Seòmar agus comataidhean

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.

Based upon information provided by NHS Scotland boards, there is confidence that boards will once again deliver planned efficiency savings for 2012-13. NHS boards have agreed financial plans to deliver efficiency savings of £271.701million in the current year. At month 6 to 30 September 2012 (the mid year point), Boards remain on target to deliver the required level of savings.

Currently over 82% of savings are classed as either medium or low risk in terms of them being delivered. Efficiency savings do not reduce the overall budget of the NHS. All savings are retained locally by territorial Boards to allow them to reinvest in front-line services which directly benefit patients.

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.

In addition to the answer provided in S4W-11046 relating to brokerage, the Scottish Government Health and Social Care Directorates (SGHSCD) have the following arrangements in place:

Financial Support

NHS 24 is in the process of implementing a new information and telephony system required to further enhance its frontline services. The Scottish Government has agreed to provide transitional support to NHS 24 over the period 2011-12 to 2013-14 to enable upfront payment of implementation costs due under the contracts. This transitional support ensures that NHS 24 and NHS Scotland avoids financing charges which would be payable if these implementation costs were phased over the life of the contract and accelerates the realisation of contractual and service redesign savings arising from the new arrangements in a more cost effective way.

A repayment profile for this transitional support has been agreed with NHS 24 to reflect the realisation of savings arising from the new contracts. This profile is incorporated into the boards’ approved financial plan.

Reprofiling of NRAC Funding:NHS Lothian has estimated the total cost of delivering additional waiting times activity during 2012-13 at £20million. The funding source has been secured with £10million being provided internally by NHS Lothian and the remaining £10million being provided by the Scottish Government Health and Social Care Directorates with this requiring to be repaid and off-set against future NRAC (NHS Scotland Resource Allocation Committee) allocations over the next two financial years (2013-14 and 2014-15).

I refer the member to the answer to question S4W–11040 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.

Our Diabetes Action Plan, published in 2010, highlights the importance of transitional care in supporting young people with diabetes to effectively manage their condition, and we expect every board to ensure that children are appropriately managed in the transition from paediatric to adult diabetes services.

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 coordinator visited each NHS board area in 2012 and has confirmed, with services, that transitional arrangement exist in every board area. In addition every NHS board area, where appropriate, now has joint clinics with representation from both adult and paediatric services.

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

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.

There are four NHS boards that have a brokerage arrangement and associated repayment schedule in place. These are summarised as follows:

NHS Western Isles received brokerage in 2008-09 to enable the cumulative deficit built up over a four year period between 2003-04 and 2006-07 (inclusive) to be cleared following section 22 reports from the Auditor General for Scotland and the work of the Parliament’s Public Audit Committee. The Scottish Governments Health & Social Care Directorates (SGHSCD) provided brokerage after agreeing a financial recovery plan with the board. Following an intended payment holiday of three years, NHS Western Isles commenced repayment a year early in 2011-12 with an accelerated payment of £0.631million. This positive action has reduced the boards’ liability in future years.

The provision of financial support is offered as an enabler to deliver financial balance and allows NHS Orkney to move forward with plans for the future, including a strengthened health and social care model and redesigned acute services.

NHS Forth Valley has a specific set of circumstances which have led to the provision of brokerage to support achievement of a balanced financial position. SGHSCD engaged with the board to deliver a package of tailored support during 2011-12. SGHSCD received robust assurances in the form of an agreed financial recovery plan from the board that the provision of funding in advance would deliver in-year financial balance in 2011-12 and recurring balance from 2012-13 onwards. In 2011-12 the board was required to implement significant operational and strategic change, including completion and transfer of services to the new Forth Valley Royal Hospital at Larbert and continuation of multi-site working. The brokerage repayment arrangement has been agreed based upon future capital receipts.

NHS Fife has a specific set of circumstances including transitional costs associated with the transfer of services to the new Victoria Hospital which opened in October 2011. Following a period of tailored support, NHS Fife delivered a balanced financial position in 2011-12 and has an agreed financial plan to achieve recurring financial balance by the end of 2013-14. In terms of financial support arrangements in place not defined as brokerage, I refer the member to the answer to question S4W-11045 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.

Despite the significant budget reductions for Scotland arising from the 2010 UK Comprehensive Spending Review, the Scottish Government has fully delivered on its promise to pass on all of the resource Barnett consequentials to Health over the period 2011-12 to 2014-15; this positive action has protected the health resource budget in real terms.

The health resource budget is increasing significantly in cash terms by over half a billion pounds, or 5.2%, over the next two year period which means that spend on day to day health services has been protected in real terms.

Territorial health boards who provide frontline point of care services will receive above inflation increases in 2013-14 and 2014-15 of 3.3% and 3.1% which represents real terms increases of 0.8% and 0.6% respectively.

In addition, the short to medium term outlook will see capital resources under severe pressure given the significant real terms reduction in capital resources available to the Scottish Government over the 2010 Comprehensive Spending Review period from 2011-12 to 2014-15. In response to this situation however, the Scottish Government has put in place arrangements to support a programme of £2.5 billion of revenue financed investment across Scotland to boost infrastructure investment. Of this total investment, £750 million is being directed towards projects within health as non profit distributing projects or via the hub initiative.

The paediatric diabetes team in NHS Greater Glasgow and Clyde (NHSGGC) provide an integrated service supported by a group of consultant paediatricians from both the Royal Alexandra Hospital (RAH) in Paisley and the Royal Hospital for Sick Children (RHSC), Yorkhill. The team is also supported by a cohort of specialist nurses, dieticians and clinical psychology. At both the RHSC and RAH there are strong links with complementary specialist services, including endocrinology.

Education is a key feature of the service with strong links in place to schools, nurseries and community child health services. Education sessions are also provided at the RHSC for patients and families.

The paediatric diabetes team has good links with the adult services and is currently developing transition plans for the move to the new South Glasgow Children’s Hospital. The new Children’s Hospital will be delivered to the same clinical high standard of the RHSC.