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NHS GRAMPIAN

Local Delivery Plan, Asset Management Plan and Health Transport Action Plan

1. Actions Recommended

The Board is asked to consider and approve the:

Local delivery plan

Asset Management Plan

Grampian Health Transport Action Plan

2. Strategic Context

Local Delivery Plan The Local Delivery Plan (LDP) sets out the annual delivery agreement between NHS Grampian and the Scottish Government Health and Social Care Directorate. The content of LDP is aligned to the NHS Scotland 2020 vision for health and social care and covers the three main aims of the vision and the six strategic priorities

Aims Strategic Priorities

Quality of Care Person Centred, Safe Care, Primary Care and Integration and Mental Health

Health of Population Antenatal and Early Years and Health Inequalities and Prevention

Value and Sustainability Unscheduled and scheduled care

The LDP also contains the Board’s

financial (revenue and capital) plan for 2016/17,

Implementation plan to deliver the 5 priorities in the Everyone Matters: 2020 Workforce vision1,

Our plans in respect of the LDP Standards, and

Actions to strengthen our approach to community planning in the context of the Community Empowerment (Scotland) Act.

Progress with delivery of the local delivery plan will be monitored by the Board’s Performance Governance Committee and as part of the Annual Review process.

1 Healthy organisation culture, sustainable workforce, capable workforce, integrated workforce and effective

leadership and management

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Property and Asset Management Plan The Scottish Government’s “Policy for Property and Asset Management in NHSScotland” [CEL 35 (2010)] requires all NHSS bodies to have a Property and Asset Management Strategy (PAMS) which is reviewed and approved by the Board annually. This is the PAMS which will be known as the Property and Asset Management Plan (PAMP) for NHS Grampian. The Property and Asset Management Plan is one of a coherent suite of supporting and enabling plans which together with an underpinning financial plan supports our “Healthfit 2020 – NHS Grampian’s Strategy” and is intended to demonstrate that the Board can successfully deliver Scotland’s health policies and the shared national ambition for achieving world leading quality in our healthcare services.

The overall aim of this plan is to ensure that the Board’s asset base is the right size, suitable for purpose, positively supports service delivery and enhances service users’ experiences Grampian Health Transport Action Plan The Grampian Health Transport Action Plan Steering Group consists of representatives from NHSG, Nestrans, Scottish Ambulance Service, Aberdeen City Council, Aberdeenshire Council and The Moray Council, the Community Transport Association, Integrated Health & Social Care Partnerships and a Patient/Public representative. The purpose of the refreshed HTAP is: “To enable providers of transport, health and social care services to work together in a more co-ordinated manner in order to improve outcomes and efficiency of service delivery, both in reducing the adverse impacts of transport choices on public health and in improving access to health and social care.” The Annual Report gives an overview of the key developments in relation to the Health & Transport Action Plan during the period 2015-2016 and demonstrates where partners have sought to work across boundaries and sectors towards common aims relating to transport and public health and access to health and social care services.

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3. Key matters relevant to recommendation

Local Delivery Plan – actions and outcomes The Local Delivery Plan (LDP) has been produced in accordance with the Local Delivery Plan Guidance 2016/17 issued by Scottish Government on 13th January 2016. It defines progress made in key priority areas towards delivery of the national 2020 vision for health and social care and our own Healthfit 2020. It also provides information on key actions for 2016/17 which will be taken forward by the Board in association with the new Integration Joint Boards (IJBs) and other partners. It outlines key workforce, financial and performance challenges for the year ahead. The Local Delivery Plan is not a comprehensive picture of the business of NHS Grampian and must be viewed in the context of wider plans and strategies, locally, regionally and nationally. These include the NHS Grampian Clinical Services Strategy, Integration Joint Board Strategic Plans and Community Planning Single Outcome Agreements. a) NHS Scotland Strategic priorities

Health inequalities and prevention

The LDP sets out how we are addressing health inequalities and improving prevention work based on the needs of the local population and those communities where deprivation is greatest. The NHS Grampian Clinical Strategy has incorporated prevention and supported self management as two of its strategic themes.

Antenatal and Early Years

Early years care will be substantially affected by the new duties to be placed on Health Boards through the Children and Young People (Scotland) Act 2014. Child Health 2020 is NHS Grampian's plan for working towards our vision that "by 2020, all children and young people of Grampian will have the healthiest possible start in life." Child Health 2020 encompasses all activities that contribute to child health, from education and early prevention through to tertiary healthcare services. It takes account of current national policy and initiatives, including Getting It Right for Every Child (GIRFEC) and Early Years Collaborative.

Person Centred Care

The LDP sets out how services will support a positive care experience, ensure actions are being taken support staff and the public to be open and confident in giving and receiving feedback and to ensure that learning and improvement is taken forward as a result.

Safe Care Patient safety is a key priority for NHS Grampian - working in partnership with staff, patients and the public. All sectors of NHS Grampian are engaged with the Scottish Patient Safety Programme. Our main aims are to ensure patient safety is integrated into the daily working routine, create a safety culture by maintaining the patient as the focus and to implement evidence-based interventions that reduce adverse events.

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Primary Care Demand for primary care is increasing and the establishment of the new Integration Joint Boards will provide the framework for a collaborative approach between primary and secondary care and between health and social care services. Engagement with local communities and a focus on prevention and reducing inequalities is a priority. The new 2017 General Practice contract will place more emphasis on the patient journey, requiring locality teams to develop communication between a wide range of partners, patients and carers. The LDP sets out our prioritised local actions in response to these changes.

Integration The Integration Joint Boards for Moray, Aberdeenshire and Aberdeen City were formally established on 6th February 2016 following the approval of their Integration Schemes and went live from 1st April 2016. A summary of the areas of focus reflected in the three Integration Joint Board strategic plans is set out within Appendix 1.

Mental Health NHS Grampian remains committed to delivering a high quality mental health service. This includes minimising access times to care. We continue to take action to deliver improvement and will work with the Mental Health Access Improvement Support Team to ensure all that can be done is done for the benefit of patients across Grampian

Community Planning

NHS Grampian remains an active participant in Aberdeen City, Aberdeenshire and Moray Community Planning Partnerships. Priorities identified through the community planning processes are included in our plans and appropriate indicators monitored through routine performance arrangements.

b) Local Delivery Plan standards The Board’s priorities in relation to delivery of performance against the national LDP standards remains in line with the prior year:

Commitment to sustained delivery of performance against the 4 hour A&E standard (95% on an NHS Grampian Board basis) and further progress in reducing the number of patients whose discharge from hospital has been delayed.

Commitment to improving our cancer access times performance.

Best endeavours within available resources in relation to the inpatient treatment time guarantee and outpatient standard within 12 weeks.

Actions to support the above include: The Local Unscheduled Care Action Plan is based on the principles of clear leadership, clinical and managerial engagement. Additional capacity was invested in 2015/16 to improve the patient pathway through enhanced consultant and medical cover and increased support in the form of triage nurses, advanced clinical practitioners and physician associates. These support the six essential areas included within the national unscheduled care programme

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Following the success of the endoscopy service plan in 2015/16, our focus in 2016/17 in relation to cancer performance will be to redesign pathways for those tumour types where we continue to have challenges in meeting the 62 day target. We will continue to work closely with the Cancer Access Team as this work progresses in order to demonstrate sustained improvement. The Board has made significant investment in additional elective care capacity over the last few years and welcomes the announcement of the Scottish Government funding for a new diagnostic and treatment centre. During 2015/16, we:

introduced the first state-of-the-art Robotic Assisted Surgical System in Scotland for minimally invasive procedures for conditions including prostate, bowel, rectal and gynaecological cancers; and

Aberdeen Royal Infirmary becoming the first hospital in NHS Scotland to use an O-Arm scanner which generates high-resolution 3D images and improves both the outcomes for patients and recovery times.

We aim to reduce our reliance on out of area private sector providers and non-core activity and work towards improved efficiency and productivity within core services to produce locally sustainable specialties. We will be participating fully in the National Scheduled Care Programme and planning in detail for the proposed Diagnostic and Treatment Centre in Aberdeen to cope with the expected increase in patient numbers over the medium term. We will continue to work closely with Access Team as this work progresses to ensure that the Acute Sector Waiting Times Plan (2016/17) is delivered c) Workforce There are challenges and risks associated with the overall workforce supply and recruitment to a number of roles. We have, however, made significant investment in the medical and nursing workforce with the consultant medical workforce increasing by 26 whole time equivalent (wte) and the nursing and midwifery workforce by 24 wte between 31st December 2014 and 31st December 2015 Through previous workforce planning cycles, in partnership, the workforce in Grampian has continued to evolve. This includes increased clinical roles for: Pharmacists; Advanced Nurse Practitioners; Healthcare Scientists; Allied Health Professionals; Paramedics; Physician Associates and Health Care Support Workers. These additional clinical roles provide enhanced capacity across patient pathways in both primary and secondary care. We continue to implement workforce planning across services to inform the annual Board Workforce Plan. Proactive steps that have been progressed around recruiting staff include: close work with the local universities and colleges; international and UK recruitment of GPs; attendance at career and jobs fairs; a collaborative Return to Practice course with RGU; improved social media presence with dedicated GP Facebook pages; primary and secondary care medical workforce symposiums and a senior charge nurses’ conference. NHS Grampian has also invested in policies and processes that support the overall health and wellbeing of staff. All sectors of NHS Grampian are signed up for Healthy Working Lives and are at various stages in the award structure.

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Local Delivery Plan – financial plan NHS Grampian’s core revenue allocation uplift for 2016/17 has been confirmed at 1.7% of our Revenue Resource Limit (RRL). Our base funding uplift of £14.1m plus the additional move to NRAC parity amounts to a £29.1million increase in funding.

In addition, amounts have been built into our financial plan to reflect NHS Grampian’s share of the £250m identified within the Scottish Government budget to support better social care outcomes. We have assumed this funding will be transferred in its entirety to the three new Integration Joint Boards from 1 April 2016.

The new resources received by NHS Grampian will be allocated to the following operating areas to meet the cost pressures and new expenditure commitments noted below:

Acute Sector £15m

Health and Social Care Partnerships £36m

Other £2m In terms of our financial plan for 2016/17, we have allocated these new resources to meet known cost increases (£28.7m) and targeted investments (£5.5m). The key cost increases are in relation to:

Increased pay costs £9.5m

National Insurance increase2 £10.3m

GP and Hospital Drugs £4.1m

Other £4.8m

Total £28.7m

The targeted investments approved for 2016/17 are in line with national health priorities and/or local priorities.

Service Commitments

Unscheduled care plan £1.2m

Additional MRI scanner £0.3m

Additional anaesthetic and obstetric consultants £0.6m

New renal dialysis unit (Stonehaven) £0.3m

HIE compliance £0.5m

National service contracts – new services £0.6m

Other £0.5m

Contingency / Spend to Save Provision £1.5m

£5.5m

In October 2014, the Board approved a significant investment in a multi-disciplinary team for the front door of Aberdeen Royal Infirmary. The funding included within the 2016/17 finance plan will enable the final stage of this investment to be committed as part of our plan to redesign the unscheduled care services in Aberdeen.

2 The increase in the national insurance contributions is as a result of the ending of Contracting Out

arrangements from 1 April 2016.

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Following a review of capacity and service requirements within our theatre suite and maternity services, we have made provision for additional consultant capacity within the anaesthetics and obstetrics departments.

We welcome the continued support of donors and community fund-raising which will enable the establishment of an additional MRI scanner at Woodend Hospital and a new renal dialysis facility in Stonehaven. Provision has been made within the financial plan for the revenue running costs of these new facilities which will deliver improved access to key services for patients. To achieve financial balance in 2016/17, the Board will be required to deliver a cash releasing saving target of c£18.5m or 2.1%. The Budget Steering Group has established a programme of targeted efficiency savings in the following key areas:

Reducing levels of medical locum expenditure and non contract agency nurse spend

Significant reduction in the use of the independent sector to meet Treatment Time Guarantee obligations

Implementation of energy efficiency initiatives, the most significant of which will be the Carbon Energy Fund project and replacement of boilers at Woodend Hospital

Implementation of an efficiency and cost reduction programme for primary and secondary care prescribing.

The above are in addition to operational sector specific efficiency savings plans and benefits that we aim to accrue from national programmes Our high level five year financial plan is set out within the pro-forma schedules within the local delivery plan. In setting out revenue plans over these years, we have applied conservative assumptions in line with the allocations advised by Scottish Government Health and Social Care Directorate (SGHSCD). We have also assumed relatively low growth in pay costs.

Whilst we are submitting a 5 year plan, this will require to be reviewed following the spending review being undertaken by Scottish Government. The framework for the allocation of resources over the next few years will reflect the national 2020 priorities, health and social care integration and local priorities which will be set out within the Grampian Clinical Services Strategy. A summary of how the Board finance resources are use to support healthcare across Grampian is shown in Appendix 2.

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Asset Management Plan The five year capital plan sets out the Board’s priorities for managing the infrastructure that supports the delivery of patient care and associated services across NHS Grampian and is integral to the delivery of the NHS Grampian Healthfit 2020 vision. The plan is focused on actions across four main areas:

Investment in infrastructure consistent with our strategic health priorities including initiatives to reduce carbon emissions;

Reduction in high and significant risk backlog maintenance in clinical areas and compliance with statutory requirements;

Replacement of essential equipment; and

Disposal of assets declared surplus to requirements. The financial plan incorporates the resources aligned against these areas of expenditure financed from revenue operating budgets, the capital programme, charitable donations and through asset disposals. We have assumed a flat formula capital allocation over the five years of the plan. This is in addition to approved brokerage and funding for legally committed schemes and other nationally agreed investment programmes such as the Carbon Energy Fund, hub initiative and non profit distribution funding. Our infrastructure programme also includes £15.5m of investment to be financed from charitable donations, a combination of individual philanthropic donations for specific projects such as the new MRI scanner and the multi-storey car park and new equipment purchases and ward refurbishment through the Board’s Endowment Funds.

We welcome confirmation of the strategic support for the Baird Family Hospital, ANCHOR Cancer Centre and the Diagnostic and Treatment Centre. A summary of the immediate investment priorities for the next 5 years is presented in Appendix 3.

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4. Risk Mitigation

Approval of the final LDP will assist in mitigating Strategic Risk 851, Delivery strategies to meet the future health needs of the population and Strategic Risk 586, Partnership working with local authorities, third sector, independent contractors and the community. Approval of the Property and Asset Management plan will assist in mitigating Strategic Risk 855 by ensuring that we implement an asset investment, disposal and backlog maintenance programme or redesign of service provision to reduce dependence on physical buildings.

5. Responsible Executive Director and contact for further information If you require any further information in advance of the meeting please contact: Responsible Executive Director Alan Gray Director of Finance alangray@nhs.net

Contact for further information Anne Ross Head of Performance and Quality Improvement a.ross@nhs.net

18 May 2016 Additional supporting information Local Delivery Plan (incorporating finance plan) Asset Management Plan Grampian Health Transport Action Plan Printed copies of the above documents will be made available on request.

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Appendix 1: Areas of focus for the Integration Joint Boards (2016/17) The three Integration Joint Boards have published their strategic plans and all have been the subject of wide engagement and consultation. The plans provide the high level direction for the preparation of more detailed commissioning plans during 2016/17. Examples of the areas of focus for each of the Integration Joint Boards are as follows: Aberdeenshire Integration Joint Board The Aberdeenshire Integration Joint Board strategic plan explains what the challenges and opportunities are for health and social care services through joint and integrated working – NHS Grampian, Aberdeenshire Council Social Work, third sector organisations, private providers of health and social care and, not least, the residents of Aberdeenshire. The principles that underpin the plan are about individuals looking after their health, planning ahead to meet health and social support needs as we get older and making informed choices about how we use our local services. Aberdeenshire is fortunate in having diverse and vibrant communities that make a valued contribution to health and wellbeing alongside public, private and voluntary services. The way services are organised and provided will have to change and the plan explains that these changes will be set out in commissioning plans that will be available during early 2016/17. The IJB vision for better health and social care services is ambitious and the plan has been developed through community consultation events that took place during 2015. Aberdeen City Integration Joint Board The strategic plan demonstrates a commitment to improving the personal experiences and outcomes of the local population when they use health and care services. The plans also shows how the IJB hopes to develop community connections and activities to complement the care and support that is offered as close to people’s homes as possible . Integrated health and care services will be delivered that support the people of Aberdeen to remain as well as possible for as long as possible and to ensure that people are admitted to hospital only when that is the best place for them to be ( i.e. fewer ‘social admissions’) and that they stay in hospital for only the minimum time that is clinically required to treat them To address these challenges the strategic priorities for the next three years are:

Improve the health and wellbeing of the local population.

Contribute to a reduction in health inequalities and the inequalities in the wider social conditions that affect health and wellbeing.

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Strengthen existing community assets and resources that can help local people with their needs and make it easier for people to contribute to helping others in their communities.

Promote and support self-management and independence for individuals for as long as reasonably possible.

Develop personalised services that promote and protect the human rights of every individual and which enable residents to have opportunities to maintain their wellbeing and take a full and active role in their local community.

Support those who are unpaid carers to look after their own health to enable them to maintain their caring role and have a quality of life outside the caring role. Ensure that unpaid carers are equal partners in the planning and delivery of services.

Work in partnership with our residents, communities and organisations across all sectors to ensure that all our activities are meaningful to them and effective.

Deliver high quality services that have a positive impact on personal experiences and outcomes

Moray Integration Joint Board

The strategy recognises the enormous and valuable contribution that communities and volunteers can make in the areas of promoting health and wellbeing.

The Reshaping Care for Older People programme and associated Change Fund enabled the partnership to accelerate local progress and to develop plans to drive sustainable improvements in the national outcomes that relate to the care of older people. It enabled the partnership to not only to shift the location of care (from institution to community) but also to transform the culture and philosophy of care from reactive services provided to people towards preventative, anticipatory and coordinated care and support at home delivered with people.

Housing as partners - Housing has become a key partner in the joint commissioning process. The partnership acknowledges the vital contribution that housing can make to improving health and wellbeing outcomes.

The community care redesign programme aims to meet future demand. A single point of access to community care is established. The access service provides an early intervention and preventative approach to care with greater choice and control over the support people need.

Moray Partners in Care – community care has developed a new model of care and support in the community which promotes independence and supports greater choice and control and improved outcomes. It is based on three offers – Help to help yourself, help when you need it and ongoing support for those that need it.

Improvement Programmes currently underway in Moray include: Modernisation of Primary Care, Focus on Dementia, Self-directed Support, Unscheduled Care, Older People in Acute Care, Patient Safety Programme, Long Term Condition Action Plan.

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Appendix 2: NHS Grampian - How we utilise our resources NHS Grampian utilises c£1.1bn per annum to provide health services for the population of the North East of Scotland, as well as providing healthcare support to other NHS Boards within the North Regional planning area.

A high level summary of how these resources are deployed is presented below:

Acute services In terms of the acute hospital based services the key areas of expenditure are as follows:

Unscheduled and emergency care £78m

Surgery £60m

Women and Children’s services £48m

Dr Gray’s – District General Hospital £24m

Clinical support services £137m

Unscheduled care has been a key priority for the Board. In December 2012, the Board opened the new £115m Matthew Hay Building (Emergency Care Centre) and implemented a new integrated model for the provision of critical care services and unscheduled care. To support the redesign of services the new accommodation included: a clinical decision unit, an observation and medical/surgical assessment area with a capacity for more than 40 patients and a 15 bed medical high dependency unit. As part of the Winter Plan for 2015/16, the Board prioritised patient flow within our major hospital sites and working with key partners regarding reducing the number of patients with a delay in their discharge and implementing a new system of multi professional daily safety briefings.

Expenditure on services

Acute sector

Primary and Community Care

Dental

Mental Health

Facilities

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These investments, together with the support of primary, community and social care resources, have resulted in significant changes and improvements to patient flow and patterns of admission and activity since 2011/12.

Patients (+65 yrs old)

Patients (+75 yrs old)

Scotland Grampian Scotland Grampian

Reduction in emergency admissions 0% 10%

Reduced admission rates per 100,000 1.6% 12% (6.1%) 9.8%

Reduction in emergency bed days 0% 10% 0% 14%

The Board has made significant investment in additional elective care capacity over the last few years and welcomes the announcement of the Scottish Government funding for a new elective centre. The capital programme has supported the establishment of three new operating theatres at Aberdeen Royal Infirmary and Woodend Hospital, as well as the re-commissioning of two theatres within the old accident and emergency unit. There has also been a corresponding and significant increase in staffing within surgical specialties, anaesthetics, theatre nursing and supporting clinical and non-clinical services. In terms of inpatient and outpatients, the level of activity on an annual basis delivered across NHS Grampian facilities is as follows:

No of patients

Outpatient appointments c380,000

In patient admissions c88,000

Day surgery admissions c44,000

Women’s and children’s services form a key element of our clinical services strategy. Key elements that we would highlight are the investment in additional obstetricians and maternity and neonatal nursing staff and the planned significant investment in the Baird Family Hospital and establishing new community maternity units in Inverurie and Peterhead in line with the Board’s maternity services strategy.

Dr Gray’s Hospital is a key element of the provision of acute services to patients in the Moray and West Grampian area. The services are integral to the regional network with established links to Aberdeen Royal Infirmary and Raigmore Hospital, Inverness. This is the largest single acute sector division and provides critical support services on a Grampian wide basis. Investments made within the clinical support services include:

A significant investment in the endoscopy service to provide access to patients referred with an urgent suspected cancer or returning for a review scope.

A new MRI scanner, increasing capacity for cardiac patients, due to be commissioned in 2016/17 thanks to a significant donation from the Craig Group.

Patient Management System and electronic ordering of laboratory tests. To support our plans for the implementation of an electronic patient record in due course.

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Mental Health Services In terms of our Mental Health and Learning Disability Services the key areas of expenditure are as follows :-

Learning Disability Services £6m

Specialisms £17m

Adult Mental Health £15m

Old Age Psychiatry £9m

Moray Based Services £6m

Other Services £2m

Recent significant investments have included funding support for regional services such as the Medium Secure Unit and Child and Adolescent Mental Health Service inpatient provision. The Eden Unit for eating disorders has also been established as a regional service in Aberdeen.

Primary, Community and Dental Care In terms of Primary, Community and Dental Care services the key areas of expenditure are as follows

Aberdeen City – Intermediate care and Woodend Hospital £18m

Aberdeen City – Community services £49m

Aberdeenshire - Community services £58m

Moray – Community services £21m

Primary Care contactors – GPs, Pharmacy, Optometry £94m

Primary Care prescribing and medicines £94m

Dental services £23m

The aim within Grampian is that the new integrated health and social care system will not only reduce the need for inpatient care in our acute hospitals but facilitate the redesign of services provided within each locality, including community hospitals.

In terms of patient contacts and provision of health and social care, the level of activity that will be delivered by the Integration Joint Boards is significant – for example, in Grampian there are over 2 million general practice consultations each year. The focus of the strategic plans will be on locality planning, building community resilience and supporting people to stay well longer in their own homes.

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Appendix 3: Summary of the 5 year capital plan Overview Our five year plan is summarised as follows :-

16/17 17/18 18/19 19/20 20/21 Total

£m £m £m £m £m £m

Source of funding

Core Government funding 16.9 13.0 10.4 10.3 10.3 60.9

Major project funding (indicative3) 2.0 31.9 100.0 81.8 7.0 222.7

Other sources 16.8 2.0 2.0 2.0 1.9 24.7

Asset disposals 6.6 12.2 3.1 4.3 26.2

Total 42.3 59.1 115.5 98.4 19.2 334.5

Planned expenditure

Primary Care 1.0 22.0 22.8 1.2 0.2 47.2

Major Hospital Developments 2.0 14.0 80.8 81.9 7.0 185.7

Backlog maintenance 19.0 10.6 1.2 30.8

Equipment –new & replacement 6.9 5.3 8.3 7.6 7.6 35.7

Other 13.4 7.2 2.4 7.7 4.4 35.1

Total 42.3 59.1 115.5 98.4 19.2 334.5

In terms of the next five years of our infrastructure investment programme we would highlight the following strategic health priorities: Primary and Community Care investments We have a comprehensive primary care premises strategy which sets out our priorities across the Grampian area, taking account of the functional suitability and capacity of existing premises and emerging new settlements in line with local development plans. We remain committed to our investment in modern new build facilities with the following projects confirmed:

the replacement of the Inverurie health centre including a new local Xray facility and establishment of a community maternity unit.

the replacement of the health centre at the Foresterhill Campus;

relocation of the Denburn Medical Practice; and

further £19m equivalent through the Hub initiative targeted at new premises in North Aberdeen City and surrounding neighbourhoods areas within Aberdeenshire.

We acknowledge the support provided by Scottish Government through the hub initiative to support our programme and we shall be submitting further bids for future infrastructure funding to meet priority developments in line with the primary care premises strategy. The immediate priority will be to support a further bundle of investment to meet priority requirements in Ellon and Banchory (where sites have been identified and populations have grown) and one further site in Aberdeen City.

3 The actual profile of funding for these projects will be confirmed on approval of the final business cases.

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Major hospital development investments The Board welcomed the confirmation of funding for:

the Baird Family Hospital which will replace the existing maternity hospital, breast screening, gynaecology and neo-natal facilities.

the establishment of the ANCHOR Cancer Centre, adjacent to the existing radiotherapy building on the Aberdeen Royal Infirmary site.

new diagnostic and treatment centre to meet future requirements for elective capacity across Grampian

Reduction in backlog maintenance statutory compliance Our planned investment programme in respect of backlog maintenance fits clearly with NHS Grampians strategic theme of delivering high quality care in the right place through providing safer, effective and sustainable services. A commitment by the Board to reducing high and significant backlog maintenance risks within the inpatient accommodation at Aberdeen Royal Infirmary (ARI). The planned work will also enable the reconfiguration of services consistent with the Health Campus Programme Initial Agreement and the Foresterhill Development Framework approved by the NHS Grampian Board in 2008 Replacement of essential equipment A key element of our capital programme is the replacement of essential equipment and critical assets within our clinical and non-clinical services. We are gradually refining our detailed equipment replacement strategy, informed by a comprehensive assessment of risk. The commitment to the backlog maintenance and to various priority strategic developments including primary care facilities and the new Baird Family Hospital and ANCHOR Centre impacts on the funding available to support a rolling replacement equipment programme. This requires a flexible approach to prioritise funding to those areas of highest priority and risk.

Disposal of surplus assets A key element of the delivery of our capital plan is achievement of our programme of disposals of surplus assets. This programme has now been agreed with Scottish Government and delivery of the required actions is monitored closely by the Board’s Asset Management Group. Sustainability

The Board is committed to reduce the level of carbon emissions across our property base and all new developments are now delivered with integral technology designed to reduce energy use and consequently carbon emission levels. In December 2015 we signed the contract for the Carbon Energy Fund (CEF) project. NHS Grampian will benefit from investment in infrastructure estimated at circa £15.6m over the 25 year life of the contract (£10.4m of initial investment with £5.2m lifecycle replacement of lights and chiller units throughout the contract period). An overall reduction in carbon emissions of 16% is anticipated.

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Priorities for further investment Whilst acknowledging the significant funding made available for the Baird Family Hospital, Anchor Centre, Diagnostic and Treatment Centre and primary care developments, the Board is facing an immediate and significant challenge in relation to the following key areas: Medical Equipment At present there are 1,572 assets fully written down with a replacement cost of £44m. Within the context of our 10 year plan, we are developing a detailed equipment replacement strategy informed by a comprehensive assessment of risk. We have committed £3m in 2016/17, £3m in 2017/18 rising to £6m in each of the following three years for essential equipment replacement. Whilst equipment can be used and maintained beyond the depreciated life, a planned replacement medical equipment programme is challenging within the Board’s current level of capital allocation. Community and Primary Care Premises Based on the Local Development Plans for Aberdeen City, Aberdeenshire and Moray the number of new housing units is anticipated to increase by over 40,000 by 2023, with the potential for an increase in patient population of between 80,000 and 100,000. Our GP premises strategy identified a need for investment in additional infrastructure in excess of £100m to meet the demands that these new and emerging communities will place on our primary and community based services. We will continue to advocate for Developer Contributions where appropriate to support proportionate development needs and to seek further national infrastructure funding to support service redesign and transformation within the community. Acute Sector Infrastructure Together with an ageing estate, and a growth in demand for services, the 10 year asset plan as reflected within the Asset Management Plan has identified the need for priority investment in a number of key areas within our acute sector infrastructure – MRI capacity; laboratory and medical equipment accommodation; replacement laundry and CDU facility; and new mortuary accommodation. Furthermore the full replacement of the theatre block and remaining inpatient capacity requires to be addressed within 15 years. We welcome and recognise the support and close working relationships we have with colleagues in the Scottish Government, Scottish Futures Trust (SFT) and Health Facilities Scotland (HFS). In addition agreement to undertake further service change and redesign will be essential to ensure sustainability, whilst allowing NHS Grampian to support the population in Grampian through our principles of “Caring, Listening and Improving”; achieving the NHS Grampian Healthfit Vision and developing Clinical Services Strategy; and that of the National 2020 Vision.