Scottish Spending Review 2011 and Draft Budget 2012-13

Chapter 7 Health, Well being and Cities

PORTFOLIO RESPONSIBILITIES

The Health, Wellbeing and Cities portfolio is responsible for helping people to maintain and improve their health, especially in disadvantaged communities, and for delivering high quality healthcare. Our remit also includes tackling discrimination; promoting equality and sport; and working collaboratively with our cities to optimise their contribution to Scotland.

SUPPORTING RECOVERY AND INCREASING SUSTAINABLE ECONOMIC GROWTH

Good mental and physical health and wellbeing is vital for individuals to participate fully in economic and social life. Investment in health improves the productivity of the individual and economic participation in general, and is also likely to support greater flexibility in the workplace and adaptability to changes at work.

Although healthy life expectancy is improving in Scotland, poor health is still one of the main factors for early retirement or for not working. Poor health and health behaviours have a cost to the economy through reduced productivity, absenteeism, unemployment and premature mortality.

The healthcare sector also contributes to economic growth through its significant investment in world-leading health-related research and development in medical and life sciences technology.

NHSScotland takes a robust approach to promoting productivity and efficiency improvements in the delivery of health services. The programme of work for the period 2011-15 is outlined in the February 2011 publication NHSScotland Efficiency and Productivity Framework for SR10. Pursuit of the ultimate aim for NHSScotland to be a world leader in healthcare quality will be the longer term means by which maximum productivity and efficiency is achieved in all Scotland's health and care services.

We recognise the importance of sport to Scotland. Direct sports-related consumer spending alone amounts to over £1 billion a year and accounts for over 51,000 jobs. The portfolio's lead role in supporting the 2014 Commonwealth Games will stimulate investment of over £1 billion in infrastructure for Games venues and associated transport networks and support an estimated 1,200 jobs across Scotland. The Games will bring particular benefits to the East End of Glasgow, where the injection of housing development and supporting infrastructure will promote sustainable economic growth. More broadly, our support for this and other major sporting events will create jobs and boost the tourism industry.

OUR NATIONAL OUTCOMES

The policies, activities and expenditure of the Health, Wellbeing and Cities portfolio contribute to all of our National Outcomes and Programme for Government objectives. Among the most significant are:

• we live longer, healthier lives;
• our children have the best start in life and are ready to succeed;
• we have tackled significant inequalities in Scottish society;
• we have improved the life chances for children, young people and families at risk;
• we have strong, resilient and supportive communities, where people take responsibility for their own actions and how they affect others; and
• our public services are of high quality, continually improving, efficient and responsive to local people's needs.

The portfolio makes the most significant contribution to ensuring that the people of Scotland live longer, healthier lives by providing high quality health and social care and by focusing on prevention and early intervention to reduce key health risk drivers of premature mortality, such as alcohol misuse, smoking, mental illness and poor mental wellbeing.

Our health and social care services provide a vast range of high quality services that improve the quality of life for many older people. The portfolio has a major role to play in achieving our aim to ensure older people in Scotland are valued, their voices are heard and older people are supported to enjoy full and positive lives in their own home or in a homely setting.

The portfolio has an important role to play in tackling the significant inequalities in Scottish society through building on the success of the Keep Well Programme. We will also promote equality and fair treatment by promoting equality across our healthcare services, and will support NHS Boards in tackling discrimination, prejudice and the barriers to equality of opportunity.

The portfolio also has a significant contribution to make in improving the life chances for children, young people and families at risk, including support for preventative measures focusing on the early years, maternity care, parenting support, education and learning support, employability services, drugs and alcohol services, community policing and services targeted at particular groups such as looked after children, offenders and children affected by domestic abuse.

OUR ACHIEVEMENTS

Health

We have made a significant contribution to the marked reductions in mortality rates from the three big killers - cancer, heart disease and stroke. Between 1995 and 2010, there has been a 60 per cent decrease in premature mortality from Coronary Heart Disease (CHD), a 54 per cent decrease from stroke and a 22 per cent decrease from cancer.

We have ensured greatly improved access to services through significant reductions in maximum waiting times standards. Waiting times standards for a first outpatient consultation following a GP or dentist referral and for inpatient and day case treatment have reduced from 6 months to 12 weeks for a first outpatient consultation and 9 weeks for inpatient and day case treatment. A new standard of six weeks for diagnostic tests has been introduced for the eight key diagnostic tests, such as MRI and CT scans. We have accelerated access to cancer treatment to 31 days from decision to treat to first treatment and ensured that urgently referred patients who present with a suspicion of cancer begin their treatment within 62 days.

We have removed the unfair tax on ill health with the abolition of prescription charges from 1 April 2011. This will ensure that cost is not a barrier to those needing to take the medication prescribed to them.

We have implemented the first phase of the Family Nurse Partnership programme in Lothian and Tayside. The programme improves maternal health, child health and development and the economic self sufficiency of families, and it is our intention to roll it out across Scotland.

Improvements in safety in our hospitals have resulted in a 7 per cent reduction in hospital standardised mortality rates since 2007.

Rates of both Clostridium difficile and Staphylococcus aureus bacteraemia (which include MRSA) in Scottish hospitals are now at their lowest ever levels, according to the latest report published on 6 July 2011 by Health Protection Scotland. By ensuring clinicians engage with the prescribing agenda, a near 20 per cent reduction across primary care has been achieved in the use of antibacterials associated with a higher risk of Clostridium difficile. We established the Healthcare Environment Inspectorate to scrutinise the healthcare environment and promote greater public confidence in health services. We tripled funding to tackle healthcare acquired infection (HAI) from

£15 million to over £50 million over the three years 2008-11 and continue to fund and support a range of targeted HAI initiatives, including:

• the introduction of new minimum national MRSA screening policy across NHSScotland to be implemented by April 2012;
• the employment of key infection control and cleaning personnel; and
• a national zero-tolerance policy to non-hand hygiene compliance by NHS staff.

We have introduced the Patient Rights (Scotland) Act 2011 to improve patients' experience of using health services and to support people to become more involved in their health and healthcare.

From 2007 to July 2011, the initial Keep Well programme of inequalities-targeted health checks has successfully engaged more 113,000 people. Local outcomes of reductions in blood pressure, cholesterol and of people quitting smoking as a result of the programme are very positive and will lead to a reduction in cardiovascular mortality and morbidity.

On smoking, we acted decisively by increasing the age of purchasing tobacco from 16 to 18 on 1 October 2007. In May 2008, we launched a smoking prevention action plan, Scotland's Future is Smoke Free, which set out an ambitious programme of measures designed specifically to prevent smoking among children and young people.

This led to new statutory controls on the sale and display of tobacco, including bans on tobacco displays in shops and sales from vending machines. We have invested record sums in smoking cessation measures.

We have backed our radical action on alcohol misuse with a record £155 million investment in prevention, treatment and support services. This, along with our reform of local Alcohol and Drug Partnerships, is significantly improving services to those in need. Through the alcohol brief interventions programme, NHS Boards have delivered over 174,000 interventions to help people to reduce their risk of developing alcohol problems and requiring services in the future.

Improvements in care for people with long-term conditions have resulted in a significant reduction in the rates of emergency bed days in hospital for people aged over 65. The latest figures suggest that, in 2009-10, over 125,000 bed days for people aged over 65 have been avoided as a result of these improvements.

We introduced a new Change Fund which enhanced the partnership approach to delivering joined up services across health and social care, providing £70 million across Scotland for investment in new and improved ways of working and delivery of higher quality, more sustainable services.

We secured the delivery of Free Personal Care by providing an extra £40 million a year, agreeing with COSLA a fair and consistent approach to the delivery of Free Personal Care across the country. This will continue to improve the lives of older people and their carers.

We began the implementation of the planned 25 per cent reduction of management staff in the NHS by 2014-15 and achieved a reduction of 8.1 per cent in 2010-11.

Nurse agency spend reduced from £25 million in 2005-06 to £4.1 million in 2010-11, a reduction of approximately 84 per cent.

We introduced pilot Health Board elections to the boards of NHS Dumfries and NHS Galloway and NHS Fife in June 2010. We believe that having elected representatives on NHS Boards will ensure that the views of local people are heard at the highest level and acted upon. An independent evaluation is currently taking place into the impact of these and we expect this to be completed in autumn 2012. It will be for the Scottish Parliament to decide if elections should roll out to all Health Boards.

We were at the forefront of the successful UK-wide response to the H1N1 flu pandemic. Measures we took included an effective vaccination programme, with higher uptake rates than in other parts of the UK, a doubling of critical care capacity, and the establishment of the Scottish Flu Response Centre within NHS 24 which reduced pressures in primary care and was a vital source of information for the Scottish public.

We launched NHS Inform in August 2010. With almost half a million people accessing the site and well over 1.5 million page views in the first 12 months, NHS Inform has become Scotland's most trusted source of quality assured health information for the public.

We have met the dental health targets for Primary 1 and Primary 7 children. The target was that 60 per cent of these children should have no obvious decay. In addition, we have improved access to dental services, and the level of the Scottish population registered with a dentist under NHS arrangements as at June 2011 now stands at around 3.9 million, an increase of 1.2 million since March 2007. The number of dentists (headcount) providing general dental services as at March 2011 is 2,940, an increase of 466 since March 2007.

We published Scotland's first ever dementia strategy and are making good progress towards meeting the national target to increase the number of people registered with a diagnosis of dementia. We have now published a set of dementia standards, which will be used to ensure that support and care for people with dementia and their carers consistently reaches the high standards we all expect and deserve.

We made considerable progress in improving the quality of care, compassion and respect for people at the end of their lives by implementing Living and Dying Well - a national action plan for palliative and end of life care in Scotland. We published a follow-up report, Building on Progress, which described the positive impact of the implementation of the action plan, and highlighted further areas for improvement.

We have launched Shaping Bereavement Care - a framework for action for the development and delivery of quality bereavement care services within NHSScotland. The booklet When Someone Has Died has also been developed to support Health Boards in implementing a number of the proposals in Shaping Bereavement Care.

We have invested £2 million per year since 2009 to deliver faster access to specialist Child and Adolescent Mental Health Services (CAMHS) in the community. We have also invested £6.5 million over 2009-12 in the CAMHS workforce, which has seen the overall clinical workforce increase by 33 per cent since 2008. A strengthened target will ensure that by 2013 no one will wait longer than 26 weeks from referral to treatment for specialist CAMH Services.

We provided funding, through the Survivor Scotland National Strategy, to develop a range of support services for adult survivors of childhood abuse to improve their health and wellbeing and reduce the burden on health and social care services - in particular GP, mental health and addiction services. We piloted a Confidential Committee, Time to be Heard, to provide a forum for people who were abused in institutions during their childhood to recount their experiences and make submissions in confidence.

In the past year, NHS Research Scotland (NRS) has delivered major efficiencies for both non-commercial researchers and industry, with study start-up approvals times reduced to 20 working days. This is now attracting significant pharmaceutical industry interest in research in Scotland. In partnership with colleagues in industry, we are now trialling new ways to improve patient recruitment to trials.

In recognition of the important role that the life sciences sector plays in improving Scotland's economic performance in today's knowledge-based economy, we have published the MedTech Roadmap - a practical guide for industry to introducing new technologies to NHSScotland.

Sport

We were successful in our bid to host the 2014 Commonwealth Games. In our drive to improve Scotland's level of participation in sport, we have started to roll out community sport hubs throughout Scotland, building on the 35 we have already identified to ensure there are 100 by 2014.

We have made considerable investment in upgrading and developing Scotland's sporting facilities infrastructure. Since 2007, we have invested over £33 million through sportscotland in direct support to projects across Scotland, as we believe that sport has the potential to significantly transform lives in every community. This has delivered

12 new and upgraded swimming pools and 23 football pitches, including 9 new 3G all weather pitches. We have also developed new training facilities, such as a new Sports Village in Aberdeen, the Peak Centre in Stirling and new state -of-the-art sporting facilities at Ravenscraig in Motherwell. We are supporting the development of new competition venues, such as the Commonwealth Swimming Pool, Scotstoun Stadium and a new National Indoor Sports Arena and velodrome in Glasgow.

Equalities

We introduced the Forced Marriage etc. (Protection and Jurisdiction) (Scotland) Act 2011 which will provide civil remedies for those at risk of forced marriages and for victims of forced marriage.

We have ensured the maintenance of a large programme of work and provision to tackle violence against women across Scotland and delivered a national programme to assist children and young people experiencing domestic abuse.

We have made significant investment in a range of equality activity and programmes to tackle the barriers to equality of opportunity, promoted equality and supported communities.

We have developed a One Scotland toolkit and resource for schools and communities to help develop local anti-racism campaigns.

We have established a shared vision around Independent Living for disabled people.

We have made real progress in the co-ordination and implementation of work around Lesbian, Gay, Bisexual and Transgender (LGBT) equality.

We published Belief in Dialogue, a good practice guide to promoting inter-faith relations.

We have continued to support the integration of asylum seekers and refugees.

MANAGING PRESSURES AND CUTS IN PUBLIC EXPENDITURE

The scale of the real terms total reduction in the Scottish Government budget for 2012-13 to 2014-15 has required tough decisions to be taken about expenditure across government and careful consideration of pressures and priorities in all portfolios. However, the health budget has received the full health revenue Barnett consequentials over this period - £249 million towards its resource budget in 2012-13, £293 million in 2013-14 and £284 million in 2014-15. This has lifted the resource budget by 2.3 per cent to more than £11.0 billion in 2012-13. Notwithstanding the increase in NHS funding, issues such as the ageing population, new technology and the cost of drugs means that the NHS will still face considerable budget pressures. These pressures mean that the NHS will need to deliver maximum value from our investment through a focus on improving the quality of care by prioritising changes which also deliver greater efficiencies. Even after recognising the resource Barnett Consequentials arising from the Department of Health's 2010 UK Spending Review settlement, there will require to be an ongoing focus on delivering efficiency savings and increasing productivity building on past success. These savings will continue to be retained by NHS Boards for reinvestment in frontline services.

As a result of substantial reductions in the overall Scottish Government capital budget the health capital budget will also reduce over the Spending Review period. However, key projects such as the New South Glasgow Hospitals have been secured. In addition, the Scottish Government is delivering a number of initiatives to ensure that available capital resources are utilised as effectively as possible. The Frameworks Scotland national construction framework and the hub Initiative will ensure efficient delivery of new and refurbished buildings. Work has commenced to develop new collaborative approaches for the procurement of major items of medical equipment. In addition to the capital budget, the delivery of a £750 million pipeline of projects through the Non-Profit Distributing model together with the hub initiative will allow key projects to be developed and delivered across the Spending Review period and beyond.

OUR PRIORITIES

The Health, Wellbeing and Cities portfolio will be responsible for public spending totalling £11.7 billion in 2012-13. Funding allocated to healthcare will be £11.6 billion, of which Territorial Boards and Special Boards will receive a core allocation of £8.8 billion. £73.7 million will be allocated to Sport, including Commonwealth Games 2014, £20.3 million to Equalities and £10.9 million to the Food Standards Agency.

Our total healthcare funding in 2012-13 of £11.6 billion reflects an increase of £214.3 million. This comprises Annually Managed Expenditure of £100 million, net capital funding of £453.5 million and resource funding of £11.0 billion. Resource funding has increased by £249 million in 2012-13, from £10,780.5 million to £11,029.5 million. This is the full amount of the budget consequentials arising from the increase to health spending in England and delivers on the Scottish Government's commitment to pass on the resource budget consequentials in full to NHSScotland.

Building on the firm foundations established over recent years, and reflecting the set of healthcare quality outcomes which have been established for Scotland, our key priorities for health from 2012-13 onwards will be:

• to continue to protect the most vulnerable people in our society through early intervention, by ensuring our children get the best start in life and by promoting equality;
• to achieve sustainable, world-leading quality in healthcare, ensuring that people are able to be in their own homes and communities when possible and appropriate, and that they have a safe and good experience of healthcare services; and
• to maximise value by supporting the people delivering health and care services; and through increased efficiency.

We will continue to address the significant health inequalities that exist in Scotland. In recent years, significant advances have been made in protecting and enabling society's most vulnerable people but substantial challenges remain. We believe that action in children's early years is the most fundamental and effective form of early intervention to address poor health. Evidence shows that the early years are crucial in developing a person's strengths and the assets they will need to maintain their health and wellbeing in the future. We have piloted the Family Nurse Partnership programme and will roll it out across NHSScotland, and we will continue to support wider preventative services such as parenting support, education and learning support, employability services, drugs and alcohol services, community policing and services, with a particular focus on vulnerable groups such as looked after children, offenders and children affected by domestic abuse. We will do this by implementing the Getting it Right for Every Child approach across all relevant parts of our health services and investing £20m/£45m/£50m over the Spending Review period in an Early Years and Early Intervention Change Fund.

Although we have made significant improvements in oral health for children, more than 50 per cent of the most deprived Primary 1 children in our most deprived communities have dental decay, and dental health problems are still the single most common reason to admit children to hospital. The Childsmile programme will continue to support this cohort of children to meet the target and to continue to improve child oral health in general. We will also bring forward plans to address the oral health improvement needs of the most vulnerable groups.

Keeping up the battle against the big killer diseases

We will invest a total of £30 million (£27 million resource and £3 million capital) and establish new approaches to detecting cancer early. This will increase the number of people who benefit as quickly as possible from the world-leading treatment and support we have for cancer patients and their relatives and carers in Scotland, reducing the impact of cancer and, as a result, reducing premature mortality in Scotland.

Building on the success of the Keep Well/Well North programme of health checks, we will extend a programme of inequalities-targeted, high risk primary prevention to all NHS Boards' activities from 2012-13. Evidence tells us that this is an effective and efficient approach to delaying the onset of cardiovascular disease and to tackling excess premature mortality within deprived communities. In addition, we will continue the roll out of Life Begins at 40 health checks.

Age, race, gender, gender identity, disability, sexual orientation and religion can impact on a person's health and wellbeing and, therefore, on Scotland's economic and social wellbeing. We will promote equality and fair treatment for all the people of Scotland and across government activity to tackle discrimination, prejudice and the barriers to equality of opportunity.

By concentrating on what really matters to people, we have established three Healthcare Quality Ambitions for Scotland which will focus our combined efforts to become a world leader in healthcare quality:

• mutually beneficial partnerships between patients, their families, and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making;
• there will be no avoidable injury or harm to people from healthcare they receive, and an appropriate, clean and safe environment will be provided for the delivery of healthcare services at all times; and
• the most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.

We will continue to implement the Healthcare Quality Strategy in partnership with local authorities, other stakeholders and the public, and we will report on the progress we are making towards achieving our Healthcare Quality Ambitions and our aim of becoming a world leader in healthcare quality.

We will be bold and innovative in facing up to the scale of the challenge we all face- not only in Scotland but throughout the world. We will not shy away from difficult conversations or decisions wherever the needs of the people of Scotland are at stake.

We will take every opportunity with the public, NHS staff and other partners to develop a compelling vision for the NHS and for care in Scotland. A vision of fully integrated care allowing everyone to live longer, healthier lives, for as long as possible at home or in the community. We will give importance to the role people themselves can play, supported as appropriate to play a fuller part in their own care.

As part of our approach to achieving sustainable, high quality healthcare services, we will provide a strengthened focus on supporting NHS Boards to increase efficiency and productivity through our NHS Efficiency and Productivity Framework, and we will prioritise approaches which increase the quality of our healthcare services by implementing evidence-based approaches which simultaneously increase the efficiency and effectiveness of healthcare services. We will maintain and improve quality by eradicating harmful and unwarranted variation and implementing key improvement programmes. We will reduce the number of senior managers in the NHS by 25 per cent by the end of this Parliament.

We will continue to focus on improving safety through the improvement and scrutiny work of the newly formed Healthcare Improvement Scotland. This will include the Healthcare Environment Inspectorate working in partnership with the revised HAI Task Force.

Providing high quality care and support for older people is a fundamental principle of social justice and is an important hallmark of a caring and compassionate society. The newly formed Care Inspectorate operates independently to scrutinise and improve care, social work and child protection services for the benefit of the people who use them.

Delivering world-leading healthcare services for people will require strong partnership working across health and care services. In recognition of the pressures on the health and social care system in a challenging fiscal climate, the Scottish Government will continue to provide a Change Fund for NHS Boards and partner local authorities to invest in partnership to redesign services to support the delivery of new approaches to improved quality and outcomes. £80 million will be allocated to the Change Fund in 2012-13. From 2012-13 onwards, at least 20 per cent of the Change Fund will be dedicated to supporting carers to continue to care. By ensuring that older people remain independent in their own homes, NHS Boards and local authorities will be able to focus on reducing unnecessary hospital admissions and speeding up discharge after a crisis. This will result in better outcomes for older people and ease the pressure on acute hospital provision.

As part of our approach to achieving world-leading person-centred quality in our healthcare services, we will continue our focus on improving the patient experience through our Better Together programme and ensure that health services recognise and respond flexibly to each person as a unique individual, build trust and empathy, and engage people in decisions that affect their healthcare and wellbeing. We shall undertake further patient experience surveys to monitor the quality of the healthcare experience across a number of elements of the NHS, including inpatients and GP services. Recent surveys continue to report that most people have a positive experience of the care and services delivered by NHSScotland.

The Reshaping Care for Older People programme will continue - as part of the implementation of the Healthcare Quality Strategy - to address the challenges faced by a rapidly increasing older population at a time of financial constraint, while at the same time delivering better outcomes for older people. This will be achieved by remaining focused on the key policy goal of optimising the independence and wellbeing of older people at home or in a homely setting. We will also proceed with plans to integrate health and social care.

We will enshrine in law new rights for people who need care and support, putting people at the heart of decision-making about their care packages. Treatment for those cared for will be improved by ensuring that unpaid carers are equal partners in health and social care. Strategies for carers and young carers will ensure that the commitments on information, respite and access to better support are fulfilled.

In 2010 we published jointly with COSLA Carers and Young Carers Strategy which sets a framework for action over five years aimed at supporting carers and sustaining them in their caring role, while enabling young carers to be children first and foremost. In 2011-12, we invested £3 million in short breaks provision by the voluntary sector and allocated £4.9 million to Health Boards for carer and young carer identification and support. Local government will continue to work with the Scottish Government towards maintenance of an extra 10,000 weeks of respite provision.

Together with COSLA, we also launched Self-directed support: a national strategy for Scotland. In 2011-12, the first year of the strategy - we allocated £3.6 million to local authorities, providers and user organisations, paving the way for new legislation set out in the Programme for Government.

NHSScotland will sustain the 18-week Referral-to-Treatment standard. Shorter waits can lead to earlier diagnosis and better outcomes for many patients as well as reducing unnecessary worry and uncertainty for patients and their relatives. The 18 week standard also reduces inequalities by addressing variations in waiting times across Scotland.

In the face of a 36 per cent real terms reduction in capital resources available to the Scottish Government over the Spending Review period, we continue to maintain a high level of investment in NHSScotland infrastructure. Contracts have been signed and construction commenced on major developments such as the £842 million New South Glasgow Hospitals Project the £43.6 million Royal Victoria Hospital Replacement in Edinburgh, the £110 million Emergency Care Centre in Aberdeen, the £8.3 million Migdale Community Hospital in Bonar Bridge, the £27 million Airdrie Resource Centre, the £27 million Acute Mental Health in Dumfries and £10.7 million Nuclear Medicine facilities at Ninewells Hospital in Dundee.

We will assess and then release a number of major projects for procurement including the Royal Hospital for Sick Children/Department of Clinical Neurosciences in Edinburgh, North Ayrshire Community Hospital, Dumfries and Galloway Royal Infirmary, the Balfour Hospital in Orkney and a national production centre for the Scottish National Blood Transfusion Service for delivery through revenue finance as part of the £750 million pipeline announced in November 2010. We will also complete the roll-out of the hub initiative by the end of 2012 which will support the development and delivery of community-based facilities for NHSScotland and other public sector partners across Scotland. In addition to the flow-through of previously-agreed primary care projects including those in Dumfries, Cupar, Renfrew, Barrhead, Possilpark, Airdrie, Musselburgh, Broadford, Portree, Stornoway, Ayr and Edinburgh, a £200 million pipeline of revenue funded projects will be delivered through the hub initiative. Hub companies are established in South East and North Scotland. Procurement for joint venture partners for the East Central, West and South West is underway.

Cities

Cities are vital to the success of the Scottish economy. The more successful our cities and their city-regions are, the more successful Scotland will become. They are home to over half of our population (51 per cent in 2009); they provide well over half of our jobs (60 per cent of all private sector jobs in 2009); and they contribute a disproportionate amount to Scotland's economy (56 per cent of GVA in 2008). We will work with all of Scotland's cities, individually and collectively, to help them optimise their potential.

In particular, we will ensure that, as far as possible, our policies are formed and our investment decisions are taken with due regard to the priorities set for our cities and city regions, whether this is in terms of: transport and infrastructure; how we invest in and fund regeneration; how we support the strong cultural identity that is crucial to the success of our cities; or how we more effectively tackle some of the deep-seated problems that still exist in our cities, such as persistent poverty and heath inequalities.

We recognise the benefits that improved connectivity will deliver for Scotland's cities, and that is why we are focusing our transport infrastructure investment to improve journey times and connections. We will provide funding for rail programmes such as the Edinburgh Glasgow Improvements Programme (EGIP) and Borders Rail line; progress trunk road schemes such as the Aberdeen Western Peripheral Route (AWPR) and a number of specific improvements to the M8 (the M8 bundle), and we will also contribute to Glasgow's Clyde Fastlink in support of the Commonwealth Games.

We have committed to publishing a Cities Strategy by the end of 2011. As we work with our cities to develop the strategy, we will find opportunities for collaboration to create projects of sufficient scale to attract new and untapped sources of finance.

Spending Plans for 2012-13 to 2014-15 are set out below.

We will:

• invest in evidence-based care and treatment which improves the quality of healthcare services, and increases the value and sustainability of our healthcare system in Scotland;
• establish a major programme to increase the early detection of cancer;
• work in partnership and invest in early interventions in order to secure the best possible start in life for our children, and to support people to improve and maintain their health in order that they can enjoy longer healthy lives;
• work in partnership to establish the most effective, person-centred, safe and sustainable treatment and care for people when they are sick with long term conditions or at the end of their lives to ensure that they are able to live in their homes, or in the community, as long as possible and appropriate;
• support and enable those delivering healthcare services to deliver the highest quality healthcare services;
• provide maximum value in terms of healthcare services by continuously improving quality and efficiency;
• ensure the successful delivery of the 2014 Commonwealth Games; and
• develop a Cities Strategy to maximise the positive impact of investment across portfolios on cities and their regions given their importance to Scotland's economy.

Table 7.01: Spending Plans (Level 2)

Level 2	2011-12 Budget £m	2012-13 Draft Budget £m	2013-14 Plans £m	2014-15 Plans £m
NHS and Special Health Boards	8,645.1	8,862.3	9,130.7	9,390.7
Other Health	2,723.6	2,720.7	2,672.3	2,554.8
Sport	66.4	73.7	132.6	207.7
Equalities	20.3	20.3	20.3	20.3
Food Standards Agency Scotland	10.9	10.9	10.9	10.9
Total Portfolio of which:	11,466.3	11,687.9	11,966.8	12,184.4
DEL Resource	10,862.2	11,128.4	11,468.3	11,841.4
DEL Capital	504.1	459.5	398.5	243.0
AME	100.0	100.0	100.0	100.0

Table 7.02: Spending Plans (Level 2 real terms) at 2012-13 prices

Level 2	2011-12 Budget £m	2012-13 Draft Budget £m	2013-14 Plans £m	2014-15 Plans £m
NHS and Special Health Boards	8,645.1	8,646.1	8,673.8	8,686.3
Other Health	2,723.6	2,654.4	2,538.6	2,363.2
Sport	66.4	71.9	126.0	192.1
Equalities	20.3	19.8	19.3	18.8
Food Standards Agency Scotland	10.9	10.6	10.4	10.1
Total Portfolio of which:	11,466.3	11,402.8	11,368.1	11,270.5
DEL Resource	10,862.2	10,856.9	10,894.5	10,953.2
DEL Capital	504.1	448.3	378.6	224.8
AME	100.0	97.6	95.0	92.5

Health

Table 7.03: More Detailed Spending Plans (Level 3)

Level 3	2011-12 Budget £m	2012-13 Draft Budget £m	2013-14 Plans £m	2014-15 Plans £m
Resource
NHS and Special Health Boards 1	8,645.1	8,862.3	9,130.7	9,390.7
Education and Training
Workforce	28.3	31.1	31.1	31.1
Nursing	148.5	148.5	148.3	147.9
Primary and Community Care Services
General Medical Services 2	710.4	710.4	710.4	710.4
Pharmaceutical Services Contractors' Remuneration	185.9	185.9	185.4	184.3
General Dental Services	398.7	398.7	398.7	398.7
General Ophthalmic Services	93.0	93.0	93.0	93.0
Improving Health and Better Public Health
Health Improvement and Health Inequalities 3	58.5	59.5	61.3	62.9
Pandemic Flu	5.4	7.3	10.0	16.1
Health Screening	3.6	3.0	4.0	4.0
Tobacco Control	12.3	12.3	12.3	12.3
Alcohol Misuse	42.3	42.3	42.3	42.3
Health Protection	40.0	40.0	39.9	39.8
Mental Wellbeing	6.0	6.0	6.0	6.0
Healthy Start	12.4	12.0	13.2	14.5
Mental Health Legislation and Services	16.2	16.2	16.2	16.2
Specialist Children's Services	21.4	21.4	21.4	21.4
Early Detection of Cancer	-	6.7	7.7	12.3
General Services
Research	68.6	69.5	70.3	70.5
Distinction Awards	26.0	24.0	24.0	24.0
Access Support for the NHS 4	101.3	27.1	29.1	31.1
Quality Efficiency Support 5	18.9	18.9	18.9	18.9
Clean Hospitals/MRSA Screening Programme	28.4	28.4	28.4	28.4
eHealth	90.3	90.3	90.3	90.3
Self Directed Support Programme	2.0	5.5	12.0	7.0
Miscellaneous Other Services	115.4	114.0	114.1	115.6
Care Inspectorate	21.4	21.6	21.8	21.9
Provision for Transfer to Health Capital 6	-	95.0	105.0	120.0
Resource Income	(119.8)	(121.4)	(123.3)	(125.1)
	10,780.5	11,029.5	11,322.5	11,606.5
Capital
Investment	496.7	473.5	400.5	259.0
Income	(8.5)	(20.0)	(20.0)	(20.0)
Total Capital 7	488.2	453.5	380.5	239.0
Annually Managed Expenditure
NHS Impairments	100.0	100.0	100.0	100.0
Total Health	11,368.7	11,583.0	11,803.0	11,945.5
of which:
DEL Resource	10,780.5	11,029.5	11,322.5	11,606.5
DEL Capital	488.2	453.5	380.5	239.0
AME	100.0	100.0	100.0	100.0

Notes:
1. The 2011-12 baseline has been restated reflecting a number of additional recurrent financial allocations confirmed to NHS Boards and Special Health Boards, funded from central budgets, and announced in February 2011. In addition, a small number of corporate transfers have been included including support funding in respect of Social Care and The Care Inspectorate and eCare.
2. Allocations for 2012-13 to 2014-15 for General Medical Services are still to be decided and are subject to UK pay negotiations with the professional groups concerned.
3. This includes the Physical Activity budget (£3.3 million per year).
4. £76.2 million transferred to NHS Boards from 2012-13
5. Quality Efficiency and Support was previously known as Improvement and Support of the NHS.
6. This provision will be for capital spend that is necessary to help Boards maximise efficiency in revenue benefits.
7. The core capital budget will be supplemented by £750 million of Non Profit Distributing (NPD) and projects through the HUB initiative.

Level 4	2011-12 Budget £m	2012-13 Draft Budget £m	2013-14 Plans £m	2014-15 Plans £m
Territorial Boards
NHS Ayrshire and Arran	574.7	588.0	607.4	626.1
NHS Borders	167.3	170.9	176.5	181.9
NHS Dumfries and Galloway	241.7	247.0	255.1	263.0
NHS Fife	507.1	521.5	538.7	555.3
NHS Forth Valley	402.8	418.8	432.7	446.0
NHS Grampian	691.1	714.3	737.9	760.6
NHS Greater Glasgow and Clyde	1,895.6	1,941.8	2,005.8	2,068.1
NHS Highland	484.8	496.7	513.1	528.8
NHS Lanarkshire	815.6	838.2	865.8	892.5
NHS Lothian	1,054.4	1,093.8	1,129.9	1,164.7
NHS Orkney	31.5	32.8	33.9	34.9
NHS Shetland	36.7	37.7	38.9	40.1
NHS Tayside	596.3	612.1	632.2	651.7
NHS Western Isles	57.7	59.2	61.1	63.0
	7,557.3	7,772.7	8,029.1	8,276.8
Special Boards
NHS Waiting Times Centre	39.1	39.4	39.8	40.2
NHS Scottish Ambulance Service	197.6	202.0	204.0	206.1
NHS National Services Scotland	266.1	264.2	266.9	269.5
Healthcare Improvement Scotland	17.2	16.5	16.7	16.8
NHS State Hospital	33.2	33.4	33.8	34.1
NHS 24	59.4	59.9	60.5	61.1
NHS Education for Scotland	393.4	391.5	395.4	399.4
NHS Health Scotland	20.2	19.3	19.5	19.7
	1,026.2	1,026.3	1,036.6	1,046.9
Other Income	61.6	63.3	65.1	67.0
Total Territorial and Special Boards	8,645.1	8,862.3	9,130.7	9,390.7

Notes:
1. Budgets for 2012-13 include a recurrent transfer of £76.2 million in respect of access support (waiting times management). Budgets for the period 2012-13 to 2014-15 are indicative and will change as final funding allocations are calculated according to the NHS Resource funding formula that will be updated later this financial year and which includes a provision for progressing towards NHSScotland Resource Allocation Committee (NRAC) parity in baseline formula.

What the Budget Does

The budget supports services and initiatives designed 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 healthcare services close to home.

NHS Territorial Boards will receive allocation increases of 2.9 per cent in 2012-13, 3.3 per cent in 2013-14 and 3.1 per cent in 2014-15. To achieve this and also to support an increase for Special Boards delivering direct patient care, such as the Scottish Ambulance Service, we have adopted a different approach in 2012-13, where a differential efficiency target has been set for Special Boards budgets which do not deliver direct patient care.

NHS Boards provide free and universal frontline healthcare services for patients and their families. NHS Boards will build on their recent achievements in order to deliver quality healthcare services. They will continue to improve health and wellbeing through the millions of reliable frontline healthcare interactions that really matter to people. Through their Local Delivery Plans, NHS Boards will demonstrate how they will work in partnership to deliver accelerated improvements for key priorities through a continued focus on improving quality by, for example, tackling health inequalities, improving access to elective mental health and substance misuse services and reducing healthcare associated infection.

In addition to formula-based allocations to Territorial Boards for statutory compliance and equipment replacement, the capital budget will support the continued construction on the adult and children's hospitals as part of the New South Glasgow Hospitals Project.

The capital budget will also support delivery of projects across Scotland, including the continuation of the £105 million Emergency Care Centre in Aberdeen due to complete in 2012-13 and completion of projects including Acute Mental Health Services in Dumfries; the Chalmers Hospital in Grampian; the Migdale Community Hospital in Highland; the Airdrie Resource Centre in Lanarkshire; and the Royal Victoria Hospital in Edinburgh.

Programmes will continue to support the replacement of vehicles and defibrillators by the Scottish Ambulance Service, as well as national programmes to support radiotherapy equipment replacement and the roll out of the hub initiative. We will also ensure the delivery of a range of other health projects, including the Royal Sick Children's Hospital and Department of Clinical Neurosciences in Edinburgh as part of the programme of Non-Profit Distributing (NPD) projects outlined in Chapter 3.

In 2012-13 we will ensure high quality sustainable healthcare services for Scotland for the future and our priorities will be to:

• protect point of care healthcare services;
• implement the Healthcare Quality Strategy;
• continue to protect and enable the most vulnerable in our society by addressing health inequalities and, through early interventions, to support our children;
• reflect the importance of our person-centred approach to improving healthcare quality by gathering new information and taking related action on patient, carer and staff experience and patient reported outcomes, and through the implementation of the Patient Rights (Scotland) Act 2010, including the delivery of a Patient Charter of Rights and Responsibilities;
• continue to focus on patient safety by rolling out our successful approaches across acute, mental health and primary care;
• continue to reduce Healthcare Associated Infection;
• support NHSScotland to achieve productivity and efficiency gains without compromising quality, through the implementation of the new Efficiency and Productivity plan;
• deliver the 18 week Referral to Treatment standard;
• continue to address the major public health challenges facing Scotland, including alcohol misuse, smoking, obesity, sexual health and Hepatitis C;
• support people in Scotland to maintain their health through commencement of the implementation of the recently enacted tobacco control legislation and the implementation of the provisions of the Alcohol Etc. (Scotland) Act 2010;
• implement the provisions of the Alcohol Minimum Pricing Bill which will be laid before the Scottish Parliament in autumn 2011. We believe minimum pricing is the most effective and efficient way of reducing alcohol consumption and hence alcohol related harm in Scotland;
• implement Scotland's first National Dementia Strategy and dementia standards in full and take forward the work to improve post-diagnostic information and support and to improve care in general hospital settings for the frail elderly;
• Improve the integration of health and social care. This will involve establishing integrated approaches to support older people and those with long term conditions to remain independent in their own homes or in the community, by a focus across NHS Boards and local authorities on supported self management, reducing unnecessary hospital admissions and speeding discharge after a crisis;
• continue to provide a Change Fund which will increase to £80 million for NHS Boards and partner local authorities to work in partnership to redesign services to support the delivery of new approaches to improved quality and outcomes;
• invest £10 million to implement the 26 recommendations of the Scottish Strategy for Autism. The Strategy will improve diagnosis, support, services and access to services for people with autism and their families;
• continue to address the variation in waiting times for IVF treatment - during this Parliament we will work to establish a maximum waiting time of 12 months;
• introduce the final phase of the Childsmile oral health improvement programme with all general dental practitioners participating, to further reduce the health burden of preventable dental disease;
• commence delivery of the three-week waiting time target for alcohol misuse services;
• deliver the Obesity Route Map Action Plan;
• continue to fund Free Personal Care;
• begin the roll out of abdominal aortic aneurism screening for men aged 65;
• continue to work to support measures which respond to the needs of equality communities and help to address the inequalities they experience;
• maintain our preparedness for a flu pandemic;
• maintain our commitment to improvement innovation and research;
• continue the implementation of the 25 per cent reduction in senior NHS managers;
• continue investment in new and replacement health facilities, IT and equipment;
• continue to fund support for carers and young carers; and ensure carer's experience and knowledge is fully taken into account so that there are improvements in the treatment and care of those who are cared for;
• continue to build on the success of the Sensory Impairment 'one-stop-shop' model of providing centres of excellence for those with a sensory impairment by rolling out additional centres throughout Scotland. We will also develop a Sensory Impairment Strategy which will shape how we deliver sensory impairment provision in the years to come;
• evaluate The same as you? to help address the gaps in policy provision that still prevent those with a learning disability enjoying equity in the provision and delivery of healthcare services. It will provide a the map for effective and joined up policy development within the Scottish Government to ensure that those with a learning disability are able to access effective healthcare services; and
• continue to build on the success of the SurvivorScotland national strategy by providing further funding for a range of support services for adult survivors of childhood sexual abuse to improve their health and wellbeing and prevent the need to access health and social care services (in particular GP, mental health and addiction services). We will consult on and develop legislation to establish a National Confidential Forum for adult survivors of childhood abuse. This will contribute to the Government's commitment to recognise the rights of victims.

Sport

Table 7.05: More Detailed Spending Plans (Level 3)

Level 3	2011-12 Budget £m	2012-13 Draft Budget £m	2013-14 Plans £m	2014-15 Plans £m
Sport	39.2	36.3	35.3	38.3
Glasgow 2014: Delivery of Commonwealth Games	27.2	37.4	97.3	169.4
Total	66.4	73.7	132.6	207.7
of which:
DEL Resource	50.5	67.7	114.6	203.7
DEL Capital	15.9	6.0	18.0	4.0
AME	-	-	-	-

What the Budget Does

The Scottish Government is the principal funder (67 per cent) and ultimate guarantor of the Glasgow 2014 Commonwealth Games. The Sport budget, augmented by contributions from Glasgow City Council and commercial income, will provide the operational costs over the Budget period required to stage the Games. The Scottish Government is working in partnership with Glasgow City Council, Commonwealth Games Scotland and the 2014 Organising Committee to ensure that the Games are an outstanding success.

The success of the Games is also about securing a range of benefits before during and after the Games. In the run-up to the Games, to reach and secure maximum benefit across a wide range of groups, clubs, communities and businesses, we will work to heighten awareness of, and involvement in, legacy activity.

The budget provides support for the development of physical activity and sport within Scotland in order to increase Scotland's level of participation and improve our national sporting performance.

We will use the Commonwealth Games as a catalyst to encourage Scotland to become a healthier, fitter and more active nation.

We will continue to use the investment into sport to increase participation levels and medal success. But we will also build on the range of programmes and interventions funded through other portfolios which contribute towards increasing physical activity and encouraging everyone to lead a more active lifestyle, using the power and excitement of the Games and Ryder Cup as a catalyst to get more people active. The new school curriculum will include two hours of PE for all primary school aged children and two periods of PE for secondary school aged young people, further supporting our ambitions for Scotland as a sporting/physically active nation. Cashback funding has also been a significant contributor and has successfully used sport as a mechanism to engage young people through diversionary activities.

Equalities

Table 7.06: More detailed spending plans (Level 3)

Level 3	2011-12 Budget £m	2012-13 Draft Budget £m	2013-14 Plans £m	2014-15 Plans £m
Promoting Equality	20.3	20.3	20.3	20.3
Total	20.3	20.3	20.3	20.3
of which:
DEL Resource	20.3	20.3	20.3	20.3
DEL Capital	-	-	-	-
AME	-	-	-	-

What the Budget Does

The equality budget is used to promote equality and fair treatment for the wellbeing of the people of Scotland. It helps to support the mainstreaming of equality across Government activity and the public sector more broadly, and it is directed at tackling discrimination prejudice and the barriers to equality of opportunity.

In 2012-13, our priorities will be to:

• improve outcomes for the people of Scotland by promoting equality across the range of protected groups and providing support to help eliminate the significant inequalities in Scottish society;
• invest in equality activity and interventions that can make a difference and which contribute to the prevention of inequality and improve the life chances of those experiencing discrimination, prejudice and inequality. This will involve
• work in relation to addressing violence against women, the integration of asylum seekers and refugees, promoting religious tolerance and understanding, improving outcomes for minority ethnic communities including Gypsies/Travellers, and addressing issues of gender, age, LGBT and disability equality;
• increase the capacity of communities and the engagement of equality groups with mainstream providers and public institutions so that they can contribute to shaping policy and service delivery;
• implement the Forced Marriage etc. (Protection and Jurisdiction) (Scotland) Act 2011; and
• take forward the development and implementation of the public sector equality duties which will provide a robust framework for the delivery and mainstreaming of equality.

In 2012-13 we will:

• sustain and improve participation in sport;
• contribute to the successful delivery of the 2014 Commonwealth Games;
• generate and maintain support for a wide range of games legacy activities among communities and stakeholders;
• implement a network of Community Sports Hubs which will bring together local people to participate in sport and physical activity in their own community;
• support the development of elite athletes focusing on the 17 Commonwealth Games sports to increase our chances of medal success; and
• seek bids for a National Indoor Football Centre to support the development of grassroots football and improve our National game.

Food Standards Agency Scotland

Table 7.07: More Detailed Spending Plans (Level 3)

Level 3	2011-12 Budget £m	2012-13 Draft Budget £m	2013-14 Plans £m	2014-15 Plans £m
Food Safety	7.3	7.3	7.3	7.3
Eating for Health	2.0	2.0	2.0	2.0
Choice (making it easier for consumers to make informed choices)	1.6	1.6	1.6	1.6
Total Level 2	10.9	10.9	10.9	10.9
of which:
DEL Resource	10.9	10.9	10.9	10.9
DEL Capital	-	-	-	-
AME	-	-	-	-

What the Budget Does

The main purpose of the Food Standards Agency in Scotland (FSAS) is to improve food safety, standards and encourage a healthy balanced diet. The primary focus of its work is to protect the Scottish public from the risk of consuming contaminated food, thereby contributing to the Scottish Government's Healthier Strategic Objective. We develop, deliver and implement effective policies, projects, scientific research and

consumer engagement events to achieve the Strategic Objectives of the FSA and Scottish Government. In 2012-13, FSAS will continue to deliver against our Strategic Outcomes to achieve the following:

• food produced or sold in Scotland and rest of the UK is safe to eat;
• imported food is safe to eat;
• food producers and caterers give priority to consumer interests in relation to food;
• consumers have the information and understanding they need to make informed choices about where and what they eat;
• regulation is effective, risk-based and proportionate, is clear about the responsibilities of food business operators and protects consumers and their interest from fraud and other risks; and
• enforcement is effective, risk-based and proportionate and is focused on improving public health.