THE NHS ESTATE IN WALES

Transcription

1 2011/12 THE NHS ESTATE IN WALES Estate Condition and Performance Report

2 THE NHS ESTATE IN WALES Estate Condition and Performance Report 2011/12

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4 CONTENTS 1 INTRODUCTION Background of the report 1.2 Purpose, format and scope of the report 1.3 Changes to the content of the report 1.4 Report validation /12 Facilities Performance Report 2 EXECUTIVE SUMMARY ESTATE PROFILE Key statistics of the NHS estate in Wales 3.2 The age of the estate 3.3 The essential and non-essential estate 3.4 Expenditure on the NHS estate 4 ESTATE PERFORMANCE Estate Performance General information 4.2 Physical condition 4.3 Statutory and safety compliance 4.4 Functional suitability 4.5 Space utilisation 4.6 Energy performance 5 ENVIRONMENTAL ISSUES Environmental Issues Waste 5.2 Transport 5.3 Water usage 6 APPENDICES Summary Appendix I Appendices II-X Appendix XI Appendix XII Health Board/Trust Risk Adjusted Backlog Costs Summary of Health Board/Trust information Details of non-essential Health Board/Trust property Performance Indicators and Targets

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6 1 INTRODUCTION 1.1 Background of the report This is the 11th Estate Condition and Performance Report published by NHS Wales Shared Services Partnership Facilities Services (NWSSP-FS) and its predecessor organisation, Welsh Health Estates The report is based on annual estate data returns submitted to the on-line Estates and Facilities Performance Management System (EFPMS) by seven Health Boards, Velindre NHS Trust and the Welsh Ambulance Services NHS Trust, and covers the period from April 2011 to March The system was introduced by the Welsh Government, formerly the Welsh Assembly Government (WAG), in April 2002 and is managed by NWSSP-FS. 1.2 Purpose, format and scope of the report The report serves two main functions: It provides the Welsh Government with high-level data and information on the condition of the health estate in order to monitor year-on-year performance trends, inform the strategic planning process and assist in the prioritisation and allocation of resources. It provides Health Boards/Trusts with data and information to enable them to compare their own individual performance with that of other Health Boards/Trusts, as well as against national trends. For each organisation the report includes data and information relating each of its hospital sites and the remainder of the estate aggregated into one group. The report, therefore, should be a driver in the process of improving the performance and efficiency of the health estate As in previous years, the report focuses on the condition and performance of the health estate measured against the following national performance indicators (PI): Physical condition Statutory and safety compliance Functional suitability Space utilisation Energy performance In addition, performance data on Fire safety compliance is included, measured separately from general Statutory and safety compliance data. More comprehensive data on fire safety standards and management is collated annually through the on-line Fire Audit Information System and the Fire and UwFS Incident Reporting System. Separate reports analysing this data are published by NWSSP-FS The report also recognises the importance of environmental issues and significant efforts have been made to evaluate the performance of the health estate in respect of energy, waste, transport and water. Reference is also made to the Welsh Government s Sustainable Development Scheme One Wales: One Planet and its Climate Change strategy and Action Plan for Wales and any requirements and targets from these documents. Estate Condition and Performance Report 2011/12 5

7 INTRODUCTION The format of the report is broadly the same as previous years and, in line with the decision taken last year, maintenance s are reported only in terms of Risk Adjusted Backlog (RAB) s. As mentioned in last year s report, NWSSP-FS recognises that there is a need to provide Health Boards/Trusts with a more effective methodology to identify and prioritise critical failures that are likely to affect the safety of patients and other users or are likely to affect the viability of the services delivered by these organisations. Accordingly, an alternative methodology is currently being considered in conjunction with the Welsh Government for possible future roll-out across the NHS in Wales at some time in the future. 1.3 Changes to the content of the report Whilst the format of the report has remained broadly the same as in previous years, some minor changes have been made to the content of the report with the inclusion of the following new waste fields: Non-infectious Offensive Waste weight Non-infectious Offensive Waste 1.4 Report validation Whilst NWSSP-FS has not carried out a systematic validation of data submitted by the Health Boards/Trusts, every effort has been made to identify and address anomalies. Responsibility for the accuracy of the data submitted to the EFPMS, however, rests ultimately with the Health Boards/Trusts. All the data used in the preparation of this report is available electronically from the NWSSP-FS intranet website /12 Facilities Performance Report This Estates Condition and Performance Report is complemented by the 2011/12 Facilities Performance Report which focuses on hotel services included in the EFPMS. These cover: telecommunications car parking cleaning catering laundry & linen security portering postal services The report is published as a separate, stand-alone document. As with the Estate Condition and Performance Report, all the data used in the preparation of this report is available electronically from the NWSSP-FS intranet website. 6 Estate Condition and Performance Report 2011/12

8 2 EXECUTIVE SUMMARY 2.1 Context of the report This report addresses the condition and performance of the NHS Estate in Wales from April 2011 to March It has been compiled by NHS Wales Shared Services Partnership Facilities Services (NWSSP FS) and is based on the Estates and Facilities Performance Management System (EFPMS) data submitted by the following NHS organisations: Abertawe Bro Morgannwg University Health Board Aneurin Bevan Health Board Betsi Cadwaladr University Health Board Cardiff and Vale University Health Board Cwm Taf Health Board Hywel Dda Health Board Powys Teaching Health Board Velindre NHS Trust Welsh Ambulance Services NHS Trust As well as hospital sites, the report includes data on other NHS sites, aggregated on the basis set down in the EFPMS data definitions. As in previous years, a number of the above mentioned organisations were not able to commit the data by the deadline of 30th June This, combined with an extensive high-level data verification exercise by NWSSP-FS 1 that revealed a substantial number of anomalies requiring rectification, added to the pressure to publish the report in a timely manner. As stated in previous years, the effectiveness of the EFPMS is largely dependent upon the reliability and consistency of its data. The problems encountered again this year remain, therefore, an issue of concern. The 2011/12 report generally follows the format of previous years 2.2 Estate profile The two new pie charts introduced last year comparing the then and now age profiles of the all- Wales health estate have been updated in Section 3.2 and graphically demonstrate the level of estate development activity during the last 11 years. By focusing on the extremes of the age profile it can be seen that the proportion of the estate built since 1995 has increased from 8% to 27% while the proportion of the estate pre-dating 1948 has shrunk from 32% to 19%. This comparison also provides a useful reminder of the importance of implementing, on the one hand, a robust disposal programme of the surplus estate and, on the other hand, investing in the modernisation of the health estate. Full details of the age profile can be found in Section Responsibility for the accuracy of the data committed to the EFPMS rests with the Health Boards/Trusts. However, in the interest of publishing a robust report, NWSSP-FS undertakes informal verification checks. Estate Condition and Performance Report 2011/12 7

9 EXECUTIVE SUMMARY The disposal of surplus building stock and the modernisation of the health estate continue to be important priorities for both the Welsh Government, and the NHS. Key to the modernisation process is the development of estate strategies that support service plans, leading to the requirement for new buildings and, where appropriate, the refurbishment of old stock. The identification of essential and non-essential buildings, based on whether or not they have a health use exceeding five years, is designed to encourage NHS organisations to dispose of stock with a short-term future as quickly as possible. Data submitted by the NHS indicates that 228,060m 2 of building area has been identified as non-essential an increase of 59,862m 2 since the previous reporting year. The rationalisation process also involves the disposal of non-essential land. According to the data provided, 94 ha of land have only a short-term future a decrease of 6 ha since the previous reporting year. This is mainly accounted for with plans to dispose of HM Stanley, Cardigan, Hill House, Gellinudd, Cefn Coed, St Tydfil s, and Rookwood Hospitals. Following the recent openings of Ysbyty Ystrad Fawr in Ystrad Mynach, Ysbyty Cwm Cynon Neighbourhood Hospital in Mountain Ash and Merthyr Health Park in Merthyr Tydfil, there are plans to dispose of Aberdare Hospital, Seymour Berry Health Centre, Hollies Health Centre and Hirwaun Health Centre. Early disposal of the non-essential estate is vital if scarce resources are to be directed where they can be used more effectively. This, combined with the current and projected capital made available by the Welsh Government and the implementation of Designed for Life: Building for Wales - the construction procurement framework based on collaborative working - will continue to play a significant part in revitalising and modernising the estate. 2.3 Estate performance General The NHS is committed to meeting a number of targets based on the following national PIs: Physical condition Statutory and safety compliance Functional suitability Space utilisation Energy performance The targets relate to the essential estate and have been introduced as a colour banding as a way of visually expressing the extent of the challenge faced by Health Boards/Trusts in achieving the required performance. Red: Significant effort required to meet the targets Amber: Some effort required to meet the targets Green: Met the targets 8 Estate Condition and Performance Report 2011/12

10 EXECUTIVE SUMMARY Physical condition and Statutory and safety compliance Over the reporting year, RAB maintenance s decreased by almost 30 million, to just over 185 million. This decrease can be generally attributed to large reductions reported by most Health Boards/Trusts. Details of the individual reductions can be found in Appendices II-X. The overall reduction hides the fact that, on a site-by-site basis, excluding WAST and the aggregated group of properties, there have been swings in both directions, with 34 sites showing reductions totalling just over 34 million and 58 sites showing increases totalling nearly 4 million. Some of the swings on an individual site basis are likely to reflect difficulties Health Boards/Trusts continue to experience in providing consistent and accurate data in line with the EFPMS definitions. The report also points to opportunities for significant reductions in the maintenance liability through the disposal of the residual estate and sites that are either closed or scheduled to close. These include Aberdare General, Maesgwyn and Fairwood. The of complying with statutory and safety requirements, including fire safety, is estimated to be 135 million, of which 132 million relates to the essential estate. According to the data provided by Health Boards/Trusts, the all-wales average for the Physical condition performance indicator improved from just over 79.5% in 2010/11 to 82% in 2011/12, against the target of 90% of the estate to be in condition category B or better. The average for the Statutory and safety compliance performance indicator increased marginally from almost 82.5% in 2010/11 to just over 82.7% in 2011/12, against the target for 90% of the estate to be in condition category B or better Functional suitability and space utilisation Data submitted in respect of the Functional suitability performance indicator shows that the all-wales average improved from 77.8% in 2010/11 to nearly 80% in 2011/12, against the target of 90% of the estate to be in condition category B or better. As for the Space utilisation performance indicator, the all-wales average increased from 90.3% in 2010/11 to 91.2% in 2011/12 against the target of 90% of the estate to be in condition category F Energy performance Weather-corrected net energy consumption for 2011/12 was 14.1% below the 1999/2000 base year and total net energy fell by 36 million kwh or 3.6% in the 2011/12 period. With regard to CHP output, the total amount of electricity generated was 17.9% of the total electrical requirement. Energy consumption associated with service demand is a long-term issue and is likely to increase rather than level out in future. The emphasis, therefore, must continue to be placed on efficiency, by improving the way energy is used. The energy efficiency PI for 2011/12 was 407 kwh/m 2, indicating an excellent improvement over the previous year s PI of 441 kwh/m 2. Estate Condition and Performance Report 2011/12 9

11 EXECUTIVE SUMMARY However, the mild winter period and decommissioning issues of older properties need to be taken into account. Carbon emissions from the reported consumption of energy fell by 0.77% during this period, with an improvement in the carbon intensity performance indicator falling from kgco 2 /m 2 in 2010/11 to kgco 2 /m 2 in 2011/12. A summary of the main findings of this year s returns is given below: The trend in net energy consumption remains downward with a 3.6% fall during this period. Absolute carbon emissions from energy consumption fell by 0.77% over the previous year with an improvement in the carbon intensity performance indicator from kgco 2 /m 2 to kgco 2 /m 2. The energy efficiency PI is 407 kwh/m 2, which is a considerable improvement over last year s figure of 441 kwh/m 2. The amount of CHP-generated electricity was 17.9% of the total electricity consumption and, at 39,600,000 kwh, continues to provide a significant contribution to the electricity requirement. 2.4 Environmental Waste Data submitted shows a small increase in the overall amount of waste reported for a second year in succession, although there has been a corresponding but more significant 6% increase in disposal s. For the first time, this year s waste data includes non-infectious clinical waste (or offensive waste as it is commonly known) as a separate reporting category. 19% of clinical waste goes via this disposal route (11% by ). Overall, clinical waste has seen a significant increase in volumes and s. Much of this may be attributed to the new non-infectious disposal stream which may previously have been included as landfill in some returns. The data shows that just under 15% of the clinical waste goes for incineration, a slight improvement on last year, while the majority, 66%, goes for alternative non-incineration treatment. The figures indicate that landfill general waste has fallen by 8%. This is partly attributable to the point mentioned above and partly to continuing improvements in recycling performance. Positive signs from the recycling figures continue and recycling performance has improved slightly to 15% this year. Continued efforts to improve recycling will be required as future changes in legislation could potentially require much stricter standards of segregation at source of recycling waste Transport Data submitted on transport for 2011/12 was, once again, incomplete. As a result of this ongoing situation, the type and nature of the data asked for within the EFPMS is to be reviewed 10 Estate Condition and Performance Report 2011/12

12 EXECUTIVE SUMMARY in order to determine a way forward to ensure that, in future, more meaningful data can be monitored and measured Water usage There was little change in water consumption in this period. The long term downward trend continues, with consumption for this period 10% lower than in There continues to be a great variation in consumption across Health Boards/Trusts, which suggests there is scope for improvement. As the of water continues to increase, the benefits of conservation measures and the introduction of additional metering on sites should be fully exploited. 2.5 Key issues arising from the report Performance in 2011/12 Health Boards/Trusts performance in 2011/12, assessed on the basis of the five national estate key performance indicator targets, was mixed. Using the colour banding or traffic light system referred to in Sections and 4.1.3, most Health Boards/Trusts achieved performance figures within the amber range, indicating that some effort is required to meet the targets, although some Health Boards have improved. Within the green range, there are examples of excellent performance, indicating that some Health Boards/Trusts have met the targets, particularly in respect of the Space utilisation PI. It is noted that the all-wales average for Fire safety, which currently is not one of the national performance indicators, has moved from the amber band to the green band. The number of Health Boards/Trusts still achieving performance within the red band, indicating that significant effort is required to meet the targets, is small. Within the red band, the performance indicator suffering the poorest performance is Functional suitability, suggesting that significant parts of the estate are still not considered suitable for the delivery of modern services. Risk Adjusted Backlog s decreased by almost 30 million since 2010/11 and now stand at approximately 185 million, the lowest figure since 2004/05 when maintenance s first started to be assessed on the basis of risk. Broadly, this significant reduction has been achieved as a result of the modernisation of significant parts of the health estate which has seen the closure and disposal of poor building stock carrying a heavy maintenance burden and its replacement with new facilities. Whilst the reduction in s is welcome, both the performance against the national PIs and the substantial maintenance s point to the fact that significant improvements in performance and reductions in maintenance s will be achieved only through the implementation of a radical modernisation programme. On the energy front, improvements have been made in net energy consumption and in performance indicators, indicating that considerable improvements have been made in energy efficiency. However, it should be noted that this period did include a milder winter in some areas, which is a mitigating factor. Again this year a major contributing factor has been the substantial Estate Condition and Performance Report 2011/12 11

13 EXECUTIVE SUMMARY contribution in CHP-derived electricity, which now stands at 17.9% of the total electrical demand for the NHS in Wales Performance over the 11-year period since the publication of the first EFPMS report When the five national estate PIs were introduced in 2002 there was an expectation that the 90% performance targets would be met by The table below, which excludes Energy performance as this is measured differently, but includes Fire safety, currently not one of the national PIs, illustrates the progress made on an all-wales basis during this 11-year period. Performance indicator Percentage compliance in 2001/02 Percentage compliance in 2011/12 Physical condition Statutory and safety compliance Fire safety Functional suitability Space utilisation It is noted that the Space utilisation and Fire safety targets have been met and exceeded. The remainder still fall far short of the targets. As stated previously, only a radical modernisation programme will address the current shortfalls. Backlog maintenance s, expressed in terms of Risk Adjusted Backlog, have fallen from almost 305 million in 2004/05, when they were first introduced, to almost 185 million in 2011/12, an indication that considerable effort has gone into addressing the most serious estates risks. Age profile has been consistently highlighted as a useful indicator of the likely condition of the estate. Over the 11-year period there has been a 13% reduction in pre-1948 buildings in the overall profile of the estate in Wales, along with a 19% improvement in post-1995 building stock. It is expected that the current modernisation programme will continue to impact on the all-wales age profile. Over the 11-year period, the percentage of the non-essential building areas still in the ownership of the NHS has decreased from 17% to 12% while the percentage of the non-essential land area has decreased from 28% to 14%, indicating that considerable efforts have been made to ensure that resources tied up in maintaining these assets are directed to where they can be used more efficiently. The importance of driving forward a vigorous land and property disposal programme, focusing on those elements of the estate in particularly poor physical condition, that fail to comply with statutory requirements and present major challenges in delivering modern clinical services, has also been consistently stated. Accordingly, during the EFPMS 11-year reporting period significant 12 Estate Condition and Performance Report 2011/12

14 EXECUTIVE SUMMARY progress has been made, resulting in the disposal of 242 hectares of land and 210,000m 2 of building with a disposal value of over 102 million. With regard to energy usage, the trends in energy consumption continue to be encouraging with further improvements in the energy efficiency performance indicator and of absolute carbon emissions. Similarly with water usage, the trend has continued downward, although absolute consumption has remained virtually unchanged. Estate Condition and Performance Report 2011/12 13

15 3 ESTATE PROFILE 3.1 Key statistics of the NHS estate in Wales Serving a population of approximately 3 million, the NHS is the largest employer in Wales. Of the 72,423 whole time equivalent (WTE) staff reported to be employed by the NHS in Wales, 1,007 (1.39%) fulfil estates functions and 6,222 (8.59%) deliver hotel services. Services are delivered from a diverse, complex and geographically widespread portfolio of properties, comprising: A total land area of almost 700 hectares; Over 100 hospitals of varying age, construction, size and function; Over 200 health centres and clinics; Approximately 80 mental health and learning disability units; Approximately 90 ambulance stations; Over 160 miscellaneous properties in the form of offices, housing, storage and distribution warehouses Although the property market remained difficult during the year, over 5m was generated from the sale of 17 surplus NHS properties. This included the sales under the NHS Affordable Housing protocol of Caerphilly and District Miners Hospital, Aberbargoed Hospital and Ty Sirhowy Hospital in Blackwood. The development of Ysbyty Cwm Cynon in Mountain Ash has released for disposal the hospitals at Aberdare and Mountain Ash, and HM Stanley Hospital, St Asaph will become available for disposal during 2012/ The age of the estate Age profile can be a useful indicator of the likely condition of the estate. Figure 1 compares the current profile with that in 2001/02 when the first EFPMS report was published and illustrates the level of estate activity during the last 11 years. Focusing on the two extremes of the age profile it can be seen that the proportion of the estate pre-dating 1948 has shrunk from 32% to 19% while the proportion of the estate built since 1995 has increased from 8% to 27%. This comparison provides a useful reminder of the importance of implementing, on the one hand, a robust disposal programme of the surplus estate and, on the other hand, investing in the modernisation of the health estate. Further changes to the profile will arise over the next few years if older hospitals continue to be closed. 3.3 The essential and non-essential estate The Welsh Government requires NHS property holding bodies to develop estate strategies that support service plans. This process can lead to the requirement for new buildings and the rationalisation of old stock. If a building or land has a health use of more than five years it is 14 Estate Condition and Performance Report 2011/12

16 ESTATE PROFILE All-Wales Age Profile 2001/02 8% 17% 32% 15% 2% 5% 21% Pre to to to to to to Present All-Wales Age Profile 2011/12 27% 19% 1% 6% 14% 18% 15% Pre to to to to to to Present Figure 1: Comparison of all-wales age profiles between 2001/02 and 2011/12 Estate Condition and Performance Report 2011/12 15

17 ESTATE PROFILE categorised as essential, and five years or less as non-essential. It is important for the Service that non-essential buildings and land are disposed of as quickly as possible to ensure that resources tied up in maintaining these assets are directed to where they can be used more efficiently. Figure 2 compares the percentage of essential and non-essential building areas across Wales in 2010/11 with 2011/12. It can be seen that in 2011/12 the proportion of non-essential building area increased by 3% compared with 2010/11. This is due to a change from essential to nonessential for parts of Singleton, St Woolos, Llanfrechfa and Whitchurch Hospitals. 9% 9% 12% 12% 91% 88% 91% 88% 2010/11 Essential Non-Essential 2011/12 Figure 2: Percentage of essential and non-essential building areas across Wales in compared with Figure 3 compares the percentage of essential and non-essential land areas across Wales in 2010/11 with 2011/12. It can be seen that in 2011/12 the proportion of non-essential land increased by 1% compared with 2010/11. 13% 14% 13% 14% 87% 87% 2010/11 Essential Non-Essential 2011/12 86% 86% Figure 3: Percentage of essential and non- essential land areas across Wales in 2010/11 compared with 2011/12 16 Estate Condition and Performance Report 2011/12

18 ESTATE PROFILE Figure 4 shows the extent of essential and non-essential buildings in 2011/12 relating to each Health Board/Trust. 400, , , , , , ,000 50,000 0 Abertawe ABM Bro Morgannwg Aneurin Bevan Betsi Cadwaladr adr Cardiff and Vale Cwm Taf Hywel Dda Powys wys Velindre dre GIA (m²) 2 ) Welsh Ambulance AST Service Essential Non-Essential Figure 4: Essential and non-essential building areas by organisation Figure 5 shows the extent of essential and non-essential land areas in 2011/12 relating to each Health Board/Trust Abertawe Bro Morgannwg ABM Aneurin Bevan Betsi Cadwaladr Cardiff and Vale Vale Cwm Taf m Taf Hywel Dda Powys Powys Velindre lindre Welsh Ambulance Service WAST Land Area (ha) Land Area (ha) Essential Non-Essential Figure 5: Essential and non-essential land areas by organisation Estate Condition and Performance Report 2011/12 17

19 ESTATE PROFILE 3.4 Expenditure on the NHS estate The NHS estate is an extremely important resource which, based on a valuation date of 1 April 2012, the Valuation Office has valued at an existing use value of over 2 billion. Its annual running is estimated at over 300 million and, in addition, capital is required to maintain and modernise it, and to develop new facilities. Figure 6 shows capital investment (dark blue) and estimated maintenance (green) in Wales since April 2000 and projected to 2016/17. The red line shows the capital investment that would have been required to keep pace with inflation at April It can be seen that the real increase in capital expenditure has had a substantial effect in reducing maintenance by the process of refurbishment or replacement of existing sub-standard assets. The maintenance line beyond 2011/12 is a prediction based upon the effects of the continued capital expenditure above 2016/17 and assumes that existing maintenance levels are achievable during this period Millions Financial year Annual net investment Investment required to keep pace with inflation Total maintenance Figure 6: Capital investment in the NHS in Wales 18 Estate Condition and Performance Report 2011/12

20 4 ESTATE PERFORMANCE 4.1 General information Welsh Health Circular WHC(2002)50 Introduction of an Estates Performance Management System, issued in April 2002, set out details of five national PIs based on guidance contained in Estatecode. The current targets agreed with the Welsh Government are shown in Figure 7. They relate to the essential estate, that is, the estate that is deemed to have a health use of five years or more. National PI Target Definition of condition category Physical condition Statutory and safety compliance Functional suitability Space utilisation Energy performance 90% of the estate to be in condition category B or above. 90% of the estate to be in condition category B. 90% of the estate to be in condition category B or above. 90% of the estate to be in category F. The estate to achieve energy B rating or better. Condition category B applies to buildings that are sound, operationally safe and exhibit only minor deterioration. Condition category B applies to buildings where action will be needed in the current plan period to comply with relevant guidance and statutory requirements. Condition category B applies to buildings that are satisfactory and minor changes are needed. Category F applies to buildings that are fully used. Energy B rating applies to buildings with an energy consumption of 410 kwh/m 2 or less. Figure 7: Table showing national performance indicators and targets The PIs and Health Boards/Trusts progress in meeting the targets are discussed in more detail later in this report The traffic light compliance code adopted previously has been used again in this report as a way of visually expressing Health Boards/Trusts progress in meeting the targets set out in Figure 7. Each PI has again been split into three bands of compliance, colour coded as follows: Percentage of the estate in condition category B / F : 90% or above (Energy performance: consumption 410 kwh/m 2 or less) Percentage of the estate in condition category B / F : Within 75-89% range (Energy performance: consumption within kwh/m 2 range) Percentage of the estate in condition category B / F : Below 75% (Energy performance: consumption 480 kwh/m 2 or above) All Health Boards/Trusts have been banded according to the above criteria for each of the national PIs. Estate Condition and Performance Report 2011/12 19

21 ESTATE PERFORMANCE Health Boards/Trusts performance against each of the targets has been estimated from the data submitted and used to obtain an average figure for each Health Board/Trust as well as an all-wales figure. 4.2 Physical condition Backlog maintenance Risk Adjusted Backlog (RAB) s across Wales have reduced by 29.6 million, from just over million in 2010/11 to just under million in 2011/12. With the exception of Powys Teaching Health Board, Velindre NHS Trust and WAST, reductions in RAB s were reported by all other Health Boards The RAB position for the seven-year period from 2005/06 is summarised in Figure 8 along with the component risk level s. A breakdown of the individual Health Board/Trust s is detailed in Appendices II-X. It can be seen that during this period RAB s have decreased by approximately 58 million, from just under million in 2005/06 to just under million in 2011/12. It is also noted that s within the high and significant risks bands have decreased over the period while s within the moderate and low risk bands have increased. Backlog Costs ( ) 2005/ / / / / / /12 High Risks 89,012,153 79,664,860 74,679,970 82,216,438 67,220,657 65,223,999 58,975,682 Significant Risks Cost 146,141, ,657, ,722, ,099, ,837, ,939, ,987,663 Moderate Risks Cost 90,578,800 95,973, ,342, ,169, ,189, ,720, ,474,312 Low Risks Cost 155,713, ,989, ,516, ,732, ,025, ,201, ,049,126 Risk Adjusted Cost 243,290, ,354, ,544, ,500, ,932, ,545, ,896,886 Figure 8: Table showing all-wales risk banded s between 2005/06 and 2011/ Figure 9 shows the four risk categories of each Health Board/Trust s total, (as a percentage of total ) and reported capital investment in (as a percentage of total ). Capital investment in is defined as The amount contained within the Total Capital Investment figure which was invested in the NHS Health Boards/Trusts estate specifically to reduce maintenance s, inclusive of physical condition, fire safety, and health & safety. It can be seen that only 4 Health Boards/Trusts appear to have invested sufficient capital to address the high-risk. The remainder are either awaiting funding associated with outstanding business cases or are striving to manage the risks. 20 Estate Condition and Performance Report 2011/12

22 ESTATE PERFORMANCE 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Abertawe Bro Morgannwg Aneurin Bevan Betsi Cadwaladr Cardiff and Vale Cwm Taf Hywel Dda Powys Velindre Welsh Ambulance Service High Risk Significant Risk Moderate Risk Low Risk Investment to reduce Figure 9: Risk profile of and investment to reduce Figure 10 shows RAB s by Health Board/Trust submitted for the period 2011/12. Detailed analysis of the individual Health Board/Trust data is included in Appendices II-X RAB Costs ( x 1,000,000) RAB Costs ( x 1,000, Abertawe Bro Morgannwg Aneurin Bevan Betsi Cadwaladr Cardiff and Vale Cwm Taf Hywel Dda Powys Velindre Welsh Ambulance Service Figure 10: Comparison of risk adjusted s by Health Board/Trust Estate Condition and Performance Report 2011/12 21

23 ESTATE PERFORMANCE Physical condition targets Figure 11 shows the percentage of the estate in physical condition category B or above. It is noted that none of the Health Boards/Trusts have met the 90% target. The all-wales performance, however, has improved but is falling still far short of the target required in order to move it into the green band. Health Board/Trust Physical condition performance indicator 2011/ /11 Abertawe Bro Morgannwg Aneurin Bevan Betsi Cadwaladr Cardiff and Vale Cwm Taf Hywel Dda Powys Teaching Velindre Welsh Ambulance Services All Wales Average Key Percentage of the estate in condition B : 90% or above (current target) Percentage of the estate in condition B : 75-89% Percentage of the estate in condition B : 74% or below Figure 11: Physical condition of Health Organisations 4.3 Statutory and safety compliance All Health Boards/Trusts must comply with current Health and Safety Standards and Codes of Practice. Some examples of the main health and safety requirements that Health Boards/Trusts have to comply with include: Electricity at Work Regulations Control of legionella Firecode Control of Substances Hazardous to Health Asbestos Pressure systems Equality Act 2010 replacing the Disability Discrimination Act (DDA) The Hazardous Waste Regulations Health and Safety at Work This list is not exhaustive and there are many other statutory requirements that Health Boards/Trusts have to comply with in order to protect the safety of their staff, patients and visitors on their sites. 22 Estate Condition and Performance Report 2011/12

24 ESTATE PERFORMANCE The of complying with statutory and safety requirements (excluding fire safety) is estimated to be almost 61 million The of complying with Firecode across Wales is estimated to be 16 million, which is an increase of 2 million on the 2010/11 figure. The estimated excludes specific remedial works associated with Ysbyty Glan Clwyd which total approximately 57 million. Remedial works have commenced on this site which are expected to last for approximately 7 years, dealing with asbestos, fire safety and a major ward refurbishment programme. Statutory and safety compliance targets Figure 12 shows the percentage of the estate under Statutory and safety compliance that is in Estatecode condition category B or above. It is noted that Cardiff and Vale University Health Board have met the current target of 90%. Health Board/Trust Statutory & safety compliance performance indicator 2011/ /11 Abertawe Bro Morgannwg Aneurin Bevan Betsi Cadwaladr Cardiff and Vale Cwm Taf Hywel Dda Powys Teaching Velindre Welsh Ambulance Services All Wales Average Key Percentage of the estate in condition B : 90% or above (current target) Percentage of the estate in condition B : 75-89% Percentage of the estate in condition B : 74% or below Figure 12: Statutory and safety compliance of Health Organisations In addition to statutory and safety compliance, the EFPMS collects separate data relating to the level of fire safety compliance within each Health Board/Trust, together with an estimate of the s required to achieve that compliance. These s are summarised in Figure 13 overleaf, shows the percentage of essential building area considered to be in full fire safety compliance. It is noted that one Health Board falls significantly short of the 90% target, while five Health Boards meet or exceed the target. The all-wales performance has moved from the amber to the green band. Estate Condition and Performance Report 2011/12 23

25 ESTATE PERFORMANCE Health Board/Trust Fire safety compliance performance indicator 2011/ /11 Abertawe Bro Morgannwg Aneurin Bevan Betsi Cadwaladr Cardiff and Vale Cwm Taf Hywel Dda Powys Teaching Velindre Welsh Ambulance Services All Wales Average Key Key Percentage of the estate in condition B : 90% or above (current target) Percentage of the estate in condition B : 75-89% Percentage of the estate in condition B : 74% or below Figure 13: Fire safety compliance of Health Organisations 4.4 Functional suitability Functional suitability is used to determine how effectively a building (or part of a building) supports the delivery of specific Health Board/Trust services. Key factors, which contribute to these assessments, are: Internal space relationships including critical dimensions are suitable for the function, observation of dependent patients by staff, separate sex/bed cubicle areas and toilet facilities and security; Support facilities such as the adequate provision of toilets and bathrooms, adequate storage space, adequate seating and waiting space and provision for disabled people; Location, including distance to key linked facilities, access to parking areas and access to public transport Figure 14 shows the percentage of the estate under Functional suitability that is in Estatecode condition category B or above. It can be seen that two Health Boards have met and exceeded the 90% target. The all-wales performance remains within the amber band, with two Health Board/Trusts showing very little improvement. 24 Estate Condition and Performance Report 2011/12

26 ESTATE PERFORMANCE Health Board/Trust Functional suitability performance indicator 2011/ /11 Abertawe Bro Morgannwg Aneurin Bevan Betsi Cadwaladr Cardiff and Vale Cwm Taf Hywel Dda Powys Teaching Velindre Welsh Ambulance Services All Wales Average Key Percentage of the estate in condition B : 90% or above (current target) Percentage of the estate in condition B : 75-89% Percentage of the estate in condition B : 74% or below Figure 14: Functional suitability of Health Organisations 4.5 Space utilisation Space utilisation explores how well available space is being used. The objective is to hold no more space than is necessary to satisfy the reasonable demands of the present function and planned requirements. Health Board/Trust Space utilisation performance indicator 2011/ /11 Abertawe Bro Morgannwg Aneurin Bevan Betsi Cadwaladr Cardiff and Vale Cwm Taf Hywel Dda Powys Teaching Velindre Welsh Ambulance Services All Wales Average Key Percentage of the estate in condition F : 90% or above (current target) Percentage of the estate in condition F : 75-89% Percentage of the estate in condition F : 74% or below Figure 15: Space utilisation of Health Organisations Estate Condition and Performance Report 2011/12 25

27 ESTATE PERFORMANCE Figure 15 shows the percentage of the estate under Space utilisation that is in Estatecode condition F. It is noted that eight Health Boards/Trusts have met the 90% target and the all-wales performance remains in the green band. 4.6 Energy performance Net energy Net energy consumption for the whole of Wales fell from 730 million kwh in 2010/11 to 694 million kwh in 2011/12, a fall of 36 million kwh or 4.9%. It should be noted, however, that this period included a milder than average winter which would have reduced the winter energy demand. Therefore, in order to accurately determine the trend in energy consumption, a factor to allow for weather correction has been used. Accordingly, based on weather-corrected figures, consumption for 2011/12 is estimated to be 692 million kwh compared with a weather corrected figure of 690 million kwh in 2010/11 and 806 million kwh for the base year of 1999/2000. The figure for 2011/12 is 14.1% below that of the base year. Transposing these figures to the graph in Figure 16 shows that since 1999 there has been a general downward trend in weather-corrected consumption. MWh 1,000, , , , , , , , , , , / / / / / / / / / / / / /12 MWh Trendline Figure 16: Graph showing net energy consumption and trend The breakdown of energy returns show that 39.6 million kwh of CHP on-site generated electricity was reported for 2011/12, which was 17.9% of the total electrical consumption. This compares with a figure of 17.7% for the previous reporting year, indicating that the NHS in Wales is maintaining its level of CHP generated electricity. Further analysis on an individual Health Board/Trust basis can be found in Appendices II-X. 26 Estate Condition and Performance Report 2011/12

28 ESTATE PERFORMANCE It is noted that Health Boards/Trusts are reporting a greater floor area (2.9% increase over the previous year and now significantly greater than the base year) resulting from new developments. Similarly, they are reporting increased service demand for high electrical energy consuming clinical services such as diagnostic imaging. Both issues are impacting on energy consumption; however, it is difficult to quantify the impact with no direct statistical comparison The total of energy across the NHS in Wales for 2011/12 was 34.2 million compared with 32 million last year, an increase of 6.7%. Although no clear long term trend can be predicted, forecasts are anticipating further rises in the of energy in the near future. It should also be noted that if the fall in net energy of 4.9% had not occurred, the rise in overall energy s would have been greater and although the drop in energy demand was not able to balance out the price rises in energy s, there was a benefit in terms of avoidance Figure 17 below shows total energy s for each LHB and the per square metre. The data indicated a disproportionately high of energy per square metre for Hywel Dda Health Board and Velindre NHS Trust. The high proportion of fuel oil used within Hywel Dda Health Board is the reason for their high per square metre. Velindre NHS Trust s figure is due to its high electricity usage which accounts for 44% of its energy requirement. This figure is much higher than other organisations and is due to the electrical power-intensive diagnostic and treatment equipment installed at Velindre Hospital. Both these high indicators contrast strongly with Cardiff and Vale University Health Board s figure which is the lowest in Wales. This low figure is mainly due to the Health Board s investment in CHP, which provides 49% of its total electrical consumption, giving it a considerable saving in the amount of purchased electricity required from the utilities supplier. Health Board/Trust Total Energy Cost Gross Internal Area Cost per square metre ( ) (m 2 ) ( /m²) Abertawe Bro Morgannwg 6,565, , Aneurin Bevan 5,120, , Betsi Cadwaladr 7,654, , Cardiff and Vale 5,730, , Cwm Taf 3,368, , Hywel Dda 4,499, , Powys Teaching 875,109 43, Velindre 411,858 15, All Wales Total 34,225,958 1,703, Figure 17: Total energy s and per square metre Estate Condition and Performance Report 2011/12 27

29 ESTATE PERFORMANCE Carbon emissions Figure 18 shows the amount of carbon dioxide emissions for each Health Board/Trust calculated from their reported consumption of energy The table shows that overall net carbon emissions have decreased slightly. However, the majority of returns are showing increases. The carbon PI indicator shows an improvement at five of the Health Boards/Trusts. It is notable that among the lowest PIs are those of Aueurin Bevan Health Board and Cardiff and Vale University Health Board both of which are fully ISO14001 certified and, in the case of Cardiff and Vale, a high proportion of its energy used is derived from CHP which has considerably improved its performance in this area. With the introduction of ISO certification at all major NHS sites in Wales expected to be in place by the end of 2012 and the introduction of annual carbon footprint reporting recently introduced, it is expected that both absolute CO 2 emissions and the carbon PI will improve in subsequent years. Health Board/Trust Change 2011/12 Previous 2011/12 CO 2 from Last GIA Year PI Year PI Comparison (Tonnes) % (m 2 ) (kg/m²) (kg/m²) Abertawe Bro Morgannwg 40, % 296, Aneurin Bevan 31, % 305, Betsi Cadwaladr 41, % 356, Cardiff and Vale 34, % 356, Cwm Taf 18, % 164, Hywel Dda 22, % 164, Powys Teaching 4, % 43, Velindre 2, % 15, All Wales Total 196, % 1,703, Figure 18: Carbon dioxide emissions Energy performance indicator Figure 19 opposite, shows Health Boards/Trusts performance against the energy PI for existing buildings. With a figure of 407 kwh/m 2 the all-wales performance is significantly improved compared with last year s figure of 441 kwh/m 2. This is generally due to improvements in performance across the board. However, it should be noted that the mild winter period will have been a contributory factor and that some older premises are still counted in the gross internal floor area as they have not been fully decommissioned, before services are moved into new premises. Comparing individual performances they have improved across the board indicating a high commitment to energy efficiency, with notable improvements at Velindre NHS Trust, Aneurin Bevan Health Board and Cardiff and Vale University Health Board. 28 Estate Condition and Performance Report 2011/12

30 ESTATE PERFORMANCE Health Board/Trust Energy performance indicator (kwh/m 2 ) 2011/ /11 Abertawe Bro Morgannwg Aneurin Bevan Betsi Cadwaladr Cardiff and Vale Cwm Taf Hywel Dda Powys Teaching LHB Velindre All Wales Average Key Energy consumption: 410 kwh/m 2 or below Energy consumption: kwh/m 2 Energy consumption: 480 kwh/m 2 or above Figure 19: Energy performance of Health Organisations Estate Condition and Performance Report 2011/12 29

31 5 ENVIRONMENTAL ISSUES 5.1 Waste Data submitted shows a small increase in the overall amount of waste reported for a second year in succession, and there has been a more significant 6% increase in disposal s. The total quantity of waste disposed of in 2011/12 was reported as 18,239 tonnes, compared with 17,965 tonnes in the previous year (these figures exclude recycled material). The of disposal of this waste was 5.46 million compared with 5.13 million in the previous year. 24,000 21,000 Tonnes 18,000 15, / / / / / /12 Tonnes Trendline Figure 20: Overall waste trend For the first time, this year s waste data includes non-infectious clinical waste (EWC code or offensive waste as it is commonly known) as a separate reporting category joining the existing clinical waste streams of high temperature infectious waste (incineration) and non-burn alternative treatment infectious waste. The inclusion of this as a separate figure has a knockon effect on other waste streams and this picture should become clearer in time. As last year, figures submitted from Powys are viewed with caution, with data in many categories showing large changes from previous years, and significant deviations from the all-wales averages. Following conversations with the Board it is hoped that changes have been implemented this year that mean that data captured is more comprehensive than in the past; this will continue to be monitored Figures 21 and 22 show the relative proportions each waste stream account for in the overall total waste. For the first time, these figures include offensive waste as a distinct element. In terms of waste volumes 46% of waste goes to landfill, 15% is recycled with the remaining 39% being clinical waste. By contrast, in terms of s landfill accounts for only 25% of s, recycling only 5%, whereas 70% of s are incurred for clinical waste disposal. This clearly demonstrates the more complex treatment and disposal requirements of clinical wastes. 30 Estate Condition and Performance Report 2011/12