Estates and Capital projects six monthly report
Produced by:
Chris Harding – Director of Estates & Facilities
Presented by:
Rob Elek – Director of Strategy & Business Development
Board of Directors Meeting
20thNovember 2014
Estates & Facilities biannual report – October 2014
1.Executive Summary
2.Backlog Maintenance
3.Capital works at City Road
4.Satellite Sites
5.Estates & Facilities directorate report
a)Development of 5 Year Estates and Facilities Strategy
b)Estates Compliance
c)Estates Services
d)Clinical Technical Services (CTS)
e)Security
f)Sustainability
g)Telecoms
h)Portering
i)Interpreting Services
j)Transport Services
k)Domestic Services
l)Catering & Hospitality
m)Waste Management
n)Water dispensers
1.Executive Summary
This report includes an update on the Estates and Facilities directoratefor the six months from April 2014 to October 2014, and includes progress reports for:
- The backlog maintenance programme and major capital projects;
- Developments which do not entail direct capital expenditure, but are estates related in that they involve contractual issues relating to our occupancy at host hospitals; and
- Estates & Facilities work streams and projects which fall below the threshold for board approvals, as these illustrate the scale of planned developments, and demonstrate the delivery of the estates and facilities strategy as an enabler to Our Vision of Excellence.
The executive summary provides a précis of the important issues for the board; the following sections include a further level of granularity if required.
The backlog maintenance programme has been successfully tendered for 2014/15 and good progress is being made on all components of the programme.
Capital works have delivered major improvements to the patient experience, service capacity and organisational resilience across a range of projects; these include:
- Expansion of paediatric ocular prosthetics;
- The creation of a new laser suite (to be completed in early 2015);
- Significant enhancements to the main entrance corridor at City Road;
- Moorfields at Ealing expansion; and
- Moorfields at St Ann’s femto-phako laser suite (due for completion in late 2014.
The Moorfields at St George’s project initially envisaged the provision of a stand-alone building that reprovided and expanded all our current accommodation. The board is aware of the issues surrounding the recent change in direction, and discussions with the host hospital are on-going with respect to both the new interim and longer-term solutions. This represents the key strategic estates risk at present.
The estates & facilities directorate section includes detailed reports for each area, the following are the key issues for the board to note:
- Compliance: A compliance manager has been introduced to the directorate, whose role is to review compliance relating to Estates and Facilities across all our sites in addition to supporting the property management function.
- Security: The NHS Protect Self Review Tool (SRT) work plan section 2014-15, has been completed and agreed with the Security Management Director (SMD). This has been forwarded to NHS Protect. The full SRT document will be completed in full and forwarded to NHS Protect by November 30th 2014 in accordance with NHS Protect guidance and advice.
- Catering: The Costa outlet has been successfully running for almost 12 months and a great deal of positive feedback has been received. The outlet is generating revenues for reinvestment in patient services.
- Telecoms: the new call management system (Netcall 59R) has been successfully implemented at City Road, leading to a significant improvement in switchboard performance and to the accessibility of detailed information relating to call handling at sub-speciality level – this will assist in targeting areas for improvement over the coming period.
The board requested information relating to call handling at our other locations and the following is a summary of the current position:
None of our other sites currently have the equivalent capability of Netcall 59R;
We are unable to interrogate host hospital’s call handling systems; and
There is a great deal of variability in how telephone communications are handled by our services in other locations; i.e. some have direct lines whilst some are only accessible through a switchboard.
In response to these issues, wehave started negotiations with Netcall and have been advised that Netcall59R can be implemented on external lines going direct to sites, and on any lines going out over our N3 links.
We are currently drafting a review to fully understand these issues and to develop plans to improve our ability to control communications at all our sites.
A potential solution could entail diverting existing phone numbers to route all incoming calls for any Moorfields site into the City Road Netcall system, which would then transfer the call to the relevant phone (including mobiles), thereby giving us full functionality across the network.
The board is asked to consider the progress made in the delivery of the backlog maintenance programme and capital projects, and the overall performance of the Estates & Facilities directorate.
2.Backlog Maintenance
The backlog maintenance programme is refreshed on an annual basis, and continues to deliver real improvements to our estate as well as ensuring we maintain appropriate standards for patient and staff safety.
The end of year estates report will include full details of the workstreams, alongside the programme for the following year.
The main backlog works undertaken in the last six months are summarised below.
- Fire alarm upgrade.
Works to install the new sounders and sensors commenced on 9th December 2013 and completed in May 2014. Software system upgrading and snagging / training continues, with completion planned within Q4.
- External façade and roofs.
Works to repair all roofs, rectify façade defects and install fall arrest systems commenced on site on 3rd February and completed on 19th May 2014.
- Fire doors and compartmentation upgrade to upper floors.
The initial high priority works were completed in earlier phases of the backlog programme, lower priority works commenced in October 2014 and will complete in February 2015. All fire related backlog works are fully coordinated with the Fire Brigade, and our revised
- Emergency lighting and Disability Discrimination Act (DDA) works package.
A full DDA audit was completed in 2013 and final designs were approved earlier this year, works are programmed to commence and complete in Q4.
- Lift upgrade works.
Following the refurbishment of the main patient lifts a programme to upgrade all City Road lifts started in late 2013. Despite problems with the initial contractor, lift 1 (by the old main entrance) and lift 3 (by outpatients) have been completely refurbished. Works to lift 6 (the goods lift) will be undertaken as part of the 2014/15 programme.
The overall programme and scope of all backlog works is adjusted to ensure that expenditure remains within the approved affordability envelope allocated by the Capital Planning & Oversight Group (CPOG).
The Estates department has also been addressing significant numbers of the smaller, discrete backlog maintenance issues through its minor works programme.
3.Capital works at City Road
- Medical Gases
This project has successfully delivered a new Liquid Oxygen Compound in the goods yard. Previously the hospital’s oxygen supply was provided from bottled gas, this facility now operates as a standby unit. This project has mitigated a significant health & safety risk as the oxygen bottles required frequent changing by porters, and a business continuity risk as the hospital did not have resilience in supply.
- Expansion of paediatric ocular prosthetics
The expansion to the paediatric ocular prosthetics department was completed in June 2014. This was a complex project entailing a crane-lift for the modular build and intricate phasing to minimise the impact of works on the goods yard. The expansion includes striking artwork that has been a big hit with the children, and adults, visiting the department.
- Private patient laser suite
A new laser suite will be created on the 4th floor. This project has just started on site and will complete in early 2015.
- Friends of Moorfields information desk
The main entrance corridor to the outpatient area represented a somewhat confusing environment for patients, and was in some need of updating. Accordingly, the Friends of Moorfields base has been moved to a more logical location by the main entrance and the porter’s desk has been removed. The new information desk has been widely welcomed as a much needed improvement to how we support and guide patients into the hospital, as well as greatly enhancing the appearance of the hospital.
- Health Information Hub
The purpose of this completed project is to provide patients with an area to access general patient information via leaflets or to browse our information screens, in a calm and welcoming environment. The hub was funded by the Friends of Moorfields, who also support patients seeking information in the hub; though the Director of Nursing & Allied Health Professionals is reviewing the PALS / ECLO services with a view to potentially having full-time staff based in the hub.
- Piano
The changes in the main entrance corridor have also enabled us to divide the former Friends ‘hutch’ into an office for the outpatient matron and to create a much needed space for a grand piano. The board will recall that our grand piano, previously housed in the City Road boardroom, has been in storage for some time. We have been fortunate in that a grateful supporter of the hospital has donated a better piano, and this new addition is now installed in the main entrance corridor.
4.Satellite Sites
Estates maintenance strategy for satellite sites
The responsibility for estates maintenance for satellite sites, and the quantum of services, varies from one location to another - ranging from the landlord (host hospital) providing all or no maintenance, and the City Road estates department directly supporting a number of sites. This inconsistent approach is confusing for operational staff, and is not an efficient or effective means of providing such a key service.As the board is aware, we piloted an improved service model at St Ann’s and Northwick Parkand following the success of the pilot, we undertook a formal tender process for the supply of the planned maintenance services and the contract was awarded to Lorne Stewart on 1st May; this contract also includes the flexibility to add our other satellite sites.
Some aspects of maintenance at our satellite sites that are the responsibility of our landlords have created some concern about quality. The Director of Estates & Facilities has now appointed a Compliance Manager to follow through with all relevant landlord estates departments a list of statutory works for confirmation by the landlord that these issues have been properly addressed (as required under the landlord and tenants act), and to ensure that Moorfields has complied with its duty of care to our staff and patients. Where this is believed to fall below the required statutory standard, or if information is not forthcoming, internal audit tests have been carried out by Moorfields estates and results shared with the landlord to action. These are then monitored to compliance completion.
Moorfields @ Northwick Park
Medical gas systems were removed from the original Northwick Park expansion project prior to construction. These systems are required to expand the scope of surgical procedures undertaken in the theatre – a key objective to enable the “repatriation” of further work from City Road and the development of new local services.
Negotiations with the host hospital have been in progress for some considerable time as our preferred solution, to connect into the existing site medical gas system, did not appear to be achievable and the landlord appeared reluctant to give permission for Moorfields to deliver a stand-alone local system.
The host hospital has very recently agreed that we can connect into the existing system and the project has been re scoped and submitted for approval by CPOG of a business case and proposed installation early 2015.
Moorfields @ St George’s Hospital (SGH)
The board approved the St George’s business case in October 2013 and positive discussions have continued with SGH around the key clinical requirements (access to main theatre space etc.) and the finalisation of the development agreement and lease documentation.
These discussions have flagged up a number of clinical issues and operational constraints, around anaesthetic support to a free-standing building, the increasingly complex case-mix of our activity at this site, and the impact of SGH’s designation as a regional trauma centre. The consequence of these issues is that SGH have stated that the planned development cannot proceed in its current form. SGH have proposed an alternate, interim, solution for the vacation of Duke Elder ward that includes outpatient expansion space, and have invited Moorfields to comment on this revised proposal. Meetings are being progressed with the key clinical and estates representatives to progress this proposal; however suitable commercial agreements will also need to follow.
At present, it is not possible to state with any certainly what the longer term solutions may entail, though SGH have revised their position and there is an expectation that a complete Moorfields unit will be provided within SGH clinical accommodation.
Moorfields @ Ealing Expansion
The long awaited expansion to the Moorfields @ Ealing service was successfully completed in August, with occupation by services in September 2014. This £660k project included lease arrangements for the modular build’s location.
Ealing and North West London Hospitals have now merged to create London North West Healthcare NHS Trust; this will enable us to reopen discussions around the occupancy provisions for the main Ealing accommodation.
Moorfields @ St Ann’s – femto-phakolaser suite
The estates works to create an appropriate facility to house a new femto-phako laser at St Ann’s are underway with completion planned by the end of the calendar year.
5.Estates & Facilities directorate report
a)Development of 5 Year Estates and Facilities Strategy
Over the next reporting period, we will be developing a 5 Year Estates & Facilities Strategy. As part of this development we will create:
- 5 year forward Estates & Facilities vision and documented strategy for the period April 2015-March 2020
- Key strategic objectives framed into a Balanced Scorecard
- Business planning SMART measures
The development of a Moorfields Estates & Facilities Strategy will take into account NHS initiatives such as Payment by Results, Patient Choice and especially the Privacy and Dignity agenda. As such it is essential for the Estate to meet patient expectations by providing a quality environment for treatment and healthcare service delivery, at all our sites.
The overall purpose of the Estate & Facilities Strategy will be to show how the estate is being used and how this resource can be used in the future to support the Trust in delivering its key objectives. The Estate & Facilities Strategy will need to flow from the Trust’s Service Strategy and Business Plans, which in turn reflect Government and local initiatives for the delivery of healthcare services.
It will also demonstrate the priority given to achieving compliance with Standards for Better Health and statutory health and safety legislation as part of the drive to improve quality.
Overall the completed Estate Strategy aims and objectives will include:
- Maximise use of the built resources available
- Enable development of high quality, fit for purpose and well placed buildings
- Ensure that all capital investment is linked to the Trust strategic direction
- Create standard approaches to project management and business case development
- Coordinate the environmental response to the needs of all
- Act as an information resource across the Trust
- Develop shared learning
Approach:
The approach to undertaking the strategy development will be a based on the following three stages:
This approach is aligned to the proven methodology already used for the development of our Corporate Strategy as detailed below.
Stage 1 – Baseline (Gathering Evidence and Analysis):
Initially we will establish a robust baseline from which future objectives can be measured against. This baseline will provide a reality check into whether aspirational strategic objectives can actually be achieved and at what cost to the organisation.
An “In-Depth” assessment of the 14 Elements of our Estate & Facilities Management function will focus on the strategic, operational and tactical aspects of each component of the service.
The baseline elements are detailed on the Maturity Matrix as below:
1)Strategy, Leadership and Organisational Design
2)Asset and Maintenance Management
3)Risk Management
4)Compliance and Statutory Maintenance
5)Safety Management
6)Supplier Relationship Management
7)Service Delivery
8)Customer Service
9)Cost and Financial Management
10)Help Desk and Processes
11)Sustainability
12)Estates & Facilities People Management
13)Client (Stakeholder) Management
14)Innovation and Change Management
The Gap Analysis will be referenced against Best Practice and will be supported through a detailed SWOT and PESTLE analysis.
Stage 2Strategic Objectives (Synthesis):
The Estates & Facilities Strategy will be aligned to the Moorfields core business strategy. Using the Moorfields “Our Vision of Excellence” document as a guiding template, we will undertake strategic planning workshops with key Team members.