Chamber and committees

<>The Scottish Government collects anticipated percentage uplifts applied to GP prescribing and hospital drugs from NHS boards as part of the annual financial planning process. These percentage uplifts are not broken down between price and volume increases. The information requested is thus not held centrally by the Scottish Government. The Audit Scotland report NHS financial performance 2011-12 refers to prescribing volume assumptions collected by the Health and Sport Committee as part of the Committee’s review of NHS boards budget scrutiny (June 2012). A summary of the information provided by NHS boards is available on the Scottish Parliament website at http://www.scottish.parliament.uk/S4_HealthandSportCommittee/Inquiries/Dr_Andrew_Walker_NHS_Board_survey_responses.pdf

Prescribing costs are funded from NHS board baseline budget allocations provided by the Scottish Government. It is for NHS boards to determine how best to utilise baseline funding to meet the healthcare needs of their resident population. The NHS Scotland Efficiency and Productivity Framework for SR10, published in February 2011, sets out a programme of activities to improve quality and efficiency across NHS Scotland. The prescribing workstream supports NHS boards in identifying opportunities to improve the clinical quality of prescribing and to improve cost effectiveness of prescribing. Current activities of the workstream include a review of polypharmacy (the use of multiple medications by a patient) and a review of repeat prescriptions; these reviews aim to reduce the risk of harm to patients and further reduce wastage from medicines being dispensed to patients when they are not required.

There are currently approximately 10,300 claims. The NHS Scotland Central Legal Office and Equal Pay Unit are continuing to monitor the progress of all equal pay claims in NHS Scotland as well as developments relating to NHS equal pay claims elsewhere that may further inform the position.

I refer the member to the answer to question S4W-11157 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.

We fully recognise the important role that technology can play in supporting the care of people with diabetes. This is reflected in our investment of £2.5 million in insulin pump technology earlier this year. We have also invested £115,000 in the “MyDiabetesMyWay” online tool which connects people with diabetes to their clinical data online.

We expect local NHS boards diabetes to take full advantage of new health technologies to benefit people with diabetes once they have demonstrated that they are clinically and cost effective.

NHS boards are supported by well established, robust advice mechanisms, including the Scottish Health Technologies Group, to help ensure that people with diabetes get appropriate access to new treatments.

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.

Based upon information provided by NHS Scotland boards, there is confidence that boards will once again deliver planned efficiency savings for 2012-13. NHS boards have agreed financial plans to deliver efficiency savings of £271.701million in the current year. At month 6 to 30 September 2012 (the mid year point), Boards remain on target to deliver the required level of savings.

Currently over 82% of savings are classed as either medium or low risk in terms of them being delivered. Efficiency savings do not reduce the overall budget of the NHS. All savings are retained locally by territorial Boards to allow them to reinvest in front-line services which directly benefit patients.

SGHSCD

Health Finance Division

Local Delivery Plan - Planned Efficiency Savings

NHS Territorial Boards	Value	Unidentified	High	Medium	Low
	£m	%	%	%	%
Ayrshire & Arran	13.094	0.00%	0.00%	13.98%	86.02%
Borders	5.904	0.00%	27.93%	30.05%	42.02%
Dumfries & Galloway	7.500	0.00%	11.27%	46.41%	42.32%
Fife	17.524	0.00%	32.01%	31.81%	36.17%
Forth Valley	11.944	5.86%	16.74%	28.69%	48.71%
Grampian	12.006	0.00%	0.00%	27.54%	72.46%
Greater Glasgow & Clyde	59.049	0.00%	7.79%	39.28%	52.94%
Highland	23.736	7.88%	12.43%	55.36%	24.33%
Lanarkshire	19.211	9.44%	2.95%	39.29%	48.32%
Lothian	37.540	12.89%	47.68%	15.82%	23.61%
Orkney	1.418	0.00%	8.82%	38.43%	52.75%
Shetland	2.671	20.97%	22.50%	20.52%	36.02%
Tayside	24.543	0.00%	32.80%	58.12%	9.09%
Western Isles	2.485	10.26%	17.67%	60.56%	11.51%
NHS Territorial Boards Total	238.625	4.21%	19.00%	36.07%	40.73%
NHS Special Health Boards
National Services Scotland	10.340	0.00%	0.00%	100.00%	0.00%
Scottish Ambulance Service	7.318	24.60%	0.00%	37.36%	38.04%
Education for Scotland	7.295	0.00%	0.00%	17.30%	82.70%
NHS 24	1.720	45.23%	0.00%	0.00%	54.77%
National Waiting Times Centre Board	2.305	0.00%	12.58%	43.21%	44.21%
The State Hospital	1.389	0.00%	0.00%	20.95%	79.05%
NHS Health Scotland	1.009	0.00%	0.00%	10.51%	89.49%
Healthcare Improvement Scotland	1.700	0.00%	15.47%	21.76%	62.76%
NHS Special Health Boards Total	33.076	7.79%	1.67%	48.67%	41.86%
Grand Total	271.701	4.64%	16.89%	37.61%	40.86%

 

SGHSCD

Health Finance Division

Position At Period 6 - Forecast Efficiency Savings

NHS Territorial Boards	Value	Unidentified	High	Medium	Low
	£m	%	%	%	%
Ayrshire & Arran	13.094	0.00%	1.15%	9.98%	88.87%
Borders	5.904	0.00%	8.53%	26.58%	64.89%
Dumfries & Galloway	7.500	0.00%	2.32%	33.03%	64.66%
Fife	17.524	0.00%	31.48%	32.71%	35.81%
Forth Valley	11.944	5.86%	16.73%	12.12%	65.29%
Grampian	12.006	0.00%	0.00%	88.70%	11.30%
Greater Glasgow & Clyde	59.049	0.17%	7.02%	28.52%	64.29%
Highland	23.736	3.50%	12.10%	56.95%	27.46%
Lanarkshire	19.211	0.00%	2.59%	37.06%	60.35%
Lothian	37.540	12.89%	45.27%	20.02%	21.82%
Orkney	1.418	0.00%	8.82%	30.78%	60.40%
Shetland	2.671	13.37%	29.94%	38.90%	17.80%
Tayside	24.543	0.00%	21.14%	42.65%	36.21%
Western Isles	2.340	0.00%	10.44%	11.24%	78.32%
NHS Territorial Boards Total	238.480	2.86%	16.44%	33.71%	46.99%
NHS Special Health Boards
National Services Scotland	10.181	0.00%	0.00%	31.38%	68.62%
Scottish Ambulance Service	7.318	1.37%	12.47%	12.88%	73.29%
Education for Scotland	7.295	0.00%	0.00%	0.00%	100.00%
NHS 24	1.720	13.02%	0.00%	0.00%	86.98%
National Waiting Times Centre Board	2.305	0.00%	12.60%	43.24%	44.16%
The State Hospital	1.389	0.00%	0.00%	0.00%	100.00%
NHS Health Scotland	1.009	0.00%	0.00%	0.00%	100.00%
Healthcare Improvement Scotland	1.700	0.00%	13.68%	9.12%	77.21%
NHS Special Health Boards Total	32.917	0.98%	4.36%	16.07%	78.59%
Grand Total	271.397	2.63%	14.98%	31.57%	50.82%

Firstly NHS Health Scotland, along with all NHS Scotland Health bodies met their financial targets for 2011-12 and they are on track to deliver their financial targets for 2012-13. In addition to successfully achieving their statutory targets, all NHS Scotland boards received unqualified opinions on the true and fair view of their financial statements, the regularity of income and expenditure and the parts of their remuneration reports subject to audit.

The NHS Health Scotland Auditors have also included the following statement in the 2011-12 Audit Report (para 15):

“We have issued an unqualified opinion on the regularity of transactions in the boards financial statements.”

Staff salaries and pay related costs are routinely made towards the end of the month for all NHS Scotland boards. Pay and pay related costs for NHS Health Scotland were in excess of £1.9million during March 2012. This was the main component of the £3.5million referred to in the question. In addition, payments to suppliers were made during March 2012 totalling £1.3million, the value of these was also weighted towards the end of the month.

The resource expenditure pattern of NHS Health Scotland is not even throughout the year. Historically the board has utilised a greater than average proportion of its expenditure in the last quarter of the financial year and particularly during the final month. This pattern of expenditure reflects, in part, the nature of the boards activities and the delivery of a wide range of project initiatives, many of which are developed in year, culminating towards the end of the financial year. Furthermore, to continue to improve performance in relation to meeting Scottish Government prompt payment guidelines, payments also increased, whilst ensuring no payments were made in advance of need.

Notwithstanding the above NHS Health Scotland recognises the need to continually assess and improve its financial performance and a number of improvement actions have been agreed and implemented during the current fiscal year (2012-13). These actions are intended to address budget phasing issues and reduce year end expenditure by delivering earlier in the year.

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

Financial Support

Repayment Profile

2011-12	2012-13	2013-14	Total	2014-15	2015-16	2016-17	2017-18	Total
£m	£m	£m	£m	£m	£m	£m	£m	£m
0.320	16.577	1.660	18.557	5.275	5.492	5.700	2.090	18.557

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).

I refer the member to the answer to question S4W–11040 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.