Capital Planning System: Planning Your Investments

Scottish Health and Social Care Facilities Conference Breaking boundaries, building partnerships and driving integration

6th Nov, 2015, Crieff Hydro

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Presentation Objectives 

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To understand the history of NHS Scotland Asset Management through to the introduction of the Capital Planning System (CPS) Illustrate the functionality of the CPS Illustrate where the CPS sits in the overall business case process Understand how the CPS has been used by NHS Boards Show you the services that HFS Asset Management Team can offer Aims for the future

Strategic & Investment Planning Process – how things fit

2020 Vision

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Capital Planning system

Refreshed SCIM

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Service Planning

Local Delivery Plan

How do we get there?

Where do we want to be?

SAFR

National perspective

(P)AMS Where are we now? Capital Planning System Business Case Process (Strategic Assessment)

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Strategic Investment Prioritisation

EAMS

Background : 

Estate asset management system (EAMS) circa 2009  

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Property database State of property assets reports

Further, more sophisticated system required  Market review & testing carried out  VFA appointed at end 2013 for 4 years to develop & implement new Capital Planning System

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Business needs : 

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To scenario model investment needs To integrate data from EAMS To develop life cycle models for each property To prioritise projects across Boards To generate informative, graphical reports

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System Capabilities:  Scenario modelling:  

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Priority filtering 

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Identify investment packages based on priority

FCI indicator 

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Impact on condition of different funding models Investment decision tool

Assessment of existing building relative to investment need

Life cycle models of each property Records strategic investment priority score for NHSScotland

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Information flow: Real time Data

Standard Reports EAMS

CPS Investment Scenarios Prioritised solutions

 EAMS maintained per current process  Data uploaded 3 times a year to the CPS  Reports generated / scenarios reviewed using inbuilt models 8

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Where are we now 2014 – 15 progress    

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User and Development groups established Training delivered to all boards Prioritisation workshops held 2014 -2015 LDPs informed by CPS output Continuing to refine and develop the CPS

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1. What do we own?

2. What is the condition & what does the condition need to be?

3. How much money do we need?

4. What is most important? 11

Facility Condition Index (FCI): A standards-based common performance metric: Measure and compare performance on facility condition using a Facility Condition Index (“FCI”) for the 4 constituent parts:

FCI =

Capital & major maintenance cost to achieve ‘Condition B’

‘Current Replacement Cost

A

0%

B

5%

C

11%

D

30%

50%

100%

FCI %

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Condition Definition Excellent/as new condition (generally less than 2 years old). Expected to perform as intended over its expected useful service life. Satisfactory condition with evidence of only minor deterioration. Element/Sub-Element is operational and performing as intended.

Classification

FCI

A

≤ 5%

B

6 - 11%

C

12 – 30%

D

31 – 59%

X

>60%

Poor condition with evidence of major defects. Elements/Sub-Element remains operational but is currently in need of major repair or replacement. Unacceptable condition. Non-operational or about to fail. Has reached the end of its useful life.

Supplementary rating added to D only to indicate that it is impossible to improve without replacement.

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How Much Money do we need?: The Funding Module

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Maintain FCI vs Reduce FCI to 5% over 10 years

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Reduce to 5% over 10 years vs £50,000 specific annual spend

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£50,000 specific annual spend

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Target 11% over 2 years and decommission in 2020 – replacement facility commissioned in 2020

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Reduce FCI to 11% over 2 years FUNDINGYEAR 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 REPLACEMENTVAL UE 1052284 1083852 1116368 1149858 1184354 1219885 1256481 1294176 1333001 1372991 1414181 1456606 1500304 1545313 1591673 1639423 1688605 1739263 1791441 1845185 1900540 RENEWALCOST 0 0 0 0 44388 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 BACKLOGDETERIOR ATION 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTALNEWLIABILIT Y 202444 0 0 93975 44388 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NEWBACKLOGTOT AL 202444 163871 122800 126484 130279 134187 138213 142359 146630 151029 155560 160227 165033 169984 175084 180336 185747 191319 197059 202970 209059 NETPLANTVALUE 849840 919981 993567 1023374 1054075 1085697 1118268 1151816 1186371 1221962 1258621 1296379 1335271 1375329 1416589 1459086 1502859 1547944 1594383 1642214 1691481 FUNDING 0 44647 45986 93975 44388 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FUNDINGRESERVE 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CUMULATIVE SPEND 0 44647 90633 184608 228996 228996 228996 228996 228996 228996 228996 228996 228996 228996 228996 228996 228996 228996 228996 228996 228996 FCI 0.192385 0.151193 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 0.11 Block Condition C C B B B B B B B B B B B B B B B B B B B Funding to maintain Constant FCI on Replacement Block FUNDINGYEAR 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 REPLACEMENTVAL UE 1052284 1083852 1116368 1149858 1184354 1219885 1256481 1294176 1333001 1372991 1414181 1456606 1500304 1545313 1591673 1639423 1688605 1739263 1791441 1845185 1900540 RENEWALCOST 0 0 0 0 0 0 0 0 0 0 2117 0 0 0 0 61443 0 0 0 0 153295 BACKLOGDETERIOR ATION 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTALNEWLIABILIT Y 0 0 0 0 0 0 0 0 0 0 2117 0 0 0 0 61443 0 0 0 0 153295 NEWBACKLOGTOT AL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NETPLANTVALUE 1052284 1083852 1116368 1149858 1184354 1219885 1256481 1294176 1333001 1372991 1414181 1456606 1500304 1545313 1591673 1639423 1688605 1739263 1791441 1845185 1900540 FUNDING 0 0 0 0 0 0 0 0 0 0 2117 0 0 0 0 61443 0 0 0 0 153295 FUNDINGRESERVE 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CUMULATIVE SPEND 0 0 0 0 0 0 0 0 0 0 2117 2117 2117 2117 2117 63560 63560 63560 63560 63560 216855 FCI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Block Condition A A A A A A A A A A A A A A A 2017 2018 2019 2020 2021 Funding to Construct new Construc Construc End of Facility Design Design tion tion Defects 20000 100000 500000 756481 10000 CUMULATIVE SPEND 20000 120000 620000 1376481 1386481

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Overall CUMULATIVE SPEND

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44647

90633 204608 348996 848996 1605477 1615477 1615477 1615477 1617594 1617594 1617594 1617594 1617594 1679037 1679037 1679037 1679037 1679037 1832332

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Funding to maintain Constant FCI

£

1,392,284

Funding to reduce FCI to 5% in 10 years

£

1,568,176

Specific annual funding (£50K)

£

1,383,824

Overall to fund replacement Faciltiy from 2020

£

1,832,332

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Prioritisation: The Budgets Module

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DEVELOPMENT OF STRATEGIC INVESTMENT PRIORITIES

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Capital planning – It’s a bit of a Balancing act !

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Things to consider Disposals process & dislocated services

Masterplans development frameworks

ICT (eHealth) strategy & priorities Medical Equipment

Maintain operational effectiveness

Demolitions Strategic Plans

Affordability Unplanned priority projects

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Prioritised Resources to support or defer

Scope of CPS module: 

CPS asked to incorporate national prioritisation module, which: • • •

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Linked to NHSScotland’s priorities Incorporated existing quality indicators, targets & standards Aligned to SCIM refresh developments

Agreed five strategic investment priorities 

Mapped against Quality Strategy, triple aim, quality ambitions & 12 priority areas 

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Person Centred Safe Effective Quality of Care Health of Population Value & Sustainability 44

Steps taken: 

Developed set of benefit indicators for each priority, based on:     

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Quality outcome indicators HEAT targets LDP standards SAFR KPI’s Allowance for local indicators

Provides possible measures to use against these benefit indicators

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Definitions Person Centred Ensures that resources are in place to support people powered health and care services, and promotes personal responsibility and self-management for individuals health and wellbeing

Safe Improves safety in the healthcare environment - building on the Scottish Patient Safety Programme in Acute Care, Primary Care, Maternity Services, Paediatrics and Mental Health Care.

Effective Quality of Care Improves the effective Quality of Care particularly focused on increasing the role of primary care, integrating health and social care, improving the delivery of unscheduled and emergency care, and improving the current approach to supporting and treating people who have multiple and chronic illnesses

Health of Population Improves health of the population particularly focused on the importance of Early Years, reducing Health Inequalities, and preventative measures on alcohol, tobacco, dental health, physical activity and early detection of cancer

Value & Sustainability Supports implementation of the 2020 Workforce Vision through modernisation, leadership and management. Introduces investment in new innovations to increase quality of care and reduce costs. Increases efficiency and productivity through unified approaches, local solutions and decision making.46

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Indicators and Potential Measures

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Further steps taken   

Pairwised strategic priorities to create ranking Developed 1 – 5 scoring criteria Developed module in CPS to:   

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Record prioritisation scoring Hold SCIM’s Strategic Assessment Report results of prioritisation

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Pairwise Ranking

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Profile of Scoring

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Scoring Score 5

Criteria

Definition

Substantial

A large, significant level of benefits will be delivered compared with existing arrangements

Moderate

A modest, reasonable level of benefits will be delivered compared with existing arrangements

Negligible

An insignificant level of additional benefits will be delivered compared with existing arrangements

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2 1

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Input Your Project Scores:

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Extract of Example of Prioritisation Results

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Strategic Assessment     

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Brief outline of a proposal Indicates intentions to Scottish Government Will be used to assess strategic priority Fits within (P)AMS document Gateway towards Initial Agreement

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What are the Current Arrangements: Older People’s Health & Care services in ‘a location’ currently support 100 community beds, 75 care home beds in 4 locations, and 5 separate GP practices. They are all run at capacity.

PROJECT: A Care Village

What is the need for change? Identify Links

More patients than necessary being discharged to care homes rather than home

Patients are staying in hospital for longer than necessary

Unable to afford projected increasing demand for service

Existing facilities are functionally ineffective & unable to support proposed service model 57

What benefits will be gained from addressing these needs? Improves quality of life through care provided

How do these benefits link to NHSScotland’s Strategic Investment Priorities? Identify Prioritisation Links Score Person Centred

Improves support to allow people to live independently Increases proportion of people with intensive needs being cared for at home Ensures timely discharge from hospital Improves financial performance

Service Scope/Size Full range of Older People’s health & care services within ‘a location’ Service Arrangement

Safe

Effective Quality of Care

Health of Population

Improves functional suitability of the healthcare estate Reduces people waiting more than 14 days to be discharged from hospital into more appropriate care setting

What solution is being considered

Value & Sustainability TOTAL SCORE

Integration of health & social care services & co-location of supporting services

Service Providers Existing NHS, Council and GP health, community & social care service providers Impact on Assets Expansion of community hospital facility Value & Procurement Hub – value circa £40m

Next Steps Next Steps   

Implementation Refinement Business as usual

FY14-15

FY15-16

FY16 - onwards

Initial roll out

Prioritised Investment plans

Further refinement of process.

Informing and linkages with PAMS & the revised SCIM process 58

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Ongoing support 

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HFS support: training, workshops and User Group VFA expertise and duration of contract Every board has access and is represented at Development and User groups (informed development)

Questions ?

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