Questions and answers

Question reference: S4W-11049

Asked by: Jackie Baillie, MSP for Dumbarton, Scottish Labour
Date lodged: Monday, 12 November 2012
Current Status: Answered by Alex Neil on 22 November 2012

To ask the Scottish Government, in light of the external review, which the Audit Scotland report, NHS financial performance 2011/12, said highlighted significant concerns about a lack of ownership and accountability for financial management, what action Healthcare Improvement Scotland has taken to meet the requirements of its action plan and whether it considers that these are now being met.

The external review was conducted by the Chartered Institute of Public Finance and Accountancy (CIPFA) who made a number of recommendations to improve accountability for financial management within Healthcare Improvement Scotland (HIS). Key areas identified for action included: budgetary control procedures, financial management training for budget holders, clarifying senior management financial responsibilities and management focus on financial management. Progress with implementing the recommendations has been reported to the HIS Finance & Performance Committee (22August 2012) and to the HIS Audit Committee (14September 2012). The implementation of the revised financial procedures has been scrutinised by Internal Audit and found to be effective, albeit some operating adjustments have been recommended. A mid-year financial review and year end forecast was undertaken during October and the outcome is a forecast of financial balance for 2012-13. HIS continue to work closely with budget holders to improve budget management and to consider improvements to processes as necessary. Indications are that the action plan has improved awareness and accountability of financial management within the organisation and on this basis it is considered that the requirements of the action plan are being met.

Question reference: S4W-11050

Asked by: Jackie Baillie, MSP for Dumbarton, Scottish Labour
Date lodged: Monday, 12 November 2012
Current Status: Answered by Alex Neil on 22 November 2012

To ask the Scottish Government what its position is on the ability of NHS boards to meet savings plans for 2012-13, in light of the Audit Scotland report, NHS financial performance 2011/12, suggesting that eight had categorised 25% of their [2011-12] savings plans as high risk.

Based upon information provided by NHS Scotland boards, there is confidence that boards will once again deliver planned efficiency savings for 2012-13. NHS boards have agreed financial plans to deliver efficiency savings of £271.701million in the current year. At month 6 to 30 September 2012 (the mid year point), Boards remain on target to deliver the required level of savings.

Currently over 82% of savings are classed as either medium or low risk in terms of them being delivered. Efficiency savings do not reduce the overall budget of the NHS. All savings are retained locally by territorial Boards to allow them to reinvest in front-line services which directly benefit patients.

SGHSCD

Health Finance Division

Local Delivery Plan - Planned Efficiency Savings

NHS Territorial Boards	Value	Unidentified	High	Medium	Low
	£m	%	%	%	%
Ayrshire & Arran	13.094	0.00%	0.00%	13.98%	86.02%
Borders	5.904	0.00%	27.93%	30.05%	42.02%
Dumfries & Galloway	7.500	0.00%	11.27%	46.41%	42.32%
Fife	17.524	0.00%	32.01%	31.81%	36.17%
Forth Valley	11.944	5.86%	16.74%	28.69%	48.71%
Grampian	12.006	0.00%	0.00%	27.54%	72.46%
Greater Glasgow & Clyde	59.049	0.00%	7.79%	39.28%	52.94%
Highland	23.736	7.88%	12.43%	55.36%	24.33%
Lanarkshire	19.211	9.44%	2.95%	39.29%	48.32%
Lothian	37.540	12.89%	47.68%	15.82%	23.61%
Orkney	1.418	0.00%	8.82%	38.43%	52.75%
Shetland	2.671	20.97%	22.50%	20.52%	36.02%
Tayside	24.543	0.00%	32.80%	58.12%	9.09%
Western Isles	2.485	10.26%	17.67%	60.56%	11.51%
NHS Territorial Boards Total	238.625	4.21%	19.00%	36.07%	40.73%
NHS Special Health Boards
National Services Scotland	10.340	0.00%	0.00%	100.00%	0.00%
Scottish Ambulance Service	7.318	24.60%	0.00%	37.36%	38.04%
Education for Scotland	7.295	0.00%	0.00%	17.30%	82.70%
NHS 24	1.720	45.23%	0.00%	0.00%	54.77%
National Waiting Times Centre Board	2.305	0.00%	12.58%	43.21%	44.21%
The State Hospital	1.389	0.00%	0.00%	20.95%	79.05%
NHS Health Scotland	1.009	0.00%	0.00%	10.51%	89.49%
Healthcare Improvement Scotland	1.700	0.00%	15.47%	21.76%	62.76%
NHS Special Health Boards Total	33.076	7.79%	1.67%	48.67%	41.86%
Grand Total	271.701	4.64%	16.89%	37.61%	40.86%

SGHSCD

Health Finance Division

Position At Period 6 - Forecast Efficiency Savings

NHS Territorial Boards	Value	Unidentified	High	Medium	Low
	£m	%	%	%	%
Ayrshire & Arran	13.094	0.00%	1.15%	9.98%	88.87%
Borders	5.904	0.00%	8.53%	26.58%	64.89%
Dumfries & Galloway	7.500	0.00%	2.32%	33.03%	64.66%
Fife	17.524	0.00%	31.48%	32.71%	35.81%
Forth Valley	11.944	5.86%	16.73%	12.12%	65.29%
Grampian	12.006	0.00%	0.00%	88.70%	11.30%
Greater Glasgow & Clyde	59.049	0.17%	7.02%	28.52%	64.29%
Highland	23.736	3.50%	12.10%	56.95%	27.46%
Lanarkshire	19.211	0.00%	2.59%	37.06%	60.35%
Lothian	37.540	12.89%	45.27%	20.02%	21.82%
Orkney	1.418	0.00%	8.82%	30.78%	60.40%
Shetland	2.671	13.37%	29.94%	38.90%	17.80%
Tayside	24.543	0.00%	21.14%	42.65%	36.21%
Western Isles	2.340	0.00%	10.44%	11.24%	78.32%
NHS Territorial Boards Total	238.480	2.86%	16.44%	33.71%	46.99%
NHS Special Health Boards
National Services Scotland	10.181	0.00%	0.00%	31.38%	68.62%
Scottish Ambulance Service	7.318	1.37%	12.47%	12.88%	73.29%
Education for Scotland	7.295	0.00%	0.00%	0.00%	100.00%
NHS 24	1.720	13.02%	0.00%	0.00%	86.98%
National Waiting Times Centre Board	2.305	0.00%	12.60%	43.24%	44.16%
The State Hospital	1.389	0.00%	0.00%	0.00%	100.00%
NHS Health Scotland	1.009	0.00%	0.00%	0.00%	100.00%
Healthcare Improvement Scotland	1.700	0.00%	13.68%	9.12%	77.21%
NHS Special Health Boards Total	32.917	0.98%	4.36%	16.07%	78.59%
Grand Total	271.397	2.63%	14.98%	31.57%	50.82%

Question reference: S4W-11048

Asked by: Jackie Baillie, MSP for Dumbarton, Scottish Labour
Date lodged: Monday, 12 November 2012
Current Status: Answered by Alex Neil on 22 November 2012

To ask the Scottish Government what its position is on NHS Health Scotland spending £3.5 million, or 16% of its total revenue resource limit, "in the last few days" of 2011-12, as outlined in the Audit Scotland report, NHS financial performance 2011/12.

Firstly NHS Health Scotland, along with all NHS Scotland Health bodies met their financial targets for 2011-12 and they are on track to deliver their financial targets for 2012-13. In addition to successfully achieving their statutory targets, all NHS Scotland boards received unqualified opinions on the true and fair view of their financial statements, the regularity of income and expenditure and the parts of their remuneration reports subject to audit.

The NHS Health Scotland Auditors have also included the following statement in the 2011-12 Audit Report (para 15):

“We have issued an unqualified opinion on the regularity of transactions in the boards financial statements.”

Staff salaries and pay related costs are routinely made towards the end of the month for all NHS Scotland boards. Pay and pay related costs for NHS Health Scotland were in excess of £1.9million during March 2012. This was the main component of the £3.5million referred to in the question. In addition, payments to suppliers were made during March 2012 totalling £1.3million, the value of these was also weighted towards the end of the month.

The resource expenditure pattern of NHS Health Scotland is not even throughout the year. Historically the board has utilised a greater than average proportion of its expenditure in the last quarter of the financial year and particularly during the final month. This pattern of expenditure reflects, in part, the nature of the boards activities and the delivery of a wide range of project initiatives, many of which are developed in year, culminating towards the end of the financial year. Furthermore, to continue to improve performance in relation to meeting Scottish Government prompt payment guidelines, payments also increased, whilst ensuring no payments were made in advance of need.

Notwithstanding the above NHS Health Scotland recognises the need to continually assess and improve its financial performance and a number of improvement actions have been agreed and implemented during the current fiscal year (2012-13). These actions are intended to address budget phasing issues and reduce year end expenditure by delivering earlier in the year.

Question reference: S4W-11053

Asked by: Jackie Baillie, MSP for Dumbarton, Scottish Labour
Date lodged: Monday, 12 November 2012
Current Status: Answered by Alex Neil on 22 November 2012

To ask the Scottish Government how much the increased volume of prescribing outlined in the Audit Scotland report, NHS financial performance 2011/12, will cost each NHS board and what action is being taken to address the issue.

<>The Scottish Government collects anticipated percentage uplifts applied to GP prescribing and hospital drugs from NHS boards as part of the annual financial planning process. These percentage uplifts are not broken down between price and volume increases. The information requested is thus not held centrally by the Scottish Government. The Audit Scotland report NHS financial performance 2011-12 refers to prescribing volume assumptions collected by the Health and Sport Committee as part of the Committee’s review of NHS boards budget scrutiny (June 2012). A summary of the information provided by NHS boards is available on the Scottish Parliament website at http://www.scottish.parliament.uk/S4_HealthandSportCommittee/Inquiries/Dr_Andrew_Walker_NHS_Board_survey_responses.pdf

Prescribing costs are funded from NHS board baseline budget allocations provided by the Scottish Government. It is for NHS boards to determine how best to utilise baseline funding to meet the healthcare needs of their resident population. The NHS Scotland Efficiency and Productivity Framework for SR10, published in February 2011, sets out a programme of activities to improve quality and efficiency across NHS Scotland. The prescribing workstream supports NHS boards in identifying opportunities to improve the clinical quality of prescribing and to improve cost effectiveness of prescribing. Current activities of the workstream include a review of polypharmacy (the use of multiple medications by a patient) and a review of repeat prescriptions; these reviews aim to reduce the risk of harm to patients and further reduce wastage from medicines being dispensed to patients when they are not required.

Question reference: S4W-11052

Asked by: Jackie Baillie, MSP for Dumbarton, Scottish Labour
Date lodged: Monday, 12 November 2012
Current Status: Answered by Alex Neil on 22 November 2012

To ask the Scottish Government what assessment it has made of the number of outstanding equal pay claims in the NHS and the cost of settling these.

Question reference: S4W-11160

Asked by: Jackie Baillie, MSP for Dumbarton, Scottish Labour
Date lodged: Monday, 12 November 2012
Current Status: Answered by Alex Neil on 22 November 2012

To ask the Scottish Government whether it has carried out an assessment of who benefits most from free prescriptions and by how much.

Question reference: S4W-11021

Asked by: Jackie Baillie, MSP for Dumbarton, Scottish Labour
Date lodged: Thursday, 08 November 2012
Current Status: Answered by Michael Matheson on 22 November 2012

To ask the Scottish Government what mechanisms are in place to review care provided against the recommendations of Scottish Intercollegiate Guidelines Network (SIGN) guideline 123.

SCOTTISH PARLIAMENT

WRITTEN ANSWER

22 November 2012

Index Heading: Health and Social Care

Jackie Baillie (Dumbarton) (Scottish Labour): To ask the Scottish Government what mechanisms are in place to review care provided against the recommendations of Scottish Intercollegiate Guidelines Network guideline 123.

(S4W-11021)

Michael Matheson: Implementation of national clinical guidelines is the responsibility of each NHS board and is an essential part of clinical governance. Local mechanisms should therefore be in place to review care provided against guideline recommendations. The reasons for any differences should be assessed and addressed where appropriate. Local arrangements should then be made to implement the guideline in individual hospitals, units and practices.

NHS boards are expected to review services and facilities regularly to ensure they continue to reflect local needs and provide the best quality healthcare services.

The Scottish Society for Rheumatology’s web-based audit programme has also undertaken audit work which will inform the improvement of rheumatoid arthritis services. The final report from this work is expected to be published by April 2013.

Question reference: S4W-11059

Asked by: Jackie Baillie, MSP for Dumbarton, Scottish Labour
Date lodged: Thursday, 08 November 2012
Current Status: Answered by Michael Matheson on 22 November 2012

To ask the Scottish Government whether it will respond to the recommendations in the Scottish Diabetes Think Tank report, Diabetes in Scotland: A Transition to Better Care.

Question reference: S4W-11060

Asked by: Jackie Baillie, MSP for Dumbarton, Scottish Labour
Date lodged: Thursday, 08 November 2012
Current Status: Answered by Michael Matheson on 22 November 2012

To ask the Scottish Government how the transition for young people with diabetes from paediatric to adult services is delivered.

We expect that every NHS boards should ensure that appropriate local transitional arrangements are in place which meet the needs of their local population.

Transitional arrangements exist in every NHS board area and every NHS board area, where appropriate, now has joint clinics with representation from both adult and paediatric services.

SIGN Guideline 116 on the management of diabetes, published in 2010, noted the limited evidence on the different adolescent transition models.

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

Question reference: S4W-11066

Asked by: Jackie Baillie, MSP for Dumbarton, Scottish Labour
Date lodged: Thursday, 08 November 2012
Current Status: Answered by Michael Matheson on 22 November 2012

To ask the Scottish Government whether it has undertaken an audit of diabetes services in each NHS board area.

The annual Scottish Diabetes Survey produced by the Scottish Diabetes Survey Monitoring Group, provides a comprehensive account of the quality of diabetes care across the whole of Scotland. This year, the Survey includes charts that will enable each NHS board and diabetes managed clinical networks to quickly review and compare their local information. The latest published edition of the survey can be found at the following link:

http://www.diabetesinscotland.org.uk/Publications/SDS%202011.pdf

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