Chamber and committees

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.

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.

SIGN has also made tools, including a quick reference guide, an iPhone and android compatible smartphone application and widely disseminated audit criteria available to support NHS boards with implementation.

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.

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.

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).

The NHS maintenance backlog figure of over £1 billion outlined in the Audit Scotland report covers properties that are to be retained and those designated as surplus for disposal. Around 20% of the current backlog maintenance expenditure requirement is in buildings which are classified as “non-clinical” and will thus have little impact on patient healthcare experience.

My officials are working with NHS boards to reduce the reported backlog maintenance through refurbishment, replacement, rationalisation and disposal of properties.

The scale of risk and associated backlog costs outlined in the Audit Scotland Report, NHS financial performance 2011-12 has been assessed as £194.8 million low risk, £272.3 million medium risk, £289.3 million Significant Risk, £252.5 million high risk.

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 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.

Guidance contained within the NHS Chief Executive Letter (CEL) 32 (2010) dated 19 August 2010: Arrangements for the Management of NHSScotland Capital Resources after 2010-11 sets out the recommendations developed by NHS Scotland via the Capital Strategy Group, agreed to by NHS board chief executives, on the future handling of capital resources across NHS Scotland. With particular regard to capital receipts, CEL 32 (2010) notifies boards that for those capital receipts not already identified as supporting projects with approved outline business cases the capital element of receipts will accrue to SGHSCD and be used to support the overall capital programme. Any element of an asset disposal that scores as revenue income (profit on disposal) will be left with the health board where the capital receipt arose.

Return of capital receipts for 2011-12 and to 30 September 2012 broken down by NHS board is as follows:

Source – 2011-12 Annual Accounts & Board Financial Returns to SGHSCD for the period to 30 September 2012.

The profit on disposal retained by boards for 2011-12 is provided in the following table. The only board to return this funding directly to SGHSCD during 2011-12 was NHS Orkney, a total of £0.151million as part of a agreed brokerage repayment arrangement.

Profit on disposal is not monitored by SGHSCD during the year, this is managed locally by boards as part of managing their overall financial position; therefore information is not available to 30 September 2012. The full year position for 2012-13 will be available from the audited annual accounts.