(a) Funding provided by the NHS

Information is not available on total NHS funding (or expenditure) on care of the elderly.

The NHS Costs Book (Scottish Health Service Costs) provides details of expenditure incurred by NHS Boards in delivering health and care services based on financial returns completed annually by NHS Boards.

The NHS Costs Book contains information on Resource Transfer payments and hospital spend on elderly patients treated within the specialty Geriatric Continuing Care Services. The Costs Book does not separately identify proportions of expenditure related to elderly people treated in other specialties. It likewise does not identify the proportion of Community and Family Health Service expenditure which relates to care of the elderly.

The following tables extract expenditure figures for the Geriatric Continuing Care specialty from the NHS Costs Book 2000-01 to 2009-10. Due to changes in the collection of data, expenditure figures are not directly comparable between years.

Geriatric Continuing Care Services - Inpatients (£)

Geriatric Continuing Care Services - Day patients (£)

Geriatric Continuing Care Services - Resource Transfer Payments (£)

Geriatric Continuing Care Services - Total (£)

Sources: Scottish Financial Return 13.0 board expenditure on board residents 2004 to 2010 / Scottish Health Service Costs, Year ended 31 March 2001 to Year ended 31 March 2003 inclusive, R260: Health care commissioned – Geriatric continuing care services

Note: *Data not available for NHS Western Isles.

(b) Funding provided by local authorities

The vast majority of the funding provided to local government in Scotland, including the funding for the care of older people is provided by means of a block grant. It is the responsibility of each local authority to allocate the total financial resources available to it on the basis of local needs and priorities having first fulfilled its statutory obligations and the jointly agreed set of national and local priorities including the Scottish Government’s key strategic objectives.

A Stillbirth Sub-Group, of the Government convened Maternity Services Action Group, was set up in February 2011, and is considering issues pertinent to stillbirth, including current practice in NHS boards, current pregnancy screening, information given to parents and professionals, and improvements in bereavement care and research. Membership of the Group includes NHS boards, Royal Colleges, the charity SANDS, Healthcare Improvement Scotland and others. Papers from the Group will be placed on the maternity services website www.maternityservices.scot.nhs.uk.

The Refreshed Framework for Maternity Care in Scotland, which was launched in January 2011, outlines the services which are expected to be in place in all NHS board areas. NHS boards should have evidence that maternity services have effective risk assessment processes in place for all women, for safe delivery for both mothers and babies, and monitor maternal and infant health outcomes.

A Stillbirth Sub-Group, of the government convened Maternity Services Action Group, was set up in February 2011, and is considering issues pertinent to stillbirth, including current practice in NHS boards, current pregnancy screening, information given to parents and professionals, and improvements in bereavement care and research. Membership of the group includes NHS boards, Royal Colleges, the charity SANDS, Healthcare Improvement Scotland and others. Papers from the group will be placed on the maternity services website www.maternityservices.scot.nhs.uk.

The Refreshed Framework for Maternity Care in Scotland, which was launched in January 2011, outlines the services which are expected to be in place in all NHS board areas. NHS boards should have evidence that maternity services have effective risk assessment processes in place for all women, for safe delivery for both mothers and babies, and monitor maternal and infant health outcomes.

This information is publically available on the National Records of Scotland (NRS) website. The 2010 data was published on 5 August 2011.

http://www.gro-scotland.gov.uk/files2/stats/annual-review-2010/rgar10-appendix1-table1.xls.

Table 1 - Number of stillbirths in Scotland, 2000-10

Source: National Records of Scotland.

Note: 1. These data refer to the calendar year.

A Stillbirth Sub-Group, of the Government convened Maternity Services Action Group, was set up in February 2011, and is considering issues pertinent to stillbirth, including current practice in NHS boards, current pregnancy screening, information given to parents and professionals, and improvements in bereavement care and research. Membership of the group includes NHS boards, Royal Colleges, the charity SANDS, Healthcare Improvement Scotland and others. Papers from the group will be placed on the maternity services website www.maternityservices.scot.nhs.uk.

The Refreshed Framework for Maternity Care in Scotland, which was launched in January 2011, outlines the services which are expected to be in place in all NHS board areas. NHS boards should have evidence that maternity services have effective risk assessment processes in place for all women, for safe delivery for both mothers and babies, and monitor maternal and infant health outcomes.

The Scottish Government is not aware of any research into the recommended injection treatment for pernicious anaemia.

I refer the member to the answer to question S4W-01754 on 11 August 2011. 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.

The exact number of people who have been diagnosed with pernicious anaemia in Scotland is not available centrally. However, national estimates can be given of the number of patients consulting a GP or practice-employed nurse for this condition based on information obtained from a sample of Scottish general practices participating in PTI (Practice Team Information). This sample covers the full range of age, sex, and deprivation classes existing in Scotland. Based on PTI, there were an estimated 12,200 patients who had a face-to-face consultation for pernicious anaemia in Scotland in the financial year 2009-10 (the latest year available), with a 95% confidence interval of 9,200 to 15,100.

PTI estimates of the rate of patients consulting should not be regarded as identical to the population prevalence of a given condition. This is because PTI measures active problems; a lifelong or previous condition will not be recorded unless the patient had a contact with the practice that was directly related to that condition. If, for example, someone with pernicious anaemia consults because of a cold and not because of their anaemia, their anaemia will not be coded as a reason for consultation.

The confidence intervals provided indicate the uncertainty around the estimate provided. These are reasonably wide, reflecting among other things considerable variation between practices. This indicates that the estimate provided is not exact and should be treated as approximate.

Tests are available for estimating the levels of some of the vitamins and minerals in the blood such as iron and calcium levels and Vitamin B12 and folate in the NHS. However, as the results are variable as they can be influenced by many other factors such as proteins in the blood, other investigations are required to support the diagnosis and management of a condition.

The Scottish Government sets national direction of policy on mental health and provides funding to agencies - including NHS boards and local authorities - to support implementation of policy. The management of local actions in implementing national policy, and decisions on local spending priorities, are the responsibility of relevant local agencies. The decision on whether to train or employ child psychotherapists is therefore one which is primarily the responsibility of NHS boards.

NHS boards, working with their statutory partners, are responsible for designing and delivering mental health services to their local population, and the decision on whether a board chooses to invest in a particular service or approach, and how to make best use of resources such as child psychotherapists, is their responsibility.

The Scottish Government has been supporting NHS boards and their partners develop the specialist CAMHS workforce in order to provide faster access to CAMHS and support delivery of the HEAT target.

We have developed the CAMHS workforce survey database (http://www.isdscotland.org/Health-Topics/Workforce/CAMHS/) which provides the Scottish Government and NHS boards and other local services with current information on the size and composition of the CAMHS workforce to enable local and national workforce planning.

We have invested £6.5 million over a three year period to increase the number of psychologists working in specialist CAMHS with £1 million in 2009-10, £ 2 million 2010-11 and £3.5 million in 2011-12. We have invested £2 million per year since 2009-10 in tier 3 and tier 4 (intensive) community CAMHS services. This is allowing NHS boards to develop the capacity of their intensive outreach services, thus reducing the length of time children and young people need to be in hospital. As a result of this investment, we have seen a 33% growth in the specialist CAMHS workforce between September 2008 and March 2011, and we expect this to have a significant impact on waiting times for CAMHS services.

The CAMHS workforce survey database shows that NHS Ayrshire and Arran, NHS Borders, NHS Fife, NHS Grampian, NHS Greater Glasgow and Clyde, NHS Lanarkshire, NHS Lothian and NHS Orkney employed child psychotherapists, and between September 2010 and March 2011 there has been a 8.2 % decrease in CAMHS psychotherapy posts which is equal to 1.3 whole-time equivalent posts.

We are investing £100,000 per year over a five year period to train an additional six child psychotherapists. There are presently six people (two from NHS Fife, one from NHS Lothian, one from NHS Lanarkshire and two from NHS Greater Glasgow and Clyde) enrolled on the Child Psychotherapy training course all of whom will complete their training in the summer of 2013.

We will shortly be meeting with NHS Education Scotland and the Scottish Institute of Human Relations to discuss the need for continuing child psychotherapy training.