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The Scottish Executive: Draft Budget 2004-05 Summary

Chapter 5 Health and Community Care

To improve the health and the quality of life of the people of Scotland and deliver integrated health and community care services, making sure there is support and protection for those members of society who are in greatest need.

AIMS AND OBJECTIVES

Objective 1: Work towards a step change in life expectancy for Scots, particularly disadvantaged members of the community, including children and older people.

• Target 1: Achieve a 50% reduction in death from coronary heart disease in people under 75 between 1995 and 2010.
• Target 2: Achieve a 20% reduction in death from cancer in people under 75 between 1995 and 2010.
• Target 3: Achieve a 50% reduction in deaths from cerebrovascular disease (stroke) in people under 75 between 1995 and 2010.
• Target 4: Achieve a reduction in smoking from 35% to 33% between 1995 and 2005 and to 31% by 2010.
• Target 5: Achieve a reduction in the incidence of adults exceeding weekly drinking limits for men from 33% to 31% between 1995 and 2005 and to 29% by 2010 and for women from 13% to 12% between 1995 and 2005 and to 11% by 2010.

Objective 2: Ensure that health care providers provide swift and appropriate access to integrated health care, covering primary, community and acute care.

• Target 6: Ensure access to a GP, nurse or other health care professional within 48 hours by April 2004.
• Target 7: No patient should wait longer than 26 weeks for a new outpatient appointment by the end of 2005.
• Target 8: No patient should wait longer than 2 months from urgent referral to treatment for all cancer cases by the end of 2005.
• Target 9: No patient should wait more than 6 months from diagnosis for inpatient treatment by the end of 2005.

Objective 3: Improve the patient's experience of the services provided by the NHS.

• Target 10: Bring 12,000 nurses and midwives into the NHS by 2007.
• Target 11: Develop a national framework for improving the quality of clinical care by April 2004.
• Target 12: All hospitals to have made significant progress towards the Clinical Standards Board for Scotland standards on infection control and clean hospitals by April 2003 and to make further progress each year thereafter.

Objective 4: Improve services for older people, at home and in care settings.

• Target 13: Progressively enable a greater number of older people to live and be cared for in their own homes in each year to March 2006.
• Target 14: Ensure by 2005 that all those with unmet need for free personal care are identified and receive the services they need.

Spending plans 2003-04 to 2005-06

Table 5.01 Spending plans (level 2)

What the budget does

Improving Scotland's health is our most important challenge. Life expectancy in Scotland is improving but there is still much more that needs to be done if Scotland is to achieve its goal of a healthy active population. Cancer, coronary heart disease and strokes account for 65% of all deaths in Scotland every year, diseases that are increasingly preventable by less smoking and improvements in physical activity and diet. Earlier diagnosis and treatment are vital to ensure optimal outcome.

Poverty and social exclusion are at the root of much of Scotland's ill-health. Although health improvements are greatest for affluent people, there have been some significant improvements in the health of relatively deprived groups. There is a long-term decline in smoking rates in men, but poor diet and physical inactivity both contribute to the rising incidence of obesity, an accurate predictor of coronary heart disease. Persistent smoking by young women, illegal drugs and more and younger alcohol misuse are also major contributors to ill-health.

New initiatives are being developed to improve health. Health improvement is an issue that affects the economy, education and social justice. We are taking an approach that draws together activity across the whole range of the Executive's responsibilities and focuses on improving the future health of children and young people, our workforce and our communities; delivering health improvements to disadvantaged people of all ages; and closing the health gap for the most disadvantaged. Ensuring health improvements for all groups is a key part of the Executive's cross-cutting policy on closing the opportunity gap.

The Scottish Executive has a key role in helping to bring about a healthier community. However, it is the people of Scotland, who will need to make healthy choices in all aspects of their lives, who will ensure that we succeed in our aims.

Portfolio priorities

In 2004-05 we will focus our resources on:

• developing and delivering health improvement action, in partnership with other departments and local government, in line with the framework set out in "Improving Health in Scotland - The Challenge";
• continuing to support the drive for reform within NHSScotland through the Centre for Change and Innovation;
• continuing to utilise the latest technologies and investing in improving the treatment of coronary heart disease, stroke, cancer and mental illness;
• treating additional hospital cases as outpatients, day cases or inpatients;
• training an additional 1500 nurses and midwives and increasing the total number of NHS consultants by 600, therefore ensuring that Scotland has the staff it needs to provide high quality health care;
• investing 30 million a year to provide 1,000 community places for people leaving hospital which will reduce the waiting time caused by delayed discharge;
• improving the quality of life for the elderly by improving personal and nursing care;
• providing swift access to advice and assistance, particularly in rural areas, by continuing to roll out NHS 24 across the country;
• offering support for development and modernisation of audiology services. This will include additional funding of 2 million per year for new equipment, staffing and training and digital hearing aids;
• improving the patients' experience of the NHS by investing at least 250 million in hospitals, primary care facilities and information technology;
• through the Arbuthnott formula, ensuring that resources are targeted in ways that take into account the problems of deprivation and remoteness across Scotland;
• developing a core set of indicators for the performance assessment framework, and for a performance incentive framework, to help focus effort in the NHS on achieving clear national targets;
• further developing regional planning and service delivery among NHS boards; and
• abolishing NHS trusts.

New resources

The Health Department has received additional funds of 12m/36.5m/32m for 2003-04 to 2005-06 respectively, towards the cost of implementing the partnership agreement. Detailed decisions on the use of these additional funds have still to be made. Announcements on how these funds will be used will be made in due course. In addition, the Health Department has received 12.35 million in 2003-04 which has been committed to IT developments.

Closing the opportunity gap

We will progressively reduce the inequalities which currently exist in the health of Scotland's population. It is accepted that better indicators of health inequality are required. An expert group is producing such indicators and a programme of research is under way. Establishing such indicators will help future financial resources to be even more effectively targeted, and will enable NHSScotland to measure progress in reducing existing inequalities.

We will continue to make a considerable effort on health improvement and the promotion of healthy lifestyles. Resources spent in these areas should benefit the overall health of the population of Scotland, and ensure that we make best use of finite financial resources.

Initiatives tackling inequalities are aimed at a variety of levels - geographic area, income level, and age, with particular emphasis being placed on improving the life circumstances and lifestyles of young people. For example, by reducing the proportion of women who smoke during pregnancy and increasing the proportion of mothers breast-feeding we aim to transform the health of Scots in the early years of life. Such measures will be reinforced not only by initiatives targeted at teenagers, which aim to reduce the level of inappropriate drinking and smoking of this age group and to increase the proportion engaging in physical exercise, but also by similar initiatives targeted at those of working age.

By targeting in this way we will help to achieve a healthy productive population for Scotland for the foreseeable future. These initiatives are seen as having significant sustainable development benefits at a time when the elderly population will continue to increase as a proportion of Scotland's population and the proportion of the population of working age will decrease.

Sustainable development

NHSScotland maintained its impressive record in energy efficiency, with total energy consumption for 2001-02 at a similar level to the previous year despite an increase in patient throughput. At a national level carbon dioxide emissions, water consumption and sewage continued to fall in 2001-02, and NHSScotland remains on course to achieve a 2% per annum reduction in energy consumption. Waste management standards are generally high within NHSScotland, but to secure further reductions a Waste Management Action Plan was implemented in 2002. This highlighted opportunities for healthcare bodies to reduce the amount of clinical waste produced. Under the Department's Environmental Management Policy all NHS bodies must have an effective environmental policy in place by which they can continually improve the environmental performance of their buildings. These policies require the preparation of travel plans when considering capital investments. For example, North Glasgow University Hospitals NHS Trust is currently in discussion with its local planning authority on how to facilitate travel by public transport to its Gartnavel site, which will be upgraded in the near future. Measures under consideration include car-parking charges; subsidies to staff to encourage travel by public transport; and the building of pedestrian bridges to make it easier to get to local train/underground stations.

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