Chamber and committees

Administration

The boards’ spending onadministration costs are taken from note 6 of the published annual accounts foreach respective financial year.

The definition ofadministration expenditure has changed over the period due to changes inaccounting guidance and also in the configuration of the health service,particularly the dissolution of NHS trusts. Consequently the figures shown maynot be entirely comparable over these years.

Expenditure will include thecosts associated with the board's responsibilities for the planning andcommissioning of health care for its resident population (such as statutory reporting, strategic planning,commissioning of health care and financial projections), but not those costs associated with the provision ofhealth care and other non clinical services provided by the board.

Management

The boards’ spending onmanagement costs are taken from the Scottish Financial Return (SFR) 5.2, whichis completed by each hospital and submitted to the NHS National ServicesScotland Information and Statistics Division for publication in the Costs Book.

This expenditure reports thehospital management and administrative costs which includes the followingsupport services:

Medical: HospitalMedical/Paramedical Administrative Support;

Nursing: Senior Nursing andHospital Administrative Support;

Medical Records;

General: Hospitaladministration, including senior management, and

Agency: Administrativeagency staff and agency services.

Budgets

Prior to the introduction ofResource Accounting and Budgeting (RAB) to the Scottish Executive in 2001-02 healthboards were given a cash allocation. Their budgets for those years havetherefore been taken as their revenue cash allocation. From 2001-02 onwards thetotal budget for each board is taken as their Revenue Resource Limit (RRL)which is reported in their annual accounts.

Population

The figures for thepopulation of each board area are published by the General Register Office for Scotland.

Administration ExpenditureAnalysis

(a) The amount spent by NHS boardsfrom 1995-96 to 1997-98 on administration, expressed both as (i) a percentageof total budget; and (ii) per head of population is given in table 1 of NHS Administration and ManagementCosts 1995 – 2004 which has been placed in the Scottish ParliamentInformation Centre (Bib. number 39532).

Details of the amount spentby individual boards on administration is not available for these three years.However these details are shown in table 1 for the years from 1998-99 to 2004-05by individual health boards.

Management ExpenditureAnalysis

(b) The amount spent by eachNHS board from 1995-96 to 2004-05 on management, expressed both as (i) apercentage of total budget; and (ii) per head of population is given in table 2 of NHS Administration andManagement Costs 1995 – 2004 which has been placed in the Scottish Parliament Information Centre (Bib. number number 39532).

(a) Diagnosis to First treatment:

Breast Cancer

Information is collated centrallyto report performance against the Scottish Executive target that by October 2001,women who have breast cancer and are referred for urgent treatment will begin thattreatment within one month of diagnosis, where clinically appropriate.

Given that the mean is affecteddisproportionately by a small number of waits that may be clinically appropriate,it is more useful to use the median to analyse trends in waiting times from quarterto quarter. As NHS Scotland makes progress towards meeting the Executive’s waitingtime targets and treats more patients who have had longer waits, median waitingtimes will rise.

Table 1: Number of Eligible Breast Cancer Patients DiagnosedEach Year, with the Median Wait Between Diagnosis and First Treatment, byPeriod of Diagnosis.

Notes:

*Exclusion categories are: died prior to receiving treatment,refused treatment, patient induced non-clinical delay and co-morbidities.

n/a: Not applicable due to smallnumbers.

1. 2002 based on patients diagnosedbetween 1 April and 31 December 2002.

2. 2005 based on patients diagnosedbetween 1 January and 30 September 2005.

3. Orkney started reporting ontheir own patients from January 2005, previously included with Grampian.

4. Shetland started reportingon their own patients from July 2005, previously included with Grampian.

5. Western Isles started reportingon their own patients from October 2004, previously included with Highland.

(ii) Other cancers¹

New systems were put in placefrom Q4 2004 to monitor compliance against the national cancer waiting times targetthat by the end of December 2005 the maximum wait from urgent referral to treatmentfor all cancers will be two months.

Table 2: Number of Eligible Other Patients with Cancer¹ DiagnosedEach Year, with the Median Wait Between Diagnosis and First Treatment, byPeriod of Diagnosis.

Notes

*Exclusion categories are: diedprior to receiving treatment and refused treatment. Patients with a patient inducednon-clinical delay or co-morbidity were excluded from July 2005.

1. 2004 includes colorectal,lung and ovarian cancers; January to March 2005 also includes melanoma; April toMay 2005 also includes lymphoma while July to September 2005 also includes paediatric,urology, head and neck and upper GI cancers.

2. 2004 based on patients diagnosedbetween 1 October and 31 December 2004.

3. 2005 based on patients diagnosedbetween 1 January and 30 September 2005.

4. Orkney started reporting ontheir own patients from January 2005, previously included with Grampian.

5. Shetland started reportingon their own patients from July 2005, previously included with Grampian.

6. Western Isles started reportingon their own patients from October 2004, previously included with Highland.

(b) GP Urgent Referral to First Treatment

Inthe period July to September 2004, new systems were piloted in breast cancer tomonitor compliance against the national cancer waiting time target. Data on breastcancer for July to September 2004 are less robust than for later period. Informationfor earlier periods is not available.

Datafor the most recent period, July to September 2005, include breast, colorectal,lung, ovarian, melanoma, lymphoma, urology, head and neck, upper GI and paediatriccancers.

Table 3: Number of Eligible Patients with Cancer¹Diagnosed Each Year, with the Median Wait Between Urgent GP Referral and FirstTreatment, by NHS Board and Period of Diagnosis.

Notes:

*Exclusion categories are: died prior to receiving treatment,refused treatment, patient induced non-clinical delay and co-morbidities.

n/a: Not applicable due to smallnumbers.

1. July to September 2004 includesbreast cancer; October to December 2004 also includes colorectal, lung and ovariancancers; January to March 2005 also includes melanoma; April to May 2005 also includeslymphoma while July to September 2005 also includes paediatric, urology, head andneck and upper GI cancers.

2. 2004 based on patients diagnosedbetween 1 July and 31 December 2004.

3. 2005 based on patients diagnosedbetween 1 January and 30 September 2005.

4. Orkney started reporting ontheir own patients from January 2005, previously included with Grampian.

5. Shetland started reportingon their own patients from July 2005, previously included with Grampian.

6. Western Isles started reportingon their own patients from October 2004, previously included with Highland.

The Executive has been steadilyreducing the maximum waiting time for those patients who wait longer. The nationalmaximum waiting time was reduced from  12 months to nine months on 31 December 2003 andto six months on  31 December 2005. This will be further reduced to 18 weeks from the endof 2007.  On 31 December 2005, no patient with a guarantee had waited more thansix months for a heart operation or for hip replacement surgery.

NHSScotland is making good progresstowards meeting the next key target of a maximum wait of 18 weeks by the end of2007. At that point, a new approach to defining and measuring waiting will alsobe introduced to replace availability status codes (ASCs), which have the effectat present of excluding patients from waiting times guarantees where for example,they are medically unfit for treatment, where they have asked for their treatmentto be postponed, or where their treatment is highly specialised or of low clinicalpriority. The new approach will be fairer, more consistent and more transparent.

Retrospective analyses of waiting times forhospital treatment compiled from SMR01 returns are based on data that does not recordwhether patients have had an ASC applied. Information requested on heart operationsand hip replacements has beenplaced in the Scottish Parliament Information Centre (Bib. number 39493): it includesthe waiting times of patients who have been exempted from the guarantee for thereasons given above and therefore overstates true waiting times. It is not possibleto estimate the extent of the overstatement. The SMR3 waiting times census data,which excludes patients with ASCs, is used for target compliance purposes, and thetables provided also include SMR3 data for hip replacements for NHSScotland fromthe censuses undertaken on 31 December in each year since 1999 and for angiography,angioplasty and coronary artery bypass graft surgery for NHSScotland from the censusesundertaken on 31 December in each year since 2002.

Waiting times for cancer treatmentsequivalent to the waiting times for the other specified procedures are not availablefrom routinely collected hospital data, as complete information is not capturedon all treatment types, such as hormonal therapy and chemotherapy, and not all cancertreatments require a hospital admission.

Information on cancer waitingtimes is currently gathered through cancer audit systems in order to measure thetarget that “by December 2005 the maximum wait from urgent referral to treatmentfor all cancers will be two months” from Cancerin Scotland: Action for Change, published in 2001. Information showingperformance against the target by NHS Board of diagnosis is currently availablefor breast, colorectal, lung, ovarian, melanoma, lymphoma, urological, Upper GIand head and neck cancers and is available from the following Scottish Executive website:

The standards defined in theOrder are related to the physical aspects of the accommodation, its proximityto essential health and education services, and its suitability for children.

More generally, chapter 9 of the Code of Guidance on Homelessness contains further guidance for localauthorities on the provision of temporary accommodation for homeless people.

The2003 report can be accessed at:

Table 1 (Bib. number 39488)shows the combined figures for acute and psychiatric hospital discharges withan explicit diagnosis of alcohol related condition for the period 1990-91 to2001-02. This has been reported as discharge information because the detail isdrawn from two datasets and one of these datasets records discharge data only. Completedata on psychiatric discharges are unavailable for 2002-03 to 2004-05.

Table 2 (Bib. number 39489)provides information on discharges from acute hospitals for the period 1990-91to 2004-05. For acute hospitals, only discharge data exists.

AllNHS regional planning groups are working together to develop appropriatenetworks and care models for this important care group.