Chamber and committees

The Scottish Government Health and Social Care Directorates has in place a number of arrangements to assist boards with their, short, medium and longer term financial planning. These arrangements have been discussed and agreed with boards, reflected within their local delivery plan, financial plans and formally approved by the Director General Health and Social Care and Chief Executive of NHSScotland. Justification for banking and brokerage (including an affordable repayment schedule) are essential in advance of approval.

The projected financial position of each NHS board fully reflects the borrowing and repayment arrangements in place.

No money has been allocated specifically for this purpose. These patients are either going through complex discharge planning arrangements, following a lengthy hospital stay, or are waiting to transfer to a more appropriate health and social care setting, as part of a joint commissioning programme.

The date of birth is collected to provide a breakdown by age. It is also used to check the accuracy of the Community Health Index number, and vice versa.

The vast majority of code 9 patients are delayed because they lack capacity to make their own decisions, and are awaiting completion of applications for guardianship.

Good progress has been made reducing the number of adults with incapacity delays. To help streamline processes we issued a Good Practice Guide in 2010, and republished this last year. We are also supporting Age Scotland to promote Power of Attorney across Scotland in a bid to reduce these delays over the longer-term.

Other code 9 delays are patients with highly complex needs, where no alternative safe community care is available. Local partnerships are working with the joint improvement team to better understand the needs of this cohort of patients and to ensure that services that address these needs are put in place.

(a) The information is not held centrally for NHS boards. However, under the Public Services Reform (Scotland) (PSR) Act 2010 public bodies are required to publish a statement of any external consultancy expenditure they have incurred that financial year as soon as is reasonably practicable after the end of each financial year.

(b) The Scottish Government Health and Social Care Directorate has incurred the following expenditure on consultancy in each of the last seven years. Consultancy costs cover a wide range of professional services such as management consultancy, IT consultancy, financial consultancy, construction or infrastructure related consultancy, research and evaluation and policy development (including feasibility studies). Management consultancy costs cannot be separately identified from the total consultancy costs.

Consultancy costs for Health and Social Care Directorate 2007-08 to 2013-14

This data is not collected nationally as part of the Scottish Intensive Care Audit.

Available data focuses on episodes of critical care, from interventions to outcome; please see our annual report which was published in August 2014 for more details http://www.sicsag.scot.nhs.uk/docs/SICSAG-report-2014-web.pdf?1.

Source: Information Services Division Scotland

Data on the number of patients accessing a stroke unit on the day of admission is published annually in the Scottish Stroke Care Audit (SSCA). Boards are also able to access their own real time data, and the SSCA team provides them with monthly and quarterly reports.

The Scottish Stroke Improvement Team supports Managed Clinical Networks to evaluate board performance, identify areas of concern and work with them to implement local action plans to improve the delivery of stroke care across Scotland. This support includes visiting all boards at least once per year to review stroke care with board representatives (board management and clinical teams), to assess performance, to highlight achievements and good practice and to formulate an improvement plan for areas of concern where necessary.

The Scottish Stroke Improvement Team met with board representatives from NHS Lothian on 3 November 2014, and a follow up meeting has been arranged for March 2015. They are scheduled to meet representatives from NHS Highland on 1 April 2015.

These drugs have been subject to rigorous assessment by the Scottish Medicines Consortium (SMC) prior to approval for use.

SMC assessment for every new medicine includes a health economic analysis. For the novel oral anticoagulants this analysis included calculating the cost avoidance associated with savings in time, due to reduced blood monitoring. Taking this, and other factors into consideration, cost-effectiveness has been demonstrated for these drugs, when compared to traditional anticoagulants. For example:

https://www.scottishmedicines.org.uk/files/advice/dabigatran_Pradaxa_FINAL_August_2011_Amended_05.09.11_for_website.pdf

A separate assessment by the Scottish Government is not necessary.

The Scottish Government recognises the importance of anticoagulation in patients with atrial fibrillation and has included it as one of the eight priorities in the Stroke Improvement Plan (published August 2014).

The Scottish Quality and Outcomes Framework contract 2014-15 has an agreement to identify those patients with atrial fibrillation, who are suitable for treatment with an anticoagulant.

According to the Scottish Stroke Care Audit (SSCA) data for 2010 to 2013, whilst the percentage of patients with atrial fibrillation who take anticoagulation treatment following assessment at outpatient clinics has fallen slightly from 79% (2010) to 77% (2013), there has been an increase in the actual numbers from 232 (2010) to 308 (2013).

The 2014 SSCA report can be accessed via:

http://www.strokeaudit.scot.nhs.uk/Reports/main.html

There is no intermediate target set for boards to meet the national standard for stroke patients requiring thrombolysis within one hour of arrival at hospital. Boards are expected to achieve the Scottish stroke care standard for thrombolysis where 80% of patients receive the bolus within one hour of arrival at hospital.

The Scottish Government recognises the importance of thrombolysis and has included it as one of the eight priorities in the Stroke Improvement Plan (published August 2014).