Official Report 189KB pdf
“Asset management in the NHS in Scotland”
Item 2 is consideration of a section 23 report. We will receive a briefing from the Auditor General on the report "Asset management in the NHS in Scotland".
With your agreement, convener, I invite Barbara Hurst to introduce the report.
My challenge is to make asset management less than dull for Stuart McMillan's last meeting.
Thank you. In paragraph 11 of your key messages report, you highlight the fact that
It is very worrying. Several years ago, we published a report on medical equipment and made a number of recommendations, a key one being that NHS bodies need to know where their equipment is, what condition it is in and what the maintenance programme is. The finding to which you refer is not good.
Despite what you said to health boards previously, five health boards still do not know the condition of their medical equipment.
That is correct.
We will want to reflect on that.
I will continue the convener's line of questioning. Exhibit 10 on page 19 shows whether information is held electronically, in paper records or not at all. The bar chart for vehicles suggests that one NHS body has no record at all of the number of vehicles that it holds. Is that correct?
Yes.
The figures for each category do not always add up to the total number of boards, because not all boards responded to all questions.
But the left-hand side of the "Vehicles" table in exhibit 10 shows that 16 NHS bodies hold their records electronically, none has paper records and one has no records at all. It seems utterly extraordinary for an NHS board to have no records of the number of vehicles that it has, nor of their location—not to mention information on their condition, replacement plans or work that has been done on them. It seems extraordinary for a public body to run a vehicle fleet without having any records about it. I am not missing something, am I?
The one body concerned is the national waiting times centre, which does not own an awful lot of vehicles. It might be that it did not answer the question.
Ah—okay.
Which were the five NHS bodies that did not know the condition of their medical equipment?
They were NHS Fife, NHS Shetland, NHS Tayside, the state hospital and the Scottish Ambulance Service.
The fact that NHS bodies did not know the condition of their medical equipment strikes at the heart of treatment. Surely tracking and monitoring are required to solve the problem, and nowadays those have to be done using IT facilities. Is there any indication that action is either likely or imminent on those issues? Do action plans exist, or are they being planned? In other words, what will be done about the situation?
A national e-health strategy was published just last year, and I know that boards are working with the Government to develop the initiatives that were contained in it around information management and technology. That includes the monitoring of equipment, patient records and the use of different software.
So the issue is recognised and is being looked into.
Yes.
We will be following up work that we have done on IM and T. We will consider the matter in the work that we do this year.
One of the very positive opening comments in the Audit Scotland summary recognises the tripling of the investment that is coming along. Given members' comments so far, I think that we have a golden opportunity to correct some practices and ensure better practice for the future.
We expected you to ask about post-project evaluation, partly because of our major capital projects report in which that came through as a theme. We do not know whether the health service is not routinely doing such evaluation, but we know that it is not monitored. We genuinely do not know whether the NHS is doing that or not. However, the issue is important, because it concerns health care facilities and we need to evaluate whether they are meeting needs. I think that Kirsty Whyte will support me on this: there is a lot of evidence that, if buildings are well designed, that can enhance the health care experience. We want to pick up on that with the Scottish Government health directorates to ensure that such evaluations are happening across the health service.
That is very encouraging. I am similarly encouraged and delighted to see that you have picked up the north-west Kilmarnock area centre as a case study on page 13. Located in my own dearly beloved Kilmarnock, the centre is a fantastic resource for the community, which combines lots of health services with housing, community and police services all under the one roof. It is a fantastic example and I am certain that, should the committee wish to see examples of good practice, it would be made very welcome down in Kilmarnock. It is lovely to see that resource being recognised. Although I recognise the comments that were made about the lack of post-evaluation analysis, I am certain that the work that is being done in that centre is delivering positive results for the community.
That is a good example of why we include case studies in the report. We would expect such a report to be read carefully and seriously by board members and senior officials. Other boards should be interested in a case study like the one that has just been mentioned and would want to explore whether there is anything that they can learn from it.
Paragraph 17 of the key messages report says that
We will probably follow that up in about 18 months or a couple of years, to give the recommendations a chance to bed in. There are also some issues coming up through the annual audit process around capital investment, which we would be likely to highlight in our overview report on the health service.
We highlighted the fact that there is a lack of performance information. The development of the performance management system that the Government is committed to producing this year should help in that regard, as it will standardise the information that is available across all the boards and make it much easier to monitor.
With regard to case studies, last year the Justice Committee went to Peebles, where there is a hub centre for the Scottish Court Service, Lothian and Borders Police and the community justice partners. Other examples, in the health service and in other areas of the public sector, could provide useful examples of such arrangements.
When the NHS boards decide to dispose of property assets, it always seems to be a long time until that property is transferred to someone else and used for another purpose, during which time the property deteriorates and the value goes down. Did you look at the process for the disposal of assets, with regard to the time that it takes to do so and the resultant costs?
No. We examined the disposals process and discussed it with the Government, and we understand that the disposals programme forms part of the capital investment programme for each board, which is planned over a number of years. As our report says, not a lot of information is gathered annually. However, one of the elements that are gathered annually by the Government is each board's capital investment, which includes all the plans for disposals over not just the coming year but succeeding years.
I am surprised that you did not examine that issue. In my old role in South Ayrshire, I constantly heard complaints about the fact that, after the health board built a new hospital, Ayr hospital, Ballochmyle hospital and all the others that were surplus to requirements were empty for years, which led to huge extra costs. Surely Audit Scotland ought to examine that issue.
We examined things in a strategic way. We considered at a global level the functional suitability of the estate—whether the estate is suitable and how it is being used—but we did not examine individual disposals of assets.
Might you consider doing that? I am sure that a lot of money is wasted through property lying unused. I understand that there is a long, complicated procedure whereby the property must be made available to other public bodies before it can be disposed of on the private market. Is that correct?
Public bodies are supposed to get the best value that they can when they dispose of land or buildings. An issue that might be coming up now, given the financial climate, concerns the fact that assumptions that were made about the extent to which land disposal can contribute to capital might prove to have been overoptimistic.
That is a separate issue, really. My worry is that properties can become less valuable when they are left to deteriorate.
The report on energy efficiency that you will consider later on your agenda examined that, to an extent. The health service is better than some other parts of the public sector in the attention that it pays to that issue. I believe that it has a target for energy efficiency in health service buildings.
I am surprised by that. That is not my experience, but there we are.
On acquisitions and procurement, is there any evidence that NHS boards are trying to partner up with regard to services or materials? I note that there is a national database for something or other—I am not quite sure what, though; perhaps it is just for vehicle tracking.
We are doing some work on procurement at the moment. I cannot remember exactly the publication date that we have planned, but I believe that we will bring a report on procurement in general across the public sector to the committee in the early summer. That will explain what is being done in the public sector to establish the sort of shared approaches that you are talking about.
There are a couple of initiatives that are quite specific to what you mention. Public sector bodies should be entering their properties into the United Kingdom-wide electronic property information mapping service—e-PIMS—so that public bodies that are looking for buildings can see what is available in certain areas. That enables the most efficient use of the space. The service has not been well used in Scotland so far, but the Government is working on promoting its use.
On page 21, exhibit 13 demonstrates that acute hospitals and non-acute hospitals account for the majority of the NHS estate. On page 5, the report reminds us that there is a
Yes, I think that there is a recognition of that among health boards, particularly given the scale of the capital investment that is being made. All boards have major investment programmes that are linked to shifting the balance of care from a heavy focus on acute services to community centres.
It seems that the focus of the Scottish Government health directorates is to look to future policy, but they do not seem to look at the existing situation. The report gives a warning signal about future problems unless the estate is dealt with. Should the focus of the SGHDs include not just existing policy but the existing estate, given that the estate is deteriorating and the health directorates do not seem to know exactly how bad the situation is? Is a switch in focus, or an additional focus, required?
The report certainly recommends that there needs to be better monitoring nationally so that we know what the current situation is. We do not suggest that the health directorates should manage the local assets, but they certainly need to know what the picture looks like across Scotland. Without a proper picture of the estate, they cannot know what the capital investment should be for the future. That is an important point.
They might be storing up future problems.
Yes.
If members have no further questions, I thank the Audit Scotland team for coming along—
What happens now?
We will decide what to do with the report under a later agenda item.
Will that item be taken in private?
Yes.
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Section 22 Report