Chamber and committees

The success of the HEAT A11 drug and alcohol waiting times target is reliant on cooperation from alcohol and drug partnerships (ADPs) and services from the health, local government and voluntary sectors. NHS boards, working with relevant partners, will be held to account for delivery of the target via existing NHS performance management structures.

It is the responsibility of local services to have protocols in place for managing access to their services and the safe and not punitive discharge of clients from waiting lists. The HEAT A11 target is firmly embedded within the wider landscape of recovery, where the focus is on the individual and what is appropriate for their recovery journey.

The new drug and alcohol treatment waiting times database, currently being rolled out for full implementation by 1 April 2011, will monitor discharge types and highlight individuals who are being discharged prior to receiving assessment or treatment. This information will be reviewed at national level for performance management and quality assurance purposes.

The alcohol brief interventions target relates to early interventions for hazardous and harmful drinkers. Individuals receive this opportunistic intervention as part of their initial contact with a service, therefore are not within the scope of the access to treatment target.

The cost to the NHS for national enhanced services in the last two years for which information is available is as follows:

	Scotland
	£000
2008-09	12,887
2009-10	13,387

This information is taken from the annual accounts of NHS boards.

We do not collect information nationally which measures shifts in the balance of care in relation to the various national enhanced service programmes. Shifts in the balance of care are a means to an end which is better outcomes measured via HEAT targets, the Community Care Outcomes Framework and other strategic priorities contained in various strategies. NHS boards are responsible for deciding on the areas for improvement in line with the policy we set out in 2009 which was agreed with COSLA and for making the necessary changes to deliver agreed outcomes.

The following table records the NHS boards and the local enhanced services undertaken in 2009-10.

Local Enhanced Service	Ayrshire and Arran	Borders	Dumfries and Galloway	Fife	Forth Valley	Grampian	Glasgow and Clyde
Care Homes (Nursing/Residential)	Yes				Yes	Yes
Care Homes (LD)		Yes
Anticipatory Care “ Plan/Prevent		Yes
Lithium monitoring
Alcohol Screen / B1		Yes	Yes	Yes		Yes	Yes
Contraception	Yes		Yes	Yes	Yes	Yes	Yes
GMS Impact
HepC / BBV	Yes
Closer Working	Yes					Yes	Yes
Counterweight	Yes
Hand Hygiene	Yes
Helicobacter	Yes
HIB/MenC	Yes		Yes
HPV	Yes						Yes
Keep Well	Yes					Yes
MMR catch up	Yes					Yes
Ring Pessary (fitting/maintenance)	Yes					Yes
Families at Risk	Yes
Tetanus / Diphtheria / polio	Yes
Med Serve Shelthousing		Yes
Orthopaedic			Yes			Yes
Pre Clinic Testing			Yes
Drug Misusers / Shared Care			Yes	Yes
HDAT			Yes
Eating Disorders			Yes
Chronic Disease Management				Yes
Renal Anaemia				Yes
Cardiac Failure						Yes
Dermatology						Yes
MMS neonatal						Yes
Asylum Seekers							Yes
Diabetes							Yes

 

Local Enhanced Service	Ayrshire and Arran	Borders	Dumfries and Galloway	Fife	Forth Valley	Grampian	Glasgow and Clyde
CHD							Yes
Strokes / TIA							Yes
Multiple Sclerosis							Yes
Mumps							Yes
Pre Chemo Phlebotomy							Yes
Breast Screening							Yes
Acute Warfarin Initiation
Child Protection
Home Detoxification
Anti-Coag Monitoring					Yes
Depression
DVT
Chronic Pain
Violent Patients
Alcohol Misuse
First Response

 

Local Enhanced Service	Highland	Lanarkshire	Lothian	Tayside
Care Homes (Nursing/Residential			Yes	Yes
Care Homes (LD)
Anticipatory Care “ Plan/Prevent	Yes
Lithium monitoring			Yes
Alcohol Screen / B1		Yes	Yes	Yes
Contraception “ v LARC/Implanon			Yes	Yes
GMS Impact			Yes
HepC / BBV			Yes
Closer Working	Yes
Counterweight
Hand Hygiene
Helicobacter
HIB/MenC			Yes
HPV	Yes	Yes	Yes
Keep Well			Yes
MMR catch up
Ring Pessary (fitting/maintenance)
Families at Risk
Tetanus / Diphtheria / polio
Med Serv Shelthousing
Orthopaedic
Pre Clinic Testing
Drug Misusers / Shared Care
HDAT
Eating Disorders
Chronic Disease Management
Renal Anaemia
Cardiac Failure
Dermatology
MMS neonatal
Asylum Seekers
Diabetes	Yes			Yes

 

Local Enhanced Service	Highland	Lanarkshire	Lothian	Tayside
CHD
Strokes / TIA
Multiple Sclerosis
Mumps
Pre Chemo Phlebotomy
Breast Screening
Acute Wafarin Initiation				Yes
Child Protection
Home Detoxification
Anti-Coag Monitoring
Depression	Yes
DVT	Yes
Chronic Pain	Yes
Violent Patients	Yes
Alcohol Misuse	Yes
First Response	Yes

Note: NHS Orkney, NHS Shetland Isles and NHS Western Isles have not supplied the relevant information.

I have asked John Ewing, Chief Executive of the Scottish Prison Service (SPS), to respond. His response is as follows:

There have been no changes to the prison rules since May 2007 relating to effective contact between parents and children.

SPS recognises the importance of family contact and each prison has a family contact officer whose role is to support the needs of prisoners'' families and children, by enhancing family contact and offering support and guidance to relatives. This can include making arrangements for family visits. In addition, the SPS currently provides financial support to Families Outside to provide information through the Scottish Prisoners'' Family Helpline.

SPS is currently reviewing its good practice guidelines for working with children and families of prisoners to ensure that the policy supports the needs of families.

NHS Quality Improvement Scotland (NHS QIS) has developed a two year programme of work with NHS boards and key stakeholders to bring about improvements in neurological services. We have provided the boards with funding of some £450,000 this financial year to assist them in developing neurological Managed Clinical Networks as the vehicle for local service improvements.

On 4 February 2010, the Scottish Government Health Delivery Directorate issued CEL 3 (2010), which provided NHS boards with the outputs of the work of a Neurological Task and Finish Group. The letter asks boards to use these materials, in conjunction with the NHS QIS standards, to continue to develop their local neurological services action plans.

By summer 2010, all NHS boards had completed a self evaluation against the first four, generic, standards. Their self evaluation against the condition-specific standards was completed in January 2011, and the results are currently being analysed by NHS QIS. This has helped to identify the issues on which NHS QIS needs to focus the support it provides to boards.

NHS QIS is also arranging a series of events between March and June 2011 linked to implementation of the condition-specific standards, in collaboration with the Neurological Alliance of Scotland. These provide an opportunity for delegates to gain a greater understanding of the priorities for people living with neurological conditions, as well as helping boards continue to develop their neurological services action plans. NHS QIS is also running a series of improvement clinics, by teleconference, to provide further support to NHS boards'' neurological improvement leads.

The cash paid for each national enhanced service broken down by (a) NHS board and (b) 1,000 population is as follows:

(a) Cash Paid for Each National Enhanced Service (NES) Broken Down by NHS Board, Financial Year 2008-09:

NHS Board	Alcohol Misuse £	Anti-Coagulation Monitoring £	IUCD Contraception £	Depression £
Ayrshire and Arran	0	208,928	188,897	0
Borders	0	125,747	18,757	0
Dumfries and Galloway	0	210,889	29,625	0
Fife	0	352,666	85,448	0
Forth Valley	0	500,700	104,050	0
Grampian	0	0	66,973	0
Greater Glasgow and Clyde	241,674	497,870	92,416	694,162
Highland	0	299,337	63,391	68,255
Lanarkshire	0	523,031	22,215	0
Lothian	0	20,333	0	0
Orkney	0	2,434	734	0
Shetland	0	0	0	0
Tayside	0	0	(484)	0
Western Isles	6,766	54,960	1,971	0

(b) Cash Paid for Each NES Broken Down by NHS Board, per 1,000 Population, Financial Year 2008-09:

NHS Board	Alcohol Misuse £	Anti-Coagulation Monitoring £	IUCD Contraception £	Depression £
Ayrshire and Arran	0	538	487	0
Borders	0	1,084	162	0
Dumfries and Galloway	0	1,361	191	0
Fife	0	945	229	0
Forth Valley	0	1,631	339	0
Grampian	0	0	118	0
Greater Glasgow and Clyde	185	380	71	530
Highland	0	930	197	212
Lanarkshire	0	886	38	0
Lothian	0	23	0	0
Orkney	0	122	37	0
Shetland	0	0	0	0
Tayside	0	0	(1)	0
Western Isles	242	1,963	70	0

Note: Costs divided by the population registered with GP practices at 1 April in each financial year.

(a) Cash Paid for Each National Enhanced Service (NES) Broken Down by NHS Board, Financial Year 2008-09:

NHS Board	Drug Misuse £	Homelessness £	Immediate / First Responder £	Intra Partum Care £
Ayrshire and Arran	0	0	0	0
Borders	0	0	0	0
Dumfries and Galloway	0	0	11,621	0
Fife	0	0	0	0
Forth Valley	0	0	0	0
Grampian	1,388,636	47,554	0	0
Greater Glasgow and Clyde	393,769	6,200	0	0
Highland	60,459	0	0	11,774
Lanarkshire	895,268	0	0	0
Lothian	0	0	0	0
Orkney	0	0	0	0
Shetland	0	0	0	0
Tayside	0	0	0	0
Western Isles	0	0	19,960	819

(b) Cash Paid for Each NES Broken Down by NHS Board, per 1,000 population, Financial Year 2008-09:

NHS Board	Drug Misuse £	Homelessness £	Immediate / First Responder £	Intra Partum Care £
Ayrshire and Arran	0	0	0	0
Borders	0	0	0	0
Dumfries and Galloway	0	0	75	0
Fife	0	0	0	0
Forth Valley	0	0	0	0
Grampian	2,453	84	0	0
Greater Glasgow and Clyde	301	5	0	0
Highland	188	0	0	37
Lanarkshire	1,517	0	0	0
Lothian	0	0	0	0
Orkney	0	0	0	0
Shetland	0	0	0	0
Tayside	0	0	0	0
Western Isles	0	0	713	29

Note: Costs divided by the population registered with GP practices at 1 April in each financial year.

(a) Cash Paid for Each NES Broken Down by NHS Board, Financial Year 2008-09

NHS Board	Minor Injuries £	Multiple Sclerosis £	Near Patient Testing £	Sexual Health Service £
Ayrshire and Arran	0	0	288,263	0
Borders	42,616	0	104,553	0
Dumfries and Galloway	0	0	96,574	0
Fife	0	0	0	0
Forth Valley	0	0	465,225	0
Grampian	0	0	636,869	0
Greater Glasgow and Clyde	261,986	37,706	360,734	75,451
Highland	265,731	0	575,020	0
Lanarkshire	0	0	304,507	0
Lothian	8,959	0	10,800	2,500
Orkney	0	0	0	0
Shetland	0	0	0	0
Tayside	88,328	0	198,660	0
Western Isles	36,118	0	20,007	55,919

(b) Cash Paid for Each NES Broken Down by NHS Board, per 1,000 population, Financial Year 2008-09:

NHS Board	Minor Injuries £	Multiple Sclerosis £	Near Patient Testing £	Sexual Health Service £
Ayrshire and Arran	0	0	743	0
Borders	367	0	901	0
Dumfries and Galloway	0	0	623	0
Fife	0	0	0	0
Forth Valley	0	0	1,515	0
Grampian	0	0	1,125	0
Greater Glasgow and Clyde	200	29	276	58
Highland	825	0	1,786	0
Lanarkshire	0	0	516	0
Lothian	10	0	12	3
Orkney	0	0	0	0
Shetland	0	0	0	0
Tayside	213	0	479	0
Western Isles	1,290	0	715	1,997

Note: Costs divided by the population registered with GP practices at 1 April in each financial year.

(a) Cash Paid for Each NES Broken Down by NHS Board, Financial Year 2009-10:

NHS Board	Alcohol Misuse £	Anti-Coagulation Monitoring £	IUCD Contraception £	Depression £
Ayrshire and Arran	0	232,748	124,451	0
Borders	0	140,477	24,589	0
Dumfries and Galloway	0	218,836	35,702	0
Fife	0	387,021	73,068	0
Forth Valley	0	0	0	0
Grampian	0	522,724	193,245	0
Greater Glasgow and Clyde	0	128,914	87,592	0
Highland	174,332	296,048	84,194	208,461
Lanarkshire	0	186,124	75,291	0
Lothian	0	671,785	(3,668)	0
Orkney	0	19,733	16,730	0
Shetland	0	9,911	1,328	0
Tayside	0	0	0	0
Western Isles	6,660	67,988	8,067	0

(b) Cash Paid for Each NES Broken Down by NHS Board, per 1,000 population, Financial Year 2009-10:

NHS Board	Alcohol Misuse £	Anti- Coagulation Monitoring £	IUCD Contraception £	Depression £
Ayrshire and Arran	0	600	321	0
Borders	0	1,211	212	0
Dumfries and Galloway	0	1,403	229	0
Fife	0	1,035	195	0
Forth Valley	0	0	0	0
Grampian	0	917	339	0
Greater Glasgow and Clyde	0	98	67	0
Highland	541	919	261	647
Lanarkshire	0	315	127	0
Lothian	0	767	(4)	0
Orkney	0	987	837	0
Shetland	0	431	58	0
Tayside	0	0	0	0
Western Isles	247	2,518	299	0

Note: Costs divided by the population registered with GP practices at 1 April in each financial year.

(a) Cash Paid for Each NES Broken Down by NHS Board, Financial Year 2009-10:

NHS Board	Drug Misuse £	Homelessness £	Immediate / First Responder £	Intra Partum Care £
Ayrshire and Arran	0	0	0	0
Borders	0	0	0	0
Dumfries and Galloway	0	0	11,652	0
Fife	0	0	0	0
Forth Valley	0	0	0	0
Grampian	0	0	0	0
Greater Glasgow and Clyde	1,722,846	53,965	0	0
Highland	112,435	29,351	0	7,619
Lanarkshire	0	0	0	0
Lothian	1,098,976	0	0	0
Orkney	0	0	0	0
Shetland	0	0	0	0
Tayside	5,800	0	0	0
Western Isles	0	0	25,504	(819)

(b) Cash Paid for Each NES Broken Down by NHS Board, per 1,000 population, Financial Year 2009-10:

NHS Board	Drug Misuse £	Homelessness £	Immediate / First Responder £	Intra Partum Care £
Ayrshire and Arran	0	0	0	0
Borders	0	0	0	0
Dumfries and Galloway	0	0	75	0
Fife	0	0	0	0
Forth Valley	0	0	0	0
Grampian	0	0	0	0
Greater Glasgow and Clyde	1,313	41	0	0
Highland	349	91	0	24
Lanarkshire	0	0	0	0
Lothian	1,255	0	0	0
Orkney	0	0	0	0
Shetland	0	0	0	0
Tayside	14	0	0	0
Western Isles	0	0	945	(30)

Note: Costs divided by the population registered with GP practices at 1 April in each financial year.

(a) Cash Paid for Each NES Broken Down by NHS Board, Financial Year 2009-10:

NHS Board	Minor Injuries £	Multiple Sclerosis £	Near Patient Testing £	Sexual Health Service £
Ayrshire and Arran	0	0	335,259	0
Borders	41,443	0	113,974	0
Dumfries and Galloway	0	0	104,177	0
Fife	0	0	0	0
Forth Valley	0	0	0	0
Grampian	0	0	474,406	0
Greater Glasgow and Clyde	0	0	1,025,361	0
Highland	219,507	33,283	176,009	1,790
Lanarkshire	296,454	0	555,339	0
Lothian	0	0	452,045	0
Orkney	8,854	0	9,917	18,744
Shetland	14,000	0	1,391	0
Tayside	118,833	0	307,266	0
Western Isles	42,532	0	26,979	63,565

(b) Cash Paid for Each NES Broken Down by NHS Board, per 1,000 population, Financial Year 2009-10:

NHS Board	Minor Injuries £	Multiple Sclerosis £	Near Patient Testing £	Sexual Health Service £
Ayrshire and Arran	0	0	864	0
Borders	357	0	983	0
Dumfries and Galloway	0	0	668	0
Fife	0	0	0	0
Forth Valley	0	0	0	0
Grampian	0	0	832	0
Greater Glasgow and Clyde	0	0	782	0
Highland	682	103	547	6
Lanarkshire	502	0	940	0
Lothian	0	0	516	0
Orkney	443	0	496	937
Shetland	609	0	60	0
Tayside	285	0	737	0
Western Isles	1,575	0	999	2,354

Notes: Costs divided by the population registered with GP practices at 1 April in each financial year.

Negative figures are recoveries of previous overpayments.

In 2009-10, there is no cash paid for National Enhanced Services against NHS Forth Valley. This board has chosen not to contract on the basis of the NES specifications.

This information is supplied by Practitioner Services Division, NHS National Services Scotland and is as per payments administered by them.

NHS boards may have paid additional sums to other providers, or included in payments to S17C and S2C practices. Such sums are not included in the tables.

The cash paid to the NHS for each national enhanced service (NES) in the last two years for which information is available (2008-09 and 2009-10) is as follows:

NES Name	2008-09	2009-10
	£	£
Alcohol Misuse	248,440	180,992
Anti-coagulation Monitoring	2,796,895	2,882,309
IUCD Contraception	673,993	720,589
Depression	762,417	208,461
Drug Misuse	2,738,132	2,940,057
Homelessness	53,754	83,316
Immediate / First Responder	31,581	37,156
Intra Partum Care	12,593	6,800
Minor Injuries	703,738	741,623
Multiple Sclerosis	37,706	33,283
Near Patient Testing	3,061,212	3,582,123
Sexual Health	133,870	84,099
Total	11,254,331	11,500,808

Notes:

Each NES apart from Immediate / First Responder included a per patient element.

The number of per patient fees paid for each NES is not held centrally.

The above information is supplied by Practitioner Services Division, NHS National Services Scotland and is as per payments administered by them.

The cash amount will differ from the expenditure amount recorded in NHS boards annual accounts which is not available at individual NES level.

NHS boards may have paid additional sums to other providers, or included in payments to S17C and S2C practices. Such sums are not included in the table.

This is a matter for NHS boards. The information requested is not held centrally.

I have asked John Ewing, Chief Executive of the Scottish Prison Service (SPS), to respond. His response is as follows:

In respect of the needs and rights of children in Scottish prisons, under Scottish law children, defined as being under the age of 16, are no longer sent to prison with effect from the enactment of the Criminal Justice and Licensing (Scotland) Act in December 2010.

In terms of the United Nations definition, children are defined as being under 18. SPS has allocated Blair House at HMYOI Polmont as accommodation to house convicted male young offenders under the age of 18. Blair House offers a specific regime to meet the needs and rights of this group.

With regard to children visiting SPS establishments, the SPS, in designing the specification for operational procedures in new and redeveloped prisons, takes into consideration the aims of the SPS Children and Families Strategy. For example, the new public sector prison at Low Moss, which is due to open in 2012, will include in its visit facility an internal children''s play area and an area outwith the confines of the main visit area to accommodate family visits.