Scotland's Budget: Draft Budget 2017-2018

Chapter 4 Health and Sport

PORTFOLIO RESPONSIBILITIES

The Health and Sport portfolio is responsible for helping the population maintain and improve their health and wellbeing. It is crucial for the people of Scotland to know that the NHS will be there for them when they need it. The services provided also contribute directly to growth in the Scottish economy by supporting people to live longer, healthier lives.

The Scottish Government is committed to high quality services, with a focus on prevention and early intervention. Where people need hospital care, our aim is for day surgery to be the norm, and when stays must be longer, our aim is for people to be discharged as swiftly as it is safe to do so.

Our forthcoming delivery plan will set out our programme to further enhance health and social care services. It will bring together our planned reforms, including the integration of health and social care, the National Clinical Strategy, regional service, financial and workforce planning, along with our work on population health and primary care.

OUR PRIORITIES

We have established a record of providing high quality healthcare. Our focus on quality and improvement remains at the heart of everything we do in the NHS, but our health and social care systems must continually evolve to meet the changing needs of our people - to help address health inequalities and improve the health of the population.

Like other healthcare systems around the world, we face the challenge of an ageing population, with people living with multiple conditions, and expectations arising from new drugs, treatments and technologies. This is why our twin approach of investment and reform of health and social care services is absolutely crucial.

In 2017-18 we will deliver an above inflation increase to the Health and Sport portfolio, against a backdrop of Scotland's fiscal DEL budget being reduced by 9.2 per cent in real terms by the UK Government between 2010 and 2020. We will use this funding uplift to support frontline delivery, and implement our delivery plan.

Our commitment to invest in our NHS remains firmly in place, with NHS Board budgets increasing by in excess of £300 million in 2017-18. This will include additional investment of over £100 million to be directed to Integration Authorities, which will deliver our commitment on the Living Wage and support sustainability in the care sector.

We will also increase the share of the frontline NHS budget being invested in primary care, community care, social care, and mental health in the coming year, and throughout this Parliament. This supports our efforts to prioritise investment which focuses on prevention and early intervention, to ensure the realisation of our 2020 Vision.

To ensure that public resources are used as effectively as possible and to help meet increasing demand and deliver reform, we have established a Sustainability and Value Programme to maximise the benefit from efficiency and productivity savings. These savings will be reinvested in frontline health and care services, supporting the shift in the balance of care towards our Community Health Service.

Further Improvement on the Quality of the Care

We have broken down administrative barriers by creating 31 Integration Authorities to deliver adult health and social care services directly in the communities where people live. In 2017-18 this will be supported by £107 million of additional NHS investment in Integration Authorities to support the delivery of improved outcomes in social care and will deliver the Living Wage for social care workers. NHS contributions to Integration Authorities will be maintained at, at least, 2016-17 cash levels.

We will address the challenge of reducing admissions, length of stay and people delayed in hospital when clinically ready to be discharged, in partnership with Integration Authorities. We will further develop innovative ways of providing care, including housing-based solutions and increased use of intermediate care, such as step-down beds. We will also continue to prioritise more effective and efficient use of resources, through better use of data and commissioning, to deliver services that meet the needs of a growing population with longer-term and often complex needs.

In 2017-18, we will invest £72 million in improvements to primary care and GP services, going towards an additional £500 million being invested in this area each year by the end of this Parliament. This commitment will mean that by 2021-22, for the first time, more than half of the NHS frontline spending will be in our Community Health Service.

Primary and Community Care is where most healthcare interactions begin and end and our aim is 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 care and GP services, including support for more multi-disciplinary teams working with GPs. We will invest £10 million to implement the recommendations of the National Review of Primary Care Out of Hours Services.

By investing an additional £150 million over the next five years in improving mental health provision we will help to reduce the inequalities of access and support experienced by people with mental ill-health. This forms part of shifting the balance of spend towards preventing people from becoming ill and supporting people to manage their own conditions and stay well. As part of this, we are investing £10 million to provide new models of support in primary care settings, and £4.2 million to develop community support for people in distress.

By increasing the share of the frontline budget being invested in mental health in each year of this Parliament, we will help deliver person-centred care and treatment and improve services and support for children and young people. This commitment means that in 2017-18, investment in mental health will exceed £1 billion for the first time and will see mental health investment exceed £5 billion over this Parliament. This will help underpin our new 10 year Mental Health Strategy, which will be firmly based on the principles of 'ask once, get help fast'.

We will take forward the National Clinical Strategy by implementing a range of actions to support the improvement of primary, community and hospital services. Specifically, in 2017-18 we will strengthen population-based planning arrangements for hospital services, and we will undertake an analysis of unwarranted variation in intervention rates across Scotland and publish an Atlas of Variation. From this clear evidence base, we will ensure NHS Boards take effective, appropriate action.

We will continue to progress our £200 million commitment to expand the Golden Jubilee Hospital and create five elective care centres in Aberdeen, Dundee, Edinburgh, Inverness and Livingston. This will, for example, allow us to meet the increasing demand for hip and knee replacements and cataract operations. Dedicated elective capacity will help tackle the knock-on effect that peaks in demand from unscheduled, emergency patients can have on planned, elective care.

We will continue to implement our cancer strategy and, over the next five years, £100 million will be invested to enhance cancer services, improving outcomes, and reducing inequalities, as well as promoting greater consistency of access to treatment across the country.

Preparatory work in relation to the creation of the new National Trauma Network will be completed. This work is based on a four centre model - in Aberdeen, Dundee, Edinburgh and Glasgow. Following completion of this preparatory work, timescales for full implementation will be agreed.

We will enhance our commitment to nursing and midwifery in Scotland by setting out a delivery plan to create an additional 1,000 training places in this Parliament. We are also investing £3 million over five years to train an additional 500 advanced nurse practitioners, with the first intake beginning training in 2017.

We will train 1,000 new paramedics over the next five years, beginning with 200 this year and including 50 specialist paramedics with enhanced skills to work in the community, helping to reduce pressure on accident and emergency services. We will also recruit up to 250 community link workers during the lifetime of this Parliament to work in GP practices, with at least 40 being recruited in the coming year.

Improving the health of the population

Getting it Right for Every Child is key to Scotland's future and we will bring together health, social care and education to build on the good work already underway to produce a Child and Adolescent Health and Wellbeing Strategy that will set the direction for the next 10 years.

In 2017-18 we will provide an additional £2 million to further expand access to in vitro fertilisation ( IVF) treatment. Couples with children in the home, but where one partner does not have a biological child, are now able to access fertility treatment and the number of available cycles on the NHS will be increased from two to three during 2017‑18.

Despite significant improvement in recent years, Scotland continues to have a poor record of healthy life expectancy and bears the costs associated with the resulting disease burden. We will continue to pursue a preventive agenda, beginning in the earliest years and 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. We will develop a new dental action plan following the analysis of the results of the consultation on the future of oral health.

We will consult on a new strategy on diet and obesity. This will include support for those at high risk of, or recently diagnosed with, type 2 diabetes, and families with young children. We will create a new national outcome for diabetes - this will support progress in addressing type 2 diabetes. We will also support those people with type 1 diabetes needing an insulin pump through investment of £2 million in 2017-18.

An extra £20 million will be invested over the next three years to increase the financial support provided to people affected by infected NHS blood and blood products. A new Scottish scheme will be introduced in 2017 to support those who are infected with Hepatitis C and/or HIV and their families.

The £13.5 million In Care Survivor Support Fund will be used over the next five years with survivors of child abuse in Scotland and the services that support them to expand and enhance existing survivor support. It will offer survivors personalised care and treatment based on their individual needs, aspirations and personal goals.

Securing the Value and Financial Sustainability of the Health and Care Services

We are looking ahead to what NHSScotland and the wider health and social care sector will need from its workforce in the future, taking account of demographic challenges presented by an ageing and part-time workforce, changes in technology, patient demographics and available resources. We will continue to promote NHSScotland as an attractive place to work, providing a sustainable career option for graduates and a destination where school leavers have a variety of career options available. We will also continue our work to ensure that staff from across the EU working in Scotland's health and care sector have their rights and their place in our nation protected.

We will continue to maintain free tuition for nursing and midwifery students, retain the nursing and midwifery student bursary at least at its current level and ensure additional support is provided to students to enable wider participation and increased retention, including through the £1 million discretionary fund.

We will provide support to Boards in delivering services more efficiently and will, additionally, facilitate the further spread of good practice through the Sustainability and Value Programme.

We remain fully committed to continued investment in NHSScotland's infrastructure, which enables our NHS to provide high quality, innovative health and social care services as well as contributing to the growth in the Scottish economy.

There will be continued focus on improving primary care facilities, maintaining the NHS estate, replacing and updating medical equipment, refreshing information management and technology and replacing key vehicles such as ambulances, providing over £200 million of investment in these areas. In addition the following capital projects will be prioritised:

• The £274 million new Dumfries and Galloway Royal Infirmary will become operational in March 2018. This new state of the art facility has single bedded en-suite rooms for 344 patients and includes a combined assessment unit, theatres complex, critical care unit, women's and children's unit and outpatients department.
• £230 million project to deliver the new Sick Children's Hospital and Department of Clinical Neurosciences in Edinburgh. This project will bring together services from the Royal Hospital for Sick Children, Child and Adolescent Mental Health Service and the Department of Clinical Neurosciences in a single building adjoining the Royal Infirmary of Edinburgh at Little France.
• £145 million Baird Family Hospital and the ANCHOR Centre in Aberdeen. The Baird Hospital will provide maternity, gynaecology and breast screening services while the ANCHOR Centre will provide outpatient and day-patient treatment for patients with cancer and blood disorders.

Table 4.01: Spending Plans (Level 2)

Level 2	2016-17 Draft Budget £m	2016-17 Budget £m	2017-18 Draft Budget £m
Health	12,977.2	12,900.7	13,168.2
Of which:
NHS Territorial Boards	9,102.3	9,102.3	9,354.6
NHS Special Boards	1,099.7	1,099.7	1,168.6
Community Health Services	1,513.8	1,518.7	1,574.1
Departmental Allocations	1,261.4	1,180.0	1,070.9
Sport	45.8	45.6	42.4
Food Standards Scotland	15.3	15.3	15.3
Total Level 2	13,038.3	12,961.6	13,225.9
of which:
DEL Resource	12,413.8	12,329.9	12,717.8
DEL Capital	519.5	528.5	408.1
Financial Transactions	5.0	3.2	-
AME	100.0	100.0	100.0

Table 4.02: Spending Plans (Level 2 Real Terms) at 2016-17 prices

Level 2	2016-17 Draft Budget £m	2016-17 Budget £m	2017-18 Draft Budget £m
Health	12,977.2	12,900.7	12,979.6
Of which:
NHS Territorial Boards	9,102.3	9,102.3	9,220.7
NHS Special Boards	1,099.7	1,099.7	1,151.8
Community Health Services	1,513.8	1,518.7	1,551.6
Departmental Allocations	1,261.4	1,180.0	1,055.5
Sport	45.8	45.6	41.8
Food Standards Scotland	15.3	15.3	15.1
Total Level 2	13,038.3	12,961.6	13,036.5
of which:
DEL Resource	12,413.8	12,329.9	12,535.6
DEL Capital	519.5	528.5	402.3
Financial Transactions	5.0	3.2	-
AME	100.0	100.0	98.6

Health

Table 4.03: More Detailed Spending Plans (Level 3)

Level 3	2016-17 Draft Budget £m	2016-17 Budget £m	2017-18 Draft Budget £m
Resource
NHS Territorial Boards	9,102.3	9,102.3	9,354.6
NHS Special Boards	1,099.7	1,099.7	1,168.6
Community Health Services*
General Medical Services	783.0	786.5	821.4
Pharmaceutical Services Contractors' Remuneration	184.2	184.8	184.5
General Dental Services	407.1	408.9	414.0
General Ophthalmic Services	100.0	101.0	102.0
Mental Health Services	39.5	37.5	52.2
Departmental Allocations
Outcomes Framework	200.1	160.6	137.1
Transformational Change Fund	10.0	10.0	25.0
Workforce and Nursing	171.1	112.6	176.4
Health Improvement and Protection**	103.4	100.2	46.1
Care, Support and Rights	111.2	97.7	112.2
Early Years	41.5	19.6	49.6
Performance and Delivery	86.4	93.0	87.2
Quality and Governance	30.9	22.1	23.7
Miscellaneous Other Services and Resource Income	(135.7)	(76.0)	(124.3)
Revenue Consequences of NPD Schemes	18.0	18.0	29.8
Total Resource	12,352.7	12,278.5	12,660.1
Capital
Investment	540.4	539.9	428.1
Financial Transactions	5.0	3.2	-
Income	(20.9)	(20.9)	(20.0)
Total Capital	524.5	522.2	408.1
Annually Managed Expenditure
NHS Impairments	100.0	100.0	100.0
Total Health	12,977.2	12,900.7	13,168.2
of which:
DEL Resource	12,352.7	12,278.5	12,660.1
DEL Capital	519.5	519.0	408.1
Financial Transactions	5.0	3.2	-
AME	100.0	100.0	100.0

* Allocations for 2017-18 for Primary and Community Care Services are still to be decided and are subject to UK pay negotiations with the professional groups concerned. These budget lines do not reflect the community health spend included within NHS Board baselines.

** This budget line does not included £53.8 million that is being transferred to NHS Board baselines in 2017-18 for expenditure on Alcohol and Drug Partnerships.

Table 4.04: Territorial and Special Health Boards Spending Plans (Level 4)

Level 4	2016-17 Draft Budget £m	2016-17 Budget £m	2017-18 Draft Budget £m
Territorial Boards
NHS Ayrshire and Arran	669.0	669.0	682.1
NHS Borders	194.0	194.0	197.7
NHS Dumfries and Galloway	279.4	279.4	284.9
NHS Fife	604.3	604.3	616.2
NHS Forth Valley	485.3	485.3	494.7
NHS Grampian	867.2	867.2	899.4
NHS Greater Glasgow and Clyde	2,078.9	2,078.9	2,123.3
NHS Highland	576.5	576.5	591.8
NHS Lanarkshire	1,106.8	1,106.8	1,129.9
NHS Lothian	1,289.7	1,289.7	1,336.9
NHS Orkney	43.1	43.1	46.7
NHS Shetland	42.6	42.6	46.5
NHS Tayside	699.2	699.2	713.4
NHS Western Isles	66.6	66.6	71.6
NRAC Parity Funding	30.0	30.0	50.0
Total	9,032.6	9,032.6	9,285.1
Special Boards
NHS Waiting Times Centre	46.5	46.5	51.9
NHS Scottish Ambulance Service	218.5	218.5	229.3
NHS National Services Scotland	293.4	293.4	324.7
Healthcare Improvement Scotland	15.5	15.5	24.7
NHS State Hospital	34.3	34.3	34.4
NHS 24	64.6	64.6	65.2
NHS Education for Scotland	408.7	408.7	420.0
NHS Health Scotland	18.2	18.2	18.4
Total	1,099.7	1,099.7	1,168.6
Other Income	69.7	69.7	69.5
Total Territorial and Special Boards	10,202.1	10,202.1	10,523.2
Delivery Plan Funding that will be allocated to Boards in-year*			128.0
Total Investment			10,651.2

* This represents funding included within Level 3 budgets that will be allocated to Boards in year to support the delivery of service reform.

The health resource budget will increase by almost £2 billion by the end of this Parliament, by which time at least 50 per cent of spending will be in our Community Health Service. In contributing to this commitment, this draft budget for 2017-18 allocates funding towards mental health, primary, community and social care at a rate which is higher than the overall increase to the NHS frontline budget. Investment in primary care will be delivered through budget increases to General Medical Services and associated budget lines which support the wider primary care team. Investment in mental health as set out in this budget will be added to the existing investment which will take mental health spending to over £1 billion in 2017-18 for the first time.

Health & Social Care Integration

We are integrating health and social care, bringing together NHS and local government services to deliver joined-up care and support that better meets the needs of Scotland's growing population of people whose needs are complex, many of whom are older. In one of the most significant reforms of public services since the NHS was set up in 1948, the Public Bodies (Joint Working) (Scotland) Act 2014 came into effect on 1 April 2016, establishing 31 Health and Social Care Partnerships whose responsibility it is to ensure health and social care services are planned and delivered jointly, to help maximise local people's wellbeing. By bringing together health and social care, and making best use of their combined resources, the new Partnerships are empowered to give real focus to preventative and anticipatory care, helping people to maintain their independence and wellbeing for as long as possible.

Integration is already changing the way key services are delivered, with greater emphasis on supporting people in their own homes and communities and less inappropriate use of hospitals and care homes. It is about ensuring people have access to the right care, at the right time, in the right place - too often, older people, and other people who have complex needs, are admitted to institutional care for long periods when a package of assessment, treatment, rehabilitation and support in the community, and help for their carers, would be better.

With the investment in this Draft Budget, including the additional £107 million in social care - almost £500 million in total - Integration Authorities have real power to address these challenges, managing more than £8 billion of resources that NHS Boards and local authorities previously managed separately. This is more than 50 per cent of territorial NHS Board expenditure and more than 80 per cent of local authority social care expenditure.

As our approach to integration enters its second year, we are providing practical as well as financial support to these Integration Authorities, so that they are well equipped to deliver services that respond effectively to the priorities of communities, based on real understanding of local needs.

What the budget does

The budget provides services to help people in Scotland to live longer and healthier lives, with a focus on early intervention and prevention and reducing health inequalities and the provision of more sustainable, high quality and continually-improving health and care services close to home.

NHS Boards provide free and universal frontline healthcare services for people and their families. They work alongside Integration Authorities to deliver seamless health and care services. Through Local Delivery Plans and as part of the strategic commissioning plans within the integrated 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 personal outcomes.

In 2017-18 we will:

• invest £107 million in Integration Authorities, to ensure improved outcomes in social care. This builds upon the £250 million included in the 2016‑17 budget for investment in Social Care, along with the £100 million Integrated Care Fund and £30 million delayed discharge fund, bringing the total additional support available for Health and Social Care Integration from the NHS to £487 million;
• support the development of more new models of Primary and Community Care in general practice and in out-of-hours, including in relation to provision of mental health services, begin to introduce 'Improving Together' for quality in GP clusters as a replacement to the Quality Outcomes Framework ( QOF), support 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. Early indicators suggest that the programme is already delivering benefits;
• 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, continue to deliver payments of ILF support to severely disabled people, to enable them to live independently in the community;
• 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;
• continue to focus on Getting it Right for Every Child with more effective and widespread early intervention, better cooperation among professionals and a holistic approach to addressing a child's wellbeing;
• continue to improve the quality of life for those with dementia and their carers and families, building on the first Dementia Strategy by now working to deliver the second strategy, with a continuing focus on diagnosis and post-diagnostic support and care in all settings, including general hospitals. Funding for dementia is drawn from the overall funds allocated to NHSScotland and local authorities;
• continue to pursue and 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;
• continue to tackle the damaging impact of drugs in Scotland and make recovery a reality for individuals, families and communities affected by drugs through our national drugs strategy. The Minister-led Partnership for Action on Drugs in Scotland will continue to progress actions to reduce problem drug use, complementing the work of the strategy, with particular focus on improving quality, reducing harm and building communities; and
• continue to invest in research and development infrastructure and capacity building, supporting vital collaborative working between the NHS, academia, industry and the medical research charities and deepening Scotland's global reputation as a destination of choice for health science.

Sport

Table 4.05: More Detailed Spending Plans (Level 3)

Level 3	2016-17 Draft Budget £m	2016-17 Budget £m	2017-18 Draft Budget £m
Sport and Legacy	42.5	42.3	39.1
Physical Activity	3.3	3.3	3.3
Total	45.8	45.6	42.4
DEL Resource	45.8	36.1	42.4*
DEL Capital	-	9.5	-

* This total of £42.4 million includes an indicative £9.5 million which was used as capital grants in 2016-17. Any requirement for this funding will be confirmed prior to the Budget (Scotland) Bill 2017-18.

What the budget does

Our vision is of a Scotland where more people are more active, more often. The Active Scotland Outcomes Framework sets out our ambitions for achieving that, and is underpinned by a commitment to equality.

Over the course of this Parliament, the number of Community Sports Hubs will be increased from 150 to 200 by 2020, targeting areas of deprivation to ensure everyone has the opportunity to lead an active lifestyle. The new National Performance Centre for Sport and Scotland's first fully inclusive para-sports facility will be complemented by a network of regional sports centres around the country with a mixture of facilities for both community and elite use so that more people can fulfil their sporting potential.

To encourage the removal of barriers to participation in sport, including those for women and the LGBTI community, an Equality in Sport and Physical Activity Forum will be established and an annual £300,000 Gender Equality in Sport fund implemented to address the barriers specific to women's participation.

In 2017-18 we will:

• build on our success in getting Scotland more active through continued support for walking and developing a world-class sporting system for everyone in Scotland, focused on increased participation and improved performance;
• reduce inequalities and encourage greater equality of opportunity in relation to participation in sport and physical activity; and
• enhance the role of community sport and give due recognition to community involvement and support.

Food Standards Scotland

Table 4.06: More Detailed Spending Plans (Level 3)

Level 3	2016-17 Draft Budget £m	2016-17 Budget £m	2017-18 Draft Budget £m
Food Safety	10.3	10.3	10.3
Eating for Health	3.0	3.0	3.0
Choice (making it easier for consumers to make informed choices)	2.0	2.0	2.0
Total	15.3	15.3	15.3
of which:
DEL Resource	15.3	15.3	15.3
DEL Capital	-	-	-
AME	-	-	-

What the budget does

Food Standards Scotland's 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 Food Standards Scotland 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 Food Standards Scotland launched its first strategy, setting out the high-level direction for the next five years. In 2017-18, this strategy will be delivered through a corporate plan outlining the priorities and key activities to be taken forward using an outcomes based approach. Those outcomes will ensure:

• food is safe and authentic;
• consumers have healthier diets;
• responsible food businesses flourish;
• Food Standards Scotland is a trusted organisation; and
• Food Standards Scotland is efficient and effective.