Chamber and committees

For the fiscal period 2011-12, nine NHS boards reported an underlying recurring deficit. For the same period, the combined underlying recurring deficit for NHS Scotland was £31.29million. For 2012-13 the number of boards reporting an underlying recurring deficit has reduced to seven; with the current combined forecast for NHS Scotland reduced to £16.68million.

The following table details the recurring surplus/deficit reported by NHS boards to Audit Scotland for 2011-12 (actual position) and projected for 2012-13. This information is contained within the Audit Scotland NHS financial performance 2011-12 report. For 2011-12 boards reported a combined underlying recurring deficit of £31.29million. The projection for 2012-13 previously reported to Audit Scotland is for the combined underlying recurring deficit to reduce to £15.04million.

The latest combined information reported by NHS boards to the Scottish Government Health and Social Care Directorates (SGHSCD) from the financial returns covering the period to 30 September 2012 is a forecast for 2012-13 of a recurring deficit of £16.68million (c0.17%).

NHS Fife has an agreed financial plan to achieve recurring financial balance by the end of 2013-14. In the context of an £11.6 billion health budget this is not considered to be a high risk area particularly when the forecast for 2012-13 is that the recurring deficit will substantially reduce from the previous year.

NHS boards’ diabetes services are responsible for ensuring young people with diabetes get access to the emotional and psychological support they need.

Our Diabetes Action Plan 2010 fully recognises the importance of improving the capacity and quality of emotional and psychological support available to people with diabetes of all ages. It states:

We want to improve the full spectrum of emotional and psychological support for people living with diabetes in Scotland through enhancing the skills of clinical staff and valuing the contribution of voluntary sector support, including peer support.

We are currently supporting a range of projects including the Psychology in Diabetes, Psychology and Diabetes project, which is running within six NHS boards. The project aims to implant psychological care within diabetes services, including two paediatric services, through training NHS staff to improve their skills in behaviour change and psychological support. This initiative provides the opportunity for

increased psychological support to people with diabetes;

integrated care across medical and psychological issues; and

building a skill base in diabetes within the psychology professions.

We are also working with Diabetes UK Scotland in the delivery of a national buddy coordinator project, which will help people with diabetes to access peer support.

The Scottish Government recognises the importance not only of transparency, but also of consistency of reporting and will provide guidance to NHS boards to further improve the consistency of board reporting in this area.

The NHS maintenance backlog figure of over £1 billion outlined in the Audit Scotland report covers properties that are to be retained and those designated as surplus for disposal. Around 20% of the current backlog maintenance expenditure requirement is in buildings which are classified as “non-clinical” and will thus have little impact on patient healthcare experience.

My officials are working with NHS boards to reduce the reported backlog maintenance through refurbishment, replacement, rationalisation and disposal of properties.

The scale of risk and associated backlog costs outlined in the Audit Scotland Report, NHS financial performance 2011-12 has been assessed as £194.8 million low risk, £272.3 million medium risk, £289.3 million Significant Risk, £252.5 million high risk.

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.

SIGN has also made tools, including a quick reference guide, an iPhone and android compatible smartphone application and widely disseminated audit criteria available to support NHS boards with implementation.

Our Diabetes Action Plan, published in 2010, highlights the importance of transitional care in supporting young people with diabetes to effectively manage their condition, and we expect every board to ensure that children are appropriately managed in the transition from paediatric to adult diabetes services.

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 coordinator visited each NHS board area in 2012 and has confirmed, with services, that transitional arrangement exist in every board area. In addition every NHS board area, where appropriate, now has joint clinics with representation from both adult and paediatric services.

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

In addition to the answer provided in S4W-11046 relating to brokerage, the Scottish Government Health and Social Care Directorates (SGHSCD) have the following arrangements in place:

Financial Support

NHS 24 is in the process of implementing a new information and telephony system required to further enhance its frontline services. The Scottish Government has agreed to provide transitional support to NHS 24 over the period 2011-12 to 2013-14 to enable upfront payment of implementation costs due under the contracts. This transitional support ensures that NHS 24 and NHS Scotland avoids financing charges which would be payable if these implementation costs were phased over the life of the contract and accelerates the realisation of contractual and service redesign savings arising from the new arrangements in a more cost effective way.

A repayment profile for this transitional support has been agreed with NHS 24 to reflect the realisation of savings arising from the new contracts. This profile is incorporated into the boards’ approved financial plan.

Reprofiling of NRAC Funding:NHS Lothian has estimated the total cost of delivering additional waiting times activity during 2012-13 at £20million. The funding source has been secured with £10million being provided internally by NHS Lothian and the remaining £10million being provided by the Scottish Government Health and Social Care Directorates with this requiring to be repaid and off-set against future NRAC (NHS Scotland Resource Allocation Committee) allocations over the next two financial years (2013-14 and 2014-15).

We fully recognise the important role that technology can play in supporting the care of people with diabetes. This is reflected in our investment of £2.5 million in insulin pump technology earlier this year. We have also invested £115,000 in the “MyDiabetesMyWay” online tool which connects people with diabetes to their clinical data online.

We expect local NHS boards diabetes to take full advantage of new health technologies to benefit people with diabetes once they have demonstrated that they are clinically and cost effective.

NHS boards are supported by well established, robust advice mechanisms, including the Scottish Health Technologies Group, to help ensure that people with diabetes get appropriate access to new treatments.

There are four NHS boards that have a brokerage arrangement and associated repayment schedule in place. These are summarised as follows:

NHS Western Isles received brokerage in 2008-09 to enable the cumulative deficit built up over a four year period between 2003-04 and 2006-07 (inclusive) to be cleared following section 22 reports from the Auditor General for Scotland and the work of the Parliament’s Public Audit Committee. The Scottish Governments Health & Social Care Directorates (SGHSCD) provided brokerage after agreeing a financial recovery plan with the board. Following an intended payment holiday of three years, NHS Western Isles commenced repayment a year early in 2011-12 with an accelerated payment of £0.631million. This positive action has reduced the boards’ liability in future years.

The provision of financial support is offered as an enabler to deliver financial balance and allows NHS Orkney to move forward with plans for the future, including a strengthened health and social care model and redesigned acute services.

NHS Forth Valley has a specific set of circumstances which have led to the provision of brokerage to support achievement of a balanced financial position. SGHSCD engaged with the board to deliver a package of tailored support during 2011-12. SGHSCD received robust assurances in the form of an agreed financial recovery plan from the board that the provision of funding in advance would deliver in-year financial balance in 2011-12 and recurring balance from 2012-13 onwards. In 2011-12 the board was required to implement significant operational and strategic change, including completion and transfer of services to the new Forth Valley Royal Hospital at Larbert and continuation of multi-site working. The brokerage repayment arrangement has been agreed based upon future capital receipts.

NHS Fife has a specific set of circumstances including transitional costs associated with the transfer of services to the new Victoria Hospital which opened in October 2011. Following a period of tailored support, NHS Fife delivered a balanced financial position in 2011-12 and has an agreed financial plan to achieve recurring financial balance by the end of 2013-14. In terms of financial support arrangements in place not defined as brokerage, I refer the member to the answer to question S4W-11045 on 22 November 2012. 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.

I refer the member to the answer to question S4W–11040 on 22 November 2012. 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.