CHAPTER 11: HEALTH AND WELLBEING
The Health and Wellbeing portfolio is responsible for developing and running effective policies and programmes that:
- protect and improve the health of people in Scotland;
- tackle health inequalities;
- promote equality, and tackle discrimination, prejudice and disadvantage;
- provide high quality health care and social care services, person-centred and close to home;
- promote social inclusion and reduce poverty;
- increase the supply of good quality, affordable housing and prevent and tackle homelessness;
- regenerate communities; and
- promote physical activity and participation and success in sport.
These policies and programmes support the achievement of our objective for a healthier Scotland, promoting greater wellbeing among all those living in Scotland. They also underpin the delivery of other programmes across portfolios to promote equality and to tackle poverty, disadvantage, discrimination and prejudice.
SUMMARY OF KEY SPENDING PRIORITIES FOR HEALTH AND WELLBEING PORTFOLIO
The Health and Wellbeing portfolio is responsible for public spending totalling £11.2 billion in 2008-09. This represents £2,200 for every person living in Scotland. The cost of running the NHS for 2008-09 will be approximately £10.6 billion. Around 70 per cent of this goes on staff salaries - the NHS employs 150,000 people and is the biggest single employer in the country. A further 12 per cent goes on prescription drugs, covering products dispensed in community pharmacies and hospitals. The remainder of the NHS budget goes into buildings and associated running costs, medical equipment and supplies, and IT. As well as treating patients, this spending on the NHS also supports people to improve their health and prevent illness, and so contributes to reducing inequalities.
The Health and Wellbeing portfolio will also improve the supply of good quality, affordable housing and help create successful and sustainable communities across Scotland.
Portfolio investment to reduce health inequalities includes the Keep Well programme to: help strengthen primary care services in the most deprived areas; promote equality and tackle discrimination; promote sport and sporting success; regenerate communities; and promote social inclusion. These are very important in terms of achieving our Strategic Objectives overall, and so these policies influence priorities within other programmes and add value over and above what is achieved through direct spending.
Chapters 17 and 27 set out the local government responsibilities for delivering national priorities and services relating to the Health and Wellbeing portfolio, through tackling inequalities, providing support for the elderly and tailored services for families and children; and supporting healthier, more active lives, including in particular:
- improving outcomes for frail older people and family carers by investing in care home quality, increasing free personal care payments and significantly extending respite and other carer support.
We have commissioned Lord Sutherland, who chaired the original Royal Commission on the Long-term Care of Older People, to undertake an independent review of funding provided to local government to implement the Free Personal and Nursing Care policy. Lord Sutherland's review is due to report in March 2008 and we will consider the findings in detail.
Our priorities for the Health and Wellbeing portfolio from 2008-09 to 2010-11 are briefly described below. More detail about spending plans is given in table 11.01 and in chapter 21.
Improving health and better public health
We attach high priority to actions to improve health and prevent illness, as part of the outcome of increasing people's healthy life expectancy. This is reflected in our spending plans for a number of programmes aimed at:
- reducing the harm done by misuse of alcohol (£20.1m/£30.1m/£35.1m);
- introducing immunisation to reduce the risk of cervical cancer (£18.0m/£18.5m/£27.5m);
- enhancing national screening programmes to help detect potentially serious illness early and to target anticipatory treatment (£16.3m/£14.2m/£10.8m);
- reducing smoking (£3.0m/£3.0m/£3.0m);
- actions to help people, especially children, tackle obesity in support of our diet and physical activity strategies (£11.5m/£11.5m/£11.5m); and
- improved access to independent sexual health information and advice in rural as well as urban areas (£0.5m/£0.5m/£0.5m).
Reducing inequalities and tackling disadvantage
Reducing health inequalities is critical to meeting the government's objective of a healthier Scotland. Resources will be targeted to those communities most at risk of poor health. There is a range of programmes and projects that target inequalities and aim to improve life chances for the most disadvantaged, such as those that address:
- increasing the supply of good quality sustainable housing (£430.0m/£507.8m/£533.2m);
- poverty and deprivation through Community Planning Partnerships to help more people overcome barriers and get back into work - resources are included in the local government settlement;
- violence against women and hate crimes;
- the promotion of equality and the reduction of discrimination and prejudice;
- cross-cutting and innovative approaches to tackle poverty and disadvantage (£8.5m/£9.0m/£11.0m);
- the strengthening of primary health care services in the most deprived areas of Scotland, identifying people at particular risk of preventable, serious ill health (£12.5m/£12.5m/£12.5m);
- early years support with targeted help for those most in need (£1.0m/£3.0m/£3.0m) with additional resources to extend school-based health services for this group; and
- sporting opportunities, including planning and delivering programmes to attract and retain non-participants with particular focus on hard to reach groups.
In addition, NHS Boards, local authorities, and their Community Planning Partners, including the third sector spend money to provide a wide range of programmes and projects that help improve health, provide opportunities for people to keep healthy, help reduce inequalities, and promote social inclusion. This expenditure is not always separately identifiable. We expect NHS Boards, local authorities and other partners to work closely together - through Community Planning Partnerships - to maximise the health improvement impact of all their activity and to give priority to reducing poverty and inequalities and regenerating our most deprived communities.
Our commitment to progressing equality and tackling discrimination, as well as our programmes for housing, regeneration and social inclusion, are key to achieving a healthier Scotland as well as our other Strategic Objectives.
Accessible, responsive and person-centred services
As explained in chapter 5, people expect health and social care services and related services, such as early years and employability services provided by local authorities, NHS Boards and their Community Planning Partners, to be responsive and to offer high quality. They do not expect to wait a long time to access services and they expect them to be person-centred. This means services that are available as quickly as possible, at times that suit service users as well as those providing the services, and in a manner that responds to the needs of all users, including the most vulnerable. It also means reducing financial and other barriers to accessing services. NHS Boards will continue to work to shift the balance of healthcare into communities to improve accessibility and to ensure that the right balance is achieved. Further work on getting this right will flow from our consultation on Better Health, Better Care, which ended on 12 November 2007.
Programmes and projects aimed at improving accessibility and responding better to the life circumstances of all users include:
- supporting the NHS to achieve a maximum wait of 18 weeks from being referred to a hospital consultant until treatment begins for routine patients, by the end of 2011 (£90.0m/£90.0m/£90.0m);
- flexible access to primary care to help make services more accessible, especially to working people so that they do not need to take time off work to see their GP (£10.0m/£10.0m/£10.0m);
- a new screening programme to detect MRSA in hospital patients at admission, and a continuation of work to prevent the spread of infection, reduce serious illness, and release hospital resources for use by other patients (£12.0m/£21.0m/£21.0m);
- investment in specialist children's services including cancer care and high dependency facilities, and services for chronically ill children including cystic fibrosis patients (£2.0m/£10.0m/£20.0m);
- phasing out prescription charges for those who still pay them (£20.0m/£32.0m/£45.0m) and providing free eye tests for everyone (£27.0m/£29.0m/£31.0m);
- improving wheelchair and seating services (£4.0m/£6.0m/£6.0m);
- developing a one stop shop for social care information - improving access by helping people understand their options (£0.5m/£0.3m/£0.3m); and
- offering the right support to people who want to enter, remain in or re-enter employment, working with Community Planning Partners and supported by the unified fund to tackle poverty and deprivation.
People also expect health and social care services to be modern, convenient, effective, and to anticipate changes in demands - for example as the number of older people increases. Programmes and projects aimed at supporting local authorities, NHS Boards and their Community Planning Partners to achieve this include:
- preparing for a flu pandemic by building up the pandemic flu vaccine stockpile;
- better access to NHS Dental Services, particularly for children, through the introduction of a prevention-based school dental service, starting in the most deprived areas, and an expansion of the dental work force through the establishment of a third dental school for Scotland in Aberdeen (£4.5m/£6.0m/£9.0m);
- continuing to invest over £500 million annually in the training and development of existing and potential NHS staff;
- expanding support for carers, including carer training and local carer centres (£1.0m/£3.0m/£5.0m); and
- providing over £0.5 billion a year to fund major new developments including:
- the new children's hospital and development of the new Southern Hospital in Glasgow;
- improvements at existing hospitals across Scotland including Aberdeen Royal Infirmary, Borders General Hospital, Raigmore in Inverness and Dumfries and Galloway Royal Infirmary;
- improvements in mental health services, including the redevelopment of the State Hospital and reprovision of services currently provided at the Royal Edinburgh Hospital, as well as the development of new acute and community-based services in Dumfries and Galloway;
- replacement of medical equipment;
- the eHealth programme, which will improve patient safety and clinical outcomes, ensuring that systems are designed to reflect the needs of patients, clinicians, managers and other users; and
- primary care and dental infrastructure.
Sport and the Commonwealth Games
Funding from the Health and Wellbeing portfolio will support delivery of our priority goals for sport in Scotland: increasing participation; improving sporting performance; and creating a legacy through major events such as the Olympic and Paralympic Games and Commonwealth Games. Funding for sport in Scotland will be £47.4m/£53.9m/£54.9m.
Following Glasgow's successful bid to host the Commonwealth Games in 2014, the Scottish Government is working in partnership with Glasgow City Council and the Commonwealth Games Council for Scotland to turn the 2014 Games into a resounding success. Funding for successful delivery of the Commonwealth Games up to 2010-11 is £4.1m/£6.6m/£11.6m.
Table 11.01 Spending Plans 2008-11
2008-09 Draft Budget £m
2009-10 Plans £m
2010-11 Plans £m
Housing and Regeneration
Food Standards Agency