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Contents

   

ANNEXE A

AUDIT COMMITTEE

EXTRACT FROM THE MINUTES

24th Meeting, 2004 (Session 2)

Tuesday 21 December 2004

Members Present:

Susan Deacon
Robin Harper
Margaret Jamieson
George Lyon
Mr Brian Monteith (Convener)
Mary Mulligan
Mr Andrew Welsh

NHS Financial Performance Overview: The Committee received a briefing from the Auditor General for Scotland on the report by the Auditor General for Scotland entitled “Overview of the Financial Performance of the NHS in Scotland” (AGS/2004/12).

AUDIT COMMITTEE

EXTRACT FROM THE MINUTES

1st Meeting, 2005 (Session 2)

Tuesday 11 January 2005

Members Present:

Susan Deacon
Robin Harper
Margaret Jamieson
George Lyon
Mr Brian Monteith (Convener)
Mary Mulligan
Mr Andrew Welsh

NHS Financial Performance Overview: The Committee received a briefing from the Auditor General for Scotland on the report by the Auditor General for Scotland entitled “Overview of the Financial Performance of the NHS in Scotland” (AGS/2004/12).

NHS Financial Performance Overview (in private): The Committee considered its approach to the report by the Auditor General for Scotland entitled “Overview of the Financial Performance of the NHS in Scotland” (AGS/2004/12).


AUDIT COMMITTEE

EXTRACT FROM THE MINUTES

2nd Meeting, 2005 (Session 2)

Tuesday 25 January 2005

Members Present:

Susan Deacon
Robin Harper
Margaret Jamieson
George Lyon
Mr Brian Monteith (Convener)
Mary Mulligan
Mr Andrew Welsh

NHS Financial Performance Overview: The Committee took evidence from-

Dr Kevin Woods, Head of Scottish Executive Health Department and Chief Executive of the NHS in Scotland , Dr Peter Collings, Head of Performance Management and Finance, Mrs Jill Alexander, Head of Analytical Services Division, and Mr Mike Palmer, Assistant Director Workforce and Policy Division, Scottish Executive.

NHS Financial Performance Overview (in private): The Committee considered the evidence taken and also considered further arrangements for this inquiry. The Committee agreed to write seeking information on a number of issues raised during discussion.

AUDIT COMMITTEE

EXTRACT FROM THE MINUTES

3rd Meeting, 2005 (Session 2)

Tuesday 8 February 2005

Members Present:

Susan Deacon
Robin Harper
Margaret Jamieson
George Lyon
Mr Brian Monteith (Convener)
Mary Mulligan
Mr Andrew Welsh

NHS Financial Performance Overview (in private): The Committee considered the evidence taken at its last meeting for its inquiry into the report by the Auditor General for Scotland entitled “Overview of the Financial Performance of the NHS in Scotland” (AGS/2004/12).

AUDIT COMMITTEE

EXTRACT FROM THE MINUTES

4th Meeting, 2005 (Session 2)

Tuesday 22 February 2005

Members Present:

Susan Deacon
Robin Harper
Margaret Jamieson
George Lyon
Mr Brian Monteith (Convener)
Mary Mulligan
Mr Andrew Welsh

NHS Overview 8th Committee Report: The Committee considered a follow-up response from the Scottish Executive to its 8th Report 2004 entitled "Overview of the National Health Service in Scotland 2002-03.” The Committee agreed to note the response and consider it in relation to its inquiry into the report by the Auditor General for Scotland entitled “Overview of the Financial Performance of the NHS in Scotland” (AGS/2004/12).

NHS Financial Performance Overview: The Committee considered evidence for its inquiry into the report by the Auditor General for Scotland entitled “Overview of the Financial Performance of the NHS in Scotland” (AGS/2004/12). The Committee agreed to consider a draft report at a future meeting.

AUDIT COMMITTEE

EXTRACT FROM THE MINUTES

10th Meeting, 2005 (Session 2)

Tuesday 17 May 2005

Members Present:

Susan Deacon
Robin Harper
Margaret Jamieson
George Lyon
Mr Brian Monteith (Convener)
Mary Mulligan
Mr Andrew Welsh

NHS Financial Performance Overview: The Committee considered a draft report on its inquiry into the report by the Auditor General for Scotland entitled “Overview of the Financial Performance of the NHS in Scotland” (AGS/2004/12). The report as amended was agreed to.

ANNEXE B

2nd Meeting 2005 (Session 2), 25 January 2005

SUPPLEMENTARY WRITTEN EVIDENCE

LETTER FROM THE CLERK TO DR KEVIN WOODS 7 february 2005

OVERVIEW OF THE FINANCIAL PERFORMANCE OF THE NHS IN SCOTLAND: REQUEST FOR FOLLOW-UP EVIDENCE

During your evidence session on 25 January 2005, the Committee requested further information in writing. I am now writing on behalf of the Committee to confirm this request. I would be very grateful if you could provide the information set out below.

Pay Modernisation Costs (Col 976)

During evidence Mike Palmer confirmed the latest pay modernisation costs as;

  • Consultant contract: £31m;
  • Agenda for Change: toward the upper end of the range of £130m-£160m; and
  • GMS contract £85m.

You also submitted information on the costs of pay modernisation in the written briefings attached to your letter of 7 February. (Responding to my letter of 22 December to Ian Gordon). If there has been any subsequent change to these figures I would be grateful if you could confirm this.

Savings in Central Budgets (Col 977 and 978)

Dr Collings gave evidence in relation to the two additional allocations of £30m and £70m which were released to Boards in March and June 04 respectively. I would be grateful if you could provide a breakdown of the savings across central budgets which enabled these additional allocations to be made.

E-health and IMT Funding (Col 994)

The Committee asked questions relating to the funding of e-health and the development of information and communications technology in general. Dr Collings stated that funding came from a combination of central budget and some money that is spent locally. Dr Collings stated that the central budget available for e-health matters would increase from £35m to £100m. I would be grateful for further information on this budget and how it will be spent.

Uplift for 2005/06 (Col 995)

Dr Collings indicated that, while the Minister had not yet taken a final decision, the uplift for 2005/06 would be of the order of £550m and that the main cost pressures Boards were facing would account for £400-£450m. I would be grateful if you could give a breakdown of the £550m setting out how much each significant cost pressure will account for (e.g. the three strands of pay modernisation; consultant costs; pay inflation and any other significant factors.)

Ring-fenced funding (Col 998 and 999)

During evidence there was a discussion on the way in which the Executive monitors how ring fenced funds are spent and how the outcomes of such spending are monitored. I would be grateful for further information on this including where possible specific information on the monitoring and impact of specific ring fenced programmes.

I would be grateful for a response by Friday 18 February if at all possible. This would enable the Committee to consider the response at its meeting on 22 February.

Yours sincerely,
Shelagh McKinlay
Clerk to the Committee

LETTER FROM DR KEVIN WOODS TO THE CLERK 16 february 2005

Dear Ms McKinlay

OVERVIEW OF THE FINANCIAL PERFORMANCE OF THE NHS IN SCOTLAND: REQUEST FOR FOLLOW-UP EVIDENCE

Thank you for your letter of 9 February in which you request further information on behalf of the Committee.

Pay Modernisation Costs

I can confirm that the estimated pay modernisation costs for 2004-05 remain the same as given by Mike Palmer in evidence on 25 January and set out in the briefing attached to my letter of 7 February.

Savings in Central Budgets

As requested, I attach at Annex A a breakdown of the savings made in central budgets in March 2004 and June 2004 that enabled the two additional allocations to be made to NHS Boards.

E-health and IMT Funding

I attach at Annex B the current budgetary breakdown for eHealth over the 3 years 2005-06, 2006-07 and 2007-08. We are currently reviewing our eHealth plans and the detail may change to reflect the outcome of that review.

Uplift for 2005-06

I attach a table at Annex C which shows the uplift for 2005-06 and the estimated cost pressures NHS Boards will have to meet in 2005-06.

Ring-fenced funding

Annex D provides details of ring fenced funding.

I hope the Committee finds this information helpful.

Yours sincerely
Kevin Woods

ANNEX A

Savings in Central Budgets

The additional funding of £30 million allocated to NHS boards towards the end of 2003-04 became available for distribution due to lower than initially estimated expenditure on demand led services for General Dental Services (£17m), General Ophthalmic Services (£7m) and the Welfare Foods Programme (£6m)

The savings which enabled the additional funding of £70 million to be distributed to NHS boards in 2004-05 were as follows:

  £m
Unallocated Funds 41.2
NHS Helpline 1.0
Patient Focus and Public Involvement 1.8
Health Improvement Programme 4.5
Welfare Foods 3.0
Profit/Loss on Disposal of Property 5.0
IT 4.0
Human Resources Initiatives 2.5
Nurse Bank 1.0
Golden Jubilee Hospital 4.0
E-Pharmacy Project 2.0
TOTAL 70.0

ANNEX D

RING-FENCED FUNDING

Details of the monitoring of ring fenced programmes are as follows:

Bloodborne Virus Prevention

Some £8.1 million annually is currently made available to NHS Boards to assist their efforts to prevent the spread of bloodborne viruses, including HIV and Hepatitis C. These resources might typically be used to fund the provision of needle exchange facilities to help avoid needle‑sharing among injecting drug misusers or for local initiatives to raise awareness about the risks of bloodborne viruses.

Under the AIDS (Control) Act 1987, NHS Boards are required to provide reports to the Scottish Executive, containing information about the number of people with AIDS, and other details, including particulars of action taken in the area to educate the public in relation to AIDS and HIV and the facilities and services provided. These reports, which are submitted annually, enable the Executive to monitor the use of prevention monies, as well as the impact achieved, while recognising that it is often not possible to attribute any change in population behaviour or incidence of disease to specific measures or initiatives.

Cancer Services

Regular monitoring reports are published which provide an update of progress with investments and other developments/activities for the North, South East and West of Scotland regional cancer networks. The reports are available on the Cancer in Scotland website.

Coronary Heart Disease

Allocations are made to NHS Boards on the basis of proposals from local CHD networks and bids which have to set out clearly what each of their activities will achieve. The success of the overall CHD and Stroke Strategy is gauged against national targets for waiting times and reducing premature deaths from CHD and stroke. The whole process is overseen by both the SEHD and by the National Advisory Committees for CHD and Stroke. Monitoring systems to track activity and spending are in place.

Audiology

Allocations are made by the Audiology Modernisation Board on the basis of proposals from NHS Boards. Monitoring systems to track activity and spending are in place.

Drug Misuse

Drug treatment funding is monitored through annual corporate action plans submitted by Scotland’s 22 Drug Action Teams. The 2005-06 plan is required to be submitted by end March 2005 and will then trigger the release of funding. The plans detail the services to which the funding has been allocated and also identify additional “non ring fenced” funding allocated to these services by locals agencies. New money (£6 million in 2005-06) is being distributed on the basis of service level agreements with each drug action team area which detail the projected impact of proposals on the key national priorities of reducing waiting times, increasing the number of new clients entering treatment and increasing the range of services available locally. The first two of these measures is monitored by the Information Services Division of National Services Scotland on a quarterly basis whilst service types are detailed in the corporate action plan.

Delayed Discharges

The Scottish Executive is investing £30 million per year to enable local authority/NHS partnerships to reduce the number of patients inappropriately delayed in hospitals. These resources are allocated to partnerships through NHS Boards, using the Arbuthnott formula, and used to help partnerships make a 20% reduction in the numbers delayed. Each partnerships has to submit an annual local Joint Action Plan to account for how they intend to utilise their funding allocations. After the end of the accounting period partnerships submit an annual progress report outlining the outcomes of the funding.

ANNEXE C

OTHER WRITTEN EVIDENCE

LETTER FROM THE CONVENER TO IAN GORDON 22 DECEMBER 2004

Dear Mr Gordon

AUDIT COMMITTEE MEETING 7 DECEMBER 2004: REQUEST FOR FURTHER INFORMATION

At its meeting on 7 December the Committee considered your letter of November in which you offered to arrange informal briefings on the issues of pay modernisation and the review of health and care statistics.

I attach an extract of the official report of the meeting for your information.

Members agreed that rather than attend an informal briefing at this point they would like to receive further written briefing from the Department in relation to these two issues.

Pay Modernisation

The Committee would be grateful for a written briefing on the latest position on pay modernisation.

Review of Health and Care Statistics

The Committee would be grateful for a written briefing on the review of health and care statistics. The Committee has of course received information on this subject previously specifically in your letter of October where you set out the aims and six key priority areas of the review. In preparing this briefing the Committee would be grateful if you could cover the issues raised in discussion including:

What data are currently collected, through what means and with what frequency; (Col 851)

Information on any draft proposals for how data collection systems will change; (Col 851)

When recommendations from the review will be implemented;

A summary of the draft report being prepared by the information and statistics division (ISD) and information on the “ownership” of this project and how it fits with the wider review. (Cols 855 and 856)

I would be grateful for a response by Friday 21 January 2005 . If you wish to discuss this letter please contact the clerk Shelagh McKinlay on 0131 348 5390.

Yours sincerely,
Brian Monteith
Convener

SUBMISSION FROM THE SCOTTISH EXECUTIVE 7 FEBRUARY 2005

Dear Mr Monteith

AUDIT COMMITTEE MEETING 7 DECEMBER 2004: REQUEST FOR FURTHER INFORMATION

In response to your letter of 22 December to Ian Gordon I attach further written briefings on pay modernisation and the review of health and care statistics. I hope the Committee finds this information useful.

I am copying this letter to Shelagh McKinlay, the Committee Clerk.

Yours sincerely
KEVIN WOODS

AUDIT COMMITTEE REQUEST FOR FURTHER INFORMATION ON PAY MODERNISATION

GENERAL

2. With the commencement of implementation of Agenda for Change (AfC) from 1 December 2004, the three major strands of pay modernisation (new GMS contract, new Consultant Contract, Agenda for Change - AfC) are now all at the initial implementation stage. The focus is on:

a) correct implementation of new terms and conditions without detriment to patient services. For a workforce of around 150,000 this is a major exercise for the Service;

b) benefits realisation.

3. A draft communication on delivering the benefits from pay modernisation will be shared for consultation with staff organisations shortly. This will be supported by a set of measures which NHS Boards will be expected to use to demonstrate the benefits from pay modernisation, linked to NHSScotland’s Performance Assessment Framework and guided by the Pay Modernisation Team (PMT.)

4. A section on pay modernisation will be included in the Performance Assessment Framework and this will be assessed formally for the first time in next summer’s Accountability Reviews with NHS Boards.

NEW CONSULTANT CONTRACT

5. SEHD is working with Audit Scotland to formally monitor the implementation of the consultant contract. Outcomes from the contract will also be performance managed through the pay modernisation section within the Performance Assessment Framework and through continuing engagement between the Pay Modernisation Team and Boards.

6. The majority of NHS Boards have now completed the job planning process and most consultants have now agreed their job plans. It is unlikely that there will be any appeals other than those around the area of fee-paying work, where some consultants may appeal against the netting off of fees earned in 2003/4 against their backpay for that year.

7. Overall Board returns show that the take-up rate for the new consultant contract is at 98%. The average number of extra programmed activities (EPAs) being worked by consultants is 1.6 per week (current indications show that this is in line with or lower than in other parts of the UK), which means the average number of weekly hours being worked is 46.4 hours, within the Working Time Directive limits. This is very close to projections made earlier in the year. The average number of weekly out-of-hours worked is 0.5 of a programmed activity (two hours), which is as predicted.

8. We are taking forward work with relevant stakeholders (the Courts Service, NHS management, the BMA, mental health colleagues) on the application of the consultant contract to the new Mental Health Act and the establishment of the Mental Health Tribunal.

9. A national Consultant Contract Employers Reference Group is continuing its work on the development of service objectives for consultants as well as agreeing collective employer approaches to outstanding areas of implementation.

Consultant contract costs

10. NHS systems were asked to provide updated cost and activity estimates for their consultant workforce, based on the establishment of consultants as at 31 October 2004. Complete data is only available for those consultants with signed off job plans (around 80% of total consultant numbers). Data is still being finalised from Boards on the cost impact of the contract, and this cannot be fully completed until all job plans have been signed off.

11. On the basis of current data the consultant paybill for 2003/4 increased by 21.5% as a result of the new contract (25.4% if one includes the annual 3.225% pay inflation award.) This equates to around £60m (£70m including the pay inflation award).

  • The paybill is estimated to increase by a further 5.4% in 2004/5 (8.8% if one includes the annual 3.225% pay inflation award) through increases in basic salaries, the commencement of out-of-hours premia (time and a third) from 1 April 2004, and the expansion in consultant numbers. This equals £19m (£31m including pay inflation.)
  • The following table sets out the breakdown of percentage increases across Health Boards. Comparisons between Boards for 2004/05 are complicated by increases in consultant numbers. In gathering data from Boards it has not, in all cases, been possible to separate out increases in consultant costs arising from increases in staff numbers. Therefore the percentage increase for 2004/05 for Scotland due to the new Consultant Contract may be overstated and caution should be exercised in comparing 2004/05 increases across NHS Boards.
  % increase 0304 % increase 0405 EPAs per week
Argyll and Clyde 23.5% 2.4% 1.5
Ayrshire and Arran 24.6% 4.7% 2.0
Borders 22.1% 10.4% 1.8
Dumfries & Galloway 16.6% 8.1% 1.8
Fife 19.1% 5.1% 1.6
Forth Valley 27.2% 5.8% 1.5
Glasgow 19.8% 10.3% 1.4
Grampian 20.5% 1.5% 1.7
Highland 22.8% 2.4% 1.4
Lanarkshire 14.5% 2.0% 1.6
Lothian 22.6% 4.3% 1.7
Orkney 8.4% 3.2% 2.0
Shetland 17.9% 5.8% 2.0
Tayside 25.7% 2.6% 1.8
W Isles n/a n/a n/a
Scotland 21.5% 5.4% 1.6

Note: Updated cost returns for Western Isles and Highland not received at the time of compiling these figures 

  • Given the difficulty of separating out consultant number increases from the cost of the contract, and the fact that not all consultants are yet signed up to the contract, all figures should be treated as indicative of the scale of cost increases.

AGENDA FOR CHANGE (AfC)

Background

12. Following formal ratification of the AfC agreement by the UK NHS Staff Council, AfC came into effect on 1 December 2004. Implementation of AfC in Scotland is overseen by the Scottish Pay Reference and Implementation Group (SPRIG), a partnership-based group comprising staff organisations, NHSScotland management and SEHD.

13. SPRIG have agreed a phased timetable for implementation of AfC job evaluation between now and September 2005. This is a rolling programme that will job match staff by job family, commencing with nursing and ancillary staff. The timetable for implementation is attached at Annex A. The job evaluation process is underpinned by a UK-wide IM&T system called CAJE (Computer-Assisted Job Evaluation), now rolling out.

14. Clearly the focus in the Service is currently on the business of completing the major job evaluation exercise and bedding in the terms and conditions correctly. The benefits and objectives which are required from AfC have been communicated to Boards and are outlined in the AfC Agreement. SEHD and the Pay Modernisation Team will be following these up with Boards, and in partnership with SPRIG, through engagement with the Boards’ pay modernisation boards, and we will be tracking and monitoring achievement through the Performance Assessment Framework.

Agenda for Change costs

15. The Executive has carried out detailed cost modelling based on a pilot site in West Lothian which was mapped across to the Glasgow payroll and then scaled up to provide an all-Scotland model. These estimates have now been supplemented by returns from Health Boards across Scotland, who have populated a costing model provided to them by SEHD with data for their own areas. Whilst the true cost of Agenda for Change will not be known until all NHSScotland non-medical staff, numbering over 130,000, have been fully assimilated onto the new system, the returns from Boards provide the best possible range for financial forecasts.

16. There are a number of assumptions attached to the current modelling work which are subject to change, and these need to be borne in mind when looking at the projections that the model provides for AfC. In addition, job matching for AfC is just getting underway. The cost modelling exercise should therefore be treated as continuing work which will be regularly updated for some time to come, rather than a completed outcome. The current figures can only reflect the latest data to hand.

17. The results for Boards will vary depending on a number of factors, including staff profile, non-Whitley conditions, absence levels and nature of services (e.g. remote & rural versus urban services). Additionally, the accuracy of results will improve as Boards input their own data – especially job-matching results and on-call information.

18. There are a number of local factors which will affect the model. These include:

  • The effect of new absence conditions for ancillary workers in the first four months of employment;
  • The costs of supporting implementation;
  • Changes in workforce profile (e.g. workforce growth, skill mix); how Boards manage turnover of staff and start to utilise the opportunities to extend individual skills and forge better team working;
  • How managers manage the workload arising from the increased annual leave for some staff groups.

19. Initial costs will therefore depend to some extent on the way in which managers apply the new pay system.

20. Current estimates for overall costs (including the annual pay uplift of 3.225%) of AfC are currently 5.5%-5.8% of the paybill in 2004/05 (£150m-£160m) and 6.3-6.9% of the paybill in 2005/06 (£180-£200m.) A Board-by-Board breakdown of these cost ranges is shown in the table below (figures do not include the 3.225% annual pay uplift.)

21. Boards have also provided estimates on levels of pay protection for their staff. The estimated overall level of pay protection (also shown at in the table) currently stands at 8.8%. This is marginally above the success criteria for pay protection contained in the initial Agenda for Change Agreement, which was 8%. We will be doing more work to provide an improved estimate as matching and evaluation progresses SPRIG will also examine the outlying protection levels among the figures indicated in the table.

Agenda for Change costs – estimates as at 19 January 2005

Includes 3.225% pay award

2 Protection numbers and % do not take account of those employees with no banding match. It must be stressed that these figures may not be representative of actual outcomes

3 Limited information available

4 The current model provides very limited results for Special Health Boards. Improved results will be achieved when data begins to be input and updated locally.

NEW GMS CONTRACT

22. The costs and benefits of the nGMS contract are being performance managed by Boards with support from a national Finance Working Group for the nGMS Contract, the SEHD Finance and HR Directorates, and the Pay Modernisation Team under the Pay Modernisation Director for nGMS. A series of ten key performance indicators for securing benefits from the contract have been developed for incorporation in the Performance Assessment Framework and Boards will be performance managed on the delivery of these.

23. The provision of new Out-of-Hours (OOHs) services is currently the key focus around implementation of the contract. All NHS Boards now have their new arrangements running, where required, and all met the 31 December 2004 deadline for taking over responsibility for OOH service provision. No major problems were reported in this area through the Christmas/New Year period.

24. Initially in many areas these arrangements will involve a significant level of GP input and increased associated costs. However the expectation in many Board areas is that out-of-hours services will develop a more multi-disciplinary team-based approach over time. On OOHs we are seeking to integrate primary medical OOHs services with the mainstream of Boards’ unscheduled care provision.

GMS contract costs

25 On the basis of discussion with NHS Boards, the current projection of combined additional investment for GMS and Out-of-Hours re-provision for 2004/05 is £85m. This figure is broken down as follows:

  £m
Additional investment indicated for 2004/5 = 53
Current projection of part-year costs for Out-of Hours re-provision 14
Current projection of additional investment to recognise achievement of quality standards 18
Current projection of total additional investment = 85

Latest information of outturn at individual NHS Board level is available from Boards’ November 2004 monitoring returns. This information was provided in a letter of 10 January 2005 from Ian Gordon to the Auditor General (attached at Annex B.) These outturn forecast figures are subject to change during the financial year and definitive figures will not be finalised until after the end of March 2005.

LETTER FROM IAN GORDON TO ROBERT BLACK 10 JANUARY 2005

OVERVIEW OF THE FINANCIAL PERFORMANCE OF THE NHS IN SCOTLAND 2003-04

Thank you for your letter of 16 December enclosing a table showing estimates of the costs of implementing the pay modernisation agreements that local NHS boards have provided to their local auditors. You ask for our estimates for each NHS board area and for an explanation of discrepancies.

I now enclose a table at Annex 1 which sets out a comparison of the Department’s estimates of the additional costs associated with implementation of the new GMS contract in 2004-05 and the Audit Scotland estimates. The Department’s figures are projections based on the best data currently available to us as supplied by NHS Boards in their November 2004 monitoring returns. In total there are estimated additional costs of approximately £68m in 2004-05. In addition we would estimate additional costs of approximately £11m associated with the introduction of new out-of-hours services (not shown), bringing the total estimated additional costs to approximately £80m across Scotland.

In comparison the estimated additional cost figures supplied by Audit Scotland are approximately £239m. Whilst it is difficult to reconcile these significantly different figures without understanding more fully how Audit Scotland has compiled its data, it does seem that an initial analysis of the figures set out in Annex 1 may provide some useful information.

It appears that in some cases, rather than using estimates of the additional costs associated with implementing the new GMS contract, the Audit Scotland estimates use a figure which appears closer to the initial Primary Medical Services resource allocations made to Boards (for example Ayrshire and Arran, Fife and Orkney). In other cases the figures used appear closer to the overall estimated outturns projected by Boards, ie the initial allocations plus the estimated additional costs (for example Argyll and Clyde, Dumfries and Galloway, Forth Valley and perhaps Tayside). Using these figures will substantially overestimate the additional costs of the new GMS contract across Scotland in 2004-05.

Given that the Consultant Contract is presently bedding in and Agenda for Change has only just commenced implementation, we are currently analysing returns from Boards and finalising costing exercises on both these contracts. We will forward our concluded costings to you as soon as possible.

IAN GORDON

 

ANNEX 1
Comparison of SEHD and Audit Scotland estimated figures
Additional costs of pay modernisation for 2004-05 : GMS Contract
             

Audit Scotland

      Initial Outturn Estimated  

Estimated

HEALTH BOARDS   Allocation Forecast Additional Costs  

Additional Costs

             

 

Argyll & Clyde 43,939 48,808 4,869   50,600
         
Ayrshire & Arran 36,700 44,572 7,872   37,000
         
Borders 11,382 13,596 2,214   1,000
         
Dumfries & Galloway 16,312 17,705 1,393   17,740
         
Fife 33,153 39,676 6,523   30,300
         
Forth Valley 27,620 31,349 3,729   31,304
         
Grampian 54,346 62,289 7,943   8,100
         
Greater Glasgow 92,719 103,481 10,762   0
         
Highland 32,132 35,985 3,853   6,337
         
Lanarkshire 50,818 51,977 1,159   0
         
Lothian 78,646 90,833 12,187   4,300
         
Orkney 3,695 4,192 497   3,694
         
Shetland 2,645 3,091 446 450
Tayside 44,762 49,081 4,319 47,421
Western Isles 5,224 5,405 181 542
Totals     534,093 602,040 67,947 238,788

 

             

 

Notes            

 

Allocations figures sourced from letter issued by SEHD Deputy Director of Finance on 11 May 2004 to NHS Boards
"Primary Medical Services Allocations for 2004-05"        
Forecast outturn figures as supplied by NHS Boards in their November 2004 monitoring returns  
Audit Scotland figures as supplied by Audit Scotland at 16 December 2004    

 

Job Family January February March April May June July
Nursing, midwifery, HV Dental Nursing OD‘s    
Ancillary {-----------------}  
A&C      
AHP’s {-----------------}      
SLTs, Clin.Psych, pharmacists      
PTB, Clinical scientists, Technicians   {----------------------------------------}    
Estates, Chaplains, Health Promotion    
Supplies, Procurement, Psychological & Art Therapists   {-------------------------}    
{-----------}  
 
  {-------------------------}
  {-----------}
  {-----------}

AUDIT COMMITTEE REQUEST FOR FURTHER INFORMATION – January 2005

Strategic Review of Health and Care Statistics

The strategic review of health and care statistics for Scotland was initiated in the summer 2004. It is important to recognise that extensi ve national information is already available covering a wide range of NHS activity. The NHS in Scotland has a worldwide reputation for gathering, quality assuring and using healthcare information. An Accounts Commission report in 1999 contained very positive observations about our national information, describing NHSScotland as “- a model of excellence in data quality”.

The Statistics review was set up partly as a response to Cabinet discussions on statistics across the Executive, and because methods of health and care service delivery have been changing, and current indicators of activity are not comprehensive. In addition to this, it has become increasingly apparent that the financial data supplied by Boards is not of sufficient quality and coverage to allow the required level of analysis and monitoring – this point has also been raised by Audit Scotland, the Health and Audit Committees.

The review, which is being carried out jointly by SEHD and ISD, consists of 5 main stages - these are described in Appendix 1. Stages 1 and 2 are now complete, and a spreadsheet which contains the results of the scoping study of current inputs and sources is attached below. This provides details of all data currently collected along with information about related outputs, frequency, status etc and will be available on the dedicated website which is currently being developed.

Stages 3 and 4 of the review involve consultation, and the production of a report in Spring 2005. This report will include recommendations for; improved presentation and packaging, new data analysis, enhancements to the data development project, and new data collection. It will also report on work in progress on related initiatives including a separate project to review and propose improvements to the range of expenditure and cost information available for health and care services in Scotland.

The statistics review does not stand alone, and is supported by a number of other pieces of work which impact upon the need for cost and activity indicators for the Scottish Health and Care sector. These include the Performance Assessment Framework and the Scottish contribution to a UK-wide project to develop indicators of public sector productivity and output (the Atkinson project), which will feed into the final conclusions and recommendations over the next 6 months.

ISD Data Development Project

A number of the gaps which will be identified as part of the statistics review will already be covered by the Data Development project which is currently being led by ISD. This project was set up almost 3 years ago to address the key gaps which were apparent at that time. The project has already delivered new information on Practice Teams and nurse led clinics, and has a ongoing programme of work which is being considered within the overall scope of the statistics review.

Background

ISD were tasked with plugging gaps in NHS activity information by SEHD. The pace of change in the modernisation of healthcare has created a growing distortion between actual service delivery, with all its different facets, and the more limited picture that can be drawn from existing routine national information. The key aspects of healthcare delivery that have been taken forward to date include:-

Primary Care practice team activity

Outpatient procedures

Nurse-led clinic activity

AHP activity

Next Steps

The Project is currently addressing a range of areas including more work on outpatients, waiting lists, nurse and AHP activity, and the measurement of the whole patient journey, all of which will be informed, and developed by the outcome of the Statistics Review with relevant improvements and enhancements coming on-stream over the course of the next 3 years.

Of pivotal importance to this work is standards-compliant, high-quality IT systems being installed across the NHS, producing management and monitoring data as a by-product.

Summary

To summarize the position described above as it relates to the key questions raised by the Committee;

What data are currently collected, through what means and with what frequency; (Col 851)

Spreadsheet attached to this document describes this data (an output from stage 1 of the statistics review)

Information on any draft proposals for how data collection systems will change; (Col 851)

The Spring 2005 report will present proposals for changes in data collection systems, presentation, datasets, analysis and for further data development .

When recommendations from the review will be implemented;

Some recommendations will be implemented immediately following consultation (e.g. presentation/packaging changes) while others will be implemented over 2005/6 (e.g. new analysis of existing data) and other will take 2-3 years (e.g. new data collections). Details of expected timescales will be provided in the report in Spring 2005.

A summary of the draft report being prepared by the information and statistics division (ISD) and information on the “ownership” of this project and how it fits with the wider review. (Cols 855 and 856).

Summary provided above.

HD Analytical Services Division

January 2005

Appendix 1 – Strategic Health and Care Statistics Review Product Breakdown

Stage 1 Initiation, existing products and sources and developments in train

  • a Project Initiation Document
  • b List of all existing outputs by subject and frequency and whether or not National Statistics
  • c List of all sources used to collect data used in H&C statistical outputs
  • d Statement of developments in train which will modify sources or create new ones, with implications for b and c

Stage 2 Improved presentation of existing data

  • a sub list of 1b which contribute to Partnership Agreement
  • b sub list of 1b which does not contribute to Partnership Agreement
  • c options paper on grouping of 2a for release in such a way that offers a coherent picture to audience, without compromising NS protocols
  • d options paper for relegating items in 2b to less frequent compendia or internet only release or sun-setting
  • e final presentation of recommendations following Board consideration of 2c and 2d

Stage 3 Identifying gaps and prioritising collection needs

  • a Paper on known gaps in data
  • b Consultation paper seeking confirmation of known gaps or additional gaps and evidence to support prioritisation; also seeking comment on proposals for sun-setting
  • c Paper commissioning specific review of Scottish Health Survey
  • d Paper commissioning specific review of Scottish Care Home Census
  • e Summary of responses to 3b
  • f Report from review 3c
  • g Report from review 3d

Stage 4 Recommendations, reporting and implementation

  • a Paper summarising findings from Stage 3 with recommendations and costings for Board approval prior to proceeding with rest of Stage 4
  • b Detailed change plans including go live timetable

Stage 5 Post implementation Review

  • a Review extent to which project as implemented meets success criteria
  • b Review the extent to which the project controlled its outputs and resources

Link to Associated Table


 

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