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It is for NHS boards to determine appropriate staffing levels based on local needs. In doing so, NHS boards are committed to achieving a balance between the use of permanent and bank and agency staff which is appropriate for the provision of short-term absence cover.

NHS boards will continue to require the use of bank and contract agency staff to meet fluctuations in unpredicted absence levels, but are expected to discuss changes to staffing establishments and the use of bank and agency staff through their relevant partnership forums.

Child health screening, surveillance and health promotion will remain a universal service as described in Health for all Children guidance issued by the Scottish Executive in 2005. Contacts outlined in the core programme include neonate, first 10 days of life, six to eight weeks, three months, four months, 13 months and three to five years as well as entry to primary school, primary 7 and at stages within Secondary School. Currently Health Visitors do not supervise or provide the child health screening, surveillance and health promotion programme in its entirety. The programme is provided by a team of appropriately trained practitioners which includes paediatricians, midwives, GPs, health visitors, staff nurses and others with the necessary skills required for each contact. The programme will continue to be provided by an appropriately trained team. A link to the guidance which contains details of the core programme can be found at:

www.scotland.gov.uk/Publications/2005/04/15161325/13269.

The personal child health record (PCHR) is completed by the health professional at the point of contact/consultation.

Health professionals based in general practice will also record this information in the child''s GP record. Health professionals based outwith the practice will send this information to the GP for inclusion in the GP record. Guidelines are in place for professionals on the completion of the PCHR.

Only schemes that comply with the definition of an efficiency saving would be accepted. The definition of a cash‘releasing efficiency saving is where the organisation delivers the same service at a reduced cost, demonstrated by delivering the same outcome(s) or output(s) for a reduced input or delivering a reduced unit cost allowing an increased volume of service for the same cost.

Potential efficiencies are considered on a case-by-case basis.

All NHSScotland boards have been issued with guidance, namely Version 3.1 of the Scottish Government Efficient Government Programme 2008-09 “ 2010-11 - Efficiency Process & Guidance. This document sets out the principles underpinning the Scottish Government Efficient Government programme. It is not intended to be exhaustive but to help with commonly occurring points of principle. Potential efficiencies are considered on a case-by-case basis.

A copy of the guidance is available on the Scottish Government website:

http://www.scotland.gov.uk/Resource/Doc/82980/0058843.pdf.

Efficiency gains may be either recurring or non-recurring. Non-recurring efficiencies can deliver a variety of valid one-off efficiencies. The Scottish Government Efficient Government Programme 2008-09‘2010-11, Efficiency Process & Guidance cites the sale of a surplus asset, e.g. a building or land plot, as an example of a valid non‘recurring efficiency, therefore NHS boards are permitted to include these savings.

Non-recurring efficiency gains only count towards the efficiency target in the year in which they are made, they are not counted cumulatively.

Potential efficiencies are considered on a case-by-case basis.

Accountancy adjustments would not in themselves be permissible in demonstrating achievement of efficiency savings. However, accountancy adjustments that relate to real changes in the way in which services are delivered may be included in demonstrating their overall contribution to efficiency savings.

The definition of a cash‘releasing efficiency saving is where the organisation delivers the same service at a reduced cost, demonstrated by delivering the same outcome(s) or output(s) for a reduced input or delivering a reduced unit cost allowing an increased volume of service for the same cost.

For example, if a service is redesigned and delivered in a more efficient way, in part by rationalising property requirements, this will have an impact on capital charges. Capital charges are a combination of two components, depreciation and a return on the cost of capital, which represent expenditure charged against boards'' resources in the same way as other operating costs. If a health board can deliver its services more efficiently by using a reduced asset base, this would reduce the impact on revenue costs in terms of capital charges and these savings may count as a recurring efficiency.

Potential efficiencies are considered on a case-by-case basis.

The Scottish Government has no plans to devolve the functions of NHS 24 to territorial NHS boards. On that basis, such costing information is not held.

However, the Scottish Government is committed to the development of local NHS 24 services across Scotland in support of its national infrastructure. In addition to the three regional centres (Clydebank in the West, South Queensferry in the East, and Aberdeen in the North), five local centres in Inverness, Dundee, East Kilbride, Kilmarnock and Dumfries were established in late 2005. The aim was to build NHS 24 capacity, aid the recruitment of specialist nurses and improve the performance of the NHS 24 service. These centres supported the development of closer strategic relationships with the host territorial health boards. They also delivered increased positive partner feedback as well as patient satisfaction from local board areas through improved service delivery. They have afforded the opportunity for flexible working and improved work life balance for the nursing workforce within those localities.

All these sites have resilient telephony and IT links and operate as part of an integrated national network. The telephony design is aimed at ensuring patient calls are answered at their closest regional centre and if a consultation with a clinician is required the call is routed to their designated local centre. However in the case of serious and urgent calls if a local nurse is unavailable within a pre-determined timescale, the call will automatically look for the first available nurse to ensure patient safety is maintained at all times.

The Better Health, Better Care action plan tasked NHS 24 to work towards establishing local services within all mainland health board areas. The following table provides details of the current progress against this action.

Health Board Area	Details of Local Service
NHS Highland	Local Centre launched in 2005, based in Inverness
NHS Grampian	Service delivered from Regional Centre, based in Aberdeen
NHS Tayside	Local Centre launched in 2005, based in Dundee
NHS Lanarkshire	Local Centre launched in 2005, based in East Kilbride
NHS Ayrshire and Arran	Local Centre launched in 2005, based in Kilmarnock
NHS Dumfries and Galloway	Local Centre launched in 2005, based in Dumfries
NHS Fife	Emergency Dental Service launched in 2007, based in Glenrothes
NHS Lothian	Dedicated nursing resource located in South Queensferry Regional Centre since May 2006
NHS Greater Glasgow and Clyde	Local centre opened in June 2008, located at Caledonia House, Cardonald
NHS Borders	Local service within Melrose General Hospital, to open by end 2008
NHS Forth Valley	Currently in discussion for the establishment of a local centre provisionally planned for Falkirk, with opportunities for further development in other community hospitals or health settings.

 

We do not hold information about every NHS board''s funding decisions following completion of a centrally funded programme during this time. However we do know that eleven out of 15 NHS boards were given time limited funding for clinical leadership and project management to test new models of service to deliver and sustain the waiting time target that by December 2005 no patient should wait longer than 26 weeks for a first out-patient appointment. This target was delivered and has been further reduced to 18 weeks from December 2007. It is for NHS boards to evaluate the success of their pilots and to mainstream the findings if they think appropriate. As at the closure of the Skin Action Scotland national programme (Dermatology) in March 2006, seven of the 11 had secured funding for 2006-07 of which five reported that this funding was recurring. £270 million, £90 million per year, has been made available nationally to improve waiting times during the period 2008-09 to 2010-11.

We are not aware of any reduction in undergraduate medical teaching in dermatology, and this view is borne out by NHS Education for Scotland and the British Association of Dermatologists.

The introduction of Modernising Medical Careers (MMC) has provided the opportunity to develop a new and better approach to GP training. All doctors entering GP Specialist Training from 2007 have already completed a two year medical foundation training programme, and the UK Royal College of General Practitioners (RCGP) approved curriculum for GP Specialist Training, which doctors in training are assessed against, has a full section covering relevant issues for dermatology.