Chamber and committees

The Scottish Government is working to develop a medium term financial framework, within the context of the budget settlement that the Scottish Government receives. This will outline the broad direction for the NHS and care services to meet the changing needs of the people of Scotland, including shifting the balance of care.

The Scottish Government recognises the need to offer Boards appropriate flexibility between financial years, and this is already reflected in the Scottish Government’s approach. In recent years, for example, banking of funds to be drawn down in future years and brokerage arrangements have been agreed with NHS Boards.

We will consider the scope to develop further the mechanisms already used to provide financial flexibility for NHS Boards, within the wider regulations in which the Scottish Government requires to operate, as set out by HM Treasury.

The Scottish Government is encouraging Health Boards, Integration Authorities and other partners to take a more joined-up approach to improving services and patient outcomes. As part of this, three Regional Implementation Leads (North, East and West) are working together with local and national partners to plan and design better services for the populations in their areas. This will help to ensure that local, regional and national planning works together in practice and for the long term.

As part of the approach to finance and performance, NHS Boards prepare plans over a medium term timescale and submit this information to the Scottish Government as part of their Local Delivery Plans.

The Budget Process Review Group was established by the Finance and Constitution Committee and the Scottish Government to carry out a fundamental review of the Scottish Parliament’s budget process. The Group published its Final Report on 30 June 2017, which included comment on spending reviews and multi-year budgets.

The Cabinet Secretary for Finance and the Constitution has responded to this Report.

Boards are continuing to reduce their waiting times below the standard, in the last quarter 13 of the 14 Boards in Scotland recorded an average waiting time within the 18 week standard with 8 of these recording an average wait of 9 weeks or lower - half the target waiting time. At the same time the increase in demand for CAMH services clearly shows that in the past there were far too many children who were unseen, and whose need was unmet and as the capacity and provision of services have increased we have seen a sustained increase in the numbers accessing treatment each quarter and this should be welcomed.

We remain determined to improve performance and we will continue to work with Boards to make sure that happens right across Scotland and announced an additional £150 million for mental health services up until 2020, and as part of this funding £4.6 million has been awarded to Healthcare Improvement Scotland to establish a Mental Health Access Improvement Support Team to work in partnership with Boards to deliver sustained improvements in access to CAMHS and psychological therapies services for all ages and ensure services are designed and delivered in the most efficient way.

Utility Costs

The Scottish Public Sector Utility contract, managed by Scottish Procurement, covers electricity, gas, water, some liquid fuels and biomass pellets. All public sector partners actively manage the purchase of energy on the wholesale market through a national Risk Management Committee run by Scottish Procurement. Through this committee, maximum target costs are set to ensure the least risk of exposure to market changes.

Agency Staff

The Scottish Government in conjunction with NHS National Procurement has implemented monthly reporting of Nursing and Medical Agency spend. This data, collated from the general ledger of each Health Board, is distributed to executive leads, allowing each NHS Board to see their exact month on month spend which is benchmarked against that of other Boards. Reports available also include the cost of individual locums used by Boards. Data is also provided all other aspects of agency staff spend.

Through a national procurement approach we also have framework contracts in place for Medical and Nursing agency which limit the agencies on this contract to rates of pay consistent with NHS rates, ensuring best value for money when agency staff need to be sourced. The sourcing of agency staff however should be a very last resort and the majority of temporary shifts are filled through the NHS Staff Bank which employs NHS staff on NHS contracts at NHS rates of pay.

NHS Boards report to the Scottish Government throughout the financial year on financial performance. This includes a specific focus on progress in delivering planned savings.

As public bodies, Health Boards and Integration Authorities are required to publish a range of information, including all papers and agendas of their Board meetings. These papers are accessible online or can be requested directly from the relevant Health Board or Integration Authority.

In 2016-17, there were 978 incidents of domestic abuse recorded by the police in the Scottish Borders. This represents an increase of 47% from 665 incidents recorded in 2008-09. The rate of incidents recorded per 10,000 population in the Scottish Borders has increased from 59 in 2008-09 to 85 in 2016-17. However, this rate has been consistently below that of the Scottish average which in 2016-17 was 109 per 10,000 population.

The Scottish Government is investing almost £30 million (2017-20) from the Equalities portfolio to support a range of projects and initiatives – including support for a range of front line specialist services working with women and children who have experienced domestic abuse. Separately, we committed an additional dedicated £20 million over 2015-18 from Justice budgets to be invested in a range of measures to tackle all forms of violence against women and girls.

We are also implementing Equally Safe, Scotland’s strategy to tackle all forms of violence against women and girls. This aims to prevent violence from occurring in the first place, build the capability and capacity of mainstream and specialist services to support survivors and those at risk, and strengthen the Justice response to victims and perpetrators. A Delivery Plan for Equally Safe will be published by end 2017.

We are also improving the justice system response to domestic abuse. The Domestic Abuse (Scotland) Bill, which is currently before Parliament, will create a new offence criminalising a course of abusive behaviour towards a partner or ex-partner. The offence will help law enforcement agencies in dealing with domestic abuse with a law that reflects a modern understanding of domestic abuse and will cover all the types of behaviour that can constitute domestic abuse; crucially this includes psychological harm. This new offence will help our justice partners such as Police Scotland and the Crown Office to more effectively deal with domestic abusers.

Rating valuation of hospitals is undertaken by independent Assessors appointed by local government, as is the case for all non-domestic properties. They also have a right of appeal against any rateable value set by independent Assessors. NHS boards are entitled to apply to Councils for the same reliefs in line with all other ratepayers.

The relatively small decrease in the number of people using cessation services in the Scottish Borders last year was more than matched by a significant increase in the numbers of those who successfully quit using the service. The Scottish Government is working with NHS Scotland to launch a major national campaign in 2018 to encourage more smokers to use cessation services.

Since the launch of our tobacco control strategy, Creating a Tobacco-free Generation, in 2013 there has been a significant reduction in smoking prevalence in the Scottish Borders, where prevalence is well below the national average. However, there is still some way to go and the Scottish Government will be bringing forward new measures to tackle smoking rates in a refresh of our tobacco control strategy in 2018.