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Scotland's Spending Plans and Draft Budget 2016-17

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Chapter 4 Health, Wellbeing and Sport

PORTFOLIO RESPONSIBILITIES

The Health, Wellbeing and Sport portfolio is responsible for helping the people of Scotland maintain and improve their health and wellbeing.

The Scottish Government is committed to high-quality services for the people of Scotland, as set out in our 2020 Vision for Health and Social Care. These services contribute directly to growth in the Scottish economy by ensuring that the people of Scotland can live longer, healthier lives in the community. That is why we are holding a national conversation on what a healthier Scotland should look like in the next 10‑15 years and how people in Scotland can be supported to be as healthy as they can be, increasing the number of people who receive all of their care at home and never require a hospital admission. Where people need acute care in hospital, we aim for day surgery to be the norm whenever possible. When hospital stays must be longer we aim for people to be discharged as swiftly as it is safe for them to do so. Our services focus on prevention and early intervention, with significant investment in world-class research and development in medical/life sciences technology and innovation.

Quality is ensured by a relentless focus on improvement.

OUR PRIORITIES

Our health and social care systems must continue to evolve to meet the changing needs of the people of Scotland. The formal integration of health and social care in 2016 is one of the key pillars of our action to improve Scotland’s public health record. Our investment in health and social care supports actions to help address health inequalities, support our ageing population, in the context of more people living with multiple conditions, and the availability of new drugs, treatments and technologies.

These priorities are being delivered against the backdrop of the UK Government cutting the Scottish Government’s fiscal DEL budget in real terms by 12.5 per cent between 2010-11 and 2019-20.

This level of cut being imposed on the Scottish Government means that with increasing demand for services, our first priority is to invest in frontline services across health and social care. Our commitment to protect and enhance the frontline NHS resource budget in 2016‑17 remains firmly in place. By contrast with the UK Government we see health and social care as parts of the same interdependent system, and so, through this budget, we will protect both NHS and social care spending. This approach ensures we can tackle Scotland’s entrenched health inequalities.

Health Wellbeing and Sport investment is at record levels, exceeding £13 billion for the first time.

NHS Territorial Boards will receive a 5.5% uplift. This will include a £250 million investment to be directed to Health and Social Care partnerships, to ensure improved outcomes in social care.

We will also prioritise investment in transforming healthcare services to meet the needs of the future and to ensure delivery of our 2020 Vision. We will protect resource to support creativity and transformation and will invest £30 million specifically to support the transformational change agenda.

This year we will also invest £45 million in improvements to primary and community care. Our investment will support the development of new models of care – where multidisciplinary teams of nurses, doctors, pharmacists, Allied Health Professionals and other clinicians, as well as social care specialists, work together to meet the needs of their communities.

We will develop plans to establish six diagnostic and treatment centres across Scotland. These centres – based on the successful Golden Jubilee model – will allow us to meet the increasing demand for hip and knee replacements and cataract operations, to pick some of the most common procedures. Dedicated elective capacity will help tackle the knock-on effect that peaks in demand from unscheduled, emergency patients can have on planned, elective care.

Cancer remains an important priority and we will invest in improving diagnosis and treatment within the framework of our new cancer plan for Scotland that we will publish in 2016.

To confirm our commitment to prevention, and knowing that prevention must begin in the earliest years, the Scottish Government is investing record levels of funding over the four years to 2018, to increase the health visitor workforce by 500. This will ensure NHSScotland has the right levels of staff to provide universal visits and developmental reviews for children.

In funding NHS Boards, we will focus on delivering strategic priorities such as reducing health inequalities, by creating a new Outcomes Framework of over £200 million for in-year funding. This will empower Boards by giving greater local flexibility on decisions on how to maximise the value from this resource against clearly defined outcomes.

Further improvement on the quality of the care

  • Integrate Health and Social Care – this will transform the planning and delivery of health and care services, improving quality and consistency, in order to improve outcomes. We will go further than the current annual investment of £130 million in the Integrated Care and Delayed Discharge Funds – by investing an additional £250 million per year through Health and Social Care partnerships to support the delivery of improved outcomes in social care. Integration will mean fewer people need to go to hospital to receive care, but where that is necessary and appropriate that they spend less time in hospital and are more likely to return home quickly, improving their outcomes, their experience of care and the sustainability of the system. We will work with Health and Social Care Partnerships to reduce the number of people delayed in hospital, when clinically ready to be discharged, developing innovative ways of providing care, including housing-based solutions and increased use of intermediate care, such as step‑down beds. We will also better utilise data and commissioning to deliver services that meet the needs of the growing population of people with longer-term and often complex needs, many of whom are older.
  • Develop the role of Primary and Community Care – Primary and Community Care is where most healthcare interactions begin and end and we aim to have as many people as possible receiving care at home or in a homely-setting. To that end, we are working with GPs and other health practitioners to transform primary and community care through testing new models of general practice care such as practice ‘clusters’, as well as testing new models of out-of-hours urgent care, reflecting the findings of Sir Lewis Ritchie’s 2015 Review. This will inform the development of the new Scottish GP contract due to be in place by April 2017, with a sharper focus on tackling inequalities. We are also working with the BMA’s Scottish General Practitioners Committee (SGPC) to dismantle the Quality and Outcomes Framework (QOF) in preparation for the new contract in 2017, with transitional arrangements being developed for 2016-17. This will reduce bureaucracy further for GPs, freeing up more GP time to focus on patient care.
  • Improve services for people with mental health conditions – by investing an additional £50 million over five years to take funding for mental health services innovation and development to £150 million over that period. The enhanced £150 million of investment will help develop new models of managing mental health problems in Primary Care, improve child and adolescent mental health (CAMHS) services, and bring down waiting times. There will be increased access to specialist services, and developments in person-centred care and treatment that do not treat mental and physical health in isolation of each other.
  • Continue the drive to improve elective care performance to deliver sustainable waiting times standards – we will develop plans to establish six Diagnostic and Treatment Centres across Scotland to address the changing demographics of the nation over the next 25 years, particularly the growing number of people living into old age and very old age.
  • Publish a palliative and end of life care strategic framework – this will set out actions to deliver palliative and end of life care that improves the quality of life of those for all who are facing problems associated with life-shortening illness.
  • Publish a new cancer plan – focusing on all aspects of cancer care and treatment, from prevention through earlier diagnosis and treatment, care after treatment, research and intelligence to underpin and drive improved outcomes for patients.
  • Continue to improve safety in all healthcare environments – building on the world-leading success of the Scottish Patient Safety Programme. We will continue the extension of this approach in Primary Care, maternity services, paediatrics, mental health, dentistry and medicines.
  • Reduce healthcare associated infection (HAI) and antimicrobial prescribing and progress implementation of the National Falls Programme – we will protect the public and raise standards by strengthening professional regulation including supporting and implementing the Nursing and Midwifery Council’s revalidation process for nurses and midwives.
  • Work with NHS Boards to roll out a national approach to supporting and assuring excellence in nursing and midwifery care – building on existing good practice, we will develop clear standards and support strong clinical leadership, to get staffing right through our workload and workforce planning tools and to ensure every nurse and midwife gets the support and training they need.
  • Continue to prioritise person-centred care – learn from feedback to drive improvement, ensuring the voice of lived experience informs everything we do through our work on ‘Our Voice’ and the NHS feedback and complaints procedure. Supported self-management and self-directed support will be promoted, ensuring that people have the skills, knowledge, confidence and understanding to be the lead partners in their health and wellbeing.
  • Improve our approach to supporting and improving outcomes for people with multiple conditions, including mental health conditions – through more productive interactions and effective collaborative care and support planning conversations, supported by enabling technology.
  • Enhance support for improvement across health and care through the creation of a new Integration Improvement Resource – we will bring together a range of currently disparate improvement expertise within Healthcare Improvement Scotland. This Integration resource will provide responsive support to NHS Boards and local partnerships to improve health and social care outcomes for people across Scotland.
  • Implement our five-year strategy to improve outcomes from Out of Hospital Cardiac Arrest (OHCA) so that Scotland becomes a world leader in the management of OHCA – so that by 2020 we will equip an additional 500,000 people with CPR skills and save 1,000 additional lives.
  • Establish and develop the role of an Independent National Whistleblowing Officer (INO) – to provide an independent and external level of review on the handling of whistleblowing cases.

Improving the health of the population

  • We know that ill-health can be founded in the earliest years, and we must tackle it there, at source. We will reinforce the Early Years Collaborative model, continuing to drive improvement across all public partners involved in a child’s early years. We will align these efforts with the Maternity and Children Quality Improvement and Raising Attainment for All Collaboratives, to boost impact and efficiency. We will continue to develop the Family Nurse Partnership programme. We will also increase our investment in Health Visiting to ensure we retain our focus on the ambition to make Scotland the best place for children to grow up.
  • We will refocus our efforts on health inequalities particularly in the context of benefits cuts from the UK Government which will directly impact those most at risk of ill-health. We will target improvement resources into Primary and Community Care in the most deprived areas of Scotland.
  • Despite significant improvement in recent years, Scotland continues to have a poor record of healthy life expectancy and bear the costs associated with the resulting disease burden. We will continue to pursue a preventative agenda in partnership across the public sector, concentrating on tackling Scotland’s relationship with alcohol, reducing tobacco-related harm by significantly reducing smoking rates, and in increasing levels of physical activity, including through sport, and improving oral health.

Securing the value and financial sustainability of the health and social care services

  • We will establish a vision for the health and social care workforce for 2020, setting out a clear plan of actions which have immediate effect. We will continue to support the development and application of our ground-breaking Nursing and Midwifery Workload and Workforce planning tools.
  • NHSScotland will work more efficiently whilst continuing to deliver improved quality. Our ‘Framework for Quality, Efficiency and Value’ sets out a range of approaches that Boards can utilise to realise this aspiration. We will continue to provide support to boards and will, additionally, facilitate the further spread of good practice through a ‘Once for Scotland’ programme of work.
  • The Scottish Government is fully committed to continued investment in NHS Scotland infrastructure, which support high-quality health and social care services as well as contributing to the growth in the Scottish economy. Investment in Capital and Infrastructure will enable the following during 2016-17:
    • Continuing focus on the maintenance of our NHS estate and equipment replacement, providing £155 million of investment in these areas.
    • NPD programme (£215 million) – will progress four strategic new facilities: the Royal Hospital for Sick Children in Edinburgh; the Dumfries and Galloway Royal Infirmary; the new Scottish National Blood Transfusion Service Centre; and the replacement Balfour Hospital in Orkney.
    • Monklands Hospital Theatres and Critical Care (£6 million) – will continue the refurbishment and upgrade of the theatres and intensive care unit at Monklands District General Hospital.
    • University Hospitals Ayr and Crosshouse (£9 million) – will provide safe, effective and person-centred urgent and emergency care in NHS Ayrshire and Arran.
    • Radiotherapy Equipment Replacement (£8 million) – will provide funding to ensure timely upgrades and replacements of radiotherapy equipment.

Table 4.01: Spending Plans (Level 2)

Level 2 2015-16 Draft Budget £m 2015-16 Budget £m 2016-17 Draft Budget £m
Health 12,161.1 12,288.5 12,977.2
of which:
NHS Territorial Boards 8,561.6 8,626.6 9,102.3
NHS Special Boards 1,064.0 1,064.1 1,099.7
Community Health Services 1,369.6 1,372.7 1,463.3
Departmental Allocations 1,165.9 1,225.1 1,311.9
Sport 71.8 71.8 45.8
Food Standards Scotland 15.7 15.7 15.3
Total Level 2 12,248.6 12,376.0 13,038.3
of which:
DEL Resource 11,927.5 12,047.5 12,443.8
DEL Capital 219.1 226.5 489.5
Financial Transactions 2.0 2.0 5.0
AME 100.0 100.0 100.0

Table 4.02: Spending Plans (Level 2 Real Terms) at 2015-16 prices

Level 2 2015-16 Draft Budget £m 2015-16 Budget £m 2016-17 Draft Budget £m
Health 12,161.1 12,288.5 12,760.3
of which:
NHS Territorial Boards 8,561.6 8,626.6 8,950.1
NHS Special Boards 1,064.0 1,064.1 1,081.3
Community Health Services 1,369.6 1,372.7 1,438.9
Departmental Allocations 1,165.9 1,225.1 1,290.1
Sport 71.8 71.8 45.0
Food Standards Scotland 15.7 15.7 15.0
Total Level 2 12,248.6 12,376.0 12,820.4
of which:
DEL Resource 11,927.5 12,047.5 12,235.9
DEL Capital 219.1 226.5 481.3
Financial Transactions 2.0 2.0 4.9
AME 100.0 100.0 98.3

Health

Table 4.03: More Detailed Spending Plans (Level 3)

Level 3 2015-16
Budget
£m
2016-17 Draft Budget £m
Resource
NHS Territorial Boards 8,626.6 9,102.3
NHS Special Boards 1,064.1 1,099.7
Community Health Services1
General Medical Services 709.6 735.1
Pharmaceutical Services Contractors' Remuneration 177.7 180.9
General Dental Services 392.4 401.3
General Ophthalmic Services 93.0 101.0
Primary Care Fund - 45.0
Departmental Allocations
Outcomes Framework 230.4 216.5
Transformational Change Fund 0.0 30.0
Workforce and Nursing 154.0 153.6
Health Improvement and Health Inequalities 83.3 89.9
Care and Caring 17.4 72.7
Immunisations 28.9 31.0
Mental Health Improvement and Service Delivery 22.5 38.2
Integration Fund² 113.5 -
Research 28.5 30.0
Distinction Awards 19.4 14.4
Access, Quality and Improvement 59.3 58.7
eHealth 9.9 13.7
New Medicines Fund 40.0 90.0
PPRS Rebate Income (40.0) (90.0)
Miscellaneous Other Services³ 160.4 68.1
Care Inspectorate 21.7 21.7
Resource Income (126.5) (139.1)
Funding transferred to Boards4 38.4 -
Provision for Transfer to Health Capital 47.5 -
Revenue Consequences of NPD Schemes 14.0 18.0
Total Resource5 11,986.0 12,382.7
Capital
Investment 221.4 510.4
Financial Transactions 2.0 5.0
Income (20.9) (20.9)
Total Capital 202.5 494.5
Annually Managed Expenditure
NHS Impairments 100.0 100.0
Total Health 12,288.5 12,977.2
of which:
DEL Resource 11,986.0 12,382.7
DEL Capital 200.5 489.5
Financial Transactions 2.0 5.0
AME 100.0 100.0

Notes:

1. Allocations for 2016-17 for Primary and Community Care Services are still to be decided and are subject to UK pay negotiations with the professional groups concerned.

2. In 2016/17 all funding for Integration is now transferred to Board baselines on a recurring basis.

3. This includes an efficiency savings target in 2016/17.

4. Funding for projects which are now fully operational and therefore the funding has been transferred to Boards.

5. To assist with comparisons, the 2015/16 figures have been restated for a number of departmental allocations to reflect the new Outcomes Framework approach in 2016/17.

Sport

Table 4.04: More Detailed Spending Plans (Level 3)

Level 3 2015-16 Budget £m 2016-17 Draft Budget £m
Sport and Legacy 68.5 42.5
Physical Activity 3.3 3.3
Total 71.8 45.8
DEL Resource 45.8 45.8
DEL Capital 26.0 -

Table 4.05: Territorial and Special Health Boards Spending Plans (Level 4)

Level 4 2015-16 Budget £m 2016-17 Draft Budget £m
Territorial Boards
NHS Ayrshire and Arran 635.5 669.0
NHS Borders 184.1 194.0
NHS Dumfries and Galloway 265.8 279.4
NHS Fife 574.8 604.3
NHS Forth Valley 461.5 485.3
NHS Grampian 827.4 867.2
NHS Greater Glasgow and Clyde 1,975.4 2,078.9
NHS Highland 550.0 576.5
NHS Lanarkshire 1,051.7 1,106.8
NHS Lothian 1,225.7 1,289.7
NHS Orkney 41.3 43.1
NHS Shetland 40.7 42.6
NHS Tayside 660.9 699.2
NHS Western Isles 63.7 66.6
NRAC Parity Funding - 30.0
Total 8,558.5 9,032.6
Special Boards
NHS Waiting Times Centre 46.0 46.5
NHS Scottish Ambulance Service 212.1 218.5
NHS National Services Scotland 283.3 293.4
Healthcare Improvement Scotland 15.2 15.5
NHS State Hospital 34.2 34.3
NHS 24 62.7 64.6
NHS Education for Scotland 392.6 408.7
NHS Health Scotland 18.0 18.2
Total 1,064.1 1,099.7
Other Income 68.1 69.7
Total Territorial and Special Boards 9,690.7 10,202.1

What the budget does

The budget provides services to help people in Scotland to live longer and healthier lives, with reduced health inequalities and to provide more sustainable, high-quality and continually improving health and care services close to home.

NHS Boards provide free and universal frontline healthcare services for patients and their families. They work alongside Health and Social Care Partnerships to deliver seamless health and care services. NHS Boards will continue to build on their recent achievements in order to deliver quality healthcare services. Through their Local Delivery Plans and as part of the strategic commissioning plans within the integration arrangements, NHS Boards will demonstrate how they will work in partnership to deliver accelerated improvements for key priorities, such as tackling health inequalities and improving outcomes for patients and service users.

In 2016-17 we will:

  • invest £250 million in Health and Social Care partnerships, to ensure improved outcomes in social care. This is in addition to the £130 million Integrated Care and Delayed Discharge Funds;
  • develop new models of Primary and Community Care in general practice and in out-of-hours and develop a new Scottish GP contract, begin to dismantle the Quality and Outcomes Framework (QOF) and transfer its funding for GPs into the Global Sum. Support will also be provided for dental and optometrist teams in their vital work on oral and eye health, and work with pharmacists to deliver Prescription for Excellence;
  • support NHS Boards to deliver elective and unscheduled waiting times targets and guarantees to ensure patients are able to access NHS services;
  • continue the Detect Cancer Early programme focusing on breast, bowel and lung cancer to contribute to improvement in survival outcomes;
  • continue to support enhanced access to specialist nursing and care, including specialist support for individuals with Motor Neurone Disease;
  • improve services and outcomes for people with heart disease, stroke, cancer, diabetes, rare diseases and other long-term conditions through our focus on the whole patient pathway, earlier referral, speedier diagnosis and clinically effective treatments and follow up;
  • through Independent Living Fund Scotland (ILF Scotland), continue to deliver payments of ILF support to severely disabled people, to enable them to live independently in the community;
  • develop a more person-centred complaints process for NHSScotland, focused on improvement as a result of learning from feedback;
  • support people to be able to manage their own mental health and continue to focus on prevention and anticipation through attention to early years, parenting and child and adolescent mental health;
  • improve the quality of life for those with dementia and their carers and families, with a continuing focus on diagnosis and post-diagnostic support and care in all settings, including general hospitals;
  • take forward the measures set out in our Strategy for a Tobacco-Free Generation, to reduce smoking rates to less than 5 per cent by 2034. We will do this by supporting young people to choose not to smoke, protecting people from second-hand smoke and supporting those who do plan to quit smoking;
  • refresh the package of measures, including minimum unit pricing, which make up ‘Changing Scotland’s Relationship with Alcohol: a Framework for Action’, and which tackle the harms associated with alcohol; and
  • continue to develop Scotland’s world-class system for sport, focused on increased participation and improved performance; investing in world-class facilities including a National Performance Centre for Sport and a National Para-sport Centre, which will both be completed in 2016; reduce inequalities and encourage greater equality of opportunity in relation to participation in sport and physical activity; and enhance the role of community sport.

Food Standards Scotland

Table 4.06: More Detailed Spending Plans (Level 3)

Level 3 2015-16 Budget £m 2016-17 Draft Budget £m
Food Safety 10.7 10.3
Eating for Health 3.0 3.0
Choice (making it easier for consumers to make
informed choices)
2.0 2.0
Total 15.7 15.3
of which:
DEL Resource 15.7 15.3
DEL Capital - -
AME - -

What the budget does

Food Standards Scotland’s (FSS) primary concern is consumer protection – making sure that food is safe to eat, ensuring consumers know what they are eating and improving nutrition. With that in mind, its vision is to deliver a food and drink environment in Scotland that benefits, protects and is trusted by consumers.

The objectives of FSS as set out in the Food (Scotland) Act 2015 are to:

  • protect the public from risks which may arise in connection with the consumption of food;
  • improve the extent to which members of the public have diets which are conducive to good health; and
  • protect the other interests of consumers in relation to food.

In 2016-17 FSS will launch its first strategy to 2021 which will set out its vision and outline the key activities that it will undertake to move towards this vision, by using an outcomes based approach. Those outcomes will ensure:

  • food is safe and authentic;
  • consumers choose healthier diets;
  • responsible food business flourish; and
  • FSS is recognised as a trusted organisation.