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Firstly NHS Health Scotland, along with all NHS Scotland Health bodies met their financial targets for 2011-12 and they are on track to deliver their financial targets for 2012-13. In addition to successfully achieving their statutory targets, all NHS Scotland boards received unqualified opinions on the true and fair view of their financial statements, the regularity of income and expenditure and the parts of their remuneration reports subject to audit.

The NHS Health Scotland Auditors have also included the following statement in the 2011-12 Audit Report (para 15):

“We have issued an unqualified opinion on the regularity of transactions in the boards financial statements.”

Staff salaries and pay related costs are routinely made towards the end of the month for all NHS Scotland boards. Pay and pay related costs for NHS Health Scotland were in excess of £1.9million during March 2012. This was the main component of the £3.5million referred to in the question. In addition, payments to suppliers were made during March 2012 totalling £1.3million, the value of these was also weighted towards the end of the month.

The resource expenditure pattern of NHS Health Scotland is not even throughout the year. Historically the board has utilised a greater than average proportion of its expenditure in the last quarter of the financial year and particularly during the final month. This pattern of expenditure reflects, in part, the nature of the boards activities and the delivery of a wide range of project initiatives, many of which are developed in year, culminating towards the end of the financial year. Furthermore, to continue to improve performance in relation to meeting Scottish Government prompt payment guidelines, payments also increased, whilst ensuring no payments were made in advance of need.

Notwithstanding the above NHS Health Scotland recognises the need to continually assess and improve its financial performance and a number of improvement actions have been agreed and implemented during the current fiscal year (2012-13). These actions are intended to address budget phasing issues and reduce year end expenditure by delivering earlier in the year.

<>The Scottish Government collects anticipated percentage uplifts applied to GP prescribing and hospital drugs from NHS boards as part of the annual financial planning process. These percentage uplifts are not broken down between price and volume increases. The information requested is thus not held centrally by the Scottish Government. The Audit Scotland report NHS financial performance 2011-12 refers to prescribing volume assumptions collected by the Health and Sport Committee as part of the Committee’s review of NHS boards budget scrutiny (June 2012). A summary of the information provided by NHS boards is available on the Scottish Parliament website at http://www.scottish.parliament.uk/S4_HealthandSportCommittee/Inquiries/Dr_Andrew_Walker_NHS_Board_survey_responses.pdf

Prescribing costs are funded from NHS board baseline budget allocations provided by the Scottish Government. It is for NHS boards to determine how best to utilise baseline funding to meet the healthcare needs of their resident population. The NHS Scotland Efficiency and Productivity Framework for SR10, published in February 2011, sets out a programme of activities to improve quality and efficiency across NHS Scotland. The prescribing workstream supports NHS boards in identifying opportunities to improve the clinical quality of prescribing and to improve cost effectiveness of prescribing. Current activities of the workstream include a review of polypharmacy (the use of multiple medications by a patient) and a review of repeat prescriptions; these reviews aim to reduce the risk of harm to patients and further reduce wastage from medicines being dispensed to patients when they are not required.

There are currently approximately 10,300 claims. The NHS Scotland Central Legal Office and Equal Pay Unit are continuing to monitor the progress of all equal pay claims in NHS Scotland as well as developments relating to NHS equal pay claims elsewhere that may further inform the position.

I refer the member to the answer to question S4W-11157 on 22 November 2012. All answers to written parliamentary questions are available on the Parliament’s website, the search facility for which can be found at:

http://www.scottish.parliament.uk/parliamentarybusiness/28877.aspx.

SCOTTISH PARLIAMENT

WRITTEN ANSWER

22 November 2012

Index Heading: Health and Social Care

Jackie Baillie (Dumbarton) (Scottish Labour): To ask the Scottish Government what mechanisms are in place to review care provided against the recommendations of Scottish Intercollegiate Guidelines Network guideline 123.

(S4W-11021)

Michael Matheson: Implementation of national clinical guidelines is the responsibility of each NHS board and is an essential part of clinical governance. Local mechanisms should therefore be in place to review care provided against guideline recommendations. The reasons for any differences should be assessed and addressed where appropriate. Local arrangements should then be made to implement the guideline in individual hospitals, units and practices.

NHS boards are expected to review services and facilities regularly to ensure they continue to reflect local needs and provide the best quality healthcare services.

The Scottish Society for Rheumatology’s web-based audit programme has also undertaken audit work which will inform the improvement of rheumatoid arthritis services. The final report from this work is expected to be published by April 2013.

Many of the areas highlighted within the Diabetes in Scotland: A Transition to Better Care report are being addressed through the implementation of our Diabetes Action Plan (2010).

We will ask the Scottish Diabetes Group, which is responsible for overseeing implementation of the Diabetes Action Plan, to consider the findings of the report at their next meeting on the 29 November 2012.

We expect that every NHS boards should ensure that appropriate local transitional arrangements are in place which meet the needs of their local population.

Transitional arrangements exist in every NHS board area and every NHS board area, where appropriate, now has joint clinics with representation from both adult and paediatric services.

SIGN Guideline 116 on the management of diabetes, published in 2010, noted the limited evidence on the different adolescent transition models.

The Scottish Diabetes Group has appointed an adolescent and paediatric subgroup, supported by national paediatric coordinator for diabetes services. This group and post will help to support an improved and standardised approach to the care of all children and young adults with diabetes in Scotland.

The paediatric subgroup and coordinator now plan to work with NHS boards to build on and strengthen these transitional services.

The annual Scottish Diabetes Survey produced by the Scottish Diabetes Survey Monitoring Group, provides a comprehensive account of the quality of diabetes care across the whole of Scotland. This year, the Survey includes charts that will enable each NHS board and diabetes managed clinical networks to quickly review and compare their local information. The latest published edition of the survey can be found at the following link:

http://www.diabetesinscotland.org.uk/Publications/SDS%202011.pdf

For the fiscal period 2011-12, nine NHS boards reported an underlying recurring deficit. For the same period, the combined underlying recurring deficit for NHS Scotland was £31.29million. For 2012-13 the number of boards reporting an underlying recurring deficit has reduced to seven; with the current combined forecast for NHS Scotland reduced to £16.68million.

The following table details the recurring surplus/deficit reported by NHS boards to Audit Scotland for 2011-12 (actual position) and projected for 2012-13. This information is contained within the Audit Scotland NHS financial performance 2011-12 report. For 2011-12 boards reported a combined underlying recurring deficit of £31.29million. The projection for 2012-13 previously reported to Audit Scotland is for the combined underlying recurring deficit to reduce to £15.04million.

The latest combined information reported by NHS boards to the Scottish Government Health and Social Care Directorates (SGHSCD) from the financial returns covering the period to 30 September 2012 is a forecast for 2012-13 of a recurring deficit of £16.68million (c0.17%).

NHS Fife has an agreed financial plan to achieve recurring financial balance by the end of 2013-14. In the context of an £11.6 billion health budget this is not considered to be a high risk area particularly when the forecast for 2012-13 is that the recurring deficit will substantially reduce from the previous year.

 

NHS Board

Audit Scotland SGHSCD to 30 September 2012 Actual Underlying Recurring surplus/(deficit) 2011-12 Projected Underlying Recurring surplus/(deficit) 2012-13 Forecast Underlying Recurring surplus/(deficit) 2012-13

	£m	£m	£m
NHS Ayrshire & Arran	0.60	0.00	0.00
NHS Borders	(0.19)	0.00	0.00
NHS Dumfries & Galloway	0.00	0.00	0.00
NHS Fife	(4.02)	(7.37)	(7.37)
NHS Forth Valley	(11.24)	0.00	0.00
NHS Grampian	2.62	(0.07)	0.00
NHS Greater Glasgow & Clyde	0.00	0.00	0.00
NHS Highland	(8.83)	(5.87)	(5.87)
NHS Lanarkshire	0.07	0.25	0.25
NHS Lothian	(7.00)	0.00	(2.41)
NHS Orkney	(1.19)	0.03	0.00
NHS Shetland	(1.56)	(1.38)	(1.03)
NHS Tayside	(2.80)	(3.10)	(3.00)
NHS Western Isles	(0.50)	(0.40)	(0.31)
Territorial Boards	(34.04)	(17.91)	(19.74)
NHS National Services Scotland	0.00	0.00	0.00
Scottish Ambulance Service	0.00	0.00	0.00
NHS Education for Scotland	1.50	2.70	2.77
NHS 24	0.20	0.00	0.00
NHS National Waiting Times Centre Board	0.00	0.00	0.00
The State Hospital	0.25	(0.25)	(0.13)
NHS Health Scotland	0.61	0.42	0.42
Healthcare Improvement Scotland	0.13	0.00	0.00
Mental Welfare Commission	0.06	0.00	0.00
Special Boards	2.75	2.87	3.06
NHS Scotland	(31.29)	(15.04)	(16.68)

NHS boards’ diabetes services are responsible for ensuring young people with diabetes get access to the emotional and psychological support they need.

Our Diabetes Action Plan 2010 fully recognises the importance of improving the capacity and quality of emotional and psychological support available to people with diabetes of all ages. It states:

We want to improve the full spectrum of emotional and psychological support for people living with diabetes in Scotland through enhancing the skills of clinical staff and valuing the contribution of voluntary sector support, including peer support.

We are currently supporting a range of projects including the Psychology in Diabetes, Psychology and Diabetes project, which is running within six NHS boards. The project aims to implant psychological care within diabetes services, including two paediatric services, through training NHS staff to improve their skills in behaviour change and psychological support. This initiative provides the opportunity for

increased psychological support to people with diabetes;

integrated care across medical and psychological issues; and

building a skill base in diabetes within the psychology professions.

We are also working with Diabetes UK Scotland in the delivery of a national buddy coordinator project, which will help people with diabetes to access peer support.