Chamber and committees

Service Level Agreements (SLA) with other public bodies are a commonly used and effective way to procure specialist advisory services for a defined period. Underpinned in Scottish Procurement law by the Public Contracts (Scotland) Regulations 2015 Regulation 13, the SLA approach is used to deliver a specific service through an individuals’ existing specialist skills and experience and so are commonly used across Health and Social Care Directorates (HSCD) to bring in the specialist, clinical knowledge and experience to enhance our vital services.

An SLA is not, therefore, an employment arrangement as the individuals’ employment contract arrangements remain with their employer. In the case of those individuals brought into HSCD, the service level agreement is between the Scottish Government and the relevant NHS Scotland Board.

The Scottish Government holds only relevant information on Service Level Agreements, such as the names of the relevant individuals and organisations to which they belong, providing start and end dates for each Agreement. Whilst we cannot provide a complete picture of all Agreements that have been ended in the past 5 years, our records have indicated however, that from April 2022 to October 2023, 71 Service Level Agreements ended with each of the specialist advisors returning to their respective NHS Scotland health board.

As at October 2023, the Scottish Government’s Health and Social Care Directorates (HSCD) have 8 specialist advisors procured under a Service Level Agreement from NHS Ayrshire and Arran.

As at October 2023, our records show that across the whole of the Scottish Government there are currently 155 individuals procured to provide specialist services under a Service Level Agreement.

The Agreements that are put in place stipulate the length of the service period, and so will often set that Agreement in place for a period of two years, or more. Some Agreements have been established with short service periods, such as 6 months, but the norm is for two to three years. Agreements are reviewed annually to consider the service being provided and whether there is a business need for that service continuation.

The percentage of individuals procured by the Scottish Government to provide specialist services under Service Level Agreements compared to the total headcount (as at 30 June 2023) is 1.44%.

Funding for mental health services is drawn from the overall funds allocated to NHS Scotland by the Scottish Government. The latest available data from the Public Health Scotland Scottish Health Service Costs shows that for
‎ 2021-22 total expenditure by NHS Scotland on mental health was £1.299 billion.

https://publichealthscotland.scot/publications/scottish-health-service-costs/scottish-health-service-costs-high-level-costs-summary-2021-to-2022/

Over the last three years (2021-24), £51 million has been provided through the Communities Mental Health and Wellbeing Fund for adults. The following amounts have been provided in each year:

• 2021-22 (Year 1) – £21 million.
• 2022-23 (Year 2) – £15 million.
• 2023-24 (Year 3) – £15 million.

This is in addition to the £45 million allocated to local authorities since 2021 to provide community-based mental health and wellbeing support for children, young people and their families.

Future funding will be subject to the annual budget process and approval by the Scottish Parliament.

Funding for mental health services is drawn from the overall funds allocated to NHS Scotland by the Scottish Government. The latest available data from the Public Health Scotland Scottish Health Service Costs shows that for 2021-22 total expenditure by NHS Scotland on mental health was £1.299 billion. The figures for 2022-2023 are yet to be published.

As part of the block funding provided to NHS Boards by the Scottish Government, NHS Boards make operational decisions on how to deploy spend, in a way which best meets local needs. The detail of this is not held by the Scottish Government.

Prevention and early intervention remain a priority for the Scottish Government.

We have placed a stronger focus on preventing mental health issues and tackling the underlying causes and inequalities through our recently published Mental Health and Wellbeing Strategy. The provision of advice and support will continue to be an important part of our approach.

We continue to undertake a range of preventative and early intervention mental health work, key examples include:

• We have invested a total of £51m since 2021 in our Community Mental Health and Wellbeing Fund for Adults, with approximately 3,300 grants made to local projects across Scotland in the first two years alone.
• We have allocated a total of £45m since 2021-22 for local authorities to provide over 300 community mental health and wellbeing supports and services for children, young people and their families.
• We published an ambitious Suicide Prevention Strategy and Action Plan with COSLA in 2022, with the vision of reducing suicide deaths and tackling the inequalities which contribute to suicide. The strategy is supported by record funding to double the annual suicide prevention budget to £2.8m by 2026 and we are well on track to achieving this target.
• Since 2016, we have invested over £21m in our world-leading Distress Brief Intervention (DBI) programme, which offers timely, compassionate support to people in distress who come into contact with frontline services. Over 50,000 people have already been referred for DBI support. We are on track to have DBI available in all NHS Board areas by March 2024.

The conditions of eligibility and access to free bus travel for people aged under 22 are set out in the National Bus Travel Concession Scheme for Young Persons (Scotland) Order 2021. There are no powers to enable local authorities to revoke a person's free bus travel card.

The Scottish Government is working closely with NHS Ayrshire and Arran to increase capacity and reduce cancellations. A number of improvement actions to enable the prioritisation of resources to areas where the capacity gap has the greatest impact are already underway, including:

• A bottom-up review of operating capacity within surgical teams;
• Increase resilience of the planned care service through protection of planned care beds to ensure that operations are not cancelled as a result of bed capacity; and
• Introduction of new enhanced roles across the wider multi-disciplinary teams to increase capacity and improve sustainability, such as surgical care practitioners, anaesthesia associates and theatre assistant practitioners.

These actions will help NHS Ayrshire and Arran deliver its plans to increase capacity which include targeted recruitment, extended workforce roles and new models of service delivery.