmental Health Officer. The 2014/15 ERIC data return, as used in the Carter Report, put the Trust in the upper quartile when benchmarked against other Trusts returning a cost per patient per day of £10.77 (average across the Trust).

A comprehensive catering review was undertaken in early 2015 , which highlighted the aged facilities at Doncaster & Bassetlaw plus variable quality and high levels of wastage at all sites. A number of options were developed and these are discussed in section 4.5.1.

3.2.6.3 Cleaning

The cleaning service is provided by an in-house team of Services Assistants, delivering a service to the level of the National Standards for Cleanliness in the NHS. The latest PLACE scores indicate that the service is performing effectively. The average cleaning cost across the Trust is £32.10/m2 – below the ERIC data benchmark used by Carter of £38.00/m2.

3.2.6.4 Portering

Theatres have their own, dedicated, porters which are not managed or deployed by Estates & Facilities. The remaining porters, Service Assistants Central Team, are managed by Estates & Facilities and are principally operated as a pool.

3.2.7 Estates & Facilities Department

In the last two years the Directorate has experienced significant issues with recruitment and retention of technical engineering staff in the local area. Some staff training and development programmes are in place for job roles, and have recently been enhanced within the Service department following the LEAN transformation review. However, a training needs analysis is required as part of the wider transformation programme.

Estates & Facilities have over 800 staff and have introduced specific initiatives to support Trust-wide staff strategies and best practice such a range of regular informal meetings been set up with groups of staff, such as lunchtime “toolbox talks” for the maintenance staff, regular Director ‘Drop In’ sessions across all sites, and staff briefings.

3.2.7.1 Engagement beyond E&F

There is some limited clinical engagement in estates projects, to consider such factors as clinical adjacencies and patient pathways, but it is crucial that this engagement is expanded as we look to reconfigure clinical services across the three sites.

2.2.3.1. Fabric Maintenance

Site Name Clea

nlin

ess

Food

Ove

rall

Org

anis

ation

al

Food

War

d Fo

od

Priv

acy,

Dig

nity

an

d W

ellb

eing

Cond

ition

Ap

pear

ance

and

M

aint

enan

ce

Dem

entia

Disa

bilit

y

Trust Score 91.49% 80.18% 75.67% 81.57% 75.35% 91.33% 76.62% 81.06%

Bassetlaw Hospital 97.60% 84.20% 75.67% 87.87% 80.51% 91.50% 67.04% 75.15%

Doncaster Royal Infirmary 89.19% 78.74% 75.67% 79.32% 73.14% 90.97% 78.86% 82.92%

Montagu Hospital 99.10% 83.49% 75.67% 86.91% 84.44% 94.54% 78.45% 77.48%

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Estates & Facilities SWOT (Strengths, Weaknesses, Opportunities & Threats)

Summarising all the above into a SWOT table, progressively “zooming in” from the external context to the Trust-wide and finally the Estates & Facilities Department perspective:

STP/Accountable Care Organisations

STP ‘Outstanding’ Rating

Locality Estates Planning & Rationalisation

Adoption of new technology to reduce costs

External Opportunities

Full range of clinical services offeredSecond largest Acute Trust in STPPotential to reduce occupancy (m2)

Above average PLACE scoresE&F Staff GoodwillEngagement with other Trust StakeholdersTotal E&F Costs significantly below Carter benchmark

Trust Strengths

E&F Strengths

Substantial Financial Deficit (ongoing)

Non-Clinical Space Usage above Carter benchmark

£50m+ in critical maintenance backlog

Fire Improvement Notices

DRI electrical supply at capacity limit

Trust Weaknesses

E&F Weaknesses

External Threats Department of Health, CQC, HSE, Fire Service or other regulator curtailing Trust operation.

Changes in NHS tariff model results in reduced income.

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Where do we want to be?3.2 External Context

The Trust is participating in the Doncaster Strategic Estates Group, the Bassetlaw Strategic Estates Group, Sheffield City Region – One Public Estate, and the South Yorkshire and Bassetlaw ACS Strategic Estates Committee. Implicit within the plans of the partnership organisations is a shared commitment to integration so that available services can be better understood, more easily accessed and delivered with increased efficiency. The local service plans include budgetary information that illustrates a clear recognition that the delivery of the highest priority public services will be dependent on the elimination of waste. An early requirement of these local estates strategies will be to obtain data on the utilisation of premises and introduce rational plans for the delivery of services from the minimum floor space at times and in locations that maximises the take-up of services by those needing them most.

The estates strategies will be used to make early progress in this through one or a combination of:

• Improved space utilisation.

• Extended use of the assets.

• More flexible use of space (less demarcation and more shared space where appropriate).

• Changes in working practice with less demand on property.

• More collaborative use of space across the public services estate – One Public Esates

• Enabling other underperforming/expensive assets to be closed and sold or leases terminated.

• Generating rental income from underutilised assets.

The Doncaster Strategic Estates Plan (2015) and Bassetlaw Strategic Estates Plan (2016) are intended to support remodelling of the wider public sector estates to create a smaller better quality estate that operates more efficiently and contributes more positively to the local community. The plans are developed on the following strategic themes and principles;

• Integration

To build on the established pattern of the delivery of health, social care and a wider range of related public services from consolidated community “hub” buildings offering good accessibility to a comprehensive range of services in a single familiar building and promoting improved collaboration between practitioners and service managers.

• Economy

To reduce the number of buildings and the associated running costs including energy, maintenance and rates by making more intensive use of those good quality buildings where design, tenure or both determine that they should have a long – term future. Estate rationalisation should be supported by increased utilisation and more flexible use of space over extended hours of suitable core and key buildings. Particular effort will be required by both commissioners and estate managers to avoid the double expense of paying for the use of space held vacant while meeting the expense of premises that may be selected by providers.

• Quality

To ensure the buildings from which services are delivered are safe and properly suited to the purpose; offering an optimal range of services and meeting all inspection quality standards. The priority will be to deliver the best possible quality of care and public services to those needing it most from facilities that are fit for purpose that support staff to continually development the services.

• Access

Services offered from a planned network of buildings in locations that are conveniently accessible by the communities they serve.

These strategic themes and principles will support judgements and appraisals to be made on the buildings where utilisation should be intensified and those that can be withdrawn from use in order to achieve savings and improved service integration.

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Restrictive covenants are in place for the Montagu Hospital, limiting potential for other uses but not ruled out, provided they are for local health provision.

4.3 Internal Context4.3.6 Trust Values

The Trust has a recognisable and embedded mission statement, which captures its high-level objectives and values, expressed as we care for you:

4.3.7 Estates & Facilities Objectives

4.3.7.1 Operational (Revenue Funded)

The Carter Report identifies three specific efficiency targets for the Estates & Facilities function:

Property supply elements to be considered are:

• Location, main purpose, tenure and managing organisation

• Running costs, backlog maintenance and capital value

• Suitability for the purpose intended.

• Current levels of actual utilisation and, accordingly, the latent capacity of the buildings

• Linkages with other initiatives such as regeneration or master planning.

The We Care philosophy is at the heart of everything do as an organisation, and as individuals, and will be at the heart of the FM Transformation project.

W e C a r eWe always put

the patient first.

Everyone counts – we treat each other with courtesy, honesty,

respect and dignity.

Committed to quality and continuously

improving patient

experience.

Always caring and

compassionate.

Responsible and

accountable for our actions – taking pride in our work.

Encouraging and valuing our diverse

staff and rewarding ability and innovation.

Carter Metric and Objective Plan to be Developed By

Target to be Achieved By

Current DBH Value 16/17

Total Estates & Facilities running costs <£320/m2 April 2017 April 2020 £166.36/m2

Non-clinical space <35% of total space April 2017 April 2020 40.87%

Unoccupied space < 2.5% of total space April 2017 April 2020 6.05%

27

operating climate needs to be considered and an acceptable model of investment agreed, or the identification of an investment partner through an investment vehicle, eg: a Strategic Estates Partnership.

4.4 Space Planning4.4.6 Approach

For the Trust estate specifically:

• Changes to the estate must be aligned to the delivery of the Trust Strategy and Clinical Site Development Strategy.

• Proposals should result in improving patient safety, efficiency and experience with a patient journey led design delivering best value and flexible solutions to allow balance of the needs of specialities.

• Proposals should result in the sustainability of the estates, and the services delivered from it.

Options outside the current footprint include:

• Re-provide the Chequer Road clinic elsewhere

• Explore opportunities with local partners for re-location or co-location of back-office staff:

• Doncaster CCG Lift buildings

• DMBC Buildings

• RDASH Estates

• NHS Property Services

Within the current site footprints, any changes should seek to enhance the co-location of sympathetic clinical functions across the Doncaster Royal Infirmary site:

The Trust has, therefore, already achieved the key cost metric, and is significantly more efficient than the national benchmark for Estates & Facilities. However, this may be an indication as to the poor level of service currently delivered by estates maintenance, and the lack of continued ongoing investment in the estate.

The second metric relates to efficient use of space by non-clinical activities – which would also include management and administrative functions. Current performance is circa 6% above the required target and therefore requires development of a Trust-wide implementation plan to enable achievement of the target by 2020.

The final metric, of unoccupied space is 3.5% above target. Therefore effort will be focussed on reducing unoccupied space. As clinical activity is unlikely to increase to require additional space, the strategy has been one of managed disposals to reduce the amount of empty space in a cost-effective manner. Following the disposal of a number of assets within 2016/17 the Trust space utilisation plan needs to be updated. Release or redevelopment of the 3.19 Ha Southside plot at BDGH before 2020 would substantially improve the Trust performance against this metric.

4.3.7.2 Strategic (Capital Funded)

The investment requirements for the estate, based on condition and compliance assurance, is identified at £103m to bring the estate to the required condition and remedy the current operational risks. There is clearly a significant investment requirement.

The current annual capital estate investment programme for 2017/18 has been fully allocated to Estates for Fire Enforcement remedial works, Electrical Works, and CT development. The 7 year investment programme, appendix C, aims to provide significant funding to tackle the identified backlog maintenance requirements using a risk based prioritisation methodology linked to both the Departmental Risk Register and the Trust Risk Register.

In considering the position of the wider NHS, and that of the Trust, with regard to the current financial position, the outlook for estate investment in the

28

on each main site used a set of principles which where adhered to throughout the review. • Patient centred, safe services • Maximise the efficiency and effectiveness of

Trust sites • Work in partnership with other providers to

improve outcomes • Standardised approach to pathway delivery

across CCGs and hospitals • Senior clinical triage with access to multi-

disciplinary triage where appropriate • Diagnostics ordered once and only when clinically

necessary • One stop services/co location to improve patient

experience • Follow up once and only when necessary • Increase the use of Integrated IT/information.

4.4.7.2 Other Disposal Opportunities

In addition to the three major disposal opportunities listed above, there is one other disposal opportunity, currently on the market, which could be achieved in 2017/18:

Site Valuation

5 Highland Grove £200,000

4.5 Estates (Capital Programme & Operational Maintenance)The Estates Maintenance function, providing both building fabric maintenance and maintenance across a range of engineering specialisms, need to be transformed in order to achieve the statutory and regulatory maintenance regimes, as well as to be able to respond to reactive maintenance request from customers. The most comprehensive means of achieving this is to conduct a full LEAN review of the services, which typically would look to increase quality whilst reducing costs. However, due to the removal of estates staff previously in order to support the agreement of a Measured Term Contract (MTC) with a local contractor, the review needs to take into account the impact of both the capital and revenue costs that have been

4.4.7 Disposal of Surplus Land

The Trust has a policy of a managed disposal of surplus land and disposed of a number of buildings in 2016/17. Three further opportunities have been identified:

Any direct sale of the Bassetlaw DGH Southside plot would require the occupants of the current underutilised buildings to be relocated either within the main hospital building, or offsite. Previous plan were to re-provide accommodation in a new “Multi-Function Building” at a costs or circa £9m. This is not a feasible solution to enable to disposal of a site with a midpoint value of circa £2.4m. Previous offers for the plot were significantly compromised by the Non-Designated Heritage Asset (NDHA) status of several of the Victorian buildings currently on the site. When this plot was marketed for sale in 2015/16, uncertainty from planners over permission to demolish the NDHA buildings resulted in an overwhelming majority of potential buyers declining to bid. However, it is anticipated that a new application for Outline Planning for the redevelopment of the site may be successful.

4.4.7.1 Clinical Site Development Strategy

In September 2016 DBTH embarked on a detailed review of its clinical services by speciality level, led by the care group directors and supported by the senior clinical and managerial staff. This enabled detailed plans for each of the services to be developed - in line with our vision and objectives.

Using the information, statistics and outcomes from the diagnostic exercise and assessments each care group was asked to determine their priority objectives for the strategy over the next five years. The clinical site strategy was in line with our 5 strategic objectives. The clinical review of services

Plot Size (Ha) Valuation Latest Offer Montagu Nurses Home 0.30 £275,000 -

£278,000£250,000

(Mar 2016)Bassetlaw DGH Southside 3.19 £2,175,000 -

£2,750,000£550,000 (Jan 2015)

Chequer Road Clinic 0.30 £380,000 N/A

29

• Must be able to achieve strict turnaround times together with a fast track option

• For any transfer of service, TUPE would be involved together with a commitment to recognise agenda for change terms and conditions of service.

• Release of space on-site to support future capital developments at the Trust.

The following page shows a table with details on how the various options address these factors.

incurred through the MTC contract rather than through direct labour and the impact this may have left on internal capacity. The review also needs to take account of skill mix, and a proof of concept trial will commence in Q3 2017 of a new Band 1 Maintenance Support Worker role that will perform low level reactive maintenance tasks that impact of reputation, aesthetics and basic operation of areas. The introduction of this lower level role aims to release more skilled maintenance staff to undertake PPM and more skilled reactive tasks with the agreed KPI’s.

The Capital Programme will be reviewed to identify which schemes (if any) are essential to the safe, continued operation of the Trust. The existing plan will be kept and updated periodically for review should the future financial position allow.

4.5 Decontamination Services (HSDU)Whilst decontamination services formed part of a Working Together initiative and options to develop a service across a number of sites had been suggested, these did not gain traction. As a result, and as part of wider CIP plans developed in 2016/17, it was agreed to test the commercial market by conducting a tender exercise for either on-site or via an off-site service. Commercial options would also bring with them the opportunity for a managed service to be introduced for complimentary services with the potential for attendant financial savings on VAT.

In considering these options, the following critical success factors were observed:

• Must be compliant with all national decontamination requirements including ISO 13485-2013, ISO 9001-2008 and Directive 93/42EEC.

• Deliver an improved information management system with opportunities to use outside of decontamination.

• Must deliver improvements on existing costs and budgets and savings of at least 20%.

• Should provide improved service, resilience with a guarantee of provision of service from other facilities.

30

Com

plia

ncy

Risk

Qua

lity

Cont

rol

Serv

ice

Re

silie

nce

Budg

etar

y Co

ntro

l

Capi

tal

Inve

stm

ent

Requ

irem

ent

HR Is

sues

Rele

ase

of

Spac

e

Man

aged

Se

rvic

e

Opp

ortu

nity

Option 1. In HouseWith Trust Direct

controlCurrently rely on grace and favour in the in event of on-site issues.

Requires high degree of input to control costs

High Area of high sickness absence

None No

Option 2. Working Together NHS ConsortiaWith Consortia

Indirect Control / SLA

Better Unknown service model, difficult to predict

Some High level of sickness absence levels to manage.

None No

Option 3. Consortia Solution run by Commercial OperatorShared by Consortia and Commercial Operator

Contractual Better Financial one unknown as an untested model which commercial sector do not like

Some, but could be funded by operator

High sickness absence levels to manage

None Yes

Option 4. Commercial management of on-site serviceWith Contractor

Contractual Best (other site backup)

Lose budgetary control therefore need good contract management but will deliver savings through improved production

Funded by operator

TUPE transfer to complete

None Yes

Option 5. Commercially managed off-site serviceWith Contractor

Contractual Best (other site backup)

Need good quality contract management but will deliver savings through better production systems

None TUPE transfer or redeployment of staff

Yes Yes

The options appraisal suggested that the option which achieves the greatest number of critical success factors is option 5, a commercially provided off-site option. The most significant advantage to this option over and above all other options would be the release of clinic space on-site that may facilitate future capital developments at the Trust or clinical reconfiguration in response the STP led service reviews. In addition, this option also provides the potential for a one-off capital receipt through the sale of equipment and would improve the Carter benchmark relating to percentage of space used for non-clinical purposes.

To take this work forward, a tendering exercise was undertaken with bids being sought against both of the commercial options i.e. both retaining an on-site service (4) or delivering a service from off-site premises (5) and that the submissions are analysed and scored against the critical success factors.

The tendering process is currently underway and at preferred bidder status, with a likelihood of an August 18 commencement date should the business case be approved.

31

4.6 Facilities4.6.6 CateringIn 2015 it was identified that there was a need to improve the service including the patient menu, the menu ordering system, reduction of food waste, and retail services. There has been little or no investment in catering equipment and facilities at DRI and Montagu hospitals, however there was investment in Bassetlaw Catering Services in 2009.

A comprehensive review of the service and options was undertaken by specialist consultants CCB* during 2015. The strategic drivers for the review were:

• Trust Catering Services have not received a wholescale review since becoming an NHS Trust in the early 1990s

• Little or no investment in catering equipment and facilities at DRI and Montagu Hospitals

• Patient Menus have been in place unchanged for 15 years

• Poor PLACE scores relating to the preparation of patients on wards for mealtimes

• Requirement through the National Contract with Commissioners to comply with new standards for hospital food following the publication of Hospital Food Standards Panel report in August 2014

• Standardise catering operations, quality and expenditure across the Trust

• Reduce food wastage• Significant capital investment is required to carry

out an equipment replacement programme at DRI, and to refurbish and update coffee shops and staff restaurants at DRI and Montagu

• Improve the patient meal experience and efficiency through using technology to modernise food services

• Maximise commercial income.

* “Catering Options Appraisal” prepared by Catering Consultancy Bureau Ltd, April 2015.

Com

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budg

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33

Com

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and

Risk

Qua

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Cont

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Opti

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the

Stat

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uo o

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Not

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” op

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All r

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Trus

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No

maj

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R iss

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Wou

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. Out

sour

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ater

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l risk

sit

s with

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or

Shou

ld im

prov

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fully

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with

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Good

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ansf

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t

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usin

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mm

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syst

ems

The review concluded that a change in food production from in-house traditional cook on all three sites, to an in-house service using bought in frozen or chilled meals would significantly increase the per patient meal cost. However, the soft market testing undertaken demonstrated that moving to an outsourced model with the same frozen or chilled meals could offer a recurrent saving compared to current costs for traditional cook.

Under such a model main kitchen will still remain on each site, but food production will be limited to accompaniments for the bought in main courses, as a result less skilled cooking staff will be required. A point to note regarding frozen or chilled food quality, whilst quality standards have improved greatly over the last 4-5 years, this style of service may not meet all of the Hospital Food Standards Panel’s recommendations, although assurance will no doubt be offered by the respective manufacturers that work is underway to increase compliance.

The review also found that to maintain in-house service substantial capital investment is required for the replacement of equipment in the main kitchens at DRI and Montagu and for the replacement of meal trolleys and ward beverage trolleys at a cost of £550,000. An in-house service would also need to invest in a much needed electronic patient meal ordering system in order to improve the patient experience, and reduce food wastage. Such systems are part and parcel of an outsourced service and are included within the delivery costs.

4.6.6.2 Retail Catering ServiceWith regard to staff and visitor retail catering services, it was felt the service currently provided by the Trust was no longer fit for purpose. There has been no investment in these services for many years. The service does not provide a suitable range of options and the facilities are in desperate need of investment, therefore retail catering is not currently fulfilling its potential in terms of income. The investment required to refurbish staff and visitor restaurants and coffee shops is estimated to be circa £835,000. However, should the investment have been available, soft market testing has demonstrated that in-house NHS brands do not compete well with high street brands such as M&S, Costa and Starbucks which are provided by the private sector as part of an outsourced solution.

34

4.6.7 Service Assistants – Cleaning and Portering

The Birch Foundation, a LEAN transformation specialist organisation working in healthcare, undertook a review of the Cleaning and Portering function in 2015. The review found that, through service redesign utilising LEAN methodology, the quality of the service could be greatly improved, avoiding and identified need for increased investment of circa £800k and increasing productivity and reducing costs by between £400,000 - £500,000 pa.

One of the many quality benefits of the review is the development of zonal working, and the ability to produce Zonal KPI Dashboards for staff, example below:

4.6.6.3 Catering Recommendations

The review by CCB identified that continuing to provide patient food services in-house by traditional cook methods is more costly than an outsourced frozen or chilled meal service. Additionally, if patient meal services were to remain in-house, investment of circa £550,000 is required to replace kitchen equipment and trolleys.

Further investment of circa £835,000 is also required to refurbish retail catering facilities. However, outsourcing this service would attract the capital investment required, and provide desirable high street brands with which the Trust could maximise its income.

Therefore, the recommendation was to formally tender the service with the following anticipated benefits:

• Redesign of end to end process with Patient Focus

• Improved Patient Experience

• Improved Customer Experience

• Demonstrably improved service quality measures

• Standard Operating Processes

• Increased Staff Engagement

• Increased mandatory and role specific training

• Reduced food waste

• Capital investment to refurbish facilities and replace equipment

• Reduce costs of patient catering through outsourcing

• Improved quality of commercial catering services

• Increased retail income

Following the conclusion of a formal tender exercise in March 2017, Sodexo have been identified as the preferred bidder and awarded the contract subject to final agreement in October 2017, with a commencement date of January 2018. The total value of the 10 year contract is £26m, will achieve a £3.6m saving against direct costs, and a £11m benefit to the Trust over the life of the contract.

35

appointments to the new B1 PEA role aims to pilot the model prior to the development of a full Business case to introduce the role on a zonal basis to synchronise with the new Service Assistant zonal model. The new PET team will work closely with the Service Assistant Team within the Facilities structure to create a seamless service aimed at ensuring the patient environment is maintained to a high standard at all times. This will also see the introduction of a PET Bleep for reactive cleaning and maintenance tasks in areas of high footfall, such as main entrances and ED.

A new committee structure is to be implemented which includes a new Estates and Facilities Committee (EFC), a sub-committee of Finance and Performance, in addition to a new Patient Environment Group (PEG). In order to address investment requirements with a patient facing focus it is proposed to ring-fencing of Patient Environment funding from the Estates Backlog budget.

5.3 Financial ConsiderationsThe heightened financial constraints within which the Trust, and therefore Estates & Facilities, must operate brings the prioritisation process into sharp relief. In putting together a plan for a five year life of this strategy, several key criteria have been employed:

• Revenue budgets will, at best, remain flat in cash terms and are expected to reduce in line with any reduction in clinical activity across the Trust.

• Capital budgets are restricted.

• Compliance issues should be prioritised by risk to patients, staff and the continued delivery of clinical services by the Trust.

• Estates & Facilities scale and scope of operation must align with that of the Trust as a whole.

5.3.6 Potential Funding Options

• Public Finance Initiative (PFI)

• Internal funding

• Supported Funding by the DoH – Phoenix

• Internal loan based funding

• Strategic Estate Partnerships (SEP)

5.2 IntroductionWith regard to the physical estate, due to the complexity, range and scope of works associated with any programme of works that would be needed to manage the identified backlog maintenance, a realistic phased critical path approach would need to be developed based around prioritisation of hierarchical risks and phased over a 7 year programme. The works cannot be achieved instantaneously as they are intrinsically linked to associated systems, services and operational factors such as isolations, shut downs, refurbishments, space management and vacation of space. A delivery programme of 7 years is considered a realistic model of delivery based on the quantity, scope and nature of the works involved.

With regard to the achievement of the five objectives of this strategy, it will be necessary to undertake a comprehensive transformation project, split into the following three key areas of activity:

A new Patient Advice and Liason Service (PALS) is to be established within the Estates Department structure. This newly formed team will subsume the current Painting and Ground and Gardens staff, in addition to the newly created band 1 Patient Environment Assistant (PEA) role that will perform basic handyman type maintenance duties in addition to cyclic and reactive front of house and external cleaning and maintenance duties. The fixed term

How do we get there?

Capacity and

Capability

Improved Quality &

ExperienceQi

Performance Project

Cultural Change Project

36

• Commercial Accommodation Strategy

• Potential to relocate some back office staff offsite

A programme to implement the above initiatives is discussed in the next section.

There is currently no Government appetite for re-introducing a phased 3 of the PFI programme leaving Trusts with sourcing independent financial models or securing DoH funded finances.

It is felt that the financial options available to the Trust are:

• seek independent financial investments and delivery vehicles from private investors

• review internal available capital resources and re-allocate finances

• seek central source government funding/loan.

5.4 Tactics for Delivery• Ongoing awareness and monitoring of

any changes in clinical services to identify opportunities for related E&F savings

• Comprehensive review of operations by workstream, to identify savings opportunities:

• (Re)Location of Clinical Services (including Imaging and other Support Services)

• Property Disposal

• Following the outcome of any cessation or relocation of services

• Catering

• Proceed with outsourcing option

• Decontamination Review

• Proceed to test the market

• Strategic Estates Partnership

• Work with other local public sector organisations to achieve estates efficiencies

• Security & Car Park Management

• Proceed with retender for security and include outsource of car parking

• Income (from Estates & Facilities Commercial Opportunities)

• Avail all sources of funding, including Charitable, Commercial Partnerships, etc.

• External Clients (Professional Advice)

• Energy Performance Contract

37

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38

6.6 Food Services OutsourcingWork to progress the potential outsourcing of patient and retail catering services was undertaken in partnership with the procurement department. No commitment has been given to outsourcing the catering service until the finalisation of the contract, lease and specification documentation.

Action Timetable

Prepare Specifications for three lots:• Patient Catering; and• Retail Catering• Both Patient and Retail Catering

Completed

Re-issue Tender for combined lot CompletedAward Contract Q3 2017New Service Commencement Q4 2017

6.7 Operational Estates Maintenance LEAN Services Review

Action Timetable

Conduct Review Q3 2017

Agree Preferred Option (or “Do Nothing”) Q4 2017

6.8 Ongoing LEAN process review for FacilitiesAction Timetable

Implement LEAN process improve-ments in Cleaning & Portering at DRI Q4 2016

Conduct Post Project Implementation Review Q3 2017

Consider LEAN process improvements in Cleaning & Portering at Bassetlaw/Montagu

Q4 2017

6.3 Property DisposalsFor the three plots previously identified:

6.3.6 Montagu Nurses Home

Consideration needs to be given to re-marketing the plot or to placing at auction for a second time to expedite disposal with reserve £250,000 against a valuation £275,000 – £278,000 based on outline planning permission for 9 residential dwellings.

6.3.7 BDGH Southside Plot

Since the NHDA buildings are a significant disincentive to the commercial partners required to progress this project, the Trust will continue to work with Bassetlaw planners with regard to their demolition, and the wider Master Plan for the area, to maximise the value and identify the best use of the land.

6.3.8 Chequer Road Clinic

At the time of writing a valuation is being sought via the District Valuer for this property. Conversations are being had with the local authority due to the close proximity of the building to their central offices and other local developments.

6.4 Decontamination Services Market Testing

Action Timetable

Prepare Specification Completed

Issue Tender Completed

Award Contract (subject to approval) Q4 2017

New Service Commencement (subject to approval) Q2 2018

6.5 Security & Car Park Management OutsourcingAction Timetable

Prepare Specification Completed

Issue Tender Q3 2017

Award Contract (subject to approval) Q1 2018

New Service Commencement (subject to approval) Q3 2018

39

Action TimetableDevelop Business Case Q3 2017Phase 1 (Close Theatres 1&2 W&C’s) Q3 2017

Phase 2 (Undertake remedial ventila-tion work theatres 1-8 DRI) Q3 2017

Phase 3 tbc tbcPhase 4 tbc tbc

6.13 Mexborough Centre of ExcellenceAs part of the Trust’s new status as a Teaching Hospital, the Mexborough site will be developed as a Research Centre of Excellence in the field of rehabilitation services and other associated research. Work is underway to develop a Business Case which will detail the benefits to patients and the wider population of creating the Trust’s first dedicated Clinical Trials unit at MMH.

Action Timetable

Commence Development of Business Case – Fred and Ann Green Q3 2017

Commence Project tbc

6.9 Fire System Statutory Compliance - Remedial WorksAction Timetable

Conduct Tender for Contractor Q2 2016

Multi-Phase Implementation, date of final completion W&C: Q3 2018

Multi-Phase Implementation, date of final completion EWB: Q3 2019

6.10 Security of Electrical Supply - Business Continuity WorksAction TimetableCommence Implementation Q4 2017TBC

6.11 STP Bids CT/HASU and ED Expansion DRI

At the time of writing CT/HASU had received confirmation of the external funding of £4.87m, and authorisation to commence with a start date of March 2018 following agreement of GMP with the Trusts P21+ partner Vinci. Consideration of a submission in June 2017 for the expansion of ED at DRI is expected in October 2017:

Action TimetableCommence Implementation CT/HASU Q4 2017

Open for Clinical Service Delivery CT/HASU Q3 2018

6.12 Theatre Refurbishment ProgrammeThe ventilation systems within the majority of theatres at the DRI site are aged and not designed therefor to meet modern standards of performance. The wider theatre refurbishment programme will reflect changes to clinical service delivery identified as part of the Clinical Site Development Strategy. The aim will be to utilise the best theatres across the three sites whilst refurbishment work is undertaken over a multi-year programme.

40

As part of the metrics used to assess the successfully delivery of this strategy, such as asset disposal and capital developments, a comprehensive list of quantitative Key Performance Indicators will be developed. These will be supplemented by quantitative measures based on outcomes to

measure the quality of services delivered across the directorate, and will be developed in collaboration with our customers and service users. This suite of EFM KPI’s will include all statutory and legislative requirements, performance against Carter, ERIC and the Naylor review, and will provide Trust Board assurance via the provision of quarterly reports.

This Estates & Facilities Strategy has been prepared to align with the Trust Strategic Direction and Clinical Site Development Strategy as well as local and national drivers for change. Key Estates and Facilities strategic aims have been identified, which will form the basis of more detailed plans for how we will get

to our future state position. The implementation of this Estates and Facilities Strategy over the next 5 years will ensure the provision of a suitable physical infrastructure, and quality performance framework, with which the Trust will ensure the delivery of sustainable services into the future.

How will we know when we’ve got there?

Conclusion

Appendix A: 7-facet survey facets, condition & risk ratings6.14 Facets• Physical Condition

• Statutory Compliance

• Quality

• Functional Suitability

• Space Utilisation

• Environmental Management

• DDA (Disability Discrimination Act)

6.15 Condition RatingsCondition Description

A As new and can be expected to perform adequately to its full normal life

B Sound, operationally safe and exhibits only minor deterioration

B(C) Currently as B but will fall below B within five years

C Operational but major repair or replacement is currently needed to bring up to condition B

D Operationally unsound and in imminent danger of breakdown

X Supplementary rating added to C or D to indicate that it is impossible to improve without replacement

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Appendix B: Archived ward refurbishment programme

6.16 Risk Ratings

Risk Rating Description

Low risk Can be addressed through agreed maintenance programmes or included in the later years of your estate strategy.

Moderate riskShould be addressed by close control and monitoring. They can be effectively managed in the medium term so as not to cause undue concern to statutory enforcement bodies or risk to healthcare delivery or safety. These items require expenditure planning for the medium term.

Significant risk Require expenditure in the short term but should be effectively managed as a priority so as not to cause undue concern to statutory enforcement bodies or risk to healthcare delivery or safety.

High risk Must be addressed as an urgent priority in order to prevent catastrophic failure, major disruption to clinical services or deficiencies in safety liable to cause serious injury and/or prosecution.

Stage WardTotal beds

Oct 2014

Single Beds

Oct 2014

Proposed Beds

Proposed Single Beds

Bed Reduction

Cost Estimate

£M

Financial Year Cost

£M

Current MAU (W14) Doncaster 26 6 (23%) 24 7 (29%) 2 0.85 0.85

Phase 1Ward 20 Doncaster 27 7 (26%) 24 7 (29%) 3 1.1

2.20Ward 21 Doncaster 27 7 (26%) 24 7 (29%) 3 1.1


1.95Ward 19 Doncaster 21 3 (14%) 16 4 (25%) 5 0.85

Phase 3

Ward 24 Doncaster 30 6 (20%) 24 8 (33%) 6 1.1

2.75C Floor Bassetlaw (CCU) - completes floor

32 4 (13%) 24 10 (42%) 8 1.65


1.95Ward 27 Doncaster 28 7 (25%) 24 8 (33%) 4 0.85

Phase 5B Floor Bassetlaw (B5 & B6) 66 11 (17%) 56 18 (32%) 10 2.7

3.80Ward 25 Doncaster 28 8 (29%) 24 9 (38%) 4 1.1

Total Doncaster 208 63 (30%) 42 9.15

Total Bassetlaw 8 28 (35%) 18 4.35

Grand Total 288 91 (32%) 60 13.5

people strategy - doncaster and bassetlaw teaching hospitals...(dri) site. the 18 month lean project...

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