Chamber and committees

The team from the Institute for Healthcare Optimization provided advice and insight to the following boards: NHS Ayrshire and Arran, NHS Fife, NHS Grampian, NHS Lanarkshire and NHS Lothian. They also presented at a national conference attended by staff from across Scotland. The main objective of the visit was the transfer of skills from IHO to NHS Scotland: IHO spoke with over 300 members of staff during the visit, bringing 4 experts to Scotland is more cost effective than sending the staff involved in this work to the USA. Most of the programme is delivered virtually but a visit also enables IHO to visit clinical units to understand our systems and issues at first hand.

Full costs and their breakdown will not be available until all invoices are received and processed. However, at this point, using economy flights as per our expenses policy, accommodation and internal travel booked through the Scottish Government’s travel provider and subsistence, our estimate is £11,200 for the team of 4 people for the visit, arriving pm Sunday, departing am Saturday.

It is estimated that this initiative has saved around £2.8 million per annum in the four pilot boards, and has potentially avoided substantial capital spend. These include creating capacity for an additional 1,072 patient admissions, alongside opportunities to increase elective admissions further by about 2,100 per year without adding resources.

The Scottish Government recognises that the retail sector in Scotland is transforming in response to, among other things, changes to shopping habits and through new technology. The proportion of retail businesses in the UK (with 10 or more employees) making e-commerce sales has increased from 25.8% in 2009 to 35.8% in 2016. This shift to on-line shopping, coupled with UK Government austerity measures, which have indirectly and directly reduced the spending power of many consumers, has had an impact on the sector.

We regularly engage with the Scottish Retail Consortium and other key stakeholders in the retail sector to discuss policy priorities and to better understand the challenges and opportunities that transformational change in the sector will present. We will continue to use all levers at our disposal to ensure Scotland remains an attractive place for retailers to do business, and with that aim, we are working with the Scottish Retail Consortium to develop a retail strategy which will set out a clear road-map for future tax and regulatory changes.

The draft budget document sets out that proposed income tax changes are likely to have a relatively small impact on the economy and consumer spending. Overall the draft budget provides significant investment in the Scottish economy by allocating additional spending in the Economy, Jobs and Fair Work portfolio; establishing a Building Scotland Fund; guaranteeing an initial capitalisation for the Scottish National Investment Bank; delivering superfast broadband for every business and household in Scotland by 2021; and increasing the spend of our enterprise and skills bodies.

Under the new GP contract practice opening hours in Scotland will remain as 8am - 6:30pm. The Extended Hours Directed Enhanced Service will be maintained. It will be clearer to patients when their local GP practice offers care in Extended Hours and when appointments with GPs and other practice staff are available within the Extended Hours period. Services provided by healthcare assistants may also be available during Extended Hours periods.

Out with normal GP surgery opening times, patients are able to access services using the out of hours service, via NHS24.

The Scottish Government has a strategic partnership with the Institute for Healthcare Improvement (IHI) based in the USA and, periodically, representatives from IHI visit Scotland. This framework contract covers all public services in Scotland, not restricted to the NHS, and relates to quality improvement work.

While some of the IHI work could be considered non-clinical consultancy work, some costs cannot be easily disaggregated to give an accurate picture of those related solely to the NHS. Where it is possible to disaggregate, the amount spent on non-UK resident personnel visiting Scotland under the IHI contract to help with purely NHS work over each of the last three years is £0 in 2015, £18,867.21 in 2016 and an estimated £63,825.83 in 2017 (the invoice for the final quarter of 2017 is yet to be received). This includes staff time and other costs.

Secondly, the Scottish Government funds a Framework Agreement with the Institute for Healthcare Optimization (IHO), based in the USA. The main objective of the programme is to improve the quality of clinical care by supporting Scottish clinical teams and, through that, the transfer of skills from IHO to NHS Scotland; extending knowledge and skills in NHS Scotland and tapering-off dependence on IHO’s skills and experience.

The majority of the work is delivered virtually, with extensive use of web-enabled communications. The programme has scheduled seven visits over the three year period stipulated, in order to provide additional educational input and to visit clinical units to understand systems and issues at first hand.

It is estimated that this initiative has saved around £2.8 million per annum in the four pilot boards, and has potentially avoided substantial capital spend. These include creating capacity for an additional 1,072 patient admissions, alongside opportunities to increase elective admissions further by about 2,100 per year without adding resources.

This has also increased compliance with the maximum clinically acceptable wait for unscheduled surgery, from around 85 per cent to over 95 per cent, with more patients moving timeously from receiving units to inpatient wards and fewer patients being asked to come to hospital the day before planned surgery.

The Scottish Government is keen to extend the clinical benefits of this work across NHS Scotland.

The costs relating to visits associated with the initiative are as follows: 2015, £27,492; 2016, £38,471; and 2017, £26,224 (2017 estimated, as invoices are yet to be received).

Thirdly, in 2017 an External Expert Panel was established in order to play a key role in advising the Scottish Government and the Strategic Oversight Group for the development of the Scottish Digital Health and Care Strategy on how digital technology can support Scotland’s aim for high quality health and social care services. The purpose of the Panel was to help ensure that a broad knowledge and evidence base was taken into account in the development of the Strategy.

In June 2017, the Panel’s chair visited the Scottish Government to plan work in more detail. Meetings were held with Ministers, and visits were made to a General Practice in Edinburgh and to the Royal Hospital for Sick Children in Edinburgh. This was in order to see at first hand the use of different types of technology and discuss the priorities of staff.

The Panel met seven times by video conference between April and December 2017. However, all Panel members were invited to (although not all were able to attend) a two day face-to-face meeting in Edinburgh, in September 2017, to discuss the Panel’s interim report with the Cabinet Secretary for Health and Sport, senior leads from the Scottish Government and wider stakeholders.

The Panel made its draft final recommendations to the Scottish Government in December 2017.

The costs, to date, for the visits associated with the Panel amount to £6,770.02. However, expenses claims for two panel members attending the September meeting are yet to be received and processed.

Finally, information on any visits arranged and funded directly by Health Boards is not held centrally by the Scottish Government.

Scottish Government officials have been working closely with HMRC and stakeholders to ensure that the implementation of the proposed income tax bands and rates will be effective. This work includes arrangements to ensure that neither Scottish taxpayers or pensions providers are unduly disadvantaged in respect of pensions relief.

The Scottish Government and NHS Boards have been implementing a number of technological approaches to support people with accessing health services and information appropriate to their needs. During the last few years, on-line appointment booking and repeat prescriptions have been rolled out in GP surgeries across Scotland as part of the Primary Care Digital Services Programme. In December 2016, Attend Anywhere was launched to enable patient-to-clinician video consultations, providing easier access to outpatient appointments and other clinical services. NHS inform, which is part of NHS 24, provides the public with reliable, quality assured health and care information online. The website was recently refreshed with new functions including self-help guides; a services directory to help people find services in their local area (including dental services, A&E units and minor injuries units, opticians and pharmacies); an 'Info for Me' tool for gathering information so that it can be saved, printed or shared with others; and a web-chat feature that connects people with the NHS Inform health information team in real-time. The website also displays trending and seasonal topics in response to commonly asked questions and supports national health and care campaigns throughout the year. Meanwhile, the national development of an online Health and Social Care Citizen Portal, which aims to provide every individual in Scotland with a single access point to online, personalised health services and information by 2020, is also continuing.

The Scottish Government is committed to ensuring people have the appropriate information, advice and treatment available to them to help them deal with instances of ill health.

NHS 24's health information service 'NHS inform' is Scotland's national health information service. It provides accurate and relevant information to enable people make informed decisions about their own health and the health of the people they care for. The website includes the national services directory which helps people find local services quickly and easily. The site also includes a number of self-help guides to support people in dealing with the symptoms of the most common conditions.

In addition, Know Who To Turn To is a national website that offers advice on access to the most appropriate healthcare professional and links directly to the NHS Inform national services directory. To support those familiar with mobile media the Scottish Government has developed The NHS Self-Help Guide mobile app for iPhone and Android which will offer information and advice on some of the most common symptoms and direct the user to the most appropriate place to access care.

NHS 24 and its partners run frequent marketing campaigns throughout the year, through social media and other channels to ensure that patients are aware of the different support available to them, particularly during the busy winter months through the Be Health Wise campaign, advising patients to stock up medicine cabinets and ensure they have enough repeat prescriptions.

The Scottish Government, in cooperation with NHS24, has been developing digital tools for effective triage to ensure that patients are supported in self-management or directed to the right service that can effectively deal with their care needs. The NHS Inform website, which is accessible from many different types of digital devices and compatible with a range of assistive technologies, already provides an interactive National Services Directory tool with information about local urgent care services across Scotland.

The Scottish Government's draft budget 2018-19 increases the health resource budget by more than £400 million, taking it to a record high of over £13.1 billion and providing an additional investment in our frontline NHS Boards of 3.7%. The budget includes a continued focus on early intervention and prevention including an additional £20 million in alcohol and drugs treatment and support services. This is in addition to our consultation on a new diet and obesity strategy and the measures we are progressing to limit marketing on products high in fat, sugar and salt, which disproportionately contribute to ill health and obesity.

HMRC have estimated annual running costs of between £1.5 and £2m if income tax rates and bands remained the same as the rest of the UK. A more significant divergence between the rates and bands that apply in Scotland when compared to the rest of the UK may lead to an increase in costs of up to a total of £5m.

HMRC estimate total implementation costs of between £20m and £25m for the Scottish Rate of Income Tax, with a further £2.6m for the Scotland Act 2016 income tax powers. These costs are required to implement the income tax powers devolved to the Scottish Parliament in Scotland Acts 2012 and 2016, and are independent of the rates and bands the Scottish Parliament sets.