Chamber and committees

Our Diabetes Action Plan, published in 2010, highlights the importance of transitional care in supporting young people with diabetes to effectively manage their condition, and we expect every board to ensure that children are appropriately managed in the transition from paediatric to adult diabetes services.

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 coordinator visited each NHS board area in 2012 and has confirmed, with services, that transitional arrangement exist in every board area. In addition every NHS board area, where appropriate, now has joint clinics with representation from both adult and paediatric services.

The paediatric subgroup and coordinator now plan to work with NHS boards to build on and strengthen these transitional services.

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.

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.

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.

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.

We want to ensure that all people with diabetes, irrespective of age get access to the best possible care - appropriately tailored to their individual needs.

Our Diabetes Action Plan 2010 notes that:

Over the lifetime of this Action Plan, diabetes care services should become more flexible and effective in their capacity to reach people in all care settings and to provide training and mentoring for non-specialist community care partners.

Diabetes Managed Clinical Networks are currently reviewing the diabetes education available to staff working in residential homes, we expect this work will help strengthen staff’s ability to deliver person-centred care.

From 1 October 2012, the Government implemented the ban on age discrimination enshrined in the Equality Act 2010, giving protection against age discrimination in services provided by the public, private and third sectors.

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.

NHS boards manage their surplus assets, within the terms of the NHS Scotland property transactions handbook.

The phasing out of prescription charges benefits all individuals in Scotland, but in particular those who are the most vulnerable. Those with low incomes and those with long-term conditions will clearly benefit most each and every time they have their prescribed medicines dispensed. Enabling access to necessary prescribed medicines is an essential component in ensuring patients’ compliance with the management of their health without reference to their income. Patients no longer face making choices between which medicines to take based on affordability.

The Scottish Government is clear that the extension of free prescriptions to all removed the inequalities embedded in the previous charges regime caused by the existence of an income threshold and approved list of conditions.

The Scottish Government recognises the importance not only of transparency, but also of consistency of reporting and will provide guidance to NHS boards to further improve the consistency of board reporting in this area.